May 12th, 2010 by AlanDappenMD in Better Health Network, Health Policy, Opinion, Primary Care Wednesdays, True Stories
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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 »
April 28th, 2010 by AlanDappenMD in Better Health Network, Health Tips, Opinion, Primary Care Wednesdays, True Stories
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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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April 21st, 2010 by AlanDappenMD in Better Health Network, Opinion, Primary Care Wednesdays, Research
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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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April 7th, 2010 by AlanDappenMD in Better Health Network, Opinion, Primary Care Wednesdays, True Stories
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In my medical practice, I have a simple yet revolutionary idea: I get paid to answer the phone. Every one of my 3,000+ patients has my cell phone and email address so that they can reach me the instant they need help, which is no different than any of my friends or family who may be trying to reach me. Our practice motto: “Talk to your doctor anytime, anyway, anywhere.”
It’s not that I’m trying to not see you, or want to be impersonal or to practice risky healthcare. In fact, each of these common assumptions is pointedly wrong. By answering my phone, I can know my diagnosis and treatment worked (or not), or I can help someone avoid an ER visit or unnecessary office visit. My patients call me when they’re traveling, or at work, or from their car, at night and on weekends. There’ve been occasions that I need to see a patient NOW and I’ve come to the office a 2AM to keep someone out of an ER. No matter what, by picking up the phone to talk to my patients, I’m the first person in the healthcare system to know something is wrong, not the last.
Although good examples supporting the power of a doctor answering a phone occur daily, I have one I want to share with you. Read more »
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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