The term “open access” in the context of primary care means that patients are able to get an appointment whenever they wish.
The ultimate in open access is 24/7 availability. No, I don’t offer this, although I come pretty close. I’m available by cell phone virtually 24/7 and I’m also almost always willing to come in and see someone if they really need to be seen. This seldom happens. Most of …
Is there a downside to open access scheduling?
I’ve been a doctor for twenty years. I’ve not lost a single patient to suicide.
I’ve lost only colleagues, friends, lovers — all male physicians — to suicide.
Why?
Here’s what I know:
A physician’s greatest joy is the patient relationship.
Assembly-line medicine undermines the patient-physician relationship.
Most doctors are burned out, overworked, or exhausted.
Many doctors spend little time with their families.
Workaholics are admired in medicine.
Medicine values …
Next in a series.
Primary care physicians (PCPs) are becoming extinct. It’s true. Not many medical students choose primary care as their career path. Older PCPs are retiring early. Many others are closing their practices or seeking employment at the local hospital. And there has always been a shortage of primary care physicians in rural and urban poor areas. Today only 30% of all physicians practice primary care (compared to …
Why is there a shortage of primary care physicians?
There are few professional careers centered around protecting and caring for others that garner so much verbal and physical abuse than a career in emergency medicine. Mental health workers, police, fire, and EMS personnel are the other fields that come to mind when I think of a service that “helps” people yet gets abuse dished upon them on nearly a daily basis.
A 2006 survey of emergency nurses showed that 25% …
When patients abuse emergency department workers
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
February is American Heart Month. Unfortunately, heart disease is a major problem in the United States that can result in surgery. In addition to discussing your procedure with your surgeon, you want to be sure to discuss your anesthesia care with your physician anesthesiologist.
Here are …
10 things to know about anesthesia and heart surgery
I was 8-years-old in June 1963 when the Readers’ Digest arrived in the mail inside its little brown paper wrapper. As usual, I sat down in my favorite overstuffed chair with my skinny legs dangling over the side arm and started at the beginning, reading the jokes, the short articles and stories on harrowing adventures and rescues, pets that had been …
The influence of Janis Babson can be felt by many physicians
I came across a really good post on the Daily Beast written by a pediatrician in New England, griping (appropriately) about parents who were unwilling to trust his judgment about vaccinating their children.
Why have so many patients lost trust in their doctors?
You might challenge the assumption that patients used to trust their doctors more, and that would be a fair question. I haven’t …
Why patients have lost trust in their doctors
This morning I went for my annual mammogram. It’s not something I generally look forward to. In fact, I mildly dread it.
In my personal experience, mammograms have ranged from quite uncomfortable to downright painful. And then there’s the general unpleasantness of standing topless in a cold room. The first time I had this screening imaging study done, the plate pressed so hard into my sternum that I was almost in …
Everyone should have a pleasant mammogram experience
The flu, RSV, colds, croup, strep throat, ear infections. They all have one thing in common: they can cause fevers. And as any parent can attest to, it’s often the fever itself that freaks us out more than anything and prompts many parents to call their child’s pediatrician or hustle them off to the emergency room.
Fever is clearly not a parent’s …
5 truths about fevers in children
Next in a series.
Primary care physicians (PCPs) have too little time per patient which means too many referrals to specialists, too little time listening and thinking, no time to delve into the stress or emotional causes of many symptoms and substantial frustration by PCP and patient alike.
Previously in this continuing series on primary care, I described a patient with a straight forward if unusual symptom who was bounced …
What is the main cause of the primary care crisis?
During my internal medicine rotation, the medical students had the opportunity to attend intern morning report, an interactive teaching session where attending physicians walk the interns through a patient’s story, starting from the moment they hit the door of the emergency room to the final stages of diagnosis and treatment.
After discussing the patient’s symptoms, complaints and past medical history, the attendings always ask the group to think carefully about the …
Shotgun medicine: An arrow is often better
Hospitals are commonly thought of as the safest place to be for sick people.
Patients have around-the-clock access to skilled care teams. Their vital signs are continuously monitored. A physician stops by every morning to check on them.
While it all sounds safe, a hospital can be a very dangerous place to be. Here are four frightening risks hospitals pose, along with their causes and some easy-to-implement solutions that could save hundreds …
4 reasons why hospitals can be very dangerous places to be
Before the adoption of new technologies which will undoubtedly improve health care (as it has the retail and finance sectors), it must be introduced in ways which are digestible, scalable, and subject to rapid iteration.
Is mobile technology different from the adoption of any other change in health care delivery? I think not. The culture of care certainly requires change as care models are changing. The point of care is shifting to the home, professionals …
5 ways to improve the adoption of medical apps
Ever felt misjudged by a doctor? Or treated unfairly by a clinic or hospital? You may be a victim of patient profiling.
Patient profiling is the practice of regarding particular patients as more likely to have certain behaviors or illnesses based on their appearance, race, gender, financial status, or other observable characteristics. Profiling disproportionately impacts patients with chronic pain, mental illness, the …
Are you a victim of patient profiling?
“What’s a high-risk patient?” asked our newly hired care coordinator.
Interesting question, and, as you would expect, one without an easy answer.
One of our patient-centered medical home certifying agencies was performing an audit for recertification, and requested information on our high-risk patient registry, including how patients were identified and assigned to the registry.
When you ask doctors or any other providers, we all know one when we see …
‘Tis the season to be coughing …
It no longer takes an epidemiologist looking at absenteeism rates in schools to predict the start of influenza season. For several years now there have been sophisticated models using search engine terms to monitor increasing incidence of febrile cough illness in regions of the world.
Or just ask a primary care clinic what its waiting room sounds like these days. A chorus of coughs, high, low, dry, …
Treating post-viral coughs: This too shall pass
Where I come from, when most people refer to the Good Book, they are referring to the Bible. This is not true for my father, because to him, the Good Books are something else entirely.
He describes a scene early in his career as a plastic surgeon, when he had taken his doting mother to see his new office. Coincidentally, a lovely thank you note had just arrived from one of …
When patients write to doctors, and what it means
Justin Bieber was arrested recently in Florida for a DUI. The smirk on his face is a bit misplaced. While it’s no longer a surprise when we hear about a celebrity’s challenge with drugs and alcohol, Bieber serves up a perfect moment for education. I mean this kid (he’s 19-years-old) really could have killed himself last night. Thank goodness he’s …
Use Justin Bieber as a teaching moment for kids
I’ve spent the past four weeks learning about primary care on my family medicine rotation. A significant portion of patient care in this setting is focused on health maintenance or disease prevention. Physicians can provide their patients with evidence-based recommendations for various screening tests and vaccinations, but it is ultimately up to the patient to decide what services he or she will receive.
According to the Centers for Disease Control and …
Refusing the flu shot: Respecting the patient’s right to choose
An article published in the New York Times last weekend has been circulating widely on the Internet, and I feel that more than ever, physician voices are needed to reach the public and counter certain misconceptions put forth by the media.
The article, “Patients’ Costs Skyrocket; Specialists’ Incomes Soar,” charts the growth of specialist incomes in the past decade, using the case of a patient from Arkansas who had a …
Mohs surgery is vilified, physicians again fail to respond effectively
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