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.
I recently had the privilege of speaking to a group of high school students who were interested in becoming doctors. A large number of them were volunteering in my hospital, and their coordinator asked me if I could spare some time to chat with them about life as a doctor and what they should be doing to get into medicine.
I remember as if it were yesterday when I was their …
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For those who want to be doctors: Follow this piece of advice
My son was underperforming at school, and I was gently encouraging him to try harder (if gesticulating like an over-caffeinated Italian qualifies as gentle encouragement). He could not understand why I was upset: “Dad, most of my friends are doing drugs and engaging in unprotected sex. You should be rewarding me for being such a good kid.”
“Reward you for not being bad?!,” I replied incredulously. That made no sense to …
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Is it fair to reward Medicaid patients for routine health care?
Bill* stops by the clinic about once a week to use the phone in our lobby. Karen* asked if she could have her mail sent here. Once we bought Daniel* a bag of groceries, and Frank* calls to speak to our nurse every few days because he says, “I’m lonely.”
There is a national push to re-envision our primary care clinics as patient-centered medical homes, with the intention that a patient can get all their …
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Sometimes patients need more than a medical home
Dear President-elect Trump,
I am writing to reach out to you, something I have never been inspired to do for a president-elect in the past. First, congratulations on your hard fought victory, and to your family. It was a surprise for many of us.
While it was probably a happy morning in your campaign and family, it was a pretty dark morning in my household. Our family was very supportive …
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A physician writes to President-elect Trump
I took a long walk with my dog today, and then I took a shower.
I like showers. I’ve always found them soothing and comforting. I can think in there. I can relax. I can’t hear the phone ring. I can’t see a television. Generally, no one bugs me while I’m in there. I come out clean, refreshed, and smelling and feeling good.
A shower can relieve aching muscles while removing the …
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A physician’s poignant election thoughts
Yesterday I woke up to a startling realization: Like the dozens of women I treat, I will soon be entering “the change” as they call it, and I instantly was catapulted on to the other side of the exam table. While all the symptoms are not present, I’ve been noticing the signs, and when I reviewed the blood work that was done last week, it was clear. The “M” word …
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The simple question that can save the lives of physicians
I started November 8th so hopeful. The polls were a comfortable 78. I wore my new berry colored pantsuit purchased especially for the election. I even wore my suffragette sash to work. The last face I saw before stepping into my office was a young woman in her 20s who gave me a thumbs up and that knowing smile that said, I’m with her too! Every woman I met had …
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A call to arms for modern suffrage
The day after the 2016 election I went to work, and from medicine, I better understood the outcome of the election and the next goal of America.
Driving into the hospital, I called the ICU of an acute rehabilitation hospital to check on a patient. He had sepsis from a very complex urinary tract infection which exacerbated his chronic hypotension. He already had renal failure on dialysis and was on chronic …
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Lessons in medicine can help America understand what it needs
Guess what America? If you pay for health insurance, you’re giving billions upon billions to health insurance CEOs, hospital administrators, pharmaceutical company CEOs. So, if you’re obeying the law, you’re contributing to their astronomical salaries.
In fact, Cigna’s CEO made around $49 million this past year, if you read the various reports on the Internet. The CEO at a non-profit hospital in New Jersey (Morristown Medical Center) made some $5 million …
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If you’re obeying the law, you’re contributing to CEOs’ astronomical salaries
In a recent PBS interview, Mayo Clinic CEO Dr. John Noseworthy suggested patients should “change physicians” when faced with non-empathetic doctors suffering from burnout. His cavalier resolution to our occupational struggle feels like a betrayal, to both his esteemed colleagues across the country and our profession. In my opinion, firing your physician is a risky proposition in light of the looming physician shortage.
Burnout is an overwhelming …
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Should patients fire their doctors if they suspect burnout?
According to recent research, a hug a day could keep the doctor away. According to another study, Twitter can predict the chance that people will experience heart attacks. A normal blogger would look at these two findings and tell a story about the relationship between stress and health. I’m not normal. I looked at these two studies and came to a different conclusion — that we …
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What does hugging have to do with physician pay?
“If my father dies, you’re going down with him.”
The words pierced the air, and suddenly there was silence.
I hadn’t noticed Frank’s son at first. He’d been pacing in the back of the family group gathered in our ICU waiting room. Now, up close, I could appreciate how large and intimidating he was. And I’d just had the thankless job of telling him, along with the rest of his family, a …
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A doctor keeps a dead man’s secret from his mourning family
Burnout is a popular topic of discussion among health care professionals, but preventing it often eludes us. While burnout is common in many professions, it is particularly present in health care. It is estimated that about half of all physicians in the United States suffer from burnout with numbers rising rapidly. Burnout is associated with detachment from those around us and feelings of isolation. Burnout can lead physicians to lose …
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It is time to build a workforce of resilient physicians
“Doc, I’m tired.”
This is a refrain that we hear from many of our patients who have been incarcerated in California’s prisons for decades. Now past the midway points of their lives, our patients describe how the absence of autonomy — what they eat, how they dress, how frequently they bathe, how they spend their day, and when they communicate with their families — has taken its toll, making them weary …
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The health impact of incarceration
Not far from the busy pedestrian streets in the center of Vienna, down a quiet narrow street, lies a small cobblestoned city square. Before World War II, this city neighborhood was the bustling, vibrant heart of Vienna’s Jewish Quarter, but today it is has a quiet, almost subdued feeling. Vienna’s current Jewish population is only a small fraction of what it was before the war, and the quiet feel of …
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The health of the natural world and humans are intimately intertwined
Do you ever have one of those days, when it seems like every patient is coming in for the same thing? And that you’ll never remember the differences, when it comes to doing your dictations at the end of the day?
A few weeks ago, six of my appointments had as their chief concern “ear pain.” But of course, in the end, no two ears were at all alike. I love …
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5 cases of ear pain lead to different outcomes
Not long ago, one of my elderly patients (who gave me permission to tell this story) began requiring blood transfusions for a condition known as ischemic colitis. Usually, it occurs because there are blockages present in the arteries that supply blood to the colon and, starved of blood, the inner lining of the colon becomes inflamed. But her arteries, it turns out, are normal. So we term her ischemic colitis …
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Is too much care as harmful as too little?
Our two presidential candidates are irksome and infuriating to everyone. We are disgruntled with them. The psychiatrist in me asks the question, why are we so angry and upset with them? The majority of us voted for these two as our nominees. What does all of this say about us? Why have we put up nominees that anger and disgust us?
We had sixteen other Republican candidates to choose from and …
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How did we get into this presidential mess?
Physicians are known to be masters of self-sacrifice, and self-control. They undergo years of training and make substantial emotional and financial sacrifices until they complete their training. The reward at the end of the road is a fulfilling job where he or she can treat people who are in need and enjoy the emotional, personal, and financial fruits of their labor.
But is this the reality? At a time when the …
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Have physicians finally joined the working class?
One thing I’ve learned is that physicians who have gone into direct primary care (DPC) practices are passionate about their decision: they not only believe that DPC is better for their patients and their own professional and career satisfaction, many assert it is the answer to just about everything ailing primary care. There is an evangelical fervor among some DPC advocates to spread the word and convert …
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Direct primary care: An evidence-based dialogue is needed
