“Stop Calling Us Mid-Levels,” Cry the NPs
Nursing is an honorable profession, neither superior nor inferior to medicine, but distinct from it. I learned this from nurses! Then last night I saw a commercial on TV for “Nurse Practitioners,” who are:
…leading the charge and growing the nation’s access to patient-centered, accessible, high-quality health care.
They’ve also got a chip on their collective shoulder over the term “Mid-level” provider. Can’t call them “Physician extenders” or “non-physicians” either. Fine. I’ll just call them “arrogant doctor-wannabes”. I was just bei...
Source: Musings of a Dinosaur - October 20, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Musical Insurances
For the moment, I still take almost all insurances in my practice. And as long as I see enough patients (ie as long as the phone rings) I’m doing okay. I’ve been billing electronically with a free clearinghouse for about five years now, and things are pretty good. (Give it another week to make sure I’m still getting paid using ICD-10 codes, though.)
Over all these years, I’ve only dropped one insurance. It covered a fair number of patients, including many of my favorites. It paid terribly, though I’ve recently realized that there’s another plan that pays even less. So why did I drop tha...
Source: Musings of a Dinosaur - October 19, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Few are Submitting for Medicare Chronic Care Management Payments; Gee, I Wonder Why?
Who’d a thunk it? Doctors leaving money on the table? Not billing for services we apparently are already providing? Surely not us greedy doctors.
But yes:
The CMS says doctors tending to tens of millions of chronically ill Medicare patients aren’t taking advantage of federal dollars aimed at improving care and reducing hospital readmissions and overall costs.
This year, Medicare began paying an average of $42 per patient per month for non-face-to-face chronic-care management services, such as consulting with other doctors caring for the same patient who might be dealing with dementia, heart disease or arthritis...
Source: Musings of a Dinosaur - October 14, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Where Have All the Bloggers Gone
I started blogging in 2006. That was six iPhones ago. There was no such thing as Twitter or Instagram, and although Facebook was around, it was mainly used by college kids. None of my kids had graduated from college yet. I was still in the same house I’d bought in 1985, right before graduating from medical school. I had four old cats and a paraplegic peke. It was a long time ago.
Blogging was different then as well. At the very beginning, there weren’t as many of us, though our numbers blossomed. For several years there was a fairly steady group making up what we called the Medical Blogosphere. We were pretty a...
Source: Musings of a Dinosaur - October 6, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Blogging Source Type: blogs
Questions, Answers, and Nature
Poster seen in the window of the local LL Bean store:
But the questions are still up to us.
#Science (Source: Musings of a Dinosaur)
Source: Musings of a Dinosaur - October 5, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Miscellaneous Source Type: blogs
In the Trenches: Week One of ICD-10
Welcome back, blog fans. Sorry for the prolonged radio silence, but as some of you may have heard (or not, if you don’t happen to work in the medical field) this past Thursday, October 1, 2015 marked the official switch-over to ICD-10, and to say things have been a little hectic is like saying Congress is a little contentious.
What am I talking about, you say? Diagnosis coding.
At the end of my residency, the program sent the third year residents to a two-day seminar on practice management. Knowing I was about to go out on my own, I paid close attention, and ending up being able to use a great deal of what I learne...
Source: Musings of a Dinosaur - October 3, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Challah for Two (Show Your Work)
First of all, Happy New Year (Jewish, that is; Rosh Hashanah) or L’Shana Tova everyone.
Empty nesthood is nice. One little issue, though, is that after years of scaling up recipes to feed a horde of growing baby dinosaurs, now that there’s just two of us — who are both trying to watch our weight, with varying degrees of success — it’s time to start scaling things down. DSS decided that he wanted to make a special dinner for tonight, the eve (or Erev) of the New Year. He’s using a cobbled-together recipe for a savory kugel, to which I suggested adding chunks of chicken, making it a true o...
Source: Musings of a Dinosaur - September 13, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Food Source Type: blogs
Caution: Groaner Ahead
Why doesn’t alternative medicine work very well for vaginitis?
