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Summit Medicine and Pediatrics PLC
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Dr. Mike has 19 years of experience in private medical practice. He practices Direct Access Medicine Care and Concierge Medicine.
Dr. Mike has 19 years of experience in private medical practice. He practices Direct Access Medicine Care and Concierge Medicine.

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The inevitable clash between The Practice of Medicine and the Practice of Metrics is best illustrated in the following commentary as experienced firsthand by Dr. Mike’s colleague and friend. It is worth the read for clinicians and laypersons alike:
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So this is what passes for clinical medicine today. I arrived this morning to make rounds on the two patients I operated on or consulted on yesterday, only to find a third name on my list. The third patient was someone I didn’t know and as far as I could recall had never seen before. Since I was on ER call the night before, I assumed this was a new consultation. Despite my repeated requests that new consults be called immediately, even if it’s the wee hour of the morning, I still find these surprises. Someone thinks they are doing me a favor by waiting until after 07:00, not understanding that my day starts at 05:00 and by 7:00 I’m often already in surgery or at another hospital.

So I reviewed the chart. The patient had been admitted five days earlier for mental status changes and worsening of dementia. Hmm, no mention of a surgical problem. A UTI and urinary retention was diagnosed and addressed. Carotid ultrasound showed some narrowing and vascular surgery had been consulted (and wisely declined any intervention). Still no mention of why a surgeon was consulted. I found the order for the consultation, but no reason why. Finally I found the CT scan done at midnight the night before which showed an inguinal hernia containing a loop of bowel but no evidence of obstruction or bowel compromise.

So when all else fails, examine the patient. What I find is a very demented elderly man, basically non-verbal, incontinent of urine and stool, with a very large inguinal hernia that I am able to reduce with minimal effort, but which pops back out again as soon as the patient coughs. This did not occur overnight. Hernias this big that descend into the scrotum have been present for a long time, usually for years.

I speak to the nurse who was on the night before who tells me the staff noticed the hernia when they cleaned the patient up after a bowel movement and informed the Night Hospitalist. That doctor ordered a CT of the abdomen without examining the patient or determining if the hernia was reducible. When the CT reading indicated bowel in the hernia, he immediately documented an incarcerated hernia (not true) and ordered a surgical consult.

What is clear to me is that no one responsible for this patient’s care up to this point had bothered to examine the groin. Even when informed of the hernia, the Hospitalist, who likely didn’t know the patient as anything other than a name on a list, opted for an expensive test rather than a simple clinical exam. Hernias, even large hernias, are not surgical or medical emergencies unless they cause bowel obstruction or bowel compromise. Those are CLINICAL diagnoses, made by examining the patient, not by ordering x-rays. This is third year medical student knowledge, not specialty knowledge. I would have harsh words for an intern who ordered a CT before performing an exam to determine if the hernia could be reduced.

This unfortunate man needed to be left alone, not subjected to radiation and a specialist consultation. Any reasonably competent physician should be able to do a physical exam and determine if a hernia is incarcerated. Any reasonably competent Internist should be able to recognize when a patient is a candidate for a non-emergent operation and make a reasoned judgment whether to even consult a surgeon.

So what’s wrong with this picture? We have a patient who is unable to give a good history and who unfortunately does not have involved family. We have a system of hospital care by committee. Rarely does any patient, much less a complicated one, have the same Hospitalist for their entire stay. They get admitted by the Night Shift, are seen by the Day shift, often as much as twelve hours after coming in, are likely handed off to another Hospitalist within a day or two. No one is in charge overall or takes primary responsibility for the patient. This is now the rule, not the unfortunate exception. As far as most Hosptialists are concerned, the patient didn’t exist before coming to the hospital and will cease to exist as soon as they leave. There is no sense of responsibility for the patient at any time during their stay. After all, the Hospitalist is a shift worker, eight to twelve hours a day for a few days, then pass everything off to someone else.

