February 10th, 2010 by SteveSimmonsMD in Primary Care Wednesdays
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I practice medicine in the suburbs west of Washington, DC, and everywhere I look I see 30 or more inches of snow. I keep reminding myself of where I am –not unlike a man pinching himself to ascertain wakefulness–because the view my window affords me is tailor made for the usual snow typical to Buffalo, NY. Two days after the snow stopped falling, schools are cancelled indefinitely, most side streets have yet to see a plow, and tens of thousands are without electricity including my partner’s family huddled together like in a dark basement enjoying the extra two or three degrees of warmth to be found there.
It is hard, but not impossible, to practice medicine when the pace of modern society grinds to a halt. Yet at least we, here, enjoy the benefits of living in a country with a well developed infrastructure prepared to rebound instead of recoiling from nature. To compare our “snowmageddon” (a term used on the news here) and the earthquake in Haiti would be both inappropriate and naïve; yet, our daily lives have distinctly altered and in that an understanding of the fragility of society and the responsibility of a physician is possible. Still, there are many differences. We ask when our power will be returned, not if; snow will melt, but buildings don’t un-crumble; and while my neighbors shiver together in their homes, many Haitians seek their loved ones with a shovel.
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January 13th, 2010 by SteveSimmonsMD in Primary Care Wednesdays
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Some patients in the 21st century approach “modern” healthcare with the same expectations I bring into a deli for lunch: “I’d like the sinus infection with antibiotics and a note for work, please.” I confess, when seeing such a patient I have occasionally acted on the impulse to ask if they would like fries with their order. Yet, these patients do have something to teach us about how to be a 21st century physician.
Eighteen years ago while a fourth year medical student I registered for an elective class on the future of computer science in medicine. This was my first time to see the Internet and I was awed by the vision my instructors had for the future. They had no idea. Read more »
December 23rd, 2009 by SteveSimmonsMD in Primary Care Wednesdays
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‘Twas the night before Christmas, and following the House
The Senators were blending their bill while some groused
The amendments were stuck to the bill without care
In hopes that Obama soon would be cheered
The Doctors and Patients were trying not to dread
The visions of full waiting rooms that flashed through their heads
All watched the TV, hoping to avoid new Red Tape
But confusing reports lead to a hypnotic state
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December 9th, 2009 by SteveSimmonsMD in Primary Care Wednesdays
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This upcoming January 4, 2010 will prove an important date for any physician who prescribes durable medical equipment for their patients to use in the home. The Centers for Medicare and Medicaid Services (CMS) have implemented an internet-based enrollment process for Medicare termed PECOS, another progeny of the 1996 HIPAA legislation. PECOS stands for Provider Enrollment, Chain and Ownership System and was created in large part to prevent fraud. Yet when I called the PECOS helpline, fraud was not a concern, and it was explained to me that PECOS is an internet version of my Medicare Application.
Since my practice makes house calls, we treat a variety of home-bound patients unable to make it to a doctor’s office without great effort. We care for stroke patients, quadriplegics, those with end-stage pulmonary disease, and many simply weakened by the effects of advanced age. Most need equipment like mattresses to prevent recurrent pressure sores, wheelchairs, nebulizer machines, or oxygen. A patient depends on their physician’s ability to order anything necessary, and it is imperative this be done without creating an exorbitant financial burden or by denying them a Medicare benefit already paid for. But, according to our Home Supplier, if we haven’t enrolled by January 4 then our Medicare & Medicaid patients will have to pay 100% of the cost for any equipment prescribed. Read more »
November 4th, 2009 by SteveSimmonsMD in Primary Care Wednesdays
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During the past several weeks, I have diagnosed several patients with novel H1N1 influenza infection with my diagnostic opinion occasionally backed by a positive flu swab. When my wife, an ER doctor, fell ill I suggested she had novel H1N1 infection and went on to advise some of my family, friends, and neighbors of the likelihood that they too had H1N1. Yet when it was my turn to suffer with fever, body aches, headache, sore throat, and malaise one word seemed best able to convey how I really felt: swine.
My symptoms began four days after having the H1N1 shot and almost immediately after putting my children to bed following a fun but rainy Halloween night. It would have been nice to blame the rain or the flu shot for my suffering but I knew better. Unable to sleep I found myself ruminating over an aphorism I first heard as a third year medical student, spoken by a man who lives in my heart as my mentor. Read more »
