I recently received a declaration of war from one of the major healthcare insurers. Not happy with its current record profits, this insurer has decided to reduce its reimbursement on immunizations and injectable medications by 40%. I do not have a 40% margin on immunizations and injectable medications. My margin is at most 10%. This means that with a 40% reduction, I will have to pay at least 30% …
Medically speaking, what’s a guy to do when there is no right answer? My patient’s solution is often to ask me what I would do given his particular circumstance. He isn’t happy when I respond with, “I truthfully don’t know.”
In reality, I always know what I would do. I’d gather knowledge, see consultants, and explore every possible option to its fullest. Then, most probably, I would still not be …
Sometimes you just don’t want to be right. Over the past 5 years, I have seen an alarming pattern arise in my profession. Many of my patients have heard me talk about Soylent Green, an old Charleton Heston movie. The premise of the movie seems absurd. Can you imagine the government of the United States providing for all the needs of its people including healthcare, food, clothing, and even death?
David …
In the Chicago Tribune recently, Bruce Japsen has an excellent article addressing Accountable Care Organizations, quality of care issues, and the change in how physicians will be paid in the future.
Clearly, the government and insurers have decided that physicians will not be paid for services rendered. Physicians will be paid based on patient outcomes and will share in any losses insurers sustain due to poor patient outcomes. There are …
I bet you didn’t know that the war for independence is being fought on a daily basis throughout our glorious country. From the time we are born until the time we die, each of us strives to assert our independence. Once the toddler learns to run, he insists on running wherever he wants to. As he ages, we foster his need to be independent and teach him …
Sometimes, you just can’t win! In medicine, sometimes is way too often. “Doc, do I need that test?” reviewed the issues surrounding screening colonoscopy exams. The dilemma is always the same. Do I order a test or don’t I?
If I order a test, there are consequences. Some are obvious; some are not. Tests cost money and money is in short supply. One consequence of ordering a test …
“Doc, do I really need the colonoscopy? It’s going to cost me $1500. I have a $750 deductible.”
That’s a tough question to answer. In reality, I’ll know the answer after the test is done.
If the colonoscopy is completely normal, then the answer is no, you did not need the test. It’s not a complete loss. You have the peace of mind of knowing that you don’t have …
I recently wrote about the importance of a differential diagnosis. Today I want to assume that you have a definitive diagnosis and discuss how we deal with that illness. First, some ground rules.
There are hundreds of medical texts and unlimited amounts of information on Google that help define an illness. They all portray the “textbook” description of how the illness should present, what symptoms …
Last night, I turned on “House,” a TV show about a physician who is in charge of a team of highly specialized diagnosticians. Every week the team solves a difficult to diagnose medical case by working through an exhaustive differential (DD) diagnosis list. While the show is absurd to the extreme (as the team of physicians almost kills the patient each week), eventually the correct …
Get free updates delivered free to your inbox.
