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.

Watch out and be informed: There is dishonesty in every profession

Suneel Dhand, MD

Physician

January 31, 2016

Within the last several weeks, I’ve had two plumbing issues that have caused me to reflect on the honorability of various professions and the way in which people go about earning an honest day’s crust.

Let me take you back to the beginning of the story. I was actually working nights a couple of months ago when I noticed, just before I was about to leave for the hospital, that my …

Doctors need to learn to say no. Here’s how to do it.

Starla Fitch, MD

Physician

January 30, 2016

If you have a life where you never, ever say yes when you mean no, then you can stop reading right now.

But I guess that you’re a lot like me. Now and then, you get caught off guard.

And before you know it, you’re staying late to see that emergency patient. Bringing cupcakes for the second-grade class. Volunteering for the coffee meet-and-greet at church next Sunday.

What’s up with that? We’re smart. …

The shocking confessions of a naturopathic doctor

Britt Marie Hermes, ND

Physician

January 29, 2016

I was a licensed naturopathic doctor in two states. I quit practicing naturopathic medicine after discovering my former boss, also a licensed ND, had been importing and administering an illegal cancer drug. I trusted my boss, as did his patients, because he was well respected in the naturopathic community and his credentials included “FABNO” (Fellow of the American Board of Naturopathic Oncology). This FABNO treated any kind of cancer, even …

Solving homelessness requires finding answers to these 2 questions

Margot Kushel, MD

Conditions and Diseases

January 29, 2016

On any given night in the United States, according to the Department of Housing and Urban Development, over half a million people are without a home. That number may have decreased nationwide in the past few years, but California remains on the forefront of the problem, accounting for 20 percent of the country’s homeless in 2014.

With the winter’s freezing temperatures and El Niño’s massive rainstorms, what to do about the …

Will the real doctor please stand up?

Kristin Prentiss Ott, MD

Physician

January 26, 2016

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In 2006, graduate nursing programs started granting doctorates of nursing practice (DNP degrees). In a media fact sheet, the American Association of Colleges of Nursing (AACN) explains the thrust for the change this way:

Some of the many factors building momentum for change in nursing education at the graduate level include: the rapid expansion of knowledge underlying practice; increased complexity of …

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Will the real doctor please stand up?

The physician’s ultimate calling faces pressure

James C. Salwitz, MD

Physician

January 24, 2016

In the fall of 1980, in my final year of medical school, I sat in the main ward of Saint Vincent’s Hospital, Greenwich Village, Manhattan. Filling the vast space were twenty-four beds, in four rows, with twenty-four patients. The prow of the open nursing station thrust from one wall into the center. A high ceiling vanished above. Yellow light filtered through ancient rippled glass windows and distant fluorescent bulbs made …

The triple aim must turn into the quadruple aim. Here’s why.

Yul Ejnes, MD

Health Policy

January 24, 2016

A guest column by the American College of Physicians, exclusive to KevinMD.com.

The election year has finally arrived. Even though the candidates have been on the trail for what seems like forever, I wanted to wait until the traditional time to announce the launch of my campaign.

Don’t worry, I’m not running for office. My campaign is an initiative to get us to start talking about the “quadruple aim” …

Why the physician shortage in the VA is a sign of things to come

Sarah Mongiello Bernstein, MD

Health Policy

January 22, 2016

The metallic mix of freshly spilled blood and sterile instruments engulfed his nostrils as he shifted uncomfortably in the cracked, worn, brown leather chair where so many others had sat before him. He tried not to sweat as the faceless, gray clinician coaxed the long needle deeper into his fleshy neck and watched as a rogue drop of crimson escaped and marred the otherwise pristine tile floor beneath him. He …

The rise of workplace confrontation in medical practices

Anonymous

Physician

January 22, 2016

The workplace environment can be full of many obstacles, especially in the medical field. These obstacles range from difficult patients, to navigating insurances, to burnout, and so on. One problem, however, appears to be worsening over time and seems to go without discussion. As life has progressed and I have transitioned from a medical student to attending physician, I have noticed an increase in workplace confrontation between employees. Is this …

An Uber for health care is closer than you think

Davis Liu, MD

Health Technology

January 21, 2016

Will there be an Uber for health care? Articles are split. The truth is there will be an Uber for health care. It just isn’t here yet. Expect it to be widely available in the next decade and as a result, people will get expert medical care that is more convenient, less expensive, and accessible.

