When I finished medical school in the 1980s, it was often easy to determine prognosis: Metastatic cancer of most types: Less than a year Cardiac ejection fraction of 15%: Less than a year Critical aortic stenosis in someone older than 80 (making them poor operative candidates): Less than a year Now, everything is so different.…
A doctor joins a group. Things seem to go well. The doctor becomes popular in the community. After a few years, things are not so well. Maybe it’s the doctor’s fault. Maybe the group is in turmoil. Maybe it is just a bad fit. The doctor leaves. Now there are issues: Restrictive covenants; Practice financial deficits; New competition; Unresolved anger issues on both sides. Patients call. They…
Doctors are selling their practices! In some areas, it feels like no practices are doctor owned. It’s depressing. The days of private practice seem to be dying. Big multispecialty groups are the future! Everyone works with the same Electronic Health Record. Efficiencies of scale allow us all to work smarter. No one gets lost in the system. Bigger is better! Aligned…
Neurosurgery is VERY DELICATE!!!Remember those days of medical school? Remember when you followed the Neurosurgeon to the Operating Room?Back in 1991, I did this animation on an Amiga 3000 computer. Tweet
Over the years, I’ve watched primary care doctors leave their practices and become hospital administrators. The reasons are obvious: The paycheck and benefits are way better than being in clinical practice. Do these practitioners-turned-administrators bring any benefits to the hospital? More than anything, the benefit is those of us in regular practice still remember they were once…
Last year, a well dressed representative came into our Internal Medicine practice, handing out glossy brochures about “Here to Help,” a system to help those suffering from mental illness and substance use. No drug was being promoted. It sounded “too good to be true.” It seemed fishy. I grabbed one of the brochures and checked out the…
This past week, my veterinarian sister suddenly collapsed. She had a cardiac arrest while driving. Her passenger was able to get the car off the road with no crashes or injuries. A few cars back, a National Park Ranger (our area is full of Civil War Battlefields) came to her rescue. He had an AED…
I was listening to NPR on my drive home from work. The story of the hour was dedicated to a hospital suing lots of patients for unpaid medical bills. This particular hospital happens to be the dominant player in our region. In fact, it’s the hospital I’ve worked with for more than 25 years! There is a lot…
There is an animation site called “The 11 Second Club”. Every month, it posts 11 seconds of audio and a competition begins to create 11 seconds of animation to match the audio. A while back, the competition used 11 seconds from the 1989 movie “Parenthood” with Steve Martin and Jason Robards. It contains an interesting…
Medicare wants…. demands… you communicate with your geriatric population through a “patient computer portal.” Sometimes, when elderly patients fret about losing their ability to drive, I mention the marvelous convenience of Uber. Then, they pull out their feature phone with its gigantic numbered buttons and I realize my mistake. The concept of giving raw medical…