US Cardiac electrophysiologists meet reimbursement reality and don’t like it.
By ANISH KOKA It’s been a while but Anish Koka, a one time regular writer on THCB and occasional THCB Gang member, is back publishing […]
Medical Practice
Matthew’s health care tidbits: Texas is the present future of abortion care
Each week I’ve been adding a brief tidbits section to the THCB Reader, our weekly newsletter that summarizes the best of THCB that week (Sign […]
Health Care Through the Back Door: The Dangers of Nurse Visits
By HANS DUVEFELT In some practices, patients with seemingly simple problems are scheduled to be seen by a nurse or medical assistant. Sometimes they can […]
BREAKING at ViVE: Jenny Schneider on Launch of New Biz, Homeward
by JESSICA DAMASSA, WTF HEALTH BREAKING! Livongo-famous Jenny Schneider stops by to talk to us first, on-site at ViVE in Miami, about the brand-new business […]
How to Talk to Clinicians: Forget Workflows, Just Tell Us How Things Work
BY HANS DUVEFELT Workflows are all the rage with EMR people. But doctors, NPs and PAs are smart. Nothing burns us out as fast or […]
Pithiatism Redux
BY MARTIN SAMUELS Those of us in medicine have all seen the famous painting of the Tuesday afternoon lessons at the Salpȇtrière in Paris in […]
What the Pandemic Taught Us About Value-based Care
By RICHARD ISSACS You’ll recall that we ran a long piece (pt 1, pt 2) about Medicare Advantage from former Kaiser Permanente CEO George Halvorson […]
Simple Bills are Not So Simple
By MATTHEW HOLT I went for an annual physical with my doctor at One Medical in December. OK it wasn’t actually annual as the last […]
The Healing Power of Even Virtual Human Connection
By HANS DUVEFELT Almost two years into this new age of varying degrees of self quarantine, I am registering that my own social interactions through […]
Where’s Our National Health Tech Academy
By KIM BELLARD It has been said that if your company has a Chief Innovation Officer or an Innovation Department, it’s probably not a very […]
Behind the Mask: A Country Doctor Writes
By HANS DUVEFELT Today I saw a patient I have known for years. He suddenly pulled his mask down and said, “I’d like to know […]
We are Asking Our Physicians to Do Too Much. It’s No Wonder They are Burnt Out.
By GAIL PEACE We have heard the phrases “physician fatigue” and “burnout” too often in the last year – and for good reason. Covid-19 has […]
We Use Too Many Medications: Be Very Afraid of Interactions
By HANS DUVEFELT I happened to read about the pharmacodynamics of parenteral versus oral furosemide when I came across a unique interaction between this commonest of diuretics […]
Medicine is a Moving Missile, Aiming for a Dangerous, Elusive Target
By HANS DUVEFELT (Desperate times called for desperate measures.) In the tech world, we have come to expect our devices to become outdated and obsolete […]
We Shouldn’t Tolerate Sloppy Allergy Lists
By HANS DUVEFELT The medication and allergy lists seem like they would be the most important parts of a health record to keep current and […]
American Primary Care is a Big Waste of Time (When…)
By HANS DUVEFELT Before Johannes Gutenberg invented the printing press in 1450, books in Europe were copied by hand, mostly by monks and clergy. Ironically, […]
I Am a Decision Maker, Not a Bookkeeper
By HANS DUVEFELT Perhaps it is because I love doctoring so much that I find some of the tools and tasks of my trade so […]
Recommendations From the Coalition for Physician Accountability’s UME-to-GME Review Committee: Winners & Losers Edition
By BRYAN CARMODY If you’re involved in medical education or residency selection, you know we’ve got problems. And starting a couple of years ago, the […]
A Man With Sudden Onset of Gastroparesis
By HANS DUVEFELT Leo Dufour is not a diabetic. He is in his mid 50s, a light smoker with hypertension and a known hiatal hernia. […]
More Laughing, More Thinking
By KIM BELLARD There was a lot going on this week, as there always is, including the 20th anniversary of 9/11 and the beginning of […]
As Doctor Burnout Climbs, Can We Save Primary Care?
