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.

Did Obamacare make it easier for patients to see a doctor?

Christopher Johnson, MD

Health Policy

May 20, 2015

One of the goals of the Affordable Care Act (a.k.a. Obamacare) was to increase access to primary care physicians. The notion is that if people have insurance it would be easier for them to get appointments with primary care physicians. This is because many physicians are unwilling to accept new patients who are uninsured.

Further, a key component of the ACA was to increase physician reimbursement for Medicaid because this program …

Paying patients for their engagement

Joseph Kvedar, MD

Physician

May 20, 2015

A couple of years ago, my clinical practice (Dermatology Associates at Massachusetts General Hospital) began sending patients a bill when they did not show up for an appointment. Dentists do this with some frequency, but it’s unusual for a physician practice to do it. Our reasoning was that we have many folks who insist they need to be seen right away and, despite a large, busy practice (we see more …

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Paying patients for their engagement

Throwing the kitchen sink at public health problems

Kenneth Lin, MD

Health Policy

May 20, 2015

The buzzwords many use in medicine today are “personalized,” “individualized,” or “targeted.” Rather than doctors prescribing tests or treatments that work in most people but might not work for you, proponents argue, we should tailor medical interventions to unique patient characteristics, such as genomic data. (The White House’s Precision Medicine Initiative is an example of this kind of thinking.) Although I am skeptical that big …

The top 10 lies of doctors

Starla Fitch, MD

Physician

May 19, 2015

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I’ve been a doctor for more than 20 years, and I hate to break it to you, but it’s time I came clean: We lie. Doctors lie. Not always. Not necessarily on purpose. But we do.

Sometimes the lies are to our patients. Sometimes, the lies are to our families. And sometimes the lies are to ourselves.

But, nonetheless, we lie. A lot. …

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The top 10 lies of doctors

This family physician doesn’t like to do procedures. And she’s OK with it.

Christine C. Chen, MD

Physician

May 19, 2015

Some doctors love to do procedures. Stitching, skin biopsies, removal of ingrown toenails — you name it, they’ll do it, and then they’ll ask for more. In fact, I used to have a senior partner who actually told me he preferred doing procedures more than any other type of visit. When I asked him why he enjoyed procedures so intensely, he shrugged and said, “Because I don’t have to think …

How health IT is a barrier to patient satisfaction

Suneel Dhand, MD

Health Technology

May 19, 2015

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I was recently talking to a patient about having some extra help at home when she left the hospital with home nursing services. The elderly lady — highly intelligent and fiercely independent — politely declined with the reply: “No, I’m fine thanks Dr Dhand — all they’ve done before is just come in with their computers, barely talk to me, enter …

This U.S. doctor is moving to Canada. Find out why.

Emily S. Queenan, MD

Physician

May 18, 2015

I’m a U.S. family physician who has decided to relocate to Canada. The hassles of working in the dysfunctional health care “system” in the U.S. have simply become too intense.

I’m not alone. According to a physician recruiter in Windsor, Ont., over the past decade more than 100 U.S. doctors have relocated to her city alone. More generally, the Canadian Institute for …

From one doctor to another: “I don’t think we’re ever getting out of here.”

PalMD

Physician

May 18, 2015

Scene: Medical office, 9 a.m., waiting room full, chairs in hall full

Players: 2 nurses, 1 clerk, 2 doctors, lots of patients

Doc 1: “Hey, what’s up? I’m sitting on my ass here, and there’s a room full of patients waiting.”

Nurse 1: “Hold on Doc, I’m almost done checking one in.”

“So, Mrs. Smith, do you feel safe in your own home?”

Patient 1: “It’s …

Knowledge and power: The fallacy that leads to a distrust of medicine

Ron Cheung, MD, PhD

Physician

May 17, 2015

Some time ago, I engaged in a debate with a proponent of GMO labeling. His main point was that the information provided by labeling would allow consumers to make better decisions about what they eat. He went so far as to condense his argument into three simple words: “Knowledge is power.”

What my opponent failed to mention is that the truth of this statement is conditional. Knowledge can be powerful, but …

Business ethics are no match for medical ethics

Steven Reidbord, MD

Physician

May 15, 2015

Compared to most others in society, physicians endorse, and are held to, higher ethical standards. (To illustrate, here are ethical codes from the AMA and the World Medical Association.)

