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Does direct primary care improve quality measures?

Physician

August 18, 2014

Part of a series.

In earlier posts, I have described direct primary care (DPC) in its various forms called membership, retainer and concierge. There are some concerns with DPC. Does more doctor-patient time really mean better quality care? Does it really mean lower total costs? It seems logical that closer care means better care, fewer referrals to specialists and fewer hospitalizations. Most DPC physicians will tell you this is the case …

When diagnosing patients, Occam’s razor sometimes fails

Rob Lamberts, MD

Physician

August 17, 2014

I don’t like to brag, but if there is one area of my skills as a doctor about which I am proud, it would be my skill as a diagnostician. I like to play Sherlock Holmes and figure out what’s going on with people, and I think I’m pretty good at it.

So I lied. I do like to brag … a little.

In most people’s mind’s eye, the role of diagnostician …

5 ways mobile apps can impact health care right now

David Lee Scher, MD

Health Technology

August 17, 2014

There is growing healthy skepticism about the past promises of mobile technologies. Issues concerning safety after the release of the FDA guidance of mobile medical apps, privacy and security, and efficacy. Followers of the sector are poised for the rubber finally meeting the road in health care. While most mobile health tools used today are reference apps for health care providers and patients, there are …

The unhealthy behaviors of physicians

Elaine Khoong, MD

Physician

August 17, 2014

As a fourth-year medical student, it was fairly easy to maintain a healthy lifestyle. When you have much leisure time and are relatively stress free, you can eat healthy, stay physically active and maintain quality mental health. However, as I begin the journey called residency, it is clear that the task of maintaining my own health will be much more difficult.

But the importance of this task should not be overlooked. …

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The unhealthy behaviors of physicians

Using technology to improve medication compliance

Kevin R. Campbell, MD

Medications

August 17, 2014

It is clear that patient compliance with prescribed medications is critical to success in the treatment of any chronic disease process. In addition, patient engagement and co-management of their disease has been proven to improve outcomes. A new study from the Annals of Internal Medicine suggests that any changes in the appearance of a medication may result in a decrease in compliance; when a pill looks differently patients often simply …

How to get the most out of your pediatrician’s checkup

Roy Benaroch, MD

Physician

August 17, 2014

In a recent post, I wrote about the value of a yearly checkup with your child’s doctor — it can be a whole lot more helpful than a quick sports physical at the local quickie-clinic. You can be sure to get the most out of your child’s checkups with these tips.

First, and most important at all, go to the visit. You’d be surprised how often children are brought by …

MKSAP: 19-year-old man with a sore throat

mksap

Conditions and Diseases

August 17, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 19-year-old man is evaluated for a sore throat, daily fever, frontal headache, myalgia, and arthralgia of 5 days’ duration. He also has severe discomfort in the lower spine and a rash on his trunk and extremities. He returned from a 7-day trip to the Caribbean 8 days ago. The remainder of …

Drug testing doctors: Will Californians see through the smoke?

Michael Kirsch, MD

Physician

August 16, 2014

California is contemplating requiring physicians to submit to alcohol and drug testing. Citizens there will be voting on this proposal this November. I do think that the public is entitled to be treated by physicians who are unimpaired. Physicians, as members of the human species, have the same vices and frailties as the rest of us.

I have no objection to this new requirement, if it passes. This will not be …

Bring your daughter to work: A reminder of what’s important in medicine

Wes Fisher, MD

Physician

August 16, 2014

“Dad, you have the nicest patients!”

She was right, of course. Daughters that you bring to work with you to shadow for a day can bring you back to what’s important in medicine. In fact, seeing medicine through fresh eyes is helpful, especially when we forget to look up from our work-a-day lives.

It had been over ten years since I had my first “bring your daughter to work” experience. Her first time …

Medicine has lost sight of the big picture

Hans Duvefelt, MD

Physician

August 16, 2014

We must bear in mind the difference between thoroughness and efficiency. Thoroughness gathers all the facts, but efficiency distinguishes the two-cent pieces of non-essential data from the twenty-dollar gold pieces of fundamental fact.
– Dr. William Mayo

The practice of medicine involves a lot of details, but details without the big picture are meaningless at best and distracting at worst.

