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.

Doctors should define who they are

Natasha Deonarain, MD, MBA

Physician

February 27, 2016

There’s stress written all over their faces.

Poised in that precarious time of life, transitioning between the teenage freedom years and the responsibilities of adulthood, those six first-year medical students look anguished. Their collective eyebrows knit together.

I’ve given them a challenging homework assignment: “Write a 500 to 1,000 word essay and read it to the class next week.”

“I’ve got a question,” J says. “You told us to write an essay about …

Read more…

Doctors should define who they are

Reduce physician burnout with meditation and mindfulness

Ayoosh Pareek

Conditions and Diseases

February 27, 2016

It is easy to lose oneself while swimming in a sea of medical facts surrounded by overburdened physicians and high-acuity cases. Initially, it is difficult taking care of one patient, much less a whole service. The transition from student to student-doctor is not as homophonic as the semantics would suggest — and this transition affects the mental health of thousands of medical students each year.

Medicine is less a profession and …

A story of how one physician overcame burnout. He is not alone.

Robert Centor, MD

Physician

February 26, 2016

Donald Ross (an obvious pseudonym) has practiced in a medium sized town for around 20 years. I count him as a protege as we worked together during his residency. As a clinician educator, we work with many interns and residents, and sometimes we develop lifelong relationships. Donald Ross and I share a love of golf, ACC basketball (although we root for rival teams), and internal medicine. We periodically communicate through …

Am I a health care business metric or a physician?

Craig Bowron, MD

Health Policy

February 24, 2016

The title of Noam Scheiber’s January 9, 2016 New York Times piece on hospitalists, “Doctors Unionize to Resist the Medical Machine,” skirts the bigger issue for doctors, which has less to do with contracts, salaries and labor relations, and much more to do with the question, “Is health care just another business, and if so, can physicians be managed that way?”

I’m a silverback hospitalist, and when I started …

The challenges this doctor faces when caring for the homeless

Vincent DeGennaro, Jr., MD, MPH

Physician

February 23, 2016

“Fifty-three-year-old homeless woman with diabetic ketoacidosis and severe emphysema exacerbation.” And suffering from adomicilia, too, I added in my head.

Much like apraxia means the inability to perform purposeful movements (praxis), adomicilia jokingly means those who are not domiciled, a pretentious attempt at gallows humor in the medical profession.

I read through the patient’s electronic record imagining a withered woman, wrinkled from years of drinking and smoking, perhaps with signs of schizophrenia. Most …

It’s time to free doctors from their boxes

Rhea Boyd, MD

Health Policy

February 22, 2016

The American health care system is set up to care for a certain subset of the population — sick people — people with chronic disease, acute illness, acute injury, and complex disorders like cancer or metabolic issues.

The problem is, this set up doesn’t create market incentives to care for the well effectively, or to identify those at risk for disease and efficiently and reliably intervene, at scale.

To reconcile this cognitive dissonance …

A Generation X physician embraces the millennial doctor perspective

Sherwin Gallardo, MD

Physician

February 21, 2016

I have been practicing family medicine as part of a large urban managed-care organization for about 15 years now. As part of my practice, I teach medical students and residents. And as a card-carrying member of Generation X, I often find myself right in the middle of the ebb and flow of the work-life balance and physician wellness discussion between my older Baby Boomer “workaholic” and “pay-your-dues” vocation-driven colleagues, and …

Patients and physicians must advocate for a transformed primary care system

Stephen C. Schimpff, MD

Health Policy

February 19, 2016

Part of a series.

Primary care needs to change. That change will need the concerted efforts of patients, doctors, and other constituents. Many are cynical and believe that no worthwhile change can ever occur; others are simply resigned. But optimism can be realistic with intense advocacy and simply taking the initiative to make change. This may surprise you, but change will only happen when patients along with doctors become …

I was unprepared to deal with a homeless patient today. I won’t be tomorrow.

Seema Khosla, MD

Physician

February 19, 2016

I met a woman today who was well-groomed, articulate, insightful and undeniably intelligent. She provided succinct responses and understood the matter at hand. Our ability to treat her, though, will likely be derailed in two weeks when she will once again become homeless.

In the midst of a booming job market in my area lies a cluster of people who are unable to find work — either due to transportation issues, not …

Pay primary care doctors what they’re worth

Allen Frances, MD

Physician

February 17, 2016

“It’s more important to know the patient who has the disease, than the disease the patient has.” This was true when Hippocrates said it 2,500 years ago — and it remains true today.

