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 science of nutrition is changing and not in the way you might expect. After years of “reductionist” thinking — where food has been viewed as the sum of its parts – a call to treat food as food has been sounded. No more poring over nutrition labels to calculate grams of fat or chasing down the latest go-to chemical – be it vitamin E, fish oil or omega-3. …
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The entire approach to food based on nutrients is wrong
There are some important new recommendations about tonsillectomy — taking out the tonsils — as a treatment for recurrent strep throats.
Some of us can recall a time when getting your tonsils out was one of the rites of passage of childhood. Usually a related procedure is added — an adenoidectomy, removing the adenoids as well. It’s called a T&A in the medical world, and it’s one of the …
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What do tonsils do and why would we take them out?
As a physician, I was inspired by the Lesley Alderman article –”The Doctor Will See You … Eventually” – that appeared in the New York Times recently.
There is a great deal of emotion in this country surrounding the debate over waiting-room delays in physicians’ offices. Doctors feel as though they are being unjustly blamed for making patients wait when physicians are now forced to see more patients in less time, and …
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Are doctors to blame for long waiting room times?
I usually write about healthcare reform from a pediatrician’s viewpoint, but what grabbed my attention recently was a story my husband, Randy, told me about an adult in his practice – a patient on Medicaid.
Randy is a neurologist in a private practice, and Medicaid patients come from every corner of Rhode Island to see him. They make this cumbersome pilgrimage because he is a member of a dying breed: …
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Why cutting Medicaid will cost more in the long run
I was working as a PA in an internal medicine office seeing patients. One afternoon, I was in the clinic hallway when I saw an elderly looking wife in her 60s actually pushing her husband into the next exam room. He had his heels dug into the floor, but she was winning, due to his obvious shortness of breath and audible wheezing.
I walked in behind the medical assistant who …
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Without wives, men’s health suffers
Last summer, I joined millions of others in the deluge of social media. I committed one year of effort to see if social would enhance or distract from my pediatric practice.
That was my goal, just one year.
At that time, I wanted to dip my foot in the pool, and see if it made any ripples. The unexpected consequence was how much social media has changed my medical practice, and …
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How social media has changed my medical practice
My patient had onychomycosis – toenail fungus. Not a devastating disease. The treatment for this fungus is a 12-week course of terbinafine. About $50 for a month’s supply … $150 for 3 months. Terbinafine’s potential side effects include liver toxicity.
During my primary care clerkship at the Bronx VA Hospital, I treated several patients who had onychomycosis and had undergone the antifungal treatment. One patient declined treatment with terbinafine because …
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Medical school rotation at a free clinic for the uninsured
What do you regret about your medical training or specialty selection?
Anything?
One thing I regret is not taking advantage of the Masters degree in Health Administration program at my medical school. At the time, I was focused solely on medicine and on being a doctor. I didn’t think the business side of medicine was all that important. In fact, I didn’t consider the business side of medicine at all.
I regret …
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How can doctors understand the business side of medicine?
“I’m sorry.”
I said that phrase a lot last night during evening patient hours.
With an overfilled schedule, I mostly said it to patients who waited twenty, thirty, even forty-five minutes for me to see them. “I’m sorry for your wait. I appreciate your patience.” I say these sentences far more often than I should. Why is it so difficult to stay on time?
I could blame my inadequate supply of nursing staff; …
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Why is it so difficult for doctors to stay on time?
There are multiple costs to non-compliance, including financial, both personal and societal, and physical-emotional. When patients fail to comply with treatment protocols, fail to get prescribed tests, or fail to stop destructive behaviors, there is a societal cost.
Today, I want to address the physical and emotional costs of non-compliance. I just read a brilliant article by Roxanne Sukol, MD. Dr. Sukol’s article discussed the fact that diabetes starts …
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The physical and emotional costs of non-compliance
I’ve heard patients say, “How could she smoke and she’s a doctor?” Alarmed and bewildered by the fact that an agent of health could partake in one of the most harmful acts of bodily destruction. In medical school, a sizable number of my classmates smoked and I always found it so counter-intuitive, mind-boggling that they would be learning about smoker’s lung in pathology and on class breaks would huddled outside …
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Doctors sometimes fail when practicing what they preach
“Mom’s been writing goofy checks…”
“Dad stopped paying his bills….”
“Grandma wired her savings to Nigeria…”
Have you heard these phrases from the family caregivers of your elderly patients? Have you ever been concerned that your patient may lack capacity for financial decision making? How do you decide if they lack capacity? What is the clinician’s role in making these decisions? What is their responsibility?
These important questions are addressed in a terrific new article in …
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Alzheimer’s inevitably leads to loss of financial capacity
Someone has gone and rained the facts down on what is generally considered a feel–good story in American medicine, the dramatic increase in female doctors in America.
In response to Dr. Herbert Parde’s “The Coming Doctor Shortage” article in the Wall Street Journal, Dr. Curtis Markel pointed out that there is a difference between the raw, gross number of physicians in America, and the effective number of practicing physicians. Not only …
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Female doctors and the physician shortage
I had a patient once—a fellow physician—who came to see me complaining of mid-back pain. When I examined him, I found I could reproduce his pain by pressing firmly on the spot he said was hurting him. He said pressing there also made the pain radiate around to his stomach, a phenomenon known as “referred pain” that meant his pain was almost certainly caused by a trigger point. I …
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How early closure can cause doctors to misdiagnose
Patients want to know why they can’t get a return call from their doctor’s office – here are six reasons why the calls have increased and physician offices are having trouble meeting the needs of their patients.
1. Medication questions and requests for a prescription change. The average number of retail prescriptions per capita increased from 10.1 in 1999 to 12.6 in 2009 (Kaiser Family Foundation calculations using data from …
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6 reasons why doctors won’t call patients back
A reader writes, “Can you do a post on what procedures constitute a thorough physical, in your opinion? I haven’t had one in several years and thinking of making an appointment now. The last doctor I went to didn’t even listen to my heart or go though the motions with feeling my belly and that stuff. And of the last 3 doctors I went to, I realized they didn’t …
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There is no such thing as a complete physical examination
Doctor D has been blogging about the doctor-patient relationship for a while now. It’s sort of the thing I’m known for. I’ve usually been on the doctor side of this equation. Most of my blogging, however, is to help patients figure out the weird world of medicine.
Doctor D recently found himself on the patient side of a nasty injury.
Even as Doctor D looked down and realized his leg wasn’t …
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What this doctor learned when he was a patient
It takes its toll on me, being a doctor.
I think as I wait in the Indian restaurant buffet. My son is curled on my lap. Uncharacteristically tired. Later he will develop a fever and I will realize why he is so warn out.
It takes it toll on me. I wouldn’t say I am a stressed out person but I certainly live with stress. Most of it is self inflicted.
It’s …
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Being a doctor takes a toll
Every year, according to a recent study from the New England Journal of Medicine, a typical physician has about a 
