Primary Care

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.

This pediatrician doesn’t fear fevers and neither should you

Cherilyn Cecchini, MD

Conditions and Diseases

September 9, 2017

As a pediatrician in training, I’ve seen countless instances in which parents, in both the ED and inpatient/outpatient care settings, have presented with deep concern regarding their child’s fever. It’s an age-old concern. But why exactly does fever cause so much distress in a parent’s world?

As a medical student, I distinctly remember rotating with an attending physician who had strong feelings regarding fever. He became angry with me when I …

I vow not to call my patients “difficult.” Here’s why.

Weisheng Mao, MD

Medical Education

September 9, 2017

I am not a doctor. (Yet.) I am a novice third-year medical student, somewhat able to perform and document a physical exam on a sleeping child, to dial the correct number to call a consult and to make wild guesses about chest X-rays (“I see a consolidation?”). I write about medicine not from a position of experience, but of malleability. I want to become like the best doctors I see.

Towards …

MKSAP: 46-year-old man with fever, dysuria, and urinary frequency

mksap

Conditions and Diseases

September 9, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 46-year-old man is evaluated for fever, dysuria, and urinary frequency of 1 day’s duration. He also notes a sensation of deep pelvic pain near the rectum. He has no urethral discharge or testicular pain. He states that he felt well before the current illness and has no other symptoms. Medical history …

A reminder that physicians are artists

Shannon Tapia, MD

Physician

September 8, 2017

Anyone entering medical training is taught that medicine is an art, one that combines scientific knowledge, discovery and application with its practice. It is both art and applied science. It should never become nor has it ever been only all one or the other.

To be medicine at all, the noble vocation that so many brilliant minds sacrifice to pursue in service to their fellow humans, the practice must balance art …

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A reminder that physicians are artists

Natural disasters in a time of telemedicine

Amy Fan, MD

Physician

September 8, 2017

My significant other is a physician working in Houston, and he missed Hurricane Harvey over the weekend, being out of town for a conference. The hospital sent out an S.O.S. asking faculty to do their best to come in. As the Houston airports continued to be closed Monday and Tuesday, he and his colleague, also a physician and a native of Houston, flew to another airport and drove a few …

3 ways to better communicate with patients via signposting

Edward Leigh

Patient

September 8, 2017

Imagine driving through an unfamiliar area, and there are no street signs. How would you feel? Frustrated? Scared? Angry? You would feel these emotions because you had no direction or guidance. Patients need direction when they enter the health care system. Signposting is a tool to provide direction.

On the streets, there are posts that have signs. They provide direction; they tell us where we are going. Hence, the name, “signposting.” …

7 ways for doctors to stay safe at work

Jenny Hartsock, MD

Physician

September 7, 2017

Being a health care provider has always come with personal risk. We care for all patients, which includes patients agitated due to psychiatric issues, dementia, acute medical illness, alcohol or drug intoxication or just anger. Patients can be extremely volatile and lash out unexpectedly causing physical injury to their doctor, nurse or another provider. Besides the physical risk, patients can be emotionally and verbally abusive as well- and both types …

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7 ways for doctors to stay safe at work

Co-production of care: A different kind of health care than we’re used to

Sylvester Jones and Laura C. Leviton, PhD

Health Policy

September 7, 2017

More than anything, Willie needed a place to pee.

Elaine needed help walking.

Willie is homeless; Elaine is affluent. They both needed someone to listen to them and help them find solutions to their most pressing everyday challenges. That’s called “co-production of care.”

When Willie found out he had congestive heart failure, his doctor put him on beta blockers with diuretics.

The medications made Willie feel better, but there was one problem: Because of …

Can we slow the aging process?

Stephen C. Schimpff, MD

Conditions and Diseases

September 7, 2017

Part of a series.

Can we slow the aging process? The answer is a definite yes. It’s not easy and requires some real diligence, but aging can be slowed.

When thinking about a car we all know “old parts were out.” It is equally true for the human body. But less appreciated is the fact that we can either slow or speed up the process, just as good preventive …

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Can we slow the aging process?

New technology might help us become more empathetic to others’ suffering

Shirie Leng, MD

Health Technology

September 6, 2017

Tele-empathy is not being empathetic over the phone. It is not crying in the sad parts of your favorite TV show. It is not beaming empathetic thoughts magically across time and space. No, tele-empathy is a technology. I should rather say, it’s a group of technologies recently being created to increase the empathy of health care providers. “This is rich,” you might say coming from an industry that brought us …

3 unconscious things you might be doing that affect your patients

Nisha Cooch, PhD

Conditions and Diseases

September 6, 2017

Patient psychology is increasingly recognized as an important contributor to health outcomes. What patients believe about their health and their providers can significantly affect their initiative and their adherence.

