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.

Our most scarce health resources are asked to carry the largest load

Jordan Grumet, MD

Health Technology

March 26, 2013

It happened, of all times, when I was in the car driving the kids to violin practice. My pager buzzed with a message from one of the medical floors. I waited till the car was parked, and dutifully pecked the numbers on my cell phone.

Hello doctor, we have your patient, can you please put admitting orders into EPIC?

I, of course, like most doctors, wasn’t sitting by my phone waiting at a computer terminal. …

7 tips to improve your patient presentations

Edward Leigh

Patient

March 24, 2013

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A presentation to patients is an excellent tool to communicate your message. However, the material must be presented in an effective and powerful manner. These tips will help you deliver dazzling presentations.

1. Know your audience. Sounds obvious, but unfortunately I have seen many presentations delivered to patient groups that were full of medical jargon and complex slides. Think about how people speak …

8 reasons why your practice needs to stay open during lunch

Cheryl Bisera

Physician

March 24, 2013

Most professional business enterprises nationwide understand that they could never expect to compete in the marketplace if they shut down their phones 20 – 25% of important business hours every day. Yet that is exactly what your medical practice is doing if you are shutting your phones down for a “lunch break”.

You might be wondering how important can this really be for a medical practice? Can’t patients just wait an …

Only one company can deliver the perfect EMR: Google

Rob Lamberts, MD

Health Technology

March 22, 2013

For the record: I am a geek. I love technology. I adopted EMR when all the cool kids were using paper. Instead of loitering in the “in” doctors lounge making eyes at the nurses, I was writing clinical content and making my care more efficient. I was getting “meaningful use” out of my EMR even when nobody paid me to do it.

But …

Why OB/GYNs are not primary care physicians

Lucy Hornstein, MD

Physician

March 21, 2013

You may have heard of the “Dean’s Lie“, the artificial padding of numbers allowing medical schools to claim ever-increasing percentages of their graduates are going into primary care medicine. This is accomplished by counting everyone going into internal medicine, pediatrics, and med-peds, in addition to family medicine as “primary care.”

It makes their schools sound more attractive by seeming more progressive, but it does nothing to enhance the supply …

Measuring quality: What doctors and teachers have in common

Shirie Leng, MD

Health Policy

March 21, 2013

I was watching Jon Stewart recently, and he had Michelle Rhee on. For anyone who doesn’t know her, she’s the superintendent of schools in Washington D.C. who made a bunch of reforms that caused some controversy and resulted in her being one of the main spokespersons for education reform in this country. Her conversation with Jon made me realize the similarities between …

Dear lawmakers: This is what it’s like to be a doctor today

Matthew Moeller, MD

Physician

March 20, 2013

I am writing this letter because I feel that our leaders and lawmakers do not have an accurate picture of what it actually entails to become a physician today; specifically, the financial, intellectual, social, mental, and physical demands of the profession. This is an opinion that is shared amongst many of my colleagues. Because of these concerns, I would like to …

AMA: Helping physicians thrive in an evolving healthcare system

Jeremy Lazarus, MD

Health Policy

March 20, 2013

A guest column by the American Medical Association, exclusive to KevinMD.com.

As American health care continues to transform, physicians in every state and specialty are attempting to comply with new rules, expectations and costs, and must evolve to meet new health care demands. The American Medical Association (AMA) is committed to helping physicians not only navigate the changing environment, but thrive in …

Doctor ratings need to be physician driven

Kevin Pho, MD

KevinMD

March 19, 2013

In the new book, Establishing, Managing, and Protecting Your Online Reputation, physician ratings are highlighted. This is a topic that gives many physicians some pause, and for some, causes tremendous anxiety.

Whether doctors know it or not, they already have online profiles. Third-party rating sites, like Vitals or Healthgrades, already have web pages of most physicians, and they …

Comprehensive annual physical exams have no scientific value

Davis Liu, MD

Physician

March 18, 2013

Is the Ontario Annual Physical Exam going the way of the dinosaur? That appears to be the case for healthy individuals between the ages of 18 to 64 in the Canadian province of Ontario. Effective in 2013, these patients no longer would have available an annual physical examination, but instead a “personalized health review.”

