Disqus - Latest Comments for MKirschMD

Re: Why this physician will no longer see nursing home patients

MKirschMD — Sat, 29 Jun 2019 09:03:33 -0000

Peter, thanks for your reply. I have never rec'd an advance communication from a PCP regarding a nursing home patient sent to my office for a consultation. You may surmise your own explanation to this lapse. All the best, MK

Re: Do opioid contracts harm the doctor-patient relationship?

MKirschMD — Thu, 11 Oct 2018 07:16:02 -0000

I realize it may not be practical, as there are not sufficient pain specialists, but if primary care physicians didn't prescribe opiates, would this be a favorable development? In a perfect world, which is not our world, if these medicines were exclusively managed by pain specialists - expert in their use and abuse - I believe many challenges would be solved. In my GI practice, for example, my patients are aware that I do not prescribe opioids, and time after time I am reminded of the wisdom of this policy, at least for me. Other physicians, of course, may have a different view and policy.

Re: Will artificial intelligence ever replace doctors?

MKirschMD — Tue, 25 Sep 2018 07:08:13 -0000

Seems an anti-technology consensus on thread! It is inevitable. It will make our forced acceptance of EMR seem like a speed bump.

Re: Restricting opioid prescribing: Some error has to be tolerated

MKirschMD — Thu, 28 Jun 2018 17:27:32 -0000

It would not be my first choice for the government to be spearheading a solution. This is why I object to a medical marijuana law passed in Ohio where LEGISLATORS have decided which medical conditions are eligible for this treatment. Of course, this is ridiculous. However, the stakes from the opioid crisis are enormous and the medical profession has not reacted to it sufficiently. Hence, the government stepped in as it should, in my view.

Re: Solving the problem of non-emergent care in the emergency department

MKirschMD — Tue, 27 Mar 2018 07:23:34 -0000

I follow your point, Eric, but do we agree that ideally a pt with a cough should receive an equivalent evaluation in the office or the ER? I don't accept that the ER 'can't miss anything' as an argument for more care. Can the primary physician in the office 'miss anything'? Why should the ER feel they need to use a wider diagnostic net, which leads to false + results and incidental findings which are so vexing? As long as the care and documentation are appropriate, and reasonable follow-up is advised, then I think we have met our obligation.

Re: Solving the problem of non-emergent care in the emergency department

MKirschMD — Mon, 26 Mar 2018 18:13:54 -0000

As I stated in my piece, I think that ideally the intensity of evaluation for a cough should be the same regardless of the venue. I'm not persuaded that more eval needed for an ER visit.

Re: Solving the problem of non-emergent care in the emergency department

MKirschMD — Mon, 26 Mar 2018 18:10:48 -0000

Steve, thanks for the reply. I am not, as you suggest deciding 'which level of care requires attention'. I am suggesting that insurance companies have a legitimate interest in not underwriting inappropriate ER care. I don't think that your deductible idea addresses this, particularly once the deductible has been met. MK

Re: Is autonomy really better for patients?

MKirschMD — Sat, 16 Dec 2017 16:17:32 -0000

Interesting comments all. A point of my piece was to inquire if the shared decision model produces superior medical outcomes compared with the prior paternalistic model. Is the era of patient autonomy delivering improved medical outcomes or merely changing the medical experience for all of us?

Re: When EMRs crash: It’s time to push back

MKirschMD — Mon, 04 Dec 2017 08:46:38 -0000

I am self-employed so sending patients home has different consequences for me and my practice.

Re: Why can’t we control outrageous health care costs?

MKirschMD — Thu, 15 Dec 2016 07:48:35 -0000

Feel free to peruse my blog where you will find numerous examples where I target my specialty of gastroenterology and myself. MK

Re: This doctor is against medical marijuana. Here’s why.

MKirschMD — Tue, 27 Sep 2016 08:28:59 -0000

@Chim Richards: You nailed it!

Re: When should physicians lie for patients?

MKirschMD — Sat, 20 Aug 2016 11:14:50 -0000

Appreciate all comments. Despite my fidelity to my personal integrity, I must confess that we do not live in an ideal world. No one is pure, certainly not me. I don't lie or knowingly become a pawn in a patient's scheme, but there are times when one must step over a line if the intent is to function in the real world. We've all seen the absurdities that result from various 'zero tolerance' policies. Sure, we're honest, but there needs to be some measure of give in the system. When we tell our mom that her meatloaf was great, when it wasn't, was this the right thing to do?

Re: Watch out for sleight of hand in deceptive medical statistics

MKirschMD — Tue, 14 Jun 2016 13:06:40 -0000

I hope it gets 'picked up' also. Thanks for your kind comments. You may wish to visit my MD Whistlebower blog for similar content. Numbers don't lie, but they sure can deceive.

Re: Don’t make waiting for the doctor a stress test

MKirschMD — Mon, 08 Jun 2015 12:27:12 -0000

I disagree with my southern colleague. I do feel that reimbursement incentives influences physician behavior. Indeed this is the strategy behind the pay-for-performance schemes, which will be mandatory. While our behaviors will adapt to conform to these incentives, I do not believe this will bring true qualitative benefits to our patients. It will be yet another victory for the box checkers.

