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Hospitalized Woman with New Complaint Everyday Diagnosed with Broken Furnace Syndrome.
Fargo, ND - Bertha Jensen was hospitalized two weeks ago for chest pain rule out, but a new complaint every day has prevented doctors from sending her home during the cold winter months.  That is, until a breakthrough in discharge planning was discovered by her current Hospitalist. Consider Broken Furnace Syndrome for difficult winter discharges."When I was a resident in Minneapolis, I took care of at least a dozen cases of Broken Furnace Syndrome every winter," said Hospitalist Dr. David Penter, who is known for his uncanny ability to spot patients with ulterior motives from a mile away.Broken Furnace Syndrome is any...
Source: The Happy Hospitalist - January 7, 2015 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs

Marijuana Doctors' Lounge at Colorado Hospital is Nation's First.
Denver, CO -  Brooks Hospital holds the honor of being the first and only medical facility in the country to offer a full service marijuana physician lounge and doctors say they wouldn't have it any other way.  Shortly after Colorado legalized possession of one ounce or less of recreational marijuana, the private physician area was opened at the urging Dr. Jeffrey Potter, a Hospitalist upset with the declining diagnostic skills of his fellow colleagues.Physician smoking marijuana in doctors' lounge"I was shocked at the number of H&Ps and consult notes that had 'heart problems' or 'vision changes' as the final...
Source: The Happy Hospitalist - December 30, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs

Hospital Weights Adjusted Downward After Thanksgiving, Scoring Patient Satisfaction Win!
Memphis, TN -- A nurse at Grover Hospital struck clinical gold Monday by recalibrating hospital scales back 10 pounds, 20 pounds, 40 pounds, even 100 pounds and more - in the weekend  aftermath of Thursday's annual Thanksgiving Day bing - to try and win the third annual Most Improved Patient Satisfaction Scores Floor Contest.Customers admitted after the holiday feast will often complain to nurses they gained too much weight gorging on turkey and stuffing.  So Brian Jamison, the good looking male nurse known hospital wide for his inappropriate comments, decided to take matters into his own hand...
Source: The Happy Hospitalist - December 1, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs

Happy Veteran's Day
(Click image to enlarge) Found this picture today in my basement from around 1996 when I has a staff cardiologist/cardiac electrophysiologist at the National Naval Medical Center, Bethesda, Maryland. There were so many great folks with whom I had the pleasure and honor to work beside, yet many of whom I've lost touch with, sadly. It's fun to look back and see the the old cath lab equipment -
Source: Dr. Wes - November 11, 2014 Category: Internists and Doctors of Medicine Authors: DrWes Source Type: blogs

Top 10 List of Social Admits Defined!
What is a social admit to the hospital?   A social admission is generally accepted by healthcare professionals to be a patient with no acute medical needs that is brought into a hospital because no safe discharge arrangements could be made at the time they presented. Most social admits involve elderly patients who present to an emergency room with weakness, have a thorough negative workup and are too weak to go home but have no where else to go. They might have a non surgical fracture limiting their mobility or a family refusing to take them home. Most social admissions occur after-hours when community services are un...
Source: The Happy Hospitalist - November 9, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs

ABIM Placates Physician Anti-MOC Sentiment with "Commitments"
From the 5 Aug 2014 issue of the Journal of the American College of Cardiology (JACC): "Note: There is evidence that the ABIM has heard the concerns of its diplomats and is acting responsively. In a July 10, 2014 letter to the internal medicine community, and in a face-to-face meeting in Philadelphia on July 15, 2014, which was attended by 26 internal medicine subspecialty societies
Source: Dr. Wes - August 6, 2014 Category: Internists and Doctors of Medicine Authors: DrWes Source Type: blogs

Should Cardiologists Boycott the 2014 TCT/ACC Conference?
Yesterday, I noticed a tweet from @angioplastyorg announcing that former Secretary of State Hillary Clinton will be this year's keynote speaker at the Transcatheter Therapeutics Conference (TCT) in Washington, DC.  The TCT occurs each year in partnership with the American College of Cardiology.  Most doctors probably won't think much of this, but for many who spend 12 hours or more each day in
Source: Dr. Wes - July 28, 2014 Category: Internists and Doctors of Medicine Authors: DrWes Source Type: blogs

