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.

Income inequality among physicians should matter to patients

Manoj Jain, MD, MPH

Physician

November 27, 2012

Recently, a medical student confided in me a thought that few in our profession would dare say aloud: “We may have come to medical school to help people, but we choose our specialty careers based on potential salaries.”

This in part explains why the most-prized residencies are in fields such as dermatology and radiology, whose procedures generate high fees. According to a physician survey by the Medical Group Management Association, the …

Click, click, click: How can I help you today?

Stewart Segal, MD

Physician

November 26, 2012

Click, click, click, “Hello, how are you today?”

Click, click, click, “How long have you had a sore throat?”

Click, click, click, “Have you had a fever?”

Click, click, click, “Have a seat on my exam table, please.”

Click, click, click, welcome to my day. Let me introduce myself, I’m a professional clicker. I used to be a member of a highly respected and sought after profession; a doctor. The modern world of government/insurer …

Mean doctors and nice nurses: It’s time to change our brand

Karen S. Sibert, MD

Physician

November 26, 2012

In my hospital’s preoperative area, upright on her bed, sat an unhappy middle-aged lady who needed an operation to treat complications from her previous bariatric surgery. She hadn’t lost weight and clearly was feeling discouraged about practically everything. She was physically uncomfortable, couldn’t even keep down her own saliva because her lower esophagus was obstructed, and was in tears.

As her anesthesiologist, …

Why aren’t more people talking about physician suicide?

Pamela Wible, MD

Physician

November 26, 2012

I live in Eugene — a sweet little community with snow-capped mountains, farmers’ markets and the friendliest people around.

But a few weeks ago, one of our beloved pediatricians shot himself in the head in a public park. Earlier this year, one of our surgeons was found dead in his car from carbon monoxide poisoning.

And just before him, a urologist shot himself in the head in his backyard. Before him, a …

Does the use of digital medicine preclude human connection?

Heather Logghe, MD

Physician

November 26, 2012

In a recent New York Times article, “Redefining Medicine with Apps and iPads,” Katie Hafner describes a “generational divide” in medicine. On one side sits the younger generation, at ease navigating EMRs and diagnosing disease with the assistance if digital apps. On the other side of this presumed generational divide, she describes the older generation, worried “that the human connections that lie at the core of medical practice …

Why patients should pay doctors directly

Stephen C. Schimpff, MD

Health Policy

November 25, 2012

There are distinct advantages for the patient who pays the primary care physician (PCP) directly: higher quality, lower cost and greater satisfaction.

The fundamental problem in health care delivery today is a payment system that is highly dysfunctional leading to higher costs, lesser quality and reduced satisfaction. The core problem? The patient is no one’s customer. With employer-based insurance, the physician’s customer is the insurance company that sets the rates, defines the rules and accepts …

A doctor reflects on the cusp of retirement

David Mokotoff, MD

Physician

November 25, 2012

June 30, 2014. I don’t need to have this date circled on my calendar, or on my phone calendar reminder app. It is now etched in my brain. That is the date of my anticipated retirement from private practice. It is hard enough for me to grasp that next summer I can enroll in Medicare, let alone quit working––something I have done with only one brief 3 month break, since …

What would your personal health checklist look like?

Barbara Bronson Gray, RN and Alexandra Yperifanos

Patient

November 24, 2012

Think of a time when you’ve felt very sick, maybe a case of pneumonia, a bad bout of the flu, or a more serious illness.

You probably didn’t feel much like “engaging” with people. That’s the term health advocates use to describe what patients need to do to be effective in managing their health care.

It’s very hard to act like the CEO of your own body when you’re unbelievably tired, or …

Why doctors need to care about price transparency

Kathy Nieder, MD

Health Policy

November 24, 2012

As healthcare costs become a bigger and bigger chuck of our Gross Domestic Product (GDP), price transparency is a subject that insurance companies and patients are talking about. The idea of knowing how much something costs, be it canned black beans in the grocery store or replacing the leaking faucet in your kitchen, seems obvious but it will be an uphill battle to enact change within the healthcare system.

The concept …

Society must come to a conclusion on how important human suffering is

Pinak S. Joshi

Physician

November 23, 2012

The art and practice of medicine is built around lessening the suffering of our fellow man. The method of doing this however, has changed dramatically throughout human history. Western medicine had its beginnings in the restoring balance to the body that was not in sync with the environment. As scientific reasoning found its way into medical practice after the dark ages, the benefits of medicine quickly became a cornerstone of …

A spectrum of medical talent to solve the primary care shortage

Anthony Brenneman, PA-C

Physician

November 23, 2012

We’ve all seen the data projecting a shortage of physicians in the United States, expected to reach a shortfall of more than 90,000 by 2020. The lack of nurses is equally well documented. These trends raise concern for all medical specialties, but especially for primary care.

