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.

Will we solve health care by blaming doctors?

Thomas D. Guastavino, MD

Physician

April 5, 2017

I started my career in the late 1980s and retired just recently. I am very grateful that I caught at least a few years of the “golden age” of medicine because those years made all the difference.

Over my career, I witnessed many different efforts at health care reform proposed, attempted and failed. DRGs, Hillarycare, private insurance capitation, “To Err is Human,” Medicare fraud crackdowns, Global and Bundled payments, general reimbursement …

Quantifying quality doesn’t help patients

Kjell Benson, MD

Health Policy

April 4, 2017

Two quality metrics walk into a bar.

One demands, “Give me the best beer you’ve got!”

The other says, “Give me the second-best beer you’ve got.”

The bartender pours the beers and states, “You can have them both for free if you can tell me why this one is better than that one.”

Quality metrics were invented to quantify the ineffable, such as the taste of a fine lager or IPA. I see that …

Think we evolved to eat meat? Think again.

Shivam Joshi, MD

Physician

April 4, 2017

Eating meat has been linked to cancer, high blood pressure, heart disease, diabetes, stroke, dementia and many other diseases. Nearly every modern lifestyle disease has been associated with meat. With so much emerging evidence against meat, it begs the question: Did we …

8 things doctors secretly want to tell their patients

Brian C. Joondeph, MD

Physician

April 4, 2017

As the repeal of Obamacare is debated in the halls of Congress and on cable TV, one common theme is: “What will happen to patients?” Questions loom about what might change with coverage, about cost, about whether you’ll still be able to keep your doctor, and if medications will still be covered

But what about doctors? What about how they’re doing?

There are things doctors want to tell their patients, not only about …

A call for compassion: Treat residents like how we treat patients

Michelle Hofmeister, MD

Physician

April 3, 2017

The alarm on my phone screeches, jolting me awake to another day of hating my patients and my work. I try to get up to get ready for clinic, but my body is nailed to the bed. I cannot even lift my head without a dizzying blur knocking me back down. I am a resident physician with depression and anxiety. I was in a top ten residency in my field. …

Do dog walkers make more money than doctors?

Pamela Wible, MD

Physician

April 3, 2017

I recently reported on a doctor-turned-dog-walker who says with her career switch she’ll enjoy more happiness — and income! In her own words:

Dear Pamela, Today I realized that if I become a dog walker and charge $25/hour and walk five dogs per day, I would make my equivalent salary with fewer hassles. I’m seriously considering this as a career move. I could …

Read more…

Do dog walkers make more money than doctors?

MKSAP: 52-year-old man with sudden onset of erectile dysfunction

mksap

Conditions and Diseases

April 1, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 52-year-old man is evaluated for the sudden onset of erectile dysfunction that has persisted for 6 months. He reports having erections that are inadequate for vaginal penetration. He feels guilty about not being able to satisfy his wife’s requests for sexual intercourse, although he still has sexual desires. He has been sleeping poorly …

The physicians who are not called “doctor”

Sharonne N. Hayes, MD, Anita P. Mayer, MD, and Julia A. Files, MD

Physician

March 31, 2017

You graduate from medical school and get your MD degree. At first, when someone calls you “doctor,” you look around and wonder who they’re talking to, but after years of hard work and sleepless nights, you realize you really are a card-carrying “doctor.”

If you’re a woman, however, you start to realize that a lot fewer people call you “doctor” than your male colleagues. At first, it’s subtle. And you shrug it …

What patients want to know about their prognosis

Linda Haller

Patient

March 30, 2017

Everyone immersed in the culture of medicine knows that physicians sometimes defer the discussion about prognosis to patients who are battling a life-threatening illness. Everyone, that is, except the patient. We arrive on your doorstep believing that our presence indicates the obvious. So, how are we to know that we have to ask for something as life altering and important as a prognosis? Deferring to the patient for prognostic discussion …

Physicians are born to do what they do

David O. Barbe, MD

Physician

March 30, 2017

I am always fascinated by my colleagues’ stories about why they became physicians and when they knew medicine was the path for them. Some describe a longing to heal, some a love of science, and others a desire for respect. For me, medicine was a calling that revealed itself in my sophomore year of undergraduate studies and was the perfect culmination …

Read more…

Physicians are born to do what they do

How a physician-mother shapes the future of medicine

Hala Sabry, DO, MBA

Physician

March 30, 2017

This week is Physicians Week, and this is one in a series of interviews with members of the physician community that are bringing a variety of ideas and networks together in order to improve the relationships between physicians and between physicians and their patients.

