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.

Should there be limits to patient-centeredness?

Richard Young, MD

Physician

October 4, 2015

A colleague recently told me of a patient encounter he had in an emergency room. When he picked up the chart, it described the patient as a 62-year-old woman complaining of epistaxis, or a nosebleed.

He walked into the room and saw a perfectly well appearing 62-year-old woman. There was no blood on her clothes and none on her face. Her nose was not bleeding. When he asked her what could he do for her, she said …

Who’s to blame for ICD-10?

Brian C. Joondeph, MD

Health Policy

October 3, 2015

ICD-10 is not a character in an upcoming fall TV show, but instead something far less glamorous. ICD stands for International Classification of Diseases and is a list of codes used by doctors and hospitals when billing insurance companies.

It’s been around since 1946, with the 10th iteration going into effect on October 1st. And it may be an unpleasant October surprise for doctors and hospitals. Don’t blame Obamacare. Don’t blame …

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Who’s to blame for ICD-10?

The surprising reason behind an early refill of alprazolam

Hans Duvefelt, MD

Physician

October 2, 2015

Theresa arrived in a cloud of noise and commotion.

She had called after four o’clock the day before, but I hadn’t noticed the new message in my electronic inbox before I left the clinic.

Her almost brand new alprazolam bottle and her pain pills were missing, and Theresa was reeling. As she walked down the hall to the exam room, I heard her explain to Autumn how she had been to Walmart …

The dystopia of modern medicine

Jordan Grumet, MD

Physician

October 1, 2015

He had been educated at the finest universities. He had graduated cum laude, or whatever the term is they use nowadays to signify distinction. His pedigree was squeaky-clean.

But as he haltingly entered the dark building at the end of an otherwise unexceptional suburban street, he felt more like a criminal than a scholar. His office was drab. Each room was glowing with the artificial light provided by an incandescent bulb. …

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The dystopia of modern medicine

Physicians must never lose their humanism

Cleveland Piggott, MD, MPH

Physician

October 1, 2015

“I’ll never forget the look in your eyes.”

Uh oh, I thought to myself.

“You had this look that you wanted to help but just didn’t know how,” said my patient.

Apparently I have very expressive eyes, and she was right. The event she was referring to was what we call a rapid response. This is when a patient’s status suddenly changes and the team wants her to be evaluated immediately. When I …

October 1, 2015: A day that will live in health care infamy

Rob Lamberts, MD

Physician

October 1, 2015

October 1, 2015 is a huge day to the medical community. It is a day that will live in infamy. It is the object of dread, of diaphoresis, of doom. October 1 is ICD-10 day. This view was further bolstered when I went to the CMS (Government Medicare) website; there was actually a doomsday countdown timer at the top of the page.

For those still unaware, ICD-10 is the 10th iteration of …

Don’t try to be your child’s friend. Here’s why.

Kathryn L. Moseley, MD

Conditions and Diseases

September 30, 2015

A piece of advice to all you parents reading this: Don’t try to be your child’s friend. Don’t get me wrong. You can be kind, you can be chummy, you can (and should) have fun with your kids — but you are not their friend.

I say this as a mom and a pediatrician who has seen way too many parents muck things up by trying to be a friend to their …

Is that bad? A difficult question doctors can answer in many ways.

Frederick Gandolfo, MD

Physician

September 29, 2015

Here is a question I get asked all the time by patients: “Is that bad?”

This is different than the similar, more appropriate question, “Is it bad?” which is usually asked after being given a specific diagnosis. For example, after a colonoscopy where a large polyp was discovered and removed I will tell the patient about the findings. He may ask, “Is it bad?” The answer is usually “No, the polyp …

ICD-10: No wonder why doctors are burnt out

Shirie Leng, MD

Physician

September 28, 2015

Attention graduates! If you’re looking for a career with a ton of job prospects, look no further than an international classification of diseases coder. This fun and fulfilling career will take you into new worlds of diagnosis, laterality, specificity, and nitpicky-ness as you dive into thousands of columns of numbers and qualifiers. You’ll even get to call doctors and harass them anytime you want. Sign up for your free brochure …

Tips to meet challenges of administering and tracking immunizations

Yul Ejnes, MD

Physician

September 26, 2015

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

When I entered practice over 25 years ago, planning for influenza vaccination season was straightforward. Every late spring, we looked at how many doses we gave out the previous year, added a few doses, ordered the vaccine, and immunized our patients in the fall. If …

Conversations lead to better health, not interrogations

Matthew Walvick, DO

Physician

September 26, 2015

Most patients think they need to come to their doctor’s visits with a strict agenda. It’s a habit forged out of wanting to get quick fix and a by-product of time constraints. This paradigm seems logical and can sometimes accomplish its goal, but too often, this approach falls short in harnessing the immense value that can result from a connected physician-patient relationship.

