As of early April, you can walk into Walgreens in 18 states (plus D.C.), and along with a gallon of skim milk, a pair of photo mugs, a six-pack of toilet paper, and a flu shot, you can meet your new primary care provider, get your cholesterol checked, pick up your statin, and schedule a return visit. That primary care provider will not be …
Free nurse practitioners from their arbitrary bondage
This month I hit a milestone on my Sina Weibo microblog; I finally reached 10,000 fans. It took more than two years, and I suppose I could have sped it up by paying for fake zombie fans. However, I preferred to earn this honor with good old fashioned hard work. Ten thousand fans is a tiny amount compared to many Chinese microblogs, including several at my own hospital like our …
Social media in China: Does it make me a better doctor?
How are you feeling today? Do you feel a bit under the weather? Maybe you have some aches and pains, or a miserable flu, or maybe you have some chronic condition like diabetes or asthma, or some other ailment. Perhaps you could benefit from medical attention, but then again getting medical care is so darn inconvenient and expensive and time consuming, and everybody knows that our health care system is …
Health delivery models that require a less costly skill mix
I would like now to delve into what I consider critical elements of patient-centric care. They all involve technology to various extents.
1. There must be buy-in from providers. I am including payers, healthcare systems as well as clinical providers in this category. While I realize that much of healthcare is devoted to satisfying legal and regulatory mandates, there is great opportunity to improve the care experience (and dare I say …
5 critical elements of patient-centric care
In her post, “The only thing that truly separates doctors from nurses,” Dr. Leng is right that our current system creates a great deal of confusion for patients. Clothing, titles and even the word “Doctor” are no longer clear enough for people to understand which member of the health care team is caring for them. However, her suggestion that ultimate responsibility for the patient is the only distinguishing feature …
Independent nurse practitioners are not the primary care solution
I recently spoke at the Student National Medical Association’s (SNMA) Annual Medical Education Conference in Louisville, KY. Accompanying me was former SNMA President Bryant Cameron Webb, MD, JD. We covered three main topics in our workshop: medical education, the practice of medicine, and the underserved.
Medical education
Many people believe that there is, or soon will be, a physician shortage. There are nearly 1 million physicians scattered across America representing a ratio …
Reflections on medical education, medical practice and the underserved
The shortage of primary care physicians in the U.S. has become a national theme. A common proposed solution to this shortage – and a central component of the patient centered medical home – is team-based care that utilizes various non-physician health care professionals as well as electronic communication. The idea is that many functions carried out by physicians can be done by nurse practitioners, physician assistants, nurses, and others on …
Should primary care limit its scope of work?
If I were asked “Why should a clinician prescribe an app?” I would answer as follows:
Because it’s likely to help the patient reach his or her most important health goals, and is a good fit within an over-arching medical management plan.
In other words, if the goal is to provide sensible medical assistance to patients and families, the use of an app should be likely to:
Thoughtful recommendations of health apps
When I was growing up in the 1960s, at the height of the Cold War, there was always some smart aleck boy on the playground who had “facts” to share about the Soviets. His recitation was meant to emphasize how weird, how different, how other our arch enemies were. “They make you wear all brown and gray there.” “They eat only boiled cabbage and potatoes.” “They tell you what to …
Is there still sexism in medicine?
Every primary care doctor has been faced with this situation. A patient reports vague symptoms and is very worried that they are a sign of a catastrophic illness. The symptoms aren’t even slightly suggestive of the disease the patient is worried about, but the patient’s neighbor’s brother-in-law was just diagnosed with the same disease, and so the patient is pretty sure that …
Ordering tests just to reassure patients doesn’t work
I have found that many physicians have a strong desire to serve, yet often don’t know where to begin or if it is the right move for them both personally and professionally. I believe that by answering a few simple questions, a physician can decide if a mission is right for them.
1. Decide where you want to help. Hailing from Africa, I wanted to return to the poorest regions such as …
How to know if a medical mission is right for you
When I came to medical school, I was certain I wanted to do primary care. Despite the forces that steer many of us off the path – how many times have we heard, “but you’re too smart to do primary care!”? – after three years of medical school, I was still committed to primary care.
But I struggled with which type of program would be best for me. I applied to both …
Why family medicine was the best choice for me
American Medical News has an important article – Will a “silent exodus” from medicine worsen doctor shortage?
Frustrated by mounting regulation, declining pay, loss of autonomy and uncertainty about the effect of health system reform, doctors are cutting back the number of hours they work and how many patients they see.
Between 2008 and 2012, the average number of hours physicians worked fell by 5.9%, from 57 hours a week to 53, and doctors …
How the silent exodus will worsen the doctor shortage
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As doctors, we’re typically compensated for the work we do, not the hours we spend. Our jobs are structured so that we’re taxed for time, making even the most routine office visit feel like a race against the clock. Trying to develop a long-term strategy with a patient in this context is not time-efficient. It is, in fact, incredibly frustrating.
Yet medicine is a team effort, and we understand that we’re …
4 ways to beat time constraints and guide patients to better health
“Patient engagement.”
What is patient engagement? It sounds like a season of The Bachelor where a doctor dates hot patients. It wouldn’t surprise me if it was. After all, patient engagement is hot; it’s the new buzz phrase for health wonks. There was a even an entire day at the recent HIMSS conference dedicated to patient engagement. I think the next season of The Bachelor should feature a wonk at HIMSS …
This is what patient engagement really is
In late fall of 2011, I was tired of medicine. While seeing patients was still enjoyable, I felt underappreciated in my employment and frustrated by the endless BS that I dealt with — new laws undermining the trust my patients place in me, increasing requirements from insurance companies for ordering tests or medications, more forms to sign, less time with patients, a cumbersome EHR to learn, more non-CME education requirements …
How social media recharged this physician
Since an iron lung costs quite a few dollars, the prevention of polio cannot make sense. Right? If that one has you scratching your head, with a “say what?” dangling from your lip, we are on the same page. Let’s populate it accordingly. Of course prevention can save dollars. But that will only be the case when what we refer to as “prevention” really makes sense.
Prevention isn’t about saving money: It’s about saving lives
Think of the last few times you watched a popular movie that involved any kind of sex scene? Not as in pornographic sex, but as in two characters ended up in bed together and had, ahem, conjugal relations.
In how many of those scenes did either participant make mention of a condom before the act?
We face a public health crisis of sexually transmitted …
Hollywood needs to make condoms sexy
Growing up, I am sure you heard many “why” questions, such as: “Why is your room so messy?” and “Why didn’t you eat your vegetables?” I am quite certain those questions made you feel defensive. Patients also feel defensive when we ask them ”why” questions. In other words, “why” questions set people off. These types of questions can turn a usually-friendly patient into an angry nightmare.
Here is an example. Your …
Stop asking why and strengthen your relationships with patients
When the American College of Emergency Physicians (ACEP) decided not to join the Choosing Wisely campaign, I was among those who expressed disappointment with this decision, in part because I have long been a proponent of efforts to encourage more cost-effective care in the ED. In fact I had already independently done a significant amount of work in the development of such strategies.
I recognized that there were legitimate concerns …
Choosing Wisely: Less dogmatic language is needed
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