http://disqus.com/by/ColoradoBob/enSat, 17 May 2014 23:33:21 -0000(u'http://www.jaapa.com/hospice-and-palliative-care-the-time-to-get-involved-is-now/article/193548/',%20131810761L)#comment-131810761<p>Well written article, thanks. Getting into the profession myself because I knew I could provide better emotional support for patients than I had received as the father of a dying child, it struck home. My son died in part from medical neglect in 1979, and I graduated as a PA in 1984. 27 years playing the game have taught me a few tricks.</p><p>As a practitioner, it has often helped to, (as Taco Bell says) think outside of the bun. When I owned a practice, and provided care, it was frequently denied by insurance companies on first submission. Other than being cynical, (maybe they just deny ALL first submissions and know that 25% won't bother to re-submit) I got creative on the denial forms, and thanked them for allowing me to review the claim. With a well documented case it is always easy to upgrade the charges to a higher legal level, given the fact that we frequently underbill, and the second submission included the additional charges. Thorough documentation for E&amp;M was the key here, and EMR software helped greatly.</p><p>So if a patient lives somewhere and receives hospice, they are most likely housebound. They are thus "at home" by definition, so make a housecall to check their diabetic feet, or blood pressure, dressing change, or inspect an IV site or do a followup on abdominal pain. Make something up for the "reason" for the visit that non outside the bun thinkers will understand. Do not bill for "hospice" care. While you are there, and of course after checking the problem billed for, you have the opportunity to interact with them in the ways described in your article. Every hospice patient has other problems, and even though treating those problems is not going to improve or change the outcome, you can address physically, document them on paper, submit the claim for care, and also provide REAL caring.</p><p></p>Robert FinlayThu, 20 Jan 2011 09:48:04 -0000(u'http://www.jaapa.com/the-jobless-physician-assistant/article/179943/',%20131815084L)#comment-131815084<p>One advantage of those gray hairs is that it is unlikely you have small children at home who need you to stay "within 50 miles" of home. There are many many jobs that can be for 4-12 weeks as you wish that pay very well and allow you to travel to a beautiful place, meet the people there, provide care, then go home. Alaska. (Besides you get to work where everybody is immediately jealous of your being to go to a place few will ever see.)</p><p>The licensing procedure is bearable (just) and once you have been licensed and approved for "remote" practice, the jobs abound. I've worked here for 10 years now, commuting from "the lower 48" and am able to make the same income in 4 months of locums that would take a year in the real world of lower 48 corporate medicine. There is a freedom here too, to provide TIME with your patients, since the clinics are seldom busy. 6-10 patients a day is a busy day. Email me for more info if interested.</p><p>Regards<br>Robert Finlay PA-C<br>Alaska Locums</p>Robert FinlayThu, 20 Jan 2011 09:59:31 -0000(u'http://www.clinicaladvisor.com/partial-limb-amputation-causes-suit/article/198277/',%20166897435L)#comment-166897435<p>This story is so typical of the types of blame that patients seek to place on medical people. The time for tort reform is now, and all costs of defense against such B.S. claims should in turn be borne by the plaintiff when they lose in such a case. Personal responsibility needs to return and sanity needs to prevail, as it did in this case. It is also time for a NATIONAL PATIENT Database ( Think National Practitioner Data Base) to log patients who have sued practitioners. This could be consulted by practitioners before accepting a patient.</p>Robert FinlayWed, 16 Mar 2011 18:52:21 -0000(u'http://www.clinicaladvisor.com/signs-clearly-show-cardiac-concern/article/200467/',%20188272828L)#comment-188272828<p>Again we are forced to "Nanny" the patients who disregard referrals and it is up to practitioners to become the patient police.</p><p>We need to stop these kinds of verdicts and following the advice of the article makes the most sense. No I will not follow up whether or not you got YOUR test, but I will defer signing off the sports physical to the Cardiology expert. YOU came to ME for this service, and I cannot provide it. Sorry, pay on your way out. If getting YOUR paperwork is important to you, YOU must get the referral or find another less cautious person to sign it off or perhaps scribble a signature on the form yourself and hope you live another day.</p>Robert FinlayWed, 20 Apr 2011 12:08:09 -0000(u'http://www.clinicaladvisor.com/derm-dx-flat-topped-slightly-violaceous-papules/slideshow/666/',%20468001955L)#comment-468001955<p>5p's  good tip</p>Robert FinlaySat, 17 Mar 2012 18:22:29 -0000(u'http://www.clinicaladvisor.com/derm-dx-unilateral-pink-rash-on-the-left-side/slideshow/695/',%20497865417L)#comment-497865417<p>The diagnosis sounds more like a descriptor than a disease. I got itwrong, picked 1</p>Robert FinlaySat, 14 Apr 2012 20:21:43 -0000(u'http://www.clinicaladvisor.com/derm-dx-itchy-purplish-papules-between-the-shoulders/slideshow/704/',%20505930211L)#comment-505930211<p>I thought AN also...</p>Robert FinlaySun, 22 Apr 2012 00:15:38 -0000(u'http://www.clinicaladvisor.com/homeopathic-advice/article/342179/',%201331904975L)#comment-1331904975<p>As a Science based medical practitioner, my main approach to "Homeopathy" is this:</p><p>It is BULLSHIT pure and simple, and I educate patients that it is QUACKERY, and a WASTE of their hard earned and possibly scarce medical dollars. One of the advantages of being old is that my tolerance for Bullshit is WAY down, and I do not pull punches. If someone believes in homeopathy, I remind them that belief is a religious realm, not a scientific one.</p><p>Reiki is another area of medical Quackery, which has the primary aim of separating people from their money.</p><p>Researching Homeopathy? Look at <a href="http://www.quackwatch.com" rel="nofollow noopener" target="_blank" title="http://www.quackwatch.com">http://www.quackwatch.com</a></p>Robert FinlayFri, 11 Apr 2014 11:01:06 -0000(u'http://www.clinicaladvisor.com/homeopathic-advice/article/342179/',%201333436246L)#comment-1333436246<p>Harsh Response? Bullshit is Bullshit. Label it differently, it still smells. If there was any truth to homeopathetic claims then ALL water on earth would be so contaminated with "treatment" that it would be impossible to come up with a pure "homeopathetic" treatment.</p><p>Common usage of "remedies" does not grant them any immunity from criticism.</p><p>Female Genital Mutilation is "common" in third world countries too. Do you refer patients to "practitioners" willing to continue the abuse?</p><p>By the way, I am "Familiar" with homeopathy. I have studied it with skeptical eye, and found it lacking entirely. James Randi frequently exposes it too, along with other nonsense, quackery, and belief based nonsense.</p><p>If a patient asks me about HOMEOPATHETIC treatment, I tell it plain and simple, and do not sugar coat or put lipstick on the pig.</p><p>How much more "Serious" an answer can you give someone than to tell them that the treatment is PURE UNADULTERATED NONSENSE, and not to waste their time, money, or hopes on it.</p>Robert FinlaySat, 12 Apr 2014 11:51:36 -0000(u'http://www.clinicaladvisor.com/derm-dx-white-patch-of-skin-since-infanthood/slideshow/1949/',%201391473779L)#comment-1391473779<p>I was thinking Tinea Versicolor</p>Robert FinlaySat, 17 May 2014 23:33:21 -0000