How many times have you popped into the exam room for a quick re-check of a patient, only to get hit with a barrage of new symptoms and concerns?
My guess is that at least a third of my day is spent wading through new symptoms, rather than focusing on the problem that originally brought the patient to me in the first place.
Don’t get me wrong. I get it that once …
Teach patients to prioritize their problems
Today’s question is a simple one. How many patients can a physician see in one day and still be thorough? Don’t get me wrong; I’m all for efficiency. But we need to recognize when efforts at efficiency become “medical sloppiness” or, frankly, malpractice.
With health care policy and insurance reimbursement what they are today, it’s not uncommon to encounter physicians seeing forty, fifty, and even sixty or more patients a day …
How many patients can a doctor safely see a day?
You may have noticed an uptick in messages from your health plan or clinician notifying you that “You are the captain of your health care team.” I have seen them here and here and here and here, for example.
My response to this message? Bad metaphor: I am not the captain of my health care team.
I may — on some days — consider myself a member of that team, should I actually …
Why patients should not be captains of their health care teams
KevinMD.com shares the stories of the many who intersect with our health care system, but are rarely heard from. Over 2500 articles were published this year from these voices, including practicing physicians, patients, policy experts, nurses, social workers, medical students, and hospital chaplains, among others.
I sincerely appreciate your continued readership and conversation.
Here are the most popular posts of 2013.
The 10 most popular KevinMD posts of 2013
The job of a doctor isn’t to diagnose, prescribe, or examine. It isn’t to be well read, efficient, or punctual. The job of the modern doctor is to convince.
We now have radiological studies whose theoretical discernment limit is subcellular. We can not only map clear and obvious genetic errors of metabolism, but also minor variations of the normal. In a few years, the majority of codes in the procedure manual will probably be laboratory …
The job of the modern doctor is to convince
Rural medicine, I guess, can be defined as health care that happens in places that aren’t big cities or referral centers. The vast majority of the populated earth’s crust that has any health care at all is served by rural practitioners. I have done a little bit of rural medicine in Haiti, in Mexico and now a bit more in South Sudan. I have also worked in a rural health …
The challenges and rewards of rural medicine
The first thing we need to do is analyze what’s broken.
Let’s approach this problem as if it were a patient in our office. It’s our job to deliver a diagnosis based on the patient’s problem.
That’s easy; we’re doctors, after all.
“So, what seems to be the problem today, Mrs. Smith? How can I help you?”
“Well, it seems that no matter how hard I try, I can’t make progress. I want to …
What is it about today’s medical care system that isn’t working?
Recently a colleague from IT who is working with us on our patient-centered medical home asked me, “when is the rollout date for your patient-centered medical home?”
As we have gone through this process for the past six months, I can definitely answer that there is no one day when this is going to happen. We are not going to close the door one night, turn out the lights, shut down …
Building the medical home requires incremental steps
Let me concede from the outset that I lean toward the negative — dire predictions, worst-case scenarios, a bit of doom and gloom, etc.
But I ask you, oh gentle, patient reader, how could I not?
Let’s go to the satellite. You can see warm air from a low-pressure system (meaningful use stage 2, not changed dramatically by the one-year extension) collide with cool, dry air from a high-pressure area (the turmoil …
ICD-10 will lead to the perfect storm in health care
A woman comes to the doctor with depression, fatigue and insomnia. A co-worker stays late in the office even when there is not much to do. A sales associate appears tired and distracted.
For each of these individuals, domestic violence — physical, sexual, verbal, emotional or psychological abuse against an intimate partner — could be the underlying cause of distress. Historically, domestic violence has been viewed as a criminal issue — …
Domestic violence is a social, business and health priority
My older brother is also a doctor, but not a PCP like me. He’s a specialist: a limnologist. If you have problems with blue-green algae in your lake, he’s the man to see. Limnology is the study of lakes, and fittingly, Bill works in the “Land of a Thousand Lakes” as a professor in fresh water ecology.
I’m not sure he’s thinking of switching over to direct-care limnology. I’ve been afraid …
Health care is not about achieving wellness in people
In the North American hemisphere flu season is here. Influenza, as most people know, is a serious respiratory infection that can be life-threatening in the very young and the very old. Some strains, as we’ve all heard about in the press in the past, are more deadly than others and may threaten even the strong. Luckily, however, we’ve developed a vaccine. It doesn’t guarantee you won’t get the flu: the …
Patients who refuse their physicians’ advice
As an advocate of patient-centered care, I have to recognize that some varieties of patient-centrism make me more comfortable than others. If I really want the patient to do X, and the patient doesn’t want to, I generally feel okay about that. Frustrated, sure, and often times convinced that my way is the right way and the patient’s way is some sort of detour.
Most often, though, I am able to …
A solution for patients who request unnecessary care
ADVERTISEMENT
Over the years that I’ve worked in acute inpatient rehab centers, I have been truly vexed by a particular type of patient. Namely, the stubborn patient (usually an elderly gentleman with a military or armed forces background). I know that it’s not completely fair to generalize about personality types, but it seems that the very nature of their work has either developed in them a steely resolve, or they were …
The downward spiral of the stubborn patient
To err is human. To really screw things up, you need government.
One half of my patient population and one fourth of my receipts are from Medicaid patients. My state has a mandatory balanced budget, which means in this age of perpetual recession Medicaid runs out of money every year.
Last year, my state capped the monthly brand name prescriptions to 1 for the summer. Apparently the information that asthma inhalers and …
There is only one reason why I still accept Medicaid
As we’ve gone through the process of building our patient-centered medical home, we have brought along a little bit of the scientific method.
As part of the medical home rollout, we developed an expanded quality improvement curriculum for our internal medicine residents. A series of talks on key topics of the patient-centered medical home has been developed, and several faculty experts have been delivering these to the residents. As a part …
How the medical home can spur academic research
If you haven’t already, you will someday see a primary care physician (PCP).
It’s practically unavoidable.
The reason for this self-declared truth is that PCPs are the shape shifters of medicine, assuming various roles at different stages of an adult’s life and wellbeing.
These responsibilities range from treating various health conditions, ushering patients in and out of hospitals, coordinating long-term medical decisions, and consulting with other specialists to better optimize patient care.
Given that …
What you should know about your primary care physician
The catchy title of a recent Harvard Business Review Blog post, The Big Barrier To High Value Health Care: Destructive Self-Interest, suggested that the Institute for Healthcare Improvement (IHI) is forging arrangements that can overcome fee-for-service reimbursement’s propensity to drive excess. As the honest broker, IHI could advocate for arrangements of mutual self-interest based on the right care, better outcomes and less money. Employers and unions would get lower costs, with …
Will fee for service ever go away?
Recently, way beneath all the press about Obamacare, there have been articles panning the president’s pick as the next Surgeon General of the United States. Wait a minute. What happened to the last Surgeon General?
Six months ago, family physician Dr. Regina Benjamin stepped down as the first Surgeon General under President Obama. Quick! Name one accomplishment under Dr. Benjamin. I can’t either. What happened?
Dr. Benjamin was a rising star in the …
Why Regina Benjamin was an ineffective Surgeon General
I use my computer a lot, so I see a lot of advertisements. Many of them are for the latest two or three items I’ve priced online (which I find somewhat creepy but fairly easy to ignore). Many of them are generic, casting a wide net. These generic ads frequently talk about “one ridiculously easy trick” to halve your car insurance payments, lose 50 pounds, learn a foreign language, look …
Doctors need to do a better job in the PR department
Get free updates delivered free to your inbox.