It is important to recognize that factors that appear to be unrelated to medical care can influence feelings about that care, as well as outcomes. The reason this occurs is that the brain is not designed to parse out each element of …

Your patient is angry. Here are 5 things physicians can do.

Suneel Dhand, MD

Physician

September 5, 2017

It’s a scenario that every doctor is familiar with. You are having a busy day and working full steam to get everyone better. You suddenly receive that unexpected message: “Mr. Johnson and his family are very upset and would like to speak with you now.”

Most of the time, any physician’s initial reaction will be one of irritation, disappointment or frustration: “My goodness, I’m working so hard here, and we have …

A way to stop social isolation? Beer.

Sarah Fraser, MD

Physician

September 5, 2017

On our first night in Dublin, my mother and I head straight to a pub. We sit at a table across the room from a cheerful woman who looks to be in her eighties. It doesn’t take her long to walk across the room and join us. She grasps her pint of beer and takes a long gulp. We learn that her name is Mary and she welcomes us with …

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A way to stop social isolation? Beer.

Physician, heal thyself. With help.

Manish Naik, MD

Physician

September 4, 2017

Doctors see firsthand the toll that today’s increasingly stressful society takes on patients: Engineers, office managers, teachers, you name it.

Work demands have increased, as has multitasking. Pressures outside the workplace add additional stress. Often, parents chauffeuring children to multiple activities must also care for aging parents with increasing needs. Electronic devices, always in hand or close by, command our attention (due to work or personal needs, sometimes simultaneously). Finding a …

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Physician, heal thyself. With help.

A radically patient-centered proposal to fix health care in America

W. Ryan Neuhofel, DO, MPH

Health Policy

September 4, 2017

An executive summary of “A radically patient-centered proposal to fix health care in America.”

The political theater over health care reform has quieted after yet another ugly show. A productive dialogue about big ideas seems impossible in our hyper-partisan climate. No matter which party holds power, any significant proposal is quickly met with fierce opposition from a variety of political and business interests.

So, for many decades, America has …

MKSAP: 38-year-old woman with a HbA1c value of 9.1%

mksap

Conditions and Diseases

September 2, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 38-year-old woman is evaluated after laboratory study results show an HbA1c value of 9.1%. Her HbA1c goal is less than 7% because she has high function, long life expectancy, few comorbidities, good support, health literacy, and access to care. Medical history is significant for morbid obesity, obstructive sleep apnea, hypertension, and …

The moral hazard of health insurance

John Corsino, DPT

Health Policy

September 1, 2017

I took a great continuing education course recently, and had an opportunity to review some useful skills and fascinating cases. Because health care knowledge areas expand more quickly than most and keeping current is an integral part of doing these jobs well, it was easily worth the time.

The cost seemed unreasonable, but I was only superficially interested in that anyway; like most, I’m fortunate that my employer offers a generous …

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The moral hazard of health insurance

The parable of the pizza shop

Emily Dalton, MD

Physician

September 1, 2017

One day a man decided to open a pizza shop. The first week he sold pizzas and collected money from his customers; the happy customers ate hot pizza, and the man made some money.

The next week many of his customers who came in had pizza insurance, and had already paid Blue Wall Insurance for their pizzas. Since so many of his customers had purchased pizza insurance, the man signed a …

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The parable of the pizza shop

Health care stole the American dream. But it’s absolutely possible to take it back.

Dave Chase

Health Policy

September 1, 2017

An excerpt from the CEO’s Guide to Restoring the American Dream: How to deliver world class healthcare to your employees at half the cost.

I often think about a question that should make us all step back a bit. Why are millennials—the largest American generation in history—the first generation to think life won’t be better for them than their …

Patients and doctors need one another now more than ever

Catherine Cheng, MD

Physician

September 1, 2017

To the patients concerned about the future of health care:

We need one another now more than ever.

In April last year, I started this blog to help patients and physicians connect in an increasingly disconnected health care system. Both patients and physicians feel bound and invaded from multiple directions, all interfering with the doctor-patient relationship. We all suffer for it.

It occurs to me that many of you may …

Primary Care

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