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 love letter to those on the primary care journey

Physician
August 6, 2016
YouTube video

We are standing at a crossroads in health care. Behind us lies a long-lost, nostalgia-tinged world of unfettered provider autonomy, sacred doctor-patient relationships, and a laser-like focus on the art and humanity of medicine. This was the world of my father, an immigrant and primary care physician in rural California. The world of Health 1.0.

While many still pine for these “good old days” of medicine, we shouldn’t forget that those days weren’t really …

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A love letter to those on the primary care journey

Even if doctors are demonized, they do make a difference

Physician
August 6, 2016

As a long-distance truck driver, he did not have time to visit a doctor. In fact, the last time a doctor ever examined him was decades ago. When his leg started hurting, he ignored the pain for months before it got too severe and started interfering with his ability to drive.  He showed up in my office in severe pain and limping. And while he tried to joke it off, …

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Even if doctors are demonized, they do make a difference

We are all connected to the well-being of LGBTQ youth and their families

Physician
August 3, 2016

The morning my patient Evan tried to end his young life, I woke up early to make banana pancakes. It was a warm spring day, and I pushed up the windows in my kitchen. That same morning, Evan opened his window with a different intent. He had argued with his parents the evening before, not unexpected at 16, yet this was different. Evan is transgender, and his parents were not …

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We are all connected to the well-being of LGBTQ youth and their families

A guide to surviving chronic disease

Conditions and Diseases
August 3, 2016

For many people with chronic disease, the toughest thing is convincing themselves they’re not crazy. This is especially true for those with an illness with no clear etiology.

For millions of people around the world suffering from multiple sclerosis, lupus, fibromyalgia, chronic abdominal pain, ALS, rheumatoid arthritis, certain types of cancer, chronic fatigue syndrome, and hundreds of other illnesses, just making it through the day is overwhelming. Not only do many of …

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A guide to surviving chronic disease

Will integrated health care startups make health care better?

Health Technology
August 3, 2016

With Obamacare and creation of health insurance exchanges, many believed that health insurers would compete for patients much the same way hotels, rental cars companies, and airlines compete for customers. By comparing identical benefits packages from different insurers, patients could select their insurer based on the monthly premium and the extent of the hospital and physician network.

In a recent Vox article, Ezra Klein urged insurers do “something like …

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Will integrated health care startups make health care better?

To fix rural health care, you have to understand it first

Health Policy
August 2, 2016

Recently, physicians in small private practices and rural areas breathed a collective sigh of relief.  There is a possibility the implementation of changes to physician reimbursement (known as MACRA) could be delayed.  Thank you, Mr. Slavitt, for listening.  I am grateful to Orrin Hatch (R-UT) and Ron Wyden (D-OR) for keeping our rural needs in mind.  We have a window of opportunity for rural health care to survive, but we …

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To fix rural health care, you have to understand it first

The word “burnout” perpetuates medicine’s cycle of abuse

Physician
July 29, 2016

burnout2

Illustration by Jorge Muniz, PA-C.

We enter medicine with our hearts and souls on fire ready to serve humanity. By the time we complete medical training many of us have anxiety, PTSD, depression — even suicidal thoughts. Why? Medicine is stressful. Many of us work 100-hour weeks surrounded by suffering and death. We may deliver a stillborn, try to save a teenager with a …

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The word “burnout” perpetuates medicine’s cycle of abuse

A physician’s response to Islamophobia

Physician
July 28, 2016

I recently wrote an email to two Muslim colleagues apologizing for our nation’s political tenor. I shared with them my embarrassment over suggestions that our government bar Muslims from immigrating and monitor those who live here, my concern that a presidential candidate’s support congeals rather than erodes when he brays that “Islam hates us” and suggests that mosques be closed, and my dismay that so few …

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A physician’s response to Islamophobia

Direct primary care: Being different is the biggest asset of all

Physician
July 27, 2016

“The road to success isn’t productivity, it’s differentiation.”
– Tony Crabbe

That statement is invaluably true — especially for direct primary care (DPC) professionals. Your patients aren’t coming to you because you’re the same as everybody else. In fact, they’ve chosen you for the exact opposite reason. You’re gloriously different. The other guys force patients into the mold they’ve created: restrained by long waits, life-sucking insurance battles, and reduction to nothing more than a chart to be …

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Direct primary care: Being different is the biggest asset of all

What I learned from the 2 Mikes, and why physicians should be like them

Physician
July 27, 2016

They were both named Mike. Both were superstar physicians and educators at MedStar Health. Both had a wife named Pam, a son, and a daughter. And both died untimely deaths within a year of 50 at the mid-point of their ascending careers, 18 months after being diagnosed with cancer. I don’t believe they knew each other, but having worked with each of them, they will be forever linked in my …

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What I learned from the 2 Mikes, and why physicians should be like them

What we can learn from old school physicians

Physician
July 23, 2016

The term “old school” in many facets of life has negative connotations. We live in a modern, technologically advanced and fast-paced world — and there’s no room for certain people who appear to hold us back.

