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Showing posts from January, 2023

How to Choose a Doctor

For most of my career, I was in a small private practice.  Our staff were like family.  We prided ourselves on providing highly personalized attention to our patients which started at the moment that the patient was greeted by our receptionist.  For a patient to enjoy an optimal medical experience, every member of the team needs to perform at a high level.  The doctor is but one member of a larger team.  Indeed, I have heard personally of patients who have left medical practices who liked the doctors but not the staffs.  Everyone counts. We saw patients who were self-referred or sent to us by referring doctors or by family members.  I have always asked every new patient how they came to see me personally, and I still do.  It is always gratifying when a patient is recommended to us by a medical professional or a family member.   You took care of my grandmother and she raves about you!   This not only feels good to the doctor, but the patient arrives already having confidence about the

How to Transfer Medical Records - A Tale of Frustration and Madness

A patient came to see me recently for a second opinion on an abnormal blood test result.  He was accompanied by his parents.  They had driven a considerable distance for this visit.  The patient’s mother announced at the outset of the visit that she had been assured that all of the relevant records had been transferred.   My forthcoming comment will shock neither patients nor medical professionals.   Nary a single page of records was anywhere in sight. This vignette illustrates two incredibly frustrating and recurrent realities. Medical records that referring offices promise they have sent me often never arrive.  They are dangling somewhere within a extraterrestrial black hole.   On a regular basis, conscientious patients see me in the office assuring me that they were told that their records have been forwarded.   They may have been forwarded somewhere, but all I know is I don’t have them.   This drives patients to a state of apoplexy, and I don’t blame them.    There are variat

Should Doctors Charge Patients to use the Patient Portal?

My employer,  a rather large and well known medical behemoth based in Cleveland, recently announced that patients may be charged for medical advice solicited on the patient electronic portal.  This has generated an array of opinions ranging from accusations of corporate greed to defending physicians’ right to be compensated for practicing medicine. Implementing this new program violates the following reality of human nature. Folks will not support losing an established benefit.   Consider how organized labor reacts when management aims to reduce worker benefits.   How would any of us feel if our employer cut back our vacation allowance?     How might homeowners feel if their mortgage interest is no longer tax deductible?   You get my point.   Over the past few decades, I have provided thousands of hours of free medical care on the phone and electronically.   I never felt that I was being ripped off since this was the only system I knew and I accepted it.   Similarly, patients n

Upgrading the Electronic Medical Record!

After 30 years or so, there is still much joy for me in the practice of medicine.   Electronic medical record (EMR) systems doesn’t make the list.   Chances are that if you asked your own doctor to assemble a Frustration List, that EMR issues would be among the top five entries.   Over the past 15 or 20 years, I have struggled through several of them.   At one point, I was using 4 distinct systems: 2 different hospital EMR systems, our office practice EMR and our endoscopy center’s software.   Does this sound like fun? Think of all the passwords I kept track of!   There is a recurrent EMR event in every system that brings doctors to our knees.   Here’s the simple phrase that transforms even a stoic doctor into a sweating and trembling practitioner: The EMR system will be upgraded overnight. Let me explain.   One might think that a computer upgrade would be a desirable event. For example, Merriam-Webster’s dictionary definition of upgrade is to replace something with a more us

Colonoscopy in the Elderly. How Old is too Old?

I am frequently asked what is the upper age limit for offering screening colonoscopy.   Patients today are often more informed on certain medical issues than their doctors are.   I support their empowerment.   Of course, we physicians, as actual medical professionals, presumably have more credibility in opining on the practice of medicine.   In my own life, I always give great weight to the folks I hire, whether they are tradesmen or professionals.   Why would I not give consideration and deference to one who has years of training and experience?   If I needed an attorney to litigate an issue, would I presume to advise on the optimal trial strategy?   ‘ He who represents himself has a fool for a client.’ Patients can acquire a great deal of medical knowledge, but they are not as easily able to exercise sound medical judgment.   This takes us professionals years to develop.   Consider this weighty maxim:   It takes 10 years to acquire 10 years of experience.     Indeed, I am still t