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.
I have a very interesting job: I travel around the country providing neuromonitoring to surgeons in the operating room. I’m also an anesthesiologist assistant, certified and licensed to provide anesthesia. Throughout my ten-year career in the OR, I’ve been the guest of nearly a hundred hospitals in the U.S. and the UK. No two hospitals are the same. My career has allowed me to meet hundreds of incredibly caring doctors, …
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Here’s how your attitude affects patients
Is the practice of medicine a different experience for male and female physicians? Two recent studies from athenahealth suggest that it is — in ways that should make us rethink what we value in health care.
The first study found that male physicians are more productive than their female counterparts. In an analysis of 47 million visits on the athenahealth network in 2016, male physicians generated 30 to 40 percent more …
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For women physicians, is there a connection between productivity and burnout?
I recently asked, “Who’s to blame?” for patients not taking their medications and cited a couple of papers describing the poor state of medication adherence. I concluded nonadherence was a huge problem, and doctors failing to educate their patients was not a major cause.
To support my contention that physicians are not the reason why patients do not take their medications as ordered I submit the following new information.
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Improving drug adherence will take more than money and technology
Dr. Tara Zandvliet was inundated with calls and emails from parents last year, after California passed a law nixing personal beliefs as an exemption from school vaccinations. Suddenly, many parents sought exemptions for medical reasons.
Someone even faked two medical exemption forms purportedly written by the San Diego pediatrician, copying a legitimate document she’d provided for a patient and writing in the names of students she’d never treated, she said. She …
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How anti-vaccine parents are finding doctors willing to exempt their kids
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old man is evaluated for elevated blood pressure noted recently at a local health fair. He has no other medical history and takes no medications.
On this visit and on two subsequent nurse visits, the patient’s blood pressure measurements are less than 140/90 mm Hg. BMI is 34. Cardiac examination reveals an …
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MKSAP: 54-year-old man with elevated blood pressure
For the last several weeks, I have been working as a medical volunteer on a remote island off the coast of Fiji called Batiki. Home to 234 natives, Batiki has no running water, and no electricity (other than solar generated power). The inhabitants are subsistence fishermen and farmers. They are filled with joy and a real sense of community. While on the island, I found extremely high rates of high …
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This South Pacific island will change how you think about health care
I’m pleasantly surprised to see how a growing number of physicians are finally starting to percolate openly with their extreme dissatisfaction about a just how broken our medical system is. I admire and am proud of these brave vanguards who are a minority but have seemed to pick up steam. I still don’t hear their fearless voices carried in major media outlets (shame on these outlets!), but they are more …
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Use your voice to change health care
One of the biggest points of contention in the ongoing discussion of burnout is that the system of health care is flawed. The endless bureaucracy, decreasing physician pay, and increasing meaningful use requirements that spawn endless clicking on an already inefficient electronic medical record platform have become unbearable by most practicing physicians today.
Furthermore, all the talk about mindfulness only riles up more anger in physicians as they feel they are …
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Take back our practices with physician cooperatives
Let me start by saying that I am a huge Dave Ramsey fan. When I completed residency and began my current position, The Total Money Makeover was the first personal finance book I read, and pardon the cliché, but it changed my life. It instilled in me a strong foundation in money management and offered me a road map to handle the situation I was in: hundreds of thousands of dollar in …
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Pay off debt, invest, or both: Advice to young physicians
As a second-year family medicine resident, wife of a nurse and mother of an almost-two-year-old, the feeling of just not being enough has a suffocating hold on me some days. Non satis. Sounds like a pretty good gig when I talk with others outside the medical profession and friends from home. Training to be a doctor? Great. Happily married to an amazing man who’s taking time off work to raise …
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A resident deals with being a wife, mother, and doctor
It’s a health care buzzword for sure, but when we talk about quality, what do we mean? We can compare the quality of similar things and focus on its absence, but otherwise, putting the idea into words becomes complicated. Context is important. And so is perspective: One’s position within the health care system influences how he defines quality to a larger degree than it does at a restaurant, or in …
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When we talk about quality, what exactly do we mean?
Last week, I spent a few hours completing an online module for one of my immunology courses. The purpose of this module was simply to expose students to the format of lecturing and assessments that would take place throughout the length of this course.
The portion of the module that I found really exciting was a series of videos depicting scenes at a local clinic where a physician examined a patient …
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Pursuing a career as a physician: A reminder why
During elementary school, I saw my dad mostly on weekends, because he traveled for business during the week. Between watching soccer games and running errands, he never missed an opportunity to tune the radio to Car Talk. He is an engineer with a passion for cars, and Car Talk was his Holy Grail. He would guess what was wrong before the expert hosts spoke, and he was usually right. “Aha, I knew it …
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When we are in need, we crave someone who knows us
The McDonald’s cheeseburger is an icon of America. Admit it, you know you love one. A guilty pleasure to say the least, but as far as cheeseburgers go, it is far from the best. In reality, if you were to taste test all cheeseburgers, the McDonald’s burger would probably rank near the bottom. The beauty is that no one cares, and they sell these things by the millions. Why? Because …
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Race to the bottom: The myth of low-quality care in America
As a pediatrician, I have always known the value of my presence. At least, that is how I remember feeling during long nights in the hospital taking care of sick children, in the clinic or in any situation that required pediatric expertise. “How can I help?” I would always ask as I entered an exam room. Answering questions from wide-eyed parents about their foreign and frightening new bundle of joy, …
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Being a CEO isn’t that different from being a clinician
The writing’s on the wall. The last few decades have seen two groups of people:
One group that is “dying longer,” yes some might call it living long but not healthy. (As a physician, I call it dying longer). These are folks who are disabled, obese or emaciated and depressed or demented, with multiple medical issues spending a quarter of their life in the medical system, and the last decade of …
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Health care is obsolete. Let’s fix it.
I was inspired a couple of weeks ago. Sitting at the WeWork facility in Northern Liberties, Philadelphia. I looked at the group of entrepreneurs, creatives and innovative thinkers sitting in front of me. What were we doing you might ask? Collaborating to help one another build our dreams. This is the epitome of the human experience.
One of the topics that came up in conversation was the difference between a man …
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Are doctors more like humans, animals or robots?
As an oncologist, I have spent my career learning how to break bad news. I am still not entirely sure how to tell my children about the tumor in my pancreas, why I will be gone from our home next week for a Whipple operation, or my excuse for abstaining from wrestling matches for the foreseeable future.
I am blessed with two kids, temperamentally diametric: a careful, sagacious nine-year-old daughter and …
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Cancer doesn’t take away from the beauty of life
Which arrow causes you more pain, the first or the second?
Fellow blogger Michelle at The Green Study recently posted a piece in which she distinguished between pain and suffering. It reminded me of a Buddhist teaching that inspires and humbles me. Blogger and curator extraordinaire
Maria Popova quotes it in an article she wrote last year on a book by Tara …
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How mindfulness may ease your suffering