On the ACC's Response to ABIM’s MOC Requirements
The American College of Cardiology (ACC) recently issued a response to the American Board of Medical Specialties (ABMS) and American Board of Internal Medicine's (ABIM) recent change to their Maintenance of Certification (MOC) requirements. The ACC's response was based in part on the results of a completed member survey that was distributed through their state chapters in the spring of 2014. The
Source: Dr. Wes - June 3, 2014 Category: Internists and Doctors of Medicine Authors: DrWes Source Type: blogs

Level 2 vs. Level 3 H&P Coding Comparison.
This lecture will assist physicians and other non-physician practitioners (NPPs) determine if their initial hospital admission note documentation meets criteria for a level 2 (mid level H&P) or a level 3 (high level H&P) evaluation and management (E/M) code.  Recovery Audit Contractors will likely continue to target high level initial hospital encounters for improper payments.  Physicians and other NPPs must continue to pursue documentation education to prevent accusations of over billing and to prevent under billing for work provided.  I am an internal medicine physician with over 10 years experienc...
Source: The Happy Hospitalist - April 10, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs

New and Established Patient E/M Definitions (CMS vs. CPT®)
I get lot of requests from readers of The Happy Hospitalist asking how to know if a patient is a new or established patient.  Identifying the correct classification will prevent delays or denials of payment.  Many evaluation and management (E/M) codes are by definition described as new or established.  This lecture will attempt to explain various important clinical aspects related to this determination.  Keep in mind while the Centers For Medicare & Medicaid Services (CMS) uses  Current Procedural Terminology (CPT) codes, CMS definitions do not always agree with CPT® definitions.  This di...
Source: The Happy Hospitalist - February 27, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs

What One Cardiologist Thinks About the CVS Caremark Decision to Ban Cigarette Sales
<!--[if gte mso 9]> Normal 0 false false false MicrosoftInternetExplorer4 <![endif]-->By now the world has heard the remarkable news: that CVS Caremark will no longer be selling its tobacco products in any of its stores.  Locked and loaded with the news, the American Heart Association, American College of Cardiologists, local public health experts,
Source: Dr. Wes - February 8, 2014 Category: Internists and Doctors of Medicine Authors: DrWes Source Type: blogs

When Scientists Accept "Flawed" as "Reassuring"
A recent essay entitled "Understanding the Customer and the New MOC Changes" by David May, MD, PhD, chair of the Board of Governors and secretary of the Board of Trustees for the American Board of Cardiology, was published online and tugs at our heartstrings by describing the Maintenance of Certification (MOC) secure examination in Cardiovascular Diseases as "flawed but reassuring measure of our
Source: Dr. Wes - December 7, 2013 Category: Internists and Doctors of Medicine Authors: DrWes Source Type: blogs

What Board Recertification Is Failing to Teach Doctors
I continue to study for my third ABIM re-certifications in both cardiovascular disease and cardiac electrophysiology. In preparation for the examinations, I purchased the review materials offered by the American College of Cardiology called ACCSAP-8 and took the surprisingly expensive Cardiac Electrophysiology Board Review course held in Chicago recently. I find I have little time to study all
Source: Dr. Wes - October 8, 2013 Category: Internists and Doctors of Medicine Authors: DrWes Source Type: blogs

Guideline Apathy
With yesterday's publication of the 2013 ACCF/AHA Guidelines for the management of heart failure, the 101st guideline for cardiologists since 2005 published jointly by the ACC and American Heart Association appeared in the literature (if my count is correct).  Then again, the National Guideline Clearing House set up by our own US Government suggests there are 483 previous guidelines pertaining to
Source: Dr. Wes - June 6, 2013 Category: Internists and Doctors of Medicine Authors: DrWes Source Type: blogs

How To Simplify Consents
He arrived at the emergency room diaphoretic, hypotensive, and with substernal chest pressure.  The patient was brought immediately to an emergency room care area and a stat EKG disclosed classic ST segment elevation in the inferior leads.  The cath lab team was immediately summoned as the ER team worked to stabilize the patient.  Within minutes, the attending cardiologist was on the scene,
Source: Dr. Wes - May 31, 2013 Category: Internists and Doctors of Medicine Authors: DrWes Source Type: blogs

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