I can vividly remember the days when the idea …

Doctors: All of you have a superpower

Saurabh Sinha

Physician

September 25, 2015

Recent essays have shed light on the Herculean task of maintaining humanism in medicine in the face of added responsibility during residency and the seemingly inevitable cynicism embroiled in patient care. The solution appears to be rooted in active reflection on the process of training and clinical practice and recognition of what it is that brought us here.

In this moment of active reflection, I contend that you have …

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Doctors: All of you have a superpower

Women medical organizations are still relevant. Here’s why.

Fatima Fahs

Physician

September 23, 2015

Did you know that September is Women in Medicine Month?

When I tell someone I’m involved in the American Medical Women’s Association (AMWA), my favorite response is, “Are organizations like that still necessary? It’s 2015.”

First, thanks for the clarification of what year we are in. Isn’t it shocking that in 2015 women in medicine are still not equal to their male counterparts? And second, to answer your question: Yes, AMWA is extremely …

The human physician will soon become history. Here’s why.

Robert Khoo, MD

Physician

September 22, 2015

In the age of spiritual machines Ray Kurzweil in 2001 predicted:

By 2020, a $1,000 computer will match processing speed of the human brain — 20 billion calculations per second.

By 2030, it will simulate the brain power of a small village about 1,000 human minds.

By 2048, it will have the brain power of the entire population of the U.S.

I predict that within 20 to 30 years the computer will replace the …

3 things Walter White can teach doctors

Suneel Dhand, MD

Physician

September 22, 2015

Breaking Bad has been rated one of the best TV shows of all time, and for good reason. The improbable story of a regular and shy high school chemistry teacher, faced with a terminal diagnosis, turning into a gangster and drug kingpin certainly makes for good television.

A compelling storyline set against the backdrop of one of the nation’s most beautiful landscapes: For …

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3 things Walter White can teach doctors

When patient-centered care becomes patient-dictated care

Elaine Khoong, MD

Physician

September 21, 2015

“I’d like an MRI for my leg pain. I haven’t had an MRI for many years, and I’m worried.”

These were some of the first words I heard from a patient I was seeing for a new patient visit. Based on this patient’s story and physical exam, her pain was most consistent with a muscle strain. My preferred approach to manage this complaint was to ask the patient to rest her …

Are physicians really to blame for the opioid addiction epidemic?

Robert Centor, MD

Conditions and Diseases

September 19, 2015

During my training in the 70s, heroin use dominated our substance abuse horizon. We saw many patients with IV drug-related complications. We saw heroin overdoses.

For the next 30+ years, we rarely heard about heroin. Over the past 10 years we have seen increasing opiate abuse, but the opiates came from prescriptions. Over the past 2 years, heroin has once again reared its ugly head.

This article blames physicians for opiate addiction: …

Why it’s important for physicians to talk about bias

Tehreem Rehman

Physician

September 18, 2015

I’m not racist.

I would never refuse to give a patient pain medication or fail to properly get her on a transplant waiting list just because she was black.

And, yet, to deny that I hold any bias would be foolish, naïve at best.

Ask any American if he or she is racist, and you’re likely to get a resounding no. Look at numbers on interview callbacks or prison sentences, and you get …

The time to reinvent medicine is now. #TakeBackMedicine

Sarah Mongiello Bernstein, MD

Physician

September 17, 2015

For too long we have let politicians, insurance companies, lawyers, administrators, and consultants tell us what is best for our patients. Over the years, we’ve stood idly by and watched as the field we love is debased, one superfluous policy after another — foolishly believing that if we just worked a little bit harder, we could make up for all the extra rules and regulations. We’ve dedicated our lives to …

The problems with patient feedback forms and how to fix them

Louise Aronson, MD

Physician

September 16, 2015

We’ve all seen them: those once paper but increasingly digital forms that enthusiastically request our feedback. “Tell us how we’re doing,” they cheerfully announce, or, “Help us improve!”

Some of us even send them out as part of our practices or health systems or educational programs.

We also fill them out, both as regular citizens and as clinicians. Or we mean to. I certainly try to, with some exceptions. Recently, I deleted …