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Latest Posts

Physician Enjoys The Ease Of A New EMR

Seven months into 2011, things look very different than they did this time last year at my office. Not only have I been using an electronic medical record for nine months now, but I’ve also been submitting claims electronically (through a free clearinghouse) using an online practice management system. I’ve also begun scanning patients’ insurance cards into the computer, as well as converting all the paper insurance Explanation of Benefits (EOBs) into digital form. I’ve even scanned all my office bills and business paperwork and tossed all the actual paper into one big box. As of the first of the year I even stopped generating “daysheets” at the end of work each day. After all, with my new system I can always call up the information I want whenever I need it.

How did such a committed papyrophile get to this point? It is the culmination of a process that actually began last summer with the purchase of an adorable refurbished little desktop scanner from Woot ($79.99, retails for $199, such a deal!) The organizational software is useless for my purposes, but it does generate OCR PDFs, which makes copying and pasting ID numbers from insurance cards into wherever else they need to be a piece of proverbial cake. The first step was to start Read more »

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

When A Medical Recommendation Is Over The Top

I saw a lady with a boil. It began as a small red bump which got bigger and harder, then drained white stuff, and was now getting better.

The reason she was worried about it was its location: it was on her breast. This was why the chief complaint officially read, “Breast lump” despite the fact that it was technically no such thing.

I examined her carefully, determining that the pathologic process was indeed confined to the skin and clinically did not involve the actual breast tissue in any way. However because she was of an age for screening mammography, I did take the opportunity to urge her to have it; which she did. The problem arrived with the radiology report:

A marker is placed over the area of palpable abnormality. Mammographic images reveal normal breast tissue with no mass or architectural distortion. The pathologic process is confined to the skin. Recommend surgical excision. (emphasis mine)

Um, no. Read more »

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

Cartoon Makes A Simple Case For Why The U.S. Has No National System Of EMRs

Many people ask why the United States, unlike other countries, has no national system of electronic medical records.

Here’s why:

Insert the number 576 instead of 14, by the way. Each of which Read more »

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

Some Patients Just Won’t Take “No” For An Answer

62-year-old black man with a two inch (that’s inch; not centimeter) lump under his left arm. It is determined that he needs to have it biopsied in order to tell for sure what it is. The differential diagnosis includes a simple reactive lymph node, lymphoma, leukemia, granuloma, sarcoidosis, and several other more esoteric entities, all of which require tissue for definitive pathologic diagnosis.

The dialogue:

Patient Who Will Not be Reassured: What is it, Doctor Dino?

Me: We won’t know for sure until we get the report from the biopsy.

PWWNBR: But what do you think it is?

Me: I have no idea. We have to see what the pathologist says.

PWWNBR: Could it be cancer?

Me: It could be any one of several different things. Yes, cancer could be one of them, but there’s no way of knowing without the biopsy.

PWWNBR: Dr. Dino, do I have cancer? Read more »

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

A Bagels And Boobs Mammogram Party

I don’t always practice what I preach. Regular mammograms, for instance. Last year I realized I had skipped a few, so I decided to turn my procrastination into an opportunity to reach out to those of my patients guilty of the same thing.

I made arrangements with my hospital to monopolize half their schedule one Saturday morning, put flyers up in my office and talked it up like crazy to every eligible woman I saw. On the appointed day, I brought a whole bunch of bagels, half a dozen spreads (I asked the ladies to bring their own coffee), and we proceeded to have a blast! Or as much fun as you can have getting your boobs squished. Hey; it’s all in the name of early detection.

Last year’s final tally was a bakers dozen (twelve patients plus me), out of which about 5 people were called back for more views (mainly those with old films not readily available from other institutions), 2 benign biopsies were done, and one case of invasive breast cancer was diagnosed and treated. Not bad, I thought. 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 Cartoon

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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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