Primary Care

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.

What can basketball teach us about health policy?

Andrew Boozary, MD, MPP

Health Policy

August 19, 2012

Basketball imposed my first patient experience in the American health care system. A loose ball and flying elbow saw me to an x-ray machine and a consult with a respected surgeon in New York City. The wait at the hospital was long. CNN blazed through the speakers and the only reading material was a sea of People magazine. For hours, I found myself in a blinking contest between Blitzer or Kardashian.

Once in …

3 simple games to lower doctor stress and prevent burnout

Dike Drummond, MD

Physician

August 19, 2012

Burnout is a constant threat for physicians. Research consistently shows an average of 1 in 3 doctors suffering from symptomatic burnout on any given office day. In my work with over stressed and burned out doctors, I have found that most of us work way too hard being the superhero to our staff, patients and families — and don’t have any fun at all. It doesn’t have to be …

Put patients to work during their wait time

Steve Wilkins, MPH

Patient

August 18, 2012

I talk with lot of physicians about the need to improve the quality of communications between physicians and patients. Regular followers of my work will know that I am an advocate for the adoption of patient-centered communication skills by the physician and provider community.

Physicians with whom I talk seldom disagree as to the need for better physician-patient communications. They know that physician communication skills top the list of patient complaints …

How to think like a doctor: Start with differential diagnosis

Suzanne Koven, MD

Conditions and Diseases

August 17, 2012

“What would you do if you were your doctor?” Mary asked me. Mary is my physical therapist and she was trying to figure out why the rehab after my shoulder surgery was progressing so slowly. A month after my operation I was still in pain and still not moving the joint well.

Without hesitation I replied: “I’d come up with a differential diagnosis.”

Differential diagnosis is a two word summary of how …

7 iPhone apps that need to be created for doctors

David Sack, MD

Health Technology

August 17, 2012

I read a few months ago that the number of available iPhone apps had exceeded a million, with new apps now appearing that are intended to help sort through the mountain of other apps. We have reached the age of meta-apps. Parenthetically, I have always loved that “meta”concept. In college, when people asked why I majored in philosophy despite the fact that I was pre-med, I explained that my intention was to become …

Real health reform cannot happen without a primary care foundation

Andrew Morris-Singer, MD

Health Policy

August 16, 2012

Annie Lowrey’s July 28 article “Doctor shortage likely to worsen with health law” in the New York Times noted the growing shortage of primary care doctors particularly in economically disadvantaged communities, both in rural and inner-city America. This problem will likely get worse before it gets better as more Americans gain coverage and seek a regular source of care. As the article suggests, training more doctors and incentivizing them …

Why must medical care be provided for free?

Edwin Leap, MD

Health Policy

August 16, 2012

Our septic tank backed up recently. When I say backed up, I mean, into the basement. And when I say into the basement, I mean, out of the bathroom and onto the carpet. And under the walls. The stars were aligned, and I had to go to work. My wife borrowed a Shop-Vac and rented a steam cleaner. I was assigned to call the septic-tank guy. The kids helped clean …

AMA works to reduce administrative burden for physicians

Jeremy Lazarus, MD

Physician

August 15, 2012

A guest column by the American Medical Association, exclusive to KevinMD.com.

Since the American Medical Association launched our National Health Insurer Report Card in 2008, there has been noticeable progress by health insurers in response to the AMA’s call to improve the accuracy, efficiency and transparency of their claims processing.

The AMA has been working constructively with insurers, and as a result the …

Why always saying yes could be dangerous for you and your patient

Jock Hoffman

Physician

August 14, 2012

Encouraging patients to be more engaged, may also encourage more people to go beyond assertive to demanding care unsupported by good clinical judgment. Of course, physicians worry that saying “no” to a patient increases their risk of being disliked, dismissed, or even sued for medical malpractice.

