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.

Herbal supplements: What are you really taking?

Michael Kirsch, MD

Medications

February 28, 2015

Many of my patients are taking herbal supplements, or so they think. This herbal and health supplements industry likely is envied by traditional pharmaceutical companies. The latter has to spend zillions of dollars proving safety and efficacy to the Food and Drug Administration (FDA). Many of these drugs are cast aside during the approval process or afterwards when serious side effects become known, or a new medicine is proved safer …

Reduce allergy costs for patients with simple solutions

Jennifer Menjivar

Medications

February 27, 2015

I grew up most of my life avoiding doctors and hospital visits. I never fancied getting shots or blood draws as a child, and without health insurance; I didn’t have much of a choice. This lack of access is what drew me to volunteer at the county hospital I was born at. Every Wednesday morning, I would report to the pediatric asthma allergy clinic at San Francisco General Hospital. Most …

The medical truth behind #TheDress. And yes, it makes sense.

Steve Christiansen, MD

Conditions and Diseases

February 27, 2015

blueandblackdress2-770x457

My mother-in-law texted me about The Dress, random friends are blowing up my inbox, and the nurses in the emergency department were huddled around the computer at 2 a.m. debating the color of the dress. Everyone in the world seems to be wondering what color the dress really is and why.

The best way to find the answer to such questions is to find …

Secrets that your doctors are dying to tell you

Jamie Coleman, MD

Physician

February 27, 2015

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I’ve been thinking about this post for awhile, and finally, am going to spill some “secrets” about me and my colleagues.

We are in debt. I mean, real debt. We are in debt. I mean, real debt. It actually costs most of us almost 1 million dollars to become your doctor.

It has taken us a long time to get here.

Let’s do some …

Patients are not customers. Here are 6 reasons why.

Shirie Leng, MD

Physician

February 27, 2015

Recently I wrote about the problems with maintenance of certification requirements. One of the phrases I repeatedly read when I was researching the piece was “the patient as customer.” Here’s a quote from the online journal produced by Accenture, the management consulting company:

Patients are less forgiving of poor service than they once were, and the bar keeps being raised higher because …

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Patients are not customers. Here are 6 reasons why.

Stop the arranged marriages between patient and provider

P. J. Parmar, MD

Physician

February 26, 2015

Assigning patients to doctors. Who still does this?

We don’t assign hungry people to restaurants, hairy people to barbers, or passengers to airlines. Even State Farm allows me to choose between Maaco or my local chop shop every time I crash my car. We do assign kids to teachers, but still, I don’t need too many analogies to tell me that assigning …

What is true maintenance of medical knowledge?

Robert Centor, MD

Physician

February 26, 2015

Maintenance is the process of maintaining or preserving someone or something, or the state of being maintained.

Our certification documents that we have trained (in my case in internal medicine) and that we can pass a test on the breadth of internal medicine knowledge. We accept that the ABIM has developed a test the evaluates our entire exposure to the many diseases and treatments that reflect our patients.

The idea of maintenance of …

What do bridges and public health have in common?

Brian Castrucci

Health Policy

February 25, 2015

Infrastructure is never quite as interesting or exciting as innovation. The grand opening of a new building incorporating all the latest integrated technology is far more exciting than bridge repairs. In our fascination for the innovation, we often turn a blind eye to our nation’s crumbling infrastructure.

In the United States today, one quarter of our bridges are structurally deficient or functionally obsolete and more …

Like hikers, patients also need guides

Abigail Schildcrout, MD

Physician

February 23, 2015

Our family loves to hike. Traveling the trails is a deeply happy place for us. In fact, I don’t think there’s ever been a time when one of us suggested taking a hike, and everyone didn’t unanimously and enthusiastically agree. A few weeks ago, my family took a lovely hike in a state park in Massachusetts. It was a gorgeous day: temperature in the upper 40s, blue skies, no wind. The …

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Like hikers, patients also need guides

Which drugs are on formulary? A little help, please.

Hans Duvefelt, MD

Medications

February 23, 2015

The letters are usually four pages long and begin by saying that my patient has received a temporary supply of the medication I prescribed.

Next, there are general paragraphs about how the drug either isn’t on their formulary or the quantity exceeds the plan limits. None of these letters contains a reference to an online formulary physicians can access to compare covered alternatives.

