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Latest Posts

How To Micro-Tweak Diagnosis And Treatment

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A common problem in healthcare is the number of times that small adjustments are needed in a person’s care. Often for these little changes, a physical exam and face-to-face time have nothing to do with good medical decision making.

Yet the patient and doctor are locked in a legacy-industrialized business model that requires the patient to pay a co-pay and waste at least half of their day driving to and from the office, logging time in a waiting room, and then visiting five minutes with their practitioner for the needed medical information or advice.

Today I’d like to visit the case of a patient I’ll call “DD,” who I easily diagnosed with temporal arteritis (TA) through a 15-minute phone call after she’d spent four weeks as the healthcare system fumbled her time with delays and misdirection via several doctors without establishing a firm diagnosis. Read more »

One More Medical Acronym To Add To The Pile

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In medicine, hardly a week passes without the introduction of some new acronym, previously unspoken in the average practice, which then grows to prominence — take HIPAA, PECOS, CPT, ICD, etc. — the list goes on and on.

I believe that after 14 years of practice I’ve earned the right to introduce an acronym of my own: CRAPP. For the last several months, my partner and I have used this term to describe the volumes of denials, pre- and prior- authorizations (is there really a difference?), and faxes that seem to grow like weeds on the fertile planting grounds of our desks.

More specifically, in our office the acronym CRAPP stands for: Continuous Restrictive And Punitive Paperwork. To put it blithely, CRAPP could represent any document you wish someone had put on your partner’s desk instead of yours.

On a more emotional level, this acronym captures the visceral response I have whenever my attention is drawn away from my patients and redirected towards some nonsensical busywork — much like someone yelling at a golfer during their backswing.

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How Direct Access To A Doctor Can Save A Person’s Life

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At my front door stood my neighbor and his daughter making their annual Girl Scout cookie trek. “Should I make it a baker’s dozen?” the girl asked, knowing I wouldn’t refuse. Her father chimed in, “I was just at a wedding where I sat next to someone who said you saved her life. She said some very nice things about your medical practice.”

The name of the patient he was mentioning flashed me back. Mrs. BB (whose name has been altered to maintain privacy) was referred by a mutual acquaintance who already used our practice. This acquaintance felt that maybe I could solve Mrs. BB’s problem, specifically because all of our practitioners are paid for time, which means we can listen and communicate to determine how we can best help our patients.
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The Power Of Comprehensive Healthcare

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Today, in a bold and not too distant place, 300 individuals who are at high risk for multiple health problems predictive of high mortality rates, are participating in a visionary experimental project for telemedicine and health monitoring.

Every day these individuals are tracked through GPS location. Their movement patterns and whereabouts easily can be observed by trained technicians who ascertain that the individuals are getting up and going about their daily activities in a normal fashion. Deviations in movements for any expected individual can be the earliest indicator that something has gone seriously wrong and might warrant an investigatory call or visit to look into a developing heath problem.
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The Primary Care Shortage: Killing The Golden Egg-Laying Goose?

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This past Monday, I was drawn to an article in the Wall Street Journal: “Medical Schools Can’t Keep Up.” The article detailed the growing shortage of primary care doctors in our country and reminded me that we in the U.S. may have something called “insurance reform” now, but without physicians to translate insurance access into healthcare, the state of our healthcare system will continue to beg additional attention and reform.

Although new medical schools are opening and some schools have increased enrollment numbers, there are a limited number of residency positions in this country. The government has always funded these residency positions and our new reform law tries to address the primary care shortage with “slot redistribution,” whereby money from unused residency positions will be deferred to primary care or general surgery residency programs.  Read more »

Latest Interviews

Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

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How Do Hospital Executives Feel About Locum Tenens Agencies And Traveling Physicians?

I recently wrote about my experiences as a traveling physician and how to navigate locum tenens work. Today I want to talk about the client in this case hospital side of the equation. I ve had the chance to speak with several executives some were physicians themselves about the overall…

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Latest Book Reviews

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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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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