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.

In health care: It’s not a customer service problem. It’s communication.

Jeffrey McWilliams, MD

Physician

January 15, 2016

Over the past year, I’ve read countless publications concerning the relationship of customer service and patient care. Many have alluded to the fact that customer service in health care is not only unfeasible, but also detrimental to patient care. As a huge proponent of customer service, it was quite natural to take a defensive stand, posturing against these “absurd accusations.” Over the years I’ve learned, quite often the hard way, …

How this physician celebrates Martin Luther King Jr.’s legacy

Cleveland Piggott, MD, MPH

Physician

January 14, 2016

The last time I cried was this past May in the brand new National Center for Civil and Human Rights in Atlanta. As I stood in the room where you hear and see clips from the day of Martin Luther King Jr.’s assassination, I was overwhelmed with emotion and began to cry uncontrollably. I was reminded of all the sacrifices millions of people have made that has allowed me to …

This physician retired years ago. So how’s he doing?

David Mokotoff, MD

Physician

January 14, 2016

In 2013, I wrote a post, “How Can Physicians Retire Gracefully?” Being on the cusp of retirement, I offered up some thoughts and predictions. Having fully retired this past year from the cardiology group that I began in 1982, I thought it was time to revisit my thoughts and predictions.

I have been able to keep structure to a minimum. I go to tai chi classes two to three …

10 rules every primary care doctor should read

Peter Elias, MD

Physician

January 13, 2016

Primary care medicine is intense and chaotic, a constantly mutating kaleidoscope of data, emotions, goals and obstacles. It is designed to confuse and distract, and will find and magnify any tendencies towards ADD in even the most organized clinician.

During my 30+ years as a family physician, I’ve come to depend on some core principles and concepts to stay grounded and maintain focus. Here are ten rules I have found useful, …

It’s time to reclaim the heart of medicine

Dr. Eric Levi

Physician

January 13, 2016

I’ve been asked previously what I think is the biggest challenge facing medicine or surgery in the future. Many physicians and futurists would suggest that personalized medicine, genetic therapy, cancer cure, public health, nanotechnology and many other things are going to form several of the biggest challenges ahead of us.

The more I spend time in medicine and surgery, the more I reflect on the future of medicine, the more I …

In health care: Fix what we can fix. Accept what we cannot fix.

Stephen C. Schimpff, MD

Physician

January 11, 2016

Part of a series.

You know the serenity prayer, written by Reinhold Niebuhr in about 1940:

God, grant me the serenity to accept the things I cannot change,

The courage to change the things I can,

And the wisdom to know the difference.

I saw an elderly woman in the hallway recently with the prayer framed and done in needlepoint by her daughter. It was very beautiful, and it got me to thinking …

What passes for medical advice online isn’t actually true or safe

Edwin Leap, MD

Physician

January 10, 2016

How do we know what to believe about anything? In times past we read books, we took classes, we spoke to experts. These days? These days we do the same, but we also search the Internet. And we seem to do it with special fervor when it comes to questions about our health.

I can’t throw any stones here. Even a physician has knowledge that is limited to his or her …

Shared decision-making in primary care: How can we make that happen?

Kenneth Lin, MD

Physician

January 7, 2016

One of the most notable things so many of last year’s biggest health stories have in common is that they envision an increased role for shared decision-making in primary care.

Some patients will want to receive few aggressive interventions at the end of life; others will want more. Some women will be fine with waiting until age 45 or 50 to get their first mammogram; others will still want to start at …

This is why patients cannot be customers

Tanya Feke, MD

Physician

January 7, 2016

The customer is always right, or so the saying goes.

If you have ever worked in retail, you may have been frustrated by buyers who ransack neatly folded tables of sweaters and leave them strewn about like tornado wreckage. If you are in the food industry, you may be annoyed by a diner who complains his soup is too cold even as you see steam rising off the bowl.

It can sometimes …

These are the moments why we practice medicine

Tara F. Bishop, MD, MPH

Physician

January 6, 2016

When I was a new attending, an older man came to see me as a new patient. He had not seen a doctor in over thirty years and was experiencing worsening chest pain that first occurred when he walked upstairs but had progressed to pain at rest. An electrocardiogram in the office showed signs of ischemia, and I advised him that I wanted to call an ambulance to take him …

Physicians aren’t burned out. They’re abused.

Pamela Wible, MD

Physician

January 5, 2016

burnout

Please stop using the word burnout. You are not burned out. You’ve been abused. Let’s get the diagnosis right.

