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.

Health care data is meaningless without context

Hans Duvefelt, MD

Physician

August 30, 2014

Cholesterol is bad. Cholesterol is an essential building block for important hormones.

Eggs are bad. Eggs are a complete protein food.

Salt is bad. Salt is essential for life.

High blood pressure kills people. No blood pressure defines death.

High blood sugar causes eye and kidney damage. Low blood sugar causes falls, fractures and car wrecks.

Low potassium causes heart rhythm problems. High potassium causes heart rhythm problems.

Too little vitamin B12 causes nerve damage. Too …

The medical chart is coming to an end. Here’s why.

Mike Sevilla, MD

Physician

August 29, 2014

“Dr. Sevilla, I have a question for you,” a patient asked me this week. “I’m going to tell you something, but I DO NOT want it put in the chart.” Hmm, I asked myself, can I really do that? It’s the patient’s wish, right?

The patient went on to tell me that she heard about this week’s story about a hospital network being hacked and 4.5 million records being stolen. …

2 ways to improve doctors: feedback and reflection

Randi Sokol, MD, MPH

Physician

August 28, 2014

In medical school I used to ask myself, “When will I feel like a real doctor?” During intern year, I asked the same question. Now as a new faculty member who has completed medical school, a family medicine residency and a teaching fellowship, I still find myself asking that same question.

As primary care doctors, we are trained to churn out differential diagnoses. We must avoid premature closure or incorrectly assuming …

Why can’t an EHR fit into a mobile device?

David Mann, MD

Health Technology

August 27, 2014

It’s been a while since my last rant about electronic health records (EHRs), so let’s remedy that right now. EHRs in their current iteration are — how to put this delicately? — an unmitigated disaster. Nevertheless, much of the criticism of EHRs, including mine, has been in the destructive category. What about some constructive criticism? How could EHR software be made better?

I am not …

The epidemic of physician burnout is heartbreaking

Samantha Meltzer-Brody, MD, MPH

Physician

August 27, 2014

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Daily, I am contacted by good doctors who are struggling with symptoms of burnout syndrome and who have become overwhelmed by the challenges of attempting to practice medicine in today’s health care environment. As a psychiatrist who runs a program to address and treat these distressed doctors, I am troubled by the ever-growing number of calls I receive.

The burned-out physician is …

My new practice saves lives

Rob Lamberts, MD

Physician

August 26, 2014

Oh yeah. Hot dang. All right. Groovy.

Boom goes the dynamite.

I had a very great day yesterday.

I saw three patients who had recent diagnoses of cancer. Yeah, those two statements seem to contradict. They don’t. Each person I saw gave me a clear view of how the practice I’ve been building over the past 18 months is making a difference. A big, big difference.

The first patient was a guy who is …

Read more…

My new practice saves lives

Solving the mid-level dilemma: Call them what they really are

Jim Pagano, MD

Physician

August 26, 2014

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Dr. Michael Pappas hates it when a nurse practitioner is called a mid-level provider: “Stop calling nurse practitioners mid-level providers.” So do I, though my reasons are a bit different. In order to understand them it will be necessary to revisit those dark ages, a time when such individuals were few and the roles played in the drama we know …

The uphill climb of complex care management

Joshua Horton

Health Policy

August 25, 2014

In an ironic analogy to the recent Occupy Wall Street movement publicizing the wealth gap between America’s elite and the general public, the health care world also has its own infamous 1%. According to the Agency for Healthcare Research and Quality’s 2012 report, the top 1% of health care seekers incurs nearly a third of the nation’s $1.26 trillion yearly health care expenses (and up to half of this expenditure …

No, direct primary care isn’t too expensive

Stephen C. Schimpff, MD

Physician

August 25, 2014

Part of a series.

A common criticism of direct primary care (DPC, membership/retainer/concierge practices) is the added expense: “Isn’t it too expensive?” Ways to think about the cost are to prioritize expenditures and to consider potential savings that make it cost effective.

I gave examples of three direct primary care practices in an earlier post. Here is a recap of costs.

AtlasMD’s annual fee is $600 for a young adult and …

3 things a restaurant taught me about patient satisfaction

Trina E. Dorrah, MD

Physician

August 24, 2014

A few weeks ago, my husband and I took my parents to dinner at one of my favorite restaurants. I was excited to go because the food is excellent and the customer service is top notch. In the past, I’d always had a great experience … until then.

