Why more primary care doctors are referring patients to specialists

KevinMD
January 24, 2012

According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever before. In fact, the rate almost doubled in the 10-year period between 1999 and 2009.

This drives up the cost of care, as specialist consults tend to be more expensive than primary care visits.  Furthermore, specialists tend to …

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Why more primary care doctors are referring patients to specialists

Insider tips to surviving your hospital stay

Physician
January 24, 2012

Hospital stays can be traumatic for patients and their family members. I give you the top 10 ways to survive a hospital stay while maintaining your sanity.

10. Bring your own pillow. Trust me.

9. Bring a laptop computer or request one from the hospital. Hospitals all have free wireless these days and many will actually provide you with a laptop if you just ask.

8.  Bring an accurate and updated medication list …

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Insider tips to surviving your hospital stay

Being treated like a celebrity when giving birth

Physician
January 24, 2012

Celebrity is an interesting phenomenon.

On a hot summer night in 1990, my chief resident and I were on call at Harlem Hospital. We were informed that a “guest” was coming to interview us. Hot, sweaty and looking haggard rather than glamorous, we wanted to choke our director when Spike Lee walked through the door with film crew in tow. Lee was there to film the infamous movie, Mo’ Better Blues. …

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Being treated like a celebrity when giving birth

Why the family meeting is important

Physician
January 24, 2012

“Are you saying, doctor, that mom’s not getting better?” Eleanor asked.

“I’m afraid so.” I replied.

“Someone should have mentioned this to me before.” she said, before returning her gaze to my shoes.

We were talking about Eleanor and Roger’s mother, Bertha, who had been hospitalized in our intensive care unit for three weeks. Bertha, 67, had been admitted with an exacerbation of congestive heart failure. Despite everyone’s best efforts, she’d steadily grown …

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Why the family meeting is important

Incorporating 12-step program concepts into cancer survivorship

Conditions
January 23, 2012

The fact that the term “cancer survivorship” is now part of our vocabulary is a testimony to advances made in management of these diseases.  Most cancer survivors, however, are not unscathed by the experience.  As I tell my patients, they won’t be entirely as they were before treatment.  How these issues are dealt with varies from person to person.  But, awareness that chronic problems may persist long after treatments end …

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Incorporating 12-step program concepts into cancer survivorship

Overweight people have a weight thermostat that is turned up too high

Conditions
January 22, 2012

I’ve written many times that losing weight is the second hardest thing I ask my patients to do. (Breaking an addiction like smoking or alcoholism is the hardest.) The frustrating thing is how little we know about how to lose weight successfully. But we are learning more all the time about why losing weight is so difficult.

Much about dieting and weight loss is poorly understood, but let’s first lay out …

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Overweight people have a weight thermostat that is turned up too high

5 ways doctors can benefit from professional connections

Social media
January 22, 2012

Looking ahead to the next several months, I’ve found myself frequently wondering how many physicians will make this their year to take the plunge and join an online social network. There are significant advantages that can be gained for doctors who embrace social media. Here are five ways you and your practice can benefit from such professional connections.

1. Finding a better job. The business of the health care economy continues to …

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5 ways doctors can benefit from professional connections

Obesity is a sign of good health in some cultures

Conditions
January 20, 2012

On the first day of the 1st Caribbean Obesity Forum, I presented various talks on obesity – its economic implications, its assessment and the need for firmly anchoring obesity treatment in primary care.

Interestingly, several family doctors in the audience raised the interesting issue that here on Barbados (as probably on other islands) many patients are actually quite happy with their weights.

One family physician noted in his presentation the case of …

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Obesity is a sign of good health in some cultures

Sleep deprivation as a medical student

Education
January 18, 2012

An excerpt from Everything I Learned in Medical School: Besides All the Book Stuff.

My body jolts awake to a familiar sound. After a few blind swipes, my blows hit their target, and once again, there is silence. The air in the room is cool and crisp, and every fiber of my being wants me to remain in the welcoming warmth under the covers. It is Saturday morning. On any other …

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Sleep deprivation as a medical student

A medical student’s first patient encounter

Education
January 17, 2012

This is an account of my first encounter with an in-patient from a little while back — I have provided only minimal details about the patient to maintain compliance with HIPAA.

