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.

A balanced way to fight physician burnout

Lisa Herbert, MD

Physician

July 26, 2017

Burnout amongst physicians is real and at an all-time high. This was even highlighted on an episode of “Grey’s Anatomy,” where a resident physician surgeon imploded after a series of stressors that happened over time. She experienced the loss of a patient during surgery and of a loved one that were not addressed. Coupled with the long work hours, the type-A personality and increased demands, this led to her state …

Doctors need to be social advocates

Rohan Patel

Medical Education

July 25, 2017

“Your zip code is a better predictor of health than your genetic code.”

A picture of this quote was projected onto the screen during our lecture. Our professor’s words echoed throughout the auditorium as he described the importance of understanding the social aspects of our patients’ lives rather than just their genetic predisposition to disease. Understanding the social and economic conditions that impact health, disease and the practice of medicine lies …

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Doctors need to be social advocates

Doctor, we can’t read your writing

Sarah Fraser, MD

Physician

July 23, 2017

“Dr. Fraser, the pharmacy is on the phone for you. Line one.”

I answer the call, pressing the gray, rectangular button with one hand while writing in a patient’s chart with the other.

“Sarah Fraser speaking.”

“Oh, hi, Doctor, we just got in a prescription of yours, but we are not quite sure what it says.” The pharmacist is gentle in her words.

It was the first time this had happened. I’d promised myself …

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Doctor, we can’t read your writing

Don’t call me “Mrs.” Call me “Doctor.”

Jennifer Lycette, MD

Physician

July 23, 2017

My smile freezes on my face as my patient says to me, “I’m so glad you’re back – that I get to see Mrs. Lycette today!”

He has been my patient for several years, and I am perplexed to hear him address me as “Mrs.” rather than “Doctor.” At the same time, I really do not think he means an intentional insult, so I keep my face neutral and continue with …

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Don’t call me “Mrs.” Call me “Doctor.”

The decline and fall of informed consent

Richard Gunderman, MD, PhD and James Lynch, MD

Physician

July 21, 2017

Margaret Edson’s 1999 Pulitzer Prize winning play, Wit, tells the story of the final hours of Vivian Bearing, PhD, an English professor dying of cancer. Early in the course of her disease, one of her doctors sees the value of her case from a research point of view and asks her to enroll in a clinical trial of an investigational therapy. In the film version of the play, which stars …

Physicians must treat patients with the utmost respect with regards to their spiritual beliefs

Neha Sharma, DO

Physician

July 21, 2017

Scientific evidence pointed to an extremely poor prognosis. Numbers and statistics emphatically declared her imminent demise. My 33-year-old patient was not going to survive.

The physicians presented the data to the mother and recommended withdrawal of care, but she remained indecisive.

She struggled for two days with the possibility of her young daughter dying.

Her child was in the critical care unit in a vegetative state. It was a parent’s worst nightmare.

I took …

Want a cure for physician burnout? Take care of yourself.

Jattu Senesie, MD

Physician

July 20, 2017

The recent celebration of Employee Well-being Month got me thinking a lot about how physicians are treated as employees with regard to well-being. There is a general consensus that the issue of physician well-being needs to be addressed at both the level of the individual physician and the level of the system in which physicians work.

Unfortunately, this insight has thus far failed to lead to significant improvement in the overall …

Are patients really the problem?

Suzanne Fiscella, PA-C

Patient

July 20, 2017

“Doctors are not the problem. Patients are.”

Anyone who has ever thought the above statement is true has not tapped into the vast well of knowledge and intellect found in their own patients. Training patients to be better patients brings the joy of medicine back into your practice.

All of us, at one time or another, sat in a classroom. The teacher spent the first day going over the rules of the …

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Are patients really the problem?

A part of patient care that I was not taught in medical school

Yul Ejnes, MD

Physician

July 20, 2017

A guest column by the American College of Physicians, exclusive to KevinMD.com.

