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Issue Date: April 2006
Innovative Practices Aim for Mainstream
Physicians are developing innovative medical practices in an attempt to get out from under the restrictions, hassles, and low pay of managed care.
One organization that supports physicians in these practices is the Society of Innovative Medical Practice Designs in Seattle, Wash. Its web site (at www.simpd.org) offers information and a newsletter about these practices. The society is an organization of providers who promote a direct financial relationship between physicians and patients. The members have a variety of financial arrangements with patients. They run retail and cash practices and operate on a retainer. They are committed to delivering patient-focused medicine and seek to improve the patient-physician relationship, the society says.
Electrolytes and Bowel Preparation Considerations for Colonoscopy Patients
For most patients, bowel preparation before colonoscopy may be somewhat unpleasant, but poses little or no medical risk. Gastroenterologists should be careful, however, when selecting a bowel preparation method for patients with possible or confirmed renal insufficiency, since certain prep formulations may cause dangerous fluid or electrolyte imbalances.
“While serum creatinine may not be a perfect guide to a patient’s degree of renal function, an elevated creatinine level should be considered a red flag,” says C. Mel Wilcox, MD, director of the division of gastroenterology and hepatology at the University of Alabama at Birming-ham. “Abnormal renal function could affect the safety of certain bowel prep methods.”
Assets Need Protection in Lawsuit
There is a common misconception regarding asset protection. Many professionals believe this area of financial planning is unimportant. These physicians and their financial advisers believe incorrectly that there is little to any risk of a physician losing his or her personal assets in a malpractice claim, especially if the physician has a typical malpractice insurance policy of $1 million/$3 million in place. Thinking that personal assets are not at risk in such a lawsuit is a myth. In fact, there is a benefit to engaging in financial planning to protect these assets. Even if the risk of such a financial catastrophe is extremely small, it is still well worth the time and effort to do such planning.
Experts Say Testing Is Required in Certain GERD Cases
Experts make a distinction between gastroesophageal reflux (GER) and gastroesophogeal reflux disease (GERD or GER with a complication). GER is common in infants and children; occurs frequently at a low, physiologic level; and usually is not associated with health problems. Evaluation for significantly burdensome symptoms or complications is typically straightforward and commonly accomplished via a thorough history and physical examination. But when significant symptoms or complications do develop (GERD), then consultation with a pediatric gastroenterologist and testing aimed at identifying important complications (such as esophagitis) or detecting dangerous co-morbid conditions (such as congenital GI tract anomalies) may be warranted.