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.
A patient I’ll call Mildred came to her appointment and handed me a report from a medical screening fair at her church. She wanted to know what to do about it. The print-out said that she had a “mild” blockage in her carotid artery. They told her to discuss it with her primary care doctor (me).
You may have seen the advertisements in your local paper, or even on your local …
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Companies should not scare us to sell unnecessary screening exams
Personal genomic tests are laboratory tests that examine up to one million or more genetic variants from a sample of saliva. These tests are available directly to consumers without involving a health-care provider. Test results are sometimes interpreted with the intention of informing disease risk and prevention strategies. Personal genomic tests are now widely available and sold directly to consumers, …
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Personal genomic tests may offer a teachable moment
As I approach my 50th birthday, I worry about Medicare not being there for me when I become eligible. I have some inside knowledge about Medicare. My parents and in-laws are patients on Medicare. As a doctor, I am a provider for Medicare, and as a public health educator I am a consultant for a Medicare quality improvement organization.
Everyone, including the leaders of both Democratic and Republican parties, agrees that …
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Fixing Medicare: Both providers and patients need skin in the game
I am riled up—almost to the point of being inflamed.
I hate it when doctors get dragged through the mud. It’s a matter of pride. Doctors are my team.
The latest kerfuffle centers on how much we should charge for return patient visits. The difference here is between moderate and moderately high visits–or about $30.
When the Center for Public Integrity is investigating your profession, it’s unlikely to be good news. And it …
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Doctors who manage patients in the office aren’t the problem
Moving from paper death certificates to an online process called the Washington State Electronic Death Registry System, or EDRS. Sounds like a simple 21st century process that should make the process of completing a death certificate faster and easier right? Oh, the government designed the system. Oops.
I’ve been so frustrated by the unintended consequences of a new state governmental process for completing death certificates.
Beginning in early 2012 Washington state started …
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Moving death certificates to the digital age: Unintended consequences
Probably the hardest part of making the change from a traditional to a direct-care practice is the effect it has on relationships. I am only taking a maximum of 1000 patients (less at the start) and will be no longer accepting insurance. These changes make it impossible for me to continue in a doctor-patient relationship with most of my patients.
For some, this transition will be more hassle than anything. Some people …
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Why I made the change to direct care practice
My esteemed colleague Dr. Bob Centor is enamored of an interesting essay from which he quotes:”Only you can educate you—and you can’t do it by memorizing. You have to find out who you are by experience and by risk-taking, then pursue your own nature intensely. School routines are set up to discourage you from self-discovery. People who know who they are make trouble for schools.”
Personally, I found it more of …
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Why medical students need to begin in the classroom
Charlotte Scott had an eye for madness—for just the right amount of madness. As a booker for The Springer Show, her job was to find—and forgive me if I’m getting too technical here—minor nut jobs, the kind of people who were just unbalanced enough to make for entertaining T.V. but not so wacky that they would pull an Uzi out on the audience.
I learned about Scott while reading Jon Ronson’s …
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Help your doctor understand where you’re coming from
Although McAlester, Oklahoma, is a relatively small, rural town, it’s the largest town in southeastern Oklahoma. Well over 100,000 people come through for a number of goods and services, including health care. Growing up 30 minutes outside of town, I understood rural Oklahoma from a patient’s perspective, and I looked forward to seeing it from the provider’s perspective. During a summer rural externship, I spent three weeks shadowing Carol Gambrill, …
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The rewards of family practice in a rural town
Have you ever returned home from a visit with your doctor and realized that you forgot to ask the one question that you really wanted an answer to? I certainly have. In fact during a recent visit with my doctor, I had every intention of asking her about a vague symptom that I had been experiencing in recent months. It was on the forefront of my mind, but when I …
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Improve doctor visits by bringing checklists to check ups
There are times when it is necessary to step up to the plate and go the extra mile on behalf of your patients. There is no job description for doing this and there is no manual that gives you instructions on what action you need to take on behalf of your patients. However, when you have the opportunity to do the right thing, at the right time and for the …
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When you do the right thing, you become a better doctor
My first week at my new job at a French-speaking university in a city of 95% francophones, I learned a useful new expression: vouloir le beurre, et l’argent du beurre. This translates literally as, ‘to want the butter, and the butter money.’ It’s the equivalent of wanting to have your cake, and eat it, too, but with a more explicit focus on dairy fat. (It is a French expression, after …
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Let’s help patients with the tradeoffs in medicine
Many premeds take time during their undergraduate careers to volunteer abroad. Popular destinations include Mexico, various Central and Southern American countries, and Africa. These are great opportunities to discover more about underserved care and, more importantly, what you are made of. I just thought I would share my reflections on volunteering abroad during college. Hopefully, you can glean something from them.
In the backcountry of India, in the state of Maharashtra, …
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Rural medicine in India: What American health care can learn
It’s natural: when you see someone doing something you long to do, you automatically search for reasons to justify why they’re doing it and you’re not. Maybe they had encouraging supportive parents and yours belittled you. Maybe they got their start at a younger age and it’s probably too late for you now. Maybe they got a great education, or were blessed with more opportunities in life.
My coaching clients won’t …
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Give life a chance to amaze you with what’s possible
If you or someone you love is considering surgery or an intensive treatment, it really pays to be sure you understand the pros and cons.
While that seems like common sense, millions of people say “yes” without learning all the facts.
Some simply rely on the trust they have in their physician. Others assume the known benefits and risks are too complicated to fully understand. And some people just want to get …
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Give patients the pros and cons of treatment options
The recent New York City law restricting portion sizes of sugary beverages offered in restaurants has stirred much controversy among policy makers, scientists, the media and consumers. Opponents support the freedom of choice in selecting beverage portions and contend there is insufficient evidence that legislation will change behavior or body weight. Proponents contend that something should be done to reduce the ever-expanding receptacles in which sugar-laden beverages …
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Healthier menus without restrictive legislation
With the 2012-13 influenza season underway, I want to remind my colleagues that while influenza vaccination has been around for 60 years, the times are changing, and physicians need to change too. We now have newer vaccine options targeting specific populations that were not available just a decade ago.
Alas, many providers have not taken advantage of these options that 1) potentially offer better protection for patients aged 65+ and 2) …
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Ways to improve influenza immunization rates
A lot of people, many of them medical students, think that rural doctors don’t get to see many interesting cases.
The opposite is true; if you are the only doctor within a wide radius, people will come to you for help, rather than try to pick the appropriate out-of-town specialist to diagnose their problem. In this state with widespread physician shortages most specialists won’t even see self-referred patients.
Sir William Osler wrote: …
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Rural medicine is the most stimulating kind of primary care