By RONALD DIXON Week after week, I hear from colleagues in diverse specialties about how exhausted they are from practicing medicine. It’s no surprise that […]
Anxiety, Worry or Fear? Disappointment, Grief or Depression?
By HANS DUVEFELT Especially in these strange and uncertain times, many people feel uneasy. Some of them come to us with concerns over their state […]
Does Our Healthcare System Work for the Most Vulnerable Americans?
By DEBORAH AFEZOLLI, CARL-PHILIPPE ROUSSEAU, HELEN FERNANDEZ, ELIZABETH LINDENBERGER “Why did you choose this field?” Most physicians are asked this question at some point in […]
Burnout? Not Even Close!
By HANS DUVEFELT I am a 68 year old family physician in rural Maine. This morning I read yet another article about physician burnout, this […]
Health Insurance is a Stumbling Block in Many Patients’ Thinking
By HANS DUVEFELT I have a patient with no health insurance but a brand new Mercedes. He says he can’t afford health insurance. He cringes […]
EHRs Are Workarounds, Rerouting the Way Physicians Work
By HANS DUVEFELT IT GUY: Hey, Doc, don’t make up workarounds, use the EHR the way it was designed. DOCTOR: Listen, your whole EHR is […]
Morning Distort
By MARTIN A. SAMUELS A 35 year old woman complains of weakness of the right side of her face and pain behind the right ear. […]
“This Doesn’t Usually Hurt that Much”: Patients With Fibromyalgia Spectrum Disorder
By HANS DUVEFELT Specialists in orthopedics and general surgery often want us, the primary care doctors, to manage postoperative pain. I don’t like that. First, […]
The Call to Be a Primary Care Doctor
By HANS DUVEFELT I suspect the notion of calling in narrower specialties is quite different from mine. Surgeons operate, neurologists treat diseases of the nervous […]
The Call to Be a Primary Care Doctor
By HANS DUVEFELT I suspect the notion of calling in narrower specialties is quite different from mine. Surgeons operate, neurologists treat diseases of the nervous […]
The Case to Realign Parkinson’s Disease Research
By STEVEN ZECOLA If asked, the leaders of the research organizations working on Parkinson’s disease would say that they have made tremendous progress and are […]
Can the Practice of Primary Care Medicine ever be Practical Again?
By HANS DUVEFELT When I first lost power and then saw my generator fail during a storm last winter, two other failures struck. As I […]
The Art and Soul of Medicine Exist in the Ordinary
By HANS DUVEFELT The Art of Medicine is Doing the Ordinary Well Primary care doctors don’t usually operate any sophisticated medical instruments or perform any […]
The Science of Clinical Intuition
By HANS DUVEFELT In 2002, Dr. Trisha Greenhalgh published a piece in the British Journal of General Practice titled Intuition and Evidence – Uneasy Bedfellows? In it […]
Why I Seldom Recommend Vitamins or Supplements
By HANS DUVEFELT People here in northern Maine, as in my native Sweden, don’t get a whole lot of natural sunlight a good part of […]
CareAlign, fixing that physician workflow–demo & interview
By MATTHEW HOLT I recently interviewed Subha Airan-Javia, the CEO of CareAlign. CareAlign is a small company that is working to fix the clinician workflow […]
Did Covid and Telemedicine Finally Make the Physical Exam Obsolete?
By HANS DUVEFELT Left to my own devices, I would be selective about when and how much of a physical exam I do: either not […]
Why “Radiopharmaceutical” Should be Part of your Healthcare Vocabulary
By JAY T. RIPTON Not to sound too alarmist, but the radiopharmaceutical industry is on the verge of an explosion. But don’t worry; it’s not […]
The Art of Medicine is Not an Algorithm
By HANS DUVEFELT The Art of Medicine is such a common phrase because, for many centuries, medicine has not been a cookie cutter activity. It […]
Voicemail, Repeat Requests and Multitasking: Inefficiencies in Today’s Healthcare
By HANS DUVEFELT My nurse regularly gets at least 50 voicemails every day, many saying “please call me back”. I have one patient who frequently […]
Off Our Chests: No Secrets Left Behind
By CHADI NABHAN She was a successful corporate lawyer turned professional volunteer and a housewife. He was a charismatic, successful, and world-renowned researcher in gastrointestinal […]
What Does Your Patient Need to Hear You Say Right Now?
