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.

The words we choose can have impact on those we interact with

Kate Land, MD

Physician

October 4, 2011

Language matters. The words we choose can have far-reaching impact on those we interact with. This is arguably more true in medicine than in any field.

Ryan Madanick wrote a recent blog post on the use of descriptor terms used by physicians in patient’s charts. He felt that the use of phrases like “is a very pleasant 52 y/o woman” or “is an unfortunate 16 y/o boy” is inappropriate. I …

The cumulative effect of viruses in day care

Roy Benaroch, MD

Conditions and Diseases

October 3, 2011

Tracy has a good question: “My 4 year old is not in day care – he stays with Granny. I heard that once you get a cold, you never get that cold again, and I am worried he isn’t exposed to enough germs now to keep him healthy later. Should we be trying to infect him with more colds now that he has the luxury of staying in PJs all …

Universal board certification can solve the Doctor Nurse controversy

Kevin Pho, MD

KevinMD

October 3, 2011

I’m going take on the Doctor Nurse controversy.

This isn’t a new issue, as the doctorate in nursing degree has been around for awhile. But a recent piece in the New York Times gave it new life.

The topic is a ripe invitation to “doctor bash,” with the predictable arguments about physicians protecting their turf, elitism, and the like.

Yawn.

To sample the …

Sometimes cyber-medicine is fraught with danger

Stewart Segal, MD

Patient

October 2, 2011

I’m worried about the future. Everyone I know is stressed. Patients fail to follow up as directed. They fail to take their medications as directed. They have too much to do. Their priority lists are in shambles.

With all the responsibilities that today’s multitasking society thrust on my patients, they don’t even have the time to pick up the phone and call each other; instead, they text, IM, SMS, and email. …

Use a beginner’s mind in your medical practice

Philippa Kennealy, MD, MPH

Physician

October 2, 2011

As a mom and first-time parent, I marveled at my tiny daughter’s curiosity about and interest in the world. Her quest for knowledge was insatiable and her ability to sit absorbed in what she was doing and the moment enviable. Now that she’s 8 (“8 and a quarter, mom!”, said with a sigh and an attitude), she seems to have morphed into a smart, verging-on-sassy pre-tween who’s beginning to think …

I concentrated to distill all that I had learned about death

Jordan Grumet, MD

Physician

October 1, 2011

The recycling container was already full. But I had two more bags to stow before lugging the bin through the gate and into the front yard for pick up. My button down shirt untidy and bulging out from the waist. My long khaki pants felt like a fur coat in the ninety plus Chicago humidity. It was 4pm and I had just arrived home from work, dropped my computer in …

The empowered patient is a relief for physician practice

Jeffrey Gladd, MD

Patient

September 30, 2011

Patients may soon be universally able to view their lab results thanks to a new rule proposed by the Department of Health and Human Services. This means patients may access without permission or release by their providers. This is a victory toward patient empowerment and a step in the right direction.

Classically patients do not see their lab results. The busy primary doctors are often left with nothing more than …

Physicians lack harmony in this age of health reform

Gary Oftedahl, MD

Physician

September 30, 2011

At every turn, we in health care are being told we must fundamentally change the way we deliver care to the patients who come to us for assistance, advice, and decisions as to how they can, if not maintain health, at least survive in an increasingly burdensome world. Whether referenced as medical home, health care home, advanced primary care, patient-centered approaches, or accountable care organizations, it all sounds the same …

Bias in CME due to the presence of commercial support is overrated

Derek Warnick

Medical Education

September 30, 2011

So I missed out on the whole CME outrage that came up earlier this year in a Archives of Internal Medicine study, but I do have a theory about it that I’d like to try out.

I’m not interested in getting into the “perceived potential bias” vs “actual bias” argument – which is a good one and one Tom Sullivan wrote about extensively – but would rather take a look …

Doctors should not treat every patient like their mother

James Logan, MD

Physician

September 30, 2011

Physicians recommend different treatments for patients than they would choose for themselves. The preceding statement is true according to a similarly titled article recently published in the Archives of Internal Medicine, and has, I will argue, important implications for how we view the doctor-patient relationship.

