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Archive for the ‘Doctors’ Category

WAITING ON DOCTORS

Posted by Tim Bryce on October 7, 2016

BRYCE ON PHYSICIANS

– Why can’t they meet you on time?

(Click for AUDIO VERSION)
To use this segment in a Radio broadcast or Podcast, send TIM a request.

One of the most uninviting places to visit has to be a Doctor’s office. First, we normally go there because we have a pain or suffer from some ailment which doesn’t put us in the best of moods to begin with, but to add insult to injury, you have to contend with the peculiarities of the doctor’s office staff, a very cold group of workers who are more concerned with processing you like an order as opposed to treating you like a human-being. On your first visit to a doctor’s office, you are bombarded with a substantial amount of paperwork in triplicate, which I guess we have to thank our attorney friends for. I visited a new doctor recently and was overwhelmed by the paperwork. There were more waivers of rights than there was anything pertaining to my medical history. I felt like I was in an attorney’s office as opposed to a doctor’s.

I’m generally pretty healthy, so when the forms asked me to list the various ailments I’ve suffered with over the years, I answer, “No, No, No, No, No, No, No,…,” you get the idea. They then ask about my dependency on alcohol, tobacco, drugs, sex, etc., to which I usually reply, “Gee, doesn’t everybody?,” which doesn’t amuse the office staff. The fact I answer, “No,” so many times makes them skeptical of my answers, to which they call be back to the office window for further interrogation.

The decor of doctor offices are basically the same which is pretty plain, with outdated or irrelevant magazines to read, and a whiff of isopropyl alcohol in the air. I find patients in the waiting room tend to keep to themselves and do not like to engage in conversation, maybe because they’re embarrassed by their ailment or maybe because they only speak a foreign language. When you try to strike up a conversation with someone, they look at you like they are being interrogated by the FBI or border patrol.

On the walls of the office are the doctor’s degrees and certificates which are intended to impress you. Some doctors tend to overdue it though as they frame everything from their college degree to their safety patrol or bar mitzvah certificates.

I guess what irritates me the most though is making an appointment with a doctor which he or she rarely keeps. If I’ve got an appointment, medical or otherwise, I tend to arrive a few minutes early as I do not like to be late. However, doctors’ really do not value your time, even when you take time off from work to visit them. I’ve got a problem with this as I wouldn’t treat my customers this way. If you cannot meet me on time, tell me up-front so I can make other arrangements, but do not take my time for granted. I might understand a couple of minutes delay due to another patient, but 15, 30, 45, or 60 minute delays? NFW.

If the doctor is late, my impatience slowly brews until I can’t take it anymore and storm out of the office (I’ve done this on more than one occasion), and frankly, I wish more people would do likewise. The office staff then tries to threaten you that they will still bill you for the appointment, which is actually a veiled threat. I just point out the time to them, tell them I had a verbal contract to meet with the doctor at a given time, and since he/she failed to appear on time, threaten to bill them for my lost time. I just can’t figure out why after practicing medicine for so long, they can’t make a simple schedule and keep it. Everybody else does. To me, its a sign of disrespect.

Doctors are not alone in terms of having poorly run offices; Dentists are just as guilty, but the only thing worse than a doctor’s office has to a hospital, which even the doctors describe as, “One of the unhealthiest places on Earth.”

Also published with News Talk Florida.

Keep the Faith!

Note: All trademarks both marked and unmarked belong to their respective companies.

Tim Bryce is a writer and the Managing Director of M&JB Investment Company (M&JB) of Palm Harbor, Florida and has over 30 years of experience in the management consulting field. He can be reached at timb001@phmainstreet.com

For Tim’s columns, see:   timbryce.com

Like the article? TELL A FRIEND.

Copyright © 2016 by Tim Bryce. All rights reserved.

Also read Tim’s columns in the THE HUFFINGTON POST

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Posted in Doctors | Tagged: , , , , | 4 Comments »

THE FAMILY DOCTOR

Posted by Tim Bryce on June 3, 2016

BRYCE ON SOCIETY

– A dying breed.

(Click for AUDIO VERSION)
To use this segment in a Radio broadcast or Podcast, send TIM a request.

My family recently suffered through a major medical emergency. My hat goes off to the paramedics who arrived in the nick of time and saved my family member’s life. They were a Godsend as were the emergency room staff at the hospital. It was certainly an enlightening experience for me to watch them work. I am very grateful.

