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.
Most doctors will tell you that Medicare payments to doctors haven’t increased in a decade, and that doctors are turning away Medicare patients in droves. But they would be mistaken on both counts.
An authoritative compilation of current data from the Medicare Payment Advisory Commission shows what is really happening with Medicare physician spending:
Medicare spending per beneficiary on physicians’ fee schedule services steadily increased from 2001 to 2011. In 2001, Medicare …
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The truth about Medicare physician spending
This past July marked the 16th anniversary of the installation of our electronic medical record.
Yup. I am that weird.
Over the first 10-14 years of my run as doctor uber-nerd, I believed that widespread adoption of EHR would be one of main things to drive efficiency in health care. I told anyone I could corner about our drive to improve the quality of our care, while keeping our cash-flow out of …
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My dream of universal acceptance of EHR has turned sour
A few days ago, I received a question that stopped me in my tracks. I was giving a talk to a local church group on the importance of patient advocacy, and most everyone was nodding. Yes, doctors don’t always listen — let’s do something about it! Yes, we need to control of our health.
Then someone raised her name. Her name is Susan, and she is the owner of a mom-and-pop grocery in …
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Improving medical care needs to involve the doctor
As doctors in training, we learn to think in patterns of symptoms and can often use “clinical judgement” to fit a patient’s presenting symptoms into a diagnosis. This generally works well, until we are presented with an unfamiliar pattern. For example, in the early 80’s I saw a 60 year old shoe salesman with fatigue and a low grade fever. He had general malaise and some muscle weakness. His exam …
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The questions in medicine never change, but sometimes the answers do
In the debate over health care reform the issue of choice is often brought up. I’m not referring to a women’s right to choose or the birth control controversies but the simple idea of individuals being able to choose their health plan or physician.
However most physicians would probably agree that for much of health care, especially unexpected and sudden illnesses, the idea of choice is an illusion. Patients rarely choose …
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A physician has difficulty choosing a primary care doctor
“The plural of anecdote is not data.”
A recent lead editorial in the Sunday edition of the New York Times was entitled “A Formula for Cutting Health Costs” and contained the byline “Alaska natives have something to teach doctors and patients in the rest of the world.”
I read the editorial with interest, hoping that a new perspective, vision, idea, or insight would be mentioned that would provide a sustainable cost solution …
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Mainstream media’s sinister undertone against doctors
Ralph Coates, PhD of the Center for Disease Control (CDC) described in the June 15, 2012 issue of Morbidity and Mortality Weekly Report that by looking back at a U.S. study done between 2007-2010 called “Use of Selected Clinical Preventive Services among Adults,” health providers need to do a more comprehensive job of offering preventive services.
According to the report, only 47% of patients with documented heart and vascular disease were …
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Doctors avoid comprehensive preventative questioning
In today’s healthcare environment, nearly half of all new physicians are salaried employees of a hospital or healthcare system. Now, more than ever, physician leadership is of paramount importance. With increasing pressure to increase care quality and simultaneously lower healthcare delivery cost, it is essential that physicians and administrators work together. Physicians must continue to grow into executive roles and lead both healthcare systems as well as manage other doctors …
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How to train more physician leaders
Costs are spiraling out of control, access is declining, and our quality of care doesn’t match what other developed nations are delivering at half the cost.
In the search to reduce costs and bring our ever inflating health care budget under control, the powers that be (insurers, government, health policy wonks (and maybe a few doctors) have looked to individuals with less formal education to perform medical services that were once …
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Go ahead and let teens read x-rays
One summer in college, when I couldn’t think of what else to do, I lived near campus in a punishingly hot walk up apartment, held down three boring jobs, and took intensive Latin. Every morning we met in a blissfully air-conditioned classroom–that was the upside!– to conjugate and decline: a whole year of Latin in 6 weeks. I remember nothing I learned, of course. I’m reminded of the great Woody …
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Go behind the scenes of naming a drug
I gently rotated his arm as the beads of sweat formed on his forehead. The pain came in waves. His face contorted and relaxed in repetitive spasms. I wondered if my exam was in vain. The cancer had spread from his lungs to his liver and into his bones. Once the blood stream had been tainted, the aggressive cells took flight and landed in various organ systems.
We already had the conversation. I …
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A tragedy based on administrative decisions
Zumba, the Latin dance-inspired fitness craze, is a great way to burn calories, up to 500 per hour. It also gives you a good cardiovascular workout without making you feel like you’re exercising. This increasingly popular workout attracts a diverse crowd at dance studios and health clubs, including a sizable number of those 50 and up.
But for people who are out of shape, taking the first classes can be like …
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How to avoid Zumba injuries: 10 physician tips
I am a patient. Yes, and a physician; a brother, father, husband, grandfather, uncle, friend, neighbor, taxpayer and concerned citizen. What healthcare reform means to you means the same to me, or more. Maybe because as a physician I focus on it a little more than the average person, I have an additional responsibility to share my perspectives? Maybe a little knowledge is a dangerous thing, as the saying goes.
I …
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Integrated care cannot change how we behave
A draft of standards for a health and medical app certification program was released recently by Happtique. As a matter of disclosure I am proud to have been the Chair of the panel that drafted these standards. The standards are in draft form and are open to public comment until August 17, 2012.
While some might say that these standards add even more barriers to the commercial adoption of these technologies, there are …
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Why health and medical apps should be certified
In a recent report released by the UNAIDS, the number of new HIV (human immunodeficiency virus) infections has fallen by 19% since 1999. And of the 33.3 million people living with HIV, only a little over 5 million people are receiving HIV treatment. That is, roughly 15 percent of the world’s population. Ghastly, some might say, but improving, optimists would say.
According to the 2010 UNAIDS Report on the Global Aids …
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The HIV vaccine does not promise the end of AIDS
One evening during my first year of medical school, I was waiting by the entrance to The Salvation Army to let another student back into the free clinic. The weekly clinic was organized by MEDiC, an organization of student-run free clinics in the Madison area. A family with four small children was returning to spend the night at the shelter, and one of the kids saw the stethoscope around my …
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Reinforcing my desire to become a pediatrician
A few days ago, I came across an article entitled “Calling Dr. Google” by Jeff Jarvis. The writer describes his experience “Googling” his symptoms and finding that the internet brought him the correct diagnosis. He uses his personal story of appendicitis to point out that physician fear of information on the internet is overblown.
One would hope that the argument that you cannot find any trustworthy information on the web is …
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Dr. Google is currently only medical student Google
Recently I was privileged again to be on the faculty for the Summer Institute of the George Washington Institute for Spirituality and Health in Washington, DC which draws participants from several health care disciplines, including medicine, chaplaincy and nursing.
One afternoon, we break up into interdisciplinary teams and interview patient actors as if we were a palliative care consultation team. For those who have not experienced patient actors in this context, …
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Why is whole person care so difficult to attain?
Most of us will not have the opportunity to just die of “old age” or to simply fall to sleep one night never to wake again. Most often, we develop an illness which causes our death. These have changed markedly over the years. For the pioneers, accidents, infections, childbirth were times and causes of great likelihood of death. A century ago, infections were the leading causes of death. Today, we …
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The dramatic change in the causes of death
