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.
Do we really have a looming physician shortage? We may, but even more acutely I believe we have a physician utilization problem, most particularly in primary care. After shadowing approximately 50 primary care physicians across the country and engaging physicians in conversation during 150 or so presentations on improving the delivery model of care, my observation is that 70-80% of the PCPs work output is direct waste: computer order entry, prescription processing, composing the billing …
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We have a physician utilization problem
Over the years I have strived to develop my bedside manner. On rounds many learners comment on this aspect of my doctoring, and these comments have led to much self reflection. This commentary may convince some readers that I have the answers, but I do not. Sometimes I do very well, but sometimes my skills fall short. I do try to connect with patients and families, and give them confidence, …
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Developing bedside manner comes from understanding who the patient is
Medical student Joyce Ho recently wrote an article in which she admitted to discomfort raising the topic of religion with patients. As a “polarizing” issue that could make the doctor-patient relationship “more unprofessional,” Ms. Ho imagined that patients would fear playing into their doctors’ prejudices, particularly if the doctor were atheist, and that this fear would push some patients away from the inquiring doctor. Despite her instructor’s recommendation to ask …
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Self-censoring of patient information may be a public health hazard
As physicians, we often write prescriptions for our patients. Where, when, and how patients fill their prescriptions are usually outside of our realm of expertise. But should we be more involved?
On occasion, the cost of a medication and possible alternatives will be the subject of my conversation with a patient. I was surprised, however, when one of my patients complained about the price of an antidepressant that I had prescribed. …
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Be more involved in how patients fill their prescriptions
Picture this.
You walk into your doctor’s office for an urgent visit for new distressing symptoms. He (or she) takes your blood pressure, temperature, heart rate. All within normal limits. He asks you several questions pertaining to your symptoms, does a thorough exam and perhaps orders a quick in-office lab or two. You ask him what he thinks is going on.
The quandary
If it’s a slam dunk diagnosis, the branch point in …
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Do patients have a right to know their doctor’s uncertainty?
I recently spoke to a quality measures development organization and it got me thinking — what makes a good doctor, and how do we measure it?
In thinking about this, I reflected on how far we have come on quality measurement. A decade or so ago, many physicians didn’t think the quality of their care could be measured and any attempt to do so was “bean counting” folly at best or …
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Can we measure what it takes to be a good doctor?
Malcolm Gladwell thinks we should tell people whats it’s really like to be a doctor. And by God I have invested the last seven years in doing just that. I have written countless blogs, given lectures, and traveled to Ireland. I have coined the term Caring 2.0 to describe the bidirectional flow of empathy. Patients will tell us what it is like to suffer with disease, and we …
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Assure patients that we are on their side
I have a confession.
It is a secret I have held for more than 10 years and it is a lesson I have learned from other women.
As society continues to debate the terms and conditions required for women to be leaders, what is often missing is the lens of the woman of color. It is time to talk about the socialization of girls, and brown girls in particular, and the guise …
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New feminism is about women, work, and the will to be authentic
Doctors today are often accused of being uncaring: Their eyes are glued to their computer screens and their attention is focused on test results and technology instead of patients.
But some doctors care too much: A seasoned cardiologist blogs about letting his emotions lead him astray in keeping an elderly patient on life support too long. Was it his emotional attachment to the charming, elderly woman, or was it professional hubris, …
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When doctors care too much
Most people, including physicians, rely on personal references to find a good doctor. But what do you do when you’re far from home, or you don’t know anyone with firsthand knowledge of local doctors? My parents recently asked me to recommend a physician for them in a state where I knew none of my colleagues personally. This is the 10-step process that I used to help them navigate their way …
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A 10-step process to finding a good doctor
Next in a series.
As a general rule, PCPs like people. This was true of them long before they started medical school and it will have only blossomed further during training. Ask PCPs, as I have with in depth interviews, and they will tell you that certain types of individuals are drawn to primary care careers.
They like to converse with people. They enjoy getting to know about a person — …
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What are the characteristics of a good primary care physician?
“Medication mishaps cause a huge number of hospitalizations and in fact the majority of hospital readmissions. Making more time for visits with aging and complex patients is critical to avoid mishaps of poor communication and rushed decisions. A dose of ‘slow medicine’ may get us to our goal of system sustainability faster,” writes colleague and fellow blogger Dr. David Moen.
Dr. Moen distills Dr. Dennis McCullough’s ideas about slow medicine down …
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How to make practicing slow medicine a reality
I like a lot of things about Facebook. It allows me to see pictures and video of my nephews and niece and of friends’ children, it quickly lets me know when something big (either happy or sad) is going on in people’s lives, it lets me know what people are thinking about, and it gives me the opportunity to share my own news, thoughts, pictures, or occasional videos with others.
But as much as …
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A doctor’s visit is not a social media situation
The stethoscope has been a symbol of the medical profession for two centuries. Dr. René Laennec probably had no idea how his idea would take off when he first invented the simple wooden tube in Paris back in 1816. After a few modifications over the course of the next several decades, it evolved into what we know today.
A central part of the physical examination, the stethoscope currently gives doctors priceless information about the cardiac and …
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Why the days of the stethoscope are numbered
Fulfilling every stereotype, I sat at my grandparents’ house in southern Sweden, sipping elderberry juice out of an IKEA glass and eating meatballs with lingonberry jam. It was Christmas Eve, and I was enjoying a getaway from the rigors of medical school. However, it wasn’t a complete escape, as my grandparents loved talking about medicine and the differences between health care in the United States and Sweden.
In this particular conversation, …
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What Sweden can teach us about primary care
With the announcement out of Washington about the 2015 budget, much has been made about the apparent presence of significant support for the development of more primary care practitioners in the years ahead.
This support includes programs aimed to encourage medical students and residents to choose primary care as a profession, including loan forgiveness packages.
Response in the press has already raised issues with this, suggesting that this move would do little …
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Is it any wonder why young doctors shun primary care?
