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.

We must redesign our health care payment systems to value primary care

Mark Ryan, MD

Health Policy

June 4, 2012

I share this post here to point out the discrepancy in physicians’ average salaries based on their specialties. In particular, I would like to highlight that the three lowest-paid specialties are the three primary care specialties: pediatrics, family medicine, and general internal medicine.

This post is not written to argue that physicians must be paid more. I would submit that if …

Primary care does not need to be expensive

Stephen C. Schimpff, MD

Health Policy

June 4, 2012

Are you a frustrated patient because you get little time with your physician each visit? Are you a frustrated physician who would like to spend more time but can’t make it work financially? Here are some developing approaches.

Reimbursement rates for primary care visits are low, so primary care physicians (PCPs) need to see many patients to cover office expenses. There are many ways that PCPs are using to escape the …

What is the role of providers when it comes to patient engagement?

Steve Wilkins, MPH

Physician

June 2, 2012

Patients often don’t get the respect they deserve. Take the subject of patient engagement. Just about everywhere you turn in the health care literature these days we are told how physicians and other providers need to do a better job getting patients involved in their own health.

But is that really their role?

Patient engagement is not the job of health care providers

Why? Because by the time a person (aka patient) …

Shared decision making is a necessary concept in modern patient care

Shabbir Hossain, MD

Physician

May 31, 2012

There’s nothing better than sitting down with a patient, going though an entire visit, and collaborating on a well thought out plan that meets everyone’s expectations.

Shared decision making is a wonderful and necessary concept in modern patient care. Paternalistic attitudes are fading away in the medical community as the next generations of doctors continue to get educated on how to manage patients who are very knowledgeable and yearn to be …

Is a good patient simply one who never complains or disagrees?

Suzanne Koven, MD

Physician

May 31, 2012

I’m currently having a chance to do one of my least favorite things: be a patient. And the whole time, I’m missing no opportunity to declare what a bad patient I am. “I’m sorry I’m such a bad patient,” I said to the phlebotomist when I winced as she drew my blood. “I know I’m a bad patient,” I said to the x-ray technician who re-positioned my fractured arm. “We …

One simple question that is the essence of medicine

Steven Lucas, MBA

Patient

May 25, 2012

A friend recently told me his daughter has been accepted into medical school with hopes of becoming a pediatrician. Along with this accomplishment will come $250,000.00 in debt.

I could not help but think of how her educational experience and future practice model will be so different from those who hold leadership positions in medicine today. Tablet computers will replace books and she will live in a 24/7 wired world.

I came …

Why Priscilla Chan may become the country’s most influential doctor

Kevin Pho, MD

KevinMD

May 22, 2012

Who has the potential to be the most influential physician of our generation?

It’s Priscilla Chan, who not only recently graduated from medical school, but also married Facebook founder Mark Zuckerberg.

When I brought this up on Twitter, someone responded that it was “disappointing at the same time. I’m certain her own merits and studies would have made waves alone.”

But her influence …

Confused about prostate cancer screening? Make a shared decision

Kevin Pho, MD

KevinMD

May 22, 2012

In a widely anticipated move, the USPSTF officially recommended against prostate cancer screening in healthy men.

Case closed, right?

Hardly.

The prostate cancer screening debate has been raging for the past decade. Increasing amounts of evidence show that screening does not save lives, and increase the risk of complications like impotence and urinary incontinence that stem from invasive diagnostic tests and treatments.

Regular …

Necessary is a word best defined when looking back in time

Stewart Segal, MD

Physician

May 19, 2012

How do you define a “good” doc? I was reading the patient responses to an article here on KevinMD.com and was saddened by how many of the patients were angry with their docs. Anger is an unhealthy emotion! One of the respondents was particularly angry about the “unnecessary” tests her doc performed on her and her family.

I have written about the vagaries of the term “unnecessary” in the past. What …

Can pit crews really heal medicine?

Scrub, MD

Physician

May 17, 2012

In his recent TED talk, Atul Gawande harkens back to the central thesis of his recent book The Checklist Manifesto: How to Get Things Right that medicine has become too complex for physicians to act as cowboys and instead should adopt the paradigm of a pit crew, utilizing teamwork and the humble checklist to solve problems and avert emergencies.

Is this really true though? Can “pit …

Read more…

Can pit crews really heal medicine?

What does a perfect pediatrics practice look like?

