The phone conversations are overheard. The other doctor is new to the game of private practice and she meticulously explains the illness to a daughter. This persists for about twenty minutes and at the end of the phone call the daughter suggests the doctor needs to talk with the son who is a surgeon […]
Category: General Medicine
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How is this possible?
First there is increasingly less reimbursement for the non-procedural aspects of medicine, then more paperwork and now a requirement from the California Department of Managed Care that doctors see patients within 10-15 days. Yes, the word require was used. Every spring when we venture to southern California to ride bikes it is impossible not to […]
Here are two vignettes illustrating the failure of doctors to master the obvious and maybe a window onto the future struggles to control medical costs. A 90 year old is referred for care due to “end stage dementia.” End-stage dementia is medical speak and as such does not really convey the appropriate imagery. It means […]
There are many highlights of this outstanding meeting but the live cases are always a standout. Today there were 2 from Rochester, MN and one from Boston. Live ablation procedures on real life patients are beamed into the lecture hall via some mysterious satellite through a maze of cables. The operators, with their NFL-coach […]
One of my new tasks in joining a new practice is learning CPT codes for what I do. Said differently, I am learning how to bill for services rendered. Never needed to this in the past as my large group had an army of business folks (coders) who did this for me. They of course […]
Being married to a palliative care doctor is enlightening in so many ways. As has been noted previously, CMS (government) decided that commonly ordered stress scans and ultrasounds of the heart are much less valuable. Undoubtedly, there are many reasons for this, but at least one is likely the notion that there are too many […]
In the doctors lunch room… “Hey doc, are you riding your bike in this weather?” “It is the off-season, I am resting my body and exercising the mind.” A look of bewilderment, like what does “off season” mean? I quickly remember that “normal” people do not do this nonsense that is bike racing. Three months […]
I am close with this doctor who works in the government health care system. She is a palliative care/hospice doctor. We live together and as such discuss clinical cases frequently. This evening’s discussion sheds much light on the many differences in the systems in which we practice medicine. A vignette… But first a disclaimer: The […]
What can an interesting case of a simple infection which nearly led to sudden cardiac death teach us about health care, health care reform and our ways of knowing? Dr Wes’ blog recently described a post from a geriatrics (specialist in the care of the elderly) doctor that highlighted the challenges of caring for the […]
So much to write about on Friday. An email from a friend, another master of the obvious, on the the happiest states, an email form ACC on holding doctors accountable for medical errors, as well as an AHA statistical report on the worsening lifestyle habits of Americans. These comment-able stories, along with this bloggers quest […]
Why would referring a patient directly to a specialist save money, time and patient outcomes? Exhibit A: A 75 year old male presents to his family doctor with a heart rate of 120. Just some palpitations and a little “funny feeling in my chest.” No pain, no shortness of breath, no dizziness. Examination shows a […]