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.

If a doctor isn’t face to face with a patient, is he still a doctor?

Hans Duvefelt, MD

Physician

April 18, 2014

It’s a strange business we are in.

I can freeze a couple of warts in less than a minute and send a bill to a patient’s commercial insurance for much more money than for a fifteen minute visit to change their blood pressure medication.

I can see a Medicaid or Medicare patient for five minutes or forty-five, and up until now, because I work for a federally qualified health center, the payment …

E-cigarettes lack scientifically based guidance

Ruth Macklin, PhD

Medications

April 17, 2014

The debate over e-cigarettes has been heating up. Are the smokeless, battery-powered, nicotine-dispensing devices a gateway to smoking for young people or a helpful way for smokers to quit? Public health experts can be found on both sides of the debate.

An article in the New York Times cited two leading figures, Dr. Michael Siegler from Boston University and Dr. Stanton A. Glantz from the University of California, San …

When free preventive screening tests aren’t really free

Kenneth Lin, MD

Physician

April 17, 2014

I recently spoke to a class of undergraduates about the benefits, harms and politics of screening smokers for lung cancer using low-dose CT scans. Afterwards, a student asked how I felt about the Affordable Care Act’s requirement that Medicare and private insurers cover U.S. Preventive Services Task Force “A” and “B” recommended screening tests and other preventive services without co-payments or deductibles, making them free at the point of care.

I admitted that …

The conundrum of communication and uncompensated care

PalMD

Physician

April 16, 2014

Going to the doctor starts as a disconcerting experience: Getting naked, physically and emotionally; talking about your weight, your smoking, your divorce. You count on your doctor’s ear and her discretion. Often enough, a patient will apologize for taking my time or for crying or whatever. I remind them that this is what the exam room is for, this is what they pay me for.

How far does this special relationship …

The role of integrative medicine in primary care

Stephen C. Schimpff, MD

Physician

April 16, 2014

Next in a series.

Beginning with a deep understanding of medical science and years of training and experience, the primary care physician (PCP) needs to delve deeply into the patient’s personal, family and social setting in order to fully understand the context and causes of the patient’s illness. The PCP also needs to know when it is important or even critical to call upon others with specific knowledge, techniques or …

Why you need to hear from miserable doctors

Kevin Pho, MD

KevinMD

April 16, 2014

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Is being a physician a good gig, or not?

In a piece that’s gone viral, internist Daniela Drake writes a strongly-worded column in the Daily Beast about how miserable it is to be a physician:

To be sure many people with good intentions are working toward solving the healthcare crisis. But the answers they’ve come up with are driving up costs and …

Read more…

Why you need to hear from miserable doctors

Testing doctors is big business

Wes Fisher, MD

Medical Education

April 15, 2014

If you want to understand the world of professional board certification, it is important to understand the business and politics of testing professionals. Such testing is big business. So big in fact, that huge international media and education companies that trade on the New York Stock Exchange have been created to service this need. According to one article on Reuters from 2012, “the entire education sector, including college and mid-career training, represents nearly 9 …

Read more…

Testing doctors is big business

The fatal error in health care

Rob Lamberts, MD

Health Policy

April 15, 2014

The janitor approached my office manager with a very worried expression. “Uh, Brenda …” he said, hesitantly.

“Yes?” she replied, wondering what janitorial emergency was looming in her near future.

“Uh …well … I was cleaning Dr. Lamberts’ office yesterday and I noticed on his computer …” He cleared his throat nervously, “Uh … his computer had something on it.”

“Something on his computer? You mean on top of the computer, or on …

Read more…

The fatal error in health care

Physicians should not be expected to blindly follow guidelines

Jordan Grumet, MD

Physician

April 15, 2014

Barron Lerner thinks he understands doctor’s motives. In his recent article in the Atlantic he laments that physicians act on tradition and emotion over adopting new science. In defense of his position, he sites the example of how cardiologists use angioplasty and coronary artery bypass to treat coronary disease.

He states,

… cardiologists have been remarkably slow to abandon the old hypothesis, continuing to perform hundreds of thousands of bypass operations …

Read more…

Physicians should not be expected to blindly follow guidelines

Providers should be active in helping patients follow directions

Donald Tex Bryant

Physician

April 12, 2014

Many times I have heard physicians and other providers lament that the outcomes for their patients would be so much better if they could “get them to listen and follow instructions.” They understand that they can be most effective in treating patients if the patients would follow all of their directions.

