CareerMedicine.com » Advice for Better Practice

Harrison’s Principles of Internal Medicine Textbook & CD-ROM

admin — Wed, 17 Feb 2010 20:02:26 +0000

Product Description
Value Package!
Harrison’s Principles of Internal Medicine, 15/e Textbook & CD-ROM only $272.00 – SAVE $48.00! You will automatically receive a 3 month FREE subscription to Harrison’s Online 2.0 with your purchase of the HARRISON textbook & CD-ROM.
Harrison’s PRINCIPLES OF INTERNAL MEDICINE textbook Eminently readable, completely current, and dramatically revised, the new fifteenth edition of Harrison’s PRINCIPLES OF INTERNAL MEDICIN… More >> Harrison’s Principles of Internal Medicine Textbook & CD-ROM

Danger Lurks Around With Every Signature!

admin — Fri, 06 Mar 2009 05:49:39 +0000

The truckload of documents on my table every single day waiting to be signed. Some are prescription refills, other are papers from the scooter people and not to mention those requests for prior authorization. Now if you have the same story there is a lot of risk hiding in those papers.

No doctor has time to read all of these papers. They all rummage through it and sign wherever the signature needs to go. After all there are atleast 100 or more signatures to be done everyday for which there is no compensation.

Among these papers are those sent by some shady vendors and companies. Here are few examples of those:

1) Diabetic Supplies:Diabetic Supply is a big business. That is why you hear those ads about free diabetic supply delivered to your door. Automatically! It is not that automatic. Once the patient requests diabetic supply from the company, they will send a form to the physician to sign. This form has the diagnosis codes and frequency of use, which is usually already filled out by the company salesmen. What they won’t tell you is that they documented the patient needs to check his or her sugar 5 times a day. Even when they are not on insulin. If you sign this form without correcting it, they will send the patient enough supply so they can check their sugars five time a day. This is called Upselling – Selling more than what someone needs. If Medicare comes after them, they have a good defence – “the doctor told us to do that!”

The doctor did not even have the time to read the form thoroughly and gets dinged for overutilization of medicare resources!!

2) Motorized Wheelchair and Scooters: You get these prefilled forms that patient needs a scooter. He may not need it. He probably will do fine with a manual wheel chair. But those sell cheap. So these wheelchair dealers will try to get you to sign a motorized wheel chair for the patient. If Medicare audits, then your neck is on the line.

3) Change Meds to Generic and save $$$: But they won’t tell who saves the dollars. The company or the patient. The patient many a times still pays the same. But if you sign it thinking patient would not mind saving this money, you will be in for a surprise. The Pharmacy will turn around and tell the patient that the doctor asked us to change it. The patients will be angry that they were not consulted before doing so.

4) Refill these prescriptions: Patients who have not followed up with you in a year may go to the pharmacy to see if they can get their meds. The pharmacist will send you a fax. Sign it for refills for next few months will increase your liability as you are now responsible for the side effects of the meds if not monitored. If such a request comes in just give out enough pills to give the patient time to et to your office. Definitely NO REFILLS!

Moral of the story: No one can read everything. But know what to check for each document before you sign it.

All Doctors should learn this important skill!

admin — Tue, 24 Feb 2009 07:13:59 +0000

The days of Doctors’ reputation of having a bad handwriting are ending. You will not be writing anymore. Medicare is forcing all medical practices and hospitals to go paperless by 2012. That will be a revolutionary change in the way we practice medicine. There will be no more bulky medical records. You will not have to fight for a chart to write your note. Pages will not go missing from the chart. It will be utopia!

But with great benefits cones even greater demands. We all will have to stop writing. No more of the sloppy handwriting we are used to. In fact handwriting will soon disappear from the face of the earth. By now, I am sure, you know what I am getting to.

Every Doctor should learn typing. Once in practice you will need to see as many patient as possible in a day. Whether you own your practice or if you are an employed physician, you will be forced to see more patients as Medicare institutes more cuts in reimbursement. These cuts will have ripple effects and will reduce reimbursements in private insurance payments too.

Once we instituted EMR (Electronic Medical Record) in our medical practice, it was a wake up call for me. I started using my two index fingers and struggled to finish my chart. It also slowed me down. Then one of my friends Edward taught my how to use all of my fingers on the keyboard. Over next six months I noticed a dramatic change. I was typing as fast as patients were speaking. By the time the patient left the room the chart was already complete. It was a miracle. It was better than dictating or writing on the chart.

