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.

The dreaded post-visit calls: Are they worth it?

Fred N. Pelzman, MD

Physician

September 21, 2014

Just the other day I received a somewhat anxious-sounding phone message from a patient of mine, approximately 72 hours after her office visit with me, and about 24 hours after I had already gone over all of her lab results from the visit with her.

She sounded quite distressed, and said she’d received a message from someone, but could not really understand what they were saying. She said she was finally …

Sometimes doctoring reveals my failings as a human being

Jordan Grumet, MD

Physician

September 20, 2014

We were intimate.

As intimate as a doctor and patient can become. He had long outlived his wife and there were no children, no family, just friends. When he first came to me he was lively and active, but the years took their toll. Our visits became more regular. Every six months. Then every three.

His memory started to slip. Occasionally he would look at me suspiciously when something went wrong. His …

Not knowing what we don’t know: How can we help doctors?

Davis Liu, MD

Physician

September 20, 2014

Dr. Daniela Drake writes an provocative and bold piece on the plight of doctors in America and the impact it has on patient care: “Why Your Doctor Feels Like a ‘Beaten Dog’.” Though health care is very bureaucratic with administrative paperwork, huddles, and hassles, her linkage of how patients were neglected as a consequence of the system doctors work in is weak.

She talks about Victoria, a teenager, who …

Doctors are hammers. Don’t automatically be their nails.

Michael Kirsch, MD

Physician

September 20, 2014

Is your doctor a hammer and you’re a nail? Here’s some insider advice coaxing patients to be more wary and skeptical of medical advice. Should you trust your doctor? Absolutely. But you need to serve as a spirited advocate for your own health or bring one with you. Ask your physician for the evidence. Sometimes, his medical advice may result more from judgement and experience as there may not be …

Urgent care won’t replace primary care. Here’s why.

Marc-David Munk, MD

Health Policy

September 19, 2014

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About seven years ago, the California Healthcare Roundtable and Health Affairs sat down to prepare a white paper on the emerging phenomenon of urgent care centers, and what it might mean for primary care. At the time the group couldn’t agree that urgent care (UC) was a disruptive innovation, but it seemed clear to all participants that it represented a threat to primary care: The …

6 major myths about health care at home debunked

Michael Fleming, MD

Physician

September 19, 2014

As every physician already knows full well, health care services delivered to the home rather than in an institutional setting are increasing, a trend destined to expand even faster in the decades ahead.

This shift is inevitable, thanks to our rapidly growing elderly population and the corresponding prevalence of chronic illness, along with the nationwide push for higher quality care at lower cost and dramatic advances in medical technology such as …

This is what population health looks like

Janice Boughton, MD

Health Policy

September 18, 2014

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It is a beautiful day here in my little college town. The sun is shining and at 11 a.m. it is about 78 degrees with a barely perceptible breeze. People are out walking on Main Street and riding their bikes. The mountain nearby calls: I can go for a hike today with my dog and still be within 20 minutes or so …

5 health care megatrends to watch for

Robert Pearl, MD

Health Policy

September 18, 2014

Recently, Cisco chairman and CEO John Chambers told me that U.S. health care is at a tipping point. A positive one, he hopes, but the truth is no one knows for sure which direction the system will tip.

At the close of our interview, I asked Chambers what health care topic he’d like me to cover in the future. He asked me to …

Read more…

5 health care megatrends to watch for

Health anxiety: What hypochondriasis really should be called

Lucy Hornstein, MD

Conditions and Diseases

September 16, 2014

“Am I a hypochondriac?”

It’s a question I hear with quite some regularity, almost never from people who suffer from bona fide anxiety disorders related to their health.

No, the fact that all you have is a simple upper respiratory infection — the common cold — instead of a potentially lethal strain of H1N1 avian flu does not qualify. Not when your response to my reassurance is relief. That’s completely appropriate, and …

Reducing health care costs through company wellness plans

Stephen C. Schimpff, MD

Health Policy

September 14, 2014

Part of a series.

Employers have seen their health care costs rise dramatically over the years. To compensate, they have expected employees to pay an increasing portion of the health care insurance premium, expected employees to pay significant co-pays with each physician visit and have purchased policies that restrict individuals to a narrow network of doctors and hospitals. Largely these have not worked. They have offset some of the expenditures but …

MKSAP: 32-year-old man with cough and nasal congestion

mksap

Conditions and Diseases

September 14, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 32-year-old man is evaluated for a 3-day history of productive cough, sore throat, coryza, rhinorrhea, nasal congestion, generalized myalgia, and fatigue. His sputum is slightly yellow. His two children (ages 3 years and 1 year) had similar symptoms 1 week ago. He is a nonsmoker and has no history of asthma.