My family member was placed in an Intensive Care Unit for five days. As I sat there, I felt I was in a mini-Mission Control room with beeps, buzzes and pings emanating from respirators, cardiac monitors, and basic life monitoring equipment. Yes, I felt like saying, “Houston, we have a problem.”

I was also charged with producing identification and insurance cards to be inputted into the administrative systems of the hospital. This went way beyond name, rank, and serial number, to a plethora of health questions.

As a systems man, I was impressed by the technology the nursing staff and administrators had to use, but beyond this, the most valuable asset we had at our disposal was our family doctor who appeared promptly at the hospital and carefully guided us through some major decisions.

We have known our family doctor for over thirty years, a good man who has a warm manner about him in treating his patients. He is empathetic, knowledgeable, a good bedside manner, and possesses vast experience. More than this, he has the ability to step back and look at a problem objectively, as opposed to acting on impulse. He’s a dedicated professional with talents no machine can match.

I understand there is a new on-line video app which you can download to your smart phone allowing you to speak face-to-face with a physician. The millennials may gravitate to this, but I certainly will not. There is something to be said about a kind word, a gentle touch, and a sense of humor to help ease the pain. It’s called “personal medicine,” something we have been moving away from in this country due to our technology addiction.

I’m not sure how much longer our family doctor will be practicing medicine. He finds himself harassed by an overbearing government bureaucracy involving countless rules and regulations distracting him from caring for his patients. Every year, more and more doctors are taking early retirement as opposed to putting up with such nonsense. I cannot help but believe this is an attempt to push socialized medicine down our throats. This results in such things as the app I mentioned where you can talk to “Bob” located somewhere in Asia.

Medical care will be more sterile and less personal without the family doctor. The government may not appreciate him, but I, for one, certainly do.

Thank you David.

Also published with News Talk Florida.

Keep the Faith!

Note: All trademarks both marked and unmarked belong to their respective companies.

Tim Bryce is a writer and the Managing Director of M&JB Investment Company (M&JB) of Palm Harbor, Florida and has over 30 years of experience in the management consulting field. He can be reached at timb001@phmainstreet.com

For Tim’s columns, see:   timbryce.com

Like the article? TELL A FRIEND.

Copyright © 2016 by Tim Bryce. All rights reserved.

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Listen to Tim on WZIG-FM (104.1) in Palm Harbor,FL; KIT-AM (1280) in Yakima, Washington “The Morning News” with hosts Dave Ettl & Lance Tormey (weekdays. 6:00-9:00am Pacific); and WWBA-AM (News Talk Florida 820). Or tune-in to Tim’s channel on YouTube.

Posted in Doctors, Society | Tagged: , , , , | Leave a Comment »

MEDICAL RECORDS INTEROPERABILITY

Posted by Tim Bryce on April 13, 2015

BRYCE ON MEDICINE

– Law makers are just beginning to realize the problem the medical community has in sharing data between systems.

(Click for AUDIO VERSION)
To use this segment in a Radio broadcast or Podcast, send TIM a request.

Five years ago I wrote a column regarding patient records in medicine, “My Dinner with the Doctor.” At the time, the government mandated that all doctors and medical institutions were required to process all patient records electronically. This created an uproar in the medical community in that doctors and nurses were forced to expend an inordinate amount of time creating and updating records. As a result, doctors were spending more time updating records as opposed to caring for their patients; Nurses were also swamped by records, leaving it to orderlies to look after patients. In other words, they were spending more time on bureaucratic red tape as opposed to caring for the sick.

There is certainly nothing wrong with the concept of electronic patient records, but the government didn’t think this through carefully and provided no standards for the data to be captured, and how to exchange it with other systems. Consequently, a plethora of software packages popped up to record and manage medical records. Graphically, they all looked nice, but they did not work cooperatively (aka “Closed Systems”).

It has long been a Bryce’s Law that, “The only way that information systems communicate, both internally and externally to other systems, is through data.” In this day and age of computing, it is difficult to imagine a software product without some form of import/export facility, be it nothing more than “Save as” (another file format), or through use of the clipboard. Instead, most of these software products have their own proprietary file formats, thereby prohibiting the exchange of data and forcing a dependency on the product.

