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.

Can direct primary care save us from the tapeworms of insurance?

Health Policy
August 24, 2018

When Amazon, Berkshire Hathaway, and JP Morgan (AmBerGan) announced their health care partnership, Berkshire CEO Warren Buffett declared “the ballooning costs of health care act as a hungry tapeworm on the American economy.”  He is right. Our broken system is infested with tapeworms. Tapeworms are parasites; they exploit their hosts, drain resources, and suck the life out of their prey. Unfortunately, Buffet failed to call attention to the tapeworms specifically; …

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Can direct primary care save us from the tapeworms of insurance?

It’s time for an army of people to help take care of our patients

Physician
August 23, 2018

This was the end-of-the-hallway conversation with an elderly patient after wrapping up a recent office visit, as we walked away from the exam room toward the front desk to schedule her follow-up appointment, and she realized that we were “celebrating” 20 years together.

I met her when she was admitted as an inpatient when I was on service as a junior attending just starting out, and after going home she came …

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It’s time for an army of people to help take care of our patients

Physicians can’t take things personally. Here are some tips.

Physician
August 22, 2018

A natural part of life is emotionally growing (hopefully) with experience. If I was to look back at my own journey, when I was in medical school and just graduating, I would say that without doubt, one of the biggest things I would tell my younger self, would be to not take things too personally. This would be particularly true in professional situations.

I look back at how personally I used to …

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Physicians can’t take things personally. Here are some tips.

The problem with telephone messages in primary care

Conditions and Diseases
August 21, 2018

Sometimes I wonder if I am wired differently from other doctors, in terms of what I remember on my own and what I need some help with.

The other day I got a “medical call” that simply said, “Mr. Brown called to report his blood pressure is 120/80.”

With more than fifty calls in my inbox and no memory of what the issue was with Mr. Brown’s current blood pressure, I replied: …

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The problem with telephone messages in primary care

A strong doctor-patient relationship: why it matters

Physician
August 20, 2018

Writing in Annals of Family Medicine a few years ago, Chicago obstetrician Benjamin P. Brown vividly described his mentor’s interaction with a patient who had just emigrated from Mexico and had no family support. “When he asked earnestly how she was doing, her hard-won defenses seemed to crumple, and all of a sudden she was sitting on the exam table, sobbing,” Brown wrote. “I watched, rapt, as Dr. Gonzales — …

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A strong doctor-patient relationship: why it matters

A physician contemplates Medicare blended rates

Health Policy
August 15, 2018

I am a terrible coder. I think I am a pretty good doctor, but when it comes to coding, the process of figuring out which billing code to pick to assign to a bill for an office visit, I am hopeless. No matter how many times I have had the rules explained to me, or how much feedback I have been given about specific visits, or which “pocket guide” to …

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A physician contemplates Medicare blended rates

Sorry doctor, you’re already an actor

Physician
August 14, 2018

Following one of my recent articles on how physicians can improve their communication skills and ultimately help attain better patient outcomes, I received an interesting comment from a physician. It went something like this: “Sorry, but I’m not an actor.”

This response typifies a small (but not insignificant) subset of responses I get when I’m discussing and promoting techniques that any doctor can utilize to better their skills in this area …

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Sorry doctor, you’re already an actor

Making the world a better place for new medical interns

Medical Education
August 13, 2018

It’s that time of year again.

The start of a new academic year, marked by the arrival of a brand-new class of interns starting out in their training.

Clutching their freshly-minted medical degrees, they appear so ready, so anxious, so excited, so eager to learn.

Now it’s our job to make sure they stay this way.

(Have I written this column before? Every year …)

We need to make sure we have a world where …

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Making the world a better place for new medical interns

The nuances of a primary care visit aren’t always appreciated

Physician
August 12, 2018

I subscribe to a financial newsletter that happens to be written by a non-practicing physician in a highly specialized field. His daily updates are a mixture of financial and health advice, and he is a proponent of evidence-based medicine. Based on the letters from subscribers, they are willing to follow his advice eagerly, and when he gives some references to support his medical opinions this seems logical. But he is …

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The nuances of a primary care visit aren’t always appreciated

Atul Gawande’s prescient 2012 TED talk

Health Policy
August 12, 2018
YouTube video

Health care is buzzing as Atul Gawande has been selected as CEO of the Berkshire-Hathaway/Amazon/JP Morgan strategic venture. I was thrilled they picked a physician, like myself, in the trenches to run their gig. After hearing the news, I remembered Gawande’s TED Talk from 2012 and decided to catch up on it during my flight to the Healthcare Finance Management Association Annual Meeting and Innovation Lab.

