Part of a series.
We tend to think of the primary care physician (PCP) as the one who does the simple stuff, a doctor who is a mile wide and an inch deep in knowledge and experience. That is a false impression. By education and experience, the PCP is actually a chronic disease specialist.
That is, provided the PCP has the time to care for his or her patients with …
Let primary care physicians be chronic care specialists
Dr. Robert Centor has an important post about hubris. It’s not a long post, if you want to click through and quickly read it. It’s about the danger of overweening pride and overconfidence that can come from blindly believing the praise that is often heaped upon us by those in our care. Essentially Dr. Bob is saying that we must avoid believing all the wonderful things our patients …
How physicians can resist succumbing to hubris
I have never been the director of any professional group. I have, however, been directed. As such, I have a few tips for those who are directors and administrators. I give you my physician satisfaction system. It is arranged in no particular order.
In every physician break room or lounge, there should be a wall for photos of girlfriends, boyfriends, children, spouses, parents, dogs, cats, horses, boats, new shotguns or whatever …
A guideline for physician satisfaction that every administrator should read
The daughter of the patient walked out of the room livid. She was convinced that the nurse had no business taking care of patients. She seethed as she recounted all the supposed injuries and mistakes that had occurred. I took a deep breath and paused for a moment, trying to collect my thoughts.
The daughter didn’t know that I had watched this same nurse successfully perform CPR on a man the …
7 surprising things patients should know about their physicians
A guest column by the American College of Physicians, exclusive to KevinMD.com.
In December, I concluded a 13-year term on the board of directors of the Rhode Island Quality Institute (RIQI). RIQI was formed in 2001 to “to significantly improve the quality, safety, and value of health care in Rhode Island.” …
A model for improving quality, safety, and value of health care
A few months ago I went to visit my brother in San Francisco. My sister-in-law picked me up from the airport with my four-year-old nephew in the backseat. Shortly into our car ride from the airport, my nephew says out loud, “My leg hurts.”
I replied, “I’ll check it when I get home.” To which he retorted, “No, I want a doctor to check it.”
“I am a doctor,” I shouted out.
He …
Researching violence is something we must do
Dear Fizzy, MD:
Your article on part-time physicians “ruining” medicine really struck a chord with me. That you, as a mother and a wife, chose to prioritize your wholeness and family above career is commendable. I applaud your courage to chart your own course in the face of a work culture that undermines your wellbeing while at the same time, expects you to deliver health and healing to others …
The guilt and shame heaped on part-time physicians must stop
I could wallpaper a rather large wall with my diplomas, certificates, awards, and licenses. Each gilded slip of paper demarcates a moment in the last 20 years when I finished, graduated, certified or did any one of many steps required to become a board certified physician. Yet, after all of the sleepless nights, deferred self-care and catastrophic debt — after all this — 3 years ago I sat at my …
How I became the doctor I always wanted to be
Did you see this recent post on MedPage Today? “Burnout: Is Medical School the Staging Area? Burnout prevention starts in medical school.”
The article describes important new work at the University of Chicago Pritzker School Of Medicine to improve medical student resilience. It’s great to see medical schools addressing burnout and equipping students with valuable coping mechanisms.
As the post states, “One way to do this is to induce a greater resiliency …
Lean provides a way to prevent physician burnout
So, you’ve finished all your job interviews and think you’ve found a perfect fit. Graduating from residency is exciting, but did you get any training on what it all means to sign on the dotted line?
Below is a quick and dirty run-down of the contracting process from an industry insider.
1. Non-compete clauses. Non-compete clauses are not just a big med phenomenon; they are part of contracts in many different clinical settings. …
7 things doctors should consider before signing for a new job
“Words are, of course, the most powerful drug used by mankind.”
– Rudyard Kipling
I read Drs. Dhand’s and Carbone’s post with great interest: Physicians are not providers: An open letter to the AMA and medical boards. I began writing a comment; it turned into an essay.
I support Drs. Dhand and Carbone in this endeavor. The word “provider” diminishes the people who cure, treat, and heal, whether they’re physicians, nurses, …
The word “provider” dehumanizes any person who cares for patients
The fact that primary care is undervalued by Medicare and other payers has been long understood to be driving the precipitous decline in the numbers of new physicians choosing primary care internal medicine or family practice, and a growing exodus of established primary care physicians.
Efforts to address this undervaluation have traditionally been to, 1) bump up the payments (relative value units) for the office visit codes traditionally billed by primary …
7 new Medicare codes primary care doctors can use to increase payments
At some point in our lives, and it probably happens more often than we’d like to admit, we fake it.
Let’s get real, shall we friends?
Think about it. Your mother is having heart surgery in a small town across the country. You are, frankly, worried sick. Do you tell anyone in the operating room, especially your patient?
What would you do?
If you’re like me (OK, this was me recently), you fake it. You smile at your …
How can physicians know when to fake it?
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As a pediatrician and future mother of black children, I am worried. I am worried about my patients who face possible death if they appear threatening to the wrong police officer, like Tamir Rice. I am worried about my patients who might be sleeping peacefully in their families’ home when law enforcement officials burst in with grenades like the ones that killed Aiyana Stanley-Jones. I am worried about my teenage …
Let’s demand accountability for the safety and well-being of our children
Whenever I have the opportunity to suggest that good medicine is based on friendship, I usually get a nod of approval mixed with a quizzical look. What’s that supposed to mean?
At a recent meeting of an editorial board on which I serve, the reaction to my suggestion was more forceful and perhaps more honest. The topic of the day concerned patient education, and how hard it can be to move patients to do things …
Good medicine is based on friendship
“How many patients do you have?”
I’m not sure what you mean. How many patients do I see on average each day? About twelve.
“No. How many patients do you have?”
Let’s see: Last week I saw about sixty patients altogether. Five of them were new patients.
“No, no. How many patients do you have on your panel?”
My panel? I don’t know what you mean by that. I don’t work as an employer in …
Why a patient panel is an outdated concept in primary care
I thoroughly enjoy my 65-year-old male with his horrendous diabetic foot ulcer. But there’s not enough insulin in the state of Tennessee to cover the two bacon, egg, and cheese biscuits he eats every morning.
And I adore my 57-year-old female with COPD. But the inhalers won’t work until she stops smoking two packs of cigarettes per day. I laugh every time I see that hilarious 32-year-old with hypertension. But the …
Society’s health should not be doctors’ responsibilities
The optimism of a Rwandan in 2015 will strike you. Take a population that has seen or been raised in the wake of more horror than the average Westerner can imagine, and bring up a problem or something negative. Too short to reach the top shelf? It’s OK, you’ll fit under doors better. Hair stands out when bright red? Easier to pick out in a crowd. Mother has had 3 …
A physician reflects on her experience in Rwanda
One of my best friends from high school is battling with leukemia. I remember days hanging out in my room, listening to music (we were both huge REO Speedwagon fans), shooting Nerf hoops and talking about life (mainly girls at that time). We were not sure of what life would bring, but we knew we were destined for big things.
Denny was always more confident than I was at the time …
Physicians need to recognize the power of vulnerability
It was several decades ago when my father, not long retired from a lifetime of denominational service as a chemistry professor, noticed pain in his abdomen. Initially attributing this to ingestion of some excessively hot tea, he ignored it for a time, hoping that, like many ailments, it would dissipate on its own. When it did not, he sought medical attention.
He ended up at the hospital where I worked, and …
The child is father of the man
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