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.

Medical ethics in the office should not be a private matter

Michael Kirsch, MD

Physician

August 1, 2011

Medical ethics has properly gained a foothold in the public square. There is a national conversation about euthanasia, stem cell research, fertilization and embryo implantation techniques, end-of-life care, prenatal diagnosis of serious diseases, defining death to facilitate organ donation, cloning and financial conflicts of interest. Nearly every day, we read (or click) on a headline highlighting one of these or similar ethical controversies. These great issues hover over us.

We …

Why this pediatrician hates bouncy houses

Wendy Sue Swanson, MD

Patient

August 1, 2011

I hate the bouncy houses. I mean, I really hate them; I get a sick, nervous stomach when the boys are inside them. And it’s created a parenting perplexity for me. See the photo? I bet my HR is about 160 and my BP 150/90 (translation: high). I’m not kidding, I have a visceral and then flight-type response when the boys jump … it’s one of those instinctive parenting responses …

Why doctors can sometimes be their own worst enemies

Steve Wilkins, MPH

Physician

July 30, 2011

“I don’t have the time … I don’t get reimbursed for that.” This is an all too common refrain from primary care physicians and practice managers when ever the subject of improving physician-patient communications comes up.

I get it. Primary care physicians in particular are under tremendous pressure to produce. Just imagine, physicians in small primary care practices spend about 3.5 hours per week just on dealing with insurance-related paperwork. Then …

Planning effective office meetings for your medical practice

Rosemarie Nelson

Physician

July 30, 2011

Do you cringe when you hear the phrase “office meeting”? Some medical practices meet too frequently and some seldom meet, but others have it just right – routine meetings with preparation, an agenda, and follow-up. Your practice can get it right, too.

And make no mistake, meetings are important. Medical practices, regardless of size, have a variety of positions that are not interchangeable, but do interact throughout the day.

To make …

Physicians who treat inmates are at greater risk of litigation

Jeffrey Knuppel, MD

Physician

July 29, 2011

Most psychiatrists and primary care physicians who work in corrections long enough will end up being named in a lawsuit or having a complaint filed against them with their licensing board. So, from a risk-management standpoint, is it worth the potential hassle?

Yes, in most cases I think it is.

It is a fact that physicians who treat inmates are at greater risk of litigation. I don’t have specific figures to give …

Patient tips for your first office visit

Jill of All Trades, MD

Patient

July 29, 2011

Starting a new job can be exciting, a new challenge, while embarking on a new journey. I have the opportunity to meet many new fellow docs, staff, and kind patients. However, I have to admit that it is a tad more challenging in the beginning when starting a new practice from scratch. I do miss the familiar patient faces that knew me and trusted my medical abilities without question. But …

Is there really a physician shortage, and do we need more medical schools?

Peter J. Weiss, MD

Physician

July 29, 2011

“Whether you think you can, or think you can’t, you’re right,” said Henry Ford noting how our mindset shapes our behavior. Now, let’s talk about our American mindset on healthcare, which is that “more is needed” and that doctors are the most important players.

In a recent message to all physicians, Dr. Cecil B. Wilson, former president of the American Medical Association, calls on us to help take vigorous action to …

Diagnosing Alzheimer’s disease sooner or later

James P. Richardson, MD, MPH

Conditions and Diseases

July 29, 2011

A recent Harvard School of Public Health survey of more than 2500 adult in six different countries has found that Alzheimer’s disease is more dreaded than any other disease save cancer. The same survey also demonstrated that 85% of respondents would want to know their diagnosis as soon as possible if they began to show symptoms. The survey was reported recently at the Alzheimer’s Association International Conference (AAIC) meeting …

How health care will change in community health centers after reform

Ricky Choi, MD

Health Policy

July 28, 2011

37 years ago, at the very tail of the civil rights movement, my community health center (CHC) was established in Oakland to fill an unmet and urgent need. A growing population of immigrants were settling in downtown Oakland and had few choices for health care. Community surveys conducted by local leaders confirmed that residents received significantly less health care than the rest of the population largely due to a …

