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.
It is a very odd thing that most doctors, especially ones who really love what they do, provide advice and sometimes treatment to family members and good friends. It is also held to be true that this is a bad practice. How do we reconcile this?
In 1847 the AMA published its first “code of medical ethics” which covered many subjects and, though short, is dense and diatribe-like. It seemed to …
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Why doctors shouldn’t treat their family and friends
Doctors don’t like to go to doctors. I suppose we might see it as a failure or more likely it is pure intellectual arrogance. Whatever the reason, there can be no excuses when you need to get an insurance examination form filled out. One way of taking the edge off it is possibly to try to use your conversational skills to awe the poor general practitioner forced to see a …
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Why doctors don’t like to go to doctors
Customer satisfaction is quite the rage these days. Many stores and restaurants, many professional offices, hand out surveys, or ask customers to log onto their survey site on the Internet. As a reward, one may win everything from a free sandwich to an iPad.
I’d be interested to know how customer satisfaction played out in my home. “Kids, now you’ve had a week of school-work. Please fill out the attached survey …
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Is customer satisfaction in healthcare a gateway to corruption?
After 18 years in private practice, many good, some not, I am making a very big change. I am leaving my practice.
No, this isn’t my ironic way of saying that I am going to change the way I see my practice; I am really quitting my job. The stresses and pressures of our current health care system become heavier, and heavier, making it increasingly difficult to practice medicine in a way …
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Frustrations with the health care system drove me to a big change
Most patients I see are surprised to find out that there’s something they should have brought to their doctor’s visit. Granted, I’m an emergency physician, and many of my patients come to me in emergency situations that they can’t plan for. However, most people have some heads-up for going to their doctor. Certainly if you’re going to your annual check-up or a routine appointment, you should bring these items with …
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Preparing for your doctor’s visit: 10 things to always bring
Atul Gawande, MD is a brilliant writer, no-doubt an excellent surgeon, and many would say a physician-visionary for all that ails America’s health care system. He speaks first-hand of the changes that have occurred in American health care and recently offered his perspective for fixing our health care system to the fertile minds of Harvard’s recent graduating class of 2011.
In his graduation speech, published front and center (yet …
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Defending the American cowboy in medicine
My husband and I had a family practice in Arcata, California, for 28 years, during which time we learned the importance of addressing the patient’s context outside of the medical visit in order to maximize health and self-efficacy.
We went to great lengths to keep patients out of the ER and hospital. I saw one patient with massive pedal edema twice weekly for months to wrap her legs, since she lived …
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Improve the triple aim by adding a fourth: Provider satisfaction
The Pap smear, in which a clinician gently scrapes and brushes cells from a woman’s cervix (the lower portion of her uterus or womb), swishes them in a bottle of fixative solution, and then sends them to the lab to determine if the cells show pre-cancerous or cancerous changes caused by the sexually transmitted human papilloma virus (HPV), is a pretty simple procedure that takes less than a minute to …
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Should standardization end when the exam room door closes?
With all of its frustrations and challenges, I love my job. In fact, the very things that make primary care so difficult and often times exhausting are also what make it in my opinion the most awesome field in medicine.
When I was in grade school, I wanted to be a physician. My parents would take me to the pediatrician for routine check-ups or when I wasn’t feeling so great and I remember …
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It is both a privilege and an honor to be a primary care physician
I’ve been asked to appear on a radio talk show to discuss one of my blog articles. It seems that the producers of the show were impressed by my article on the beauty of medicine when it works the way it’s supposed to.
“When It Works Right, It’s a Thing of Beauty” was published this summer and is one of my favorite articles. The practice of medicine is a beautiful thing. …
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Our medical system needs more positive stories
I’m often surprised to hear my patients say that they got their tattoos while they were intoxicated. These confessions usually pour out spontaneously, prompted by anxiety, as I prepare to insert a needle for medical reasons. Getting a tattoo may be exciting, but you shouldn’t get drunk and cloud your judgment before you get one.
Permanent tattoos have been growing in popularity (pop star Justin Bieber’s tattoos even have their own …
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Health risks of tattoos and tips for safer inking
Over the past several decades medical costs in the United States have escalated rapidly, exceeding the pace of inflation and threatening bankrupt to Medicare. As we heard in last week’s presidential debate, different solutions have been proposed on how to slow Medicare’s growth and reduce cost. President Obama highlighted his administration’s success in tackling fraud and waste within the system. This strategy appears to be supported across party lines. On …
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Why upcoding isn’t necessarily fraud
It happened again three times in clinic today. In the middle of a patient visit, a parent picked up their cell phone. To answer a call, to text a friend, to read their email. The trend of being always connected and available has reached the exam room. When this first started happening I was sort of incredulous. I mean, I’m there, talking to you about your child’s health, and you’re …
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Why using your cell phone during a visit distracts me
Health care reform is a locomotive barreling down America’s tracks. In two years, the Affordable Care Act (ACA) will cover some 30 out of 50 million of us that currently lack health insurance. Political beliefs aside, it would seem that supplying insurance to protect the health of more people is a societal good. Though the costs of reform will be debated for years to come, one major question remains that …
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Having our own doctor treat us in the hospital is a thing of the past
“Wait until you see what is waiting for you in the next exam room …”
My clinic nurse was barely able to contain a smirk. This meant one thing to a doctor in training: the next patient must be a “train wreck,” with so many things wrong that I would never get beneath the surface during my brief visit. I was running 30 minutes behind, so I took a deep breath.
As …
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A driver’s license that needed rescinding
More than 40 years ago as a third year medical student, I recall the Chief of Medicine praising a fellow student for his rare diagnosis of paroxysmal nocturnal hemoglobinuria in a patient who had presented with the common symptom of “painless hematuria.” The lesson was not lost on any of us: good medicine means an expansive differential diagnosis and an even longer list of tests (including expensive ones) to “rule them …
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Reward doctors for evidence based problem solving, not test ordering
I struggle every time I’m ill. This week, it’s not so much my own illness that’s been the major problem. It’s the kids. Because they can’t sleep. And if they can’t sleep, we can’t sleep.
It started last week with this upper respiratory bug that’s going around. Cold viruses mutate just enough over time that every few years, I get hit hard. I call it the “three year cold.” This one …
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When can a doctor call in sick?
One of my biggest problems of the RVU system is that it decided by a secret society composed of specialists. Nobody seems to have a problem that a “secret society” decides how much work and how much cost should be allocated to a medical service.
Medical procedures are very dangerous and have a lot of risk, but so is trying to provide healthcare to a complicated 2-year old that can’t tell …
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Why the RVU system gives a false sense of productivity
