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.
On the afternoon of July 26, I opened an email from Dr. Peter Slavin, president of Massachusetts General Hospital, where I work as a primary care doctor. Dr. Slavin frequently sends messages to all MGH employees, uncontroversial broadsides announcing new hospital initiatives, grant awards, promotions and retirements that often end with: “Go Sox!” (or, depending on the season, “Patriots!” “Celtics!” “Bruins!”).
So I was not expecting that …
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A hospital leader speaks out against the transgender military ban
Advocacy groups have been busy lately with their fancy-pants chemical detection science instruments, and their press releases have made it into the news. But is there news here, and are these chemicals something parents really need to worry about?
First it was a big lead from the New York Times called “The Chemicals in your Mac and Cheese.” The article started:
Potentially harmful chemicals that were banned from children’s teething rings and …
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Chemicals in your food? Please don’t panic.
As is customary for every administration in recent history, the Trump administration chose to impale itself on the national spear known as health care in America. The consequences so far are precisely as I expected, but one intriguing phenomenon is surprisingly beginning to emerge. People are starting to talk about single payer. People who are not avowed socialists, people who benefit handsomely from the health care status quo seem to …
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A single-payer system is the American way
I told you so. I also told the POTUS in my open letter, but he did not read it.
Who could honestly believe the nation would support dumping coverage for 22 million people? As David Leonhard wrote recently op-ed in the New York Times: “They [Republicans and President Trump] had only one big weakness, in fact: They weren’t dealing in reality.” When faced with reality, it is interesting what a few good …
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Health reform is stalled. Here’s how to do it right.
Two seemingly unrelated national policy debates are afoot, and we can’t adequately address one unless we address the other.
Health care reform has been the hottest topic. What to do about America’s aging infrastructure has been less animated but may be more pressing.
Yet even as cracks in America’s health system and infrastructure expand, political divides between parties and within parties have stalled efforts to develop policies and implement solutions. Problematically, debates …
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Bridges and roads are also important to your health
I get on the phone with a physician. She is stressed. Her tone is exasperated. Her frustration has been building and building. I hear the stress in her words.
She feels like she has been juggling ball after ball after ball. Living her circus of a life. Taking care of her patients. Pulling extra shifts and doing locums.
Somehow, fitting in a little bit of time when she can for her caring …
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Am I using money, or is money using me?
I feel privileged to be practicing medicine. Many people consider doctor careers and imagine how great it may be. Is it the right thing for you? Yes there are days of frustration, exhaustion, and utter defeat, but at the end of the day I home and know that I helped at least one person if not two from the 16 I meet.
The fact that I alleviated one individual’s anxiety or …
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10 reasons why being a doctor is a privilege
Recently, getting dressed after working out in the gym, the guy in the next locker decided to complain to me about his recent surgery.
Having lockers next to each other had led over time to “What do you do for a living?” After discovering that I was a physician he has occasionally asked some medical questions, and done what a lot of people do when they know you’re a health care …
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How EMRs are making informed consent meaningless
Many people love to vilify doctors. They think we are all greedy and we don’t listen. They say we perform procedures just for profit. We are not available when we need them. Sure, there are doctors that fit this stereotype. But, in my experience, most doctors do not and care about their patients trying to do the best for them.
I hear patients complain about other doctors and some of the …
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Find the right doctor for you: Here’s what to look for
Today’s patients must adjust to seeing many physicians, many of whom are strangers. If you need a doctor on the weekend, at night or just need a same day appointment, you may very well not be seen by your physician. This is not your father’s medical practice. The days of the physician house call have vanished. There are many reasons responsible for this evolution (or devolution) in medical care. Patients …
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When it comes to after-hours care, expectations need to be adjusted
Over the past decade, I have thought often about the benefits and the problems of clinical guidelines.
The first concept that attracted my attention was reading about conflicting guidelines. Given the same data, different guideline committees would have significantly different recommendations. At the least, this problem raises questions about guideline validity. It makes clear that committee perspective could influence recommendations. Guideline recommendations sometimes are clear and demonstrably evidence based, but too …
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Guidelines are wonderful. Guidelines are dangerous.
June 30 is a date that those in the medical world know well; it’s the official end of the medical training calendar year. July 1 represents new beginnings: beginning of the academic year, an internship, a residency, or a fellowship. This year was our tenth and final passing through the medical new year. Looking back, I realize that we never would have predicted what we were going to learn and …
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Here’s what it’s really like when your spouse is a doctor
Much has been written in recent weeks about the failure of direct primary care giant and pioneer Qliance. Much of the conversation has examined the reasons for their closing and the negative impact it will have on the direct primary care movement. Questions have been raised about the longevity of the movement, with many exclaiming that “If they can’t sustain it, no one can.”
While I don’t pretend to know all …
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Forget what you’ve heard. Direct primary care is here to stay.
Humanity often exists as a bell curve which cuts off and marginalizes its own tail. We judge individuals at the end of a spectrum rather than recognizing them as products of deeply rooted systemic failures within a society. In all cultures, both ancient and modern, humans have created scapegoats — individuals designated to “take on the sins” of a people, to represent and be held responsible for the shortcomings of …
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Lost in America: Reflections on homelessness and societal marginalization
In the U.S., approximately 30 percent of physicians work in practices that they own. This number has been dwindling down over recent years. Perhaps more surprising, the number of women doctors who are self-employed are a mere 18 percent.
Many hospitals and other corporate entities are actively looking to purchase the remaining practices. It is not just to make money from that practice; it’s to make money from services that are …
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Why are doctors leaving private practice?
To a runner, numbers are everything. It’s data. It’s workouts. It’s goals. It’s pace. It’s winning or losing. To a physician, numbers are everything as well. Before you get into medical school, numbers are your schedule, your GPA and your MCAT. In medical school, numbers are your grades, your board scores and your rank in the class. It goes on and on. …
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Being Latina, a physician, a mother and a runner: by the numbers
We’ve been talking to doctors all around the world, and the mood is consistent. Physicians are frustrated and suffering from burn out because the old model of practicing medicine is no longer meeting their needs. From decreased compensation to desire to spend more time with our families to the combination of loss of autonomy and an increasingly impersonal and inefficient system, a career in medicine is not meeting its end …
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2 stories of how physicians dealt with burnout
There has been much publicity recently surrounding the issue of doctor mental health after a spat of doctor suicides, and sadly not a new thing in the history of medical training. I think the crux of this issue is the idea that doctors are somehow above the concept of humanity. We are held to standards above human abilities, yet we bleed the same blood, cry the same tears and feel …
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Doctors: Don’t lose your humanity