Wendy Sue Swanson, MD

Physician

May 15, 2012

I had a phenomenal day in clinic yesterday. Imperfect for sure but inspiring, connected, and busy. I felt useful and like anybody else, that feels so good to me. Productivity can be defined in various ways and yesterday I fulfilled my personal definition. I wrote an email to a friend and cardiologist this morning where I said, “But I must say, it’s a sincere fortune to be a doctor some days. Yesterday …

Primary care requires more than knowledge

Tabor Flickinger, MD

Physician

May 11, 2012

“You are too smart to do primary care.”

I have heard this far too many times, directed at me and at others seeking career advice. There are many reasons for the shortage of primary care doctors in the U.S., but at least part of it is this. Smart, capable, successful trainees are discouraged from choosing primary care. It is perceived as a less prestigious pathway than specializing.

The knowledge base of primary …

Am I going to die because I cannot afford the test?

Ralph B. Freidin, MD

Physician

May 11, 2012

On my way to the hospital last week, I heard a 26-year-old woman describe her experience of becoming deathly ill. When she first realized that the many bruises appearing spontaneously across her body were unusual, she was working as coffee shop to pay off school loans. With the urging of a friend, she went to see a physician. The diagnosis was acute leukemia.

Her job did not provide health insurance and …

Being a physician is like trying to parent two thousand teenagers

Jordan Grumet, MD

Physician

May 9, 2012

I walked down the hospital corridor listlessly. My feet dragged as they fought each attempt to lift off the ground. My body was tired and achy. The phone calls the night before had been relentless. Each stolen moment of sleep was interrupted before a deep, restful state was reached. It was Monday morning.

I sat at the nursing station flipping through charts. A colleague across the table was staring intently at …

Sudden death makes a mockery of preventive medicine

Stewart Segal, MD

Physician

May 9, 2012

Here today, gone tomorrow. The older I get, the more often I get the call: “This is the ER at Any Hospital, can you hold for Dr. X?” Dr. X then comes on the line and tells me my patient had a catastrophic event, that the paramedics and ER crew did everything possible but that the patient expired.

My patient had no reason to die. He was relatively young and healthy. …

Look to technology to reduce health costs

Stephen C. Schimpff, MD

Health Policy

May 7, 2012

Technology to lower costs rather than accelerate them. Smart phones to increase physician and other providers’ productivity. Fewer primary care physicians but more involvement by nurse practioneers and others. And increasing appreciation of the value of integrative medicine. These are but a few of the disruptive changes in care delivery that are coming.

I have posted concepts on how the health care delivery system will change in coming years – quite …

Shift the cultural obsession away from skinny

Solmaz Amirnazmi, MD

Physician

May 6, 2012

If you Google “skinny definition” what will pop up is the following:

Adjective: (of a person or part of their body) Unattractively thin.

The word skinny according to Webster’s is defined as the following:

1. resembling skin: membranous
2a. lacking sufficient flesh: very thin: emaciated
2b. lacking usual or desirable bulk, quantity, qualities or significance.

So how did our culture take this word and use it to represent a goal, or rather set “skinny” as a …

How an EMR makes connecting with the patient more difficult

Shabbir Hossain, MD

Health Technology

May 6, 2012

I have the great privilege of being a medical educator. Everyday, I have an incredible time working with internal medicine residents at their continuity clinic, teaching the art of ambulatory medicine. Our working environment here is academically rich and fulfilling. The name of the legendary Dr. Martin Leibowitz (an iconic figure in ambulatory medicine here) stands outside our conference room as a constant reminder of how medicine is practiced and …

A doctor has difficulty making sense of medical bills

Manoj Jain, MD, MPH

Physician

May 2, 2012

Rarely do people think about medical costs when there is a medical emergency or an urgent need for a test. Recently, I was in such a situation.

A few days after a 22-hour international flight, the calf muscle in my right leg began to ache. If it were not for the recent flight, or if I were not a doctor, I would have just let it pass.

But long periods of sedentary …

What do patients want from the health care delivery team?

Stephen C. Schimpff, MD

Health Policy

May 2, 2012

Ours is a provider-oriented system. Doctors like me and (former) hospital executives like me hate to admit it but it is true. Consumerism will slowly but surely drive it toward being a patient-oriented service model. What do patients and their families want from the health care delivery team? First and foremost is respect followed by service given in a high quality, very safe manner. Patients expect that the information gap …

Primary Care

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