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.
Today’s healthcare consumers are increasingly asked to take a more participatory role in their care. For many this is a daunting task – even if the patient desires being in the driver’s seat. There are a myriad of issues undermining patient-physician communication – such as time constraints, lack of comfort with the subject matter, lack of shared language, or even fear – that can make the task of …
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Patients need to overcome the fear of asking questions
I got a really unexpected honor recently: according to Sharecare, I’m the top online influencer for children’s health.
I truly didn’t see it coming. I didn’t go into the online space to be an influencer. I’ve been writing about health and parenting for more than twenty years; when publishing moved into the online space, I just moved along with it. But having been online, blogging and doing other social media, it …
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Doctors: There is tremendous opportunity in the online space
We’re a disgruntled bunch these days. We think there must be a better way to experience health care.
Doctors say they’re pressed for time, don’t make enough money, have to hassle with insurance companies and typically feel generally burned out about medicine.
Patients feel they wait too long in the waiting room, don’t get much time in the examining room to ask questions or share concerns, want to be more involved in …
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How can we improve the patient experience?
I’ve always had a tough relationship with cigarettes and the people who love them. As a lung doctor I hate cigarettes, and I hate that patients I see everyday continue to use them. But I also understand that vilifying smokers seems to be in vogue right now. I figure that if someone does something that is not considered socially palatable, and that does them harm, even as they strive to …
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Should doctors stop prescribing inhalers for smokers?
Last fall, I went with my 12-year-old son to his middle school’s opening home football game. The bleachers were lined with parents, the smell of hot dogs and nachos wafted over the field, the announcer’s voice blared, and the cheerleaders jumped out of sync.
The boys were dressed in shoulder, chest, thigh and kneepads covered with clean white numbered uniforms. They each wore a helmet that seemed to weigh more than …
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I hope my son never asks me if he can play tackle football
May I tiptoe onto a ledge for a moment?
Some (just-back-from-Europe) thoughts on health care policy, perhaps?
One of the many differences between the European Society of Cardiology (ESC) Congress and a typical American cardiology meeting was the scarcity of healthcare policy sessions at the ESC. That’s hard to explain; perhaps European countries are settled on their own systems and do not wish to — or can’t — influence their neighbors.
It goes …
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What can we learn about health care from Europe?
I recently viewed health care through the lenses of a technology entrepreneur by attending the Health Innovation Summit hosted by Rock Health in San Francisco. As a practicing primary care doctor, I was inspired to hear from Andy Grove, former CEO of Intel, listen to Thomas Goetz, executive editor of Wired magazine, and Dr. Tom Lee, founder of One Medical Group as well as ePocrates.
Not surprising, the most fascinating person, …
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How can technology entrepreneurs disrupt health care?
What does it mean to be a professional? And how do we maintain our professionalism at a time when things such as stress, burnout, and caregiver fatigue threaten our motivation? As an anesthesiologist, the ability to remain professional in many scenarios is something I constantly strive for. Aside from how it affects my relationships with the interdisciplinary OR team, professionalism is an important attribute given that my job requires patients …
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Remember the Professionalism APGAR during times of stress
While our dad was in the hospital last winter, my brother shared with me his strategy for talking to the doctors we encountered – an approach honed over ten years of marriage to an internist and dozens of pediatrician visits for his two little boys. He asked smart questions that used medical terms to earn their respect, he told me. He was appropriately deferential, admitting his lack of clinical experience. …
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Doctors need to make room for disagreement with patients
If you believe what most people are saying about health care reform and future practice models, you or your physician, will soon be part of an accountable care organization (ACO).
Health policy experts tell us that as physicians, we’ll be embarking on a wonderful journey that bears no resemblance to the HMO/managed care heyday of the early 1990s. Of course, there’ll be similarities, like limited networks, top down implementation of health protocols, and …
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My wish list for a perfect ACO
In a word, yes.
And this is a difficult concept for many doctors to get because we have long been taught that the gold standard is culture.
Let’s back up a little. These are the symptoms of a bladder infection: needing to empty your bladder a lot (urinary frequency), when you gotta go, you gotta go (urgency), pain just over the pubic bone, blood in the urine, burning when you empty your …
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Can I still have a bladder infection with a negative urine culture?
Research radiologists at the Massachusetts General Hospital in Boston evaluated the accuracy and detail of imaging the colon (a virtual colonoscopy or colonography) with no laxatives as preparation and comparing it with traditional colonoscopy. There are clear evidence based guidelines suggesting that all low-risk men and women have a screening for colon cancer with a colonoscopy at age 50. If that study is normal they are directed to repeat it …
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Is there a role for the laxative free virtual colonoscopy?
Janus is the Roman god of doors and gateways but also the god of beginnings. Interestingly, good beginnings and required for good endings. The Temple of Janus had doors facing east and west, which allowed illumination of the temple at the beginning and the end of the day. Most statues of Janus show him with two faces facing opposite directions.
The Janus principle in your medical practice is the idea of …
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Use the Janus principle in your medical practice
By now most of us have heard of a nurse practitioner. But what exactly is a nurse practitioner? What can they do? How can they be incorporated into a medical practice?
A nurse practitioner is a registered nurse who has completed graduate-level education and advanced practice training. Nurse practitioners can see a wide range of patients, both well and sick, and perform many in-office procedures. Prescribing medications, ordering and interpreting tests, …
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These are the reasons why nurse practitioners are special
Dr. Anthony Youn, a plastic surgeon practicing in Detroit places most of the blame for long office waiting times at the feet of the patients themselves. He comes up with three general categories; patients who arrive late for their appointments, emergencies that require the physician to leave the office, and “oh by-the-way” scenarios:
“Here is a typical scenario: It’s the end of a 10-minute office visit, scheduled as …
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Don’t blame the patients for long wait times
Medicine has gone down Alice in Wonderland’s rabbit hole. Looking at the size of practices today, it seems like some of them have taken red pills and the rest have taken blue ones: most of them are getting bigger and bigger and bigger, while some are getting smaller and smaller. As the giant practices gobble up their competition to become ever more gargantuan, others are shrinking down into micropractices.
Everyone has …
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Practices are getting larger to provide micropractice service
“The specialist rescheduled me again,” the patient told me, looking embarrassed. ”I think he doesn’t want to see me any more.”
“I’m sure that it isn’t that he doesn’t want to see you,” I replied. ”This has to be a miscommunication with the front desk. It happens all the time; it drives doctors crazy.”
“I don’t know,” he continued. ”I just got on Medicare, and I wonder if maybe he doesn’t want …
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Matching Medicaid payments to Medicare: From pitiful to pathetic
