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.
Doctors have become a profession of whiners. Meetings, dinners, doctor lounges and the blogosphere are flooded with physician complaints, tirade, and anger. The volume of pained voices suggests that health Armageddon is only a few moments away.
It was not always so. Medicine is a career where idealism runs rampant. In medical school interviews, young students really do answer that they want to help their fellow man. Nonetheless, in recent years …
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Before you say doctors are whining, think about who they are fighting for
“Customer service” is the new buzzword in health care. (Yes, I know it’s two words. Stay with me here.) Health care has become a service industry, like a restaurant or a company that comes to your home to replace a broken windshield. The shrimp is too salty, or the tech left footprints on your floor mat? You complain, and you send the shrimp back, and the tech apologizes and says …
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Why patients shouldn’t always get what they want
I was really anxious. My father’s legs were getting weaker and his pain was worsening. He had been having pain for quite a while, and that pain was often disabling in its severity, but the weakness was alarming.
Dad went to the neurosurgeon, who was also alarmed at the weakness, but didn’t feel that the problem was surgical in nature. When I heard this I broke one of my most tightly-held …
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An avalanche of data buries the patient story
Shhh. I think this is supposed to be a secret, but this Wednesday at the super-elite AMA House of Delegates meeting in Chicago, where only the mostly highly connected and AMA devoted doctors get to attend, they actually stood up for us. It is now AMA policy that the AMA opposes mandatory ABMS recertification exams.
Crazy, right? News of this random act of fortitude trickled out to us on Twitter by the small …
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The AMA calls for an immediate end to MOC
The street was glistening with Christmas lights, and tiny flurries were falling onto our hats as we walked down a picturesque Philadelphia street. It was the end of one of the first “real” dates that I have ever had in my young thirty years of life. We started the night with dinner at a fancy restaurant followed by attending the musical White Christmas.
As we walked down the street, my date …
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Gay pride: We have made progress but the pot of gold is missing at the end of the rainbow
Every day on my way to work, I walk through one of the most famous and historic LGBT-friendly neighborhoods in the U.S. This past Saturday, my walk back home from the hospital was a particularly entertaining one. It was Pride weekend. People were celebrating, the sun was shining, the rainbows painted on the street seemed brighter. Even though I had worked a long day, my walk back home left me …
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We need a moonshot to curb gun violence
As many who are pediatricians or know pediatricians are aware, the quest to end gun violence is a passion for our profession and an advocacy issue of utmost importance for our professional organization, the American Academy of Pediatrics (AAP). Having practiced in areas with a high incidence of gun violence for most of my career until recently moving to California, I have seen first-hand how this tragic issue affects the …
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It’s time for physicians to raise their voices and end gun violence
“I should be home well before nine o’clock,” I said to my wife on the phone as I steered my eight-cylinder SUV quietly down the highway at 75 mph with more than 100 miles left to go.
“More like eight fifty-five,” I added.
“That’s well before nine?” She sounded both weary and incredulous. I knew what she meant. I am not as obsessive about time as I used to be, but even …
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How this doctor manages time
At our last visit, she asked me “not to forget us” and gave me a photograph of her family. She included a picture of her daughter, whom I had never met. I had missed her by four years almost to the day because she was shot and killed driving through her neighborhood in the middle of the afternoon.
I first met Mrs. P early in my training as a physician in …
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Gun violence is a public health issue
I like to read. I always have, and I’m sure I always will. I read almost everything that I come across. I often find myself reading the articles on this site. Some I agree with and some I don’t, but I like that part of the site too. I read, and I learn and I’m informed, and I gain knowledge, but then something always seems to happen. I always wind …
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I’m a physician assistant. It’s time to stop the bitterness.
Recently I attended the funeral of a prominent gastroenterologist in my community whom I knew socially as the father of my son’s friend. It was an untimely and rapid death due to pancreatic cancer. He left behind a young wife and four children, two of whom are in college. I would see him periodically at school functions; he would sneak into an event at the last minute and often struggle …
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This doctor was remembered for his devotion to patients. Was it enough?
Dad had taken a turn for the worse, but my family was not ready to give up on him and consider end-of-life care. Nevertheless, choices had to be made. Would Dad be allowed to pass while in assisted living or have his life prolonged in a skilled-nursing facility? What kind of a doctor am I? When perceiving that a patient is dying, what type of physician neglects to intervene and …
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Physicians are society’s scapegoats
“I solemnly pledge to consecrate my life to the service of humanity.” Standing with my medical school colleagues, we continue: “I will respect and hold the secrets that are confided in me. I will exercise moral integrity.”
I easily agree. But then, “The health of my patient will be my first consideration.” I’m 40 weeks pregnant, with swollen feet and raging heartburn. My baby kicks wildly. With certainty, I know that …
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Living the oath requires physicians to set boundaries
The news media is hooked on the opioid prescription drug abuse story. Every day, it seems, I read a new announcement:
- The CDC has issued guidelines for prescribing opioids for chronic pain.
- The FDA has announced immediate-release pain medications will need to have “black box” warning labels about the risk of addiction, abuse, overdosing and even death.
- The White House has requested $1.1 billion in its 2017 budget to combat …
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What I learned about prescription drug abuse from San Diego
We have a problem in our clinic.
Between our EMR implementation a few years ago and our PCMH recognition shortly after that, our office visit documentation has become bloated and our cycle time has almost doubled.
There are no brief visits anymore, since every visit entails screening for multiple psychosocial conditions and consideration of various immunization and health maintenance reminders.
Nobody sees over thirty patients a day anymore; we’re lucky to exceed twenty.
That …
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Medical homes weren’t supposed to be this way. What went wrong?
As a mid-career faculty physician in a family medicine residency program, I have taken a keen interest in the big picture of what is happening to the way our graduates and colleagues practice in the real world. I’ve watched our residents as they prepare to graduate, deliberating among the most prevalent practice options presented to them in our region, usually as an employed doctor in a large multi-specialty practice, or …
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It’s time for academic medicine to embrace direct primary care
“I love you,” she said as I was leaving the room.
Although I was stunned for a second or two, I wasn’t really surprised. She and I had gotten along famously from the beginning of our 15 minutes together. She didn’t “love me” in the way a patient with borderline personality disorder “loves” her enabling prescriber. She loved me because I was there, I was experienced, I was kind, and I …
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I’m a better doctor than any computer
I am a scientist and a medical economist. I have been privileged to work beside doctors in both their caregiving role and their research role for 20 years. I have seen their challenges and tried to build products and services to help. I have deep respect for the challenge of medicine and the committed practitioners.
When I left graduate school in 1988, it was the beginning of the movement from fee …
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Health insurance must be driven by physicians. Here’s why.
What is your dream job? It’s the one you would do every day even if no one paid you. When you find it, you never really go to work each day, you go and play. If that is the kind of joy received from working, then burnout will likely be a long way out of reach. Are there any jobs like that out there for doctors? Yes, there are. But …
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When looking for a physician job, salary is the least important factor
Like many physicians, I’m a people pleaser. On my medical school application, my personal statement was a literary cliché filled with my dreams of helping others, easing pain, soothing suffering — and I really meant it. What I didn’t know then was how difficult it would be to negotiate making patients happy while doing the right thing medically.
Medical school and residency didn’t adequately prepare me for the emotional strain of …
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It’s time for physicians to stop being pushovers
