THEORY OF MEDICAL PAGERS
LAW OF PAGING ORDERS
The more orders you write, more pages you will get. Vice versa is also true: The more pages you get, more orders you will give.
LAW OF SOCIAL PAGING
Number of pages you get are inversely proportional to your social skills.
LAW OF UNEXPECTED PAGING
The less you expect a pager to beep, more are the chances it will actually do so.
LAW OF DEMOLITION PAGING
No matter how hard you throw the pager on the ground, how many times you dip it in water, or put in fire, it will not stop serving pages.
LAW OF STATUS PAGING
The number of pagers on your belt are directly proportional to the confidence of patients in your treatment.
LAW OF GARBLED PAGE
More important the page is, more are the chances that it may show up garbled on your pager.
LAW OF FORGOTTEN PAGER
Your pager will get the most pages on the day you forget it at home.
How to crack a tough clinical case
What to do when you are stuck with a tough clinical case? What if all labs and imaging that you do is not giving you an answer. You feel like a detective but not like Sherlock Holmes. Here are the ten commandments to solve a difficult clinical case.
1) THOU SHALL LOOK FOR A SINGLE CAUSE FOR SEVERAL SYMPTOMS: If the patient is exhibiting several symptoms which appear unrelated, then try to link them all together to one cause. Almost always there is a single diagnosis causing all clinical symptoms rather than several diagnoses causing several symptoms.
2) THOU SHALL GIVE TIME AND REVIEW THOROUGHLY: Most of the time we encounter simple cases. In our busy lives we encounter mostly simple or straightforward cases. Pneumonia, UTI etc. But when a clinical mystery comes along you need to stop and think. I sit down with the chart and promise myself not to stop reading it until I find a solution or headway. Usually within 15 to 20 minutes the bulb in the mind will go off.
3) THOU SHALL HAVE PASSION AND COMPASSION: Put yourself in patients shoes. Imagine how it feels to be sick without a diagnosis. Also remember that you first joined medicine to do the glamorous stuff like solving a tough clinical case.
4) THOU SHALL ASK THY FRIENDS: You may want to anonymously (without violating HIPAA) discuss the case with your colleagues. They may come up with some good idea.
5) THOU SHALL STOP DOING MEDICINE THAT DOES NOT WORK: If your patient is not getting better on a treatment. Do something different. Do not let some treatment continue when it is not working.
6) THOU SHALL ADMIT THY LIMITATIONS: Be honest with your patients. Admit that you don’t know the diagnosis. But reassure them that you will not rest until you find one. They will respect you for being honest.
7) THOU SHALL LISTEN LONG ENOUGH: Do not hesitate to retake the history in a tough clinical case. May be the patient forgot to tell you something. Or may be you did not listen long enough.
THOU SHALL LOOK FOR HORSES: Remember the saying “If you hear hoofs, think of horses not Zebras”. More likely you are looking at a common diagnosis with an uncommon presentation, than an uncommon diagnosis with a common presentation.
9) THOU SHALL NOT IGNORE: Just because we are not able to find a diagnosis does not give us a right to ignore it, or call it fibromyalgia. Take all symptoms seriously unless proved otherwise. Ignoring can be a very humbling experience.
10) THOU SHALL CELEBRATE: Once you have cracked a challenging clinical diagnosis, you need to boast, feel good and proud about it. Let it all out, after all you deserve it.
Are you late for physician job hunt? Last Minute Strategies
It is almost July and most of the residents should have landed a physician job. If not, but you are mulling over several physician job offers — then you are still good to go. But if you have not done a single interview yet or worse if you have not started applying yet, then you are really getting late. But do not despair, as there are plenty of physician jobs available. Those who have visa issues need to be extra careful about the deadlines for applying for one.
There are several strategies to catch up for your Doctor job search. These techniques can be used by the early birds too as they are very effective in getting the contract in hand.