Dr. Hala Sabry is the founder of a physician social media group, that started with 20 people that has grown in two years to over 65,000 women …

Does tough love equate to wellness or destruction?

David Kolker, LICSW, JD

Conditions and Diseases

March 29, 2017

Heroin abuse in the United States is reaching epidemic proportions. According to SAMHSA, between 2007 and 2012, the number of Heroin users has doubled from an estimated 375,000 to over 665,000. Additionally, in 2010, the number of deaths as a direct result of overdose surpassed auto accident deaths.

It is impossible to avoid the facts about heroin. We are bombarded daily by the national and local media and extensive online resources. …

I felt that I couldn’t let him face this journey alone

Jonathan Gotfried, MD

Physician

March 29, 2017

From my wife’s grandparents’ Manhattan apartment, I could hear the noises of traffic and pedestrians in Central Park seven floors below. The sounds were a refreshing change from the beeping monitors, overhead pages and ringing phones that are the usual backdrop to my work as a physician in a large Philadelphia medical center. Here the only background conversations I heard were those of loved ones in the kitchen, not those …

What can doctors learn from La La Land?

Suneel Dhand, MD

Physician

March 28, 2017

Last week I finally got around to watching La La Land. As a fan of musicals, I had wanted to see it for quite some time, and before I stepped into the theater, I didn’t know what it was about nor what kinds of reviews it had been getting. Spoiler alert: Don’t read on if you haven’t seen it and intend to watch it (and I’ve never told anybody before …

Read more…

What can doctors learn from La La Land?

The problem with price transparency

Niran S. Al-Agba, MD

Physician

March 26, 2017

Transparency — including price, quality, and effectiveness of medical services– is a vital component to lowering costs and improving outcomes. However, it is imperative transparency go hand-in-hand with financial incentives for patients and consumers; otherwise, the quest will be in vain. The single best way of reducing costs while not worsening health outcomes is to redistribute resources from less cost-effective health services to more cost-effective ones. Americans are extremely uncomfortable …

Read more…

The problem with price transparency

Solving the telephone problem in primary care

Fred N. Pelzman, MD

Physician

March 26, 2017

The phones, the phones, the phones.

Every time we look, everywhere we look, getting the phone answered seems to be a problem we just can’t lick, a continual thorn in the side of our practice, something that’s hindering all the other efforts we try to make things better, to get ourselves to the best care environment for our patients, our staff, and our providers.

Without …

Let’s pay doctors like we do athletes

Hans Duvefelt, MD

Physician

March 24, 2017

Think about it; athletes aren’t the ones who document their performance. It’s other people that keep the score. That’s a whole science in itself. People talk for hours after the game or tournament is over about how each athlete did this or that in whatever way they did it, and the numbers are in many cases captured by extremely sophisticated electronic equipment.

Physicians work hard to diagnose and treat their patients, …

Read more…

Let’s pay doctors like we do athletes

A hospital, a stranger, and a bottle of beer

Linda E. Clarke

Patient

March 24, 2017

Once upon a long 18 years ago, I got sick.

I was sick from a growth in my brain.

The growth was found after I’d shuttled from doctor to doctor, from appointment to appointment, from X-ray to scan. It took a year. By then, my pain was clothed in shame. Undiagnosed pain does that: It draws the gaze of friends, family and providers. Everyone looks for the cause.

“Soul pain,” said one doctor. …

Angry? Welcome to being a doctor. And here’s how to fix it.

Jordan Grumet, MD

Physician

March 23, 2017

It will start as a minor curiosity. Maybe a student will seem slightly too close to the resident on your team. When the grades are posted, you’ll wonder why you didn’t get honors, but he did. You might wallow for a few days. Make an offhanded comment to your fellow students. Then you’ll let it go and move on. Or so you think. Until during surgery when the scrub nurse …

Why many patients are afraid to come to the clinic

Elisabeth Poorman, MD

Physician

March 22, 2017

The young woman sat in the corner of my exam room, facing away from me as I asked her questions. Her answers were short. “I’m from El Salvador.” Why did she come? “Because of the violence.” Her voice was flat. Her hands trembled. I knew she had suffered terribly and I needed to ask her how.

Slowly, quietly, she recounted the gang violence she had fled in El Salvador. The assault …