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.
As women in the medical workforce increase, women physicians are faced with the unique position of training the hardest they ever had in their lifetime cutting into precious childbearing years. Many women physicians seek time off or engage in part-time jobs to address the dilemma of fulfilling the obligations of their careers while enjoying the tender years of their babies. Others pursue non-clinical routes such as medical chart reviews or …
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How to get back into the medical workforce if you’re a mom
When I started treating opioid dependence, I began with high expectations. I was frustrated with what had become a mindless, ineffectual exercise in providing medication for chronic pain. I saw too many patients “circling the drain” on opioids. Most admitted they still had chronic pain despite their high consumption of opioids. Many patients needed their medication just to feel normal and avoid withdrawal. Others wished they could stop taking opioids …
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What’s our goal with opioid treatment?
A guest column by the American College of Physicians, exclusive to KevinMD.com.
I recently saw a 35-year-old patient of mine who came into clinic requesting brain imaging. Although she had no specific symptoms, she had a friend who was diagnosed with a brain tumor several months ago and is concerned about the possibility that she …
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The challenge of the worried well
During our lifetimes, the role of physician has been shrinking, from healer to technician.
You’ve probably seen the famous painting, Doctor and the Doll, done by Norman Rockwell in 1929. It depicts an old country doc listening with his stethoscope to the heart of a doll held up to him by a worried little girl. Today there’s no time for such play, and no pay for it, either.
The gradual transformation of …
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Turning doctors into technicians is a mistake
Doctors are intelligent people, but are we good thinkers? And how should we think?
There are two basic kinds of thinking: analytic and intuitive. (And maybe good and bad, so that’s four.) Within medicine, analytic thinking can perhaps be best exemplified in the evidence-based movement, which began in the early 1990’s. It was a gilded age, full of promise, and bolstered by the reality that computers would give physicians instant access to the …
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How doctors should think: Heuristic thinking isn’t heretical
I’ve been single for nearly a decade. A career-driven professional, juggling parenting, PTA, and post-graduate studies, my time is precious.
But there’s something about this season — the heart-shaped Valentines and assorted chocolates — that has a way of evoking a longing for love. So this year, bowing to the goading of friends and against my better judgment, I decided to do something I never — never — thought I’d try.
I …
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I’m speed dating my doctor
Patients and their family members are impressed when doctors show up for memorial services. They tell me about it. “The doctor liked my mother so much that he came to her wake,” a patient recently confided in me as I examined her. She had been a sole caregiver for her aging parents for years, and her mother had passed a few months earlier. The physician’s presence at her mother’s service …
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This doctor doesn’t go to patients’ memorial services
On my outpatient family medicine rotation, I met a patient I will never forget. She was a white middle-aged woman — a new patient to the clinic — there to establish care. When I walked in and introduced myself, she looked me up and down with a glazed expression.
Within two minutes, while I was trying to gather a history from her, the patient interrupted to say, “Dr. Smith (name changed), …
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A medical student was discriminated against by a patient
With over 300,000 opioid-related deaths reported since 2000 and two million patients battling addiction today, it’s evident that more qualified medical providers are needed to care for substance abuse patients. Psychiatrists and addiction specialists are struggling to meet the demands of this high need population. The good news amid this national health care epidemic is that more than 1,200 certified PAs practicing in psychiatry work hard to help fill these …
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Fight the opioid crisis with physician assistants
The subject of physician burnout has become a major point of contention in our community. Institutions try to help by implementing “mindfulness programs” or bringing in “burnout experts” for a one-time lecture. Physicians complain that the system is flawed and mindfulness is just another way for them to “blame the victim” for being burned out. Meanwhile, there are doctors who are simply trying to survive through each day; they walk …
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Who’s really to blame for physician burnout?
Steve was special — even as an intern and first-year resident.
Out of more than two hundred letters of recommendation for our physician trainees I’ve written over the last fifteen years, I have only written this statement a few times: “Steve has the clinical acumen, integrity, work ethics and wonderful bedside manner that would give me full confidence in having him care for my family member.”
Steve eventually finished seven long years …
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Racists drove a doctor from the U.S.
Meet Johnathan, a 34-year-old male from rural Georgia we recently treated for back pain as a result of some extra contractor work he took on over the holidays. We see patients like him every 11 minutes, which doesn’t leave much time to get beyond Johnathan’s chief complaint. He leaves with his first prescription for opioids.
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Of the 91 Americans taken each day, Georgia now claims Read more…
A drug problem in rural Georgia
As a private practice specialist in an affluent metropolitan area, I am often inundated with requests for consultation by local residents and primary physicians. That’s fine — it’s what I do, and it’s what I enjoy doing. Hey, it pays the bills, and I won’t complain about that.
Concierge medicine has taken a foothold locally, and this means more referrals directly from doctors who insist we take care of their patients …
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Concierge medicine sucks for specialists. Here’s why.
Some doctors choose medicine because of the medicine, and some doctors choose medicine because of the people. I veer towards the latter: Medicine is my tool to help the person sitting across from me.
However, I am finding more and more stuff getting in between me and my patients, primarily my computer. The increasing burden of gathering coded health data in the EMR, especially in light of the impending MACRA, MIPS …
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Why medical scribes are accidental blessings
Have you ever come out of an interview feeling like you spent an hour (or more) talking about yourself but learning absolutely nothing about your potential employer? I certainly have.
Sure, interviews are a chance for potential employers to see if you are a good fit, but after way too many one-sided interviews, I came to a realization. Interviews are also the best way to find out if this medical institution …
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Top 5 questions doctors should ask during a job interview
I remember the moment I first saw a female chest X-ray. It was my own. My lecturers in the first months of medical school showed a few chest films, but I failed to recognize that the bodies all looked the same. I proudly showed my sister my clear lungs. She laughed and said, “I can see your boobs.” I looked again at mine with new eyes, taking in the dull, …
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Medical education systematically ignores the diversity of medical practice
