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 turns out that the practice of medicine is just common sense. If someone has fallen and their hip hurts, it is probably related. If someone does not have an infection, do not give an antibiotic. Exercise and good food are, well, good for you. If it is not broken, do not fix it.
Usually, patients understand this basic idea. The best chance of becoming and staying healthy is the simplest …
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When patients stray from the common sense approach to health care
When I was traveling around the country interviewing for a residency spot in family medicine in the fall of 2008, I was eager to find a patient-centered medical home (PCMH). At every interview, I asked whether the program’s clinic was a certified PCMH or whether it was moving in that direction. “Well, we don’t yet know what that looks like” was the answer that I heard at nearly every destination. …
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Care delivery transformation requires an upfront investment
As an emergency physician, I tend to work on the other side of preventive care services. I see what happens when women don’t know about safer sex and birth control, and end up with complications from sexually transmitted infections. I see what happens when women do not get routine screening for cervical cancer and struggle with life-threatening cancer. I see what happens with out-of-control hypertension and diabetes, and the heart attacks and strokes that …
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The well woman visit: An easy way to obtain preventive services
With regard to antibiotics, physicians and the public have each been enablers of the other. Patients want them and we doctors supply them. There’s nothing evil about this arrangement. Antibiotics are one of medicine’s towering achievements and have saved millions of lives. Shouldn’t we prescribe them to patients who need them? Of course we should. But why do we prescribe them to patients who don’t?
Before you race to the comment …
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Antibiotic overuse: Physicians and patients enable each other
When I was a kid, my pediatrician was a friend of my parents who practiced out of a first floor office in his home across the street from ours. He was a wonderful man and doctor, I’m sure, but I was terrified of him because I associated him with the injections he gave me periodically. Even when he and his wife came to our house for dinner I hid–just in …
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When the fear of needles paralyzes medical care
Have you ever sat on your bed after being discharged from a hospital stay and suddenly felt – along with the relief of being home – overwhelmed by what you have just been told that you and your loved ones must now do? Similarly, have you ever walked out of an appointment with your clinician and said, “HUH? Exactly what did we agree I am going to do about this …
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An OpenTable approach to hospital discharge planning
Sitting on a dusty wooden bench in the rural Sacred Valley in Peru with the Andean mountain range serving as a scenic backdrop, it dawned on me that I was the first physician that my 43-year-old Peruvian patient had ever seen.
After treating his acute diarrhea, I was faced with his elevated but asymptomatic 162/89 blood pressure. I knew he needed treatment, but my concern was whether or not to start …
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Primary care is the missing link in global health
“Medical training rarely deals with helping the dying patient find peace and comfort. In fact, most physicians are uncomfortable with the entire subject. I believe it is one of the most neglected aspects of medical care. I have spent my career as a pulmonary and critical care physician, and I have cared for thousands of dying patients. In many cases, both the patients and I knew that they were dying. …
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A glimpse of dying from literary authors
A few weeks ago I was brought in to speak to the staff of a local university. I gave a two hour workshop, which is even more fun for me than giving a keynote as I get to interact personally with the audience and draw their stories out. One of the sections of the workshop was about listening to your body. Every person’s body “speaks” to them in a different …
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Learn to understand and interpret your body’s language
Today was a great day. Despite the shortcomings of our medical complex, when it works right, it is a beautiful thing. Actually, it’s not just beautiful, it can deliver the best care available anywhere in the world. I know. I saw it happen today.
Today, Mr. X presented with a troublesome history and an even more threatening physical exam. I was afraid that the disease I was about to diagnose would …
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When our health system works, it’s unbeatable
Greg Smith, formerly of Goldman Sachs, has described a positive organizational culture as being the “secret sauce of greatness.” What is the nature of this secret sauce? A simple, popular definition is that “organizational culture is the way we do things here.”
The relationship between organizational culture and organizational success is unassailable. In our commercial dealings, has not each of us easily recognized when a business culture is truly customer-focused, and …
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The secret sauce of great health care organizations
Is the placebo effect something that demands the presence of a living human – or can we program it into a cell phone app? What happens to healthcare if we can?
I must admit I have always been fascinated by the concept of placebos. You give a research subject with a documented medical condition a sugar pill – and they get better. They heal themselves despite the fact they have not …
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Can digital medicine have a placebo effect?
It was a challenging transition, when I shifted from being a medicine resident to supervising medicine residents. There is much to be said about this shift (and similar shifts of ever-increasing responsibility at various stages of doctors’ training). The aspect on my mind at the moment is the role of clinic preceptor.
When I was new to the role and new to the clinic, I was paired with a more experienced …
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The delicate balance of supervising medical residents in clinic
Something that has been on my mind recently is obesity, specifically obesity in doctors. This may be because we cover obesity in a high percentage of our stories (1 in 3 Americans is obese, after all) or because I recently discovered that I gained ten pounds since moving to New York City. Either way, after watching Dr. Snyderman speak her mind on national television about how obese leaders are unfit …
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Would you accept obesity advice from a fat doctor?
If you follow sports media, you have no doubt heard of PRP by now. Hines Ward made it popular in 2009 when he received PRP treatment for a knee injury just before the Super Bowl. Kobe, Tiger, A-Rod, and many other high profile athletes have reportedly received PRP treatments. But what is it? Why are these athletes receiving it? Can you get it, too? Let’s discuss.
I’ll begin with the basics. …
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Does PRP work for knee injuries?
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Even though September is “back to school month” and students won’t get their report cards for a while, I have a report card to share with you now. In September 2006, my practice went “live” with an EHR, so I thought that the sixth anniversary of this …
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ACP: My EHR report card
Everybody has a shadow. Although as a small child you may have tried, you cannot separate yourself from your shadow no matter what you do. Electronic medical records may be the first tiny step on the road to attaching yet another indivisible part to your persona, a “panoramic, high-definition, relatively comprehensive view of a patient that doctors can use to assess and manage disease”, and this, in the words of …
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Striking the balance between the public good and patient privacy
If you’re a fan of star surgeon overachiever Atul Gawande, then reading his New Yorker article “Big Med” is a must. The rest of us skeptics should still use the article to signal our health care adroitness by knowingly referring to the “Cheesecake Factory” in our policy medical meetings, conferences, PowerPoints and bloggery.
What he wrote
Dr. Gawande uses the successful restaurant chain to extract lessons and draw health system parallels, ultimately …
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Did Atul Gawande unwittingly support specialty hospitals?
Once again, legislators are meddling into healthcare. This time, it’s in my own home state, where Governor Cuomo has just signed a bill requiring radiologists to notify women when their normal mammogram also shows that they have dense breasts. In such cases, the following text must be included in the lay summary mammogram report given to the patient:
“Your mammogram shows that your breast tissue is dense. Dense breast tissue is very …
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Mandatory breast density notification violates physicians’ free speech
Many elderly patients get admitted to the hospital with profound weakness due to their acute and chronic medical conditions. Many of them will leave the hospital with profound weakness from their acute and chronic medical conditions (and unfortunately without a palliative care consult). In many situations, these patients will be too weak to take care of themselves. They will need extra help with their activities of daily living either from …
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Any doctor can make the decision for mental capacity
