It’s hard to believe that nearly 1.5 years ago have elapsed since my first-year orientation to medical school. Much of it seemed protocol with session after session on rules and regulations, but I vividly remember the few hours spent outlining standardized patient encounters and how my assessments over the next four years would be based on my interactions with a complete stranger. As alien as that idea sounded to me, …
In preparation for a panel discussion at Internal Medicine 2012, the annual scientific meeting of the American College of Physicians, I was asked some questions about changes I would make in health care if I were king. That stimulated some serious thinking. For those of us in practice it is more usual to think about what new regulation …
I wasted time, and now doth time waste me.
-William Shakespeare, Richard II
A friend recently asked me a simple question: Why do we have to wait so long for doctors and not for other professionals, like lawyers, accountants, or dentists? And what can we do about it?
A study by Press Ganey showed that the average time patients spend waiting to see their health provider is 24 minutes. The research was done …
It was always the same with Ronald. After years of absence, he would appear at my doorstep with some particular problem that had progressed to alarming proportions. Once, it was the abscess that seemed to swallow up his whole back. The next time, it was a hernia that had grown to the size of a grapefruit hanging out of his undergarments. But today was different. In fact, …
In the first week of the 5th grade, our class had a special music afternoon. It was our opportunity to try out the different instruments in the school band. We were to make a decision, that very day, about which instrument we would play almost every day for our school music careers.
I was so excited. I had been busy deafening my parents for years by creating high-pitched squawking melodies on …
Something difficult has unfolded around here lately and when news got out a dear friend came by with a gift of a story. She told us about a day years ago when one neighbor heard the other had breast cancer. The well neighbor was shocked and saddened. She was at a loss and wanted to help; wanted to do something but, what? In a daze but motivated none the less, …
Only a generation ago, medical students thought about what specialty to choose simply in terms of what interested them most. All doctors made a comfortable income; money wasn’t a primary motivator. There was a sense that cardiac surgeons or neurosurgeons could make more than most other physicians, but in fairness their training was much harder and longer. Internal medicine was held up to us as the most prestigious and intellectually …
There will be some very disruptive and some transformational changes in the way health care is delivered, not as a result of reform, but as a result of the drivers of change described in a previous post on KevinMD.com. They included an aging population, an obese society, shortages of doctors, and emerging consumerism, among others.
I interviewed in depth about 150 medical leaders from across the United States to collect …
For various reasons our nation’s public health programs have been decimated. This comes at a time when the number of unemployed and health uninsured are at a record high number. Additionally, we are seeing individuals live longer and experience more chronic debilitating illnesses and conditions that stretch the resources of an already under manned and under funded health system. Emphasizing prevention and healthy living should be a lifetime necessity for …
I have to disagree with Kenny on this one, despite having written an article in the New York Times Magazine that strongly supported Kenny’s work at the US Preventive Services Task Force, which found …
Over the past few years, insurers and Medicare officials have fostered the idea that physicians should be reimbursed on a pay for performance (P4P) basis. Many articles, both pro and con, have been written regarding P4P. I have been strongly opposed to P4P, believing that the sole purpose of the performance indicators designed by the government and insurers is to reduce payments to docs and hospitals. I also believe that …
I’ve just come back from my semi-annual renewal in my belief that family medicine is the foundational solution to make healthcare more affordable in America: the interim session of the Texas Academy of Family Physicians. The most important activity at these meetings is the networking: the chance to bounce ideas and experiences off colleagues from around the state.
The issue of cost came up and two colleagues in private practice told …
Fed up with our health care delivery system? Maybe even angry? What should a person do? What can a person do?
I recently wrote a post on drivers of change in health care delivery such as the aging population, adverse lifestyle behaviors, shortages of physicians and developing consumer expectations. I planned to follow up today with what those drivers will produce as change in the delivery system. But a commentator responded …
As a child, the only physician I ever knew was our crusty opinionated and entirely trustworthy family doc. His physician career spanned almost five decades, in one unbroken line from his first days as a GP in solo practice until his retirement, which occurred way past the age at which most of us would like to stop working.
His was the typical physician career, representing continuity, professional satisfaction and a lifelong commitment …
One of the most common stressors for physicians is the sheer toxicity of what are considered full time hours. While the rest of the world considers full time to be 40 hours a week, we all know a full time doc starts at 80 plus, if you include all the hours you must be available on call.
In physician surveys, schedule flexibility and the ability to function as a part time …
I am used to being called a “medical provider” instead of a doctor or a physician these days, but it makes me think about the implications of our choices of words. The word “provider” was first used in non-medical contexts over 500 years ago. It is derived from the Latin providere, which means look ahead, prepare, supply.
“Medical provider” is part of the Newspeak of America’s industrialized medical machine. …
The American Board of Internal Medicine (ABIM) and nine other professional medical societies announced that doctors should perform 45 tests and procedures less often than currently done because there is no good medical evidence that they add any value. Specifically, a xray or other imaging for low back pain in an otherwise healthy individual or an EKG as part of a routine physical, just add a lot of unnecessary cost …
The following column was published on April 11, 2012 in CNN.
When you visit the doctor, chances are you are given a prescription for a drug or an order for an X-ray or lab test. Before you leave, it’s important to ask whether your doctor’s recommendations are truly necessary.
Even though much of what physicians do is meant to help patients, sometimes it’s not always the case. Drugs may have harmful side …
As I pulled into the parking lot across the street from the large urban hospital where I now work, I considered the number of cars in the physician parking lot. Could there really be a physician shortage when the lot borders on full by 8am? While I fully believe that there is a maldistribution of physicians in the United States, my mind took off pondering what the parking lot would’ve …
Long relying on feedback from not only my patients but also family and friends, I try to continually improve upon how I provide care. A family member points out what they don’t like about a recent office visit and I make a mental note. A patient I referred to a specialist is less than thrilled about the way she was treated, again I make a mental note. Many of my …