Re: Why your doctor won’t refill prescriptions over the phone

MKirschMD — Tue, 14 Oct 2014 22:04:08 -0000

@goonerdoc, well said!

Re: Complications are a reality of medical life

MKirschMD — Sun, 28 Sep 2014 21:34:56 -0000

" A baseball player may make an error 1 in 100 chances, but that one time is still an error within his control. " Of course, this is true. What if 90 of those 100 plays were initially called 'Errors', when only 1 play was a true error? Is it fair and reasonable for the player to have to defend himself against all of the false Error designations? The difference between malpractice and a complication should be clear from my post. The former is a negligent act. The latter is a blameless event. I realize these terms are easily confused. If an adverse event occurs, and the physician was practicing according to acceptable standards, then this would be classified as a complication.

Re: Drug testing doctors: Will Californians see through the smoke?

MKirschMD — Sun, 17 Aug 2014 19:18:07 -0000

Exactly!

Re: Why the ER admits too many patients

MKirschMD — Mon, 09 Jun 2014 07:56:36 -0000

I have read the comments to my post on this blog and elsewhere. Regrettably, some have resorted to vituperative language and demonization, rather than to engage in civil discourse and debate. If I have made factual errors regarding the reimbursement of ED physicians, then I am prepared to stand down from these comments. The fact that one commenter above who was particularly critical of me wrote, “the hospital loves it when I order tests”, suggests that there do exist economic incentives. I am not prepared to retreat, however, from my belief that over-diagnosis and over-treatment are embedded in American medical culture. This is an undeniable fact. If some commenters wish to opine that their specialty is somehow not part of this reality, then they are free to do so. I think they have a tough case, but they are free to make it. Regarding my own specialty, I have written more than once under my own name, and expressed elsewhere, that my specialty and me personally are part of the problem. A fair minded reader of my own blog would already know this.

To write and circulate throughout the internet that I am an ‘ER basher’ may have some red meat appeal, but it is false and defamatory. I write in my post that “If I were an ER physician I would behave similarly facing the same pressures that they do”. I continue for several sentences offering a sympathetic view of emergency medicine physicians. Not quite my definition of a ‘basher’.

Regarding my NY colleague’s assertion that gastroenterologists are not qualified to evaluate acute abdominal pain, I believe that the other physician readers will agree that this claim has no basis. In my experience, we are the specialists who are first responders to acute abdominal pain.

Responding to the claim that emergency room physicians do not admit patients, this needs some context. While ED doctors may not sign the admission order, they have often advised patients and later the admitting doctors that the patient needs admission. How many times have emergency physicians called primary care physicians or consultants telling us, “this guy needs to come in”? This is a proper exercise of their role, in my view. It is somewhat disingenuous to claim that “Emergency physicians don’t admit patients”, which may be only technically true.

Finally, personal attacks only demean the attacker and provide little opportunity for a dialogue that could offer all participants the chance for a civil airing of divergent views. We can do better than this and we should.

Re: Why an elite academic medical center may not provide the best care

MKirschMD — Wed, 07 May 2014 11:57:46 -0000

Nice post, Val. Those of us who practice in the shadows of these Ivory Towers can relate to your views. Wonder what you have been up to since Better Health days.

Re: Save mammography or save women? Supporters face a quandary.

MKirschMD — Sun, 02 Mar 2014 15:01:55 -0000

I'm glad you're ok. My point is that folks who undergo a screening test should be informed of the proven benefits and the potential drawbacks. In my experience, the benefits of many screening tests, including mammography, are exaggerated while the risks are diminished. Can't give informed consent if you are not truly informed.

Re: Save mammography or save women? Supporters face a quandary.

MKirschMD — Tue, 25 Feb 2014 21:41:37 -0000

Appreciate it, Shirie. Not only is there a fair amount of zealotry out there on this issue, but there are also huge economic forces that are in play here.

Re: Should this Jehovah’s Witness be transfused?

MKirschMD — Wed, 05 Feb 2014 20:38:35 -0000

Excellent comments. I do not think that a child who is not of sufficient maturity to comprehend the depth of the issue should be forced by parents or anyone to forego a treatment that is highly likely to save his life. In my view, the state's right to preserve life of one who cannot competently provide informed refusal trumps the parents' right of religious freedom. I invoke this principle when the stakes are high, not for routine medical matters.

Re: When patients are late: Should doctors charge extra?

MKirschMD — Wed, 29 Jan 2014 15:24:23 -0000

When being on time becomes one of the pay-for-performance 'quality' metrics, this may improve physician punctuality. We institute a fee for no shows recently, but it remains to be seen if this will change behavior. As stated, we're not interested in the fee; we want timely cancellations. Excellent comments all.

Re: Should Conrad Murray be allowed to practice medicine again?

MKirschMD — Sat, 02 Nov 2013 16:21:31 -0000

I think it will be challenging, even in California, to find examples of MDs who have done worse and yet retained their licenses or had them restored.

Re: A gastroenterologist dishes on unnecessary colonoscopies

MKirschMD — Wed, 11 Sep 2013 22:05:56 -0000

Theft is theft regardless of the value of the purloined item.