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.
Nothing seemed to help the patient — and hospice staff didn’t know why.
They sent home more painkillers for weeks. But the elderly woman, who had severe dementia and incurable breast cancer, kept calling out in pain.
The answer came when the woman’s daughter, who was taking care of her at home, showed up in the emergency room with a life-threatening overdose of morphine and oxycodone. It turned out she was high …
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Dying at home: The problem hospices have with stolen opioids
Despite assurances over the course of his presidency that undocumented immigrants brought to the United States by their parents would be protected by this administration, President Trump has announced recently that he is considering ending the deferred action for childhood arrivals (DACA) program.
DACA was announced by former President Obama in August 2012 as an initiative providing individuals who came to the United States as children and who meet certain other …
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The effect of rescinding DACA on immigrant communities
When health officials learned that the 2015 measles outbreak was caused by clusters of unvaccinated children, Americans once more wanted to understand why some parents do not vaccinate their children. In our highly polarized culture, media commentators and even academics began to connect opposition to vaccination to either the left or right of politics.
So a question arises: Who is more likely to be opposed to vaccination, liberals or conservatives? As …
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Anti-vaccination beliefs don’t follow the usual conservative and liberal lines
We have believed a lie to prop up an increasingly untenable system. We have behaved as if we could safely put our emotions aside to do our jobs at no substantial cost to ourselves in the process. We’ve all heard the admonishments.
“I don’t want my surgeon crying in the operating room. He needs to leave those emotions outside.”
Or: “This is just the way medicine is now. It has nothing to …
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The deception at the heart of physician burnout #SustainableDocs
In this current era of health care, patients are increasingly being labeled as “customers” to provide a landscape suggestive of the need to provide customer satisfaction. Many health care providers grow increasingly frustrated with that terminology. It demeans the relationship that is fostered in the patient-physician encounter; belittling it to a transaction that occurs as the exchange of goods for an expected outcome. Perhaps a more appropriate corollary to the …
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Why patients should be investors, not customers
Congratulations on the new job! After countless, grueling hours of juggling school with the rest of your life, you’ve finished and secured a job, a huge accomplishment indeed.
Negotiating your compensation package can be a nail-biting, heart-racing all around anxiety-producing experience. While some of this anxiety might just stem from inexperience with negotiating a contract, you might also be worried about not knowing what to ask for as a new nurse …
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Nurse practitioners! Tips for negotiating your first job
Last week a physician friend recommended watching the movie the Big Short. The description given to me was that it was a great movie that was all about a bunch of guys who saw the 2008 financial crisis coming. Sure enough, that very weekend, I planned a night in to get take out and watch it on Netflix.
And it sure didn’t disappoint. Starring Ryan Gosling, Steve Carrell, Christian Bale, and …
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The Big Short in health care: What happens after the bubble bursts
Next month when our youngest child leaves for college, the biggest change may not be in his life but in ours.
We are done with dropping them off at school, or giving them driving lessons, or helping them with difficult homework assignments: We will officially become “empty nesters.”
My wife and I ponder sitting at the dinner table and standing by the kitchen counter, where exuberant political dialogue takes place, and common …
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How this physician transitions to becoming an empty nester
I missed a drug interaction warning the other day when I prescribed a sulfa antibiotic to Barton, a COPD patient who is also taking dofetilide, an uncommon antiarrhythmic.
The pharmacy called me to question the prescription, and I quickly changed it to a cephalosporin.
The big red warning had popped up on my computer screen, but I x-ed it away with my right thumb on the trackball without reading the warning. Quite …
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Alarm fatigue is problem. Here’s a pragmatic solution.
The age-old saying is that knowledge is power. But what happens when you are overwhelmed with the information you need to make a decision without the understanding of how that information fits together to answer your question? It’s like trying to put together a large, complex puzzle without a finished picture for comparison. Oh, and by the way, you also aren’t sure you have all the pieces. This situation can …
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We are clinicians in the era of information overload
In days of yore, people in distress usually turned to family, friends and occasionally the clergy for help but for many years now, much of the burden of dealing with human misery has been transferred to medical professionals. Going forward and given that the iPhone and social media are ubiquitous in the daily lives of most of us, it is probably no surprise that the latest psychological support system comes …
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Will bots replace docs?
It was an ordinary day in clinic — I had gotten very behind schedule when a 90-year-old gentleman, who was in for his third visit in a month related to falls, came in with his equally frail wife. We had to spend extra time discussing his placement in a nursing home for safety concerns.
I hastily entered the room of a 46-year-old attractive female, who was here to meet me as …
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A patient becomes the teacher
I work in a male-dominated field. As a cardiac anesthesiologist, I work with mostly male cardiac surgeons in a department where the majority of my fellow anesthesiologists are male. I work with some fantastic male colleagues. They are caring, skilled doctors, and I consider many of them to be friends.
While most of them know how to handle emergencies, trauma and difficult work situations, many times they clam up when we …
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15 tips for working with women
In Houston, all of my colleague’s offices are closed, and there is limited access to the Texas Medical Center due to Hurricane Harvey. As a virtual medical doctor, there was only one thought on my mind this entire weekend, “How can I help?”
As a Floridian, I have certainly faced my share of natural disasters beginning with Hurricane Andrew, a category 5 hurricane in 1992. Living through Hurricane Andrew gave me …
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5 ways virtual doctors can help during a natural disaster
Reformers have expended considerable effort to change the way Medicare buys health care for millions of Americans, finding a wide range of support across the political spectrum. But Medicare’s current structure may doom these reforms. Some primary care doctors fear that the skewed incentives in Medicare’s pricing system will get built into any new system, whether it is “accountable,” “affordable,” or “value-based.” This fear is well-founded. If special interests buy …
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Fix the pay imbalance between specialists and primary care physicians
An exchange between former Vice-President Joe Biden and EPIC CEO Judy Faulkner at a Biden Cancer Initiative event has again elevated the discussion of patient access to their medical records.
You can read the discussion on Politico. However, Biden’s main point was that patients needn’t justify their claim to their own EHR records.
In fairness to Ms. Faulkner, they did express a common view: medical records are too complex for …
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Patient first: How EHRs can better serve our shared mission
We all practice medicine for different reasons. Of course, it’s almost reflexive to say we practice medicine because we care about people. I’m sure this is true for many physicians. However, if I were being honest, I think I went into medicine more because of the educational challenge. In addition, the profession yielded respect, status, money (back in the day!) and yes, an opportunity to help. I won’t challenge my …
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What I learned as a hospice director
We are all guilty of having biases. Some of them we know about and proudly flaunt. Some of them have been ingrained so deeply that we do not even know they exist. Weight is an issue that brings out strong biases, and multiple studies have demonstrated a high level of bias from physicians against overweight and obese patients. Obese patients are often treated rudely and are not given the same …
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Doctors must stop fat shaming their patients
There is a definite finality to the decision of which specialty a physician pursues. The reasons are as vast as they are individual. Hopefully, the med student has done due diligence and has a solid grasp on what their future entails, at least for the future as far as anyone can confidently foresee. Here is my story.
1. Challenge. No day is quite like another, and life as an emergency medicine (EM) …
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4 reasons to choose emergency medicine
