Primary Care

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.

Complementary remedies for the flu: How Good Morning America failed

Kevin Lomangino

Conditions and Diseases

January 29, 2018

Talk of the widespread and dangerous flu circulating this year has the public on edge and hungry for quality information about how to protect themselves.

ABC’s Good Morning America isn’t helping with this segment featuring chief medical correspondent Jennifer Ashton, MD, titled “3 complementary natural remedies for the flu.”

It’s a mess of conflicting messages about herbal approaches to managing flu symptoms. And it positions Ashton — an ABC …

Health suffers when ground down by poverty

Janice Boughton, MD

Health Policy

January 28, 2018

I finally finished reading the many journals piled up on my dining room table, which have been shunted to other flat surfaces for projects or the visits of friends. I didn’t read them all well, but I touched them all and read what interested me.

The early October edition of the Annals of Internal Medicine particularly caught my eye. There were two major articles that looked at determinants of health in …

How to tell seniors they’re too old for cancer screening

Peter Ubel, MD

Conditions and Diseases

January 26, 2018

Cancer screening can save lives. Mammographies reduce the chance women will die of breast cancer; and colonoscopies reduce the chance people will die of colon cancer.

But should my 93-year-old father receive a screening colonoscopy? The test is uncomfortable, carries risks, and costs money. Even more importantly, my dad probably won’t live long enough to benefit from the test. That’s why most medical experts think people like my dad—people unlikely to …

What Celine Dion can teach us about patient care

Edward Leigh

Patient

January 26, 2018

During a recent Las Vegas performance, an intoxicated concertgoer got on the stage and stood next to singer Celine Dion. This situation could have been handled in multiple ways, but Ms. Dion never lost her composure and handled the situation with grace and kindness. She brilliantly was able to diffuse the situation without anger while maintaining her dignity and that of the fan. The way she handled the situation and …

A physicians care for patients in jail and wonders: Could it have been prevented?

Maria Yang, MD

Physician

January 25, 2018

Some of the people under my care in the jail right now are quite ill. (This statement is always true, but it seems that the intensity of illness is greater now than usual.) As a result, the perennial question seems more urgent now: Is there any way to prevent All of This?

For some of them, it seems that the answer is No. Some of them sought out psychiatric services, attended …

How to avoid #MeToo in medicine

Karen S. Sibert, MD

Physician

January 24, 2018

Let me say first that any woman who has ever been harassed or assaulted should never be made to feel that it is her fault. It is always the perpetrator’s fault. Men can be boors, or worse, and testosterone can be toxic.

I went to Princeton University at a time when the ratio of men to women was 8:1, graduated from medical school in the 1980s, and raised two daughters. I’ve …

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How to avoid #MeToo in medicine

10 steps to keep physicians sane

Suneel Dhand, MD

Physician

January 24, 2018

These are tumultuous times for practicing physicians. The health care landscape is changing at breathtaking pace and less and less of our time is spent doing what we were actually trained to do: taking care of patients. I absolutely love the patient care part of my job, do everything possible to always remember why I went to medical school in the first place, and maintain focus on the aspects of …

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10 steps to keep physicians sane

Being a doctor isn’t glamorous. But this physician keeps coming back for more.

Uzma Khan, MD

Physician

January 24, 2018

My last clinic patient of the day was a frail, elderly man. I initially found him to be ornery. He had the air of someone who was chronically irritated. He was also incredibly hard of hearing. Due to the awkward set up of the exam room and computer, his wheelchair was positioned in such a way that we sat side-by-side. His wife sat sleeping in her chair, her red lipstick …

The simple thing patients can do to help doctors run on time

Gawayne Vaughan, MD

Physician

January 24, 2018

It happens all too often. I am done with a visit and wrapping things up. Sometimes my hand is even on the doorknob to leave the room. Then the patient says it. “Oh, by the way, doctor …” This is inevitably followed by some symptom they have that is serious and needs further attention. The classic case is when it is chest pain, a grave symptom that needs to be …

The dangers of being always connected

Greg Smith, MD

Physician

January 23, 2018

The ad is compelling.

A surfer rides a blue wave, seen from below in crystal clear reflection. The Apple Watch on his left arm cuts through the surf, elegant, sparkling ripples trailing behind. Suddenly, it breaks the surface, and the screen lights up, announcing an incoming call.

Let’s face it, shall we? We are always connected. We are always wired in. We are always on.

