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Thursday, November 1, 2018

Bronchopneumonia: Symptoms, causes, and treatment

Get your protective pneumococcal vaccinations. There are two pneumococcal vaccinations for adults--Prevnar 13 and Pneumovax 23. A good time to get it is when you get your flu shot this season. Ask for it.
from Rajesh Harrykissoon, MD

Friday, October 26, 2018

Does cold weather make you sick: What's the link?

A number of different respiratory viruses travel together during the colder months, October-April. Some manifest flu-like symptoms, but unlike for the influenza virus, we have no vaccinations for these other respiratory viruses. Indeed, many instances of "getting the flu after getting the flu shot" is probably due to one of these other viruses. After the first holiday contacts (Halloween and Thanksgiving) where contagion is spread by increased person-to-person exposures, viral spread typically goes rampant. Between October-April, keep those hands clean, avoid hand-to-face contact, and get the flu shot before Thanksgiving.
from Rajesh Harrykissoon, MD

Wednesday, October 17, 2018

COPD and age: Onset, life expectancy, and more

Listen doc, I don't have COPD. I've been smoking for 30 years without any problems and now you're telling me I suddenly have COPD? I'm skeptical. This is not an uncommon position of many current or former tobacco smokers presenting with shortness of breath and being newly diagnosed with COPD. The reason it takes is a long time to become symptomatic from progressive loss of lung function is because we are gifted with excessive lung capacity. In essence, we are born with one extra lung. So, to develop symptoms like shortness of breath with minimal activity or at rest, we need to lose the equivalent of one whole lung or a bit more. That loss occurs over the years of smoking and at some point that smoker hits the tipping point and symptoms manifest. To preserve your quality of life, quit smoking before you become symptomatic.
from Rajesh Harrykissoon, MD

Monday, October 15, 2018

Here's what is not covered by Medicare and here’s how you can prepare

Medicare open enrollment: October 15 - December 7, 2018. Here’s what you need to consider:
from Rajesh Harrykissoon, MD

Saturday, October 13, 2018

Prior Authorizations: Who is Responsible for the Death of a Patient when Insurers Practice Medicine?

This tragic story is an example of the co-fiduciary obligation alluded to in my post on September 28, 2018. I spent hours and hours over the past two weeks trying to get a prior authorization on behalf of a patient. I couldn't even speak to the same medical director twice because this particular insurance company had a different medical director assigned by day of the week and each medical director was not even in the same state, much less the same office, and they were general practitioners, not specialists in the matter to be discussed. One even stated she did not review the case and did not have the computer open in front of her because she was walking briskly down the sidewalk to an afternoon meeting. After each unresolved contact, the insurer would close the case so when I called back I had to request the case to be reopened and start anew. The sad part is that this is not atypical when dealing with health insurers. This can't be patient-centered or patient-responsive care... 😔
from Rajesh Harrykissoon, MD

Thursday, October 4, 2018

Chronic laryngitis: Symptoms, causes, and treatment

A good read for those suffering from chronic laryngitis.
from Rajesh Harrykissoon, MD

Friday, September 28, 2018

Hospital Chain Will Pay Over $260 Million to Resolve False Billing and Kickback Allegations; One Subsidiary Agrees to Plead Guilty

“It is critically important to all of us that the patients’ interest drive the physicians’ decisions on care,” said U.S. Attorney Lydon. This is a lofty statement, but it is not entirely true for healthcare in America. Rather, three parties exercise co-fiduciary obligations to the patients. Those co-fiduciary parties are: 1) The health insurer 2) The healthcare organization 3) The physician For instance, your physician may refer you to the best orthopedic surgeon in the area, one with excellent outcomes and quality records relative to her peers, yet, your health insurer may state that surgeon is out-of-network. Your copayment to use that surgeon may be prohibitive, so you utilize another surgeon who is in-network but has lesser clinical outcomes. An additional example: you may come to the ER with meningitis and need an urgent lumbar puncture to diagnose a severe brain infection, but the hospital did not maintain inventory on the relevant procedural kit. A fiduciary is someone who is entrusted to provide you with advice deemed in your best interest. Whether you take that advice or not is your decision. For instance, as a fiduciary, your financial adviser may advise you not to spend every monthly paycheck at the casinos. If you, nevertheless, hit the casinos frequently and don't meet your other financial obligations in life, that fiduciary has done her job of providing you advise she judged was in your best interest. The days of your physician being a wild west gunslinger who is the sole effector of all that is good and best for your care has been a bygone era for 35 years now and counting. Co-fiduciaries have to work collaboratively to effect such care. The first step is to acknowledge this relationship exists, then we can have a meaningful conversation on how to better serve you the patient. While the above commentary is not the major subject matter of the posted article, I thought I would call out this element contained in that news release. Another element worthy of discussion is that of "inducement of physician referrals." Do you know when the US government itself engaged in the largest ever inducement of physician referrals?
from Rajesh Harrykissoon, MD