Recently, I’ve been thinking about how physicians express condolences. This weekend, I attended calling hours to visit with the family of a recently deceased patient. As I drove back from the funeral home, I tried to recall when I started to attend my …

Cheaper health care isn’t hard

Edwin Leap, MD

Physician

July 20, 2017

I have never wanted to be the medical advice columnist. “Dear Dr. Leap: My feet sweat all the time. I’ve tried everything! What should I do?” Nope, I’m not your guy. Nor do I want to opine on study after study about statin drugs for cholesterol or discuss whether women should take estrogen. There are physicians who love those questions! And I think they’re fantastic. But I’m an emergency medicine …

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Cheaper health care isn’t hard

A physician’s journey about the complexities of gender

Andrea Eisenberg, MD

Conditions and Diseases

July 19, 2017

Entering the dimly light room, I could hear soft music playing in the background. The laboring room was so peaceful, it was hard to believe the patient in the bed was in active labor. But once up close, you could hear her breathing become deeper and louder every three or four minutes as she rode the wave of another contraction. Her husband was by her side, breathing with her, toweling …

In this world of burnout, doctors have to remember why they do this

Cory Fawcett, MD

Physician Finance

July 19, 2017

Recently, I had the privilege of presenting the Clinical Specialty Award for General Surgery at the 2017 Graduate Awards Celebration at Western University of Health Sciences College of Osteopathic Medicine of the Pacific (COMP-NW). It was amazing to hear all the accomplishments and meet so many wonderful new doctors in this year’s class. I also got the opportunity to meet a few proud parents and professors.

The list of accomplishments of …

Remembering Larry Weed, founder of the SOAP note

Robert Centor, MD

Physician

July 18, 2017

1973, as we prepare to start our clinical rotations, the chief medical residents taught us the new concept of SOAP notes.

Larry Weed developed the concepts of the problem-oriented medical record and notes that included subjective, objective, assessment and plans for each problem. We wrote our notes each day using his system.

I have wondered in many conversations what he would think of the unreadable computer printout notes of …

How a text message saved this patient’s life

Jennifer Adaeze Okwerekwu, MD

Physician

July 17, 2017

As a new doctor, I’ve learned that the best patient care happens as often outside of the hospital as inside. While we treat sick people and get them tuned up, each patient’s opportunity to get better and stay better often depends on their access to resources beyond clinical walls.

One of those resources, I’m learning, could be mobile technology. I’ve …

Doctors are smart but not emotionally intelligent

Maiysha Clairborne, MD

Physician

July 15, 2017

As physicians, we are regarded as intelligent. Are we, as a community, as emotionally intelligent as we could be? The answer is no. Let’s face it. We are trained from the time we are medical students to disconnect and suppress our emotion, and we are taught to appear stoic and strong. Showing emotion in front of patients is discouraged, even in a situation that would be deemed acceptable by most. …

Doctors are in the way of progress. And thank God they are.

Jean Robey, MD

Physician

July 14, 2017

Yesterday was the perfect storm.

The combination of articles printed over the weeks seem to give me a morose outlook on the medical profession.

Article 1: A specialist had reasoned the medical world was in shambles because “specialist” try to rule the world with unnecessary obscurity. His example was acid reflux and how addressing it was a failure in delivering simple remedies. My throat was bitter with betrayal.

Article 2: An insurance company …

Don’t be impatient with your doctor

Erin O'Laughlin, DO

Physician

July 13, 2017

Fifteen minutes. This is the typical amount of time allotted for any single follow-up or acute type appointment in Primary Care. 30-minute spots are reserved for new or complicated appointments. Now, I just want that to sink in for a minute. I want everyone to sit down and think real hard for a moment, about how much they can get done in 15 minutes.

How long does it take you to …

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Don’t be impatient with your doctor

The great dilemma: Go part-time now or retire early?

Dr. Curious, MD

Physician

July 12, 2017

Early retirement is a hot topic these days, particularly in the field of medicine. It is associated with the concept of financial independence, and together they are known by the acronym FIRE (financial independence and retiring early). In essence, FIRE means having enough saved that you can live off your investments, and no longer need to work for a salary. While FIRE is not for everyone, it is something my …

What this physician practice did to fight burnout

Diane W. Shannon, MD, MPH

Physician

July 10, 2017

As a physician who left clinical medicine because of burnout and as a writer, I’m drawn to stories of physicians whose professional and personal lives have improved after reasoned interventions. So my ears jumped to attention earlier this month when a colleague at a summit on physician burnout described the positive results his practice had achieved in reducing burnout. Read Pierce, MD, is interim director of the Hospital Medicine Group …

Don’t just learn about medicine. Educate yourself about money, too.

Zoe Smothermon, DO

Physician Finance

July 9, 2017

In honor of everyone graduating and moving on to the next step, let’s talk about money. And by money — I mean debt because new doctors don’t have any money! All we have are bills to pay!

I am the one who does the finances in our household. It really happened by accident. My husband was deployed shortly after we got married, so all daily responsibilities were de facto handed off …

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