The new personalized health review would only be available to those who were healthy and did not …

Empower whistleblowers to improve the health of all Americans

Kenneth Lin, MD

Physician

March 18, 2013

The first instinct of a bureaucracy is self-preservation, and health care bureaucracies are no exception. This rule applies not only to government agencies, but to academic and industry settings as well. This was the conclusion I came to after listening to a panel of scientist and physician “whistleblowers” at the Selling Sickness 2013 conference in Washington, DC.

One by one, they described their painful discoveries that widely prescribed …

Can group visits be an ideal way to practice primary care?

Joshua St. Louis

Medical Education

March 16, 2013

After a long day on the internal medicine ward at St. Elizabeth’s Medical Center, I rushed across town to lead that evening’s two-hour group diabetes visit at Union Square Family Health Center in Somerville, MA. So when my preceptor asked me if I’d lead the group on a field trip after the two-hour visit, it was the last thing I wanted to do.

Although we had discussed taking our Brazilian patients …

Health reformers fail to hold patients accountable for health costs

Kevin Pho, MD

KevinMD

March 15, 2013

To cut costs in our health system, reformers target the massive of waste. One way to reduce waste is to change the way doctors are paid. The fee for service payment system, they say, encourages doctors to prescribe more expensive care, which lines their pockets and drive up the cost of care.

To combat this trend, reformers often have providers in their crosshairs, …

The key for patient satisfaction is physician satisfaction

Dike Drummond, MD

Physician

March 14, 2013

In these early days of pay for performance (P4P) reimbursement, as the size of your paycheck begins to reflect your patient satisfaction scores, let’s have a frank discussion about three important topics all healthcare providers and organizations must understand going forward.

How your performance will be measured
How to get the highest patient satisfaction scores and be a happier doctor at the same time
The first step to improving performance …
Read more…

The key for patient satisfaction is physician satisfaction

My workflow for going through old paper charts

Leslie Kernisan, MD, MPH

Physician

March 14, 2013

A few months ago I wrote a post about the 159 page digital fax that I received, containing records for a patient’s recent lengthy hospitalization.

I’ve now discovered something even more time-consuming and annoying: a 202 page paper record mailed to me by a major medical system. (I won’t name names right now; suffice to say this system uses Read more…

My workflow for going through old paper charts

Why the primary care physician shortage is overblown

Peter Ubel, MD

Physician

March 14, 2013

Are there really too few primary care physicians? And if so, what can we do to solve the PCP shortage? The standard answer to the first question is “yes, we have too few PCPs.” And the standard solution is to train more such docs, or allow more foreign-trained primary care docs into the country or, better yet, simply pay PCPs more money, so that graduating medical students will be more …

Is this the year Congress repeals the SGR?

Bob Doherty

Health Policy

March 13, 2013

An elderly doctor passes away, and he find himself standing before the Pearly Gates. The Almighty greets him and says, “In recognition of your stellar life of service to your patients, family and community, I welcome you to paradise. And because I know that doctors have a great sense of curiosity about all things, you can now ask me any question—any—and I will answer it.” The doctor ponders for a …

Doctors: Pronounce the names of your patients correctly

Deep Ramachandran, MD

Physician

March 13, 2013

I have it on good authority that it’s not easy being green. But I’m willing to wager that it’s a whole lot easier when you have a lovable name like “Kermit.” Imagine being green (or brown) with a name like “Ramachandran”? Growing up with a name like mine certainly had its disadvantages. While most neighborhoods have a local bully who kicks ass and takes names, in my case, he would …

ACP: 5 excuses physicians and patients should question

Yul Ejnes, MD

Physician

March 13, 2013

A guest column by the American College of Physicians, exclusive to KevinMD.com.

Whether we call them “unnecessary,” “not indicated,” “inappropriate,” or “overused,” certain tests and procedures add little or no clinical benefit to patients and in some cases they cause harm. They also contribute to the cost of care without improving care. At a time when payers are challenging payment …

Home genetic testing raises more questions than answers

Lucy Hornstein, MD

Physician

March 12, 2013

A reader recently wrote:

My [spouse] and I are 63 and childless. We are thinking of spending $99 to get genetic screening on the theory that it could help us plan a little better for our old age. Just as a random example, if I knew my chances for getting Alzheimer’s disease were high, I might want to move into assisted living sooner rather than later. We have many questions. Is …

Read more…

Home genetic testing raises more questions than answers