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.
Blockchain technology has the potential to dramatically transform health care delivery by facilitating data exchange between providers and electronic health record (EHR) systems. A decentralized and transparent platform, blockchain technology provides an authenticated platform that applies a consensus-driven approach to facilitate the interaction of multiple entities through a shared ledger. For the health care sphere, blockchain is simply the sharing of medical information through EHRs across numerous hospital systems that …
Read more…
Blockchain technology can dramatically transform health care delivery
They say to be a good doctor, you have to leave everything behind when you enter the exam room. You walk in with a clean slate — shiny and sterile, crisp, clean and decontaminated. I wonder if that’s why we wear a white coat? To symbolize the unscathed, untouched and pristine figure who walks into the room and solves all the problems. The one who just woke up from a …
Read more…
Does being a good doctor mean being superhuman?
I’m sitting in the waiting area across the endoscopy room of a major hospital. Mindless talk show TV runs in the background. Patients are waiting patiently. They anxiously look up every now and then from their phones towards the reception desk.
It’s a scene I’ve experienced for years while working in health care while waiting for doctors.
But there’s something different in the air now.
Patients, like those around me, will encounter a …
Read more…
Why some physicians thrive and some struggle to survive
As has been much discussed in the last few years, our health care system is in crisis. We spend $3 trillion a year on Medicare. MRIs bill out at $5,000. My recent bilateral mastectomy totaled $33,000 with $800 of that actually going to my surgeon.
I left my role as an employed physician in the traditional insurance-based fee-for-service structure because I spent 80 or more hours a week typing, collecting data, …
Read more…
Physicians: Let us rise. Let us lead.
Physician burnout is increasing at an alarming rate. According to a January 2017 AMA Wire report, physician burnout rate has increased from 2013 to 2017 across every specialty in medicine. Greater than 50 percent of primary care providers are burned out. Therefore, every patient at the entry point of medical care is, more likely than not, going to be treated by a burned out physician. The question is why are …
Read more…
A relatively simple solution to physician burnout
Growing up with a father who is a physician made for a natural draw to medicine. However, as young people are prone to do, I did my best to rebel. Early into my undergraduate career I proudly announced to my father that I had decided to go to law school. And perhaps to dig the needle a little deeper, I told him I planned on going into medical malpractice, on …
Read more…
How this physician became a financial advisor
Recently, I was asked to give a talk on resilience and its role in reducing physician burnout. I was excited by the opportunity, but asked if I could focus more on cultural change and institutional solutions for burnout. When they said no, I declined. Why?
Well, it’s not that I don’t see the value in resilience. A lot of physicians that I really respect write and speak about resilience. I think …
Read more…
Physician burnout shouldn’t be linked to resilience
It all started out with Malaysian methimazole, and didn’t end until two highly trained medical professionals sat on opposite ends of a telephone call, scratching their heads and wondering how two digits being transposed could lead to so many problems.
Those two transposed digits caused a thyroid uptake scan to become a bone marrow scan (whatever that is). But look at all it took to get there.
Mystery illness, mystery medicine
It started …
Read more…
Insurance denials: the law of the land
Picture an alternate universe where you as a physician look forward to your lunch break so that you can refuel and engage with your fellow colleagues. In this imaginary world, not only do you have time to eat and converse with others, but you also have time to throw on your sneakers and go for a walk outside before you start your afternoon. And the best part of all, while …
Read more…
Refuel and engage: small tweaks towards addressing burnout
It was not so much the words as the overall tone of the interaction. The doctor-patient relationship had been generally affable. There was the usual exchange of pleasantries over the years. Questions about family, children, and grandchildren. It was a good relationship — until Harvey got sick, that is.
Originally, there was weight loss and fatigue. The initial physical exam and slew of testing showed nothing but a frail, cachectic, middle-aged …
Read more…
When a physician gets yelled at
A doctor is working down their long list of patients, powering through the day, striving to use their skills to get them better. Some of the patients will be follow-ups who they already know; others will be brand new patients, who they are meeting for the first time. Of course, the job of any doctor is first and foremost to heal their patient in whatever way they can. That’s what …
Read more…
Your patient has judged you 7 seconds after meeting you
We’re all human beings, but we’re not all alike.
Each person experiences pain differently, from an emotional perspective as well as a physical one, and responds to pain differently. That means that physicians like myself need to evaluate patients on an individual basis and find the best way to treat their pain.
Today, however, doctors are under pressure to limit costs and prescribe treatments based on standardized guidelines. A major gap looms …
Read more…
Why physicians should respect the pain patients report
While our elected officials in Washington spin political rhetoric and quote scary statistics around the opioid epidemic, New Jersey was one of the first states to take actual action. In February of this year, New Jersey Attorney General Gurbir Grewal declared its plan of combat: a 24-hour response team, improvements to the prescription monitoring program, and over a million dollars in federal grants. In fact, the Office of …
Read more…
The opioid crisis: Doctors cannot lose hope
For many years, I’ve held a brief huddle with my team every morning to make sure we are ready for the day: Anybody with complex problems coming in today? Anybody who’s been in the ER? How is Mrs. Jones’s husband over at the nursing home, is she worried about his condition? Where can we squeeze in more add-on’s?
Now other people have tried to hijack the word “huddle” for a completely …
Read more…
When preventive care becomes upselling in medicine
When it comes to the opioid epidemic, physicians are some of the best drug dealers around with almost unrestricted access to the purest substances. As the opioid epidemic spirals out of control, physicians continue to be able to provide their patients with a variety of options, including oxycodone, morphine and fentanyl. Many people would be surprised to know that physicians don’t need any additional training to prescribe opiates to their …
Read more…
Primary care physicians are on the front line of the opioid epidemic. Help them.
Dear millennial,
Mea culpa!
I’m not so old — but old enough to have thrown out my share of jabs at the millennial generation. My quips have been nothing creative: lazy, entitled, lacking work ethic, you know, the usual stuff. These generalizations were how I would describe the work-hour restricted medical residents, the girl behind the Brandy Melville counter, heck even my brothers (one of whom I don’t even think technically classifies …
Read more…
Do millennials have the key to fight burnout?
As part of the interview for my book, I asked why it is difficult to be a doctor. Some of it has to do with integrating information and making decisions.
“The public thinks that we know more or can do more than we can. Ultrasounds don’t mean it’s a perfect baby. All of the tests and technology moves so fast that we don’t know what we see.” A doctor explained, “You cannot know …
Read more…
Why is it difficult to be a doctor?