So for all those who are entering residency or into practice, hone your skills in typing. It will serve you well and make your more efficient. Two finger typing is not enough. You should be able to type without looking at the keyboard.

How to negotiate with medical vendors.

admin — Mon, 25 Aug 2008 03:38:15 +0000

How should we negotiate with Medical Vendors. When you have your own medical practice and you will have to buy medical equipments and or Medical Services, you will find salesmen and coming in droves to your medical office to sell you almost anything under the sun.

Any time that you have to buy an equipment or service, you will have to do your homework. Just because one salesman gives you a price for a product, does not mean that is the market value of that product. People in the business community are well aware that physicians lack of training in the business aspect of anything. They use that to their full advantage by inflating the prices, selling unnecessary services, and even to the extent nickling and diming the doctors.

Always be paranoid and when dealing with business people. Even if it saves man appears to be your friend, he may not be so. Salesmen and are trained to develop a relationship with their customers on a friendly basis. And that is how they get their stuff sold.

Be aware of common sales techniques. It is important. For it will give you better handle on negotiations. Here are some of the commonly used sales techniques:

Upselling: It is a technique by which a salesman will sell you something more than what you initially asked for. For example when you go to buy food at a fast food restaurant, they ask you if you need French fries and Coke with it. Even though you did not initially plan to, there is a good chance you will say yes to the offer. This is Upselling.

Management fees: Somehow seems like all the doctors get charged management fees. Whenever we tried to buy a product or service, the salesman would tag on a management fee to the whole deal. If you look closely they charge anywhere between $100 to $200 management fee per hour. That is ridiculous. Even Physicians do not make that much for an hour anymore.

Inflating price then giving discount: Many times salesman will give you a very high price. Then he or she will deeply discount it for you for a limited period of time. It will make you feel you are getting a deal. You will be surprised, if you did some research, that even the deeply discounted price is much more than that product or service is available for elsewhere.

Deadlines: One of the favorite ways for the salesman to close a deal is by telling you that the offer is good until end of the week. In my opinion, if they can give you a product for X price this week, they should be able to give you the same product for X price next week.

Charging extra for various modules: Companies love to nickel and dime Physicians. This is especially true in the case of Electronic Medical records. The Electronic Medical records software is sold in various modules. Many of these modules are mandatory. This way they can bulk up on the total price without making the Physician realize it.

Appearing desperate: salesman may try to invoke your sympathy to be able to make a sale.

So once you know the common tactics the sales personnel uses, it will become easier for you to read in between the lines and continue to negotiate better through these gimmicks.
How do you make sure you’re getting a good price? Here are some pointers. Keep one practicing with every purchase you make and every time you will get better at it.

Get offers from three or four companies for a medical product or services. Never rely on bid from a single company or salesman only.

Go online, Google it, search and see how much the product or service is available online for.

Let the companies bidding for the purchase know that you have researched the price. Then ask them to beat the price.

Go for the lowest offer with the most reliable post sales service.

5) If two companies offer you the same price, go with the one which has been honest with the dealing during the process.

You can find medical vendors at directories such as VendorMD.com

How to crack a tough clinical case

admin — Tue, 24 Jun 2008 04:44:12 +0000

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.

WHY SHOULD PHYSICIANS HAVE A WEBSITE? AND HOW TO GET ONE !

admin — Mon, 09 Jun 2008 06:10:12 +0000

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.

<
/blockquote>

Comforting the patients – is it a Doctor’s job ?

admin — Wed, 23 Apr 2008 05:09:51 +0000

Several times in a day, physicians find themselves in a situation breaking bad news to the patients. At other times, physicians are informing patients about a preliminary results which needs further testing. And that further testing can lead to a potentially disastrous news. ( Or may be a good news ! ) How should a doctor handle that. One can make an argument that since empathy is a skill not taught in the medical school, may be it is not a Doctor’s job to comfort their patient. But lets not jump to a conclusion

Before answering this question, lets put ourselves in the patients shoes.

Imagine yourself being taken to a big corporate building (aka hospital). Then you are put into one of the rooms in that big building. You know you cannot leave that building without permission. Then several strangers come into the room and poke needles, take your blood, put cuffs and tubes around you. When you ask them what is going on, they have no clue. They tell you to talk to another stranger (aka doctor) about it. Finally this busy looking stranger comes in to the room. He flaunts his power, tells you the results of a test done on you, casually tells you that further testing may show a diagnosis which can result in your death. Before you could overcome the shock, he leaves the room. You lean to your family for support but in your heart you know that they cannot help you. The only person who may have the key to your cure was that stranger who had been in the room for 5 seconds. How do you feel at this point !