High standards apply to professionals in other fields as well, especially fiduciaries such as attorneys, accountants, school teachers, and judges. But standards of medical ethics may be among the most stringent. We put patient welfare first, and anything that interferes with this …

Dr. Oz shouldn’t be fired. And here’s why.

Dr. Saurabh Jha

Physician

May 15, 2015

If I could invite four people for dinner, alive or dead, they would be Mark Twain, William Shackleton, Christopher Hitchens and Homer Simpson (Bart’s dad). If Mehmet Oz turned up with a bag of Garcinia cambogia, I would excuse myself.

Few things drive me to the abyss more reliably than the banality of status updates on Facebook and the monotony of health …

When did primary care physicians stop becoming doctors?

Jordan Grumet, MD

Physician

May 15, 2015

We both agreed that it was unfortunate.

I sat on Paul’s living room couch with a computer perched on my lap as he recounted the events of the last few weeks. His business flight was interrupted by severe spasms of cough and high fever. He called me upon landing, and based on my advice, went to a local urgent care center. After …

Value and quality are fuzzy concepts. Here’s why.

Robert Centor, MD

Health Policy

May 14, 2015

Now that we no longer have to worry about the SGR, we have a new worry. The law consolidates several measurement tools into one big tool. CMS has declared that it wants to pay for value. The law provides a blueprint for paying for value. The underlying assumption of this approach is that we can define and measure value through measuring quality components.

Can we define health care value through measurement? …

This doctor didn’t support Vivek Murthy. And it’s not because of what you think.

Suneel Dhand, MD

Health Policy

May 13, 2015

Recently, the new surgeon general of the United States, Vivek Murthy, was officially sworn in by Vice President Joe Biden. Congratulations to him, it’s quite an achievement at the relatively young age of 37. Nobody can doubt the hard work, intelligence and passion that must have gone into reaching such a height.

His nomination was first put forward at the end of 2013, and he faced something of an uphill political …

Tax tips for doctors and young physician families

Bruce Roscher, CPA

Physician Finance

May 13, 2015

Although the time of year when everyone has their list of tax questions has just passed, tax questions are appropriate all year. It’s best to be prepared at tax preparation time, so much less stress is created. Tax time can be especially stressful for younger taxpayers who are going through life changes, or earning substantially higher income for the first time.

Young physician families are an excellent example of this type …

Powerless in the setting of patient autonomy? Try maternalism.

Tracy Cardin, ACNP

Physician

May 13, 2015

My 85-year-old patient was brought in from home. She was cachectic, contracted, minimally responsive to questions, covered in multiple decubitus ulcers on both hips, both knees, both shoulders, and her sacrum. She had polymicrobial sepsis-bacteremic with two different organisms. She was, in fact, dying.

Despite her profoundly debilitated condition, her son, who cared for her at home wanted “everything” done. So she was placed on IV fluids, antibiotics, received an infectious disease …

Being a patient is tough. Here are 3 reasons why.

Starla Fitch, MD

Physician

May 13, 2015

A while ago, I wrote about “The secret lives of doctors.” The post must have struck a nerve because it went viral, maybe because it helped patients to realize that doctors are human.

We doctors can’t really know how human we are until we become a patient.

That happened to me recently. And it wasn’t pretty. You need to know the …

Less is more in medicine: You get what you pay for

Rocky Bilhartz, MD

Health Policy

May 12, 2015

You gotta hand it to our health department. They are laser focused on this one. They want 85 percent of payments made to doctors by the Centers for Medicare & Medicaid Services (CMS) to be linked to clinical quality measures within the next two years.

Moreover, I suspect the health department is still giddy from Congress passing a new health care …

I encourage patients to fire me. Here’s why.

Pamela Wible, MD

Physician

May 12, 2015

Not all relationships work out.

My prescription: If a relationship isn’t working, end it. Now.

Recently an insurance plan told me they were sending a nurse to my office for a chart review that would take 3 hours. After 24 years of education, state licensure, board certification, and over 50 hours of continuing medical education each year, I’m not trusted to provide Pap …

Meaningful use stage 3 is an illusion. Here’s why.

Michael Chen, MD

Health Technology

May 12, 2015

It is with regret that meaningful use legislation has barreled down the path of insanity. As a primary care physician, I don’t see how 700+ pages of rules and proposals mean any bit of relevance to my clinical practice anymore. As the attrition continues regarding eligible providers, it is leading primary care physicians towards the junction point of going off the grid entirely or being enslaved by horrible EHRs forever.

I …

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