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.

How managed care is bad news for pregnant women

Linda Burke, MD

Physician

August 31, 2011

I read an article in my local newspaper the other day that gave me reason to pause. The State of Florida intends to hand over 3 million Medicaid patients to managed care companies who will reduce payments to physicians and hospitals. In exchange for accepting these low payments for professional services, doctors are guaranteed through pending legislation that no matter what egregious errors they make, the patient will only receive …

Family medicine needs to take advantage of buzzwords

MaverickMD2012

Physician

August 31, 2011

I was driving into work recently listening to the radio and heard one of the fancy ads that our hospital has been airing over the last few years of it’s “Good People, Great Medicine” campaign. The ad was talking about getting results for a patient recovering from a heart attack. Around central PA, this patient is far too common. And listening to the ad brag about how quickly this …

How a Google printout can strengthen your relationships with patients

Lukas Zinnagl, MD

Patient

August 30, 2011

If you are a practicing physician then it probably already happened to you more than once. Mature and responsible patients tend to Google their symptoms, medication and illnesses on the web – a phenomenon commonly referred to as cyberchondria. Nine out of ten women more or less decide which oral contraceptive they will take and not the doctor does. She will just let the doctor know whether his choice …

Obesity needs to be treated in primary care

Arya M. Sharma, MD

Conditions and Diseases

August 30, 2011

Given the staggering prevalence of overweight and obesity in most developed countries, there is no other hope than to have general practitioners (and their allied health colleagues) take on the considerable burden of managing obesity in their practices.

In fact, a recent example of a successful weight management program run in primary care just found considerable media attention in local newspapers.

But research shows that most general practitioners (GPs) neither feel confident …

Coronary CT screening is low value health care

Kenneth Lin, MD

Physician

August 30, 2011

Like many states, Texas is facing a fiscal crisis caused by decreased revenue from the economic recession and skyrocketing health care costs. Even without the expansion of publicly financed health insurance mandated by last year’s health reform law, the percentage of the state budget devoted to Medicaid expenses is projected to rise from 28 percent to 46 percent by 2020, even faster if the law withstands current …

The secret to better patient care is time

Rick Donahue, MD

Physician

August 29, 2011

Lets face it — the system of primary care medicine in the United States is broken. Even in Boston, the mecca of medicine, patients struggle hard to find an accessible doctor. And when they finally land an appointment, their well-intentioned internist, pediatrician or family physician often seems overworked, rushing from patient to patient, with little time to really listen to details.

As a primary care family physician for 20 years, …

A rural medical school to train rural physicians

Robyn Liu, MD

Medical Education

August 28, 2011

Are big-city academic institutions really necessary to train excellent clinicians? What irreplaceable benefits do they provide?

When I attended medical school a decade ago, there was a group of students comprising about 50% of my classmates that I rarely ever saw. Most of these were students who had come to medical school straight out of college, and still denied that anything important in the world happened before noon. They skipped …

Intuition saved this patient from a potentially fatal diagnosis

Sharon Bahrych, PA-C, MPH

Conditions and Diseases

August 27, 2011

I was working in a rural health clinic when I went into to see a new patient. Amy was 18 years old, with her 6 day old newborn son by her side.

I introduced myself and then asked, “what brings you into the clinic?”

Amy responded, “Shortly after giving birth, I started having problems with shortness of breath, ankle swelling, and high blood pressure. I told the OB residents and they brushed …

Why specialists should join primary care to end the RUC

Paul Fischer, MD

Health Policy

August 25, 2011

The old doctors know. The practice of medicine has changed in a very basic way over the last 20 years. Physician relationships have lost their civility and have been replaced by a level of tension that takes the fun out of collegial interactions. I remember my first year of family medicine as the only doctor in Weeping Water, Nebraska. My personal medical community had gone from an entire medical …

Will patients trust sociable humanoid robots?

Kent Bottles, MD

Health Technology

August 25, 2011

Within in five years primary care providers will begin being replaced by sociable humanoid robots, avatars, and computer programs. Within ten years you will no longer hear any complaints about medical students choosing specialty residencies over family practice because the role of the physician will be completely redefined to complement a rules based approach to the diagnosis and treatment of many diseases. This transformation is inevitable because of demographics, economics, and …

Converting a practice to a no insurance accepted model

Robert Tomsett, PA-C

Physician

August 25, 2011

Not long ago, I was working for a pain management firm with 19 clinics scattered throughout three states. I was fast approaching my three year mark as the travel PA and more recently, the compliance officer. Little did I know that my career path was about to go off-road, into a new world of clinic ownership coupled with the unchartered territory of no-insurance accepted.