Recently, a report was brought to my attention from “MedicalMedicine,” one of a group of medical publications offered by UBM Advanstar. In the report, a fellow at the Brookings Institution Center for Technology Innovation, had a recent epiphany whereby vendors have taken patient data “hostage,” meaning they prohibit interoperability. All I can say is, “No fooling!”

The report goes on to say the marketplace is now saturated, and the only way to make money is in data migration. For example, if a doctor wants to move from one package to another (which is quite common), it’s not simply a matter of exporting the data from the old package and importing it into the new package. Instead, he must pay a fee for someone to reconfigure the file format, thereby permitting its use in the new package. At the end of the article, readers added their comments which is where I discovered doctors were paying such fees as $3,500, $6,500, and as much as $12,000 to migrate their data. Again, had the government thought about this properly, there would be an import/export facility and standard file formats (such as Delimited ASCII or fixed length records), and this data migration ripoff would have been avoided and costs cut.

What is frustrating is this problem of data interoperability is just coming to light. The medical community has known about it for years, but the government had no clue about it. This is an instance of automating for the sake of automating, without any consideration for data exchange. The true purpose of patient electronic records is to allow the easy exchange of medical data. For example, if I were to happen to have a medical emergency in a distant town, such as Cincinnati, my records could easily be transmitted electronically by my Palm Harbor physician. However, this is not how it works. Because of the lack of standards by the government, my doctor would have to FAX my medical records instead, a much slower process.

What is happening in medical records management is simply barbaric. There is no other way to describe it. As a systems consultant, I just shake my head in disbelief. As Stengel would have observed, “Whodathunkit!”

Keep the Faith!

Note: All trademarks both marked and unmarked belong to their respective companies.

Tim Bryce is a writer and the Managing Director of M&JB Investment Company (M&JB) of Palm Harbor, Florida and has over 30 years of experience in the management consulting field. He can be reached at timb001@phmainstreet.com

For Tim’s columns, see:  timbryce.com

Like the article? TELL A FRIEND.

Copyright © 2015 by Tim Bryce. All rights reserved.

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Listen to Tim on WJTN-AM (News Talk 1240) “The Town Square” with host John Siggins (Mon, Wed, Fri, 12:30-3:00pm Eastern); WZIG-FM (104.1) in Palm Harbor,FL; and KIT-AM 1280 in Yakima, Washington “The Morning News” with hosts Dave Ettl & Lance Tormey (weekdays. 6:00-9:00am Pacific). Or tune-in to Tim’s channel on YouTube.

Posted in Doctors, Technology | Tagged: , , , , | 5 Comments »

MORE PROBLEMS IN DOCTOR OFFICES

Posted by Tim Bryce on December 9, 2013

BRYCE ON HEALTH CARE

– Poorly designed systems, as dictated by the federal government, are strangling physicians.

(Click for AUDIO VERSION)
To use this segment in a Radio broadcast or Podcast, send TIM a request.

In the past, you have heard me talk about system snafus in Doctor offices, both systems and their inordinate dependence on fax machines. Suffice it to say, doctor offices are perhaps the most barbaric from an administrative point of view, not because they want to run this way, but because the federal government is forcing them to. Now, it appears it is going to go from bad to worse, thereby stretching their patience to the breaking point.

As I’ve written earlier, the government is forcing doctors to prepare extensive electronic records on their patients. This means doctors and nurses are spending more time performing data entry and less time caring for people. I might understand if the data is assembled according to standards, thereby providing the means to easily transfer it from one system to another. Unfortunately, it doesn’t which explains why doctors are so dependent on fax machines to transfer patient data, a horribly primitive approach in this day and age.

