In 2005, I was invited to participate in an innovators’ workshop by the Harvard Interfaculty Group, funded through a grant from the Robert Wood Johnson Foundation. The question at the meeting was this:
“If primary care is critical to a vibrant and cost effective healthcare system, and
If primary care is going extinct, which most now predict;
Who is out there innovating new primary care systems and what is their vision?”
During the four years since this conference, I’ve found that this question is first and foremost when it comes to changing primary care.
I felt honored and surprised to be invited to the meeting. After all, our practice and its innovations are simple and are based on the following: Read more »
I am approaching an important anniversary of my heart attack. Until then, I had missed but a single day of work due to illness since starting medical school in 1975. Even in the middle of the heart attack, I played an entire ice hockey game, slept a few hours, had a business meeting with a fellow doctor at Starbucks, and went back to the office to see patients. In retrospect, my actions could be labeled as folly, bravado, machismo, denial, and lucky. I accept all labels as true. Without a trace of shame I have shared this archetypal story with friends, and patients hoping that by laughing hard enough at me, I might prevent at least one person from dropping dead from stupidity. Read more »
“To see what is in front of one’s nose needs a constant struggle…” George Orwell
Do you know what the “P” in HIPAA stands for?
If you said “privacy” you are quite wrong. HIPAA stands for Health Insurance Portability and Accountability Act and was originally intended to guarantee health insurance when someone changed jobs. But the word “portability” is a far cry from “privacy.”
Since April 14, 2003, patients have been required to sign these forms, creating the durable illusion that our medical records are private. We sign HIPAA forms when we see our dentists, doctors, and upon receipt of a host of other health-related services. Yet your personal health information is anything but private — and the more legislation Congress passes the more public this information becomes. Read more »
I was interviewed about my participation in DocTalker Family Medicine, a new type of medical practice that dramatically reduces the administrative burden of healthcare. The solution is easy: transparent fees, low overhead, reliance on technology, and no insurance paperwork. Patients who are tired of waiting to see a doctor, or filling out insurance forms, can get immediate care, generally for under $50. The average patient in our practice spends under $300/year on their primary care – and carries insurance for catastropic events.
To be a great internist you have to be great at blood gas interpretation. And you have to be able to do it quickly and efficiently. You have to understand what all the numbers mean and you have to get a good clinical sense of how to interpret them and how to change management based on their result. And you have to be able to do it without pulling out your formula books. In six years as a hospitalist I have never calculated what the compensatory responses should be. I just know.
Sometimes blood gases change your management or your medical opinion on what’s happening. Take for example my patient with advanced MS. She presented through the emergency department with “oropharyngeal bleeding of unclear etiology”. Her original BMP:
Na 137
K 4.0
CL 99
HCO3 36
BUN 35
CR 1.0 Read more »
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