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.

A culture of rape: What can we do as doctors?

Linda Girgis, MD

Physician

September 8, 2016

Around the U.S., millions of college age kids head back to start their fall semester in college. Their courses carefully selected months ago and their packing completed in a frenzy of activity. But, little thought is given to the most violent crime that happens on college campuses: rape and sexual abuse. Estimates show that approximately 25 percent of college women have been victims of rape. In fact, every 21 hours …

Fostering wellness: Tips and practical advice from front line physicians

Sima Pendharkar, MD and Tiffany I. Leung, MD

Physician

September 7, 2016

“If physicians aren’t happy, they can’t heal others”
– Vivek Murthy

Last year, nearly 400 physicians committed suicide, a rate higher than other professions. Our nation is facing an epidemic of overwhelmed physicians subjected to increasing external stressors. Modern medical practice has evolved into a system driven by incentives to meet care quality measure benchmarks, implement incomplete electronic systems, provide care that is satisfying to patients and more. To keep up, physicians …

Accountable care organizations: Who are the winners and losers?

Ashish Jha, MD, MPH

Health Policy

September 6, 2016

Recently, CMS sent out press releases touting over $1 billion in savings from Accountable Care Organizations. Here’s the tweet from Andy Slavitt, the acting Administrator of CMS:

NEW ACO RESULTS: physicians are changing care, w better results for patients & are saving money. Over $1B. https://t.co/FEfe3QErb5

— Andy Slavitt 🇺🇦 (@ASlavitt) August 25, 2016

The link in the tweet is to a press release. The link in the press release citing more details is to another press release. There’s little in the way of analysis or data about how …

Your EpiPen is too expensive. These are your 4 options.

Roy Benaroch, MD

Medications

September 5, 2016

EpiPens have gotten crazy expensive, yes: $600 for a two-pack. Here are some alternatives that might help you save a few bucks.

1. Wait a few weeks, and see what Mylan does. Mylan, the company that makes the “EpiPen” brand of epinephrine auto-injector, has been under a lot of pressure lately to back off their unseemly price gouging. They’ve introduced a savings card that claims to lower your …

The art of medicine cannot be measured by selecting letters on an exam

Amanda Breviu, MD

Medical Education

September 4, 2016

You are currently on inpatient wards and notice your chief medical resident has been demonstrating erratic behavior, frequently muttering about MEN syndromes and antibodies associated with rheumatologic diseases and has been reciting gene translocations. What is the most likely cause of her symptoms?

A. Hospital-associated delirium
B. Conversion disorder
C. Symptoms related to completing an excess number of multiple choice questions in preparation for taking internal medicine boards

If you guessed C, you understand what I have been going …

The cure for a poor historian? A good medical record

Eric Beam, MD

Physician

September 4, 2016

Think keeping your life organized is hard? Try keeping your doctors organized.

In this era of fragmented health care, patients find themselves in the impossible position of having to coordinate their care themselves — a task that many can’t meet. Having multiple chronic medical conditions often means being subjected to a dizzying assortment of specialists, medical terminology, and tests that can quickly overwhelm patients.

How many times have you found yourself in …

Direct primary care physicians are trying to rescue other doctors

W. Ryan Neuhofel, DO, MPH

Physician

September 2, 2016

In a recent interview, Dr. Farzad Mostashari (former national coordinator for health IT and current CEO, Aledade ACO) gave some advice to physicians on how to avoid burnout and “restore their role as caregivers”:

The key is two things. One, if you’re in a kayak in the rapids, you have to lean in and dig your paddle in and push ahead. If you lean back, you’re done. You’re going to flip …

Read more…

Direct primary care physicians are trying to rescue other doctors

How a board of optometry is restricting eye care to homebound adults

Helen Kao, MD

Physician

September 2, 2016

This spring, the California Board of Optometry shut down the only optometrist providing services to homebound patients in the San Francisco Bay Area. I learned about this because affected patients included several referred from our UC San Francisco Housecalls program, one of a few non-profit, non-concierge home-based practices in the state providing geriatrics care to homebound adults.

With over 1 million adults homebound in California, why would any board deliberately limit …

Physicians are the emotional punching bags of society

Jean Robey, MD

Physician

September 1, 2016

The Washington Post featured an article by Dr. Michael Stein, “We all want doctors to be kind. But does kindness actually help us get better?” He presented intriguing but inconclusive data regarding the benefits of a “kind” doctor on control of diabetes or on perceived duration of colds for instances. In the end, Dr. Stein concludes, “At the moment, the best answer to the kindness contrarian is: Even …

Mylan Pharmaceuticals made these 2 critical mistakes

Justin Reno, MD

Medications

August 31, 2016

Pharmaceutical companies are brilliant. They make profit off of chemicals that can be potentially life-saving. The list is quite impressive: antibiotics for somebody who would otherwise succumb to sepsis, insulin for someone whose pancreas loses the ability to function, antivirals for chronic viral suppression, antineoplastic agents for somebody whose cells have lost their regulatory mechanisms, just to name a few.

