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.

Teach caring people how to be caring doctors

Shirie Leng, MD

Medical Education

December 12, 2013

Let’s talk for a moment about medical education. I went to a work-related party recently and rode in the elevator with a dear friend who is my contemporary, and a more senior and highly regarded faculty member known for her work in medical education. Both were afraid for the future of medical education in different ways.

My contemporary was concerned that the emphasis on the use of advanced technologies like ultrasound …

Treating pain without addressing suffering

Hans Duvefelt, MD

Physician

December 12, 2013

Suffering ceases to be suffering in some way at the moment it finds a meaning.
-Viktor Frankl

It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.
-William Osler

Back in the 1990s when pain was the newest vital sign, physicians were mandated to treat it, often with powerful medications and without truly understanding the cause and significance of the …

Defining the patient’s goals of care

Michelle Nall, MPH, ANP-BC

Patient

December 11, 2013

I moved to Florida three months ago to take a job as a primary care nurse practitioner in a clinic for the underserved and uninsured. This position followed four years spent as a home-visiting nurse practitioner working with high acuity, chronically ill patients in the Boston area. I didn’t realize it would be such a transition to go back to taking care of patients in the clinic setting after spending …

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Defining the patient’s goals of care

Performance measuring tools aren’t up to the task

Ira Nash, MD

Physician

December 11, 2013

I was invited to give a talk about patient satisfaction at a recent grand rounds. I have written previously that satisfaction is a pretty low bar, and so I spoke instead about the patient experience.

I opened my talk with the cartoon above.

As I anticipated (and intended), it got a few chuckles from the audience, and I pointed out …

Direct pay primary care and the ACA still don’t mix

Rob Lamberts, MD

Health Policy

December 9, 2013

Lately I’ve gotten hooked on watching the reality TV show, the Deadliest Catch. It’s astounding to me what these guys go through to catch crab in the Bering Sea.

One of the recurring themes on the show is the new crop of “greenhorns” — new recruits to the profession of working crab boats — that try to show they can hack “the world’s most dangerous job” each year. They often come with …

Radiologists and primary care doctors need to talk to one another

Dr. Saurabh Jha

Physician

December 8, 2013

Recently, I spoke with a primary care physician (PCP) about a young runner who had a syncopal episode. Because of the increasing awareness of sudden cardiac death in athletes, she had an electrocardiogram and an echocardiogram to look for structural abnormalities of the heart.

The PCP was inclined to dismiss the syncope as an isolated episode. However, the echocardiogram, otherwise normal, equivocated: “possible hypertrabeculation of the left ventricular apex, consider cardiac …

Doctors: 10 lessons from the humble bumblebee

Neil Baum, MD

Physician

December 7, 2013

Bumblebee_05

Practice medicine like the bumblebee.

We also know the basics of the beehive containing a single queen bee, hundreds of worker bees, and several hundred to several thousand drones with their only function is to mate with the queen (and after they perform this function they die!), each with their own degree of specialization and place in the honeybee society. However, there is …

5 preventive services to do, and 5 to avoid

Edward Pullen, MD

Physician

December 6, 2013

Early diagnosis, preventative care and aggressive disease management are mainstays of American medicine today. Proponents argue that early diagnosis and prevention are the keys to healthy living. Skeptics suspect that many of the screening tests for early asymptomatic disease and preventative treatments we undergo lead to overdiagnosis, unnecessary expense, exposure to diagnostic and therapeutic interventions which themselves have risks, and that often cause more harm than good.

As a physician and …

Rwanda provides primary care lessons we can learn from

Kenneth Lin, MD

Health Policy

December 5, 2013

As reviewed in many other sources, the relative underinvestment of resources in primary care in the U.S. has a great deal to do with the fact that we spend far more on health services than anywhere else in the world but rank near the back of the pack in key health metrics such as life expectancy, infant mortality, and disability compared to other high-income countries. Although economic inequality, lack …

What happened to doctors serving as advocates for their patients?

Wes Fisher, MD

Physician

December 4, 2013

The Hippocratic Oath. Most medical students in America recite some version of this oath at their medical school graduation. Its text implies a sacred and overriding respect (ethic if you will) for the individual.

