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.

Practicing medicine in a place where the children have no name

Linda Girgis, MD

Physician

October 2, 2016

I recently spent a week with the Floating Doctors in Bocas del Toro providing medical care to the Ngabe people in western Panama. In the jungle, there is little concern about prior authorizations or deductibles. There is also a critical lack of access to services that we have available in the U.S. The Ngabe people do not own much. In fact, some kids do not even have names.

In the Ngabe …

The lost art of asking questions

Hans Duvefelt, MD

Physician

October 2, 2016

Most people know from experience or through intuition that there is a right time and a right way to ask important or sensitive questions. You don’t usually just blurt out requests for raises or marriage proposals, for example.

In many areas of life, knowing when and how to ask difficult questions is viewed as an extremely valuable skill, for example in criminal investigations and in journalism.

In some cases, this kind of …

Read more…

The lost art of asking questions

Physicians can lead from the bedside

Jean Robey, MD

Physician

September 30, 2016

A recent movie series called Divergent depicted a dystopia that created five factions: Abnegation (selflessness), Dauntless (bravery), Erudite (intellectual), Amity (peaceful or charitable), and Candor (honest or just) or Divergent (a unique combination of traits that thinks for the whole more seamlessly). This movie’s premise made me wonder: What faction would a modern day doctor belong to?

I recently wrote a piece, “Physicians will take back the beside.” One …

Read more…

Physicians can lead from the bedside

How Captain Sully inspired this physician

Mike Sevilla, MD

Physician

September 29, 2016

“I’ve had 40 years in the air, but in the end, I’m going to be judged by 208 seconds.”

This is a line spoken by Tom Hanks, who played the title role of Captain Chesley “Sully” Sullenberger.

I remember being on Twitter on Thursday, January 15, 2009, when I started seeing pictures of a plane in the water and people standing on the wings. I learned that it was US Airways Flight …

6 unintended consequences of online doctor reviews

Chris Thiagarajah, MD

Physician

September 29, 2016

Online reviews for doctors are here to stay. Letting patients review their doctor sounds great right? What could go wrong?

That being said, there are several things that reviews do that is, in fact, damaging to the care of patients in medicine. Here are six things that many physicians now do in the world of online reviews.

Focus on showmanship not results. “Sometimes I spend extra time on the exam even when I …

I wish my patients knew

Niran S. Al-Agba, MD

Physician

September 27, 2016

Referencing a recent New York Times article “What Kids Wish Their Teachers Knew” got me thinking about both sides of the coin. Physicians are human beings and sometimes this fact gets lost when a patient is angry or frustrated seeking help from the medical system. Here is a primer on what I wish my patients knew. (This is a companion piece to “I wish my doctor …

Read more…

I wish my patients knew

Helping a patient is more important than following a policy

Jeff Kane, MD

Physician

September 27, 2016

Pretend you’re a 30-year-old woman who’s 34 weeks pregnant. You develop a cough while cleaning a dusty room. You put up with it for several days. After a week you realize the cough has kept you from sleeping and is creating pain in your rib cage. Time, you think, for medical attention.

That should be an easy thing to do. After all, you have health insurance, and you’re articulate and assertive. …

How primary care is being held hostage to tertiary care

Pamela Wible, MD

Physician

September 26, 2016

an-ingrown-toenail-is-not-a-lung-transplant

Illustration by Jorge Muniz, PA-C.

Here’s a quick review of health care delivery basics:

Primary care. Stuff you can get handled with your primary care doctor in your neighborhood. Example: ingrown toenail.

Secondary care. Stuff your primary care doctor refers to a secondary specialist down the road. Example: colonoscopy.

Tertiary care. Complex stuff you need to deal with at a big-city hospital. Example: lung transplant.

Simple. Right?

Here’s the problem: …

Is what is good for doctors always good for patients and public health?

Vincent DeGennaro, Jr., MD, MPH

Physician

September 22, 2016

The Haitian doctors’ strike ended recently, and it is unclear if there are any winners. The conditions in which the striking doctors — medical residents in Haiti’s public hospitals, to be precise — work are appalling, and the low pay was galling, but without the doctors, hospitals shut their doors and the poor were left to take care of their own illnesses and injuries for nearly five months.

At issue were …

Narrative medicine for social and physician wellness

Jean Robey, MD

Physician

September 22, 2016

Physician wellness begins in realizing our identity in medicine and society. Shamans, priest, and healers have existed in ancient times and in small and large indigenous tribes since man began to gather together in social packs. The unique role of tribal and community leaders who guarded health and wellness was understood as important for the whole of society.

