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.
As the weather heats up and the allure of grilling returns, it is important to consider some of the potential health risks. One of the great joys of my life is “manning” the grill – beer in hand, wafting smoke rising through the air, a delicious anticipation building. It seems worth the risk of consuming carcinogens present in the smoke …
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Grilling with aluminum foil: What are the health risks?
Let me start by saying that I am by no means an expert in medical oncology and I have great respect for what my colleagues in this field are able to do for their patients and their families.
From my earliest days of internal medicine training at the University of Virginia, I can remember the oncologists as being some of the most caring and compassionate physicians around. However, recently I came …
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Ask patients if they feel comfortable asking questions
Physicians are bothered by their patient’s fear. One of the worst parts of actually caring is that when other people suffer and especially when they are frightened, you suffer with them. It is bad when the trepidation is about something real, such as a new disease, but it is particularly disturbing when the source of the fear is confusion or bad information.
There are several common sources of inaccurate terrifying data. …
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Looking up health information online: Do you really trust your doctor?
Below find excerpts of an email sent by a faithful reader. I have included the whole text, but broken it down to respond to each point accordingly.
I have really enjoyed your blog postings and the sensitivity you showed toward patients. But, your new venture is a real turn off, and makes it hard for me to want to read your posts anymore.
I have been waiting for this. Expecting it. I knew …
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Responding to patient concerns after changing my practice
“Maybe we shouldn’t urge people to engage in their health care: it sets them up for failure and punishment from their clinicians.”
A senior patient advocate and researcher recently made this comment to a gathering of experts in patient engagement.
For a few minutes, I was inclined to agree with her. I thought back over the previous three months: the passive aggressive (and aggressive-aggressive) responses of some of my clinicians to my …
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Does patient engagement set patients up for failure?
Since I’ve always had an interest in food and nutrition, as a young nurse and student, I just assumed that all health care providers assessed nutrition. After all, we know how important it is. However, as a staff nurse in the ER and a nurse practitioner doctoral student, I learned that wasn’t true. Many providers in both arenas reported it was not the priority that medication and disease management were.
Throughout …
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It is not feasible for a provider to be expert in everything
As a medical student nearly two decades ago, I remember how excited I was to begin my rotations on the wards. After two intense years in the classroom, I felt that I had a good fund of knowledge that I could finally apply in a clinical setting. Still, very soon after beginning my ward rotations, I noticed that while I was able to adequately manage my patients’ symptoms, I could …
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The soul of our vocation is to heal our patients
There was a hole in the wall of our bathroom that was a painful reminder of a bad encounter with a plumber. Yes, that hole has been there about a year, and it has been on my to d0 list for the duration, daring me to show if I inherited any of the fix it genes I got from my father. Why not hire someone to come fix it? I …
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The ultimate DIY project: Create your own EMR
Exercise is good for you. Eat more fruits and vegetables. Stop smoking. Drink less alcohol. Such messages abound in public health campaigns and there is a firm belief that they will ultimately change behavior. This is based on the assumption that individuals are motivated to change behaviors to reduce their individual health risks.
While healthy individuals may understandably ignore such messages, one would certainly assume that people who already have conditions …
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Simply knowing about health risks does not change behavior
One reason is to apply an extra “facility fee” to patients’ bills.
Another reason is that primary care docs generate a ton of money for the hospital. A new survey was sent to hospital chief financial officers across the nation and based on data submitted by 102 facilities, it found that PCPs generate more annual revenue than specialists do.
PCPs (defined in the survey as family physicians, general internists, and pediatricians) generated a …
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Why do hospitals buy primary care practices?
For most of our patients, the student run homeless clinic is the last stop in a long, fruitless search for healthcare in the city of New Orleans. Recently, an insulin-dependent diabetic came in who had his insulin pump stolen, an unfortunate side-effect of homelessness. The physician prescribed a 150 dollar-per-month supply of insulin—far out of our price range—not knowing how much insulin costs. This was in addition to a sixty-dollar …
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One expensive patient can prevent treating a dozen others
A few months ago marked the 20th anniversary of the launch of evidence based medicine (EBM). Now seems a good time for a retrospective. After twenty years what does EBM mean? Where has it taken us? What are the distortions and unintended consequences? You might be surprised.
What I intend to do is start with a little of the history of EBM, talk about the essential notion as originally conceived by …
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Where has evidence based medicine taken us in 20 years?
As a third-year med student, I was doing an ER shift when the call came through our dispatch: 56-year-old man, status epilepticus, being flown in from Yosemite, 10 minutes out. I watched the residents snap into a semi-ordered chaos. Ten crucial minutes. Prepping the trauma bay. Anticipating acute management, who was going to do it, half-tying the yellow paper gowns. Anyone who had looked tired didn’t anymore.
We raced in the …
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Doctors think about their patients all the time after they leave
During my ambulatory care rotation, I got the opportunity to tag along with my attending on a house call to a geriatric couple. The husband, “Joe,” had recently been in the hospital for severe respiratory illness. His wife, “Sally,” had recently fallen and broken her hip and was recovering from a hip replacement.
While my attending checked on Sally, he advised me to talk to Joe. We chatted a while about …
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Why medical residents should do house calls
The Atlantic this week published a provocative article entitled “The Robot Will See You Now.” Using the supercomputer Watson as a starting point, the author explored the mind-bending possibilities of e-care. In this near future, so many aspects of medicine will be captured by automated technology that the magazine asked if “your doctor is becoming obsolete?”
The IT version of health includes continuous medical monitoring (i.e. your watch will …
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Will patients trade human imperfection for computerized perfection?
So how’s my new practice going? In some ways things are going about as well as they could. My patients are amazed when I answer their emails or (even more surprisingly) answer the phone.
“Hello, this is Dr. Lamberts,” I say. This usually results in a long pause, followed by a confused and timid voice saying something like, “well…uh…I was expecting to get Jamie.”
Yet I am often able to deal with …
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What I look for in an EMR: Think of a good story
