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Hospital Medicine: Trying To Recruit A Lead Doctor

How can you find a hospitalist director with enough experience to lead a team of hospitalists? Recruitment can be tough. A reader recently asked for my opinion:

I am searching for a Hospitalist to lead a department in the state of XXX and I’m not finding any leads. On a good day, I can find a new graduate interested in moving to XXX, but I have not been able to find an experienced Hospitalist who has the supervisory experience to lead a department.  …and this is an opportunity (full time & permanent) for good pay with an excellent work/life balance. Where would you suggest I look for my Lead Hospitalist?

My first thought is for you to purchase a booth at the Society of Hospital Medicine’s yearly conference and then bombard all the hospitalists with pens and squeezy balls while trying to pocket an email and home address or two. Read more »

*This blog post was originally published at The Happy Hospitalist*

When Doctors Opt Out Of Medicare

I opted out of Medicare several years ago. This means I don’t see Medicare patients other than in the emergency room when I’m on unassigned call. I don’t submit bills to Medicare or to those patients. I just let it slide.

Last Wednesday I received the following letter from a large radiology group in my home town:

September 2010

RE:  PECOS Enrollment

To our referring physicians and their office managers:

At __________we have begun a project to identify ordering physicians who are not enrolled in Medicare’s Provider Enrollment, Chain and Ownership System (PECOS).  Our purpose is to remind physicians of the importance of enrollment to them and to us.

Beginning in January, 2011 those providers filing Medicare claims listing an NPI number on the claim of an unenrolled provider will have their claims denied.  This would apply to any claim you send in and to any claim we submit for services provided to your patients because we are required to list your NPI number on our claims.  This applies both to patients referred to our private offices and the hospitals where we provide radiology professional interpretations or services.

So, you can see our effort is not purely altruistic.  We have a financial interest in reminding you of the importance of PECOS enrollment.  In trying to ascertain whether you are enrolled, we are using an online program you can find at  Simply enter your NPI number in the entry block and press enter.  If you enter a valid NPI number, your name will appear and beside it will be a symbol indicating where Medicare recognizes your PECOS enrollment.

Since Medicare is continually updating the files, we may have accessed the system before your enrollment was completed.  We will continue to monitor the situation in hopes you will enroll if you intend to continue seeing Medicare patients.  If you have already enrolled or have no plans to enroll, please excuse our intrusion.


This bothers me. It is not likely that I will be sending them any patients from my office, but that doesn’t mean there won’t be the occasional patient with my name on their chart in the ER. If I need to take a Medicare patient to the operating room from the ER, will the hospital not get paid? Will the anesthesiologist not get paid?

Will my non-participation in Medicare affect my fellow healthcare providers receiving payment? If so, that is just not right. I voiced this concern to Senator Blanche Lincoln shortly after receiving this letter. She agrees with me. Read more »

*This blog post was originally published at Suture for a Living*

Aspartame: Facts Vs. Fiction

If you believe everything you read on the Internet, then is seems that a chemical found in thousands of products is causing an epidemic of severe neurological and systemic diseases, like multiple sclerosis and lupus. The FDA, the companies that make the product, and the “medical industrial complex” all know about the dangers of this chemical, but are hiding the truth from the public in order to protect corporate profits and avoid the pesky paper work that would accompany the truth being revealed.

The only glimmer of hope is a dedicated band of bloggers and anonymous email chain letter authors who aren’t afraid to speak the truth. Armed with the latest anecdotal evidence, unverified speculation, and scientifically implausible claims, they have been tirelessly ranting about the evils of this chemical for years. Undeterred by the countless published studies manufactured by the food cartel that show this chemical is safe, they continue to protect the public by spreading baseless fear and hysteria.

Hopefully, you don’t believe everything you read on the Internet, and you don’t get your science news from email SPAM, where the above scenario is a common theme. While there are many manifestations of this type of urban legend, I am speaking specifically about aspartame — an artificial sweetener used since the early 1980s. The notion that aspartame is unsafe has been circulating almost since it first appeared, and like rumors and misinformation have a tendency to do, fears surrounding aspartame have taken on a life of their own. Read more »

*This blog post was originally published at Science-Based Medicine*

The Government’s Involvement In New Primary Care Models

Government healthcare reform efforts are picking up the pace to roll out new reimbursement and practice models for primary care.

Medicare is giving out $10 billion for pilot projects encouraging new models of primary care, including the patient-centered medical home. New Jersey just passed legislation to explore the patient-centered medical home. Now, Massachusetts, the early adopter of mandatory health insurance, is now ambitiously planning how to take on the fee-for-service reimbursement system and moving toward accountable care organizations. Under discussion are the scope of power for state regulators, what rules will apply to accountable care organizations, and how to get rid of the existing fee-for-service system.

Blogger and pediatrician Jay Parkinson, MD, MPH, comments about the “bureaucrats in Washington” that, “they’ve decided for doctors that we’ll get paid for strictly office visits and procedures when, in fact, being a good doctor is much, much more about good communication and solid relationships than the maximum volume of patients you can see in a given day.”

Now, it’s those same bureaucrats who are changing the system, trying to find a model that will accomplish just those goals. (CMS Web site, NJ Today, Boston Globe, KevinMD)

*This blog post was originally published at ACP Internist*

Why Pain Can’t Be A Vital Sign

There’s been a movement afoot for several years now to quantify pain as the so-called “Fifth Vital Sign.” It all started as a well-intentioned effort to raise the level of awareness of inadequate pain control in many patients, but has gotten way out of hand. The problem is that the word “sign” has a specific meaning in medicine that, by definition, cannot be applied to pain.

When you hear us medicos talk about “signs and symptoms” of a disease, it turns out that they are not the same thing. “Symptoms” are things the patient experiences subjectively. “Signs” are things that can be observed objectively by another person.

Headache is a symptom; cough is a sign. Itching is a symptom; scratch marks over a blistery linear rash are a sign. Vertigo, the hallucination of movement, is a symptom; nystagmus, the eye twitching that goes with inner ear abnormalities that can cause vertigo, is a sign. If someone other than the patient can’t see, hear, palpate, percuss, or measure it, it’s a symptom. Anything that can be perceived by someone else is a sign. Read more »

*This blog post was originally published at Musings of a Dinosaur*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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