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.

How to revolutionize health prevention efforts around the world

Abraar Karan, MD

Health Policy

July 30, 2013

Imagine your 7-year-old son’s face, abdomen, and legs begin to mysteriously swell one morning. Your initial reaction as a parent would likely be to worry first. However, your second instinct is probably to rush to your computer and search the Internet for what might be going on. This is easy enough for the roughly 72% of people in America who have a computer with Internet access in their homes.

Now, imagine …

Break the cycle of event centered care

Fred N. Pelzman, MD

Health Policy

July 28, 2013

Creating a patient-centered medical home within our existing system seems, at times, like a Herculean task. Getting all the pieces in place so that we can make the needed changes sometimes seems too vast to get it all right.

We find ourselves asking: Why bother? Is our healthcare system that broken? Is the way we take care of patients now failing, satisfactory, or outstanding? If we just continue on the path …

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Break the cycle of event centered care

The benefit of a public health degree in medical education

Joshua St. Louis

Medical Education

July 28, 2013

On a rotation in internal medicine last year during my third year of medical school, I spent several days watching the residents work to optimize a homeless patient’s insulin regimen. They were understandably concerned with his diabetes medications because he had been admitted in a diabetic coma, but the real reason for the coma, as far as I could see, had nothing to do with his medication regimen and everything …

Why more medical information does not lead to better health

Beth Waldron

Patient

July 28, 2013

As the director of a health education program at a public university, my work is predicated upon the belief that greater knowledge is the key to improving health outcomes. If patients and healthcare professionals simply had better access to the latest information on a particular medical topic—if they simply knew more about a diagnosis, treatment, or prevention strategy—then we’d surely see improved health outcomes.

I have come to realize this assumption is wrong. …

How to aggressively pursue population health

David B. Nash, MD, MBA

Health Policy

July 27, 2013

A good recipe is one that combines high-quality ingredients in appropriate quantities to produce a savory main course or a decadent dessert.

It strikes me that, in order to answer the Affordable Care Act’s call for us to aggressively pursue population health, we must first understand what the recipe calls for.

Dichotomous as it may seem, the primary ingredient for population health is accurate, comprehensive data on the individuals who comprise the …

Patients and clinicians don’t have the same goals in mind

Jessie Gruman, PhD

Patient

July 27, 2013

What we look for when we participate actively in our health care differs from what our clinicians, employers and health plans believe will result when we shift from being passive to active participants.

We don’t have the same goals in mind. Does this matter?

Ask patients who use the phrases “patient engagement,” “patient participation” or “patient empowerment” about their goals and we talk about having some measure of control over our health …

The societal cost of low health literacy

Mary S. Kelly, PhD

Patient

July 26, 2013

The mother, clearly agitated, came to my office holding a bottle of liquid antibiotic prescribed for her daughter’s ear infection. She asked, “How the hell am I supposed to get this into her ear?”

She could not read the directions, which said to give the medication by mouth.

A survey conducted between 2008 and 2010 by the Adult Literacy Program at Einstein’s Fisher Landau Center for the Treatment of Learning Disabilities found …

We are spending billions to train the wrong kind of doctors

Kenneth Lin, MD

Medical Education

July 26, 2013

Earlier this year, the physicians at my academic family medicine practice met with two senior officials from our parent health care organization to be oriented to its new initiatives and projects. Their presentation documented the organization’s ongoing investments of many millions of dollars into renovating subspecialty care suites and purchasing new radiology equipment that was likely to be highly profitable, but provide dubious benefits to patients.

Two of my colleagues asked …

Doctor bashing has become a national sport: How to stop it

Carla J. Rotering, MD

Physician

July 25, 2013

Doctors used to be among the most admired and respected persons in the community; now just a mention of this formerly revered title in a social setting will generate a totally different response.

Patients far too often will pour out stories of traumatic healthcare experiences, insults suffered, acts of disrespect or poor bedside manners, and disappointments in a system and in doctors who let them down. Doctor bashing has become a …

Reform creates new incentives in health care

Kohar Jones, MD

Health Policy

July 24, 2013

I advocated for the Affordable Care Act, and celebrated when it was passed.