On …

In the age of EHRs, don’t turn your backs to patients

David Mann, MD

Physician

September 13, 2014

One of the most important tricks of the trade that I learned in medical school was what some might have considered a little throwaway bit of advice.

During my psychiatry clinical rotation the preceptor advised that, when applying the stethoscope to the patient’s back, one should rest the other hand gently on his or her shoulder. Human touch was important. It would relax the patient and convey subconsciously a sense of …

If a doctor doesn’t do excess testing, he isn’t going to be able to live

Sandeep Jauhar, MD

Physician

September 13, 2014

An excerpt from Doctored: The Disillusionment of an American Physician.

After the blowup with Rajiv, I committed myself to changing my standoffish ways. Rajiv had been urging me for some time to meet socially with his physician friends in a relaxed atmosphere away from the hospital, and so there I was a few weeks later at a doctors’ party in Manhasset, a tony …

Take 5 minutes: Tip the scales of work-life balance in your favor

Starla Fitch, MD

Physician

September 13, 2014

When you feel yourself sinking deeper into a bad case of physician burnout, finding a way out can feel daunting, if not impossible.

But it doesn’t have to.

I believe recovering from burnout begins when you start taking small, purposeful steps in a new direction. I recommend you start by getting a handle on your work-life balance.

Do you balance the time and energy you spend at work with the time and energy …

The medical home checkup: Impressing the regulators in 40 minutes

Fred N. Pelzman, MD

Physician

September 12, 2014

The state stopped by to see us the other day.

Wow, that sounds ominous.

No, really, I mean it felt like the entire Empire State: multiple people from multiple offices of New York state government, department of health, office of compliance this, oversight that, all with a vested interest in how things have been going (i.e., how we have been spending their money) in our patient-centered medical home resident pilot program.

A few …

Hard truths: Dispelling 10 health care myths

Luis Collar, MD

Health Policy

September 12, 2014

1. Most physicians are intellectually gifted and therefore rarely make mistakes. Perhaps Hollywood is to blame for this misconception, or maybe we simply find comfort in believing that exceptionally brilliant diagnosticians abound. Either way, I wish it weren’t a myth. But the truth is that the vast majority of physicians are average in virtually every way. Despite all claims to the contrary, …

Between paternalism and servility: A balance physicians must straddle

Steven Reidbord, MD

Physician

September 12, 2014

Even today there are patients who leave diagnosis and treatment entirely to their doctors. They make no effort to inform themselves about their illness or chart their course; they do whatever their doctors advise. Once the norm, this passive, willfully naive attitude has withered in the face of a multigenerational attitude shift, coupled with the wealth of medical information at hand today.

Direct-to-consumer drug ads on television, online peer support, medical websites and …

Value-based care: Bad for doctors, bad for patients?

Margalit Gur-Arie

Health Policy

September 11, 2014

Value-based health care is antithetic to patient-centered care. Value-based health care is also diametrically opposed to excellence, transparency and competitive markets. And value-based health care is a shrewdly selected and disingenuously applied misnomer. Value-based pricing is not a health-care innovation. Value-based pricing is why a plastic cup filled with tepid beer costs $8 at the ballpark, why a pack of gum …

Docs versus Glocks: Why doesn’t the public trust physicians?

Abigail Schildcrout, MD

Health Policy

September 11, 2014

Doctors talk with their patients about many things that might make some people uncomfortable — sexual issues, abuse (physical or emotional), anxiety, depression, sleep habits, bowel habits, and fears about health-related topics — things that many people might not talk about in casual conversation at the coffee shop or at work. Doctors talk with their patients about smoking, weight, eating habits, exercise, seat belt use, helmet use, and a myriad …

Doctors must speak like accountants

Hans Duvefelt, MD

Physician

September 9, 2014

You have to think fast in medicine. Not that most doctors handle life and death emergencies all day long, but even seemingly mundane clinical situations require a lot of rapid gathering of data, processing of applicable information and attention to detail in formulating a plan.

I have always been bemused by the so called E&M (evaluation and management) coding that dictates payment by requiring documentation of how doctors think. Ironically, the …

Read more…

Doctors must speak like accountants

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