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.
“Medical training rarely deals with helping the dying patient find peace and comfort. In fact, most physicians are uncomfortable with the entire subject. I believe it is one of the most neglected aspects of medical care. I have spent my career as a pulmonary and critical care physician, and I have cared for thousands of dying patients. In many cases, both the patients and I knew that they were dying. …
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Advance planning should be a public health issue
It is critical for physicians to share unusual patient diagnoses that present to clinic with routine type symptoms. In a hospital setting, these are cases for discussion and debate at Grand Rounds. In a primary care setting, we do case reviews when we can with informal sharing for the purpose of teaching and learning. The bottom line, whether in a formal academic setting, or an informal setting around the lunch …
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The possibility of zebras in primary care
I usually cringe when I see a pharmaceutical company ad on TV. I think most pharma commercials do more harm than good. The ads scare patients out of taking medications they need.
Actor: Do you have uncontrollable diarrhea? I did, and then my doctor prescribed “No-More-Poop!” Now I feel great and don’t have to worry about embarrassing accidents.
Commentator: Clinical studies done at a leading university prove that “No-More-Poop” cures 99% of …
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How medications are like vehicles
With health care industry reaching unsustainable lows, media attention is on physician’s relationship with the pharmaceutical industry. A Google search will give results that paints doctors as culprits, leading to a prejudiced opinion where doctors are thought of as co-conspirators with drug companies. This article teases this tainted relationship, from a typical doctor’s perspective.
Pharmaceutical companies have strategies not only to survive, but also to grow with general public investing in …
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Taking the knife to doctor-drug company relationships
Political correctness and sensitivity training are interfering with medicine and healthcare. In a recent article published in the journal, Pediatrics, a group of researchers published their findings regarding parental perceptions of the terminology that doctors use to describe childhood obesity (ages 2 to 18). The researchers found that it was undesirable to use the term “fat,” “obese,” or “morbidly obese” because they were stigmatizing, blaming, and the least motivating to …
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How political correctness interferes with healthcare
Sonia struggled to express herself through broken English. Her lively facial expressions and exuberance betrayed by her inability to string the words together fluently. One hand gesticulated widely while the other rested gently on the elderly woman’s hair.
She somehow managed to coo quietly in her companions ear, calming her, as she continued the conversation with me. Sonia’s eyes opened and closed in an exaggerated blinking manner as she questioned me …
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Health quality requires looking at our caregivers
I have not always been excited to hear patient complaints. As a younger manager I absolutely dreaded when a patient wanted to speak to me. I felt that I had little to offer a patient who expressed anger or frustration with something that had happened and I was very impatient to get past the complaint and get back to my “job.”
Now, I can’t wait to hear patients’ complaints. Complaints …
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Why patient complaints are an opportunity
How is a doctor allowed to mess around with body parts he doesn’t understand?
If doctors were required to understand everything we touched we wouldn’t be able to touch you at all!
The human body is still a deep mystery. Doctors understand more than most people, but what we know is still a vague approximation. Just because our educated guesses often work out well doesn’t mean we have any idea what’s actually …
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The myth of physician omniscience
Have you ever Googled yourself or your practice? Did you know that you have an ever growing online reputation? Whether you know it or not, doctors have an online presence. When you type your name in a search engine you may be surprised by what you find. Everything you do professionally creates a digital footprint. If you are involved in social media then you are contributing to your online reputation. …
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Doctor, Google thyself
Fortunately, the 27% reduction in Medicare payments to physicians that is set to take place in a matter of weeks unless congress acts is getting some press. Fox News published a piece recently, as did the Washington Post. Writer Merrill Goozner breaks things down nicely in his article, “Is There a Doctor Fix in the House … and Senate?”
However, one thing that seems to be getting confused in all the …
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Primary care doctors are set to lose more than half of their salary
As we get older, having a good doctor in our corner becomes incredibly important.
And you don’t want just any doctor for your parent. Smarts, signs of basic compassion and a few other things are essential for the relationship to work.
Good doctor quality #1: Listening skills
Picture it: Your Mom’s doctor’s office. 10am Tuesday. She reaches into her pocket for her list of three concerning symptoms she plans to mention, if she can …
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Good doctor qualities for your aging parent
“Superior doctors prevent the disease.
Mediocre doctors treat the disease before evident.
Inferior doctors treat the full-blown disease.”
-Huang Dee Nai-Chan 2600 BC; 1st Chinese Medical Text.
Not only does my work in integrative medicine have me on the front lines of big pharma-created “syndromes”, like chronic fatigue, fibromyalgia and irritable bowel (these are real for patients, but are not formal syndromes), but I get to see the worst of our sickcare system. I …
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Find a physician, not a general
In my new role as one of the directors of an internal medicine training program, I help select new interns out of medical school for the three year training stint of residency.
At the end of residency, many graduates go on to subspecialty fellowships, another two to four year period of intensive training in fields like cardiology, nephrology, critical care etc.
For those that don’t choose a subspecialty, one choice remains: traditional …
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Young doctors don’t see value in primary care careers
Doctors inevitably come into spotlight, being at the front end of health care delivery. Sometimes seen as guardian angels restoring health and life, other times, greedy minds sucking resources while they carelessly harm and kill patients to fill their wallets. After experiencing, observing, and hearing from others like me, I wonder if doctors are given more responsibility than they can handle, often attributed more aura than they deserve and frequently …
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Are doctors given more responsibility than they can handle?
“When is it time to break up with your doctor? It can be a tough decision to make. After all, if you don’t like your experience at a store, you shop somewhere else next time. If you go for a haircut and hate it, you find someone else.
With your doctor, it’s a bit different. This is someone who might know some of your deepest, darkest secrets. There is a history …
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When is it time to break up with your doctor?
Health insurance is very complicated. At our practice, we deal with health insurance all the time and even for us, it gets to be very complicated sometimes. So it is natural that patients have a hard time understanding it as well.
Therefore, I decided to summarize a conversation I had with a patient in an effort to help other patients understand, at the very least, a portion of how medical health …
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What patients need to know about coding
Historically, American physicians and surgeons were fiercely independent practitioners, who owned their own practices, worked long days and maybe longer nights, made a good income, but saw little of their families. They trained in a male-dominated world in “residency,” so named originally because their extended 120 hour/week work schedule demanded them living in dormitory type residence adjacent to the hospital.
They developed long-standing professional commitment to their patients that superseded time …
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Impersonal care from the new generation of physicians
Test your medicine knowledge with the MKSAP challenge, in partnership with the 
