These days they have navigators for everything. When we got lost back in the day, we used to consult a map, or lacking a map, we would pull in to the nearest “filling station” (what we used to call gas pumps) and ask for directions from the friendly young man who would appear to wash our windshield, check the oil and the tire pressures, and of course, pump the gas. …
When a doctor offers to speak the language of medicine for you
Several years ago I wrote an article for physicians on the topic of balance, and one of the suggestions was to place family first. There are two stories that I have learned since the publication of that article that I would like to pass along.
Balance in a doctor’s life is best achieved if there is balance between family and work. One of the best suggestions is to place …
Doctors need to place their families first
In recent months, AAFP President Reid Blackwelder has been editorializing and debating what they see as the encroachment of nurse practitioners (NPs) and other “mid-level providers” (physicians are, presumably, “upper-level”) on the practice territory of family physicians (FPs). Dr. Blackwelder has repeatedly said that NP and physician roles are “not interchangeable.” The AAFP’s position on this issue seems to be resistance to the increasingly common decisions by state legislatures to …
Why family physicians are a threat to themselves
At first we thought it was funny when the doctor said, “Fatigue. That’s a tough one. At 75-years-young, your chronic conditions are catching up with you, sapping your energy.”
That was the end of exploring the presenting problem at my husband’s twice a year primary care visit.
On the way out to the parking lot, we said we’d like to be bugs on the wall when, 25 years from now, someone says …
A doctor’s attitude toward his older patients
A patient calls or emails me with a problem. I talk with them over the course of a few days, using whatever form of communication works best. Eventually, they need to come to the office to be seen – either for something needing to be done in-person (examination, procedure, or lab test), or because of the advantages of face-to-face communication. At the visit, I not only deal with one problem, …
Radical changes to how I think about care
“Doc, if I have cancer, I don’t want to know. Stop bugging me about this colonoscopy.”
Mr. H said to me, his primary care physician, during our appointment. He folded his arms and nodded his head, indicating that his decision was final.
“Mr. H, as uncomfortable as colonoscopies seem, they can actually find lumps that might grow into cancer, and cut them out before they ever become cancer. That’s why I’m bugging you so much about this.”
I …
For patients, reforming the RUC matters
The specter of loss of choice and freedom to select the doctor you want haunts again. This time it’s being raised on the airwaves with an ad from Americans for Prosperity, a group that advocates limited government and free markets. The ad, an attack on Obamacare, plants doubt in viewers’ minds about whether they can choose their own doctor, a theme that continues to resonate with both the public and …
Limiting your choice of doctors: Is Obamacare to blame?
The notion that doctors can be replaced by technology has sparked a series of brawls between doctors and technologists over the last couple of years. Today, both sides continue to throw punches in the press and online.
As health care technologies become more sophisticated, the opportunity to automate medical decisions becomes more seductive. Yet, physicians are unwilling to throw in the towel. They point to the importance of human interaction and …
Technologists versus doctors: Who wins?
To the literal-minded, burning out is the fate of light bulbs and matches. But whether you read the popular press or medical journals today, you’re likely to find writers who are deeply concerned about physician burnout.
What defines physician burnout, and who exactly is suffering from it? Is burnout an actual clinical syndrome, a slang term connoting fatigue and boredom, or a hazy …
Burnout: The perfect storm of physician stress
There are lots of generalized complaints out there about insurance companies increasing physician workloads without additional compensation. I thought I would share a specific instance of this so everyone else can get an idea of what we’re up against.
I received the following mailing:
We want you to screen our members for cancer. Please do these things:
- Call the member to discuss colorectal, skin, and prostate …
Why one doctor throws away insurer mailings
When I was a med student, the thing I loved most about primary care was continuity of care. I loved feeling like I had a sense of my patients’ lives, of the intimate details of their day to day, of their fears and dreams. I thought that this connectedness was all I needed to have a successful career as a primary care …
Doctors: Fight burnout like it’s the plague
I guess what is so utterly frustrating is that the guys up there don’t see what is going on down here. The march of health care reform continues with little realization of what it feels like to be one of the tiny peon foot soldiers on the ground. We are not deaf. We hear the politicians and policy wonks. We read as non-clinician “doctors,” ivory towered administrators, and the business …
Our patients pay for dumbed down American medicine
Most healthcare professionals do not consider themselves to be in the field of sales. However, healthcare professionals do sell something so they are in sales! Even if you may not have the titles of “salesman” or “saleswoman,” you are still in sales. Everyone sells something. Kindergarten teachers sell something (i.e., the value of education). What do healthcare professionals sell? We sell the benefits of treating illness and promoting wellness. During …
Healthcare professionals need to be proficient in sales
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A guest column by the American College of Physicians, exclusive to KevinMD.com.
I will begin this month’s column with a confession on something that most people don’t know about me. I hope it doesn’t lose me any friends. I am a member of the AMA/Specialty Society Relative Value Scale Update Committee, better known as the RUC. Actually, I’m an alternate, but …
Are we unfair to the RUC? A view from the inside
Nothing seems to please a fly so much as to be taken for a currant;
and if it can be baked in a cake and palmed off on the unwary, it dies happy.
-Mark Twain
Returning to clinic after time off for a summer break, I worry I’m like a fly hiding among the black currants hoping to eventually become part of the currant cake. Just maybe no one will notice I don’t …
I know I’m a real doctor, and I will die happy doing this
On July 18th 2013, the city of Detroit filed for bankruptcy. Early estimates size up Detroit’s as the biggest in history with composite debt figures approaching the ballpark of $20 billion. Through the eyes of a clinician why should we care and what does this mean for our practices.
Detroit is dying.
While filing for Chapter 9 bankruptcy may give the city an extra lifeline, …
What Detroit’s bankruptcy means for patients
That breakfast is important is denoted by the name itself. At some point, we either break our fast, or just keep fasting — and eventually, starve. So for those of us disinclined to starve, fast breaking has to happen at some point. By convention, that’s breakfast.
Much else about breakfast, what we eat and when for instance, also tends to be a matter …
Skip breakfast at your own risk
The Mayo Clinic Proceedings came out with a study that shows that many of the treatments that doctors once swore by are useless or worse.
The New York Times did a piece on it and the commentary contained a great deal of doctor-bashing. So of course I opened my big mouth and pointed this doctor hatred out. The comment I got back was this: “It’s not hatred, it’s fear.”
Wow. If people …
How can doctors and patients regain trust in each other?
I remember how my son’s autism diagnosis was delivered. He was three years old. It wasn’t a surprise really, merely a confirmation of something that I expected and feared. He was already enrolled in speech and occupational therapy making very little progress. He saw a developmental specialist at age two and two and half who initially believed that he was not autistic but merely delayed with sensory issues. After we …
It’s time primary care doctors diagnose autism
The digital health and wellness space is growing a mile a minute, with thousands of new sensors, apps, trackers, and websites promising ultimate health and fitness born every day. Data requests to MyFitnessPal’s API alone – from wearable sensors like Jawbone’s UP and Nike’s Fuelband to GPS-enabled tracking apps like Runtastic – roughly doubled from 28 million to almost 55 million in one month, between March and April of 2013.
We have entered a new era when it …
3 data driven health technologies I’d like to see
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