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.

An open letter to America’s white working class

Keith Pochick, MD

Physician

December 2, 2016

What an upset, right? Your voices were heard, loud and clear. The current system wasn’t working for you, and you won a major paradigm shift. The insulting irony of the word “progress” hidden in “progressive agenda” wasn’t lost on you. You looked around your respective communities and what you saw sure didn’t seem like progress. Employment opportunities were scarce, your health insurance costs had risen, and your infrastructure had eroded. …

Atheist doctors must come out of the closet

David Mann, MD

Physician

December 2, 2016

Reading about the opening of the Noah’s Ark Theme Park in Kentucky brings to mind the days when I worked as a physician in that state. I had moved from an academic position in Colorado and joined a large group of private practice cardiologists in Louisville. I found that people in Kentucky were different from those in Colorado. They were much more overtly religious.

As an interventional electrophysiologist, I would meet …

Are nudists, nature, and hippies the cure for an uptight doctor?

Anonymous

Physician

December 1, 2016

When I was heading to a retreat held by the physician who started the ideal medical care movement, Dr. Pamela Wible, I expected an orderly and structured program on how to improve the current culture of medicine. I knew, with about 40 physicians and 10 other medical students, there would be a lot of Type A personalities since that’s typically the sort of people that go into medicine. While I …

Be the kind of parent you wished yours were

Hans Duvefelt, MD

Physician

December 1, 2016

A young man with chest pains, shortness of breath and heart palpitations had come back for his follow-up visit.

His thyroid test and blood count were well within the normal range. His EKG was normal, and his chest X-ray was declared normal by the radiologist.

We talked some more about his anxiety and poor sleeping habits. We talked about his late shift at work, and we talked about his late gaming habits …

Reminder: Keep it simple for outpatients

Hamsika Chandrasekar

Medical Education

December 1, 2016

As a clinical student, I’ve been a part of dozens of outpatient clinic visits, but several days ago, I witnessed a clinic visit much unlike the others.

For one, our patient arrived not for a 20-minute appointment, but for a three-hour one. As a hemophiliac, this patient came to Stanford once a year, for a comprehensive, coordinated patient care visit, where she saw not only her hematologist but also her social …

Doctors are teachers too

Hans Duvefelt, MD

Physician

November 30, 2016

Madame Theriault refused a rectal exam but agreed to get me some stool cards, the first one the next morning, Saturday. Sadie, the lab tech, had enough blood to send off a B-12, folate and iron studies. We agreed to be in touch Saturday morning and Tuesday. If she gets worse, she will go to the emergency room.

The man who felt bad all over had a bilirubin twice the upper …

Read more…

Doctors are teachers too

How to provide individualized care in an era of standardized office processes and procedures

Yul Ejnes, MD

Physician

November 29, 2016

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

It’s been several years since we transformed our practice into a patient-centered medical home and started to truly work as a team. As I’ve written before, working as a team is one of the biggest reasons for my practice satisfaction increasing …

How this physical therapist left her insurance nightmare behind

Kristi Anderson, PT

Health Policy

November 29, 2016

It is time for me to dig out from under the frustrating quagmire of paperwork imposed on me by my insurance contracts so I can reclaim my sanity and love of my work. I am terminating all of my in-network contracts, firing my billing service, and focusing my clinic time and energy entirely on patient care. Removing my practice from the control and limitations of health care insurance companies allows …

Is independent practice better for doctors or patients?

Ira Nash, MD

Physician

November 26, 2016

A recent story in Crain’s New York Business cited the difficulty small independent medical practices face coping “with declining reimbursement rates from insurers, rising overhead costs and a torrent of new regulations that have come into play in recent years.”

According to the article, only 26 percent of New York state physicians now own their own practice, compared with national rates of physician ownership of 76 percent thirty years ago. …

Ignore the economists: Keep the yearly physical

Eric Beam, MD

Physician

November 25, 2016

In the years since the medical community first got revved up on the idea of “value-based care” — the conceptual antithesis of the “more is better” fee-for-service model — a common target of criticism has been the routine physical, one of the most time-honored traditions in medicine.

