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.
When I am facing an alcoholic in the office, I do not advise him to stop drinking.
Other physicians may advocate a different approach. We live in a free society and individuals are free to make their own choices. I have decided, for example, not to own a firearm, ride a motorcycle or bungee jump as these activities are not only beyond my risk tolerance threshold, but are also activities that …
Read more…
This physician won’t tell his alcoholic patients to stop drinking. Here’s why.
A physician friend commented recently that practicing doctors and nurses, the highly trained professionals who understand health care better than anyone else, are always too busy working to be involved in health care administration and reform. It is one of the most basic and profound problems affecting our health care system — one of the reasons that health care in America does not get better. And it got me thinking.
Once …
Read more…
We need fewer rules, less regulation, and more time with patients
When it comes to the review of systems, I’ve been a natural, a savant — a prodigy you might say.
During my first few weeks of medical school, I remember doing mock interviews with fake patients. This was long before I learned anything about “HPI,” “ROS,” physical exams, billing or anything medically relevant for that matter. As other students stuttered, trying to figure out what to ask a lady pretending to …
Read more…
Let’s get rid of the review of systems
During medical school, my head was buried in the books while I was studying pharmacology and pathophysiology. In residency, my body remained in the hospital for most of my waking hours while I was caring for patients. And, during fellowship, my hands were busy learning how to perform endoscopic procedures.
All the while, my friends working in other industries were tapping into a different kind of skill set. They learned how …
Read more…
7 lessons I’ve learned from my friends not working in medicine
Hardly a week goes by without hearing about another case of police brutality. Many times, seemingly unnecessarily lethal force has been used, and these incidents have sparked protests across America. Each case is unique with differentiating circumstances, but the result is all too often — death. Many people have grouped these incidents together concluding that white officers have unnecessarily killed black men. This has initiated and reinforced mistrust of the …
Read more…
Cops and doctors have the same problem: People don’t trust them
I drive a fast car. Which if you know me, is quite uncharacteristic. I would say that it is one the few possessions that generally doesn’t reflect upon who I am. How I chose this car, the make, and model, are a long story not to be discussed here. But let’s just say that it has quite a kick.
These thoughts jostled through my mind this morning as I pulled into …
Read more…
Physicians have to stay in their lanes
With the ruination of American teaching using “value-based” purchasing and payment concepts virtually complete, the U.S. government is now training its sights on medicine with similar intentions. With the new MACRA pay-for-performance program, CMS bureaucrats believe they can force health care providers to practice better “quality” care by collecting clinical performance, practice-related, and cost data, and basing payment increases and penalties on the results.
There is one big problem associated with …
Read more…
Instead of value-based care, how about giving clinicians the resources they need?
Although every technology product released today seems as if it is “powered by artificial intelligence,” the actual AI revolution is ahead of us. When it arrives, it will be on par with the industrial revolution in changing our lives, especially in the world of medicine.
John McCarthy, a legendary computer scientist, coined the term “AI” in 1955. He defined it as “the science and engineering of making intelligent machines, especially intelligent …
Read more…
Your next doctor, powered by artificial intelligence
For many centuries medical practice was a black art. What physicians did was based upon theories of how the body worked that turned out to be fanciful at best, dangerous at worst. The late nineteenth century brought breakthroughs in the biological sciences, such as the identification of bacteria and new understandings of physiology, which increasingly placed medical practice on a scientific basis. That process has continued over the past 150 years, …
Read more…
The promise and pitfalls of evidence-based medicine
Now, I’m just a country doctor, but I have to say I find it very hard to understand why folks in this country, on one hand, keep talking about a doctor shortage in primary care and, on the other hand, keep piling sillywork on those of us who are still here.
The net effect is that the doctor shortage is going to be a whole lot worse than it has to …
Read more…
The doctor shortage is worse than it has to be
During a recent internal medicine rotation, a senior resident expressed disappointment that I’ve chosen a career in family medicine. He was concerned that my talents would be wasted, because — in his words — I wouldn’t get to care for the “more complex patients” he sees in internal medicine. Although I appreciated his confidence in my abilities, I felt my heart sink, as it does each time I am faced …
Read more…
No, I’m not settling for family medicine
I think it’s fair to say a small part of all of us died along with Grace McDermott. Grace was a beautiful, talented PhD student studying in Ireland who tragically passed away in a house fire this past week. She was many things — musician, blogger, extrovert, women’s rights activist — but she was also my first girlfriend. I’m still in shock.
It’s hard to comprehend something like this. The mind shudders and reels, seeking …
Read more…
A physician’s ode to someone who changed his life
An open letter to the American Board of Family Medicine (ABFM):
I recently chose to sit for my sixth (and I hope final) family practice maintenance of certification (MOC) examination, having now practiced as a board certified family physician for the past 34 years and intending to work a few more years. I want to share my experience taking this examination your organization prepares, promotes and uses at a high cost …
Read more…
This family physician is deeply disappointed in maintenance of certification
Maintenance of certification (MOC) for something as significant as the practice of medicine seems like a harmless enough idea. But for physicians across the country who dedicate thousands of hours to study, earn licensure, achieve board certification, and practice medicine, MOC is not only unnecessary but also a resource-consuming mandate that does nothing to improve patient outcomes and quality of care.
According to the American Board of Medical Specialty’s (ABMS’) own …
Read more…
Mandating MOC to practice medicine is an appalling overstep of nonexistent authority
As the world digested the events that unfolded aboard United Airlines Flight 3411 at Chicago O’Hare, and watched the horrific video of Dr. David Dao being forcibly dragged off the plane that was supposed to be taking him home, social media was red with rage at United Airlines. People vowed never to fly with them, customers ripped up their loyalty cards, and United’s stock fell over a billion dollars in …
Read more…
United Airlines and Dr. Dao: Who we should be really mad at
Doctors and nurses like facts. After all, we’re evidence-based thinkers — rational scientists. Yet, we can be surprisingly superstitious.
Many of us believe in a thing called “call karma,” which is when certain doctors attract sick patients while working on call (these people are said to have bad call karma). Other doctors attract less sick patients, meaning they have good call karma.
As a medical student, I quickly learned that I fell …
Read more…
It’s bad luck to say that in a hospital
It is not something that is taught enough in medical school, but practicing physicians quickly realize that in this business: Communication is everything. The reality of health care is that you can be the worst physician in the world clinically (not that it’s something desirable to be), display great interpersonal skills, communicating well with your patients — and they will do absolutely anything you say and put you up on …
Read more…
3 communication mistakes doctors make. And how to fix them.
My old strategy for getting insurance approvals for imaging tests doesn’t seem to be working anymore.
I used to put my thinking in my office notes so that a reviewer at one of the imaging management companies would clearly see my rationale for ordering that CT scan or MRI my patient needed.
Now I am getting more and more requests to initiate a “peer-to-peer” call instead. My heart sinks every time; each …
Read more…
The evolution of prior authorizations
