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.
Healthcare costs keep rising. Your insurance premiums go up, your deductible and co-pays go up, pharmacy benefits go down. Despite the high cost you get little time with your physician, insurance statements are complex beyond belief and “customer service” seems to be a foreign concept. To combat high costs we are often told that rationing will be necessary. Is that true?
Why are costs so high in this very dysfunctional healthcare …
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Is rationing necessary to reduce health care costs?
As the nation, physicians, hospitals, and political pundits await the Supreme Court’s decision on the Affordable Care Act, I find myself waiting for something else: to begin medical school. I will be hitting the books, studying vigorously, and desperately trying to remember the myriad of information being thrown at me well after the justices decide the fate of President Obama’s landmark legislation. So what does this mean for me, or …
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Become not just a physician, but a great physician
When asked what makes for good patient care in medicine, a typical answer is that it should be “patient-centered.” Sure, “evidence-based medicine” and expert clinical guidelines are helpful, but they only serve as the scientific foundation upon which we base our individualized treatment decisions. What’s more important is how a disorder manifests in the patient and the treatments he or she is most likely to respond to (based on genetics, …
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What does patient centered care say about psychiatry as a science?
“What about combined psychiatry-family medicine-neurology-internal medicine programs? Should I try to do a triple board program in psychiatry-child psychiatry and pediatrics?”
Every April, I field such questions from a slew of rising fourth year students who have become, to their surprise (and sometimes dismay), passionately interested in psychiatry. Psychiatry is a shortage specialty and psychiatric issues rank high among the challenges facing medical care systems here and around the world. For …
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Should medical students consider a combined psychiatry residency?
I figured it out! I realized what the basic, underlying, fundamental problem is with medical care in this country.
The problem is that it’s too expensive and often isn’t very good, but that’s clear.
The reason medical care in this country is fragmented and overly expensive is that there is a perverse inversion of the correct ratio between primary care and specialty physicians (should be significantly greater than one, instead of significantly …
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Most medical students don’t have what it takes for primary care
A year ago, KevinMD.com was kind enough to post my piece, 10 Tips from 10 Years Sick. Well, a year has gone by and I’m still sick. So, I’ve re-visited that post, changing several of the tips and adding to others. And, of course, there are now 11 tips, not 10! At the end of the piece, I hope you’ll share your own experiences.
1. The onset of chronic illness …
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11 tips I’ve learned from 11 years sick
One of the big practice challenges most physicians face is a frustrating gap in our leadership skills. We step out of residency and are instantly installed as the leader of a multidisciplinary team charged with delivering the highest quality care to our patients.
This new leadership role can be daunting. We are prepared to diagnose and treat, but what about all the other questions that come our way? At times It …
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The frustrating gap of physician leadership skills
For years, I have been telling families in my practice, especially those with teens, to eat dinner together. Family dinners make a difference, I tell them. Studies show that they not only help prevent obesity, they help kids do better in school and help keep them out of trouble.
Now a study says that’s a bunch of hogwash.
Well, not exactly hogwash. The researchers from Cornell who wrote “Assessing Causality and …
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Don’t give up on the family dinner
Hydrocodone as it is currently prescribed in the U.S. is a schedule 3 drug. The FDA puts rules and regulations on the prescribing of medications that have a significant potential for abuse, diversion or addiction, and the lower the schedule number, the more the restrictions.
Schedule 1 drugs are illegal in the U. S. They are deemed to have no legitimate medical purpose. Examples are heroin, LDS, methamphetamine, marijuana (strange but …
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Should hydrocodone be changed to a schedule 2 drug?
The year is 2012. A 58-year-old veteran Family Physician who has just finished a day with more human heartaches than clinical triumphs settles down among the pillows with his wife in front of his MacBook to watch a movie, delivered wirelessly over the Internet:
“The year is 1969. A 62-year-old veteran general practitioner who has just seen his health threaten to fail him, speaks passionately to a group of doctors about …
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Marcus Welby, MD is still relevant today
Does your doctor have something on the wall that starts with “American Board of … “?
The terms “board certified” and “board eligible” are confusing to people not in the medical profession. It doesn’t help that more than a few doctors blur the distinctions to their own benefit. This post gives you a brief rundown of the distinctions at stake.
The first thing to understand is that anybody who has graduated from …
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Does it matter if your doctor is board certified or board eligible?
Mirrors reflect, and give us pause for reflection. Not always eagerly sought after or welcome, this reflection does not always reinforce the image one has of oneself. For a physician, publicly-posted patient ratings that contradict the doctor’s perception of his or her standard of care can be jarring.
Through “How Does Your Doctor Compare?”, the physician practice rating collaboration between Massachusetts Health Quality Partners (MHQP) and Consumer Reports, patients can access …
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Physician ratings can help identify missed opportunities
Recently our department of medicine grand rounds was on the subject of asthma. It began with a clinical vignette about a child with asthma, lasting three minutes, and, was followed by 47 more of intracellular cascades. The talk was like many others this year, and the speaker, who was introduced as a physician scientist, lived up to the part.
As someone who works in an academic hospital, I know many physician-scientists. …
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Clinician researchers meet the physician scientists
In an effort to combat obesity and all the health problems that are associated with it, New York mayor Michael Bloomberg recently announced a plan to ban the sale of sugar-sweetened drinks to 16 ounces or less. It also includes a $200 fine to vendors who violate it. If passed, the ban could take place as early as next March. The ban would not include diet drinks, juice-based drinks, or …
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Banning large sugar sweetened drinks is a start
What do you think is the physician-view of an “ideal patient”?
Well, as physicians, though we would like to think of caring for an ideal patient, we have to face the reality that this would rarely happen. You see, the ideal patient would be one who, first of all, bears many of the views and goals of the physician. As physicians, we really can’t believe that we will be so lucky. …
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Should doctors really want ideal patients?
Before I started medical school I thought it would be phenomenal to become a doctor. What could be more amazing than to possess a thorough, complete and intimate understanding of the human mechanism? I came to medical school to learn physiology and pathology in their entirety. I could not imagine a more valuable understanding than to fully know the secrets of the human body, what befalls it and how to …
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Medical students need guides during their clinical years
Does it really make sense for a neurosurgeon to be quoted in a news story about a new treatment for diabetes or prevention of obesity? Some news reporters think so, leaving primary care physicians frustrated at the media’s lack of understanding about the wide range of expertise they practice on a daily basis. In both news and entertainment media, seeking out and representing primary care expertise seems to be the …
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Primary care physicians are negatively portrayed in the media
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