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 of the attention given to the nascent state health insurance exchanges has largely focused on their role in improving access to insurance for individuals and small employers, not on the role they can play in improving health care quality.
As envisioned by the Affordable Care Act, health insurance exchanges provide an opportunity to create more organized and competitive insurance markets by offering a choice of plans, establishing rules on the …
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How health insurance exchanges can improve quality
When I see patients in the office, I try to guess their occupations from their demeanor and mannerisms. Salesmen are the easiest to ID. In general, they are gregarious males with manly handshakes. They laugh loudly and like to tell jokes. Teachers are more reserved and often give their narrative in a logical and chronological order, as would be expected. Another clue that the patient is an educator is that …
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How should physicians give bad news to patients?
I love my new EMR, which I’ve been using for about 18 months now. I love having all my patients’ information at my fingertips in and out of the office. I don’t miss the piles of paper charts all over the place at all! In short, there’s really nothing about it I don’t like.
My staff, on the other hand, hates it.
Now that they’re not jumping up and down all the …
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I love my new EMR, but my staff hates it
In the summer of 2007, then-U.S. Preventive Services Task Force member Russ Harris, MD, MPH approached me about taking on what he suggested would be a fairly quick and straightforward project: summarizing the small amount of medical literature on the benefits and harms of the prostate-specific antigen (PSA) test that is commonly used to screen asymptomatic men for prostate cancer.
Little did I know that this research and its implications would …
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Reaching the end of PSA screening
I had an unexpected gift this week: a not-so-sick sick day with my 5 year-old. And it really couldn’t have come at a better time.
We’ve never had a sick day like this before and he’s off to Kindergarten in September so the days were running out for preschool stolen-away sick leave.
In the past when he’s been ill he’s been well enough for me to head off to clinic or work …
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Sick days: When our children show us the way
Recently a physician reporter for the New York Times, Elisabeth Rosenthal, argued in the cover article of the Sunday Review that routine physicals are in many ways pointless, and perhaps even dangerous.
In the article, entitled “Let’s Not Get Physicals,” Dr. Rosenthal goes on to point out that many routine tests performed during physicals — EKG’s, pap smears and blood work, are unnecessary. In my opinion, Dr. Rosenthal’s front page …
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Let’s not get rid of the annual physical
I was talking to some new friends over lunch recently, at the nationally renowned Hominy Cafe, in Charleston, SC. Any place with a fried green tomato BLT, and shrimp and grits for breakfast, has my vote!
To the point: my question to these esteemed emergency medicine educators was this: “Do you ever have irrational fears about the people you love, because of …
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Doctors experience trauma to their hearts and stress to their souls
The ACA passed and is already in trouble. The Republicans are up in arms, calling the ACA an overreach of a totalitarian governmental regime. The Democrats are defending it, promoting its cost-saving measures as a progressive step forward for America.
To say the rhetoric has heated would be an understatement.
I’m not here to debate politics though. In the run up to the Supreme Court’s ruling on the ACA and the recent aftermath, …
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A review of NY Med, and fixing health care’s public image
Too often, bedbugs prevent cost-effective and quality health care – both literally and figuratively.
In the literal sense, consider the case of an elderly woman we’ll call Mary. A frequent visitor to emergency rooms in Northern Colorado, Mary has a long list of medical and behavioral health problems.
Recently, a pilot project implemented by the North Colorado Health Alliance brings together a team of providers representing different walks of the health care …
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How hot-spotting stops bedbugs and other social ills
Most of the American public doesn’t know that different pharmacies can and do charge drastically different prices for their prescription drugs. Does that surprise you? It sure surprised me when I found this out a few months ago in my medical school class.
I consider myself well educated. I’m a college graduate and in the throes of professional school — in healthcare nonetheless. I have an open mind and I read quite …
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Pharmacies can charge different prices for their prescription drugs
Choosing Wisely is the new campaign advocated by the ABIM Foundation to help physicians “be better stewards of finite health care resources.” The recommendations in the campaign have been published in Consumer Reports and has been distributed to AARP members.
At first glance, the campaign seems to make sense. Limit unnecessary testing and decrease costs. However, I predict that the Choosing Wisely campaign will also have many less desirable effects. I picked out …
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Will recommendations from Choosing Wisely ever be followed?
In a previous post on the Social Media Healthcare blog, I made an argument as to why physicians should be involved in social media—especially on Twitter. The purpose of this post is to describe how I use social media as a busy clinician and teacher of family medicine to keep up to date with clinical and policy information and also how I find the time to use social media. …
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Doctors: Find balance between work and social media
Much of the debate over the future edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has centered on what disorders will be added, modified or dropped. But lost in the discussion is a change that will align disorders along a developmental continuum—one that looks at them across the lifespan. This shift will provide clinicians with a critical perspective that until now has been missing.
Historically, disorders were classified …
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DSM-5 will capture the dynamic nature of mental illness
You know the headlines. You read them and hear them and see them every day.
Someone gets angry at the system and shoots someone or several someones in cold blood, often having planned the act, gathered the necessary firepower and ammunition ahead of time, stalked the victims, checked the schedules and shown up at the right time to do maximum damage.
A family including mother and young children in a van are …
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Do people need to suffer the consequences of their bad behavior?
Most of us do not want to die in the ICU tethered to tubes — not the quality of life we expect. Yet only 30 percent of us have made arrangements to prevent this from happening. Death and dying is a tough subject for us to broach. Be aware that very few of us will die in our sleep — most have a slow sometimes excruciating decline to death.
As we …
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What is the goal of palliative care?
LeBron James exploded past his defender and raced towards the lane. Serge Ibaka, the Thunder’s mountainous center, planted his feet and raised his hands straight up into the air. LeBron ducked his left shoulder and plowed right into Ibaka, who went crashing backwards into a nearby cameraman.
Offensive foul?
Maybe if it had been the first quarter. But given that this was the last minutes of a tightly fought game, the referees …
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Why does fear of litigation turn into preference for action?
If you want to identify me,
ask me not where I live,
or what I like to eat,
or how I comb my hair,
but ask me what I am living for,
in detail,
ask me what I think is keeping me
from living fully
for the thing I want to live for.
– Thomas Merton
As a patient waiting to see my health care provider, I would adapt Merton’s template …
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Patients want to tell us their story
