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.
Inquisitive reader Amy asked me if I had any opinions about online screening for depression. The British Medical Journal recently published a debate on this issue.
What an excellent question, Amy! I read the opposing arguments, and these are my thoughts:
First, I see two different issues. The first is whether the 9-question Patient Health Questionnaire (PHQ-9) is an appropriate tool to use to screen for depression. The second is …
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Online screening for depression: Here’s what one physician thinks about it
According to Wikipedia, “Productivity describes various measures of the efficiency of production. A productivity measure is expressed as the ratio of output to inputs used in a production process, i.e., output per unit of input. Productivity is a crucial factor in production performance of firms and nations.”
Please tell me how this relates to being a physician or a patient. We do not produce anything. Rather we work with individuals to …
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It’s time to ban productivity from medicine
This year, I stood on the curb at the 2017 Halifax Pride Parade and watched high-energy floats pass by. Leading the parade was the indigenous float. The vibrant trans youth float warmed my heart. The prime minister waved and called out “Happy Pride!” to the spectators. It was a stream of enthusiastic faces, song, dance, and brightly colored banners.
I love pride. It’s is a special time for a lot of …
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How to improve primary care for trans patients
“The doctors who did this should be hanged.”
It’s a statement the came at me with a bang. It stood out in its thread, in the accusatory way of old courtroom scenes of black and white movies, where the heroine dramatically screams out at the jury, seated wide-eyed in their box nearby.
But it was merely a response to a Facebook post on the topic of the opioid epidemic, typed in nonchalantly, …
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Doctors are taking the blame for the opioid epidemic. It’s time to push back.
It’s 8:45 p.m. in rural Chiapas, Mexico. A cool blanket wraps around the previously warm day in the small farming town of Honduras. With a syringe of medicine in his front pocket pasante, Dr. Ivan Martinez does a steady jog up a steep hill to see about a patient’s chronic pain.
Nestled in the Sierra Madre Mountains, there are few flat places. At the door, he’s immediately and warmly greeted by multiple …
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What it’s like to follow a first-year physician in Mexico
Devastating. That alone cannot fully describe the extent of the destruction of property, the displacement of tens of thousands of residents, the injuries and loss of life in the wake of Hurricanes Harvey and Irma. As Americans, our hearts ache for those affected by the flooding. As a medical student, former international development worker in Afghanistan and EMT in South Africa, I also lay awake thinking about the many infectious …
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In this era of increased globalization, infectious diseases show no boundaries
As I approach the end of my medical school training, I want to take a moment to reflect upon the invaluable education that my classmates — novices in medicine but rich in life experiences — have provided.
Nearly all of us identified with the common struggle of medical school: late night study sessions, difficult days, and the general balancing act of focusing on work as well as our own wellness. All …
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Advancing physician diversity and representation
We humans can’t help but shove as much as possible into one minute, one hour, one day. We’re rewarded for doing it, too. Society says that the more you check off your list, the more productive you are. And by default, then, the more productive you are, the more successful you are. So, we rush. We search for ways to skip steps and still get the same result. We fill …
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Gain time by slowing down with your patients
Most parents have been deeply distressed by the rising violence and streams of hate as a keynote in our national discourse. For a constructive response, I encourage parents to write to their school administrators and partner with the adults in their children’s community to stem the tide of vitriol that has engulfed our views on race, religion, and the study of history in our everyday lives. Here is an edited …
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An open letter about hate and how to fix it
That first paycheck as a new attending means so much more than what is direct-deposited into the bank account. The emotions of finishing medical school and training to finally seeing the fruits of your labor positively affect the bank account is something to be proud of. As a medical student (like myself) and resident, it is the light at the end of the tunnel. You’re probably asking yourself, “Why should …
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The key to financial freedom: Live and work like a resident
After almost fifteen years as a research physician, I grew tired of the relentless cycle of applying for grants, failing to obtain funding, and reapplying with variable success. Conducting clinical trials was rewarding, but the responsibility seemed endless. I began to feel burnt out, scorched. It was time for a change. I needed a hobby.
Around this time, I read Frank McCourt’s memoir, Angela’s Ashes. The author described it as a story …
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How a doctor turns life into story
Nearly every American is touched by serious chronic illness, either as a patient or as a caregiver. The federal government recognizes the far-reaching effects of such conditions, and agencies like the National Institutes of Health and Centers for Disease Control and Prevention conduct surveillance of these diseases. Such research allows us to better understand the burden of different diseases, develop new treatments and prevention practices, and protect the public’s health. …
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Food allergies are a public health crisis we can no longer ignore
“So, I’m getting routine labs on her.”
Wait, what?
Statements like these often make the hair on the back of my neck stand up. One of our residents was seeing a healthy young woman for her “annual physical,” seen just a few days after a routine postpartum visit with her OB/GYN after the uneventful birth of her third child two months ago.
The resident was coming for his afternoon continuity clinic from an …
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It’s time to stop it with the “routine” labs
I entered the room to see a face that I recognized. As soon as I looked at my chart, I immediately knew this patient. I saved their life last year. I know this because the patient told me so.
The teachers and mentors that I was privileged to learn from and train with 25 years ago emphasized the essential principle of osteopathic medicine — we make physical contact with our patients. …
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In Iraq I saved lives. Now, I can’t give an allergy shot.
Despite what the textbooks say or how much research is devoted to substance use disorder, I still meet people who feel that addiction is a “choice,” and that these patients don’t need “treatment” (you made your bed, and now you can just lay in it).
To a certain degree, this is true. Like Little Debbie cakes and type 2 diabetes, cigarettes and lung cancer, lack of exercise and essential hypertension, addiction …
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Addiction doesn’t just ruin the addict’s life
I have been working on this essay for some time now. It has been difficult for me to convey in words this complex issue of physician-patient relationships that, to me, is the crux of the art of medicine.
The first time I met Rachel was when she showed up at my office with Mary, her closest friend for her first prenatal exam. When a year later, I walked into my office …
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What does trust mean to a patient?
Sexuality can be hard to talk about. I think this is true for adults far more than for children. Children are naturally curious and nonjudgmental. They just want to know: What is that, what’s it for, why are yours different from mine, and why does he have one of those and I don’t? It’s we adults who squirm and dodge, deflect and bolt. From a very early age, children learn …
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Skirting around language is a disservice to your patients