After a firm handshake with each of us, our preceptor embarked purposefully up two floors to our first in-patient encounter. As we walked, I peeked into the rooms with the door left ajar and wondered what brought each individual to …

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A medical student’s first patient encounter

Radiologists who cheat on their board exams: Who’s to blame?

KevinMD
January 17, 2012

In a widely circulated CNN article, many radiologists have been found to cheat on their board exams: “Doctors around the country taking an exam to become board certified in radiology have cheated by memorizing test questions, creating sophisticated banks of what are known as ‘recalls,’ … The recall exams are meticulously compiled by radiology residents, who write down the questions …

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Radiologists who cheat on their board exams: Who’s to blame?

When pimping a medical student can backfire on a doctor

Education
January 17, 2012

The third year of medical school is a lesson in humility. In the OR, you’ll invariably cut the suture too short, or too long, or too slowly. On the floors, the one laboratory value you haven’t checked is the only value vital to the patient’s survival.  And just when you think you know everything there is to know about a disease, the Attending Physician will keep asking you questions until …

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When pimping a medical student can backfire on a doctor

Physicians should be concerned about malingering

Conditions
January 15, 2012

Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs. The word “malingering” comes from the French word “malinger” meaning “poor or weakly” as these are the characteristics feigned or exaggerated by the malingerer. Malingering has been documented as far back as in the Bible when …

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Physicians should be concerned about malingering

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MKSAP: 25-year-old with diffuse muscle and joint pain

Conditions
January 14, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 25-year-old woman is evaluated during a follow-up visit for a 6-month history of diffuse muscle and joint pain above and below the waist, fatigue, and difficulty sleeping. She has a 2-year history of hypothyroidism treated with levothyroxine. Her only other medication is hydrocodone-acetaminophen, which has …

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MKSAP: 25-year-old with diffuse muscle and joint pain

A guide for entrepreneurs to get a doctor’s attention

Tech
January 12, 2012

I’ve had the luck to attend medical school in the city of San Francisco during what will be looked back on as the start of transformational change in our health care system. My growing interest in technology and new business models as the disruptive forces behind this change, as well as marriage to a technology entrepreneur, has me frequently rubbing elbows with movers and shakers in the digital health space. …

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A guide for entrepreneurs to get a doctor’s attention

How patients can remember their doctor’s name

Physician
January 8, 2012

“Do you remember my name?”

Like a broken record, I repeat this question again and again as I make rounds in the hospital. My patients’ universal answer, given with furled eyebrows and an apologetic look is “uh, no, I don’t remember”.

My response: “Don’t worry. It’s Dr. Tony Breu, but call me Tony.” Theirs’ (again with furled brow, but also a smile): “Oh, okay.”

In a busy teaching hospital, it is not uncommon …

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How patients can remember their doctor’s name

The 3 types of residents that medical students will encounter

Education
January 6, 2012

Every medical student is a bit apprehensive when he/she knows they will be assigned a new resident. The same questions always come up. Will the resident be nice? Will they understand my busy schedule? Will they make me do a ton of scutwork? Will they make me write all of his/her progress notes? And maybe most importantly, will they let me leave early to study for boards or enjoy the …

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The 3 types of residents that medical students will encounter

Doctors: Don’t be ashamed about going bankrupt

KevinMD
January 5, 2012

Are doctors really going broke?

According to this piece from CNN Money, some are: “Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat. But some experts counter that doctors’ lack of business acumen is also to blame.”

That’s all entirely true.

Pressure on reimbursement, combined with a lack of …

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Doctors: Don’t be ashamed about going bankrupt

Our healthcare system is unfair and unbalanced

Policy
January 5, 2012

About six weeks ago, while in clinic, I developed pain in my stomach — specifically, in my right upper quadrant, just below the ribs.  I had experienced this a few times before, but this time it seemed more persistent than usual.  Following the rule that physicians make the worst patients, I kept working through it until my nurse told me I looked poorly, and made me see my own primary …

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Our healthcare system is unfair and unbalanced

Requiring doctors to give orders on patients they have not seen

Physician
January 4, 2012

To meet Federal patient satisfaction goals, our hospital administration is requiring community based physicians to give patient admission orders before we have a chance to see the patient. Patients who self-refer themselves to the emergency department, are evaluated by the emergency room staff, and who are determined to require admission must be admitted by their community physician within 20 minutes of receiving a call from the ER staff advising the …

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Requiring doctors to give orders on patients they have not seen

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