After watching the …

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Atul Gawande’s prescient 2012 TED talk

Don’t throw the E&M baby out with the bath water: the proposed CMS changes

Health Policy
August 11, 2018

By now, everyone has heard that the Centers for Medicare and Medicaid Services (CMS) has proposed to dramatically change how physicians get paid for evaluation and management (E&M) services in the office as part of the proposed 2019 Physician Fee Schedule Rule. In fact, as of the end of July, CMS has received over 600 comments on the proposed rule, with virtually all of them criticizing the proposal. I suspect …

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Don’t throw the E&M baby out with the bath water: the proposed CMS changes

What parenting has taught me about doctoring

Physician
August 10, 2018

Last year, my high school aged son took an interest in healthy eating. He began examining nutrition labels and scrutinizing the foods that we routinely keep around the house and came up with a list of criticisms and suggestions — some well-founded, and others a bit extreme. At first, my wife and I were quick to debate him on certain choices like eliminating any breakfast cereal that has enough sugar …

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What parenting has taught me about doctoring

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A better way to handle patient handoffs from the hospital

Physician
August 4, 2018

As we all know, the time around discharge from the hospital is a tricky one.

In more ways than one can imagine, patients are in a delicate state, judged by those caring for them to no longer be sick enough to need to remain in the hospital, but possibly not quite completely ready to be fully back in the community, on their own at home.

Over the past few years, there have …

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A better way to handle patient handoffs from the hospital

Can empathy be taught to physicians?

Medical Education
August 2, 2018

We want competent physicians, but we also want compassionate ones. How do we get them? Is it nature or is it nurture? Is it more important to search out more compassionate students, or should we instill compassion somehow in the ones we start along the training pipeline? I think the answer lies in nurturing what nature has already put there.

My background is in pediatric critical care, which I have practiced …

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Can empathy be taught to physicians?

Is double health insurance coverage better?

Physician Finance
July 30, 2018

You have just gotten a job offer that includes health insurance.  You’re lucky enough that your spouse has great family insurance already, but hey that health insurance is going to cover the cracks in the deductible and co-insurance, so you feel great about that double coverage as you sign your contract.

Well, you just got scammed.  That is, double coverage is a scam, and you would have been far better off …

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Is double health insurance coverage better?

The simple, powerful question doctors should ask their patients

Physician
July 29, 2018

As physicians, we are used to asking our patients lots and lots of questions. It’s our job to elicit information, listen, and then come up with a management plan. There’s a standard script every doctor goes through, based on the science of medicine, and we usually have this memorized to a tee. And that’s all very well and good. However, as with many things in life — especially those that …

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The simple, powerful question doctors should ask their patients

What personality type fits your medical specialty?

Physician
July 29, 2018

Both patients and providers realize that an internist is different from a surgeon, but specifically how they differ and how this affects their approaches to patient care is largely under-appreciated. Over the last four years, I have conducted over 250 interviews with physicians across specialties and institutions about what they do and why they do what they do. With each project, I continue finding remarkably distinct, specialty-specific values, perceptions, and …

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What personality type fits your medical specialty?

Serving the underserved: a win-win situation

Physician
July 28, 2018

Medical school was a difficult adjustment for me. Coming from a blue-collar background and lacking a medical pedigree, I did not relate to most of my classmates, and I made very few friends.

That changed when I met J., a second-generation physician-to-be without the competitive guile or sense of entitlement implicit in most of the medical students I had met. With a generous personality undoubtedly sculpted by the experience of motherhood, …

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Serving the underserved: a win-win situation

Should I or shouldn’t I? The dilemmas faced by the chronically ill.

Patient
July 26, 2018

After many years of being mostly housebound by chronic illness (which includes chronic pain), here are a few of the dilemmas I’ve faced over and over. I’m confident that I’m not alone in my “should I/shouldn’t I?” world.

Do I accept an invitation from a friend to get together or do I refuse it?

If I refuse the invitation, depending on who issued it, it may be the last one I’ll receive …

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Should I or shouldn’t I? The dilemmas faced by the chronically ill.

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