By HANS DUVEFELT Today a patient told me a cancer doctor had told her husband that he only had a year to live. She was […]
“Tell Me More”
By HANS DUVEFELT Words can be misleading. Medical terms work really well when shared between clinicians. But we can’t assume our patients speak the same […]
Five Weight Loss Myths I am Constantly Fighting
By HANS DUVEFELT 1) EXERCISE MORE I talk to people almost every day who think they can lose weight by exercising. I tell them that […]
Screening for Depression: Then What?
By HANS DUVEFELT Primary Care is now mandated to screen for depression, among a growing host of other conditions. That makes intuitive sense to a […]
Please Sign Below: Fraudsters Phishing for Physician Signatures
By HANS DUVEFELT Almost every day I catch a suspicious fax needing my signature. Often it is an out of state vendor who wants my […]
The Parallel Realities of Health Care: Ratio and Intellectus
By HANS DUVEFELT Every patient is unique, with some common basic and measurable features and parameters. For a couple of decades now, healthcare has professed […]
The Pain Is In Your Brain: Your Knees Know Next to Nothing
By HANS DUVEFELT A “frozen shoulder” can be manipulated to move freely again under general anesthesia. The medications we use to put patients to sleep […]
Doxepin, a Little Known Super Drug in My Personal Black Bag of Tricks
By HANS DUVEFELT A while back I was able to completely stop my mastocytosis patient’s chronic hives, which the allergist had been unable to control. I […]
The Art of the Chart: Documenting the Timeline
By HANS DUVEFELT The timeline of a patient’s symptoms is often crucial in making a correct diagnosis. Similarly, the timeline of our own clinical decisions […]
Playing Poker With the Devil: “Prior Authorizations” are Paralyzing Patients and Burning out Providers
By HANS DUVEFELT The faxes keep coming in, sometimes several at a time. “Your (Medicare) patient has received a temporary supply, but the drug you prescribed […]
“I Don’t Do Windows” Says the Maid. “I Don’t Do Machines” Says this Doctor – “But I Do Nudge Therapy”
By HANS DUVEFELT The hackneyed windows phrase, about what a domestic employee will and will not do for an employer, represents a concept that applies […]
The Art of Clinical Decision Making: Friday Afternoon Dilemmas
By HANS DUVEFELT The woman had a bleeding ulcer and required a blood transfusion. The hospital discharge summary said to see me in three days […]
The Art of Asking: What Else is Going on?
By HANS DUVEFELT Walter Brown’s blood sugars were out of control. Ellen Meek had put on 15 lbs. Diane Meserve’s blood pressure was suddenly 30 […]
The Art of Listening: When the Inner Voice Whispers
By HANS DUVEFELT “I worry, so you don’t have to”, is how I explain to patients when something about their story or physical exam makes […]
Kelsey Mellard, CEO Sitka
By MATTHEW HOLT Kelsey Mellard is CEO of Sitka, one of the emerging companies that’s providing specialty consults online to primary care docs. They’ve been […]
The Paradigm Shift That Wasn’t: The ISCHEMIA Trial
By ANISH KOKA A recent email that arrived in my in-box a few weeks ago from an academic hailed the latest “paradigm shift” in cardiology […]
Driverless Cars or Keyboardless EMRs? Which Do We Need Most?
By HANS DUVEFELT I love cars and dislike computers. My car takes me where I need to go, but it also gives me pleasure along […]
1896 – The Birth of Radiology
By SAURABH JHA and JEANNE ELKIN Mr. Smith’s pneumonia was clinically shy. He didn’t have a fever. His white blood cells hadn’t increased. The only […]
Quality in Healthcare: Cultural Competence, Diagnostic Accuracy or Patronizing Insensitivity?