Unfortunately, doctors no longer know their patients. GPs are overworked, underpaid, and must shuttle patients in and out of the office in less than ten minutes. Specialists tend to treat the test, not the patient, and earn their …

The games drug companies play can dramatically raise costs for patients

Rob Lamberts, MD

Physician

February 14, 2016

I had a patient last week who was a real pain in the ass. Wait. No. He was actually a really nice guy. He wasn’t a pain in the ass; he had a real pain in the ass. Literally.

I was initially concerned about a pilonidal cyst, given the unfortunate fact that he was previously afflicted with this condition (which I consider to be incontrovertible proof of Satan). But, fortunately to …

When it comes to positive change, physicians are their own worst enemy

Suneel Dhand, MD

Physician

February 14, 2016

Physicians are an interesting and eclectic bunch of people who have sacrificed a lot to get to where they are. Just getting into medical school alone is an academic achievement to be proud of. And that’s just the start of the journey. What follows is one of the most rigorous courses of study in existence. Test after test, exam after exam. And when you’re finally done with medical school and …

Can we truly heal another if we can’t heal ourselves?

Dr. Eunice J. Minford

Physician

February 12, 2016

“Liver Transplant Surgeon Addicted to Alcohol” — reads like a headline from a tabloid paper selling sensationalism.

How could it be?

How could a liver transplant surgeon, someone who sees up close and personal the devastating effects of alcohol on the body, be addicted to alcohol? Surely the diseased, fibrosed, hard, shrunken cirrhotic livers with dilated and engorged veins that can rupture and bleed catastrophically; the yellow eyes and skin of the …

10 ways to become a physician entrepreneur

Natasha Deonarain, MD, MBA

Physician

February 9, 2016

I find myself standing in front of six first-year medical students. They’re waiting for me to tell them something about how to become a physician entrepreneur.

These students are now elite amongst their peers. They’re the ones who’ve had the courage to sign up for my course. And, perhaps unbeknownst to themselves, they’re also among the 1 percent of early adopters to lead the way for health care change.

How do I …

Can our health system really go downhill any further?

Wendi Lovenvirth, DO

Health Policy

February 9, 2016

All hopes were abandoned. In theory, it was supposed to jump start medical care and provide access to the uninsured. It was the promise of a new day. Every American would have access to good, quality (I really have learned to hate that word), affordable medical care.

I’ll never forget that day. It was raining hard, and my clothes were soaked through. The air felt particularly raw against my skin. The …

Why are female physicians scared to be women?

Nisha Mehta, MD

Physician

February 7, 2016

Women physicians are a testament to evolution; they’ve spent years, decades even, navigating through systems that do anything but cater to their unique needs, and actually find a way to thrive within these systems.

My question is this: Why haven’t these systems really evolved with them? It’s now been 167 years since Elizabeth Blackwell became the first woman to graduate with a medical degree in the United States. Nowadays, just shy of …

Communication with patients is a problem. How do we fix it?

Jeff Kane, MD

Physician

February 6, 2016

In my practice of facilitating cancer support groups, all I do is listen to patients and their families. Consequently, I hear much about the nature of their care. They generally speak favorably about its technical aspects, and indeed these are often awesome. But when they complain, it’s uniformly — and I mean one hundred percent — about communication.

One man has been trying to get an appointment with a pulmonologist for …

Why this doctor won’t close her practice to new patients

Lucy Hornstein, MD

Physician

February 3, 2016

Closing a medical practice to new patients is like cutting off the very top of a tree. It’s the beginning of the end.

The top of the tree, the crown, is where the newest leaves are. It’s also the part that continues growing ever upward, at least until it reaches it’s maximal genetic height, depending on environmental factors like the availability of water and sunlight (both of which also depend on …

Celebrate National Women Physicians Day #Iamblackwell #NWPD

Hala Sabry, DO, MBA

Physician

February 3, 2016

It’s amazing what you can learn from the stranger sitting next to you on a flight.

As I wait for my neighbor to grab her seat next to me, I secretly hope she embodies the qualities I hope for in a fellow passenger — keeping to herself and not requiring in-flight medical assistance. I make eye contact with a young woman who gives me the nod that she has the middle …

The interview before transferring to a new doctor

Hans Duvefelt, MD

Physician

February 3, 2016

Today I met a man who wanted to interview me before transferring his records.

He was about my age and seemed polite and pleasant enough. He told me his doctor of a dozen years had started to taper him off his long-term narcotics after he reported some of them missing because of theft. He used to take the equivalent of about 1,200 mg of morphine per day for his back pain. …

Primary Care

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