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.
Disruptive innovation is competitive strategy for an age seized by terror.
– Jill Lepore, author of The Disruption Machine: What the Theory of Innovation Gets Wrong
“What do you want me to do with all the stuff in this box?” my wife asked this weekend.
I looked inside and saw my former self: one of BNC and pin connectors, wires, a notebook with sin, cos, theta, and a host of other equations — a …
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What kind of doctor are we breeding in medicine now?
A stark reality of the past year has been the ever-looming ICD-10 transition, which ultimately got punted on by the federal government to October 2015.
With the deadline to make the transition to ICD-10 now more than a year away instead of six months (and who knows if that will even be the case next summer), I’d still wager that many health systems are working to keep their transitions on track …
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How to prepare yourself for the ICD-10 era
Let me show you four simple steps, requiring just 15 seconds, that will turn a patient thank you into a two-way healing encounter of the highest order.
It is incredibly easy for a thank you from a patient to slip by during a busy day in the office. We can get so caught up in the blizzard of clinical tasks we fail to hear what the patient is trying to communicate. We don’t …
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What to do when a patient says thank you
Opening my mail today, there are multiple letters from multiple insurance companies, reportedly communicating valuable information to me about my panel of patients that they cover.
One of the envelopes holds two single sheets of paper, one of which contains a listing of my panel of patients and the providers they have been referred to over the past quarter.
The second sheet, mysteriously, contains only a single line: This page intentionally left …
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Blank pages are emblematic of health care waste
There is a growing recognition in medical education and practice that the spiritual component of human existence must be recognized and addressed. The American College of Physicians has concluded that physicians are obligated to attend to all dimensions of suffering: the physical, psychosocial, spiritual, and existential.
Similarly, the Joint Commission on Accreditation of Healthcare Organizations (JAHCO), which accredits hospitals, recognizes that spiritual concerns are often important for patients and that hospitals …
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Physicians should recognize patients’ spirituality
I often hear people talking about their doctors. I overhear it restaurants, nail salons, while walking down the street. I hear what people think of their doctors, what their doctors said or what they didn’t say, why people were disappointed by or validated by their doctors. I hear people analyzing, criticizing, and surmising about this relationship quite a bit, and I don’t blame them. The relationship you have with your …
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Technology and the doctor-patient relationship
It’s a cold and rainy morning, and we’ve traveled to the middle of Central Pennsylvania to see a presentation at a conference about a patient-centered medical home product produced by one of the largest health care systems and insurers of the region.
There are clinicians and administrators from all over the eastern half of the U.S. (plus one from California), and also a large contingent visiting from the U.K., on a …
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The patient-centered medical home isn’t ready-made
The U.S. spends nearly $3 trillion a year on health care, significantly more than any other nation.
In fact, America’s annual health care spending is greater than the total gross domestic product (GDP) of every other country except China, Germany and Japan.
Yet our measurable health outcomes — from infant mortality to life expectancy — aren’t any better than nations spending much less.
I’ve written about this paradox before, pointing to a few …
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Why do we think more care is better for us?
Tom Insel, director of the National Institute of Mental Health (NIMH) in his recent blog post, “Are Children Overmedicated?” seems to suggest that perhaps more medication is in order. Comparing mental illness in children to food allergies, he dismisses the “usual” explanations given for the increase prescribing of medication. In his view these explanations are; blaming psychiatrists who are too busy to provide therapy, parents who are too busy to provide …
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Young children are silenced by psychiatric medication
From the moment some patients arrive in your office, nothing seems to suit them:
- Your parking lot charges too much.
- Your front desk staff has too many forms for them to complete.
- Your waiting room magazines are too old.
- The temperature in your exam room is too cold.
So why are some patients so grumpy?
I believe many patients come to us with a wall of fear around themselves. They are worried about the outcome of their …
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Medicine isn’t about pleasing all of the people all the time
It’s one thing to ask a doctor to stay current on his knowledge, it’s quite another to insist he survey his patients for a private enterprise, especially if that survey represents unvetted independent research.
Recently, a colleague of mine was attempting to maintain his board certification credential with the American Board of Internal Medicine (ABIM) and signed up for the ABIM’s requirement for a practice improvement module worth a required 20 …
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Maintaining board certification: Stop with the patient surveys
In the forty years since I started medical school, I have worked in socialized medicine, student health, a cash-only practice and a traditional fee for service small group practice. The bulk of my experience has been in a government-sponsored rural health clinic, working for an underserved, underinsured rural population.
Today, I will make a couple of concrete suggestions, borrowing from all the places I have worked and from the latest trends …
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A country doctor’s proposal for health insurance reform
There’s no arguing the fact that evidence-based medicine (EBM) is moving us in the right direction as far as treating and preventing illness in medicine as a whole, but what does EBM, in its current interpretation, mean for medicine as an individualized art?
Everything new or controversial in medicine seems to have a swinging pendulum. From vaccines to hormonal treatment to alternative therapies, the pendulums of medicine seem to be in …
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How does evidence-based medicine affect the art of medicine?
Nearly all physicians are now subject to patient satisfaction ratings. In my case, and many thousands of my colleagues across the country, it is via the survey tool sold to health care facilities by the Press Ganey Company. There are also many, many online sources that rate physicians.
The idea is a good one: Physicians should be subject to feedback from patients about patient perceptions of how good a job the doctors …
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Why patient satisfaction surveys are riddled with problems
I know the ropes at the VA … I’ll pick up the phone in a heartbeat and call my senator and get what I need right away. A lot of guys aren’t like that.
–Max Gruzen, PTSD patient, Vietnam veteran from the New York Times
So this is what it means to be an “engaged” patient in the VA system today. You have to know a senator who will intervene …
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How entitlement undermines patient engagement
I’ve listened over the years to well-meaning people say that the general public doesn’t care about physician payments, because they think all doctors are rich and any physician who complains is just whining. This is a huge mistake on the part of people who want to have a long-term relationship with comprehensive family physicians as their primary care givers, and those who want better health care at a lower cost.
Let’s …
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The payment bigotry against primary care doctors
Next in a series.
What are some of the characteristics of healers? They listen and do so nonjudgmentally. They respond on the patient’s terms. They are humble. They are truthful. The healer communicates on the patient’s (and family’s) own terms. The healer always explains his or her reasoning. The healer tries to diminish the information gap.
Despite all of medicine’s sophisticated technology and providers’ skills, the patient still needs the doctor …
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What are some of the characteristics of healers?
It was just a regular hot and humid Saturday morning in Miami, and I was on my way out of a local Walmart after buying a few items. As I walked to my car at the end of the parking lot, I heard a voice asking me “Son, any change?” In a neighborhood that is known to have a disproportionately large amount of vagrants, I did what I usually do …
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The civic responsibility of physicians in our community
“Robert Loeb was the best damned ethicist I ever met.”
When I first heard a senior colleague of mine utter these words in the mid-1990s, I was surprised. Time had not been particularly kind to Loeb, who had been the chairman of medicine at Columbia-Presbyterian Medical Center from 1947 to 1960. Among other things, critics had chastised Loeb for being imperious and unwilling to listen; former students had even accused him …
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Ethical physicians, now and then
