Niran S. Al-Agba, MD

Invest in primary care and you get what you pay for

August 26, 2016Aug 26, 2016

In 1978, the Institute of Medicine published A Manpower Policy for Primary Health Care: Report of a Study where they defined primary care as “integrated, accessible services by clinicians accountable for addressing a majority of heath care needs, developing a…

The four main features of “good” primary care based on this definition are: 1. First-contact access for new medical …

Physician outcomes should be quality measures

August 20, 2016Aug 20, 2016

Quality measures began as tools to quantify the health care process, using outcomes, patient perceptions, and organizational structures associated with the provision of high-quality health care. Overall, the goals should focus on delivery of care that is effective, safe, efficient, and equitable. Did you notice a particular word missing? Yes, I missed the word physician too, because they have been left out of the conversation entirely.

Measuring quality health care by …

How this pediatrician practices medicine. Her way.

August 11, 2016Aug 11, 2016

My thoughts settled on the Frank Sinatra song, "My Way," when asked about necessary resources for rural health care to survive. Seven years ago, my father and I changed office buildings. We closed the office that Friday to allow three…

My thoughts settled on the Frank Sinatra song, “My Way,” when asked about necessary resources for rural health care to survive. Seven years ago, my father and I changed office buildings. We closed the office that Friday to allow three full days to get settled. However, we ended up seeing sick patients in the parking lot (seriously), while the movers were loading up the truck.

“All we need is a stethoscope, …

MACRA will do to medicine what No Child Left Behind did to education

August 4, 2016Aug 4, 2016

Why must we keep repeating history? NCLB significantly increased the federal role in education by holding schools accountable for the academic progress of all students. NCLB held teachers responsible for education of children; MACRA-proposed changes will hold physicians responsible for…

Why must we keep repeating history?

NCLB significantly increased the federal role in education by holding schools accountable for the academic progress of all students. NCLB held teachers responsible for education of children; MACRA-proposed changes will hold physicians responsible for the medical progress of our patients. The largest problem with this approach is students and patients go home each day to whatever environment in which they live. Neither teachers nor physicians …

To fix rural health care, you have to understand it first

August 2, 2016Aug 2, 2016

Recently, physicians in small private practices and rural areas breathed a collective sigh of relief. There is a possibility the implementation of changes to physician reimbursement (known as MACRA) could be delayed. Thank you, Mr. Slavitt, for listening. I am grateful to Orrin Hatch (R-UT) and Ron Wyden (D-OR) for keeping our rural needs in mind. We have a window of opportunity for rural health care to survive, but we …

How MACRA will decimate the private practice physician

July 20, 2016Jul 20, 2016

Small, independent private practices are closing, increasing numbers of physicians are retiring, and fewer medical school graduates are choosing primary care. The old-fashioned practice my father and I have built is a dying entity. Parents say coming to see us for an appointment feels more like a visit with a friend than a medical encounter. I am fighting for the survival of primary care practices. MACRA proposed reimbursement will decimate …

Providing comfort to another tiny human being is absolutely breathtaking

July 14, 2016Jul 14, 2016

This story has been on my mind for many years, but each time I have sat down to write it, the words would not fall into place. The other day, a family mentioned having their “rainbow baby” referring to a…

This story has been on my mind for many years, but each time I have sat down to write it, the words would not fall into place.

The other day, a family mentioned having their “rainbow baby” referring to a child born after a tragedy. To me, rainbows symbolize that even after the roughest storm, things can get better. To see a rainbow, there must be moisture, like falling rain, in …

A physician responds to Sarah Kliff

A physician responds to Sarah Kliff

July 4, 2016Jul 4, 2016

A response to Unpaid, stressed, and confused: Patients are the health care system's free labor. Dear Sarah, I am genuinely sorry about your chronic foot injury. Thank you for your insightful article and feedback. You are correct the system is…

A response to Unpaid, stressed, and confused: Patients are the health care system’s free labor.

Dear Sarah,

I am genuinely sorry about your chronic foot injury. Thank you for your insightful article and feedback. You are correct the system is fragmented and places “considerable burden” on patients to “coordinate their own care.” You (the patient) and me (a physician) are now in the same boat, headed the same direction with the …

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The humiliation a nursing physician faced during her board exam

July 2, 2016Jul 2, 2016

To the American Board of Pediatrics: I took and passed my recertification exam in Washington State last fall and would like to express my sincere gratitude to your organization for setting up more hoops for pediatricians to jump through under…

To the American Board of Pediatrics:

I took and passed my recertification exam in Washington State last fall and would like to express my sincere gratitude to your organization for setting up more hoops for pediatricians to jump through under the guise of helping us stay up-to-date. The first hurdle was the exam application and the second was the testing day experience, which was one of the most humiliating of my …

Physicians have a duty to respond to emergencies if they can

June 27, 2016Jun 27, 2016

“Someone else will lend a helping hand,” a physician told me once, when asked to help with an emergency in public. As a PALS instructor for more than a decade, I have always responded when possible. In the last decade, there have been three in-flight emergencies, two elderly individuals who passed out in church, and a host of other less serious maladies. A week ago, I discovered the best reason I …

The public needs to see physicians as human

June 18, 2016Jun 18, 2016

Physicians today are not held in the same high esteem as they used to be. We are often portrayed as callous, intolerant, clutch-fisted, know-it-alls who schedule patients around our daily golf game. (For the record, I do not play golf.)…

We are human beings: mothers and fathers, sisters and brothers, sons and daughters. Like everyone …

A child’s father knew when to let go. The health care team didn’t.

June 2, 2016Jun 2, 2016

Physicians are accustomed to seeing patients at the end of their lives. It is difficult to let families know they may lose their loved one. Clinicians are often accepting of patients DNR orders before family members are ready. This story is about a time where the health care team was ill-prepared, yet a parent made the difficult decision to discontinue intervention. It taught me an unforgettable lesson.

During the first ICU …

Maybe it’s time to go back to index cards for medical records

May 25, 2016May 25, 2016

During our dermatology section in medical school, a classmate recounted having had Henoch-Schonlein purpura as a child. Over a holiday break, he visited his primary care physician and asked if he could review his records out of curiosity. His family physician pulled out the index card that served as this man’s medical record. Yes, you read that correctly. It was not a chart or computer printout; rather a 4 x …

My relationships with patients last generations

May 16, 2016May 16, 2016

At 6 a.m. one morning, I was playing tennis at our local athletic club a few months ago. Sam, working at the front desk came running down onto the courts. “There is an emergency and a woman on the phone…

I will be honest; I panicked a little. My husband was home asleep as were my four children. My thoughts as I raced up two flights of stairs …

This pediatrician learned why it’s so important to listen to a parent

May 8, 2016May 8, 2016

Medicine can wear down our hearts and souls. My journey in pediatrics has been filled with many rewarding experiences but haunting ones as well, like this one from my third year of residency. By that final year of training, I was no longer certain medicine was really the right choice for me. I was struggling with the notion that after almost 11 years of education, the destination was not quite …

Conditions

Vaccinations are more about trust than science

April 26, 2016Apr 26, 2016

I am going to confess that I am my children’s pediatrician. I have given them every vaccination they have ever had and probably would not trust another provider to do it. I endorse the vaccination schedule recommended by the American Academy of Pediatrics; I believe it is safe and prevents disease. I completed medical school and three years of pediatric training that helped shape this belief. I have seen death …

How a physician suicide 30 years ago affected this doctor today