It’s good to have everyone covered, I thought.

Insurance for everyone is the first step to health care for all.

Alas, access to health insurance isn’t the same as access to health care.

First there is the niggling detail of providers. We already have a primary care provider shortage. Internists, pediatricians, family physicians are already working at full capacity in caring for …

5 reasons why music would be great for digital health

David Lee Scher, MD

Health Technology

July 24, 2013

Music as a healing mechanism has been accepted for over 50 years. Music is a source of primal memory similar to that of smell. It has been used in brain injury patient management, as well as to promote wellness, manage stress alleviate pain, promote physical rehabilitation, and enhance memory in Alzheimer’s Disease patients. I have appreciated the power of music my whole life and as a physician and …

Beware of that new car smell when shopping for a new car

Dr. Charles

Conditions and Diseases

July 22, 2013

As I shopped for a new car last year, I realized that my priorities were considered odd by most car salesmen. The three most important characteristics I desired in a new car were good gas mileage, good crash safety, and relatively low concentrations of “new car smells.” The often celebrated (but particularly noxious) new car smell is actually a synthetic blend of respiratory irritants and potential carcinogens off-gassing from the …

There should be no quarterbacks in health care

Bob Doherty

Health Policy

July 20, 2013

The seemingly irreconcilable conflict between the medical and nursing professions usually boils down to one question: who is in charge? Physicians often use a football analogy: they are the quarterbacks of the team, calling the plays that others on the gridiron must follow, because of their greater training and skills. Advanced practice nurses (APNs) respond: not so, we are also highly trained and qualified to call the plays and lead …

Would C. Everett Koop be an effective Surgeon General today?

Peter Ubel, MD

Physician

July 19, 2013

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I have been thinking a lot about C. Everett Koop lately, ever since his death on February 25 at the ripe old age of 96 and more recently with the announcement that our current Surgeon General, Regina Benjamin, is planning to step down from that post. In particular, I have been pondering what made Koop such an effective Surgeon General, and what …

Confessions of a recovering doctor

Rob Lamberts, MD

Physician

July 18, 2013

Hi.

I’m Rob and I am a recovering doctor. Yeah, I am recovering … doing a lot better, actually. Things are tough, but they are a lot better since I left my destructive relationship with Medicare, Medicaid, and insurance companies. I’ve had to learn how to manage my own money (now that I can’t count on them to bail me out any more), but things are looking a lot better. I …

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Confessions of a recovering doctor

What is the biggest mistake patients make?

Alex Lickerman, MD

Physician

July 18, 2013

The biggest mistake patients make isn’t what you think. It isn’t turning down tests or treatments their doctors recommend. Nor is it deciding not to take the medicines their doctors prescribe. It isn’t insisting on getting a test or beginning a treatment their doctors recommend against, either, and it isn’t failing to exercise, stay out of the sun (or use sunscreen), quit smoking, or lose weight. No, the biggest mistake …

The 3 biggest HIPAA myths debunked

Mary Pat Whaley

Physician

July 17, 2013

As a healthcare consultant, it is not unusual to be asked about HIPAA regulations on a weekly basis. Three questions come up regularly and seem to cause the most confusion when discussing HIPAA. I call them the Three Big HIPAA Myths – you can’t place medical charts on exam room doors, you can’t use sign-in sheets, and you can’t leave messages on patients’ voice mail or answering machines.

Here, then are …

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The 3 biggest HIPAA myths debunked

Doctors should give patients their damn data

Zackary Berger, MD, PhD

Physician

July 16, 2013

There are plenty of books out there to teach us how to boldly and proudly advocate for ourselves in the doctor’s office. Doctors have held the reins too long, goes the …

Do corporate wellness programs work?

Trudy Lieberman

Health Policy

July 15, 2013

On a recent trip to Lincoln, NE, I visited Lincoln Industries, a company that makes chrome trims for Harley-Davidson motorcycles. I was curious about the firm’s award-winning wellness program, especially since more employers are penalizing workers by making them pay more for their health insurance if they fail to meet certain health goals.

At the heart of Lincoln Industries’ wellness program is its Platinum Scorecard, which awards points to workers who …

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Do corporate wellness programs work?