We have become a world of interconnected people, …

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The dangers of being always connected

Forget the PC police and telemedicine: Give your patient a hug

Neil Baum, MD

Physician

January 23, 2018

Today, the public has criticized health care as too high in technology and too low in touching. Computers take patients’ histories, provide a differential diagnosis, supply educational materials and even submit a bill for the services that we render. A new specialty — telemedicine — offers health care service to rural areas that were previously underserved or couldn’t afford the latest diagnostic technology. Telemedicine, a technology in its infancy, offers …

If you are a practicing physician, you need rest

Physician on FIRE, MD

Physician

January 23, 2018

“It is neither wealth nor splendor, but tranquility and occupation, which gives happiness.”
– Thomas Jefferson

If you are a practicing physician, you need rest.

Why do I say this? Because you have gone through an enculturation process which focuses on hyperactivity and super high-level achievement. In training programs and in practice, admitting that you are tired or needing a rest break is a sign of weakness and is discouraged, to say the …

Should the SOAP note be changed?

Jennifer Middleton, MD

Physician

January 22, 2018

Our hospital system’s IT department has recently encouraged us all to change our default encounter note template from the traditional “SOAP” format to the “APSO” format.

For those not familiar with those acronyms:

S: subjective — the patient’s story
O: objective — physical exam, labs, other data
A: assessment — the identified issues/diagnoses
P: plan — details of how to address issues/diagnoses in the assessment

The argument in favor of APSO, putting the assessment and plan …

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Should the SOAP note be changed?

Opioid addiction is an epidemic. Let’s treat it like one.

Heath McAnally, MD

Conditions and Diseases

January 21, 2018

If we want to talk about the opioid epidemic as an actual epidemic, let’s use the same terms we use for communicable disease: agent, vector/environment, host. Virulence. Transmission. Immunity.

The media has done a great job of providing descriptive statistics of the epidemic. And recent oversight, both legislative and advisory, have attempted to focus on altering vector (prescriber) behavior in the wake of apparent failed attempts to reduce agent virulence. What …

13 things every doctor wants their patients to know

Joanne Jarrett, MD

Physician

January 21, 2018

1. We worry. We lie awake worried sick about you more often than you’d think. The stakes are so high, and we know it.

2. We wonder. I ran into a friend who’d met a patient I’d had sixteen years earlier. She gave me some follow-up, and it made my day — maybe my month. It was a year ago, and I’m still thinking about it. She’d had blood cancer. I referred her …

10 ways this primary care physician will work smarter in 2018

Hans Duvefelt, MD

Physician

January 20, 2018

I don’t regularly make any New Year’s resolutions, but this year I am tossing around a couple of ideas. One reason is that I have so many things going on that I need to be clever about how I use my time.

I work four days a week at my regular clinic, and I also work two long days at a clinic in far northern Maine. In addition, there are many …

What’s the point of a perfect patient chart?

Fred N. Pelzman, MD

Physician

January 18, 2018

Last week I made a patient’s chart perfect.

Not bragging, but ultimately it ended up being pretty easy, and I’ll explain how and why in a little bit.

This was a patient I had not seen in several years, with a number of chronic medical problems, for which he had been taking less than optimal care of himself since I had seen him last.

Here for a “checkup,” we talked about his health …

A physician cancels his life insurance policy. Here’s why.

DocG, MD

Physician Finance

January 18, 2018

My blog is called “DiverseFi” because my path to financial independence was not the typical one. Although I’ll talk more about this in another post, my journey neither started from humble beginnings nor was frugality my guiding principle. In fact, it was only after discovering the FIRE community, did I realize that I was indeed financially independent.

That changed my life. Changed my habits. I slowly became more …

The patient is your only focus

Gil C. Grimes, MD

Physician

January 17, 2018

It was another weekend of training in Hakomi. We were working on figuring out our resources (those things in our lives that help us get through tough times). It was the second day of training for this block, and my student therapist asked how things were going “day by day, usual days, the usual stuff.”

“Why don’t you take me through a usual day then, how do you start seeing your …

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The patient is your only focus

A physician’s descent into guideline fatigue syndrome

Robert Centor, MD

Conditions and Diseases

January 16, 2018

It started slowly. My former resident and present colleague, Terry Shaneyfelt first authored “Are Guidelines Following Guidelines? The Methodological Quality of Clinical Practice Guidelines in the Peer-Reviewed Medical Literature.”

This paper alerted us to the problem. But guideline fever continued to rage. Almost every specialty and subspecialty society decided that they needed to join the guideline movement. They needed to tell us the right way to practice medicine.

While …

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