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.
Living in the fine city of Boston, I am fortunate enough to be located right in the middle of a medical hub. A place that’s full of exciting new research, developments, and ideas. Working at the front line of hospital care, also with a keen interest in quality improvement, patient experience, and technology, I frequently attend social and professional healthcare networking events around the city.
While doing this, I’ve gotten to …
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A piece of advice to those who want to disrupt health care
A.J. Smith, a pseudonym of course, walked into my office today, unhappily. Most of her topical medications for acne caused too much irritation. The ones that didn’t, weren’t working. The doxycycline caused photosensitivity in the past. But her friend’s dermatologist gave her isotretinoin, better known as Accutane, and she completely cleared. As such, that’s what my patient demanded. There was only one problem. The degree of her acne didn’t warrant …
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Welcome to McMedicine, may I please take your order?
The federal government has been trying to control the health of citizens for nearly a century, increasingly separating patients and their physicians.
WWII wage controls firmly established health insurance as an employee “benefit” in lieu of salary. This gave the employer power to choose coverage based on its needs, not the employee’s: the first degree of separation.
Since WWII, government has imposed a multitude of programs that add degrees of separation: Medicare, …
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Eliminating the 6 degrees of patient-physician separation
Quality measures began as tools to quantify the health care process, using outcomes, patient perceptions, and organizational structures associated with the provision of high-quality health care. Overall, the goals should focus on delivery of care that is effective, safe, efficient, and equitable. Did you notice a particular word missing? Yes, I missed the word physician too, because they have been left out of the conversation entirely.
Measuring quality health care by …
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Physician outcomes should be quality measures
“Hello? Hello, Mr. Bertsie. It’s Dr. Robey. I wanted to call you and check on you,” I said into the phone stopping my constant wrestling with papers and resting what was in my hands on my lap. Mr. Bertsie and I were meeting in the equinox.
“Oh, hello Doctor,” he said with a little relief, a little surprise, a little delight in his voice. “I’m doing OK. I walked the dog …
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This story shows the humanity of medicine
In July, I found myself needing to step away from social media and news coverage of the recent shootings in Louisiana, Minnesota, and Dallas. Being a psychiatrist has made me sensitive to the toll of pain and anguish that life may bring, even as a bystander. This occurs even more so when I can all too easily imagine myself as a victim of one of these unfortunate events.
In the aftermath …
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The physician role in the time of Black Lives Matter
I recently took care of a young patient whose case left an impact on me. When I admitted him, he was fighting a lost battle with cancer.
A few months prior to admission, he had been experiencing new headaches. When he sought medical attention, he was diagnosed with an extremely aggressive brain tumor that had spread to his spine, and was given a very poor prognosis.
Unfortunately, his condition deteriorated quickly thereafter, …
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A reminder that life is indeed too short
I was in the break room at the hospital scarfing down a power bar between three-hour cases. The truth is, I was multi-tasking: eating, writing on a chart, and checking my email on my phone.
I had received an email from a businesswoman, whom I have known for a few years. She wanted to know if I wanted to join her for lunch next week.
I had to laugh out loud.
The rest …
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Doctors experience the world differently
“I’m going to the doctor next week for my yearly physical.” So normal. Of course you are. Everyone should do that.
But the concept of a yearly examination of one’s whole body to see if everything checks out fine is a relatively new invention and whether or not it is necessary is a very controversial question.
I just read an article by Abraham Verghese, an internist and champion of physical diagnosis, professor at …
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We can’t agree on the value of the yearly physical
Let me preface this blog by stating that I write this to stimulate discussion and debate, not to sway opinions.
Today, doctors are required to spend more and more time doing administrative work — including checking off electronic boxes in the electronic medical record (EMR) — the result is less quality time with patients.
Now, those that are in Washington, DC think that requiring physicians to ask about guns in the home …
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Should guns be discussed in the exam room?
My medical student found it difficult to get any information from a patient. When she presented the patient’s medical history to me, she was quite flustered and did not know what to say. I went with here to talk to the patient and met the same wall. It is not always an easy task finding the patient within.
Often, when what a patient is saying doesn’t make sense, or it is …
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How can we find the patient within?
“Why do you want to go into family medicine?” my internal medicine preceptor asked.
It was an innocent enough question. I’d known from day one of medical school what I wanted to do, so I answered with confidence, and perhaps a bit of a chip on my shoulder.
“I love being with people and getting to know them,” I said. “I’ve always been this way, so it makes sense that’s what I …
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The kind of family medicine I knew I needed to practice
Dear Hippocrates,
I want a divorce.
Let’s face it, you and I were young, idealistic, and naive when we met. Everyone said we were perfect for each other: valedictorian and humanitarian. We thought we could change the world, one sacrifice at a time. Sleep deprivation, grueling academic hurdles, delayed gratification. We proudly wore those badges as a testament to our commitment together when we started our board certified family medicine profession in …
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Dear Hippocrates: I want a divorce
We were the consummate lovebirds. We studied together, exercised together, and went grocery shopping together. When she started medical school, I took a summer job in the school’s maintenance department, just so we could eat lunch together. We couldn’t fathom being separated an entire day.
It was a magical time. We worked hard, played hard, and talked late into the night — yet rose early the next morning, energized and ready to go. …
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Married to medicine: My ménage à trois
As clinicians continue to debate the merits and limitations of retail clinics, it is increasingly clear that they are here to stay. These nontraditional sites have proliferated around the country, appealing directly to patients’ desires for convenience in ways that many traditional primary care practices do not. A report by the Robert Wood Johnson Foundation found that retail clinics have increased by 900 percent over the last decade, an expansion …
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What economic theory can teach physicians about retail clinics
To those of you who are still in the midst of pursuing a seemingly elusive goal of being in medical school I highly encourage you to take a few moments and jot down why you want it so badly. Make a quick list of all the reasons why you want to be a doctor and how you will feel once you achieve that monumental goal. For those of us in …
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A stark reminder of the opportunity we have as physicians
My thoughts settled on the Frank Sinatra song, “My Way,” when asked about necessary resources for rural health care to survive. Seven years ago, my father and I changed office buildings. We closed the office that Friday to allow three full days to get settled. However, we ended up seeing sick patients in the parking lot (seriously), while the movers were loading up the truck.
“All we need is a stethoscope, …
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How this pediatrician practices medicine. Her way.
Can you trust online physician ratings? Many people believe you can.
But here’s what a recent article in the Harvard Business Review (HBR) about the reliability of online user ratings regarding buying a product. The authors concluded that online ratings were generally not to be trusted for three important reasons:
- The reviews are usually based on a small sample of users. The authors said, “We can be more confident …
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Can flawed doctor ratings harm patients?
Last week, a patient with severe gastroparesis came in for an unexpected visit. She seemed very upset, on the verge of tears. Instead of asking her why she was in, I asked her why she was so sad.
“My hematologist just retired; I was her last patient. I don’t know who will take care of me like she did. And she wasn’t even old enough to retire,” she said. This took …
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Caring and dedicated physicians are being driven out of medicine
To close out my first week of medical school, the class was treated to a talk by a stuffy but soft-spoken lecturer on the relationship between poverty, education, and poor population health. “Social determinants of health,” he labeled them, a clunky and unwieldy term if ever I’d heard one. In those days, audiovisual aids consisted of an overhead projector for black-and-white transparencies. And boy did that talk have transparencies. Chart …
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Social determinants matter most to a person’s health. Here’s one story.