In the study, one group of physicians was asked to choose between two hypothetical treatment alternatives for either avian flu or colon cancer as …

How to isolate problems in your scheduling system

Adam Alpers, DO

Physician

September 29, 2011

Though there will always be times when an emergency disrupts your schedule, there is usually little reason for patients to wait more than 20 minutes for their visit. You will also find that continually double booking, arriving late, or having general mayhem in your office will inevitably result in everyone having to stay later than expected. Rather than experiencing all of these problems, you will be well served by isolating …

An MRI for back pain may only confuse the diagnosis

Kerrie M. Reed, MD

Conditions and Diseases

September 29, 2011

“Doc, my back is killing me! I think I need an MRI.”

I don’t know if you’ve ever uttered those words, but I can tell you I’ve sure heard them … more times than I can count. And believe me, I get it. When you’re in pain, all you care about is finding out what’s causing it as soon as possible so you can get rid of it as soon as possible. It’s quite tempting to …

Physicians need to be part of the overall wellness process

Joseph Boffa, DDS, MPH

Health Policy

September 28, 2011

After nearing the brink of political collapse, Congress and the President reached agreement on a plan for deficit reduction. Part of the agreement is that a “super committee”will cut an additional $1.5 trillion from the federal budget. Cuts are being considered for a range of programs, including Medicare. As director of a wellness program for retirees, however, I remain acutely concerned about the impact Medicare cuts will have on …

Doctors with great bedside manner can also provide great clinical care

Davis Liu, MD

Physician

September 28, 2011

The New York Times recently published an article titled, Finding a Quality Doctor, Dr. Danielle Ofri an internist at NYU, laments how she was unable to perform as well as expected in the areas of patient care as it related to diabetes. From a New England Journal of Medicine article, Dr. Ofri notes that her report card showed the following – 33% of patients with diabetes have glycated hemoglobin …

Honesty between doctors and patients goes both ways

Stewart Segal, MD

Physician

September 28, 2011

Yesterday, someone asked me, “Can I be perfectly honest with you?” I wanted to reply, “No, just be dishonest, I like it better that way!” “Can I be” implies that, in past conversations, my patient has been dishonest. Dishonesty is a relationship breaker. Dishonesty leads to distrust and if I cannot trust what a patient is telling me, I cannot be effective; the doctor-patient relationship is terminated.

Am I being too …

Father and son, doctor and grieving family member

Jordan Grumet, MD

Physician

September 28, 2011

The edges of Cameron’s lips rise undeniably toward the clear blue sky. His legs move methodically. One motionless on the scooter and the other periodically kicking to propel himself forward. He weaves in and out dodging my shadow as I jog beside him.

I struggle to keep pace. My breathing unsteady and labored. My joints aching. And my brain foggy from lack of sleep and replaying the events of the day.

***

The …

Doctors can help patients make informed decisions and prevent overtreatment

Davis Liu, MD

Patient

September 26, 2011

There are many tips to saving money on medical costs like asking your doctor only for generic medications, choosing an insurance plan with a high deductible and lower monthly premiums, going to an urgent care or retail clinic rather than the emergency room, and getting prescriptions mailed rather than go to a pharmacy.

How about getting your old medical records and having them reviewed by a primary care doctor? It …

My good intentions had helped start a reaction

Jordan Grumet, MD

Patient

September 25, 2011

If death was the end zone, George had been on the one yard line twice in the last five years. And I, as part of his team of doctors, watched as he stubbornly maintained his goal line stand. Miracles rarely happen in medicine. They certainly don’t happen to the same person more then once.

Yesterday as George glided into my office you would have never known that eternity’s grip had been …

Why I left a top children’s hospital for a private office

Anonymous

Physician

September 25, 2011

All medical students and residents, those with any sense of introspection anyway, wonder if we (they) should be on the front lines. We wonder if we should be meeting, examining, trying to diagnose and treat families and children when we know that an experienced clinician just around the corner or in the next room could see the patient, perform the procedure faster and with more panache than our feeble …

Why a physician recruiter needs to consider the spouse of a doctor

Bo Claypool

Physician

September 25, 2011

Whether you are a physician saddled with the task of spearheading the recruitment efforts of your practice, a group practice administrator, an in-house physician recruiter, or an agency recruiter like myself, you have probably heard the following at least once (if not several times, as in my case) in your career from a prospective physician candidate you are seeking to recruit:

“You know, I just wanted to say that I really …

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