My morning practice session started out with a few patients arriving early, so I was able to get a jump on the day, and it looked like I was going to actually be running on time.
As I was walking from one exam room to the other, my administrator came down the hallway, grabbed my arm and said, “Can I have you for a minute?”
It seems that a group of systems …
What being overwhelmed by rules and regulations looks like
Part of a series.
Over the past few months KevinMD.com has posted a series of articles by me on what I call the “crisis in primary care.” Most recently have been a few posts related to direct primary care. They have generated many comments: some pro and some con. I have greatly appreciated everyone’s interest; it makes it worth the time to write. I am also working on a book on …
Direct primary care: A response to your comments
Most of the time I feel as though I am running in quicksand attempting to bring patients to a place of grace and dignity in dying. On occasion, there is someone who jerks me out of my quicksand and plants me squarely on stable shore and then proceeds to show me what grace and dignity in the face of death really look and feel like.
Please meet Mr. Jefferson.
Mr. Jefferson had long, lacy …
This surprising request brought an emergency doctor to tears
An excerpt from The Cost of Cutting: A Surgeon Reveals the Truth Behind a Multibillion-Dollar Industry.
Deciphering the hieroglyphics of hospital bills, especially when it involves surgery, is not a job for the faint of heart. As Mr. Wilkes discovered when comparing notes with a friend, there’s another puzzle: the huge …
Deciphering hospital bills is not for the faint of heart
You know it’s going to be one of those days when one of the first tweets on vacation inquires about the closest hospital.
Victor, one of my 11-year-olds, had something in his eye courtesy of a big gust of wind outside of Westminster Abbey. He was complaining enough to let me flip his eyelid and irrigate his eye on the square in front of Big Ben. (I’m sure several people thought …
An American doctor’s experience with the NHS
Cholesterol is bad. Cholesterol is an essential building block for important hormones.
Eggs are bad. Eggs are a complete protein food.
Salt is bad. Salt is essential for life.
High blood pressure kills people. No blood pressure defines death.
High blood sugar causes eye and kidney damage. Low blood sugar causes falls, fractures and car wrecks.
Low potassium causes heart rhythm problems. High potassium causes heart rhythm problems.
Too little vitamin B12 causes nerve damage. Too …
Health care data is meaningless without context
In no other field is unity and collaboration between administrators and frontline staff more important than in health care. Unfortunately my own experience is that the disconnect and mistrust, especially from doctors and nurses, towards hospital administration is growing larger all the time.
Let me start off by saying that I have intimate experience of both sides of the divide. Obviously as …
How to be a great health care administrator
“Dr. Sevilla, I have a question for you,” a patient asked me this week. “I’m going to tell you something, but I DO NOT want it put in the chart.” Hmm, I asked myself, can I really do that? It’s the patient’s wish, right?
The patient went on to tell me that she heard about this week’s story about a hospital network being hacked and 4.5 million records being stolen. …
The medical chart is coming to an end. Here’s why.
In medical school I used to ask myself, “When will I feel like a real doctor?” During intern year, I asked the same question. Now as a new faculty member who has completed medical school, a family medicine residency and a teaching fellowship, I still find myself asking that same question.
As primary care doctors, we are trained to churn out differential diagnoses. We must avoid premature closure or incorrectly assuming …
2 ways to improve doctors: feedback and reflection
He left a little early to stop by the cath lab to see his patient before her procedure. Cordial “hellos,” “good mornings,” and “any last questions?” were mentioned before she signed her consent. The team was working feverishly to prepare her for her procedure. “Have you met the anesthesiologist yet?” was next, and almost on cue, the anesthesiologist arrived and took over for a bit.
He hurried upstairs to the conference …
This is what lifelong learning in medicine should look like
Daily, I am contacted by good doctors who are struggling with symptoms of burnout syndrome and who have become overwhelmed by the challenges of attempting to practice medicine in today’s health care environment. As a psychiatrist who runs a program to address and treat these distressed doctors, I am troubled by the ever-growing number of calls I receive.
The burned-out physician is …
The epidemic of physician burnout is heartbreaking
Oh yeah. Hot dang. All right. Groovy.
Boom goes the dynamite.
I had a very great day yesterday.
I saw three patients who had recent diagnoses of cancer. Yeah, those two statements seem to contradict. They don’t. Each person I saw gave me a clear view of how the practice I’ve been building over the past 18 months is making a difference. A big, big difference.
The first patient was a guy who is …
I’m all for free speech and I’m very hostile to censorship. The response to ugly speech is not censorship, but is rebuttal speech. Of course, there’s a lot of speech out there that should never be uttered. Indecent and rude speech is constitutionally protected, but is usually a poor choice. We have the right to make speech that is wrong.
I relish my free speech in the office with patients. I …
The consequences of prohibiting physicians’ free speech
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A resident once offered me this piece of advice: Find mentors whom you admire. Not just for their rapport with patients, but also for their lifestyle, their hours and their family life. Make goals that you know to be realistic because someone has already accomplished them.
My question now: Why stop there? Why not share that ounce of brilliant advice with our patients? Why don’t we link older, successful patients with diabetes …
Introduce our patients to mentors
Dr. Michael Pappas hates it when a nurse practitioner is called a mid-level provider: “Stop calling nurse practitioners mid-level providers.” So do I, though my reasons are a bit different. In order to understand them it will be necessary to revisit those dark ages, a time when such individuals were few and the roles played in the drama we know …
Solving the mid-level dilemma: Call them what they really are
“If a tree falls in a forest and no one is around to hear it, does it make a sound?”
Chances are that many of you have duked this out with your college roommates back in the day, but how about this one? “If a doctor and a patient make an advance care plan, but when an emergency happens, nobody can find a copy of it, the proxy doesn’t know what’s …
DNR/DNI: More code than status
Several months ago, a post called, “Everything’s my fault: How a surgeon says I’m sorry,” appeared here on KevinMD.com. It was written by a plastic surgeon who feels that no matter goes wrong with a patient, surgeons should never blame anyone else.
She gave some examples such as the lab losing a specimen, a chest x-ray that was ordered and not done, a patient eating something when he was not to …
Surgeons can’t be responsible for every mistake
Part of a series.
A common criticism of direct primary care (DPC, membership/retainer/concierge practices) is the added expense: “Isn’t it too expensive?” Ways to think about the cost are to prioritize expenditures and to consider potential savings that make it cost effective.
I gave examples of three direct primary care practices in an earlier post. Here is a recap of costs.
AtlasMD’s annual fee is $600 for a young adult and …
No, direct primary care isn’t too expensive
A few weeks ago, my husband and I took my parents to dinner at one of my favorite restaurants. I was excited to go because the food is excellent and the customer service is top notch. In the past, I’d always had a great experience … until then.
That night, the restaurant was packed as they were offering half-priced desserts. My husband and I arrived first. I noticed when we ordered …
3 things a restaurant taught me about patient satisfaction
Direct primary care (DPC) and concierge medicine are rapidly growing models of primary care. Though the terms are used interchangeably, both are not the same. Such liberal use of terms, many times by even those within the industry, confuses those who are attempting to understand how these primary care models operate. As former concierge physician for the Pebble Beach Resorts, and subsequent founder of one of the nation’s largest direct …
Direct primary care and concierge medicine: They’re not the same
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