The expression, “the devil is in the details” implies that the details can …

Quality measures benefit from quality improvement

David B. Nash, MD, MBA

Health Policy

August 16, 2014

I am a long-time proponent of measuring provider performance and aligning it with payment as an effective means for improving the quality of care and with it, patient outcomes.

Because of this, I welcomed the value-based purchasing concepts and quality improvement initiatives that are fundamental to the Affordable Care Act (ACA).

But, as in so many things, the devil is in the details and, despite their best efforts, measure designers can’t always …

Incorporating urgent care into the medical home

Fred N. Pelzman, MD

Physician

August 16, 2014

During her annual physical exam, one of my patients recently asked me, “Are urgent care centers any good, Dr. P?”

She recounted an incident a few months earlier where she awoke with an acute illness and was sick enough that she felt she needed to receive care — at least some medical attention — more imminently than she could get from waiting to speak to my office in the morning. She …

MKSAP: 57-year-old woman with decreased exercise tolerance

mksap

Conditions and Diseases

August 16, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 57-year-old woman is evaluated for a 2-week history of decreased exercise tolerance and substernal chest pain on exertion. She also has an 8-month history of macrocytic anemia.

On physical examination, temperature is 36.7 °C (98.0 °F), blood pressure is 137/78 mm Hg, pulse rate is 104/min, and respiration rate is 17/min. BMI …

Consider the messages that tattoos are sending

Edwin Leap, MD

Physician

August 15, 2014

shutterstock_186576560

Ink is everywhere these days, and I don’t mean on newspapers or in magazines. Tattoos are far more pervasive than I can ever recall in my fifty years. There was a time, when I was young, that boys were awestruck by the old Navy veterans, whose arms bore anchors, and the Marines with Semper Fi across their battle-scarred chests. Occasionally, …

Are American doctors paid too much or too little?

Kevin Pho, MD

KevinMD

August 15, 2014

A version of column was published in USA Today on July 2, 2014.

There are some who think that I’m overpaid as a physician, and that my salary fuels rising health costs. I can understand their point: A May 2014 survey released by the Medical Group Management Association found that internal medicine doctors like myself have a starting median annual salary of $190,000, …

Reducing health care costs is a team effort

Megan Sanders-Sneller

Medications

August 15, 2014

There are several different scenarios that I can think of in the past four years of pharmacy school that exhibit the high cost of prescription health care. Prescription medications are constantly becoming more expensive. Patients are unaware of their prescription benefits and how prescription insurance works. It leads to a lot of frustration for pharmacies and patients on a daily basis. However, every now and then there is something that …

A relationship between a surgeon and an intensivist

Sid Schwab, MD

Physician

August 15, 2014

Not too long after setting up shop in this town, I shared a tough case with one of my favorite intensivists.

(By way of diversion, I’ll add there were only two of them at the time, and they were both my favorites. Practical and canny, surgical-patient-wise, they were a pleasure to work with. Over the years we developed great mutual respect and affection; to the extent that caring for critically ill and deeply …

How perception of the patient transformed in a single visit

Gregory Bledsoe, MD

Physician

August 15, 2014

Have you ever had a situation where your perception of some event or entity changed dramatically in an instant?

I specifically remember an instance of this happening to me while working as a junior medical student in a family practice clinic.

It was a typical day and I was doing the typical thing that you’re supposed to do as a medical student — feign interest in the clinic’s goings on and try …

The 7% plan to fix primary care

Charles Smith, MD

Health Policy

August 15, 2014

This is a simple plan that would empower patients, improve the lot of primary care physicians and likely hold down medical costs while improving quality in the health care system. I would first like to present the plan, then elaborate on how it could accomplish the above objectives.

The first part of the plan would set aside a portion of each person’s health care dollars (i.e., insurance premiums) and place it …

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The 7% plan to fix primary care

Fixing the physician-patient relationship

Duncan Cross

Patient

August 14, 2014

I wish I had a dollar every time someone gets misty-eyed about the physician-patient relationship — and two dollars every time they say protecting it is the key to health care. That might be true, if you thought health care was awesome circa 1960.

Hereʼs what the physician-patient relationship meant back then: Physicians say, patients pay. We have seen little progress since then. The claim that the relationship is now symmetrical …

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