I never considered any specialty other than family medicine. I always saw the other specialties as necessary but supportive adjuncts. I always thought that the other specialties were all fascinating in their own way but saw them more as a part of a library that I could access when needed rather than ever feeling the need to delve deep into any specific subject. Specialists were the masters of the marvels …
I was misinformed about medical school. Growing up, I wanted to help people become healthy. After four years at the Ohio State University Medical School and three years of a family medicine residency, I still did not know enough to accomplish my goal. My training allowed me to become a disease-care expert, not a health care specialist. I was taught little to nothing about nutrition and true disease prevention. Despite …
In 2013, the American Medical Association (AMA) announced its decision to classify obesity as a disease, moving against the recommendation at the time of a group studying obesity. Yet there are still those who believe that obesity is not a disease but rather a “condition,” and this has downstream ramifications for health policy, health care provider reimbursement, and, ultimately, societal health and well-being. But this is …
An 82-year-old woman is evaluated for a 1-week history of urinary incontinence with lower abdominal discomfort. She reports no dysuria, fever, or back pain. Medical history is significant for hypertension and allergic reaction to sulfa drugs, which cause a generalized rash. Her only medication is amlodipine.
On physical examination, temperature is 36.8 °C (98.2 …
When a patient calls up to schedule an appointment, or sends us a message through the patient portal, or calls our front desk staff to leave a message, what is it that they’re looking for?
I think, more than anything else, our patients are looking to us as health care providers to be able to be there for them, to address their health needs …
The health care experience is so much more than a buzzword to be talked about in administrative circles. Some physicians I encounter (a minority, but still enough) really scoff when they hear this term. Responses I’ve heard from doctors include: “Hospitals are not hotels!” or “If that means giving our patients as much Dilaudid as they want, then count me out!”
Aside from these sweeping statements being entirely silly, they are …
Many patients who end up in Suboxone treatment have chronic pain. They were originally prescribed other opiates and ended up addicted to them.
Skeptics argue that is just substituting one opiate for another. But that isn’t quite accurate. More on that in a bit.
In my seven years of prescribing Suboxone for opiate addiction, I have often observed how potent a pain reliever this medication is, even in fairly low doses. More …
The vein stands up proudly. It’s good to look at; it’s inviting. The tourniquet is satisfyingly tight, the syringe waits like a shark on the bedside table, the new orange needle catches a glint of …
We know the statistics. More than 50 percent of physicians are experiencing burnout at the hands of EMRs, a nonexistent work-life balance and regulatory constraints to name a few. This is causing physicians to leave clinical medicine and find other work. Some are opting for nonclinical administrative roles, and others are leaving altogether for careers outside of medicine. This is adding to the shortage of physicians that we were already …
Among the many recurring topics, this year has been the impact of machine learning in our lives, especially the implications for our future work life. Prophecies range from ubiquitous utopian machine servants to a dystopian ravaging, hollowing out the work and economic standing of the middle and lower classes. “What can machine learning do? Workforce implications” by Erik Brynjolfsson and Tom Mitchell in Science provides some perspective on machine learning …
This is not a story about anti-vaxxers. This is a story about primary care.
Running a smaller practice, as I do, has inherent rewards and challenges. There is literature on both sides of the Atlantic that patients prefer small practices. Lately, consolidation of practices has been frequent, mostly under the auspices of hospitals, sometimes into larger private groups. Although vertical integration appears to have increased costs and by various mechanisms inadvertently …
When George W. “Billy” Campbell, MD, walks down the street, he never knows who — or what — he’s going to encounter. Anything can happen when you’re the doctor at Foothills Family Medicine of Westminster, South Carolina, a small town with a population of only 2,500.
For longer than anyone could remember, he was the rural community’s pharmacist. A skilled compounder of prescriptions, he was conversant in chocolates, greeting cards, and how to obviate a trip to the doctor’s office by using an over-the-counter remedy.
A devoted family man, he was involved in many civic and church activities. Most have forgotten all the roles he once played in the community, but no one will ever forget that …
I came across Dr. Kevin Tolliver’s post, “Beware the Limits of Telemedicine,” and found it to gloss over the benefits of telemedicine and the opportunities that increasing telemedicine uptake can afford to the patient and provider. With this post, I aim to show that these opportunities for systemic change to the health care delivery model – particularly driven by telemedicine – surpass the listed limitations of telemedicine.
At a quality and patient safety meeting recently, one of the departments was presenting their annual report on all they have done, reviewing progress that has been made around several quality and patient safety initiatives.
One of their project centered on efforts to decrease an incredibly high no-show rate.
Coupled with their desire to avoid overbooking appointments, the problem has compromised patient access, both for their own established patients and for new …
The United States spends more on health care per capita than any other country in the world — yet health outcomes continue to fall short. In order to close the spending gap with other countries, United States health care policy must focus on reducing costs. While a variety of suggestions have been put forth by economists and medical professionals on how to cut spending and improve health, one Read more…
Several years ago, a group of us concerned about health care costs and outcomes met with some local HR benefit managers. One was the head HR person of a city. In part of the conversation, she raved about a local chain of urgent care centers. She loved the fact that she could go to one after work to get her steroid shot for her colds. I had enough experience dealing …
Back when cholesterol target numbers ruled unopposed (before 2013), we all checked fasting lipids every three months. Before 2012, we also checked liver function quarterly in hapless riders on the cholesterol pill merry-go-round. That year the FDA announced there had not been enough reports of statin-induced liver problems to recommend routine monitoring.
I have many colleagues who still do this, and who also routinely monitor routine labs quarterly …
Shock. Horror. Did you just read the title correctly, or are you seeing things? Well, after you recover from the shock of reading a line you probably never thought you could possibly see in writing — let me tell you this: Physicians and politicians are probably as opposite as you can imagine in terms of their daily work life, guiding principles, and yes, level of respect shown to them by …
Physician well-being is a major focus of many physician organizations and is frequently highlighted in popular media. Some have described the root of the problem as a disconnect between expectation and reality. This is a helpful framework for situations that result in disappointment. I recently rented a house on Airbnb. Eagerly anticipating our vacation, I was dismayed to find upon arrival that the house lacked electricity and water. Camping in …
