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.
Days are getting shorter and evenings are getting cooler in temperate regions in the Northern hemisphere. This also means that the flu season will be around the corner soon. Most people group influenza (flu) and cold together and refer to the “cold and flu season” as the time of the year when we expect to come down with a “flu bug” and consider it “normal” or customary. Some are even …
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This is the deadly virus you need to look out for
“In Puerto Rico, we call those plants morir vivir,” said a patient who sat by the side of the road while we checked her blood sugar. When I reached to touch the small fern, it swiftly closed its leaves shut, and then after a few minutes cautiously reopened. As a young doctor I was fascinated with the poetry of the name. “It’s just like us Puerto Ricans,” she smiled.
For two …
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An emergency physician travels to Puerto Rico. Here’s what she saw.
Baseball, like medicine, is deeply imbued with a sense of tradition, and no team more so than the New York Yankees, disdainful of innovations like placing players’ names on the backs of their jerseys and resistant to eroding strict standards related to haircuts and beards.
It’s why doctors and patients alike should pay special attention to why the Yankees parted ways with their old manager and what they now seek instead. In …
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What baseball can teach doctors
I distinctly remember the excitement I felt during my first year of medical school when exposed to the breadth of general and specialty fields that seemed all so equally rewarding and medically influential. I envisioned myself holistically understanding my patient, seeing the problem in the context of her other medical issues, her personality, her family and her environment — an approach I considered at the heart of the oath we …
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How to inspire medical students to pursue primary care
There were fewer black men enrolling in medical school in 2014 than in 1978.
In a world where the first black president of the United States was elected nearly a decade ago with many declaring it to be a new day of progress for blacks in America, statistics such as this one come as a surprise. Fifteen years ago only 677,000 blacks held an advanced degree. Today that number is 1.6 …
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Recognize the many accomplishments of black men in medicine: #BlackMenInMedicine
There are highs and lows in doing any job and throughout one’s career. The highs, and the possibility of highs, can often overpower the effect that the low moments have on well-being and professional satisfaction.
The health care context is no different. But unlike most professions, physicians, nurses and other health care workers are exposed to a higher frequency of distress, pain, suffering, death and trauma and all the accumulated personal …
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Health care professionals need balance
Four o’clock on a Friday afternoon is an anxiety-inducing time to be running behind in clinic as patients and staff both begin to show signs of wanting to leave. After finishing with a particularly complicated case involving chronic pain with multiple spinal and abdominal surgeries, I rushed into the room of the patient scheduled for 3 p.m. frazzled. The patient was an elderly man, seated with arms folded, looking sternly …
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We must ask patients obvious questions
Trump recently declared a national public health emergency. In this statement he was not talking about HIV or hepatitis C nor was he referring to the increased incidence of gun violence in the country. The president’s statements focused on a very different public health problem; he was talking about America’s high incidence of opioid-related deaths mostly from overdose.
This declaration has been met with various pronouncements including …
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Here’s how to win the opioid war
Recently I had an interaction online with a physician regarding his thoughts on ADHD treatment. (Let’s call him Dr. Stigma). This post is not about doctor-bashing but more to point out the prevalence of stigma against those with a psychiatric diagnosis even from within the medical community. Stigma, unfortunately, is so indoctrinated into our culture that sometimes people don’t recognize the pure ugliness of their words.
Dr. Stigma’s comments:
Many patients use …
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It’s time to stop prejudging your patients
The last few passengers filter in and buckle themselves up before takeoff. The emergency exit row is occupied by an elderly couple, and I am seated behind them. The flight attendant asks whether they are comfortable in those seats, given that they’d have to respond in the case of an emergency.
“Not that I expect anything bad to happen,” the flight attendant adds with a smile.
I, too, am familiar with discussing …
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The worst-case scenario question you must ask patients: even healthy ones
If patient-centered care is the current winning game plan for health care, then shared decision making (SDM) is the secret weapon. But we physicians need a new way to approach it.
SDM, as defined by the Society for Medical Decision Making, is “a collaborative process that allows patients and their providers to make health care decisions together, taking into account the best scientific evidence available, as well as the patients values …
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A new approach to shared decision making
This open enrollment season, patients will be considering their health care coverage for the coming year. To ensure they are fully utilizing their primary care benefits and building relationships with health care teams that will keep them healthy, we need to encourage them to connect with a primary care practice or medical home.
A medical home is a place where a patient can seek treatment from primary care physicians and other …
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Prioritize primary care this open enrollment season
Scourge:
- An instrument of punishment or criticism
- A cause of wide or great suffering
- Whip or lash — especially for torture
Introduction
They say you never forget your first time. I remember mine, vividly. If only I could erase the memory. I had high expectations and higher hopes, but what I got was disillusionment. I felt violated and humiliated. I’m talking about my first time using a system for electronic health records …
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The scourge of electronic health records
While doing my doctoral dissertation research at a clinic for kids with diabetes, I observed the attachment that some of them had to the physician faculty member who directed the clinic. I particularly remember one teenager who complained that this doctor “did not care” about her, as he sent “fake doctors” (residents) to take care of her, not coming himself. She was refusing to cooperate. When I suggested to the …
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The doctor-patient relationship is everything
Healthy or not, everybody has his or her share of frustrations in life. The chronically ill don’t have a corner on that market! This piece focuses on frustrations that are unique to those with ongoing health issues. I’ve experienced all of them as a result of being chronically ill with a debilitating illness that settled in after I contracted what appeared to be an acute viral infection in 2001.
Here are …
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The most frustrating things about being chronically ill
Periodically we should reflect on what challenges face patients and physicians. Over the past few days, I have worked on a list of the issues that concern me the most. I welcome suggestions for expanding the list.
1. Diagnostic errors. All patient care requires that we make the proper diagnosis. Too often we make errors. A recent paper estimated that 30 percent of cellulitis admissions did not have cellulitis. A similar …
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These are the biggest medical issues of 2017
Many physicians have become world famous writers, and in Greek mythology, Apollo was the god of both poetry and medicine. I can personally think of many prominent physician writers I have come across in my reading over the years:
There was the 12th-century rabbi Maimonides, Copernicus in the 15th century and the poet John Keats in the 1700s.
In the late 1800s to early 1900s, there were Anton Chekhov, Sir Arthur Conan …
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EMRs are robbing physicians of their writing skills
Mrs. Smith is an 81-year-old female. She worked a long time doing very physical work and is now on a fixed income and comes to my office with chronic pain. X-rays show she has degenerative arthritis in her hips, knees and lumbar spine. She has taken Norco twice a day for years and has been able to be very stable on this. She has always been compliant with her medications. …
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Don’t let the opioid crisis affect the treatment course for your patients