Greater transparency in health care means patients are more aware of options for screening, testing, procedures, and medications—often via direct advertising or public service campaigns. …

Why medical management is critical to health reform

Brian Klepper, PhD

Health Policy

August 14, 2012

Several years ago I had dinner with a woman who had served in the late 1990s as the national Chief Medical Officer of a major health plan. At the time, she said, she had developed a strategic initiative that called for abandoning the plan’s utilization review and medical management efforts, which had produced heartburn and a backlash among both physicians and patients. Instead, the idea was to retrospectively analyze utilization …

Do I need the shingles vaccine? A doctor explains

James C. Salwitz, MD

Conditions and Diseases

August 14, 2012

What if there was an infection that can cause permanent nerve damage and pain? What if the virus could affect the eye and cause blindness or affect the brain and cause meningitis? What if the burning rash attacks almost half of all Americans sometime in their life? If you knew there was a vaccine which could protect you from that malady, would you get the shot? The disease is called …

Used needles on the sidewalks: Why we need needle exchange programs

Erin Marcus, MD

Physician

August 13, 2012

On a recent afternoon, Hansel Tookes stood on a sidewalk in downtown Miami, peering into a thicket of scraggly weeds. “I found a bunch over here,” he said, edging toward an overpass. A small orange plastic cap came into sight, and next to it two slender insulin syringes, with the needles exposed. Scattered about were tiny plastic zipper bags — evidence that the needles had been used to inject heroin …

For health care to be better, doctors must lead the change

Davis Liu, MD

Physician

August 13, 2012

Recently New Yorker staff writers and best-selling authors Malcolm Gladwell and Atul Gawande addressed the question of whether the problem in health care is that patients are too reliant on doctors and don’t have the ability to make decisions. In reading between the lines, is that the reason health care is not affordable and care not commoditized or consumer driven like other industries?

At a conference for America’s Health Insurance Plans, …

Work-life balance in medicine: Is it possible?

Karen S. Sibert, MD

Physician

August 13, 2012

Unless you’ve lately returned from a retreat at a remote Cistercian abbey, if you’re interested at all in women’s issues you’ve probably read Anne-Marie Slaughter’s recent article in the Atlantic, “Why Women Still Can’t Have It All.” The author eloquently tells how she left her dream job in the State Department as the first woman director of policy planning in order to return to her husband, her …

Why are so many doctors complete jerks?

Eric Van De Graaff, MD

Physician

August 12, 2012

As odd as this might sound, my mother was upset when I declared my intention to go to medical school.

It wasn’t the mountain of debt I was sure to incur since I’d already figured out how to get Uncle Sam to pick up the bill (a small deal that put me in a military uniform for a decade). It wasn’t the …

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Why are so many doctors complete jerks?

Should I get a spray tan? A doctor discusses whether it’s safe

Bobby Ghaheri, MD

Conditions and Diseases

August 12, 2012

We all know that the use of baby oils and baking in the sun for hours on end is probably not a good idea. We know that increased sun exposure correlates with increasing skin cancer rates. We know that it can cause accelerated skin damage in the form of pigmentation changes, wrinkles, and increased skin laxity. Don’t believe me? Check out this picture! Truck drivers tend to get increased sun …

Apply folk wisdom to your family practice patients

Peter Elias, MD

Physician

August 12, 2012

“The best defense is a good offense.”

This folk wisdom is variously attributed to Sun Tzu, Carl von Clausewitz, Mae Zedong, and the heavyweight prizefighter Jack Dempsey. Regardless of origin, it deserves its place in the pantheon of behavioral truths.

During a recent conversation with a patient about her irritable bowel syndrome, I asked about possible stressors.

“So, tell me, I know it’s hard to manage both full time school and a part …

The need to watch medical students interact with patients

Christopher Johnson, MD

Medical Education

August 11, 2012

I’ve written about this before, but some recent encounters with medical students have me thinking about it again. I went off to medical school thirty-eight years ago. For the era, I went to what folks regarded as a very progressive place. It had a curriculum that was quite revolutionary for the time. Among other things, we started having interactions with actual patients during our first year, rather than the third …

How I define patient engagement

Barbara Ficarra, RN, MPA

Patient

August 11, 2012

Do you feel connected with your doctor or other health care providers? Do you partner with your providers? How important is patient engagement to you? What words do you use to define patient engagement? Do you consider yourself an empowered patient or health care consumer?

What is patient engagement?

Here is how I define patient engagement.

Patient engagement is a connection between patient, caregiver and health care provider. An empathetic and trusted relationship …

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How I define patient engagement