Clinician's Roundtable

Host: Michael Epstein, MD Guest: Peter Adamson, MD There may be many reasons for a patient to consider elective aesthetic surgery, but whatever the reason, they are often linked to the patient's expectations for the surgical outcome. While we know that most patients maintain a reasonable outlook for their care, how can we work to maintain an affable relationship with those who have unrealistic post-surgery expectations? Dr. Peter Adamson, professor of otolaryngology-head and neck surgery, and head of facial plastic and reconstructive surgery at the University of Toronto, details his experiences and his extensive research on patient relations with host Dr. Michael Epstein. How often does the thought of turning away a patient come into play in a typical practice? Are more of the so-called "problem patients" specific to certain procedures?

Host: Mark Nolan Hill, MD Guest: David Felson, MD, MPH A patient in your office describes the knee pain they have been feeling for an extended period of time. The MRI that you order on their knee reveals meniscal damage. New research is telling us that meniscal tears may be more common than we realize, and further, raises questions as to whether the meniscal tear is really the source of your patient's knee pain. Dr. David Felson, professor of medicine at the Boston University (BU) School of Medicine and professor of epidemiology at the BU School of Public Health, explains that damaged meniscal cartilage may not be directly linked to knee pain. Dr. Mark Nolan Hill hosts.

Host: Mark Nolan Hill, MD Guest: David Felson, MD, MPH Despite previous evidence to suggest that arthroscopic surgery does not improve symptoms associated with osteoarthritis of the knee, the procedure continues to be a common treatment for arthritis. Now, novel data is backing up this earlier research on arthroscopy. Going forward, how will this development impact practice? Host Dr. Mark Nolan Hill talks with Dr. David Felson, professor of medicine at the Boston University (BU) School of Medicine and professor of epidemiology at the BU School of Public Health, about the utility of the procedure, and explores alternative thoughts on the pathogenesis of the pain experienced by this class of patients.

Host: Bruce Japsen Guest: Kurt Mosley It seems fewer and fewer physicians want to go into internal medicine, with a recent study showing only two percent of 4th-year medical students elect to enter this field. Kurt Mosley, Vice President of Business Development for Merritt, Hawkins & Associates, the largest physician search and consulting firm in the country with more than two decades in the business, tells the Chicago Tribune's Bruce Japsen about the trend away from internal medicine, despite the national movement toward finding patients a medical home and the continued emphasis by policy makers on the importance of primary care medicine.

Host: Bruce Japsen Guest: Kurt Mosley More than 90 percent of new physicians coming into the job market received at least 10 job solicitations and face a much different employment dynamic than older doctors. Kurt Mosley, vice president of business development for Merritt, Hawkins & Associates, the largest physician search and consulting firm in the country, tells the Chicago Tribune's Bruce Japsen what doctors face in today's complex employment market and shares his insights into navigating it.

Host: Lisa Dandrea Lenell, PA-C, MPAS, MBA Guest: Carolyn Zaumeyer, NP, RN Carolyn Zaumeyer, a nurse practitioner, discusses with host Lisa D'Andrea the key barriers for a nurse practitioner to establish an independent practice. The nurse practitioner must ensure the practice structure and operations are in compliance with the applicable laws. Ms. Zaumeyer also highlights the importance of establishing a relationship with a collaborating physician for the success of one's practice. Another hurdle that Ms. Zaumeyer examines is the nurse practitioner's relationship with the insurance company to assure the services billed by the nurse practitioner are properly processed and reimbursed.

Host: Lisa Dandrea Lenell, PA-C, MPAS, MBA Guest: Carolyn Zaumeyer, NP, RN Carolyn Zaumeyer, a nurse practitioner, discusses with host Lisa D'Andrea the key factors to evaluate and analyze when starting an independent practice. Ms. Zaumeyer also provides guidance on establishing competitive charges for services, a relationship with a supervising physician, defining one's scope of practice, and the applicable state laws that define the limitations of a nurse practitioner's independent practice.

Host: Larry Kaskel, MD Guest: Donald Patrick, MD, JD Medical license applications have jumped 58% since Texas approved tort reform legislation that limited non-economic damages in medical liability cases to $250,000 among other provisions. Dr. Donald Patrick, JD, the former executive director of the Texas Medical Board discusses with host Dr. Larry Kaskel the key elements of the legislation and the role of the state's medical board in fixing the medical crisis that affected Texas.

Host: Lisa Dandrea Lenell, PA-C, MPAS, MBA Guest: Jay Fotland, NP, RN With a focus on wellness rather than illness, Jay Fotland opened a healthcare clinic that offers flat fee health memberships to patients. Host Dr. Lisa D'Andrea discusses with guest Jay Fotland, a nurse practitioner, the low-cost business model that Mr. Fotland developed as a means to reduce the red tape associated with the health care system. Mr. Fotland also discusses his business philosophy and, located in the backyard of the well-established Mayo clinic, is able to compete.

Host: Lisa Dandrea Lenell, PA-C, MPAS, MBA Guest: Sue Kling-Colson, PA-C Hyperglycemia in critically ill patients increases the risk factor for inpatient morbidity and mortality. Host Lisa D'Andrea explores with guest Sue Kling-Colson, a physician assistant at the University of Michigan Health System, the intensive insulin protocols established for managing hyperglycemic inpatients. Ms. Colson outlines the protocols and explains the responsibilities of the physician assistant under the Hospital Intensive Insulin Program.