More and more Americans are expected to need these services in the coming years, at a time when fewer and fewer students are committing to …

Without patient participation, there is no patient engagement

Mack Baniameri

Health Technology

November 22, 2012

Healthcare innovation companies are just beginning to understand technology challenges that come with engaging patients with chronic diseases in care management and care transition. Many of healthcare IT vendors assumed that a simple access to portals with half-baked information and fragmented medical records will do the trick. Boy… were they wrong!

For the past twenty years, the HIT industry has focused on developing software solutions exclusively for healthcare providers. These companies …

How entertainment has altered our desire for diagnosis

Kevin R.R. Williams

Patient

November 22, 2012

I remember, some years ago, sitting with a relative across a large wooden desk in a doctor’s private office. We discussed symptoms for half an hour during an initial consultation. On a different occasion, I recall another doctor pinning an MRI on the wall, circling an area and articulating exactly why the radiologist overlooked a diagnosis. There once was a doctor who stood bedside, outlining what was known, what was baffling and …

A FAQ on the Lisfranc injury

Edward Pullen, MD

Conditions and Diseases

November 22, 2012

Sports fans have heard a lot about football players with Lisfranc injuries recently. Maurice Drew-Jones, running back for the Jacksonville Jaguars and Santonio Holmes, receiver for the New York Jets, have been in the news. Matt Schuab, QB for the Houston Texans missed last season from a Lisfranc injury.

Many of you may know that a Lisfranc injury is a type of foot injury and that it can sometimes be very serious …

Read more…

A FAQ on the Lisfranc injury

Repeated story syndrome: Finding the right balance for patients

Ishani Ganguli, MD

Physician

November 21, 2012

The other night, a patient gave me a piece of his mind. Mr. Q was a middle-aged man debilitated by days of nausea, vomiting and intractable belly pain. That morning, his wife finally convinced him to get medical attention and drove him to our emergency department. On arrival, he sat in a cubicle in the waiting room and explained his story to a triage doctor: how he was doing well …

Enough with government interference in the patient-doctor relationship

Bob Doherty

Health Policy

November 21, 2012

Worried about a government takeover of health care?

You should be, but it isn’t the bureaucrats and politicians in Washington that you should be most concerned about. Instead, it is the growing propensity of state legislators to dictate to physicians what they can and can’t say to their patients, what tests they must provide, and what advice they must give to them—the patient’s wishes, the medical evidence, and the physician’s clinical …

If pilots worked like doctors, the sky would rain planes

PalMD

Physician

November 20, 2012

“This note was produced using [mega-brand] medical dictation software. While every effort has been made to insure accuracy, errors may still exist.”

Really? What kind of doctor would admit in a medical chart to being too lazy or incompetent to produce an accurate record?

A lot of them. Dictations are easy to read if you are willing to confound legibility and accuracy. Dictation software is relatively cheap, and with the continued profusion …

Why there’s still value in the routine physical

John Mandrola, MD

Physician

November 20, 2012

Millions of Americans believe in the practice.

Government reformers believe in it.

Doctors too.

Heck, even I, an accused therapeutic nihilist, tracked down a poor soul who agreed to be my primary care doctor. Call it old-fashioned, but I wanted my own doc, and I wanted yearly “checkups.”

No procedure—not even AF ablation–is as good as prevention. Taking your body in for routine checks and scheduled maintenance makes perfect sense. Call such a notion–obvious.

But …

The futile attempt to provide cheaper care to poor people

Margalit Gur-Arie

Health Policy

November 20, 2012

Wherever health care reformation and transformation is discussed, sooner or later the imperative of patient engagement is sure to materialize. Patients, it seems, are no longer content to be passive spectators while care is administered to them, and instead are demanding to be active participants in their own health care decisions. Gone are the paternalistic days of doctor knows best, replaced by informed and educated patients on an equal footing …

Why I hate the SOAP note

Suzanne Koven, MD

Physician

November 19, 2012

Medicine, like law, the military, and many other professions, has its own language–a kind of verbal secret handshake by which its members recognize one another and close ranks against outsiders.

Sometimes, the use of technical terms, abbreviations, and other forms of jargon can impair patients’ understanding of their medical care. This article discusses the extent to which clinicians overestimate patients’ “health literacy“–with potentially dangerous results.

But sometimes, medical lingo has …

Read more…

Why I hate the SOAP note