We enter medicine as inspired, intelligent, compassionate humanitarians. Soon we’re cynical and exhausted. How did all these totally amazing and high-functioning people get so f’d up so fast? Attention medical students and doctors: It’s not your fault.

Burnout is physical and mental collapse caused by overwork.

So why …

A surefire way to see pharmaceutical reps in a timely fashion

Neil Baum, MD

Physician

January 4, 2016

Today so many physicians are not able to see pharmaceutical representatives (PRs). However, PRs do serve as a great resource and finding a way to make their visits more efficient and focused is an objective we all need to strive for.

I recall requesting an interview with Lou Holtz, then the head coach at Notre Dame, and was told by his secretary the date and time that the interview would take …

How partnering with urgent care created a dream primary care job

Rebekah Bernard, MD

Physician

January 3, 2016

I have a dream job.

I make my own hours, working three 12-hour shifts on Tuesday, Wednesday, and Thursday. I’m off Friday through Monday, and I don’t take any call. I take as much vacation as my budget will allow, and if I wake up with the flu, I call off from work without the usual feeling of guilt and anxiety.

It wasn’t always this way. Like all new doctors recently out …

We owe it to our patients to lead and support climate change action

Richard Bruno, MD and Elizabeth Wiley, MD, JD, MPH

Physician

January 1, 2016

After months of negotiations, the Conference of Parties 21 (COP21) adopted a historic and unprecedented climate change agreement in Paris recently. The Paris Agreement reflects nearly universal recognition among parties that climate change demands an urgent, coordinated response. This agreement includes cutting greenhouse gas emissions to curtail the average global temperature rise to “well below 2ºC above pre-industrial levels and to pursue efforts to limit the temperature …

These are the 10 most popular KevinMD posts of 2015

Admin

Potpourri

January 1, 2016

Thank you for another great year! I sincerely appreciate your continuing readership.

Here are the 10 most-read posts of 2015. Enjoy.

Watch 2 magicians destroy the anti-vaccine movement in 90 seconds.

Measles in Disneyland should be a wake-up call for the anti-vaccine movement. Will it? Magicians Penn and Teller do their part and show us why anti-vaccination is nonsense. (Warning: explicit language.)

An R&B anthem on hospital readmissions. It captures what’s wrong so perfectly.

ZDoggMD …

Is your doctor a marijuana user? Maybe you should ask.

Raymond Abbott

Conditions and Diseases

December 31, 2015

Marijuana use today is not limited to the poor, the marginalized among us; nor is it kept in the inner city, as it pretty much was when I was a kid. Now it is widespread, even legal in some states. One might even make the argument it has become a substantial part of the life of the elite, the affluent of America. And when we think of elite and powerful …

Accidental death is a public health problem. What can we do about it?

Natasha Bhuyan, MD

Physician

December 31, 2015

“Do you have a family history of sudden death?”

In medical school, I learned to ask my patients this standard prompt during sports physicals, in search of possible hypertrophic cardiomyopathy. Their answers often surprised me.

Many of my patients do have relatives who suffered a “sudden, unexplained death,” often the result of a murder or suicide. Which feels, in a way, utterly unexplainable.

The impact of violence, including deliberate self-harm, is overwhelming: According …

The best way to inspire others is to be inspired. The best way to motivate is to be motivated.

Jeffrey McWilliams, MD

Physician

December 30, 2015

How do you motivate and inspire? How do you create an environment where people are eager or excited about their daily work?

This question has created a multi-million dollar industry of motivational speakers, consultants, and higher education learning curriculum. I have to admit that I’ve been an avid pupil of the movement, focusing on others when the answer is literally staring me in the face each morning while brushing my teeth. …

We’ve killed the way physicians should be

Michael P. Jones, MD

Physician

December 28, 2015

Every now and then, more often when on call, I experience what I think it was like to be a physician when I was a boy.

I remember the era of the house call. I remember the physician as a part of the community. You saw him around town, school, and at church. You knew his wife and went to school with his kids. I remember that. And I remember the …

6 tips to be a great physician leader

Edward R. Mariano, MD

Physician

December 27, 2015

I was recently invited to visit an academic anesthesiology department to speak to the residents about becoming a leader. In addition to recognizing the honor and privilege of addressing this important topic with the next generation of physician anesthesiologists, I had two other initial thoughts: 1) I must be getting old; and, 2) This isn’t going to be easy.

I came up with the following list of lessons that I’ve learned …

Read more…

6 tips to be a great physician leader