All doctors have degrees of empathy. We as an order select for this …

What medicine can learn from Wells Fargo

Andrew Spector, MD

Physician

September 20, 2016

In 1996, Jerry Maguire was fired for advocating a reduction in his sports management firm’s client base thereby risking the firm’s profits. While writing his infamous memo (or as he would tell you, his mission statement), he recalled his mentor’s advice: “The key to this business is personal relationships.”

Tom Cruise’s voiceover continues: “Suddenly, it was all pretty clear. The answer was fewer clients. Less money. More attention. Caring for them, …

If doctors wanted to be wealthy, they would have become UPS truck drivers

Neil Baum, MD

Physician

September 19, 2016

figure-1-for-kevin-pho

Do doctors make too much money?

I don’t think so. I read with great interest the blog by Dr. Michael Kirsch defending physicians’ salaries: “If you think doctors make too much money, think about this.” Unfortunately, the public’s perception of physicians’ incomes has been that physicians make too much money.

Whenever I hear this remark from patients or even non-physicians, I …

How can patients get better if they live in homes tailor-made for disease?

Franklin Warsh, MD, MPH

Physician

September 17, 2016

I’m new to the job of coroner. Though I’m sure it won’t surprise anyone to hear that it’s nothing like C.S.I.; you measure the wait for test results in months, not minutes. It’s not like Quincy, M.E. either, where the same person responsible for the autopsy hops about cracking a case that somehow befuddles police. Most deaths are natural, with a good number of accidents and suicides, despite the media’s …

The social history: Our patients are more than their diseases

David Goldberg, MD

Physician

September 15, 2016

“Any alcohol use? Any tobacco use? Any other drugs?”

These are the three main questions that most health care providers ask their patients when documenting a social history on a note.

“What stressors do you have in your life? What social support do you have? What is your home life like? What do you do for fun? Do you wear a helmet when you ride a bike? Do you wear a seatbelt?”

I …

What this family physician learned from his dog

Justin Reno, MD

Physician

September 15, 2016

I, much like many others, made a terrible decision on my 21st birthday. Mine, however, didn’t involve alcohol; I adopted a dog.

She was a scruffy, brindle-coated, malnourished 30-pound terrier puppy. So in between organic chemistry, physics, Spanish, studying for the MCAT, and multiple other classes, I had to housebreak a puppy. Those glorious visions I had of dog ownership hadn’t included several key aspects, like cleaning up accidents, cleaning up …

Physicians must lead. Here’s why.

Patty Fahy, MD

Physician

September 14, 2016

Some docs consistently say “no thanks” to formal leadership roles. They prefer not to run for a board position, become department chief, or step into an executive role because their passion and focus is patient care. This primary interest in the core work shows up in other professions, too. My brother, a mechanical engineer (I’d say “brilliant mechanical engineer,” but he might read this), eschewed management positions his whole career. …

Read more…

Physicians must lead. Here’s why.

To prevent burnout, physicians need less resilience, not more

Rebekah Bernard, MD

Physician

September 13, 2016

With the latest data calculating physician burnout at greater than 50 percent, American medicine is at a tipping point. How to fix this crisis? Why, make physicians more resilient, of course!

Except physician resiliency is exactly what got us into this problem.

Let me explain. Doctors are notorious people pleasers. We spend years of our life at study, sacrificing the fun and freedom of youth, deferring childbearing, and delaying …

Do white coats make us better doctors?

Lauren B. Smith, DVM

Physician

September 12, 2016

It is 80 degrees in the exam rooms. The air conditioner is broken and despite calling and alerting our clients, almost none of them want to reschedule. I finish writing up a chart in the treatment room where the air conditioner from the kennels still has some influence. Despite the temporary respite from the heat, my skin is still glistening with a thin layer of perspiration. I look sullenly at …

Read more…

Do white coats make us better doctors?

Medi-Cal for all: It’s coming soon

Manuel Momjian, MD

Physician

September 11, 2016

The Affordable Care Act has been touted as the answer to our country’s huge uninsured epidemic. There is no denying the fact that millions of uninsured people signed up for insurance through an expanded Medicaid program, which is called Medi-Cal in California. The blessings of a decrease in uninsured patients makes for a great sound bite and has been repeated over and over in the media. The only problem is …

Read more…

Medi-Cal for all: It’s coming soon

Physician burnout may not happen. But “burn in” is guaranteed.

Jean Robey, MD

Physician

September 9, 2016

I saw a new residency graduate post about how balanced she will choose to be and how not taking work home would keep her idealism alive. Like a woman who has been pregnant and gone through delivery and postpartum, I wanted to tell her the truth about how emotions get changed in practice and how the emotions become physical ailments at times. I wanted to tell her birthing and raising …

Primary Care

Most Popular

Past Week

Past 6 Months

Recent Posts

Subscribe to KevinMD and never miss a story!

Most Popular

Past Week

Past 6 Months

Recent Posts