Doctors on Tape
During a clinical encounter recently the mother I was visiting with reached down to the phone sitting on her chair and discreetly hit a red record button.
Increasingly, parents are interested in recording their encounters with me. Sometimes one parent can’t be present for a visit. Perhaps the mother of an inconsolable 6-week-old wants to remember what her fatigued brain won’t allow. Read more…
What I Didn’t Learn in Medical School
Mrs. B was washing dishes in the kitchen when she heard a thump. She ran to where her 12-month-old son had been sleeping and found he had fallen from a chair (code: e884.2). He was crying (code: 780.92) and visibly shaken, but did not have overt signs of bleeding, bruising, or trauma. She picked him up and immediately brought him to the emergency room. There, he was triaged by the nurse (nursing report #1) and vitals were taken (nursing report #2). Shortly after the mother and son settled into the pediatric emergency room, he vomited once (code: 787.03).
The emergency medicine resident came by an hour later to conduct a focused interview, and perform a comprehensive physical exam (code: 89.03). He took care to ask at least four elements of the history of present illness that included location, quality severity, duration, timing, context, or associated symptoms from the event. He performed a complete review of at least ten organ systems and surveyed the patient’s social history (code: 99223). It was decided that the boy was to be observed in the ED for the next few hours for signs of brain injury or concussion. Read more…
Medical Fraud and Iris Scans: A Futuristic Solution
An article from Bloomberg Businessweek highlights an interesting and often-overlooked area of medical fraud: patients who use false identification to obtain care, racking up huge bills under someone else’s name. Here’s the lede: “When a Columbus (Ohio) man was indicted by a grand jury in April on identity theft charges, the case had nothing to do with stolen credit cards or bank accounts. Instead, police say the suspect, who pleaded not guilty, used a South Carolina man’s identity to obtain more than $300,000 in treatment at Ohio State University’s Wexner Medical Center.”
The piece points out that we know very little about how big the problem of medical ID fraud actually is, citing an estimate of about seven billion lost dollars per year in the U.S. alone. In an effort to curtail these costs, some leading edge places have started using iris scans to verify patients’ identities – like something out of a spy movie. Read more…
How to Talk to Your Patients About Herbal Medications
Herbal medicines make most doctors cringe, laugh, or want to put blinders on and pretend they don’t exist. This is understandable. While allopathic medical education hammers pharmaceutical formulas and mechanisms of action into our brains, we learn little-to-nothing about herbs in medical school. Quite the opposite – we are most often told to uniformly discourage our patients from taking herbs out of concern for safety; a conversation stopper with little room for nuance.
In Western medicine, at best, herbs and plants are recognized for their role as an anchor ingredient in many pharmaceutical drugs. At worst, herbs are shunned for being unstudied and unregulated – fraught with reports of contamination, false-advertising and misuse by patients. This, thanks in large part to the Dietary Supplement Act of 1994, which allowed their sale without prescription. Read more…
Embracing Technology and Providing Care: The Role of Email and Texting in the Patient Encounter
A recent article in the Wall Street Journal addressed the controversies surrounding the use of email communication between doctor and patient. This practice is fraught with significant legal, personal, and professional issues. Patients certainly deserve prompt answers to their questions and reasonable access to their providers – but should we as physicians be accessible via email 24 hours a day? The WSJ piece profiles a few physicians and highlights the way in which each uses email to communicate with patients. Based on recent national surveys, it appears that currently nearly 30 percent of physicians communicate via email to their patients. Nearly 18 percent actually used text messaging to interact with patients. Estimates suggest that only 5 percent of American patients included in the survey use email or text to communicate with their physicians or other healthcare providers. Read more…
Scaling Pain: What Being a Patient Showed This Medical Student
As both a patient and a medical student, I have found myself staring at the walls of many exam rooms. Most contain a poster depicting a rainbow of faces that express increasing degrees of discomfort. The first face has wide eyes and a grin that exclaims, “No pain today!” Its expression mocks the little face at the end of the row, which sobs and grimaces, its visage scrunched to depict the “worst pain ever” captioned underneath.
No one can know what hurts the“worst,” because all we can ever feel is a product of our own experience. The end of my pain scale may not objectively come near that of a person undergoing chemotherapy or a neurologic pain disorder, yet it is equally real for me. The last time I was at the end of the scale, I sat in the ophthalmologist’s office, my face akin to that red, agonized looking icon. Read more…
Obesity in the Latino Population: What We As Physicians Can Do
The Latino population is now the fastest growing immigrant population in the U.S.; it’s also far from the healthiest. In Los Angeles, (where I, a Latino cardiothoracic surgeon, have lived and practiced for decades) 60 percent of Latinos are overweight and 40 percent are obese. To look at just one subgroup nationwide, Mexican American women are 40 percent more likely than non-Hispanic women to be overweight, according to 2010 data from the Center for Disease Control and Prevention.
Unsurprisingly, diabetes and cardiovascular disease are the two most frequent medical health concerns within the Latinos population. For example, Hispanic baby boomers – 20% of the next generation of older adults – have poorer outcomes for such metrics, as well as for self-rated health scores. Read more…
Do You Follow These Guidelines? (If Not, I Hope You Have an Alternative)
The American College of Physicians and the Federation of State Medical Boards recently took an important step by publishing a new policy paper. Online Medical Professionalism: Patient and Public Relationships reviews how email, text messaging, blogging, and social media are affecting the doctor-patient relationship, and offers best practices for navigating these changes. This particular elephant has inhabited our waiting rooms for years, and it is high time that we address it concretely. Read more…
Four Steps to Growing a Profitable Practice (Even If You’re Starting from Scratch)
When was the last time you bought a car? If it was recently, then chances are you didn’t walk up blindly and start speaking with the first salesperson you saw. You researched, you asked around, and armed yourself with so much information that before even stepping foot onto a dealer’s lot, you already knew the Kelly Blue Book value, the dealer’s markup, and perhaps even the individual salesperson you wanted to work with (this, based on past customer reviews).
Technology and transparency have leveled the playing field. Today, a full 82% of consumers research a product before buying it, according to Forrester Research. Google calls this pervasive trend the “Zero Moment of Truth.” It’s a critical part of today’s marketing environment, underscoring the fact that buyers can now find all the information they need to make a purchasing decision without even going to the product or service’s website or location, or talking to a company representative on the phone. This trend spans across all industries, even healthcare. Read more…
It’s Time to Take Charge and Help Deflate Medical Bills: Seeking Your Ideas
At a time when one in three Americans reports difficulty paying medical bills, up to $750 billion is spent on care that does not help patients become healthier. Although physicians are routinely required to manage expensive resources, traditional medical training offers few opportunities to learn how to deliver the highest quality care at the lowest possible cost. While the gap is glaring, the problem is not new.
Thirty-eight years ago, in 1975, the department of medicine at Charlotte Memorial Hospital initiated a system to monitor medical costs generated by house officers. Writing in the Journal of Medical Education, leaders of the Charlotte initiative described how simply making caregivers aware of the way clinical decisions affects the costs of care could decrease inpatient length of stay by 21%. Read more…
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