The recipe seems to be quite simple: Charge as much money …

A wonderful hour of being a real doctor

Justin Reno, MD

Physician

August 30, 2016

Sometimes the business plan completely falls apart. I look at my clock; it’s 11 a.m., and I only have two patients remaining for the morning? Something must be wrong. Every fail safe measure to keep the assembly line going must have failed. The initial card with the appointment time to carry in the wallet? Failed. The reminder phone call the day before? Failed. Even the insurance company gift card to …

Read more…

A wonderful hour of being a real doctor

To the doctors struggling with depression: You are not alone

Elisabeth Poorman, MD

Physician

August 30, 2016

By the end of my first year of residency, I knew I was in trouble.

I was overwhelmed by the 15-hour days, the unbearable sadness of the tragedies I witnessed, my feelings of impotence and my fears of making a mistake.

My life was my work, and everything else seemed to be falling apart: my physical health, my relationships, my ability to sleep after months of night shifts.

Yet, I came to work …

How the power of song connected me with a patient

Pepi Granat, MD

Physician

August 30, 2016

She smiled fetchingly and threw her arms around me. She was so happy to have someone to hug. She was large, obese, kyphotic and almost bent double while edging slowly with her walker toward the examining room. She had sent a Christmas card and a birthday card, and I thanked her for them, while secretly praising myself for remembering she had sent them.

She was diabetic and hypertensive and 88 years …

Physicians will rise to take back the bedside

Jean Robey, MD

Physician

August 28, 2016

Art explains medicine by explaining human needs. In December of 2015, Dr. Michael P. Jones wrote a piece that had 27K shares: “We’ve killed the way physicians should be.” It is interpreted that 27K readers or more identified with what Dr. Jones wrote.

In his essay, he claimed the identity of a physician was being “killed” by the reality of practice demands. The essay referenced an image of the …

Invest in primary care and you get what you pay for

Niran S. Al-Agba, MD

Health Policy

August 26, 2016

In 1978, the Institute of Medicine published A Manpower Policy for Primary Health Care: Report of a Study where they defined primary care as “integrated, accessible services by clinicians accountable for addressing a majority of heath care needs, developing a sustained partnership with patients, and practicing in the context of family and community.”

The four main features of “good” primary care based on this definition are: 1. First-contact access for new medical …

Politics in the exam room? Here’s what this doctor does.

Steve Schlozman, MD

Physician

August 26, 2016

When I was 17 years old, I insisted that my father, a pulmonologist, join Physicians for Social Responsibility. I had just read about the organization in my history class, and I was feeling increasingly hopeless that I would live to see my 30s if the world continued its march toward nuclear Armageddon.

My father refused to even have the discussion.

I’ll get to why he refused in a minute, but first, a bit of …

The bureaucratic hassles physicians face are extraordinary

Peter Ubel, MD

Physician

August 25, 2016

Left to our own devices, most of us physicians try our best to provide high-quality care to our patients. But almost none of us provide perfect care to all of our patients all of the time. In fact, many of us get so caught up in our busy clinic schedules we occasionally forget to, say, order mammograms for women overdue for such tests, or we don’t get around to weaning …

Donald Trump’s medical letter has so many things wrong with it

Jennifer Gunter, MD

Physician

August 25, 2016

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Donald Trump is talking about Hillary Clinton’s health as are two doctors who have never evaluated Clinton. This attention on Clinton has renewed some interest in the letter Donald Trump released last year from his personal physician.

Many outlets have picked it apart, but I want to tell you as a doctor exactly how bad it is. I would never write …

A physician tells a health insurance CEO what she really thinks

Cathleen London, MD

Physician

August 24, 2016

I graduated medical school in 1995. I believe in a single-payer health system. I am about championing for my patients. I left a salaried position in academic medicine to go an underserved area of rural Maine and start a practice. This is the letter I wrote to the CEO of a large health insurance company recently.

Dear Mr. CEO,

My name is Cathleen Greenberg London. I am a family medicine physician who …

Young doctors can set themselves up to be financially free

Natasha Deonarain, MD, MBA

Physician

August 24, 2016

“Z” and “S” were both hesitant skeptics from the start.

Earlier this year, they’d signed up for an entrepreneurial class I taught. Z was a first-year medical student with a dream of having millions. S was his blonde-haired, model-type wife; ex-ballerina-come-cancer-survivor who wanted to help people with similar experiences.

Before the course, she’d contemplated taking out even more debt in student loans so she could go into physical therapy. After the course, …