Why primary care is due for a renaissance

Dave Chase

Physician

July 28, 2011

At a time when half of primary care doctors say they’d leave medicine if they had an alternative and the NY Times reports on a family physician who can’t give away his practice this hardly seems like the obvious time to claim that primary care is positioned for a renaissance. However, if there’s one thing savvy investors have demonstrated, when everyone says to invest in something that is usually the time to …

How a doctor learned how to suture

Fizzy, MD

Physician

July 27, 2011

One of the skills I really wanted to learn in med school was how to suture. It’s just one of those things that I felt like you’re supposed to know if you’re a doctor. How can you be a doctor if you don’t know how to suture?Anyway, by fourth year of med school, I had totally failed at my goal. I had already done a surgery rotation, but while …

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How a doctor learned how to suture

How secure messaging helps this doctor connect with patients

Jeff Livingston, MD

Health Technology

July 27, 2011

I commented on a blog post recently that cited a recent study called “Secure web messaging between patients and doctors: Not well received.” I was pleased to see that other professionals who left comments had the same reaction I did to the study: it is simply not accurate. I have 4,900 patients and five other physicians in our practice who can attest that secure messaging, when used the …

Screening for mental disorders in children and adolescents

Kelly J. Kelleher, MD

Conditions and Diseases

July 27, 2011

For many academics and researchers, the debate is over: The use of mental health screening questionnaires in a routine fashion in primary care offices greatly increases the detection of mental disorders among children and adolescents. With such information, the American Academy of Pediatrics, Bright Futures, the US Preventive Services Task Force and others have weighed in. Screening is the order of the day, at least for adolescent depression. The remaining …

What would an ACO would look like if it was truly patient centered?

Kent Bottles, MD

Health Policy

July 26, 2011

Health care leaders are busy talking to attorneys and consultants about how to set up Accountable Care Organizations (ACOs). A recent Advisory Board survey found that 73 per cent of hospital finance executives said that creating such an organization was a top priority for their health system.

Last year my most popular keynote topic was patient-centered medical home creation; this year everyone wants a presentation on ACOs.

However not …

Being a primary care doctor is an utter privilege

Wendy Sue Swanson, MD

Physician

July 25, 2011

Being a primary care doctor is an utter privilege. Think of this post as part proclamation and part journal entry.

Yesterday afternoon I sent out this tweet:

It was a spontaneous tweet in the middle of my 15 minute “lunch break” when I realized I still had hours to go in my clinical day. The motive was incredulity, not remorse or a …

Why receptionists are integral to the health care team

Kevin Pho, MD

KevinMD

July 25, 2011

Health care is a team sport, and one of the most important members is the office receptionist.

Receptionists are often the first people patients see when the visit the clinic. And those first impressions count.

In a recent piece from the New York Times, Pauline Chen notes a study of the responsibilities of the medical receptionist, and finds they impact …

A Physician Family Office for high net worth families

Arnold C. Friedman, MD

Physician

July 24, 2011

As a middle-aged physician all too aware of the fact that we are all merely “passing through” life on our way to somewhere else, I am increasingly concerned with having a good work-life balance. Gone are the days of my residency when I was only able to catch a couple of hours of sleep here and there and be lucky to have the time to eat a fast food …

Poor, illegible entries in medical notes can cost lives

Norman Briffa, MD

Physician

July 22, 2011

I was present recently at a meeting between representatives of a hospital and the relatives of a recently deceased patient. The death had been the subject of an inquiry and in preparation for the inquest, the family had been given copies of the medical notes. A significant part of the meeting was spent, explaining the meaning and significance of various entries in the notes. Embarrassingly, some handwritten entries in …

The role of non-physician clinicians in primary care

Cedric Dark, MD, MPH

Physician

July 22, 2011

With sixteen million more Americans expected to gain health care coverage in the coming years as a result of the Affordable Care Act, access to actual health care providers may become more difficult. This may be especially true for patients with marginal coverage such as Medicaid.

The Kaiser Family Foundation recently explored the role of non-physician clinicians – specifically nurse practitioners (NPs) and physician assistants (PAs) …

Primary Care

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