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.
If you’re thinking about a career in medicine, there’s a piece of technology you’ll come to know intimately. It’s small and sleek, with excellent battery life and remarkable durability. It’s not an iPhone; it’s not a Pixel. It’s a beeper. You will come to know, and to respect, this tiny black rectangular prism. It will govern your life. You will be at its mercy, yes, but it also offers you a chance at salvation. …
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The physician’s relationship with the beeper
I’m now walking the second mile in another man’s moccasins, and it’s no more enjoyable than my first mile.
Many doctors cringe when they see a chronic pain patient on their day’s schedule or at least certain chronic pain patients. Some of that dread isn’t directly caused by the patient but rather the deluge of third-party administrative demands: workman’s compensation updates, disability applications, insurance forms, lawyers’ letters, etc.
Still, even when the …
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7 reasons why being in pain is a pain
Greetings from the library. I’m writing to you through caffeine jitters, wrapped in a scarf that doubles as a blanket. I’ve marked my territory with my things: several Apple products, remnants of oatmeal in a mason jar, a sketchbook exhibiting my best attempt drawing the inside of a skull, and the most-essential item: my planner, detailing all the tasks I now avoid.
I’m in the midst of my first round of …
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Pass-fail in medical school. But the stress remains.
In a very unique study, researchers have tabulated how often family physicians provide patient care that is not covered with a CPT code. This is a little complex, for the non-physicians and even for many physicians to grasp, so I will provide a little more background first.
CPT stands for Current Procedural Terminology, which is the book written by the American Medical Association (AMA) since about 1965. This …
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How the CPT system shortchanges primary care
It was a busy yet mundane morning. I was returning to work after having a few days off. I commenced my day by perusing patient details while sipping on some coffee and reacclimating to the customary hospital cacophony. Some patients were critical, some ready to be released. It seemed like the usual assortment of diagnoses. Next, I reviewed my calendar and strategized an action plan for the day.
As I was …
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Why doctors should practice active listening
I often say in my keynotes that KevinMD shares the story of the many who intersect with our health care system, but are rarely heard from.
KevinMD has completed its 14th year as the web’s leading social media platform for these voices. Over 3,000 contributors power the site, and together, we are making our voice heard as our health care world changes around us.
I sincerely appreciate your readership …
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10 most popular KevinMD stories of 2017
Although I consider myself an extrovert, I find it more than a little intimidating to talk to strangers. Yes, like many of us, perhaps I was warned as a child not to talk to strangers. That may have had an effect, but I think it is most likely due to the fear of rejection.
However, I recognize that it’s a fear that needs to be overcome. While my skills have improved …
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The secret to a better life? Talk to strangers!
Every day, I see and hear physicians sharing and complaining about how burned out they are. However, I am struck by the fact that while we coach our patients to get help when they are suffering, sick, depressed or in a state of hopelessness, we refuse to follow our own advice. Furthermore as physicians, when presented with potential avenues to alleviate our pain and suffering, we find reasons to be …
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8 reasons burned out doctors refuse help
While on the way to a national meeting on health and public policy, I ponder on what the practice of medicine has become and whether this meeting will provide any hope for improvement. It hasn’t been clear to me that those most responsible for public health policy are listening to doctors. Politicians have been leading this charge, sometimes solo, sometimes in a group but rarely in a collaborative fashion — …
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Can technology and the art of medicine coexist?
There is a strange and peculiar place in American society. Some say that when one enters this place, there are many odd-looking people walking about wearing white coats and wearing funny looking shoes. This place has a name. It is called Medical Zombie Land.
Entering into Medical Zombie Land for the first time, it is hard not to feel that one has been enveloped in a mysterious dimension of irrationality. Home …
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Are we living in a medical Zombie Land?
The question was recently posed on Twitter about how long it takes to recover from burnout, even when positive changes have been made. I have considered burnout from many angles, both personally and professionally, and had not really considered this question specifically before.
Physician burnout has come to the forefront of discussions in the medical community for both physicians and organizations. With burnout cited as impacting over 50 percent of practicing …
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Can doctors recover from burnout?
“Nurse practitioner (NP) education is seriously underfunded. The profession is attempting to saddle private physicians with this cost.”
That is how “Dr. X” replied to my email asking whether he would be willing to precept a nurse practitioner student for her clinical rotation. I read through his clearly disgruntled letter and wanted to explain to him why NPs have to train “on the backs” of physicians and why funding for nursing …
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Why nurse practitioners train on the backs of physicians
I have good days and bad. Some days I am content, connected, focused, and motivated. On those days I enjoy my job, I enjoy the people I’m with, I am willing to be inconvenienced by interruptions.
On other days, not so much. I wake up as grumpy Rob and (despite multiple cups of coffee) the old codger doesn’t leave me alone. I keep score of all the ways in which life …
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A doctor saved a patient’s life. Twice.
As doctors, we simply want to spend more time with our patients. As a doctor for 13 years, and someone who now recruits doctors as a large part of my job, I’m witnessing the battle for more time with patients wage on, but there are no winners. Patients are waiting longer for hurried appointments. We spend more of what little time we have, prescribing and referring out because we’re racing …
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What I learned as a house call physician
It used to be that doctors knew best. We told you what to do, and you obediently complied. The world has changed, and the paternalistic system of yore has given way to the shared decision model where patient autonomy is respected.
The old way: “Well, I’ll be setting you up for surgery soon.”
The new and improved way: “Let’s discuss all of the reasonable options with their respective advantages and drawbacks. Then, …
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Is autonomy really better for patients?
Primary care doctors don’t usually have scheduled blocks of time to read incoming reports, refill prescriptions, answer messages or, what we are told the future will entail, manage their chronic disease populations. Instead, we are generally expected to do all those things “between patients.”
This involves doing a little bit of all those things in the invisible space between each fifteen-minute visit, provided we can complete those visits, their documentation and …
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The myth of multitasking in primary care
178 measures.
This is what we’re up to — the collected compilation of quality and performance metrics for our ambulatory care network, across all the different divisions.
Where did these come from, who decided this is what we should measure, does anyone really have any idea if measuring these things reflects the true quality of the care our patients receive?
That’s a lot of questions all at once, and I’m not sure we’re …
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Do quality metrics really improve patient care?