If you do feel scared, disgusted or hurt, you would rather leave the building. But you can’t leave without that stranger’s (aka doctor’s) permission, who does not give a dime on how you feel. If you do sign out AMA you will be stuck with a big hospital bill which your insurance may refuse to pay. So you wait in that room again to have more strangers come into the room and poke needles into you. And of course a long cold night dealing with the suspense of what that stranger is going to say tomorrow.

This is how the patients view their experience. Now lets tackle the argument that if empathy is so important then why is it not taught in the medical school. It is because the whole academic system believes that empathy is common sense. Every physician has empathy but it needs to be triggered. Empathy is common sense until the humanity of a physician is constantly dealing with death, disease and misery. Persistent exposure to vulnerability of a human being makes physicians so numb that the empathetic response does not get triggered when someone is diagnosed with cancer etc.

It is a physician’s duty not only to diagnose and treat patients but also to make patients comfortable to their new surroundings and experience. Patients call it bedside manners. Those extra minutes spent to comfort the patients may not be reimbursed, but the value they add to your reputation is enormous. It is what defines a good doctor and makes them a popular doctor.

Why Documentation is Important ?

admin — Wed, 19 Mar 2008 04:36:05 +0000

Just like the payors continue to get miserly to pay the doctors, the hospitals are facing such problems too. The video news content is worth watching. If you do not document a decubitus ulcer if present on admission, in your History and Physical, Medicare may assume that it developed in the hospital and not pay for its care at all. Surgeons already do not get paid for the care of most complications from the surgery. Even from medico legal standpoint, such observations should be noted in the initial H&P. For example a lawsuit claiming that hospital was responsible for decubitus ulcer was quickly dropped, after a note in the H&P stated that it was present on admission.

Six Must Read books for Physician Entrepreneurs

admin — Tue, 04 Mar 2008 07:00:24 +0000

If you are embarking on a journey to start your own medical practice or business, then preparation is the key. I am listing six books every physician entrepreneur must read.They are the pillars of my tiny library. All of them may cost not more than $100. But the practical knowledge they provide will be worth thousands of dollars. Every book will change your outlook in its own little way. Each book will switch on the business mode of thinking in your brain. So happy reading !

Become the greatest Code Blue Leader of all times !

admin — Tue, 05 Feb 2008 06:17:06 +0000

Everyone remembers the first Code Blue they had to lead. It is a surreal experience where everyone is freaking out and everything is overwhelming. It is the place where psychology meets technology. Mastering the art of leading a Code Blue team is an art. It lasts few minutes but those minutes define you as a physician.

Have you seen some Code Blue leaders completely ignored and others seamlessly able to carry out the ACLS ( Advanced Cardiac Life Support ) protocol. Leading the Code Blue is not just about knowledge but also about psychology. Yes! Psychology. Your ability to convince in the first few seconds that you can actually lead a code blue.

As you enter the room of a patient in cardiac arrest, it is a mayhem going on. Even though initial BLS is being performed, trust me , everybody in that room is freaking out. Everyone wants to be able to find that person, who they feel knows it all, and can tell them exactly what to do. After all, calling the shots in a code blue is a great responsibility. Every order given, every action taken, will be peer reviewed. And to make it worse, someone’s life depends on your orders.

Follow these steps to take full control of a code blue:

1) Technical Knowledge: Read up all the ACLS and BLS protocol. Remember the flow charts by heart. Knowing these tables will give you confidence. And your confidence will show.

2) Slow arrival: You can run upto the door of the patient’s room, but take a deep breath and enter the room at a slower pace. Everybody ese in the room is surely pacing or feeling like pacing anyways.

3) Be calm: Do not show anxiety, anxiiousness, or franticness in your face or actions. Even though you are working at a fast pace, a calm look will assure others in the room that you are not flustered by the situation. This builds trust and communicates confidence and ability.

4) Speak loudly: Anything that you say to anyone in the room, make it loud and make it clear. If you want someone to take a blood pressure, point to the person who you think should do it.

5) Speak Confidently: Do not let your voice quiver. Do not let it sound inconfident. Any such mistake will make everyone doubt your orders.

6) Follow the protocol: Many a times someone will suggest you something off the protocol. Do not implement it unless it is the protocol. After all, being the leader, your reputation is on the line.