What a difference a few months can …

Medicare patients should bring a companion to office visits

James Haddad

Patient

August 25, 2011

When a patient shows up for a doctor’s appointment with a companion, I often find myself studying (and later, interacting with) them as much as I do the patient. Most times, a quick review of body language is all I need to make an assessment – is this person looking out for the interests of the patient? Are they here begrudgingly, or out of concern? Are they indifferent, or …

Should pediatricians be punished for asking about guns in the home?

Ricky Choi, MD

Physician

August 24, 2011

Far be it for me, a Bay Area pediatrician, to tell Floridians about how to keep their kids safe. But having spent half of my life in the south (and I don’t mean LA), perhaps I am only partially carpetbagging.

Florida’s Governor Scott has signed a law that penalizes doctors for asking about guns in the home. It shockingly included a $5 million fine and a five year prison sentence if …

Why medicine actively and legally stifles innovation

Jay Parkinson, MD

Physician

August 23, 2011

Upon finishing my second residency at Hopkins in Baltimore in September of 2007, I moved back to Williamsburg to start a new kind of practice:

Patients would visit my website
See my Google calendar
Choose a time and input their symptoms
My iphone would alert me
I would make a house call
They’d pay me via paypal
We’d follow up by email, IM, videochat, or in person

It was simple, elegant, and affordable for me to start. But …

How Medicare undermines primary care

Kohar Jones, MD

Health Policy

August 23, 2011

When I was a family medicine intern, I met a diabetic patient in the hospital who had stopped seeing his regular doctor after he lost his job and his health insurance. His untreated diabetes made his feet go numb. He stepped on a nail and didn’t realize it until he noticed a smell that cost him his foot.

He spent thousands of dollars on the surgery and subsequent hospital stay—far …

Read more…

How Medicare undermines primary care

Why my family doctor is a superhero

Bryan D. Peach

Physician

August 23, 2011

In the interest of full disclosure, I’m not a family physician. I never aspired to be one – I wanted to be a superhero as a kid. When I got older, I realized that all the best ones (like Spider-Man and Superman) spent their non-costumed hours as newspaper reporters or photographers, so I decided to go into that line of work instead. It eventually led me to the Pennsylvania …

Read more…

Why my family doctor is a superhero

The art of medicine and the power of human touch

James Asante, MD

Physician

August 22, 2011

Though I had a less than comfortable childhood, I did not know what I missed in nurturing until I played football at around age 10. The coach, a big burly man, with a voice as huge as his girth, put his hand on my shoulder as he explained something to the team.

I have never been able to explain the feeling that went through me that day, that moment, like a …

Take the effort to reach across cultural and language barriers

Sharon Bahrych, PA-C, MPH

Patient

August 22, 2011

I was working in an urgent care clinic when I walked into the exam room to see my next patient. He was a six-year old who primarily spoke Spanish, with some broken English. Jose’s mom was with him, she only spoke Spanish.

I sat down and picked up the phone receiver to contact our translator service. With the Spanish interpreter on the line I was able to proceed. I then asked …

Regrets after patients have lost their health

Stewart Segal, MD

Patient

August 22, 2011

Regret is a harmful emotion. Regrets are best avoided. Its one thing to regret buying a stock that plummets. It’s another to regret that you ever smoked because your chest x-ray shows a large tumor.

People often don’t appreciate what they have until they’ve lost it. When you’ve lost your health, you will regret its loss for the rest of your (shortened) life. Imagine that you were supposed to take your …

Why concierge and direct pay medicine is not unethical

Steven Reznick, MD

Physician

August 21, 2011

A response to Concierge Practice: Unjust for Patients and Doctors Alike.

Like the shots fired at Concord and Lexington in 1776, concierge medicine and direct pay practices are the initial shots fired by concerned primary care physicians in the revolution against health care systems which limit access to physicians and destroy the doctor / patient relationship. Concierge medicine arose as a result of government, private insurance, and employer intrusion into …

Primary Care

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