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.
If you think health care is expensive now, wait until you see what it costs when it’s free.
-P.J. O’Rourke
I distinctly remember that in first grade I had an idea of breathtaking wisdom and profundity. Candy should be free. You may have had a similar thought at the same age. This idea was supported by an incontrovertible rationale, namely that I really liked candy. Tragically, it only took a moment for …
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How will doctors handle the flood of newly insured patients?
Many recent conversations in the advancing world of health care delivery have integrated the term “disruption.” At first glance, this is perhaps quite jarring and counter-intuitive to the mind of the forward or progressive thinker. It is ever the more uncomfortable to the medical mind that is trained to carry on in the face of adversity, through exhaustion, and despite resistance. Paradigmatically, the medical world has recently been presented with …
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Family physicians are patient specialists
Doctors of my generation have experienced dramatic changes in the way we access the information we need to care for patients. As a medical student 15 years ago, my “peripheral brain” consisted of fat textbooks sitting on office bookshelves or smaller, spiral-bound references stuffed into the bulging pockets of my lab coat. As a doctor-in-training, I replaced those bulky references with programs loaded onto PDAs. Today, smartphone apps allow health …
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View medical apps with caution, just like any new medical device
And issue of Newsweek quotes me as saying, “A lot of our weight-loss recommendations are unethical because we shouldn’t be saying lose weight when there is no chance people will keep it off.“
This quote appears in the context of a lengthy article by Daniel Heimpel that examines whether or not the obesity epidemic is being oversold.
While I personally do not think that the obesity epidemic is being oversold, I do …
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Why weight loss advice may be unethical
Excessive health care spending is overwhelming America’s economy, but the subtler truth is that this excess has been largely facilitated by subjugating primary care. A wealth of evidence shows that empowered primary care results in better outcomes at lower cost. Other developed nations have heeded this truth. But US payment policy has undervalued primary care while favoring specialists. The result has been spotty health quality, with costs that are double …
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Diminishing primary care leads to excessive health spending
As you may know, I left Maine to come to Virginia to work in an urgent care center. It was not how I pictured myself when I trained to be a family doctor 18 years ago but the world has changed.
I like my present job fine and there isn’t a bunch of suits looking over my shoulder all day. That being said, I want to share my thoughts about the …
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The journey from family practice to urgent care
Dr. Atul Gawande has written a much-ballyhooed essay in the New Yorker, entitled “Big Med.” His piece proposes The Cheesecake Factory as a model for healthcare. For me, a physician, Dr. Gawande’s message left a bad taste in my mouth.
The Cheesecake Factory succeeds because of standardization and efficiencies, with complete control over purchasing and production. What recipes work become menu items throughout the chain. What recipes don’t work are …
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Patient care is not meal preparation
Many doctors are now getting into movie production and making videos that are loaded onto YouTube. These videos are effective in attracting new patients and educating your existing patients. There are a few guidelines that you can use to create an effective script for each of your videos. These scripts can be loaded onto your computer in a PowerPoint format and will serve as poor man’s teleprompter to assist in …
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How to create YouTube videos for patient education
The most common complaint about physicians on the Internet is, “They didn’t listen to me.”
You were sitting in the office and the doctor was physically present in the room, but they weren’t all there. Even worse is when the doctor doesn’t try to understand what you are going through. Sometimes it can seem like they didn’t even care.
Most of us take for granted that we are the center of the …
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My doctor isn’t listening to me! How you can help
All American physicians should be members of the American Medical Association (AMA). And, while they are at it, they should also be members of their county, state, and principal specialty societies.
Why? Because they are the only games in town, and both security and safety are top Maslow imperatives.
The only real political power any physician has is the individual power of persuasion and participation (or not) and the power of a …
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If you’re not an AMA member, you have no right to complain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 27-year-old man is evaluated for a 6-month history of cough, which is worse at night and after exposure to cold air. Often his cough is brought on by taking a deep breath or by laughter. He does not have postnasal drip, wheezing, or heartburn. He has a strong family history of allergies.
Physical examination, …
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MKSAP: 27-year-old man with a 6-month history of cough
A staple of conservative critiques of universal coverage is that having health insurance doesn’t equal access. The corollary is that the uninsured already have access to care—from doctors and hospitals willing to take care of them on a charitable basis and from “safety-net” institutions.
This argument isn’t new, having been made years before the Affordable Care Act became law. In 2007, the Council for Affordable Health Insurance opined that universal coverage …
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An evidence based assessment of universal coverage
I’ve talked to hundreds of people about the health care options and decisions they face at the end of life. It’s a challenging time and understandably many have little knowledge, while others have misconceptions, and some have bitter disagreements.
Here’s a basic primer for two common approaches: hospice and palliative care.
Hospice care
Two myths about hospice care are prevalent. First, many people believe hospice is provided in a place like a hospital. …
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Hospice care and palliative care: What’s the difference?
In order to be with my Dad, after dinner I’d go on house calls with him. We’d drive to parts of town I’d never seen, and using the car’s spotlight we’d search out the right house number, often with no small difficulty. I’d usually wait in the car. He hefted up his rather large mysterious black doctor’s bag and headed for the door. He spent about a half hour listening …
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My Dad never quit making rounds
I am an EMR geek who isn’t so thrilled with the direction of EMR. So what, I have been asked, would make EMR something that is really meaningful? What would be the things that would truly help, and not just make more hoops for me to jump through? A lot of this is not in the hands of the gods of meaningful use, but in the realm of the demons …
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10 ways to make an EMR truly meaningful for doctors
An investigative newspaper article published in the Milwaukee Journal Sentinel, in cooperation with online periodical MedPage Today, chronicles the increased use of narcotics for chronic pain relief in the elderly.
The article highlights how in 2009 the American Geriatrics Society put together a panel of geriatric pain specialists who published geriatric narcotic pain relief guidelines that have led to the dramatic increase in use of narcotics in the elderly. There is apparently …
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Chronic pain in the elderly: The role of opioids