1) Networking: Talk to your attending physicians in the hospital and program. Many if them will be looking for a partner in the near future. May be you can fit into that role. Even if they are not looking, they may know someone , who is looking for physician employees.
2) Medical Staff Office: Talk to the Medical Staff Office in your training hospital. They are usually aware of MDs looking for potential partners/ employees.
3) Pick up the phone!: Yes! pick up the phone and call up all the places you have put your resume to. Ask them for the physician responsible for making hiring decision. Talk to the hiring MD and ask him if you can set up an interview to discuss the opportunity further. Many a times, a reverse interview offer like this does work.
4) Physician recruiters: Call the physician recruiters in your specialty and they will be do glad to have you signed up somewhere. Why? Because that’s how they make the big bucks.
5) Friends and Seniors: Do not forget friends and seniors who are already employed or own their own medical practice. They can also hook you up with a physician job.
What if the worst fear comes true. What if you graduate and there is no physician job in sight for you. Well that is a rare thing and should not happen if you have read the ‘Secrets of physician job hunt’. But even if it does, then you still have option of locum tenens and moonlighting. This option is not for you if you need a visa for employment. The biggest drawback of having a gap between residency and employment — you will have to explain it on all your applications in the future. I hope this sets you on fire to get started!!!
WHY SHOULD PHYSICIANS HAVE A WEBSITE? AND HOW TO GET ONE !
Technology is changing all around us. So is the way of doing business. More and more people are using internet to find what they want to find or shop. Patients used to search for doctors in the yellow book. That is all changing very fast. Now patients are using google and other search engines to find doctors. Many a times they end up on sites like healthgrades from google. They are able to review your credentials, what insurance you accept etc. Once they chose a doctor, they go to that physician’s website and evaluate him or her further. So if you or your medical practice does not have a website – you need to get it now.
Website names (also called domain names) are running out! More than 80 million websites have been registered so far per ICANN. Do you realize that there are no single word website names left in most languages including English. People who invest in website names (also called Domain Name Investors) have taken them all. In fact to get a two word website name is also very hard.
But what can a website do for a doctor? Ever heard of HillaryClinton.com or BarrackObama.com? A website in your name can make it easy for your patients to follow you on the web. Many a times they will enter your name in the browser and see if they could get some information about you. Now if your competitor registers a website in your name before you could, he can lead your potential patients to his website. And worst of all, you won’t even know.
It is vitally important for you to at least register your name as a website name or domain name. e.g. RobertSmith.com or RobertSmithMD.com. If you know what you will name your medical practice in the future, then you should register that website name too.
Here are some FAQs for registering a website.
But I am in the medical school why should I register now? Can I do that later? Registering website names or domain names is very cheap to do. If you wait too long, someone else may register your name as a domain name. Then you will have to buy it from those domain investors or you will have to settle for something different.
But isn’t registering Domain names a highly technical stuff?
No. In fact it is as simple as typing the name and click submit. Follow the instructions to a credit card payment and you can get your own website name (domain name) at www.HelloDello.com where CareerMedicine.com is registered.
But how do I make a website on my domain name?
The easiest way to make a website is to use a website template. It is a readymade website design. All you have to do is type in the content just like you do in Microsoft word. I register website or domain names at www.HelloDello.com because they give access to a website builder for free. Some of the registrars charge for that kind of stuff. That way I do not have to spend more cash to design the website or keep it running.
What can I do on my website?
You can write a blog on your website, share pictures, and advertise your services etc on your website. The possibilities are endless.
How do I register domain names?
You can go to easy to use website such as www.HelloDello.com. Then type in the desired website name. Press search button. It will tell you if it is available or not. If it is then you may want to register it right then and there, to prevent any other person from registering it.
Summary:
Advantages of Domain name registration (or registering website names)
Creates your identity on the web.
Easy for patients to find you.
Easy for you to find patients.
Once registered by you, no one can snatch your website name from you.