That night, the restaurant was packed as they were offering half-priced desserts. My husband and I arrived first. I noticed when we ordered …

Direct primary care and concierge medicine: They’re not the same

Samir Qamar, MD

Physician

August 24, 2014

Direct primary care (DPC) and concierge medicine are rapidly growing models of primary care. Though the terms are used interchangeably, both are not the same. Such liberal use of terms, many times by even those within the industry, confuses those who are attempting to understand how these primary care models operate. As former concierge physician for the Pebble Beach Resorts, and subsequent founder of one of the nation’s largest direct …

Physician wellness: Take time to find what works for you

Sara Taylor, MD

Physician

August 23, 2014

I wholeheartedly support the message behind the project, What Works For Me. As health care professionals, we continually encounter human suffering and work under stressful conditions. As a family physician for the past 14 years, I have been fortunate enough to work in a variety of clinical settings, including several in general family practice.

Currently, I practice family medicine in the sexual health clinic of a community health center. …

Before you retire, see your doctor first

Edward T. Creagan, MD

Physician

August 23, 2014

The big day has finally arrived. Your boss shakes your hand and wishes you well. Your colleagues gather around a cake and make small talk about landing the big fish in your retirement, or joke about what you’ll do now that you don’t have to come to the office.

A cardboard box is filled with the contents of your desk: your family pictures, desktop trinkets, snowball paperweight, and stale candy. Your …

Like it or not, urgent care centers are here to stay

John Schumann, MD

Physician

August 22, 2014

The New York Times had a front-page story about the growth of urgent care clinics nationwide.

These are the places that are often referred to as “minor emergency rooms,” or “doc-in-a-box” outfits. Their value proposition is simple: You don’t need an appointment. The costs are “reasonable,” and much more transparent than usual medical care at a doctor’s office, emergency room, or hospital. Best of all: They can treat a majority of acute conditions …

Why do doctors ignore their own self-care needs?

Starla Fitch, MD

Physician

August 21, 2014

Most busy doctors completely forget (or ignore) the importance of integrating personal downtime and self-care into their schedules.

It’s no surprise so many doctors wrestle with overwhelm. Downtime is crucial for stress management.

What about you? Are you guilty of skipping your “you time?”

No, I don’t mean attending a seminar, reading an article, or talking about stress reduction at a staff meeting.

I mean, when is the last time you scheduled some real …

How to move the needle on wellness

Dean Ornish, MD

Physician

August 21, 2014

When it comes to preserving health and prolonging life, study after study shows that prevention is essential. From type 2 diabetes to early-stage prostate cancer, clinical trials have demonstrated that countless diseases can be avoided or even reversed through (often simple) lifestyle changes. We know the solution. Yet the challenge is reaching it. For example, tens of millions of overweight Americans are dieting at any given moment, but only a …

Read more…

How to move the needle on wellness

Top 10 ways to know it’s time to quit your job as a doctor

Pamela Wible, MD

Physician

August 21, 2014

Attention all doctors: The first three are mine. The rest are from miserable colleagues. All true. And common. If you’re a doctor and you recognize anything on this list, please quit your job.

10. You feel nauseated when you see your clinic logo; you alter your commute to avoid streets with your clinic’s billboard.

9. Discouraged by the general despair among staff, you …

Why do some patients go to the doctor in the first place?

Jordan Grumet, MD

Physician

August 20, 2014

William was doing great. His C. Diff was finally gone after a month taper of vancomycin. He was stronger. The nursing home staff reveled in how much progress was being made over such little time. It seemed every one was ecstatic, except for, of course his family. Every step this octogenarian took forward was accompanied by a litany of concerns and complaints from his daughter.

If he was not gaining weight, …

Teach the basics of practice management to medical students

Raymond Tsai, MD

Physician

August 20, 2014

For three years before I applied to medical school, I worked in post-Katrina New Orleans helping to rebuild school-based health centers. One of the main challenges, however, was how to create a sustainable safety net for at-risk youth to whom we were hoping to provide much needed health services — key word being “sustainable.”

All too often, there isn’t funding to carry out primary care’s mission of improving the health of communities and …