Because:
Yeast is yeast,
and est is est
And never the two shall meet. (Source: Musings of a Dinosaur)
Source: Musings of a Dinosaur - September 5, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Finding Doctor Right
Proudly Co-Authored with the NinjaBaker, Cross-posted at his group blog, Science ACEs
FINDING DR. RIGHT
Finding the right primary care physician for you and your family is a lot like dating. You can swipe right at the first doctor who takes your insurance, then find out he’s a complete jerk when you meet him. Maybe you’ve looked at his medical profile in great detail, then you go for your first check-up and just don’t feel that spark. That’s fine. It’s okay to be picky, and to keep looking for the right person who will take you as their patient, to have and to hold, for better or worse, in sickness and in health,...
Source: Musings of a Dinosaur - August 20, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
How Dare the FDA Approve Pain Relief for Kids
How dare they!
This senator is disgusted — DISGUSTED — with the FDA’s recent decision to approve the long-acting opiate pain medication OxyContin for children as young as 11.
“An 11 year old’s brain has another 14 years before it is fully developed. We have years of evidence that shows that drug use at an early age makes a child more likely to abuse drugs later in life,” he said in his letter to the FDA. “You have ignored all of this. Instead, under your new guidance, we are literally poisoning our children’s brains and setting them up for future drug abuse.”
Excuse me, Senator, but this kind ...
Source: Musings of a Dinosaur - August 18, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Building a Clavichord – 6 & 7
I’ve been so busy building, I haven’t gotten around to writing. Or doing anything else.
The listing cloth, a long ribbon of red felt, has been woven between the strings:
It pulls together the pairs of strings struck by each tangent, and it stops the string from vibrating once the key is released.
I managed to “chip” it to tune; ie pull it very roughly into something vaguely resembling “in tune.” But I still have to set the temperament and do the actual first tuning.
In the meantime, I went ahead and finished the stand:
It’s also made of cherry, finished the same way the case is (...
Source: Musings of a Dinosaur - August 17, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Miscellaneous Source Type: blogs
Building a Clavichord – 5
The case has been finished, as have the keys, including gluing on the sharps:
If you look carefully, you can see that I’ve already started installing the strings. Just two so far in this picture, but I’ve been working on it. (Obviously, instead of writing.) I’m also putting the tangents in as I go. They’re the little brass wedges that actually strike the strings.
I’ve made the executive decision to omit the “roof carvings.” The keys are supposed to be carved to a sharp point between the two bends, or knuckles. If you look at the two lowest keys, you can see where I tried my best....
Source: Musings of a Dinosaur - July 20, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Miscellaneous Source Type: blogs
Building a Clavichord – 4
The lid is on. So is the fallboard, though it wasn’t at the time of the picture:
Don’t worry: the lid is straight. It’s the optical illusion of photographing it against the full scale drawing with so many parallel diagonal lines.
Immediately after this, I was instructed to remove the screw eyes for the lid cord and the lid hinges, and put them all back in their envelopes. I get to put them back on at the very end when everything else is done, but between now and then they’ll just get in the way.
Next up: finishing the case. (Source: Musings of a Dinosaur)
Source: Musings of a Dinosaur - July 9, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Miscellaneous Source Type: blogs
Mammography Doesn’t Save Lives
Preventive care doesn’t save money and now it turns out mammograms don’t even save lives.
After sitting through a presentation by a general surgeon about treatment of small breast cancers (the vast majority of his patients do great), I was stunned to hear him opine, “Every woman needs a mammogram every year starting at age 40.” Really. That’s what he said.
I’ve had my doubts. I’ve diagnosed women with breast cancers less than a year after their last mammogram because the tumors grew so damn quickly. Mammography didn’t save them.
Now we have new research (linked above) loo...
Source: Musings of a Dinosaur - July 7, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Building a Clavichord – 3
Part way through “Finishing the Case”:
Sound board now built and installed, surrounded by its tiny cute little moldings. Holes drilled for tuning pins (on the right), marked for the hitchpins (on the left and back.) Next steps include dressing the sound board with two thin coats of shellac, drilling for the hitchpins, and adding moldings to the outside bottom edges. Can’t even think about getting started on the action (the keys) until after the lid and fallboard (the little section that will cover the front of the keys when its closed) are done.
Long way to go. But it is looking pretty. (Source: Musings of a Dinosaur)
Source: Musings of a Dinosaur - June 27, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Miscellaneous Source Type: blogs