The attacks come from all angles: The annual check-up isn’t cost-effective, it doesn’t lead to better outcomes, it actually might lead …

How this physician embraces diversity and acceptance in medicine

Dominic Wu, MD

Physician

November 24, 2016

My new patient looked around dodging my eye contact, scanning the ceiling, the room, and me. I felt that she was hiding something. In my clinic, I often find it one of the most difficult challenges to get new patients to open up, and one of the most beautiful moments when they finally do. I stopped interviewing midsentence and took a step back.

“Let’s just get to know each other. I’m …

How do we deal with change in medicine?

Tracy Asamoah, MD

Physician

November 22, 2016

Early in my career, I learned that keeping my focus on patients would help me define the physician I wanted to be. One of my first offices was in a cell of a repurposed juvenile detention unit with cinder block walls painted pasty white. Occasionally, I had to apologize to my patients as I explained that the smell was sewage from the toilets backing up. In that cold, harsh room, …

Read more…

How do we deal with change in medicine?

Dr. Mommy: When will you put yourself first?

Maiysha Clairborne, MD

Physician

November 21, 2016

Beyonce wasn’t kidding when she wrote the song “Girls Run the World.” We as women wear as many hats as some of us have shoes. However, the cost of that can be grave if we never learn to create balance in our lives. When I say balance I don’t mean the balancing act, I mean the act of giving back to ourselves. Imagine that you have an energy bank account. …

The story of how a stranger helped a physician

Caroline Wellbery, MD

Physician

November 20, 2016

In the middle of a five-way thoroughfare intersection, with the early-morning sun’s glare on my windshield, I hit the curb of the median and blew out my left front tire. Amid stopped traffic, I ran to collect my escaped hubcap, whose silver eye stared helplessly from among the automotive debris of previous accidents.

A policeman blocked the lanes until I could pilot my car into the gas station on the other …

The exam room post-election

Megan S. Lemay, MD

Physician

November 20, 2016

It’s Wednesday, the day after the election. I spent the previous night clicking from one website to another, trying to find someone who was refuting what the others said was true. And when it became inevitable, I held my infant twin boys and cried.

Now I’m in front of my exam room, walking in to see Mr. Bundy. I open the door to find him wearing a red hat embroidered with …

Read more…

The exam room post-election

Why physicians need to organize

Andres Barkil-Oteo, MD

Health Policy

November 19, 2016

In my previous post, “Have physicians finally joined the working class,” I discussed the changes in the health care system regarding physicians roles in these systems. In this post, I propose two strategies that could help physicians regain some influence over their work and to participate fully not just in the execution of strategy from management but also have an input in creating it.

Building unions

There has …

Read more…

Why physicians need to organize

There’s something missing in the doctors vs. AI debate

Robert Centor, MD

Physician

November 17, 2016

Over the past two days, listening to separate podcasts, I have heard the same story and now have a better understanding of artificial intelligence. A Freakonomics podcast — The Future (Probably) Isn’t as Scary as You Think:

And in general, what’s happened in the past couple of years is the best chess player on this planet is not an AI. And it’s not a human. It’s the team that …

Read more…

There’s something missing in the doctors vs. AI debate

It’s time to update the physical exam

Peter Pronovost, MD, PhD

Physician

November 16, 2016

In the technology-thick landscape of modern health care, the physical exam remains in a backwoods.

Sure, there have been advances — blood-pressure cuffs, for example, now inflate themselves — but on the whole, the exam has barely changed in the past century. Patients still open up and say “ah,” take deep breaths and gaze at a tiny light peering into the back of their eyes.

A well-done exam can still determine whether …

Read more…

It’s time to update the physical exam

Why doctors resist change

James C. Salwitz, MD

Physician

November 15, 2016

In my home, we have two conversations: politics and medicine. The most vociferous discussions are around their product, health care. We know doctors on the right and left, Democrat and Republican, boisterous blues, rebellious reds and garrulous grays. Respecting opinions and debate, we love ‘em all. However, no matter on what side of the aisle they stand, which lever they pull, they share one trait. All physicians are deeply conservative. …

Read more…

Why doctors resist change

Doctors should stop using the language of war. Here’s why.

Robert Pearl, MD

Physician

November 15, 2016

As soon as the microphone opened for Q&A at a conference I recently attended in New York City, a physician in the audience began his question with, “as a front-line physician.” Another asked from the perspective of someone “in the trenches.” And a third wondered how to provide medical care when we are getting “bombarded by mandates.”

As I speak to physicians across the country, I am increasingly jarred by these …