In the future, you may be able to sell your website name just like real estate. But not all website names sell for millions, most of them sell for few hundreds to thousands dollars only.
It is cheap to do so. HelloDello.com charges only $9.99/ year to register most website name.
Disadvantages of not registering a name as soon as possible:
Someone else may register it and you will never get a chance at it.
You will miss out on a lot of business because of not having a web presence.
To register a website:
Go to www.HelloDello.com
Type in your desired website name in the search bar.
If the domain name is available to register, grab the domain name right away.
If not available, try a different variation to see if that is available – such as RobertJones.com, RobertJonesMD.com, RJones.com and so on.
Also consider registering different extensions of the website name such as .com .net .org etc.
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Two Big Mistakes Graduating Medical Residents Make !
The two most common issues facing graduating medical residents are the ones that we will discuss in this post. As a graduating date is near, we all think about taking a break and also to postpone the medical board exams by an year or two. Why are these big mistakes? Lets find out.
Let us talk about taking a break after a medical residency program. Once we are through with the hard labor of medical residency program, the long hours, and the stress, which has haunted as for at least last three years, there is a natural tendency to take a break, To rest, to rejuvenate.
Lets consider the question of financial implications of taking a break after residency. Since you have not the started a Physician job, it is quiet clear that you will not be paid for this vacation time. Other thing to note is that your salary would almost quadruple after graduation. And so taking a break will cost you more than $10K for each month you do not work assuming your starting salary is $120K. This does not includes the money you will spend to enjoy that vacation. That makes it a very very expensive break!
You should rather start working at the physician job and then take a vacation maybe three to four months later which would be paid vacation at that time. So by delaying gratification by four months, you actually earned more than 15K. If you have a higher starting salary then 150K, then the stakes are even high.
The other issue to be discussed is the timing of your board examinations. Should you give board examination right after residency, or may be two or three years down the road?
The likely reason medical residents try to take a break is because of all the stress of examinations. But remember this stress is something that you have been used to already. So why not go through the stressful medical board exams, while you’re used to taking huge amounts of stress. Almost all hospitals require board certification for approving your privileges to the hospital. If you do not have privileges to the hospital, you cannot enter the hospital to work there.
The problem with delaying the boards is that the longer you are away from the residency graduation, the harder preparation you will need for the boards. It is the easiest to pass the medical board’s or specialty medical boards right after residency. Why? Right after residency the knowledge is fresh in your mind. That reduces the amount of readings you may have to do. Also it is the latest knowledge, which is most relevant for the medical board exams. Not to mention your recent practice in preparing for multiple in-house examinations does keep your efficiency at the highest.
So make sure you avoid these two big mistakes often graduating from the residency program. Number one, do not take a break right after residency whether to relax or to prepare for the board exams. It is not worth it. Number two, take your board exams right away.
DESIGN A MEDICAL OFFICE SPACE series: Modifying a plan
Once you receive a medical office layout plan designed by your architect for the medical office, it is time to review it yourself and see if all of your major goals are met or not. If not then you have another chance to voice it out now. Remember once the plans become more detailed or the construction starts it becomes more and more expensive to change anything. So you really need to look into the details and make sure you like every inch of the floor plan.
How to do it ? Well you compare the program we made in the last post and make sure those things are incorporated in there. Also if you have forgotten something to include in the program you can easily ask the architect to modify the layout.
NOTE: The image on a plan could be rotated just to add to the confusion ! Point I am making is that it matters from which direction you are looking at the plans. Especially during signing real estate contracts for medical office building, check and double check to make sure that you know exactly which wall are you looking it. Say if you wanted your sign on the front door but it is marked on the back wall of the building in the diagram– then you will have a problem !!
Change Medicine Series: Pagers are an outdated technology !
Every doctor has a pager. A doctor may not have a stethoscope, but he will definitely have a pager barely hanging to his belt, waiting for a chance to interrupt the doctor’s life. But the question is: Do we really need pagers in the era of cell phones?
