There’s a patient I don’t like very much. I’ll call her Mrs. X.
Mrs. X has definite medical problems, though she doesn’t seem to think so. Her lipids and blood pressure really are much higher than they should be. She could stand to lose a couple of pounds, and she really should be more active. She does not concur.
Every time she makes an appointment, …
A frustrating patient, and how that affects her physician
Even if you don’t live in a city yet that offers Uber’s rideshare app, you probably have heard about it, because the media has widely reported on job actions by taxi cab drivers — and the gridlocked traffic that resulted — that has taken place in Washington, DC and in other major cities across the world including London, Berlin, Paris and Madrid.
Uber is an “on demand” smart phone app that allows users …
Physicians on demand: The Uberization of medicine is underway
Dr. Sandeep Jauhar, a cardiologist, believes with good reason that many physicians have become “like everybody else: insecure, discontented and anxious about the future.” In a recent, widely-circulated column in the Wall Street Journal, “Why Doctors Are Sick of Their Profession,” he explains how medicine has become simply a job, not a calling, for many physicians; how their pay …
So doctors are sick of medicine: What can we do to fix that?
Actionable items.
Today I decided to take a look at one of the dashboards that the information technology (IT) department built for our electronic health record, to help us a look at our patients enrolled in the multiple registries of diseases and conditions we are following for the patient-centered medical home.
I booted up the program, and with just a couple of clicks of the mouse the program began running, checking with …
Actionable items: Reduce the work for physicians
Part of a series.
Helping employees improve their health is right for the company’s bottom line and is doing right by our employees. Healthier employees are happier, demonstrate less absenteeism and presenteesism, and are more productive. This is a win for everyone involved.
– John Torinus, Jr., a retired CEO and current board chair of Serigraph, Inc., a mid-sized Wisconsin company with about 500 employees
In my earlier posts in this series …
A business approach to controlling health care costs
A recent report from the Commonwealth Fund, which placed U.S. last amongst developing nations in health care, analyzed Britain’s high score on the management of chronic conditions. The authors attributed care coordination to the widespread adoption of health information technology in the National Health Service (NHS).
That’s like someone saying Chinese food is tasty because chopsticks are widely used.
Like quants so fastidious about decimal points they’ve missed the overall point.
Where do …
To those who admire the NHS: Empower primary care physicians
The hardest conviction to get into the mind of a beginner is that the education upon which he is engaged is not a college course, not a medical course, but a life course, for which the work of a few years under teachers is but a preparation.
– Sir William Osler
“You’re not gonna be happy with me, doc,” Richard said as he walked into the exam room at the Pine Street …
From house staff to healer of the homeless
According to a new Commonwealth Fund sponsored study published in Health Affairs, “Small Primary Care Physician Practices Have Low Rates Of Preventable Hospital Admissions.” The study of over one thousand practices of various sizes and ownerships, conducted by some of the most respected names in health care, found that the smallest independent primary care practices, that are physician owned, provide better care …
The study you never heard of: Small practices aren’t dead yet
One of my main interests in primary care is providing care to all people, regardless of their income or ability to pay. In my limited experience with health care, I have found it most rewarding to work with the underserved and underprivileged, those who do not have their own money available to allocate to health care. These patients are on Medicaid or are at the mercy of free clinics. This is why I …
Can direct primary care solve the physician shortage?
Sometimes my day is like a book. The first chapter may begin in the darkness of a self imposed corner as a phone call is made. A voice, full with the thickness of slumber, answers unexpectedly.
“I think today is the day.”
No matter how many years I have been discussing death I still find myself using poor euphemisms. The bane of medical school teaching, I often struggle with the directness. “Your mother …
One doctor’s day: Everything comes full circle eventually
We are, I trust, all but universally familiar with the knee-jerk, or patellar, reflex. A doctor taps the patellar tendon with a rubber mallet, and our leg kicks forward in response.
The reaction is famously unthinking. In fact, it is literally so. What makes a reflex a reflex is that the brain is substantially uninvolved. The stretch of a tendon by the mallet …
Beware your doctor’s knee-jerk reflex: 3 questions to ask
I see nearly 100 patients a week. Of these, easily 35% are overweight and 15-20% are obese with a BMI greater than 30. I live in New Orleans, Louisiana, which along with Mississippi has the highest rate of hypertension, diabetes mellitus, arthritis, and other diseases commonly associated with obesity. There are many explanations for the obesity academic in America but certainly poor nutrition and lack of exercise are at the …
The cheapest prescription that’s most beneficial to patients
I got the following email a few weeks ago (details changed for confidentiality reasons):
Dear Sir,
I read about your unique practice online. I have an 91-year-old ambulatory father who will not go to a doctor. He definitely is not well and this is the only way I can get him the attention he needs. He is adamant about not wanting medical interventions, however he still needs to be seen …
Set free: Thank you for the freedom to care for this sick patient
ADVERTISEMENT
So much in medicine and in life is done out of habit. We do stuff simply because that’s the way we always did it. Repetition leads to the belief that we are doing the right thing.
In this country, we traditionally eat three meals each day. Why not four or two?
We prefer soft drinks to be served iced cold. I’ve never tried …
Is much of the annual physical a waste of time?
Welcome to college, young people! It’s an amazing time in your lives. These years will impact your life dramatically if you use them well. So, to help you along the way, allow me to give you some wisdom.
First and foremost, get some wisdom. You are bright and capable, otherwise you probably wouldn’t be in college in the first place. But for all …
Don’t be stupid, and other wise words to new college students
The electronic medical record that my office uses features a clinical protocol button that we are encouraged to click during patient visits to remind us about potentially indicated preventive services, such as obesity and tobacco counseling and cancer screenings. I once tried it out while seeing a 90-year-old with four chronic health problems. The computer suggested breast cancer, colorectal cancer, and cervical cancer screenings: three totally inappropriate tests for the …
Cancer screening in the elderly: Don’t be stupid
What do eggs, roofing nails, men’s haircuts and plastic cups have in common? A bizarre fraternity ritual or my Saturday morning honey-do list? Gasoline, copying paper and paperclips? Shopping for a mobile accounting office? Nope. What these items share is that who ever makes them, wherever you buy them, they are essentially the same. They are commodities. They do not vary significantly in construction or quality. The only way to …
Allowing medicine to become a commodity would be a disaster
An excerpt from The Doctor Crisis: How Physicians Can, and Must, Lead the Way to Better Health Care.
I just listened. They were very unhappy and angry.
I was elected executive medical director in November 1998 but would not assume the leadership role until January 2000. This was fortunate. I knew that …
Dissent and cynicism: Learning from listening to doctors
My morning practice session started out with a few patients arriving early, so I was able to get a jump on the day, and it looked like I was going to actually be running on time.
As I was walking from one exam room to the other, my administrator came down the hallway, grabbed my arm and said, “Can I have you for a minute?”
It seems that a group of systems …
What being overwhelmed by rules and regulations looks like
Part of a series.
Over the past few months KevinMD.com has posted a series of articles by me on what I call the “crisis in primary care.” Most recently have been a few posts related to direct primary care. They have generated many comments: some pro and some con. I have greatly appreciated everyone’s interest; it makes it worth the time to write. I am also working on a book on …
Direct primary care: A response to your comments
Get free updates delivered free to your inbox.