Last year I wrote an article about an experience I had with an “old school” physician. That experience really caused me to reflect on the situation the medical profession finds itself in, …

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What we can learn from old school physicians

I will go on treating patients, because that is what I know

Physician
July 21, 2016

You’ve all heard it. Those ads about that wonderful product that will change your life. The new kind of mattress that will finally give you a good night’s sleep every night. The new electric car. The superfood. They go on about them for thirty seconds or a minute, you are enthralled, and you dream of going right out and purchasing. Ah, marketing, how powerful you are. How much we want …

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I will go on treating patients, because that is what I know

The art of taking an excellent medical history

Physician
July 21, 2016

The art of eliciting the medical history requires medical knowledge, cultural knowledge, and many “people skills.”  History taking is not science, but rather, art, because it requires interpretation and clarification.  Patients with the same symptoms express them differently.  A major feature of the art of medicine involves learning how to interpret different descriptions of the same phenomenon.

A few examples might clarify these concepts.

The patient tells you that they have chest …

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The art of taking an excellent medical history

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I have seen both worlds, and the naturopathic one is terrifying

Physician
July 20, 2016

I find it amusing to be accused of being an unsuccessful practitioner of naturopathic medicine. I graduated with high grades from Bastyr University. I landed a highly competitive naturopathic residency. Had I remained in practice, I would currently be eligible to take the naturopathic pediatrics “board-certification” exam offered by the Pediatric Association of Naturopathic Physicians.

I was making decent money at my practices in Seattle and Tucson. By all accounts, I was …

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I have seen both worlds, and the naturopathic one is terrifying

Don’t rant about MACRA. Propose solutions instead.

Health Policy
July 20, 2016

Recently, ACP offered practical solutions to physicians’ concerns about Medicare’s proposal to implement the new payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA).

The College’s detailed recommendations, summarized here in a press statement that is linked to the comment letter itself, would replace CMS’s proposed and unnecessarily complex quality scoring system with a much simpler and understandable approach as developed by the College.

We challenge CMS to completely …

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Don’t rant about MACRA. Propose solutions instead.

How MACRA will decimate the private practice physician

Health Policy
July 20, 2016

Small, independent private practices are closing, increasing numbers of physicians are retiring, and fewer medical school graduates are choosing primary care.  The old-fashioned practice my father and I have built is a dying entity.  Parents say coming to see us for an appointment feels more like a visit with a friend than a medical encounter.  I am fighting for the survival of primary care practices.  MACRA proposed reimbursement will decimate …

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How MACRA will decimate the private practice physician

The word “provider” should be politically incorrect

Physician
July 19, 2016

It turns out that when Shakespeare asked, “What’s in a name?” he didn’t have medical providers in mind. In the last decade, the nondescript and confusing term “provider” has crept into the American medical lexicon thanks to the Centers for Medicare & Medicaid Services (CMS) which defined a provider as a Medicare participant that is contractually obligated to provide health care to Medicare beneficiaries. This was beginning of clubbing all …

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The word “provider” should be politically incorrect

More guns or fewer? The problems with evidence-based gun research

Health Policy
July 17, 2016

In the wake of the Orlando shootings, the usual battle lines are drawn in the usual, predictable way. Urban liberals and many Democrats call for more regulations and enforcement to limit access to firearms (especially assault weapons); hunters and conservatives and many Republicans — and especially the National Rifle Association …

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More guns or fewer? The problems with evidence-based gun research

The pharma-fed doctor and the foundation-fed journalist

Medications
July 16, 2016

In his recent article “Feed Me, Pharma,” ProPublica’s Charles Ornstein has been calling attention to studies showing that the prescribing decisions of doctors are linked to the amount of money that drug companies can bestow on them, usually in the form of meals, travel expenses, tuition support to attend courses, and so on.

I find nothing surprising about that, and Ornstein need not be so scrupulous when he clarifies that “the …

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The pharma-fed doctor and the foundation-fed journalist

Why nurses deserve a place in primary care

Health Policy
July 16, 2016

I’m feeling pretty good about myself today. My patient, recently admitted to home health care, was just not herself, low O2 sats, irregular heart rate with pain on inspiration and feeling a little clammy. While her recent surgery was a neck fusion, it still didn’t completely eliminate the possibility of a pulmonary embolism. Instead of spending 15 to 30 torturous minutes in her primary doctor’s voice mail hell, I made …

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Why nurses deserve a place in primary care

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