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.
It is open season on erectile dysfunction. First, a politician in South Carolina introduced a bill to make it hard to get Viagra and then a politician in Kentucky. If the bills pass, they will hold patients with erectile dysfunction hostage to unrelated agendas. You might think that erections would be as politically untouchable as guns. After all, erections are nearly as popular as they are …
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Why is erectile dysfunction so politically impotent?
When I was growing up in the ‘50s and ‘60s, virtually every primary care doctor (pediatrician, internist, GP-there were no FPs) I knew of had his office (women in practice were rare) located in a wing of his home, with the driveway enlarged to accommodate patients. A new physician in practice would simply hang his name on a shingle in front of the house. These doctors were paid in cash, …
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Why this primary care doctor retired early
In the last month, I have used the ICD-10 codes Z59.0 (homelessness), Z59.1 (inadequate housing) and Z59.9 (unspecified housing or economic problem) far more than I ever would have imagined. Several patients came into my urban clinic with varied chief complaints, including issues with uncontrolled asthma, chest pain, stress, worsening knee pain and sciatica. However, after listening and asking questions, I quickly realized that all of these initial complaints shared a …
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Why doctors should care where their patients live
It is a common experience to feel that our body has let us down when we get sick. We may feel it is broken or flawed in some way and if only it was better designed we wouldn’t have to suffer illness and disease. Likewise, we tend to consider illness and disease as something bad that has happened to us and which we associate with suffering of some kind, be …
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The way we are living is killing us
Part of a series.
I have advocated in this series of posts on direct primary care in one form or another (i.e., membership, retainer-based, concierge and various other incarnations and conceptions) because it works well for both patients and primary care practitioners. Direct primary care allows the doctor the opportunity to give the type of outstanding care that each of us needs, whether currently healthy or beset with multiple …
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How else can we improve our primary care system?
No matter how early I rise with the intention of getting my workout done before my children wake up, I’m rarely able to do it alone. Most days my 3-year-old daughter climbs out of bed and comes straight down to our home gym and watches me do my workout.
Often times she’ll sit quietly in the corner, but sometimes she’ll join in and follow the trainer on my workout DVD and …
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How to talk with your kids about exercise
The idea that we have to “change incentives” for physicians is all the rage. Oceans of ink are being spilled over the transition away from the traditional fee for service payment model to a menagerie of value-based ones. At the core of much of the discussion about how to make the transition is figuring out how risk-bearing organizations like large physician groups, health systems, ACOs and the like are going …
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It takes more than incentives to engage physicians
Apologies to Mark Twain, but reports of the death of private practice are somewhat exaggerated. There are still plenty of us around, and most of us are making out quite well. Not all, though. I’m quite sure the murmurs of discontent have reached many ears by now. So much so that many doctors unhappy with the status quo have taken action. One such action is to “go concierge.”
Concierge practice, also known …
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Concierge medicine isn’t right for this doctor. Here’s why.
There was a tragedy in France recently: Innocent French citizens were taken down by a profession whose mission is to heal and comfort. A medical clinical trial careened off the rails and crashed. Were these volunteer study patients properly informed? Are medical study patients here in the U.S. truly making a free choice?
From time to time, friends, patients, and relatives ask my advice if they should participate in a medical …
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Are volunteer study patients making a free choice?
Step 1: Greet patient.
Step 2: While chatting, check all boxes in electronic medical record for a complete review of systems and physical exam. Copy and paste parts of previous chart note while looking at patient every once in a while. Smile if possible.
Step 3: Tell patient to do yoga.
Step 4: Bill insurance company for complete physical exam.
Welcome to big box assembly line medicine.
Ever wonder what …
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How to do a no hands-on physical in 3 minutes (or less)
Last year, several scandals unfolded involving the Veterans Health Administration. Close to home, the Fort Collins VA hospital falsified its wait times for clinic appointments. To meet the VA goal of clinic appointments within 14 days, the hospital instructed its clerks to “cook the books,” falsifying appointment records to give the illusion that the vets were being seen in a timely manner.
Farther away in Phoenix, the local VA hospital had …
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Wait lists at the VA may be a sign of things to come
Sticks and stones may break my bones but two words — thank you — will not hurt you but will certainly help you.
We, myself included, are often so busy and always in a hurry rushing from one task to another that we often forget common courtesies. I believe that we can accomplish so much more with our patients, our staff, and even in our personal lives by not forgetting to …
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Two powerful words that more doctors should use
I quit medicine. I was five months out of residency, and I was leaving medicine. I had dedicated my heart, soul, several years of my life along with weekends, holidays, special events, and my children’s first words to this honorable profession. Medicine was never suppose to “just be” my job. It was suppose to be my calling, and it had betrayed me.
I was finally a full fledged physician, and I …
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This doctor quit medicine. It saved her life.
Fifty years ago, it was very uncommon to find doctors married to other doctors. Why? To answer that question, we need to explore the sociology of the time. Fewer women went to college, which meant fewer female doctors. Many couples married early, right out of high school or right after college. If the wife had career aspirations herself, these were often put aside in order to help her husband get …
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Should doctors marry doctors? Here are the challenges they face.
1. You either over or under-react to everything related to your child’s health. Your kid chokes? You perform the Heimlich and are back to dinner conversation 2 minutes later. Your infant spits up a little more than usual after their introduction to rice cereal? You decide they may have FPIES and stay up all night worried they may require tube feeds. True story.
2. You can’t go to …
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10 truths of physician parents
Mental illness has long been associated with shame and stigma. Although progress has been made through the efforts of global celebrities like Stephen Fry and many others to de-stigmatize mental illness — many are still ashamed to admit to it, and the stigma is far from being annihilated.
Nowhere is this stigma more entrenched than within the medical profession itself. A fact that should shock us out of our judgmental slumbers …
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We are human beings before we are doctors
I was spending time with friends and family over the holiday when I started to experience various vague symptoms without an obvious etiology. Having been treated for high blood pressure about ten years prior before successfully overcoming the issue with exercise, I immediately recognized the return of the condition. (As an aside, it should be stated that elevated blood pressure typically produces no symptoms at all.)
Stopping by my local pharmacy, …
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A doctor who forgot the basics they teach you in medical school
There’s a code among physicians, both in the private and academic setting. It is that, as a physician — unless you are dying, or very close to it — you show up to work. Taking unscheduled time off, for either physical illness or grieving, is not easy as a physician. Doctors experience a huge amount of guilt and pressure, and rather than experience that, most of us will drag ourselves …
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It’s time for doctors to stop feeling guilty for taking time off