Doctors are currently witnessing the profession of medicine moving from the ethic of the individual to the ethic of the collective. The passage of the Affordable Care Act has solidified this treatment ethic and, as a consequence, …

How Obamacare will creatively destroy primary care as we know it

Margalit Gur-Arie

Health Policy

December 4, 2013

As Obamacare is winding its way through a hellish bureaucratic labyrinth of its own creation, accompanied by cheers and boos from the blood thirsty spectator crowds, confusion, fear, trepidation, despair and exhilaration, are gripping America’s doctors all at once, because whatever else is accomplished in the next decade, medicine will never be the same.

At the confluence of cutting edge technology, great poverty and unimaginable fortunes, a new vision for the practice of …

I can’t always cure, but I can always care

Pamela Wible, MD

Physician

December 4, 2013

LOU-ME1

I started kissing patients in med school. And I haven’t stopped.

During my third year pediatric rotation, I used to stay up late at night in the hospital, holding sick and dying children. I’d lift them from their cribs, kiss them, and sing to them, rocking them back and forth until they fell asleep. One day the head of the department pulled …

How charisma can improve patient care

Kevin R. Campbell, MD

Physician

December 3, 2013

By its very nature, medicine involves close personal contact with others. Communication with patients, families, staff and colleagues is essential to success. All physicians have different ways in which they communicate — some more effective than others. The best communicators are able to inspire, engage, and cultivate trust. Everyone is born with different skill sets and communication styles may vary widely.

Recently, I came across an article in Inc.com that discussed …

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How charisma can improve patient care

What a doctor learned from a visit to an e-cigarette store

Natasha Burgert, MD

Medications

December 2, 2013

From gas stations to grocery stores, slender cylinders of nicotine “e-juice” seem to be available everywhere. On my drive to work, in fact, 2 new e-cigarette shops have opened their doors in just the last 3 months. So I was not surprised to read a recent report suggesting a rise in the number of teens trying e-cigs.

E-cigarettes deliver nicotine by heating nicotine-containing fluid into a vapor that is …

We can’t treat patients if they don’t trust us

Aaron J. Stupple, MD

Physician

December 1, 2013

Leana Wen’s Who’s My Doctor? campaign is an important step to help health care. She endorses a total transparency manifesto where physicians can describe their sources of revenue and other potential conflicts of interest. It’s an effort to build trust.

We can’t fix health care without patients’ help. A quick look at the numbers for chronic disease are compelling enough– half of Americans have at least one chronic disease, …

The key to saving primary care

Yogesh Khanal, MD

Health Policy

December 1, 2013

Despite the current outcry over Healthcare.gov, Obamacare will soon bring 30 million Americans healthcare coverage. But if the website to signup may have lacked adequate planning, is our infrastructure for primary care ready? With some estimating a current shortage of 20,000 doctors, legions of new patients will add stress to an already crippled system. As a junior medical resident managing my own panel of outpatients at our local VA hospital, …

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The key to saving primary care

Diabetes: More than a word, much more than a diagnosis

Bernadette Sheridan, MD

Conditions and Diseases

November 30, 2013

As a family doctor based in Brooklyn, New York, who has served the needs of my community since completing residency in 1982, I find myself with a unique privilege and opportunity to observe disease and wellness, the effects of lifestyle, policy and the collective efforts of myself and others, as we attempt to keep our patients well and affect the statistical bottom line. I’m typing this as I also think …

How to improve patient engagement

Rosemarie Nelson

Patient

November 28, 2013

Much is being made of the meaningful use requirement to use secure online messaging to communicate with patients about relevant health information. The new Stage 2 measure requires that more than 5% of unique patients seen by the eligible professional during the reporting period were sent a secure message using the electronic messaging function of certified EHR technology.

But to meet that goal, we have to get our patient population engaged …

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How to improve patient engagement

Patients must be given the results of their tests

Fred N. Pelzman, MD

Physician

November 28, 2013

Just the other day one of the medicine residents presented a case to me, and mentioned that in looking through the patient’s chart he noticed that the patient had undergone a prostate biopsy 1 month prior to this visit, with a follow-up appointment in urology scheduled next month. The result of the biopsy was positive for cancer, but that had not been communicated to the patient. His first instinct, he …

Is saving primary care simply a matter of seeing fewer patients?

Davis Liu, MD

Physician

November 26, 2013

As a practicing primary care doctor, I very much enjoy my career choice. I’m fortunate enough to be in a large multispecialty practice that is collegial and forward thinking. If I was in a smaller practice like other colleagues, I would not quite feel the same. Yet concern about how to make primary care attractive for both future doctors and those currently in practice has been something I’ve been occupied with …

Primary Care

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