According to my doctor friends, more trouble is brewing. On October 1, 2014, all medical diagnosis coding will convert from ICD 9 to ICD 10 codes. The number of codes will increase from 17,000 to 141,000. The codes are supposed to be very specific so that disease processes can be narrowly described with one code number. Here are some examples:

W59.22 Struck by turtle
W59.22XA … initial encounter
W59.22XD … subsequent encounter
W59.22XS … sequela
W59.29 Other contact with turtle
W59.29XA … initial encounter
W59.29XD … subsequent encounter
W59.29XS … sequela

V96.01 Balloon crash injuring occupant
V96.01XA … initial encounter
V96.01XD … subsequent encounter
V96.01XS … sequela
V96.02 Forced landing of balloon injuring occupant
V96.02XA … initial encounter
V96.02XD … subsequent encounter
V96.02XS … sequela
V96.03 Balloon collision injuring occupant
V96.03XA … initial encounter
V96.03XD … subsequent encounter
V96.03XS … sequela
V96.04 Balloon fire injuring occupant
V96.04XA … initial encounter
V96.04XD … subsequent encounter
V96.04XS … sequela
V96.05 Balloon explosion injuring occupant
V96.05XA … initial encounter
V96.05XD … subsequent encounter
V96.05XS … sequela

V91.05 Burn due to canoe or kayak on fire
V91.05XA … initial encounter
V91.05XD … subsequent encounter
V91.05XS … sequela
V91.06 Burn due to (nonpowered) inflatable craft on fire
V91.06XA … initial encounter
V91.06XD … subsequent encounter
V91.06XS … sequela
V91.07 Burn due to water-skis on fire
V91.07XA … initial encounter
V91.07XD … subsequent encounter
V91.07XS … sequela
V91.08 Burn due to other unpowered watercraft on fire
V91.08XA … initial encounter
V91.08XD … subsequent encounter
V91.08XS … sequela
V91.09 Burn due to unspecified watercraft on fire
V91.09XA … initial encounter
V91.09XD … subsequent encounter
V91.09XS … sequela

Seems kind of silly doesn’t it?

For each injury or symptom, the physician will be required to enter one of these codes into the electronic patient records, from a list of 141,000. Hopefully, there will be some on-line help to point doctors in the right direction, but more likely they will have to reference a paper manual in order to look-up the proper entry.

In systems parlance, the code itself is referred to as a “group” data element, meaning it is a concatenation of data elements. We can find examples of “group” data elements in such things as a telephone number (area code-exchange-number), credit card numbers (financial institution-branchID-account-number), check numbers, power company numbers, and many more. It is simply a way to uniquely assign numbers in order to prevent redundancy.

In the example above, the code is probably decomposed accordingly:
First character (alphabetic) – Type of condition
Positions 2+3, Accidents/Conditions by general category
Position 4 – a decimal (presumably to delineate categories from treatment of conditions)
Positions 5+6 – Specific accident/condition
Positions 7+8 – Treatment

In other words, it’s a taxonomy for specifying a specific medical action. The government’s solution though is to force medical personnel to memorize these codes or look them up in a voluminous document or on-line help. A simpler way would be to provide a series of simple prompts to guide people through the taxonomy and assign the proper code.

One doctor friend claims he was told the new coding system will be very difficult to implement, such that insurance claims submitted will not likely be processed because of “computer glitches” in accepting the claims. Errors in uploading and downloading the encrypted codes are likely. So much so, the government is encouraging physicians to secure a six month line of credit to ensure their practices can remain open while the claims fiasco is corrected. He claims this is described by the government and mentioned on Medicare websites in many states.

I have dealt with a lot of information systems over the years, but I’m beginning to think we no longer know how to build them. Obamacare is as glaring an example as I can think of, this is another.

Currently, physicians are spending as much as 2-3 hours each day on meaningless computer work to satisfy government regulations. Time which does not improve the care of patients. Unfortunately, as of next October 1st, it will get worse and we’ll likely see many experienced doctors finally throw in the towel.

Keep the Faith!

Note: All trademarks both marked and unmarked belong to their respective companies.

Tim Bryce is a writer and the Managing Director of M&JB Investment Company (M&JB) of Palm Harbor, Florida and has over 30 years of experience in the management consulting field. He can be reached at timb001@phmainstreet.com

For Tim’s columns, see:
timbryce.com

Like the article? TELL A FRIEND.

Copyright © 2013 by Tim Bryce. All rights reserved.

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Listen to Tim on WJTN-AM (News Talk 1240) “The Town Square” with host John Siggins (Mon, Wed, Fri, 12:30-3:00pm Eastern), KGAB-AM 650 “The Morning Zone” with host Dave Chaffin (weekdays, 6:00-10:00am Mountain), and KIT-AM 1280 in Yakima, Washington,  “The Morning News” with hosts Dave Ettl & Lance Tormey (weekdays. 6:00-9:00am Pacific). Or tune-in to Tim’s channel on YouTube.