By HANS DUVEFELT I sometimes tell patients “I work for the government”, but sometimes I say the opposite, “I work for you”. Herein lies a […]
3 Patient Lessons: What Cancer Patients Teach Me
By YASMIN ASVAT An estimated 1.8 million people in this country may face a cancer diagnosis this year, in what has already been a bleak year of […]
A Christmas Message to All Physicians From a Swedish-American Country Doctor in Maine
By HANS DUVEFELT, MD Growing up in Sweden without a Thanksgiving holiday, Christmas has been a time for me to reflect on where I am […]
Two Surgeons—a Veteran and a Newcomer—Talk Fighting COVID Burnout
By MICHAEL E. LIPKIN and RUSSELL S. TERRY, JR. Burnout has always been a concern in medicine, and that concern has been amplified by the […]
The Year When Everything Changed: Covid, Self Care and High Tech Innovation In Medicine
By HANS DUVEFELT Life as we knew it and medicine as we had viewed it shapeshifted so dramatically in the past year that it is […]
CRAZY AMERICA: Health Insurance Covers Testing When You Are Well But Not When You Are Sick
By HANS DUVEFELT Insurance is the wrong word for what we have here. Our private health insurance system’s prioritization of sometimes frivolous screenings but non-coverage for […]
Stewardship: We Worry More About the Environment than Our Own Bodies
By HANS DUVEFELT Sooner, rather than later, we will be driving electric cars because of the environment. We use energy efficient light bulbs and recyclable […]
The Art of Listening: Beyond the Chief Complaint
By HANS DUVEFELT A doctor’s schedule as typical EMR templates see it only has “Visit Types”: New Patient, 15 minute, 30 minute. But as clinicians […]
Health Professionals Are Tomorrow’s Health Journalists. Here is a Code of Ethics to Guide Us and Trump’s White House Doctor.
By MIKE MAGEE The patient/health-professional relationship is fundamentally grounded in science and trust, and involves the exchange of compassion, understanding and partnership. The Covid-19 pandemic […]
Health Professionals Are Tomorrow’s Health Journalists. Here is a Code of Ethics to Guide Us and Trump’s White House Doctor.
By MIKE MAGEE The patient/health-professional relationship is fundamentally grounded in science and trust, and involves the exchange of compassion, understanding and partnership. The Covid-19 pandemic […]
How Can Patients Get Medical Records from a Closed Medical Practice?
By GRACE CORDOVANO, DEVEN McGRAW, and AARON MIRI The HIPAA Privacy Rule gives patients the right to copies of their medical records, with rare exceptions. […]
Physicians’ Communication Skills are Overlooked and Undervalued
By HANS DUVEFELT Interviewing celebrities can make you a celebrity yourself, and it can make you very rich. So there’s got to be something to […]
Talking Politics in the Exam Room: A Physician’s Obligation to Discuss the Political Ramifications of Science with Patients
By HAYWARD ZWERLING I walked into my exam room to see a patient I first met two decades ago. On presentation, his co-morbidities included poorly […]
Meaningful U’s
By HANS DUVEFELT Meaningful Use was a vision for EMRs that in many ways turned out to be a joke. Consider my list of Meaningful […]
I Cured My Patient, But What Was His Diagnosis?
By HANS DUVEFELT He cancelled his followup appointment because he was feeling fine. He didn’t see the point in wasting a Saturday to come to […]
Why is a 1980 Drill in my 2020 Brain?
By SHVETALI THATTE Late one evening, a trauma patient, a mother of three, comes through on an ambulance. She’s having trouble breathing, despite the breathing […]
Post Covid Healthcare is Becoming Like Buying from Amazon Instead of Going to the Mall or Reading an eBook Instead of a Paperback
By HANS DUVEFELT, MD Now that we are seeing patients via telemedicine or even getting reimbursed for handling their issues over the phone, our existing […]
Medical Education Must Adapt to Support the Broadening Role of Physicians
By SYLVIE STACY, MD, MPH As a physician and writer on the topic medical careers, I’ve noticed extensive interest in nonclinical career options for physicians. […]
Everyone has a role to play: Reducing your child’s risk of developing food allergies
By RUCHI GUPTA, MD, MPH The average American elementary school class includes two students living with one or multiple food allergies. That’s nearly six million […]
Equipoise and Its Problems
By MICHEL ACCAD, MD I recently participated in a debate opposing me to Professor Adam Cifu on the topic of “Evidence-based medicine in the age of […]
“When Blood Breaks Down”: It Can Break Your Heart
By CHADI NABHAN, MD, MBA, FACP “The goal for me and for my clinical and research colleagues is to put ourselves out of a job […]