To answer this question, lets rewind our lives way back to the medieval times where the calls were handled by a messenger. There were no telephones, no pagers and of course no cell phones. The doctor on his on call day would not leave his house. A messenger would come to his house to let him know about an emergency. If the doctor had to leave his home, he will leave a trail behind for the messenger to locate him.
Then came the landlines. Now the doctors could be called on landline and summoned to the hospital. But this still did not negate the need for a doctor to be stuck in his house on an on call day. But technology eventually finds solution to everything. So pagers were invented. Pagers were an announcement of freedom for the doctors. They could go anywhere on their on call day and yet could be reached in a matter of beep beep beep. The doctor would then stop whatever he was doing, fine a land phone and call the number.
Then came the cell phones. But they did not get the same welcome as the pagers by the medical community. We decided not to dump our pagers but hang the cell phones next to them. Now we could play golf and still answer our calls from middle of nowhere.
But in my opinion pagers are a giant waste of time for physicians and those trying to reach them. Would you want me to prove it? Fine! Here is a 10 step process we all follow several times a day:
Step 1: The Beeper Beeps
Step 2: We let out a cry of despair
Step 3: We fumble to get the beeper from its holder on the belt
Step 4: We press the button on the beeper to look at the number
Step 5: We then fumble for the cell phone
Step 6: We dial the number on the beeper, with our eyes zig zagging between the beeper and the cell phone screens
Step 7: We talk to the person on the other line , asking him to find out who paged.
Step 8: We then wait frustratingly for the other person to appear on the phone.
Step 9: We talk to the person who paged us. Finally !
Step 10: We replace the beeper and the cell phone back into their respective folders.
Why we cannot cut this 10 step ritual of hospital calls to a simple three step process by dumping our pagers and using cell phones? Here is a 3 step process using just cell phone for your calls.
Step 1: The cell phone rings
Step 2: You pick up the cell phone and answer the call
Step 3: Hang up and holster it on your belt.
Life can be easy. Why make it difficult by sticking to old technology. We can save a lot of time by dumping the pagers in favor of cell phones. Whether its the pager or the cell phone, you will have to answer it anyways ! So make it easy on you and the person trying to reach you.
This is a ‘Change Medicine Series” article of CareerMedicine.com. Here we sound ideas to change common medical practices which should be changed. Do you have any such ideas? Leave us a note.
This post is republished as this topic is hot on KevinMD
DESIGN A MEDICAL OFFICE SPACE series: Creating a Program
Usually what you will have is the outline of an empty medical office or floor plan. It is just outside walls and is called a ’shell’. Now we will develop a program or a list of requirements we need in the space. Here is a sample program:
THE PROGRAM
1. Four Exam Rooms
2. Two Restrooms
3. One Break Room
4. One Doctor’s Office
5. One Billing Office
6. One Manager’s Office
7. One Reception Desk
8. One Waiting Room
9. One Conference Room
10. Storage Room
11. Keep as many windows as possible in the hallway.
Remember list everything that you want in a program for the architect. They then can try to get as much as they can incorporated into the medical office lay out plan. You can list 100 rooms in the program. Then the architect can come and let you know that it is impossible to get 100 rooms in there so you can get 8 rooms only.
Also the program may change later in the design phase as we will demonstrate. For example you may want to increase the number of exam rooms to five instead of four in the above program. But you may need to delete one restroom to make space for it.
Design a Medical Office with us !
One day for those who realize the dream of starting their own medical practice will face the exciting opportunity to design their own medical office space. This is a primer article to kick off a series of articles in which we (The CareerMedicine authors and the readers) will design our own medical office space. We are not talking about renting or leasing a medical office space. It is mainly about either building a medical o office from scratch ("including the building!") or buying a "Shell" building and then upfitting it – aka adding rooms etc to the shell.
