tag:blogger.com,1999:blog-7323692122514281455.comments2024-03-18T17:51:23.018-04:00MD WhistleblowerMichael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.comBlogger3452125tag:blogger.com,1999:blog-7323692122514281455.post-30965811360834435982024-03-18T17:51:23.018-04:002024-03-18T17:51:23.018-04:00Insightful as always. We are in a transition perio...Insightful as always. We are in a transition period where AI may be helpful and improve productivity and may increase efficiency, such as creating office notes. Then AI will start to replace Practioners and do things better than we can. It will be a brave new world where we will need to adapt to remain relevant. My suggestion is to enjoy AI and take advantage of it while you can but recognize that eventually things will drastically change. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-40096079918443777982024-03-12T22:27:13.208-04:002024-03-12T22:27:13.208-04:00Absolutely!Absolutely!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-40749081062440898232024-02-26T09:28:43.904-05:002024-02-26T09:28:43.904-05:00Plain and simple....doctors know more than insuran...Plain and simple....doctors know more than insurance companies! We pay insurance companies so we can see doctors that know more than insurance companies! If "off label" meds may work for the issue, then the insurance company should pay for them!!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-55674352844154237392024-02-17T15:13:49.995-05:002024-02-17T15:13:49.995-05:00My guess is that you usually refer when you need a...My guess is that you usually refer when you need a procedure that you don’t do such as endoscopic Ultrasound or ERCP. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-85918542578491113832024-01-21T15:51:22.000-05:002024-01-21T15:51:22.000-05:00This marijuana stuff is pure crap! I have a family...This marijuana stuff is pure crap! I have a family member that called some "doctor" on the phone and said she has fibromyalgia and for a large fee received a "license" for "medical" marijuana! "Someone" is making money off these "licenses"! I have another family member with RA that vapes it daily!!! I'm getting real tired of smelling "skunk" smell all over the stores and in cars in the parking lot and even when someone pulls right up next to you at a light!!!! I think it is certainly a gateway drug and very addictive!! I hope somehow they can stop the train!!!!!!!!!!!!!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-6028961434911992762024-01-20T08:01:18.215-05:002024-01-20T08:01:18.215-05:00If I could marry comments that relate to 2 of your...If I could marry comments that relate to 2 of your recent columns, this one and the one on pharma. Pharmaceutical companies have spent a great deal of money developing their drug and want to sell their med. Sometimes they oversell and are in cahoots with the medical establishment. For example, say drug X reduces people from being hospitalized for Heart Failure from 10 per year to 8 per year. This is a relative risk reduction of 20% which sounds pretty good. But the absolute risk reduction is only 2 per year which means you have to treat 50 to benefit one person. Somehow these modest benefits often make it into society guidelines and all the specialists start doing it even though it costs a lot. Can you see how this might add to health care costs with marginal benefits?<br />Elliot Davidson, MDAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-80803495943285736352024-01-20T07:38:18.183-05:002024-01-20T07:38:18.183-05:00As usual, you your column is prescient and on the ...As usual, you your column is prescient and on the nose. I fear that the excitement of innovation with drawn out the voices of caution. We often get ahead of ourselves like this such as in genetic engineering. AI is so widespread and with so many repercussions even Chat GPT can’t imagine them all. Interesting, incredibly helpful and remarkably scary! <br />Elliot Davidson, MDAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-40350029623572458052024-01-20T07:29:31.509-05:002024-01-20T07:29:31.509-05:00Those that have been in this business for a while ...Those that have been in this business for a while have witnessed truly remarkable medications and therapeutics. Some that come to mind are statins and human insulin. Before statins, our choices to reduce cholesterol were mostly lousy and statins have made many a CV surgeon less busy. Pork insulin was all we had once and patients developed antibodies. Someone figured out how to get bacteria to make HUMAN insulin and millions have benefited. Thanks for a good column. You have given me another good idea for a podcast!!