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.
My job as a standardized patient (SP) at several different medical schools means that I spend a lot of time being interviewed and examined by students at every stage of their education. Occasionally, the interview is of such a nature that the SPs are told to dress in a certain “costume” because it signifies to the student that there is something about our cultural representation that affects our medical care. …
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Are cultural sensitivities affecting care?
How important is it for a doctor to want to be a doctor?
At first glance, that question is ludicrous. The path to becoming a practicing physician is so long and tortuous that no one would do it if they didn’t want to. Right? First, there’s the four years of undergraduate education, then four years of medical school, then at least three years of residency. No one has ever suggested that …
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Why do doctors who hate being doctors still practice?
Measuring metrics is a common catch-phrase in health care. The goal of capturing certain data is to improve patient outcomes. But, as doctors, we were taught to treat the patient and not the numbers. While optimizing clinical outcomes is a needed goal with all the complexities in medical treatment currently, the system seems to have gone too far in its quest for targeted numbers.
If, for example, a patient suffers metastatic …
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Good doctoring transcends numbers
There’s a common affliction that’s rampant in my practice, but it’s not a gastrointestinal condition. It’s called polypharmacy, and it refers to patients who are receiving a pile of prescription and other medications. I see this daily in the office and in the hospital. It’s common enough to see patients who are receiving 10 or more medications, usually from 3 or 4 medical specialists.
Of course, every doctor feels that he …
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Who’s responsible for polypharmacy in the elderly?
Diana Feliz Oliva, a 45-year-old transgender woman who grew up outside Fresno, Calif., remembers being bullied when she was younger and feeling confused about her gender identity. She was depressed and fearful about being found out, and she prayed every night for God to take her while she slept.
“I was living in turmoil,” said Oliva, who now works as health program manager in a clinic for transgender people at St. …
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Mental health problems in the transgender population
I first noticed this phenomenon while watching the world news on a weekday after work. It was a commercial for a new diabetes medicine that showed overweight people dancing at a barbecue, cooking and enjoying life. How different this was from my day in the wound clinic, where I saw patient after patient with obesity, diabetes, and nonhealing wounds, as well as other dire medical complications.
So I tucked this image …
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The new battleground of prime time media, disease, and death
As a corrections physician I frequently heard the question, “How can you take care of those people?” I understood what they were asking, after all, I was caring for people convicted of such crimes as murder, rape and child abuse.
And yet I had very little difficulty providing the same care to inmates that I provided to everyone else. In fact, the corrections environment was generally easier to work in and …
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What I learned as a corrections physician
A little ways back, I was at a gathering of friends and family and was in the kitchen setting out a dish of black bean and quinoa dip. Suddenly, I heard someone from behind me exclaim: “What is that? If that’s something healthy, I am not eating it.”
Although somewhat intended as a joke, there was no doubt a truthfulness to what was said, just as exists in similar comments which …
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Here’s why we don’t care about our health
We have all seen and heard the story: a patient who is overweight and has heart problems (or arthritis, diabetes, low back pain or any number of other chronic conditions) is told by their doctor that they need to exercise.
The patient agrees, “Yes, I really will try to start an exercise program.”
Six months later, the patient is back in the doctor’s office, and the conversation goes something like this:
“Well, I …
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Prescribe exercise like you prescribe medicine
Robots read EKGs. Computers interpret chest X-rays. Algorithms decide which treatment a patient gets.
I asked myself this question this morning, “What job can I do as a doctor that cannot be done by a computer or a robot?” And one of the first things I said to myself was, “Comfort a human.”
But I dwelt on this for a moment and found it’s not quite true. Because computers and robots can …
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The one job robots can never take away from doctors
Why do we want to become doctors? What was our main motivation that we have written in our motivation letters and repeated in our interviews? Regardless of the specific incident or the general motivation, it can be all summarized in one sentence: We are here to save lives. After all, this is what the physicians do, isn’t it?
Preventing deaths is actually hinted to by the original Hippocratic Oath, written between …
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We need to accept our failure as doctors
Here’s some advice for your career in health care: Leave the country as soon as possible.
This has nothing to do with the president’s attempts to euthanize the Affordable Care Act. Or with EMRs, Medicare reimbursements, or the burnout surveys you get from your employer, who also sends emails aimed at getting you to work faster and more efficiently.
It’s none of that. You need to leave the country, just for a …
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Do yourself a favor: Leave the country and see how health care is abroad
When looking at why we as an industry have been largely unsuccessful in combating the epidemic of burnout that is plaguing our community, we must deal with our approach to solutions.
One of the biggest things to distinguish about burnout is that it’s not a problem to be solved. It’s not a diagnosis to be made, and it’s not a condition to be treated. Burnout is a perplexity; a vicious cycle …
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Understanding physician burnout: It’s a perplexity
Do you know we have record rates of physician burnout, dissatisfaction, and suicide? Ongoing shortages in primary care, without improvement in sight? Physicians exiting medicine earlier than in the past?
What about burnout? Do you know it affects patients as well as their doctors? Affects physicians’ families and friends? Increases mistakes and malpractice risk? Affects patient adherence and outcomes? Is costly to the entire system?
How do we start to fix this? …
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Physician wellness at the personal, institutional, and cultural levels
The practice of medicine is a lot like the practice of parenting. It is full of highs and lows, moments of pure joy and those of devastating heartache.
When I talk to my friends who are parents, they agree with me. Some of the most difficult times as a parent is watching your kids fail. When your child is hurting, it hurts far worse than if you had experienced it first …
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The practice of medicine is a lot like parenting
I have no business background: zero, zilch, nada. Growing up, I was the kid who bought the lemonade, not the one who set up shop on the busy street corner. My parents bought the cookie dough, coupon book and every other school fundraiser from the kid next door instead of their own child. Job interviews? Never had them. All the jobs I’ve ever had I got because I knew the …
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Physicians: Want to overcome burnout? Start studying business.
“How did you know what to say to her?” asked the resident, “We have been trying to figure her out all morning and have gotten nowhere.” An expression of mixed curiosity and frustration crossed her face.
“I try not to focus on how she is acting, as much as I try to talk to the part of her Jesus would love,” I found myself answering. This catchphrase would find its way …
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Want to make meaningful connections with patients? Here’s how.
Earlier this week, one of the residents and I saw a new patient who apparently had been sent in to see us for a pre-op visit, an evaluation to make sure that her medical conditions were well controlled and that the surgery was safe for the surgeons to proceed with. She reported that she forgot the paperwork they gave her. All she knew was that whatever we wrote had to …
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Let’s get one thing clear: pre-op comments from primary care