How does the whole process work. Lets look at the bird’s eye view of the whole process:
STEP 1: Buy a shell (just four walls building enclosure) or a piece of land.
STEP 2: Find a Medical Office Architect
STEP 3: Sit with the Architect and develop a "program". A "Program" here means a long list of things you want for your new office. For example — a window in the doctor’s office, number of exam rooms, approximate people you need to fit in the billing office and any other specifics. The program helps the architect determine the size and layout for the office space.
STEP 4: The architect will send you a preliminary drawing drawn by their draftsman using the program above as a guideline.
STEP 5: The physicians will then review it. Feel free to change anything that you feel is needed. It is much cheaper to correct the drawing than a building.
STEP 6: Once you approve the layout of the medical office space, the medical office design will enter the phase of the electrical and plumbing designing.
STEP 7: Now you will have to mark the location of power outlets, telephone outlets, cables etc on the approved layout. Once done send it back to the architect for electrical layout.
STEP 8: Architect will finalize the drawings including elevations etc. which determines your counter height etc.
So get ready for our next series of posts in which we will design a medical office space.
Buying Medical Equipment for your practice: Caution Advised !
If you own or run a medical practice, or plan to do so, one of the most frequent decision you will have to make is whether or not to buy or lease a medical equipment. As the cost of technology is going down, more and more medical equipment is becoming affordable for medical practices to acquire. As technology advances, older models are becoming available in the used medical equipment market for fraction of the price.
Why should a medical practice acquire medical equipment: Reasons can be:
1) Out of necessity: If you are an ophthalmologist, you need some of the equipment to practice your trade.
2) Service to patients: Patients prefer to go to their Doctors office for procedures rather than to a hospital.
3) Tax Breaks: Your accountant can tell you how to depreciate the price of the medical equipment to get some relief from Uncle Sam.
5) Survival: In the era of reducing insurance reimbursement rates, an additional income from the procedure may become an important source of revenue.
But beware of the medical equipment salesmen. Many of them are good but many of them are not. Their job is to sell the equipment. They may promise to stick by you after the sale but admit it, how many times have you seen a any sales guy checking on you after a sale. Also the only way they can convince a physician to buy a medical equipment is to talk about the profitability of the tests. So ultimately it is the duty of the physician purchasing the medical equipment to decide whether or not it is a good buy.
How do you determine if an equipment is a good buy or not ? How do you know if the medical equipment salesman is telling you the truth about the reimbursement rates. The answer is you cannot guarantee the reimbursement rate by insurance companies for a particular test. The only way to do it will be to submit a claim to the insurance company. You can submit a claim only after you buy the equipment and do the procedure. Even if you submit the claim, whether it gets paid or not will take atleast one to three months. Thanks to the processing times of various insurance companies.
So here is a list of questions you should ask before purchasing any medical equipment:
1) Do I trust this medical equipment salesperson? The answer should be No most of the time. The mistrust will motivate you to do more research on your own.
2) Do my patients need this medical equipment? If yes, then how often ?
3) Do medical insurance companies traditionally reimburse for the procedure or will my patients end up footing the bill ?
4) Does the amount reimbursed by the insurance companies will recover my investment in a reasonable period of time ?
5) What is the future outlook of reimbursement on these procedure by third party payors. Are they planning to decrease it or increase it (LOL).
6) Is Medicare or Medicaid planning to add certification requirement for that medical equipment. If so then you need to factor in the added cost of training and paying someone to be a medical director.
7) What is the difference in pricing between a new and the used medical equipment ?
9) Do I have a place in the medical practice to use it ?
10) Will my patients benefit from having the test here ?
11) Will the quality of reports generated by the medical equipment be sufficient enough that I can give a good service to my patients ?
You can find a list of Medical Vendors from the Medical Vendors Directory VendorMD.com for your research. Answer the above questions you do not get stuck with a medical equipment sitting in your office and laughing at you !
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