Then there are several cumbersome explanations about the appeal …

Primary care physicians: Fight for your value

Margalit Gur-Arie

Health Policy

February 22, 2015

There are close to a quarter million primary care physicians in the U.S., more than any other individual specialty, and about half the total number of all specialists combined. Yet, somehow, primary care seems to lack the power and social influence necessary to chart its own professional course. As the availability and granularity of specialist physicians increased, the value proposition of a generalist primary care doctor seems to have become unclear to …

What do patients really want from doctors?

Pamela Wible, MD

Physician

February 22, 2015

Ever wonder what patients really want from doctors?

Is it the fancy buildings with marble fountains?

Is it the board certifications and diplomas on the wall?

Is it the expert medical jargon and starched white coats?

Nope. None of the above.

Listen up, docs: Patients just want the real you. Ya know — you. The competent and caring you who really listens with compassion. The real you …

A tale of two strep throats: Retail clinic vs. PCP

Leslie Kernisan, MD, MPH

Conditions and Diseases

February 21, 2015

Six years ago, just after arriving in Baltimore for a winter conference, I fell sick with fever and a bad sore throat.

After a night of feeling awful, I went looking for help. I found it at a Minute Clinic in a CVS near the hotel. I was seen right away by a friendly NP, who did a rapid strep test …

How to make a great first impression with patients

Edward Leigh

Patient

February 20, 2015

You don’t have a second chance to make a great first impression.

If twenty random numbers were read aloud, most people would remember the first few numbers and the last few numbers. We tend to remember beginnings and endings. It is the same with patients; they tend to recall what they hear at the beginning and …

The misguided case against the annual physical

David L. Katz, MD

Physician

February 19, 2015

Recently in the New York Times, Dr. Ezekiel Emanuel suggested that this year’s resolution might be to abandon the ritual of your annual physical. The title of his column, perhaps chosen by an editor to maximize glibness and thus provocation was: “Skip Your Annual Physical.”

But permit me to suggest you don’t commit to that just yet. The annual physical exam warrants some more examination, a defense to follow its prosecution.

Dr. …

Want to know why your doctor is late? Read this.

Sanaz Majd, MD

Physician

February 19, 2015

One of my biggest pet peeves in life is tardiness. I hate it when other people are late. It’s as if they are not respecting my time. But you know what? I hate being late myself even more. In fact, I cringe at the thought. Conscientious, successful people are on time.

Always.

So you can imagine that nothing irks me more than being …

Giving test results directly to patients: What’s missing is context

Kathryn A. Hughes, MD

Physician

February 19, 2015

I do not think that word means what you think it means.
– Inigo Montoya, The Princess Bride

Stick to Facts, sir! … In this life, we want nothing but Facts, sir: nothing but Facts!
– Charles Dickens, Hard Times

“Information without context isn’t transparency” flashed across my Twitter feed. So now I am thinking about context, and communicating context, in medical care.

This quote, from Heather Pierce, JD, MPH, Director of Science Policy and Regulatory …

How to get your doctor to do what you want

Pamela Wible, MD

Physician

February 18, 2015

Sick of phone trees, endless refill requests, packed waiting rooms, out-of-control bills, and other medical misadventures?

Follow these seven simple steps to get your doctor to do what you want.

1. Get organized. Be clear about what you need from your appointment. Make a comprehensive list of all the issues you want to discuss — and your ideal outcomes for each. Patients who are …

Solving the physician shortage requires these 3 things to happen

Suneel Dhand, MD

Health Policy

February 16, 2015

The nationwide shortage of physicians is a very real crisis across all 50 states, causing a huge strain at all levels of health care. Hospitals and clinics are struggling to hire, current physicians are overworked, and ultimately patients have to wait longer.

There are a number of reasons why this has happened, but one thing’s for sure: With the aging population, the …

My role in patients’ behavior is smaller than I thought

Aimee Falardeau English, MD

Physician

February 15, 2015

My mother is a very smart woman. I see it in the way she solves problems, creates complex crafts, and navigates hard conversations. She can’t, however, add fractions. She was never very good at math, she says.

“I was never very good at math” is a dirty phrase that garners much attention in my household. My husband, a sixth-grade math intervention teacher, spends just over 170 days each year attempting to …

Primary Care

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