<br />Elliot Davidson, MDAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-53793406218709340352024-01-16T09:40:41.505-05:002024-01-16T09:40:41.505-05:00It is shameful that we, doctors, do not wash our w...It is shameful that we, doctors, do not wash our white coats regularly. I remove my white coat when seeing patients under 18. I also ask elderly patients in Rehab and nursing home to read my white coat headings to test their vision and literacy level: I will say: seeing is believing. This helps me a lot in having our 1st interaction and bit of neurological exam. I should have had the letters in prints for easier reading. www.SameDayFamilyMedicine.comnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-33000808255118943242024-01-13T12:51:59.248-05:002024-01-13T12:51:59.248-05:00i wear diffrent color coats and that too medical s...i wear diffrent color coats and that too medical student style and not knee length as a FP.We deal with sick and depressed clients they appreciate colors ascolors can lift moods and spiritsI wish we can wear royal emblems / cartoons etc as well.life should be fun as there is enough negativity all aroundAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-8313644583700742024-01-13T11:16:41.270-05:002024-01-13T11:16:41.270-05:00I took typing as an audit class in summer at a com...I took typing as an audit class in summer at a community college between high school and first fall semester of college. No grade just coaching. The smartest move ever. My mom bought a typewriter that could backspace erase...great solution pre computers. Helped us type paper in an emergency. Bought the first computer in parts with home assembly because it was more affordable. 5 and a half inch floppy drives as well. Learned in dos until there was Java. Took class notes for pay as a notetaker in med school. Got paid to perfect my typing skills - win win win. Have been perpetually working on solutions to do typing less and templates more and dictating into text if essential. Most importantly remind myself that noone ever died from notapenia. Lets hope AI gets us out of 85% of the typing and dictating. Not everyone has the trifecta of hand eye esr coordination and communication skillsAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-53405347685450406772024-01-08T23:42:36.754-05:002024-01-08T23:42:36.754-05:00I wear a clean white coat mainly because I like to...I wear a clean white coat mainly because I like to have my scripts ready and ample supply of stickers and small toys ready for my pediatric patients immediately after any annoying procedure that I have to perform on them. They appreciate it and I don't have to rely on an over taxed MA or RA to hand out the goods! Works for me and I keep my little patients very happy.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-1664247846721234382024-01-08T23:03:47.008-05:002024-01-08T23:03:47.008-05:00I am not a good typist, but I am a good listener. ...I am not a good typist, but I am a good listener. I leave my keyboard in my office and jot notes on paper for later in the day when I have time to do my charting. Yes, I am the last person to leave the clinic most days. I like EMRs because they make the record of a clinic visit very legible and easy to review. This is not only good for me but for any consultants to which I am referring patients. However, over the years, my position has allowed me to review charts of many providers and I have seen a disturbing recurring practice in which the provider uses a template designed to describe a typical visit and due to time constraints, fails to modify the template to address the patient's visit on that day. This can be interpreted as fraudulent and may severely attenuate the strength of a provider's defense in a malpractice site. For instance, an above the knee amputee does not have bilateral patellar reflexes, a patient with poorly controlled a fib does not have normal sinus rhythm and a patient with spastic quadriplegia does not have normal strength and tone. Let me be clear. I have been just as guilty. We all know that treating the patient optimally is paramount, but getting the record right is important too. Perhaps AI will help keep us honest.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-48329253510307110862024-01-08T21:18:39.676-05:002024-01-08T21:18:39.676-05:00The premise is that the EMR is designed primarily ...The premise is that the EMR is designed primarily to enhance patient care is SEVERELY FLAWED. It was built as a mechanism to capture charges and monitor work. Until the paradigm changes it continue to achieve the design goals and NOT patient care as the primary goal......<br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-64063906285738669752024-01-08T20:57:03.273-05:002024-01-08T20:57:03.273-05:00Agree 100%!Agree 100%!