January 6th, 2010 by AlanDappenMD in Primary Care Wednesdays
Tags: DocTalker Family Medicine, Lawsuit, Primary Care, Primary Care Wednes, Primary Care Wednesdays
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About a year ago I made a house call to an elderly widow which has left a lasting impact on me.
Our “trusting relationship” began twelve years earlier while I attended to her dying husband at home. She couldn’t find another doctor to come in to help. Now it was her turn to need help, and like her husband insisted that she stay at home. The woman was being cared for by her middle-aged granddaughter who remained her daily companion.
Both granddaughter and grandmother distrusted the health care industry and had formed many conspiracy theories. They believed in the power of healing through “the Lord” and natural remedies, especially vitamins. I admired their fierce independence while holding my tongue on the magical and, in my opinion, misinformed views of the science of medicine. Both tried, in vain, to convince me that I should use the vitamins and other products they endorsed for my patients. I smiled obligingly, yet made no move to implement these ideas while pondering the paradox and danger of being invited into the “trusting circle” of such divergent world views. Read more »
December 30th, 2009 by AlanDappenMD in Primary Care Wednesdays
Tags: DocTalker Family Medicine, Dr. Alan Dappen, Primary Care Wedensdays, Telemedicine, telephone visits
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A Case Report: Even a Doctor Needs to Talk to His Doctor
I love the following battery of questions I hear from doctors and patients alike regarding telemedicine: “Don’t you think it might be dangerous to answer a patient’s medical questions by phone or email?” and “Shouldn’t you handle all issues in the office with a face-to-face visits like most other primary care physicians (PCPs)?” and then “Isn’t medical care by phone or email impersonal, shoddy, and second rate?
I however argue that everyone with these assumptions is wrong, Wrong, WRONG!
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December 23rd, 2009 by SteveSimmonsMD in Primary Care Wednesdays
Tags: DocTalker Family Medicine, Dr. Steve Simmons, Healthcare reform, Primary Care Wedensdays
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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 16th, 2009 by AlanDappenMD in Primary Care Wednesdays
Tags: DocTalker Family Medicine, Dr. Alan Dappen, Health Insurance, Primary Care, Primary Care Wednesdays
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Over the past few weeks, I’ve presented a parody of family medicine, whereby each character (Mrs. Doctor, Mr. Insurance, Patients) represent the current triad of the most dysfunctional of all American families: that of primary care practice. This week, Mrs. Doctor airs her grievances to her counselor about her evermore demanding and unreasonable spouse, Mr. Insurance).
A week after Mrs. Doctor’s visit to her PCP’s office, she sits in a waiting room, awaiting her first visit with the therapist.
Unlike the chaotic, tense reception at her primary care physician’s office, the therapist’s waiting room is everything but: it boasts relaxing designs and colors, is not crowded, and no noise save the soft bubbling from a Zen water fountain can be heard. A feeling of calm invites Mrs. Doctor to sit and reflect.
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December 9th, 2009 by SteveSimmonsMD in Primary Care Wednesdays
Tags: DocTalker, Dr. Steve Simmons, House Calls, Medicare Opt-Out, PECOS, Primary Care
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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 »