Posted in Doctors, Government, Healthcare, Systems | Tagged: , , , , | 6 Comments »

LONG LIVE THE FAX MACHINE

Posted by Tim Bryce on March 11, 2013

BRYCE ON BUSINESS

– Why +830,000 physicians rely on this aging technology.

(Click for AUDIO VERSION)
To use this segment in a Radio broadcast or Podcast, send TIM a request.

As a small businessman, I haven’t had to use a fax machine in quite some time. Like most people these days, I rely primarily on e-mail. If I have a lengthy document, I convert it to a PDF file and attach it to the e-mail. Many years ago, we relied heavily on fax machines to communicate with customers overseas (and TWX machines before that), but in recent times we have little use for such devices. We keep a fax machine in the office for “just in case” situations, but we mostly leave it unplugged to avoid the many spam faxes still plaguing the public. I am also able to interface with other systems to upload/download data in a variety of file formats with Delimited ASCII being the most prevalent.

I recently visited my doctor for a routine checkup. We’ve known each other for years and I am always fascinated by the latest medical technology in his practice. His office consisted of a modest sized staff with the typical number and type of computers you would expect to support administrative needs. Interestingly, I noticed he had a fax machine which was slowly chugging away and spitting out voluminous reports. Frankly, I was surprised to see a fax machine being so actively used; certainly he transmitted/received data by e-mail or some other computer protocol I thought. Actually, No.

Although physicians have abundant computer software available to them for communication purposes, it is not as actively used as the fax machine which is the true work horse of their office. The doctor claimed his office received on the average 18,000 faxes each year. This does not include sending documents which is probably just as voluminous. Patient records, test results, prescriptions, hospital reports, etc. are all regularly sent by fax, and no other device. This means the data has to be re-keyed into the doctor’s computers by his staff. It doesn’t take a systems man like me to realize this is not an efficient or cost-effective approach for operating any office. Frankly, I was thunderstruck just how primitive the office systems were, and this was just one office. As I was to learn, most doctors operate in the same manner thereby representing a model of system dysfunctionality on a colossal scale.

A mandate from the federal government a few years ago requires doctors to digitize all of their medical records (see “Turning Everyone into Data Entry Clerks”). This means every medical institution in this country has been busy entering data about all of their patients, a herculean task which the medical community is currently embroiled in. To accomplish this, a variety of medical software packages have been introduced with little or no compatibility between them. This means your medical records with your General Practitioner cannot be read by another doctor, unless he happens to use the same medical records software, which would be a very remote coincidence. There are, of course, strict privacy issues concerning the exchange of patient records. Regardless, assuming consent is given by the patient, there is no easy way to electronically exchange data.

Blame for this incompatibility falls squarely on the shoulders of the federal government who has not devised a standard file format for exchanging data. They may have mandated all doctors digitize their patient records, but they never devised a means for exchanging data. This incompatibility issue is so glaring, you have to suspect it is premeditated.

Now consider the enormity of this problem; there are over 830,000 physicians in this country, all of which are busily digitizing patient records, none of which can be exchanged electronically with other doctors. So how do they communicate? You guessed it; by fax. It also means all of these doctors and their staffs have to work double-time to record patient data as transmitted by fax. Doesn’t make a lot of sense does it?

Let’s take it a step further, assuming my friend’s office annual workload of 18,000 faxes is an average, and considering there are over 830K doctors, this translates into over 15 trillion pieces of paper being printed each year by physicians alone (not counting hospitals). This isn’t exactly environmentally friendly, but certainly supports the bottom-line of paper companies.

This system snafu places a significant burden on doctors and inhibits their ability to practice medicine and care for their patients. Not surprising, a mutiny is in the offing. Tired of growing governmental bureaucracy, many physicians are opting to retire early or quit their practices outright, thereby creating a shortage of competent doctors.

My visit to my doctor’s office taught me a couple of things; first, the fax machine is the Achilles’ heel of any physician’s office, without it, the doctor is lost. Second, this need not be the case if the federal government would just devise some simple standards for data exchange. However, knowing the government, I do not think I’ll hold my breath. I’m quite confident doctors will go on killing trees for many years to come.

Keep the Faith!

Note: All trademarks both marked and unmarked belong to their respective companies.