What issues must an Uber for health care solve?

Media articles that have prematurely proclaimed that Uber …

I’m grateful to be open for business. This doctor is in.

Emily Gibson, MD

Physician

January 21, 2016

I have the privilege to work in a profession where astonishment and revelation awaits me behind each exam room door.

In a typical clinic day, I open that door up to thirty plus times, close it behind me and settle in for the ten or fifteen minutes I’m allocated per patient. I need to peel through the layers of each person quickly to find the core of truth about who they …

Healing patients shouldn’t be killing doctors

Amaryllis Sánchez Wohlever, MD

Physician

January 21, 2016

Healing others shouldn’t be killing you. This warning in a physician recruitment ad pulled me in, while an image of a choking stethoscope triggered flashbacks of my years in medicine. Many physicians feel like they’re choking. Squeezed in from every angle. Stretched to the max. Spent.

And they feel this way right as they open the door to greet their next patient.

I know of a prominent office that lost three superb …

Dare to make yourself more human

Aleah Chang

Conditions and Diseases

January 20, 2016

“Hey mon, you alright?”

“You have a blessed day.”

“How is your morning walk pretty ladies?”

“Yeah mon, no worries. Everything alright.”

These “stock phrases” are just a few of the things I heard each and every day while staying in Negril, Jamaica. I travelled to the island to take a short vacation and also attend a destination wedding this past month. While on the island, I was pleasantly greeted by the local Jamaicans …

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Dare to make yourself more human

Patient satisfaction often forces doctors to “do something”

Marjorie Stiegler, MD

Physician

January 18, 2016

Recently, I read an article about a new mother’s experience taking her toddler to the emergency room after a face-first fall onto an iron table, bleeding profusely. After her child was evaluated, it was determined that no serious injury was sustained, and no further intervention (i.e. stitches) was needed, and the toddler was discharged home with some wound care instructions and a popsicle. When the mother subsequently …

What you don’t know about medical training and culture can kill you

Pamela Wible, MD

Physician

January 18, 2016

An excerpt from Physician Suicide Letters — Answered.

When is a taboo topic no longer taboo? When is it OK to stop hiding behind euphemisms? When is it safe to tell the truth? The answer is now.

This week I uploaded 53 chapters of physician suicide letters in …

Primary care doctors are specialists in diagnostics

Hans Duvefelt, MD

Physician

January 17, 2016

Every primary care physician has had this experience: We refer a patient to a cardiologist, pulmonologist or gastroenterologist and get a note back that says our patient’s symptoms are not cardiac, pulmonary or GI related. “Not my department,” in essence.

Medical specialties are organized by organ or organ system, and not by symptom. This really leaves primary care doctors in the default role of being specialists in diagnostics. I often say …

He felt that doctors were no longer helping people. Here’s why.

Jordan Grumet, MD

Physician

January 17, 2016

It was never his intention that the name would stick. A decade ago, when he first began working in the restaurant, some of his fellow employees knew that he was formerly a practicing physician and started to call him “Doc.” Although many of his coworkers had since moved on, taking the knowledge of his previous profession with them, his moniker persisted.

Doc liked the simplicity and tedium of his bartending job. …

These are the times why I got into medicine

Justin Reno, MD

Physician

January 17, 2016

“She’s ready to push, doc.”

It’s 2 a.m. I’ve been up for the better part of the evening, doing my part in the process of labor. I groan; I have a full day of clinic patients six hours from now.

But these are the wonderful times.

These are the times, in the rural hospital that I work, where it’s completely and totally about that laboring soon-to-be mom and her soon-to-be child. There are …

Wanted: Medical Sherpas to guide patients through the unfriendly world of health care

Rob Lamberts, MD

Physician

January 16, 2016

2015 was a hard year for my father. He’s a remarkably healthy 89 year old, with no diabetes, no hypertension, and (most importantly) he’s got a sharper mind than I do on most days. Perhaps that’s a low bar to cross, but it’s pretty good for him. I think this is from all the crossword puzzles he’s done over the years.

Dad’s troubles started around the middle of the year when …