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.
Practicing medicine sometimes feels a bit like pulling teeth, and getting regular exercise often resembles flossing.
I have only recently started flossing on a regular basis. For most of my life, the bulk of my flossing activities would happen in the few days before my rapidly approaching dentist appointments. The “logic” I used to employ: I could make up for months of neglect by applying some short-term elbow grease to the …
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6 reasons how exercise makes you a better physician
At the start of the transition to electronic health records (EHRs), I was totally on board as one would expect of a millennial doctor. I, along with my fellow millennials, grew up alongside the internet. We can type with our eyes closed, navigate pop-ups in a jiffy and intuitively know how to manipulate electronic charts to serve our purposes.
But, I did find myself in a unique position in the millennial …
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A millennial doctor’s love-hate relationship with EHRs
First, a history lesson. Back in the mid-2000 oughts, the AAFP launched a wholly owned subsidiary called TransforMed. It was originally started to help practices implement the “new model of care” from the Future of Family Medicine Report. Soon after it was launched, the joint principles of the patient-centered medical home (PCMH) were announced, so TransforMed pivoted to help practices implement the PCMH model of care.
In …
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The tiny gains of patient-centered medical homes. Are they worth it?
If you have ever had surgery or told your doctor about physical pain, no doubt you have heard the question: “How would you rate your pain on a scale of zero to 10, with zero being no pain and 10 being the worst pain you can imagine?” That sounds like a reasonable question, but everyone has a different pain tolerance. In extreme cases, there are individuals who are born with …
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The pain scale shares the blame for the opioid crisis in America
An interesting paper in CMAJ Open reports on a series of interviews with coders concerning their perceptions of their interactions with doctors. The study was done in Canada, but it rings true to what we experience in the U.S. The fundamental objective of coding is the same: to translate information about the patient’s story into a series of numeric ICD-10 codes for various administrative purposes. Several themes emerged from these interviews. Form …
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When medical coders blame physicians
Hustles are hustles, and side hustles add a little on the side. But if you want to maximize your income. You have to innovate.
When I started as an employed medical physician at the beginning of my career, I was overjoyed to make X. After years of watching money go out the door in medical school, and then making 0.25X in residency, I couldn’t believe that I was earning so much. …
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Incorporate side hustles to your primary care practice
If you get health insurance through your job, beware: you might be picking up more of the cost of your medical care than you realize. With increasing frequency, employers are directing their workers to the kind of high deductible, high out-of-pocket insurance plans that leave workers financially responsible for a surprising portion of their health care expenses.
Not long ago, having insurance coverage meant your costs were largely …
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How high-deductible plans are a bait and switch
During my third year of medical school, I received a harrowing phone call, “Can you please go over to Steve’s place? I am worried about him. He might want to hurt himself.” The person requesting this was the mother of one of my best friends in medical school. I was a third-year medical student on my surgical rotation. Steve’s mom was concerned he might commit suicide. Sleep deprived as I …
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Physician, know thyself
The “doctor switch,” a protective coping mechanism ingrained into the emotional training of doctors, is a double-edged sword.
Doctors see and experience things that many people would consider intimate, gory, horrifying and even repulsive on a regular basis. Doctors must balance the scales of life and death in their hands in addition to the heavy responsibility of carrying the health and wellness of their patients in addition to living their own …
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The doctor’s emotional switch
There is no glory in defense. Fans don’t notice it. The most perfectly-executed defensive play results in a non-event; that is, the other team doesn’t score. Then everyone forgets about it, and the game moves on.
But there is an art to defense. It is reactionary in nature: You must read the offense and anticipate what’s coming. You have to study the opposing players one-by-one, so you know their strengths and …
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Why medical school is like playing defense
It’s 10 p.m. on Wednesday night, and I’m finishing up my notes for my patient visits from this morning while I do my bowel prep for my colonoscopy tomorrow.
Now, I know we can argue the biomechanical challenges of doing both of these tasks at the same time, and this certainly may be TMI, but it struck me as I was sitting there trying to do both of these things how …
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Doctors: Don’t forget to take care of yourselves
In past years, the opioid crisis has become a topic of interest among the adult population. More recently, attention has grown surrounding the pediatric population, as well. In fact, the topic was included in the State of the Union address given by President Trump just a few weeks ago. He vowed to end the crisis and named it a “public health emergency.”
When discussing true addiction, …
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The opioid crisis hits children
When did patient satisfaction become more important than appropriate medical care? Medicine has been turned into a service with bonuses related to the patient’s satisfaction score. There is a complete disregard for the appropriate medical care if the patient is dissatisfied with what they’re told. Doctors are so afraid of losing satisfaction scores and getting sued that inappropriate medical care has become the norm. The opioid epidemic is just one …
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Online ratings have me scared for the future of medicine
The gender pay gap is a hot-button issue among women physicians. A few years ago at a local women physicians group meeting, I listened in awe as a gynecologist discussed interviewing for a job early in her career. She and her male co-resident were under consideration for the same position. Upon touching base with her colleague after the interview, she realized he was offered significantly more: on the order of …
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Commit to a conversation about the gender pay gap
Many things in life can only be truly appreciated once reflected upon — like the onset of dementia, depression, and cancer, just to name a few. This got me thinking about the onset of burnout and how the true presentation in life is quite different than reading about it.
The term “burnout” is often thrown around loosely but is an actual syndrome comprised of the progression of “exhaustion, cynicism and reduced …
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Is your spouse experiencing physician burnout?
When I was two years old, I ran naked through my living room. Mom reached out and playfully swatted my rump. I skidded to a stop, planted my fists on my little hips, and faced off. “Don’t touch that! It’s mine!” Everyone who knows me and hears the story just laughs and says my sassy started early.
Now, I read story after story of inappropriate comments made to women, and I …
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#MeToo: Tactics for fighting harassment
As physicians, we are seen as leaders whether we like it or not. And as such, we are charged with modeling greatness. But do we? Our training, while teaching us to be experts and authorities, does not teach us how to be leaders.
One thing our training does teach us: self-neglect, self-sacrifice and unrealistic expectation. This is where I believe our training has failed us. For most of us, our training …
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Leaders can bring doctors out of burnout
The internet is an amazing source of information and misinformation. How do you know if what you are reading is accurate?
Be a skeptic
Last summer we were inundated with alarmist headlines about “dry drowning” after the tragic death of 4-year-old Frankie Delgado, who died days after an apparently harmless dunk under water while swimming off of the coast of Texas. While this child’s death was heart-breaking, the …
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Truth or hype? How to tell the difference in medical news.
