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.

Can the dwindling numbers of primary care physicians explain decreased life expectancy?

Niran S. Al-Agba, MD

Health Policy

January 15, 2018

Newborns born in 29 other countries of the world have life expectancies exceeding 80 years; yet, an infant born in the U.S. in 2016 is expected to live only 78.6 years according to recently released statistics. While death rates fell for 7 of the 10 biggest killers, such as cancer and heart disease, they climbed for the under-65 crowd. The irrefutable culprit is the unrelenting opioid epidemic.

Last year, life expectancy …

How can we be patient centered in the age of technology?

Hans Duvefelt, MD

Physician

January 15, 2018

Four and a half years ago I read an editorial in JAMA, the Journal of the American Medical Association, that etched a short phrase into my memory. These five words seemed so profound and poignant that I really think they almost define primary care medicine today, perhaps with the alliterative addition of the word “teach”.

Dr. Abigail Zuger wrote of how the computer had changed the dynamic in the …

20 anecdotes that describe the world of female medical students and physicians

Jamie Katuna

Medical Education

January 13, 2018

I recently collected anecdotes from women in medicine who have noticed the same thing I’ve noticed: We’re not as comfortable here as our male counterparts. Despite progress, medicine remains a patriarchy — an “old boy’s club” — and the women in this world are frequently reminded of this status quo. In collecting these anecdotes, I’ve noticed two main themes for the type of advice and comments women receive.

The first one speaks …

Success stories in driving up adult immunization rates

James Appleby, RPh, MPH

Conditions and Diseases

January 12, 2018

As we continue to lead longer and healthier lives, too many Americans aren’t taking advantage of an easily accessible set of tools that could protect their well-being into old age: adult vaccines. As a nation, we’ve embraced a regular schedule of vaccines for our children. But science shows that they are proven life-savers for us grown-ups, too.

The numbers are staggering: tens of thousands of Americans die each year from flu …

Are physicians losing the healing touch?

Philip A. Masters, MD

Physician

January 11, 2018

A guest column by the American College of Physicians, exclusive to KevinMD.com.

I keenly remember the thrill of making my way to the medical bookstore as an early first-year student to buy my first stethoscope.

Although receiving the short white coat at the start of medical school symbolizing the transition into the medical profession was incredibly …

Here’s why doctors must know prescription costs

Mark Kelley, MD

Medications

January 10, 2018

As the health care debate drags on, prescription drug costs continue to rise by almost 10 percent annually. It is the rare patient who is spared this expense.

Over the years, I have seen how these costs have affected my patients. At first, most patients had little in the way of co-pays. However, once the local economy deteriorated, co-pays skyrocketed as employers tried to curb their health care expenses. Now, large …

Structured settlements are ruining patients’ lives

Thomas D. Guastavino, MD

Physician

January 10, 2018

There are a lot of TV commercials for structured settlement companies these days. You know, the companies that say if you are cash-strapped but have a structured settlement they will be happy to buy your settlement and give you “cash now.” Some of the commercials are quite clever and catchy featuring everything from operettas to boy bands. After seeing so many of these, one has to conclude that there has …

The other opioid epidemic that we ignore

Hans Duvefelt, MD

Medications

January 9, 2018

“I made myself a hypodermic injection of a triple dose of morphia and sank down on the couch in my consulting room … I told her I was all right, all I wanted was twenty-four hours’ sleep, she was not to disturb me unless the house was on fire.”
– Axel Munthe, MD, The Story of San Michele (1929)

When people in this country mention the opioid epidemic, most of the time it is …

5 tips to better communicate with your patients

Suneel Dhand, MD

Physician

January 9, 2018

Communication is the cornerstone of good health care. Despite all the external challenges we face with the system in which we work, those few minutes we spend with patients and their families are precious — and are what we will be remembered for. We, therefore, owe it to our patients to be at our very best and to make them the absolute center of …

15 minutes aren’t enough for a primary care visit

DrizzleMD

Physician

January 9, 2018

Have you bought a new memory foam mattress recently? Many come vacuumed in shrink bags. Once air gets in the bag, the mattress expands to its normal size. It is fascinating to watch how they expand.

