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.

In any situation, listening is always best. Doctors should remember that.

Rob Lamberts, MD

Physician

April 25, 2017

“Wait. When did you say you started that medication?”

“Two weeks ago.”

“And when did you say you started having those symptoms?”

“Uh … about … let me think … it was — two weeks ago.”

This kind of circumstance is my holy grail. It is the ultimate moment where I connect the dots. It has happened several times recently where patients have had chronic symptoms and have related to me that they have …

Does telemedicine save or cost money?

Val Jones, MD

Physician

April 24, 2017

Over 1 million virtual doctor visits were reported in 2015. Telehealth companies have long asserted that increased access to physicians via video or phone conferencing saves money by reducing office visits and Emergency Department care. But a new study calls this cost savings into question. Increased convenience can increase utilization, which may improve access, but not reduce costs.

The study has some obvious limitations. First of all, …

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Does telemedicine save or cost money?

Why physicians are anxious today

Robert Pearl, MD

Physician

April 23, 2017

Recently, I heard from a student in her third year of medical school. To date, she has borrowed more than $100,000 to fund her education. She is in the top 10% of her class, with honors in all of her subjects and high scores on her national exams. She would be a valued resident in the most competitive specialty training programs. Her goal is to become a primary care physician …

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Why physicians are anxious today

Providers and patients must listen to the evidence

Jennifer Gunter, MD

Physician

April 22, 2017

There is an interesting article from ProPublica called “When Evidence Says No, but Doctors say Yes” making the rounds. It’s about the number of doctors who disbelieve, don’t know or don’t care about medical evidence to the detriment of patients. I do not find any fault with the article. I rail against this daily. I have my whole professional life. It is actually a big reason …

This physician delayed residency to take paternity leave

Kevin Dueck, MD

Physician

April 20, 2017

“Daddy, time to wake up! It is morning time!”

I open my eyes to our four-year-old daughter at the foot of the bed smiling, her hair meticulously braided. I get up and wake her younger brother from his crib and carry him downstairs. The baby is still sleeping. Soon come shouts of “coffee!” as we enter the kitchen — they know my routine well. After breakfast, we all get dressed, I …

Physician leaders’ role in preventing burnout

Diane W. Shannon, MD, MPH

Physician

April 20, 2017

A few weeks ago, I had the opportunity to interview a faculty physician at a large academic medical center. We spoke about burnout in students and faculty in general terms. He was aware of the problem yet did not seem affected himself.

I asked him how he managed to avoid burnout. He talked about remembering his purpose in entering medicine — that the profession is a calling, not just the daily …

What life is like for this retired physician

David Mokotoff, MD

Physician

April 16, 2017

I have now been out of the active medicine for two years. I still have dreams about being a doctor and practice. I don’t think you can do the same thing day in and day out for 40 years and not have it be a part of who you are. I am still asked my opinion by friends and family about their health issues, and frankly, I find my fund …

Your physician is the everyday champion

Supreeya Swarup, DO

Physician

April 15, 2017

The average amount of time it takes someone to become a physician is approximately 11 years, and for those pursuing further specialization, one can easily add a couple of years to that. The time certainly adds up by investing years in college, medical school, residency, and fellowship. By the time I will be an independently practicing cardiologist, I would have invested about 16 years into my training. That’s almost half …

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Your physician is the everyday champion

I sometimes need to be reminded I’m not just a doctor, I’m human too

April Edwards, MD

Physician

April 13, 2017

I took my dog to the vet today. You’d think this would be a straightforward sort of thing for a medical professional. You’d be wrong.

When I woke my dog up at 5:15 a.m. (my new daily start time, as it’s apparently the only way I can find time to do board questions and is also the excuse I use when I miss the majority of said questions), he seemed sleepy.

He’s …

Please stop asking about my wife

Anonymous

Physician

April 13, 2017

“Do you have sex with men, women or both?”

This is the way that we were taught in medical school to ask a patient about their sexual history. When we took our sample standardized patient exams, we were scored whether or not we asked this question. In my understanding, this was supposed to be a non-judgmental, non-assuming way to elicit a sexual history.

However, romantic partners generally come before sex (unless we …

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Please stop asking about my wife

Physicians can choose to nurture their human side

Gretchen Diemer, MD

Physician

April 12, 2017

A keynote address to Gold Humanism Honor Society Induction Ceremony, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.