How did it come to this? This is the direct consequence of Medicare and a reimbursement process that emphasizes metrics over patient care, attaches no value to experience or an established doctor-patient relationship, and considers physicians to be ‘providers’ with no more importance that a triage nurse. This is the extra thousand pages of the ACA that no one read or paid any attention to. No one cares anymore. Those of us who do, or did, have had it progressively beaten out of us by mind numbing EMR alerts, coding queries, Core measures, Medicare and insurance denials or requests for documentation, new prescribing rules and a thousand other indignities that make patient care a chore rather than a joy.

No wonder most of my peers are happy to cede these headaches to the Hospitalists who can tolerate it only because they work shifts and have no calls or responsibilities once they leave the hospital. To those of you out there who think the Medicare for all is a good idea, I can only say caveat emptor, buyer beware.
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BRUCE C. DAVIS MD is a Trauma Surgeon in the Greater Phoenix area, and has graciously given his permission to share his thoughts and insights. Posted originally on September 14, 2018
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Summit Medicine and Pediatrics honors the memory and legacy of bravery and sacrifice in the men and women who confronted pure evil on 9/11/01. 💛🇺🇸 #NeverForget
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‪A Day in the Life of Summit Medicine and Pediatrics...‬

‪When two Italians meet, there is always a better way to say, ‘hello’! 🍷 Thank you, Joe and Ro!‬

‪Lovin’ the Practice of Medicine Again!‬

‪#DrMike #SMP #DirectAccessMedicine #ConciergeMedicine
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9/11/18
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Skin Health is most important! Summit Medicine and Pediatrics invites you to join Mary Ellen McClung Lucherini and others for a Mary Kay® Satin Soft Spa Saturday event from 1 PM to 3 PM on September 8th in Scottsdale, AZ.

Experience firsthand the latest in spa treatments and facial masks and purchase gifts for both women and men for homecoming, Thanksgiving and Christmas.

RSVP and get location details by calling Mary Ellen directly at 480-250-7142.

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Over the years, many have asked Dr. Mike why their health insurance is so expensive. Finally, PragerU has created as simple and straightforward an explanation as any... even for Dr. Mike!

#SMP #DrMike #DirectAccessMedicine #ConciergeMedicine #HealthInsurance

https://www.facebook.com/prageru/videos/1983507088358804/
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Happy Labor Day from all of us at Summit Medicine and Pediatrics!

"Labor Day is for all those who work hard to push through trials and obstacles to make better their nation, their family, and themselves." -- Dr. Mike

#SMP #DrMike #DirectAccessMedicine #ConciergeMedicine #LaborDay

https://youtu.be/kfG7IBNsEmU
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The shortage of access to primary care physicians in Arizona is real. If your healthcare is important to you, plan now to find the physician who is committed to ensuring your health wellness...

#Healthcare #DrMike #SMP #DirectAccessMedicine #ConciergeMedicine

http://www.allaboutarizonanews.com/article/the-doctor-is-out---arizona-faces-a-critical-doctor-shortage
All About Arizona News
All About Arizona News
allaboutarizonanews.com
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ObamaCare doesn’t work for any other purpose than to generate more tax dollars for our government. Are we Americans simply apathetic to its effect on our nation or too pathetic to understand its effect on our wallets?

“ObamaCare has never been about ensuring ‘healthcare’ in America. The law is no more than a boondoggle to our bloated, inefficient, over-budgeted federal government by creating yet another way to turn over our savings accounts to the progressive, globalist politicians who still support it.” — Dr. Mike

#ObamaCare #Healthcare #DrMike #SMP #DirectAccessMedicine #ConciergeMedicine

https://www.westernjournal.com/illegal-obamacare-fees-trigger-839m-reimbursement-several-states/
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Summit Medicine and Pediatrics remembers and honors Sen. John McCain (R-AZ) for his service to our nation. We offer our most sincere condolences to the McCain family... #JohnMcCain
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‪Stop by my office on Saturday morning between 9 AM and 11 AM to learn more about Direct Access Medicine® care and how it will change your healthcare experience for the better...‬

https://www.facebook.com/events/2090277394558235/?ti=ia

#healthcare #DrMike #SMP #DirectAccessMedicine #ConciergeMedicine
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