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.
Take a look around you. What do you see? Babies playing with gadgets, four year olds playing with cell phones, and teenagers and adults playing with iPads or typing away on their personal computers. With the exponential increases in technology, specifically the digitalization of communication, in the past decade, our citizens have moved to the point of paying more attention to our devices than to each other.
As we begin to …
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Communication skills are lacking in health care today
I was recently honored to attend a discussion at the White House, convened by Health and Human Services Secretary Kathleen Sebelius. It was one of those rare “clear my schedule immediately” invitations; I thank my patients and family for allowing me to take this last minute trip.
Physician leaders from around the country were invited to the White House for a dialogue with lead government health officials (specifically administrators from the …
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Our health problems will remain, despite how the Supreme Court rules
“Cheers!” “To good health,” my girlfriend and I toasted in the living room of our apartment joined by my parents on speakerphone.
It had been 12 years since my last radiation treatment—my last treatment for Hodgkin’s Lymphoma. Tonight was the anniversary of my remission, and in the case of Hodgkin’s—a cancer with an exceedingly low relapse rate—tonight was my anniversary of being cured.
I kissed my girlfriend goodbye and tread the dark …
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Long waits to access primary care are avoidable
Pretty much everyone chats up shared decision making these days. And that is good. It seems intuitive that people (patients) who are knowledgeable about their condition and buy in and/or help to shape the treatment plan are more likely to follow it.
Here is an example from my seatmate on today’s flight from SFO to our nation’s capitol. Her son, let’s call him Alex, is a teen with cystic fibrosis (CF). …
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Why isn’t shared decision making standard practice?
It’s been two days now since I basked in the glory. I still find myself floating above the ground. I can still feel the weight of the heavy gown and the velvet tam. I can feel the tickle of the tassel on my ear. My eyes fill with tears at the thought of my classmates – those who toiled alongside me – experiencing the same emotions. The reminders of our …
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The selfless people in medicine are the people a patient never sees
“I just love working here!” my nurse told me. “We have great supervision, I have wonderful colleagues – we all help each other in an emergency. The doctors are really responsive and I feel like I am doing important work. I thought I would only stay for a year because oncology is so hard, but I’ve been here ten and I still love it.”
This is what we want to hear …
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Physician disrespect impedes patient safety
There is enormous waste in American healthcare delivery. One estimate is anywhere from 20% to nearly 50% of total expenditures are frankly unnecessary. What is this waste? Is it real? Could it be eliminated or at least reduced? How difficult would such a reduction be to achieve? And what would be the unintended consequences?
Donald Berwick, the former administrator for the Centers for Medicare and Medicaid Services, along with Andrew Hackbarth …
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Reduce health costs by reducing waste
The Medicare physician payment formula is a case-study in failed policy. Physicians have long known that it is not working. Polls show that an overwhelming 94 percent of Americans believe the massive cuts it schedules are a serious problem for seniors. Even members of Congress from both parties agree – and that is no small accomplishment – that it is …
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AMA: Moving past a failed Medicare formula to focus on quality care
The medical profession has always been marked by division: town versus gown, primary care versus specialty medicine, states versus national. But the real fault line today is not defined by specialty, geography, or teaching versus practice, but by size of practice.
Physicians in smaller practices, without regard to specialty or where they are located, are embattled and defensive—and therefore are more skeptical when someone tries to peddle the need for delivery …
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Is there a future for smaller physician practices after health reform?
Willful blindness of our public health officials on tobacco is still killing hundreds of thousands of Americans each year.
Here are the facts:
i) There are approximately 46 million tobacco smokers in the United States.
ii) While three-quarters say they want to quit smoking, and about one-third try to quit each year, fewer than 10% succeed.
iii) The FDA-approved smoking cessation aids simply do not work: They improve quit rates only minimally, if at …
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The truth about reduced risk smokeless tobacco
Which electronic health record system should I select?
Among physicians and managers in small-group practices today, there is no more common question.
But lately, another vexing question has emerged: Whether to install EHR software on servers in your office, or subscribe to an Internet-based system maintained in “the cloud.”
What Is “the cloud”?
When EHR vendors began offering their products via the cloud, many physicians were puzzled. Some think that the cloud is simply …
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Should you consider an EHR in the cloud?
Obesity is becoming a major health issue in the United States across all age groups. It is well known that obesity is a major contributor in the occurrence of type 2 diabetes and heart conditions. Although physicians and other clinicians are often called upon to become the primary players in the prevention and treatment of chronic conditions, it is not possible for them to do so alone when it comes …
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What can local groups do to prevent obesity in children and youth?
At the end of long days I often stand gazing out my window at the beautiful, timeless Rocky Mountains in Colorado Springs and am taken by their sense of permanence. I recently returned from Nampa, Idaho, where I presented hospital Grand Rounds on Accountable Care Organizations.
The parallels between the timeless mountains and the physicians I met in Nampa struck me. Strange, you say? Maybe, but I am accustomed to the …
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What does an ACO mean in small town America?
It used to be simple: build a practice website, stuff it with some keywords and your online spine practice marketing is done. Those days are long gone and search optimization and social media strategies continue to explode and cause confusion among medical professionals. New Google changes have caused practice sites to disappear or plummet in search ranks. Guidance for a proper social media strategy varies wildly or is non-existent. Mobile …
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New Google and Facebook changes that affect your physician website
Patient satisfaction is an important element of medical care. It was always important, but it has taken on a new significance since hospitals and physicians will be graded on their bedside manners. And, these grades count for cash. Money motivates. Who believes that a leopard can’t change its spots? Throw a leopard into the pay-for -performance arena, define spots as inferior quality, and watch what happens. We would all witness …
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Finding the right model for patient satisfaction
My in-laws are in town for my daughter’s graduation. When I came home yesterday I was greeted with a big smile and vigorous handshake from my father-in-law. ”I just want to thank you,” he said, standing up from his chair, “for finding us a good doctor. The one you found for us is wonderful.”
My wife smiled at me warmly. I just earned myself big points. Yay!
Her parents and mine are …
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Being on the other end of finding a good doctor
Why would anyone want to become a doctor? Seriously. Think about it, because this is a very important question for the future of healthcare in our country.
The future of medicine is somewhat unclear in this age of healthcare reform, but we do know a few things. Physician compensation is currently falling while lawsuits and malpractice premiums are rising. Doctors must see many more patients in a day to maintain their …
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The reasons our future doctors are choosing medicine have changed
I recently learned the sorry news that my childhood pediatrician has died. Not only was he my pediatrician, but he was also my father’s pediatrician. Our family became rather close to him over the years.
He came from a different generation of doctors, one that made house calls, that served in wars abroad, and that learned how to diagnose patients in the days before MRIs and CT scans. Even though I …
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My pediatrician inspired me to become a physician
“Oh, by the way” are four simple words that cause most docs to shudder. Yes, shudder. Your patient signed in for a sore throat, congestion, and cough. The nurse did her job. She’s recorded the patient’s chief complaints. She’s taken the patient’s vital signs and readied the patient to see me, the doc.
I take a history, asking questions about the problems that brought the patient to the office. I ask pertinent …
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What patients think is not trivial
Guidelines for care increasingly help guide medical decision-making. If you’ve followed top health news over the past several years you’ve read conflicting statements about the utility of various medical procedures and tests. As a general internist I’ve devoured these reports with particular interest trying to wade through bias to formulate views that I believe will be of most benefit to my patients.
Recently I put together a talk about recommendations for …
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The problem of conflicting professional medical guidelines