As an intern, I was assigned to 9 weeks over the year on the bone marrow transplant inpatient unit. It was medically fascinating but emotionally draining and anxiety provoking. I began to get nauseated going to work because I was having such a hard time with the rotation. As I sank deeper …

Never underestimate the power of pus

Lucy Hornstein, MD

Physician

April 12, 2017

Everyone has their abscess story. Tales of pressurized pockets of pus abound. Trust me: However far-fetched they may seem, they’re not. I had one such experience last week in which a man came to me with a painful red swollen lump on his back. It was about 2 inches in diameter, angry and fluctuant (softened) and ready to be drained, which he pleaded with me to do. So I did.

Although …

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Never underestimate the power of pus

Medicine comes in second for me

Stephen F. Chambers, MD

Physician

April 10, 2017

My entire childhood I wanted to become a doctor. When asked by adults what I wanted to be when I grew up, it was always the same answer. Never did I consider being a fireman or policeman or professional athlete. It was always the same answer: doctor. You see, my father was a small-town, general practice doctor who was somewhat of a legend in town because of his unfailing dedication …

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Medicine comes in second for me

My prayers and my medical practice

Fredy El Sakr, MD

Physician

April 10, 2017

“Help!” I yelled out of our open apartment door.

I was seven years old, and my family had recently emigrated from Egypt to the U.S. We’d been feeling elated that week because, after months of interviews, my father had matched into a pediatric residency.

That morning, he’d awoke feeling nauseated. My mother and sister went to buy some soothing food. I noticed that he’d vomited in the bathroom; now he was feeling …

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My prayers and my medical practice

Fighting burnout: No is the wrong answer. It is not acceptable.

Fred N. Pelzman, MD

Physician

April 9, 2017

Down in Baltimore for a meeting, long days full of plenary sessions and workshops, awards ceremonies and poster sessions. Recycled hotel air, bad coffee, great camaraderie.

Lots of new ideas, lots of new ways of looking at things, lots of reinventing the wheel, lots of hope for change. Lots of sessions about how to improve the environment for learners, how to engage medical students, how to build a curriculum, how to …

Recognize the importance of the physical exam in the history of medicine

Rafid Rahman, MD

Health Technology

April 9, 2017

A patient comes into the ER complaining about throbbing migraines after falling off her bicycle; thus, the physician quickly orders an X-ray, complete blood count, and asks the nurse to schedule the patient for an MRI of the head and neck in case both those tests come back inconclusive. As an ER scribe, I saw many conditions where the physician would quickly do a physical exam, and then use a …

This is what every medical practice should have

David J. Norris, MD, MBA

Physician

April 8, 2017

An excerpt from The Financially Intelligent Physician: What They Didn’t Teach You in Medical School.

Every practice should have a dashboard of financial and performance metrics that the physician leader studies on a regular basis. A good dashboard should …

We’re not just doctors, we’re ambassadors of science

Ryan Steele, DO

Physician

April 7, 2017

The next time your patient walks into the exam room try starting off your visit a little differently. Instead of asking them how their weekend was, why not ask them, “Out of curiosity do you know any scientists?” No matter the answer, that visit is likely to be a standout memory in both of your days.

At a time when scientific debate, and rational thought, all too often falls silent to …

This one question changed how I thought about medicine

Jessica Celine Morgan

Medical Education

April 6, 2017

It’s 4:00 p.m. on a Thursday: time to present at teaching attending rounds. I have prepared my presentation and know about the patient’s pathology, but I can never help myself from being incredibly anxious for these moments. I gather my papers and begin:

“This is a 49-year-old undomiciled male with a past medical history significant for alcoholism, insulin dependent diabetes mellitus and chronic pancreatitis who presents with hematemesis.”

I take a breath. …

5 ways physicians suffer by complaining

Maiysha Clairborne, MD

Physician

April 5, 2017

There’s a saying: “Pain is inevitable, but suffering is optional.” However, some people thrive by complaining. These people, when presented with potential solutions to the problem, argue and invalidate all possibilities presented. Sounds familiar? Being a physician advocate in the battle to lower physician burnout and prevent suicide in doctors, I am disheartened to see this phenomenon in our community. While there are frontline physicians — even physician leaders — …

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5 ways physicians suffer by complaining