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.
Recently a patient of mine brought in a bottle given to her by her acupuncturist. She had turned to acupuncture with my encouragement after traditional medicine fell short at addressing her chronic pain. Indeed, there is data to support the efficacy of acupuncture in the management of chronic pain. I was encouraged to hear that this treatment, often labeled as “alternative,” seemed to be helping her substantially.
However, my patient’s questions …
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How to know whether alternative medicine is safe
A fascinating op-ed piece by Brigham and Women’s physician and Harvard Medical School professor Jerry Avorn appeared on June 11th in the New York Times. It’s called “Healing the Overwhelmed Physician.” What the ‘overwhelmed physician” about whom Dr. Avorn writes is overwhelmed by may surprise you.
It surprised me.
Looking at the title of the piece, I thought it might be about the emotional toll of practicing medicine, which may contribute …
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One source of information that never feels overwhelming
Patients do need the power to complain about bad doctors and, trust me, there are some bad doctors out there. That being said, the other way for patients to get some retribution is to stop seeing that doctor. Word of mouth will spread, like any other business, and that doctor’s business goes under.
Right now, state boards allow patients to complain about anything and they have to investigate that complaint. …
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Allowing patients to define a medical adverse event
Your front office staff are the face of your practice — an expression of your practice’s philosophy, attitude, and values. So it should be a top priority to hire and retain top-quality people to fill such roles as receptionists, phone operators, medical secretaries, and transcriptionists.
But it can be a challenge to keep these people and keep their morale high because these positions often include high levels of stress for low …
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Finding and keeping great front office staff
Everyone has opinions. You probably know what they say about that. But leaving aside the olfactory qualities of all the opinions to which we are entitled, we at least tend to know when our opinions are just opinions. But not with nutrition, where not only does everyone have an opinion, but everyone seems to think theirs is an expert opinion. And our culture seems to be okay with that. I’m …
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Not everyone who has an opinion on nutrition is an expert
A recent survey found that 60 percent of adults have gone online at least once in the past year to look up health information. Unfortunately, finding high-quality health websites is a challenge. Several years ago, a review of 79 studies published in the Journal of the American Medical Association concluded that online health information for consumers is frequently flawed, inaccurate, or biased. Based on my experience, the …
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How to evaluate health websites
Tests like cholesterol levels are considered screening tests because they are cost effective, have high sensitivities (a low rate of false negatives), and have been proven to be beneficial in the identification of conditions that may require treatment before symptoms occur. The vast majority of medical tests are not considered to be “screening” because they violate one or more of these principles, …
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Should drug testing be considered screening tests?
A post I wrote nearly three years ago has recently gone viral, bringing tens of thousands of readers and a huge number of comments. It’s a letter I wrote to my patients who do something that all but guarantees a bad relationship with many (if not most) physicians: they don’t get better.
There are basically two responses I get to this post: either readers are grateful to have a doctor admit …
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How can we fix the doctor-patient relationship?
Jeff Goldsmith recently opined on why practice redesign isn’t going to solve the primary care shortage. In the post, Goldsmith explains why a proposed model of high-volume primary care practice — having docs see even more patients per day, and grouping them in pods — is unlikely to be accepted by either tomorrow’s doctors or tomorrow’s boomer patients. He points out that we are replacing a generation of workaholic boomer …
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Primary care doctors need 35 hour work weeks
A dichotomy has emerged as we consider the best way for women physicians to realize both their potential and their dreams in the service of patients and society. One position states that women have to internalize behaviors that are known to result in success and are based on a long history of professionalism, albeit developed for and by men physicians over the last 100 years. This is more along the …
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How should the workplace accommodate women physicians?
In the Department of Public Health (DPH) clinics in San Francisco, CA, demand for doctor’s appointments far outweighs supply. This has been especially dramatic in clinics that have switched to “open access” scheduling, an innovation that allows patients to schedule same-day or next-day appointments. Open access is meant to eliminate long waits for appointments, but the reality is that often dozens of patients call for a limited number of appointments. …
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How teamwork can help improve primary care access
In 2009 I wrote a post titled “Quality or Conformity,” where I pointed out that many of the quality measures in primary care have more to do with whether doctors follow guidelines than if they deliver care that helps patients live long and well. There is a tendency to focus quality efforts on measuring what is easy to measure, rather than what matters the most.
That phenomenon is called …
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Quality is a word that lacks universal meaning
Do you want to know if your doctor has been eating pizza for lunch that was purchased by Pfizer as she listened to a drug rep describe a new medication? Do you want to know if your endocrinologist has been paid $1,500 to give a brief talk about a new injectable diabetes medication to his colleagues as they gobble down filet mignon? If the answer is “yes,” then you are …
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Should the Sunshine Act be celebrated?
My time as a medical student has quickly come to an end. This past winter, with nearly four years of arduous study, countless examinations and numerous clinical rotations under my belt, I couldn’t help but think, Yes, I’m ready to be a doctor.
And then I became a patient.
I’d always thought I knew what it’s like to be the patient. For much of my childhood, my father suffered from chronic fatigue syndrome, …
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It’s hard to grasp the experience of being a patient
I recently completed my last day as chair of the ABIM, and ended my eight-year tenure on the Board. In this blog – a bookend to the one I wrote at the start of the year, which went near-viral – I’ll describe some of our accomplishments this year and a few of the challenges that I leave my talented successors to grapple with.
I had two very tangible tasks to …
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Dr. Wachter reflects after completing his term at the ABIM
As a little boy I had a dream that I have always wanted to join the circus. I thought for sure I could be a clown or even the ringmaster. At age 34 a friend who did public relations for Ringling Brothers and Barnum & Bailey Circus gave me the opportunity to make my dream come true and I was invited to be a clown in the circus.
The show was to …
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Physicians: Learn to pick up the proverbial poop
As with most things in life, romantic relationships are, for many of us, a double-edged sword: while most find it wonderful to love and be loved, developing intimate emotional ties to someone makes us emotionally vulnerable—vulnerable not only to being hurt by our partner’s opinions of and feelings toward us, but also vulnerable to being affected by our partner’s bad moods. If a colleague or a friend gets depressed, we’re …
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What to do if your partner is in a bad mood
If you are a healthcare provider—physician, administrator, or some other leader at a healthcare site—then you know that you face many challenges. Some seem overwhelming and you may be thinking that you may not be able to handle some of them well. Perhaps the transition to ICD-10 coding is your main concern right now.
The solution to difficult challenges begins with the first step. I am taking the liberty of adapting …
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The transition to ICD-10: Where to begin?
As we celebrate Independence Day, I ask that you consider taking care of a few TRICARE patients as a way of thanking our service members for their sacrifice. I must admit I originally avoided taking care of any TRICARE patients because of the low pay. When one of the surgeons I work with first talked about caring for some of the military families, I gave a large internal groan as …
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Help military families with TRICARE