Do the physicians’ or care providers’ responsibilities end with this wish? Can physicians do more than just hope and pray …

Electronic medical records: Questions journalists should ask

Jan Gurley, MD

Physician

April 11, 2014

It’s rare for doctors to turn out en masse for a public protest. But that’s what happened at “Doccupy” in Contra Costa County, California in 2012. A group of safety net physicians testified before county supervisors — in what they only half-jokingly called “Doccupy” — that the cumbersome move to electronic health records (EHRs) had taken an enormous toll on patient care. The doctors saw half their usual number of patients. …

Doing a lot more than the doctoring than bargained for

Hans Duvefelt, MD

Physician

April 9, 2014

The horse that came into my life has made me think about many things from a different perspective. I have learned about the horse’s subtle ways of communicating, her extrasensory (compared to our own) perception, and her instincts of flight. I have also become more aware of the energy I bring to my relationship with her. With no learned tricks or horse management skills, I have established a way of …

Do rural provider bonus payments do more good than harm?

Peter Ubel, MD

Health Policy

April 9, 2014

If you live in the rural U.S., you probably face relatively limited access to the wonders of American health care. There won’t be as many physicians per capita offering you their services. This paucity of health care professionals will be especially stark for subspecialty care. There are not many ENT specialists opening up shops in rural Texas when they can find jobs in Houston or San Antonio.

This undersupply of physicians …

The alarming decline of internal medicine recertification pass rates

Kevin Pho, MD

KevinMD

April 9, 2014

Let’s talk internal medicine maintenance of certification (MOC).

I recertified back in 2011, and it was an onerous process capped off with a challenging exam. Thankfully I passed, and I’m good until 2022.

Since then, the American Board of Internal Medicine has made maintenance of certification a more “continuous” process, and is sparking some outcry among physicians. Wes Fisher has multiple posts …

Explain the reasoning behind new prescriptions

Val Jones, MD

Medications

April 8, 2014

A Canadian study published in the Annals of Internal Medicine suggests that about one third of new prescriptions (written by primary care physicians) are never filled. Over 15,000 patients were followed from 2006 to 2009. Prescription and patient characteristics were analyzed, though patients were not directly interviewed about their rationale for not filling their prescriptions.

In short, patients were less likely to fill a prescription if the treatment was expensive, but certain …

An erosion of privacy in health care settings

Abigail Schildcrout, MD

Physician

April 7, 2014

Our privacy is eroding. Some of this erosion is our own fault — we post to Facebook, Twitter, and other social media with reckless abandon. Some is the nature of modern communication — electronic trails are just as easy to find as paper trails (if not easier). Some of the privacy erosion really doesn’t bother me so much — if Target knows that I buy a lot of Cheerios, I’m …

Feedback your patients wish you knew about portals

Dana Tee

Patient

April 6, 2014

I’m not a doctor. And sure, you know your patients better than I do. But, I have been a patient and as a patient, I know how we think. As someone who works in health IT helping to create software to better connect patients and providers, I like to think I have a hypersensitive pulse on what’s going on.

I know that as patients, sometimes we get frustrated trying to solve …

The choice between family medicine and internal medicine

Hugo Torres, MD

Physician

April 4, 2014

My third year of medical school cemented the passion for primary care I developed as a volunteer in a clinic for undocumented immigrants in San Francisco. Relationship building, continuity of care, and seeing the impact a primary care physician can have on a patient’s health all ignited my passion more than any angioplasty or neurosurgery ever could. But one question continued to nag me as I filled in the bubbles …

Doctor and patient: Insecurity meets insecurity

Rob Lamberts, MD

Physician

April 4, 2014

She looked at me, eyes pleading, telling me without needing to say a word: I am not lying to you. I am not crazy. I am not making this up.

I sighed. “We’ve done the work-up and know this is not your heart. I don’t think there are a lot more tests that can be run.” I studied her expression, trying to discern what she wanted to hear from me.

I’ve come …

Frustrations of the primary care physician should be a wakeup call

Stephen C. Schimpff, MD

Physician

April 4, 2014

Next in a series.

Primary care physicians (PCPs) have multiple frustrations today. The greatest frustration is “time, time, time.” From in-depth interviews with over 20 PCPs, everyone said that time or more correctly lack of time was the greatest frustration of their practice (or was previously if they now were in a practice that limited the patient number to a manageable level). Each knew that they could not give the …

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