Tim Bryce is a writer and the Managing Director of M&JB Investment Company (M&JB) of Palm Harbor, Florida and has over 30 years of experience in the management consulting field. He can be reached at timb001@phmainstreet.com

For Tim’s columns, see:
timbryce.com

Like the article? TELL A FRIEND.

Copyright © 2013 by Tim Bryce. All rights reserved.

NEXT UP:  POST OFFICE INEFFICIENCIES – How far behind is the USPS operating behind its competitors?

Listen to Tim on WJTN-AM (News Talk 1240) “The Town Square” with host John Siggins (Mondays, Wednesdays, Fridays, 12:30-3:00pm ET), and KGAB-AM 650 “The Morning Zone” with host Dave Chaffin (weekdays. 6:00-10:00am MST). Or tune-in to Tim’s channel on YouTube.

Also look for Tim’s postings in the Palm Harbor Patch, The Gentlemen’s Association, and throughout the Internet.

 

Posted in Doctors, Management, Politics, Technology | Tagged: , , , , | 9 Comments »

MY DINNER WITH THE DOCTOR

Posted by Tim Bryce on February 28, 2011

My wife and I went out for dinner the other night with our doctor and his wife. Actually, there was nothing unusual about this as we have known them for 25 years as good friends and neighbors. He practices Internal Medicine and I have always known him to be sincere about his work. I’ve met a lot of physicians over the years, several of whom are out for a quick buck, so it is refreshing to talk to one who is dedicated and takes his work seriously. Knowing of my background in systems and Information Technology he began to tell me about some recent changes in his practice that are affecting the very nature of his work. Frankly, I was disturbed with what I heard.

There are administrative changes underfoot in doctor offices that will ultimately affect us all. In a nutshell, the government is blackmailing doctors to provide extensive data about their patients. If they fail to provide it by certain deadlines, the government will withhold a percentage of their Medicare/Medicaid compensation which can be quite substantial. Even though the doctors realize this will be a burden to them, they also know resistance is futile.

Electronic records management is intended to improve patient health care simply due to the sharing of medical data on a national level. To illustrate, if a patient from Florida who suffers a problem away from home, such as in Ohio, local doctors can easily access the patient’s medical records and treat him more effectively. There is only one problem with this, patient records are voluminous thereby making it laborious and time consuming to input.

The new reporting procedures require the doctors to personally review the records of each of their patients and input the data themselves, not an office manager or clerk. When completed, the doctors will be required to continually update the records using computer software. Even after the initial setup of patient data, which is no small task, asking physicians to update the records on an ongoing basis is considered a huge imposition and a distraction tending to interfere with the treatment of their patients. The technology for input is not conducive for simplifying the process and primarily consists of keyboards and mouse pointing devices. Voice-to-text has been around for some time, but it is not nearly at the level of sophistication required by physicians to stay on top of the task.

Another aspect that should be of consideration to American consumers is that the government will now have access to their medical records. They already have access to criminal and financial records, not to mention employment, citizenship and personal possessions (such as automobiles, housing and real estate). Now add in medical history and there will be little else the government will not know about us. Wow, talk about “Big Brother” watching. This should make all citizens gravely concerned about privacy and security issues.

Doctors are already being squeezed by insurance companies and malpractice attorneys. Now the government is going to add another level of bureaucracy to complicate their lives. So incensed are a lot of physicians about this that it appears a whole generation of doctors will likely abandon their practices over the next five years thereby radically disrupting patient care in this country.

“So, how are things in your business?” my Doctor friend finally asked.

I replied, “Not nearly as bad as I thought.”

Keep the Faith!

Note: All trademarks both marked and unmarked belong to their respective companies.

Tim Bryce is a writer and the Managing Director of M. Bryce & Associates (MBA) of Palm Harbor, Florida and has over 30 years of experience in the management consulting field. He can be reached at timb001@phmainstreet.com

For Tim’s columns, see:
http://www.phmainstreet.com/timbryce.htm

Like the article? TELL A FRIEND.

Tune into Tim’s THE BRYCE IS RIGHT! podcast Mondays-Fridays, 11:30am (Eastern).

Copyright © 2011 by Tim Bryce. All rights reserved.

Posted in Doctors, Life, Management | Tagged: , , , , , | 2 Comments »

 
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