It is not so fascinating to watch a patient expand to their actual size, when they are forcefully squeezed into an enclosed time space like an office …

The non-difference between MDs and DOs

Brandon Jacobi

Medical Education

January 8, 2018

“What’s a DO?” is something virtually every osteopathic medical student and physician have been asked at some point in their training. There is this public misconception that professionals who carry MD after their names are the only qualified people to medically treat their ailments. Any other degree is categorized as “alternative medicine” in their mental schema. Truth be told, DOs, or doctors of osteopathic medicine are just as qualified as …

Read more…

The non-difference between MDs and DOs

Take a pill and stop aging. Really?

Stephen C. Schimpff, MD

Medications

January 6, 2018

Part of a series.

A pill to end aging.

Is there or could there be such a pill? Some researchers think so.

Many believe that rather than attack the causes and treatment of chronic illnesses one by one, it would be better to understand the biology of aging and from that learn how to slow the process and hence prevent or delay the onset of various …

Read more…

Take a pill and stop aging. Really?

Independent practice: Both nurse practitioners and physicians should be outraged

Rebekah Bernard, MD

Health Policy

January 5, 2018

The United States is facing a looming physician shortage, and some groups see this as an opportunity to promote an agenda of replacing physicians with nurses.

The nurse-as-doctor concept appeared in the Institute of Medicine Future of Nursing 2011 report, which called for a radical change to the nursing structure in the United States, including a goal of …

Do you see me or your computer screen?

Michele Luckenbaugh

Patient

January 5, 2018

The current state of health care in America, in my opinion, has been negatively impacted by Big Pharma, health insurance corporations, health care corporations and a plethora of governmental mandates. All have placed an immense burden upon our practicing physicians who spend much of their day doing paperwork and inputting into computers rather than face time with their patients. Some find it necessary to leave the profession. Please give us …

Read more…

Do you see me or your computer screen?

It is time for physicians to take back medicine

Amaryllis Sánchez Wohlever, MD

Physician

January 4, 2018

I remember medical school and residency vividly. How could anyone forget such a sacrifice, such a vital investment in a top-notch education? Hours upon hours of hard work while practical knowledge amassed exponentially every single week. As a lifelong learner committed to excellence, I loved being surrounded by equally dedicated, intelligent high achievers. My classmates in med school and residency were at the top of their class, and we helped …

The door that connects two worlds is still elusive

Andrea Eisenberg, MD

Physician

January 3, 2018

It had been a long gloomy Fall day. When I got home, all I wanted to do was climb into bed and sleep and sleep and sleep. Emotionally, I was spent after a long day at work. But my husband and I had planned to go to services at temple that night – there was a guest singer that comes once a year, and I love his music. So, with …

Why the social history is important

Maria Yang, MD

Physician

January 3, 2018

From the notes I read, it seems that other medical specialties limit “social history” to whether or not someone uses tobacco, drinks alcohol, or uses drugs.

“Social history” is meant to get a sense of the context in which people live. Where do they live? Who do they live with? How did they come to live there? Where did they grow up? What sort of work do they do? How much …

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Why the social history is important

Doctors aren’t just white coats without a face

Devon Romano

Medical Education

December 31, 2017

Doctors are all the same: A sea of uniform “white coats without a face” caring for “patients without a face.”

They heal the sick. They save lives.

And they drive their fancy sports cars to their expensive homes and cushy lives.

Not.

I am embarrassed to admit, as a pre-med/medical school hopeful, this was my perception of physicians and patient care before completing two summer internships at a doctor’s office.

A problem that the majority …

Are family physicians the best weapon against opioid crisis?

Layne Kamalu, MD

Physician

December 30, 2017

As the national opioid crisis takes center stage, I want to make a case for the authority of the family physician in managing and treating this problem.

I am a family physician and have been treating patients with opioid dependence and addiction for 12 years. These patients comprise about half of my practice. The other half is representative of a typical primary care practice. I have patients who have been treated …

Doctors and patients are drowning in data. What can be done about it?

Fred N. Pelzman, MD

Physician

December 30, 2017

Too much data, big and small.

Every morning when I log onto our electronic health record, one group of messages are from patients with their self-recorded health information data that they’ve sent to me for review.

Here’s my home blood pressure over the past 24 hours. Here are my fingerstick glucose readings over the past 24 hours. Here’s my weight over the past 24 hours. Here is my depression score over the …

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