Physicians writing on KevinMD about the primary care shortage, the fifteen-minute visit, panel size, what primary care is paid against procedural specialties, continuity, and the administrative load that has grown around the work. Four maintained records draw on this archive: Primary care: what physicians say, in their own words, Direct primary care: what physicians say, in their own words, Prior authorization: what physicians say, in their own words, and Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words.
A few weeks ago, I was giving a day-long seminar in California on improving communication skills, optimizing the patient experience, and how this is all ultimately linked to better proven outcomes. Part of the day involved doing role plays, playing the part of doctors and patients in various difficult hypothetical scenarios.
My experience of this type of group exercise is that all clinicians usually really enjoy it, when it’s done in …
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Imagine yourself treating a celebrity
Earlier this week, I was pleased to learn that my practice had achieved a statistically significant increase in box clicking.
In reviewing data from our accountable care organization, graphs were shown to us demonstrating improved compliance with several of the measures that they’ve instituted institution-wide for the purpose of reporting back to Medicare on how well we are taking care of our patients.
One of these measures is the ever popular “falls …
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Clicking checkboxes doesn’t meaningfully improve care
The other day I felt like a used car salesman.
I was carefully phrasing my words, picking out just the right ones — the kind that really pack a punch — and delivering them at the right moment, with the perfect momentum. I was trying to make a sale.
Now, my cadence happened to be spot on, as I approached the finish line: the part where I get to package it all up. …
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Your doctor may need lessons from a used car salesman
My country rotation as a medical student was overshadowed by a heated argument between the general practitioner and his wife. She was sacrificing her life in this “hole of a place” and angrily stormed out to visit her children in boarding school in the city. Decades later, I now understand the frustration and challenges of rural general practice for a doctor, who is also a mother:
Being ignored in the street …
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Where this physician finds joy in medicine
I saw two patients with a chief complaint of bubbles in their urine this month.
One middle-aged woman had eaten some wild mushrooms she was pretty sure she had identified correctly, but once her urine turned bubbly a few days later, she came in to make sure her kidneys were OK.
Even though she was feeling quite well, they were not, and she ended up going straight to Cityside hospital for IV …
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It’s the physician’s job to think of worst-case scenarios
I practiced general internal medicine from June 1979 until November 2003. Immediately after training, I became an employed physician of an older internist covering my employer’s patients and building my practice for two years before embarking on my own.
I saw 20 or more patients per day in addition to providing hospital care and visiting patients as they recovered in nursing homes. As managed care made its clout felt by kidnapping …
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A physician celebrates 15 years in concierge medicine
I spent my first two years of medical school collecting stories. I journaled about my thoughts in the anatomy lab. I wrote about what it was like to learn how to interview and examine patients, about the immense honor and privilege I felt just being able to don a white coat with a stethoscope around my neck. I wrote about the patients that touched my heart – the patient with …
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One of the biggest lessons medical school can teach you
The California Department of Justice mandate to consult CURES (Controlled Substance Utilization Review and Evaluation) prior to prescribing, ordering, administering, or furnishing a Schedule II, II or IV controlled substance becomes effective on October 2, 2018.
The law states that CURES must be consulted the first time a patient is prescribed, ordered or administered a Schedule II, III or IV controlled substance. CURES must be consulted every four months thereafter if the …
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CURES is not a fix for the opioid crisis
I’m proud to announce that I have partnered with Health eCareers to launch Careers by KevinMD.com: a new, dedicated career center ready to support your career at every stage.
Whether you’re ready to make the leap to a new job or just keeping your ear to the ground, there’s something here for every medical professional.
Here are some …
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Welcome to your new career center!
Does the flu shot cause the flu?
Let me tell you, without a doubt, that the flu shot does not give you the flu. This is perhaps one of the most common misconceptions I hear as a physician. People absolutely swear by it. I’ve even had people tell me that family members got the flu shot and then died suddenly. I’m sympathetic, but how misguided!
Before we talk more about the flu …
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No, the flu shot doesn’t cause the flu
A thought, a word, a story. Simple concepts in a complex world, but they can have a profound effect on how we live our lives. Today’s world may seem, at times, a blur. We are inundated every day with headlines of natural disasters, man’s inhumanity to man, and simply, just life slapping us in the face. How can we maintain a sense of sanity and security when the world around …
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Every patient has a story
I was walking in the store the other day and ran into a recently deceased elderly patient’s relative. As he walked by, I thought to myself, I better stop to say I am sorry. So I shouted to him, “Hey how are you?” He paused, and I continued to walk over and proceeded to offer my condolences. I stated “I am sorry about the death of your loved one. I …
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Medical training can’t prepare us for the loss of patients
So many moving parts.
Just last week, a patient I’ve cared for over 20 years came to see me, and she was despondent over a number of issues.
First and foremost was that her partner of over 60 years has had progressive dementia, and finally things got so bad that he had to be transferred to a long-term care facility, no longer safely able to be cared for at home despite all …
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Health care has too many moving parts
It’s been said in the world of business that people only buy two things: good feelings and solutions to problems. In medicine, the single most important factor that brings patients through our doors isn’t a “toward” kind of desire, but an “away” one — away from feeling bad.
More specifically, it is pain and fear that most often cause patients to call and ask for an appointment. They hopefully leave with …
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Real doctoring means mitigating the fear patients have
A doctor writes prescription, pharmacist fills prescription, insurance covers prescription. Simple, right? But that’s not the way it works anymore.
Some changes are good. Gone are the cryptic abbreviations and illegible handwriting — replaced by computer printed scripts, or better yet scripts magically transmitted via the ether. But along with fewer errors there’s even less transparency on pricing and coverage. Patients, who haven’t been to pharmacy school and couldn’t possibly decode the pages of …
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Tips to help you afford medications
Physicians everywhere are having to deal with ever-shrinking time slots with their patients. Every doctor (or nurse) would love to have more time if possible, and it’s probably one the biggest frontline frustrations for any clinician who wants to do a good job. Time to go over the history in more detail, examine the patient thoroughly, and then spend adequate time discussing everything afterwards. Wouldn’t that be nice?
The reality though …
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How to make the most of rushed physician visits
Ironically, the same electronic health records (EHRs) initially designed as a tool to help physicians diagnose diseases have largely evaded diagnostic scrutiny. Talk to physicians who utilize them on a daily basis, however, and it becomes abundantly clear that today’s EHRs are ailing. They are adding hours to the physicians’ workday, siphoning attention from patient care, and sowing the seeds of demoralization across the profession of medicine. To address this …
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The impaired interactivity of EHRs
I sit before you and others like you, in silence, anxious about what I might be told. You deliver a litany of questions to my countenance as I sit in a chair beside you. Your attention is diverted to the cold and detached computer screen where my responses are entered without you ever noticing the fear in my eyes. There is no acknowledgment to indicate a level of understanding of …
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A patient waits. And waits.
When I’m working in a hospital setting as a physician, part of my everyday job duties involves going over consent forms with patients. I am of course a medical physician, rather than a surgeon, so generally don’t have to go over them as often. But I do have to take consent regularly for certain interventions including blood transfusions and minor procedures. The process of getting consent is something everybody is …
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The trust patients place in their doctors
