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Latest Posts

The Best Thing A Patient Can Do Following A Heart Attack

I’ve been telling my smoking patients for years that nothing I do for them is going to make an ounce of difference until they quit smoking for good.  And the Italians are out to prove me right.  The American Journal of Cardiology reported July 11th, 2011 on the Effect of Smoking Relapse On Outcome After Acute Coronary Syndrome.

In a study of just under 1,300 patients,  Reuters reports that just over 1/2 the patients started smoking within 20 days of hospital discharge, despite in-hospital smoking cessation consultation for all patients.   Researchers also found that resuming smoking increased  death 3-fold compared with those that did not relapse and quitting smoking had a similar lifesaving effect as taking cholesterol and blood pressure medications.  And I’m sure these folks all landed themselves back into the hospitals for a very expensive dying process.

That’s why billing the patient or their insurance for smoking cessation (CPT® 99406 and 99407) is so important.  And that’s why I give many of my smoking patients my smoking lecture.  You know how much Medicare pays for a ten minute consultation to help cardiac patients quit smoking right now? Read more »

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

Even With Insurance, Childbirth Is An Expensive Undertaking

Childbirth hospital costs these days aren’t cheap. Some studies suggest the cost of raising a child exceeds $200,000, not including education expenses.   Most insurance companies charge women of childbearing age more for their insurance because the actuarial tables say so.  Mrs  Happy and I now have a 3 month old Zachary in our wings.  He is a cute little peanut.  His two brothers, Marty and Cooper adore him.

Forty-two days after his April 21st, 2011 delivery, we still had not received our explanation of benefits from Blue Cross Blue Shield for the midwife charge.  I had previously received a statement from them saying the charge was under review.  Perhaps they believed that delivering Zachary was not medically necessary.  I can’t explain it.

When I called to ask them why this charge had not been approved,  they said they could not give me a reason why my explanation of benefits statement had not been finalized after 42 days.  I pressed for more information, but to no avail. I was given no reason other than to say that they had a lot of claims to review.   That’s not an acceptable reason to delay a payment of a claim. Read more »

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

When Physicians Fail To Take Responsibility For Their Own Orders

A physician asked me a question regarding what should be the role of hospitalists in carrying out discharge orders written by other physicians.

I have been following your blog since I was a resident and recommend it to a lot of people.  Thank you so much for enlightening me on so many day to day hospital issues.  I wanted to know your opinion about something that puzzles me.  When a specialist changes a medication or requires a lab to be done as outpatient after a discharge order is written (for example you write: okay to D/C if okay with cardiology, and they change a dose or request stress test out-pt) who is required to write the new scripts and arrange that test? Is it the hospitalist’s responsibility to do it? Or is the specialist who changed the dose after you rounded required to handle it? It was easier during residency due to abundance of residents/fellows and the fact it was electronic RX access. What are your thoughts? As so far I always return back and make the adjustments needed for the patient welfare, and the fact I don’t know whether I should take stance and request that physician to do their job.

Dear physician, there is nothing puzzling here.  It’s black and white.   Read more »

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

Nurse Prompts Are Key To Successful Implementation Of ICU Safety Measures

Over the last few years, you may have heard a lot about the value of checklists in ICU medicine and their ability to reduce mortality, reduce cost and reduce length of stay.   But a recent study took the concept one step further and suggested that checklists by themselves may not be  effective unless physicians are prompted to act on the checklist.

As reported in the American Journal of Respiratory and Critical Care Journal, a single site cohort study performed at Northwestern University Feinberg School of Medicine’s medical intensive care unit compared two rounding groups of physicians.  One group was prompted to use the checklist.  The other group of physicians had access to the checklist but were not prompted to use it.

What they found was shocking.  Both groups had access to the checklist.  However, patients followed by physicians who were prompted to use the checklist had Read more »

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

Do Physicians Prefer Ventilated And Sedated Patients?

You ever wonder what doctors really think but are afraid to say out loud?  Here’s one example:

“I wish all my patients were on a ventilator”

There’s a reason vented and sedated patients are considered desirable.  In addition to the obvious economic benefits of

There are the less talked about, but equally pleasant side effects most hospitalists, ER doctors, cardiologists, gastroenterologists, pulmonologists,  surgeons, infectious disease doctors, endocrinologists, psychiatrists, rheumatologists, dermatologists, nurses, respiratory therapists and physical therapists wouldn’t admit, but would agree, without hesitation.  As a general rule:

  • Patients on ventilators are just faster, easier and more pleasant to take care of. Read more »

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

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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