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-9150597503729493342024-01-08T20:52:00.955-05:002024-01-08T20:52:00.955-05:00I also can type very fast since my mom made me tak...I also can type very fast since my mom made me take summer school typing classes in high school. But even though I can type while maintaining eye contact with the patient, I cannot LISTEN nor THINK when I am transcribing what they say. The healthcare system requires you to interview the patient and transcribe at the same time, but IMO it is suboptimal.Dr. Carol, Locum Tenens Hospitalisthttps://www.blogger.com/profile/10964649447883846210noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-79043853951065430692024-01-07T14:45:28.133-05:002024-01-07T14:45:28.133-05:00Totally agree! EHR has increased physician non cli...Totally agree! EHR has increased physician non clinical workload, burnout and doesn’t improve the quality of your work. Excellent comment:”Physical exam is frequently unhelpful. But, unless you perform one, you will not be able to determine if it is unhelpful in a specific case.” AI’s usefulness will be in the “Mechanical Learning” modality. But be aware of biases on the data that the “creators” of the tool feed into it. Also, we must be careful regarding the way we ask a question. We must avoid “yes or no like” type of inquiries. Also references must be provided for us to evaluate them. In summary: EHR, Telemedicine, AI/Mechanical learning are here. But, we physicians have to accept the responsibility to refine them. All of them at this moment ,have more limitations than benefits.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-35369415409978817322024-01-07T12:07:41.027-05:002024-01-07T12:07:41.027-05:0045 years of medical practice have taught me flexi...45 years of medical practice have taught me flexibility in patient care. Video and phone visits to treat visually available conditions saves patient time, physician time and exposure to waiting rooms of infectious disease that can be safely treated remotely. The bigger issue is reimbursement for time spent by the provider. As always administrators time is more valuable than patient care time whether done by video or phone or in person, this is what needs addressing. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-42931363792560857132024-01-06T15:13:35.529-05:002024-01-06T15:13:35.529-05:00Undoubtedly correct, technically as well as philos...Undoubtedly correct, technically as well as philosophically. My hope is that electronic records ultimately add value to “the system” — by which I mean patients whose records can be more easily shared among physicians as well as humanity because AI crawlers will catch patterns in diagnosis and care that, over time, should be even better than one doctor’s memory from that one doctor’s experiences. Imagine after a doctor enters a list of symptoms and his/her diagnosis into the electronic record, an AI avatar pops up to ask the doc if he is aware that there are alternative diagnoses or treatment protocols? Not the mindless stupid shit that will annoy on day one because you clearly knew/thought about those alternatives, but the big data assessment capable of actually improving care. Luddites can reduce the pain by accepting the inevitable or taking on big tech. You have found the better course of (in)action.LewietheTunanoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-81493533041008378672024-01-06T14:57:06.509-05:002024-01-06T14:57:06.509-05:00You are a poet and a scholar!You are a poet and a scholar!LewieTunanoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-45360115086429133482024-01-02T11:56:47.661-05:002024-01-02T11:56:47.661-05:00Good points.Good points.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-91228202838711925702023-12-17T00:00:19.437-05:002023-12-17T00:00:19.437-05:00But did you swab your “non-white coat” attire at t...But did you swab your “non-white coat” attire at the same time? That may have grown plenty, as well. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-85833338530865956632023-12-15T10:01:37.057-05:002023-12-15T10:01:37.057-05:00Wow good for you. Who cares? Dead topic that need...Wow good for you. Who cares? Dead topic that needs to stay dead. Waste of server space. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-85306544951681839462023-12-14T17:02:36.139-05:002023-12-14T17:02:36.139-05:00Certain European countries have banned white coats...Certain European countries have banned white coats for physicians as well as ties and are mandating bare-below-the-elbow practice. Reason behind this is infection control as they found out that doctors don’t wash their white coats and ties. Also any watches and jewellery are perfectly designed to harbour bacteria and hence carry them from one patient to another. Another benefit they claim is removal of presumed hierarchical elitism between the doctor and the patient which purportedly translates into better patient care as doctors appear more approachable. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-25692027895000695282023-12-14T15:58:23.749-05:002023-12-14T15:58:23.749-05:00Agree fully! ( as a petite woman MD of color) Agree fully! ( as a petite woman MD of color) Anonymousnoreply@blogger.com