Avoiding the ER and arranging a direct admit is not easy

Are emergency departments solely responsible for the bulk of unnecessary tests?

Most would like to believe so, but emergency physician Edwin Leap says that’s not the case.

He cites an instance involving a primary care doctor and hospitalist:

Local physician, who does not admit to the hospital, sees patient in the office. Patient has uncontrolled hypertension and is having some chest pain and shortness of breath. Local physician contacts hospitalist. …

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Internal medicine is dead, will concierge physicians thrive?

by Steven Knope, MD

For the last several years, writers in the New England Journal of Medicine and the Journal of the American Medical Association have authored doomsday editorials about the prognosis of primary care medicine. There has been much discussion about the fact that internists and family practitioners cannot keep pace with rising overheads and falling reimbursement under the traditional third-party payment system.

Paraphrasing a recent …

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Primary care is burdened by excessive paperwork

by Charles R. D’Agostino, MD

We’ve all seen the headlines –- “Primary Care Physicians Becoming a Scarce Breed”, “Wait Times for Appointments Increasing”, “Primary Care in Crisis” –- and have heard the pundits pontificating on the deteriorating state of primary care.

But rarely do we hear what’s happening from physicians on the front lines, those actually seeing patients. Consequently, with direct access to the primary care trenches, replete with an overworked …

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Treating critically ill patients on Mount Everest

Ken Kamler tells an incredible story of collective resilience in the face of one of the most dangerous mountaineering expeditions ever attempted: “I was faced with treating a lot of critically ill patients at 24,000 feet, which was an impossibility.”

Incredible lecture from TEDMED 2009.

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Alternative medicine isn’t taught to doctors in medical school

by Crystal Phend

Physicians don’t know much more about complementary and alternative medicine than their patients do, according to a new survey.

Most healthcare professionals who answered an online survey of Drug and Therapeutic Bulletin subscribers said their profession was just as poorly informed about herbal medicines (75.5%) as the general public (86.3%).

And almost half of respondents rated their own knowledge about herbal medicines as “quite” or “very” poor (36.2% and 10.4%, …

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Patient satisfaction scores improve when doctors sit

Patient satisfaction, as I wrote previously, is being increasingly focused upon.

Doctors are often pressed for time, and appear rushed — which can potentially lead to unhappy patients.

I saw this small study showing that the simple act of sitting down while talking to patients can have a profound effect. Many doctors I know already do this, but now there’s some data to support sitting.

According to the study, performed at …

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President Obama should have had colonoscopy without sedation

by Michael Kirsch, MD

Does anyone out there know why President Obama underwent a virtual  ‘colonscopy’ (VC) instead of a conventional colonoscopy earlier this year?

In my gastroenterology practice, we do not offer colon cancer screening to 48-year-old individuals, unless special risk factors are present. Of course, maintaining the president’s health is in the national interest, so I understand why professional screening guidelines might not apply to him. For …

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Primary care needs better physical exam skills

by Joseph Biundo, MD

Not long ago, primary care physician Rob Lamberts did a blog post about the economics of seeing Medicare and Medicaid patients, stating that doing so was bad business. While I agree with most of his points, I have a quarrel with his statement that primary care physicians keep down the cost of care by keeping people healthy, away from specialists, and out of the hospital.

That may be …

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Medicine residency survival tips during pregnancy

by Dr. Whoo, MD

Q. I just found out last week that I’ll be a new mom in November, making me an official mother in medicine! I’ve been reading the blog for a while, because I love hearing what all of you have to say about your lives. Here’s my question: What tips would you give for surviving residency while pregnant, especially 30-hour calls (without caffeine)?

— From a future mom and …

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Primary care is the loss leader of medicine

Medicare’s sustainable growth rate, or SGR, has been the bane of doctors for years now.

To encapsulate, this is the reason for Medicare’s annual threat to cut doctors’ fees by 20% or more, only to be staved off at the last minute.

Emergency physician Shadowfax has a nice take on it, explaining why it has devastated primary care:

Primary care has many fixed expenses in addition to those we bear: they pay …

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Diet Coke and the AHA red dress endorsement

Originally published in MedPage Today

by Peggy Peck, MedPage Today Executive Editor

A red dress jauntily displayed on cans of Diet Coke has become the latest symbol in the ongoing debate about pharmaceutical company support of research or CME.

But whose dress is it? The American Heart Association says it’s “not our red dress,” even as leading pharma critic Steven Nissen, MD, …

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