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.

Why the annual physical exam is essential to both doctors and patients

Physician
June 22, 2011

I have listened to health economists debate the value of an annual physical exam.  Is it cost effective?  Does it prevent disease?  It doesn’t matter.  It is an essential part of the development and continuation of the doctor patient relationship.

The annual physical exam is a form of benchmarking. It allows the doctor and patient to review all the pertinent aspects of your health history …

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Why the annual physical exam is essential to both doctors and patients

A new organization for primary care

Health Policy
June 22, 2011

Recently, the Board of the American Academy of Family Physicians (AAFP) announced that, for now, it would continue participating in the Relative Value Scale Update Committee (RUC), the secretive American Medical Association committee that, through a longstanding relationship with the Centers for Medicare and Medicaid Services (CMS), has heavily influenced physician reimbursement.

At nearly the same time, Medicare announced that it will go broke in 2024, a decade sooner …

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A new organization for primary care

Using video games to fight childhood obesity

Patient
June 22, 2011

“I don’t study because it gets in the way of my video game time”

-15 year old patient.

Sorry mom and dad, video games are here to stay. In my clinic, this is a topic of discussion every day:

“How many hours of screen time does Mikey get every day?” I ask.
“Tell the truth”, Mom says looking at Mikey.
“brmfbr mbbrm,” says Mikey looking away.
Mother turns to me with the familiar look that …

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Using video games to fight childhood obesity

Medical practice career choices commonly become medical business failures

Physician
June 21, 2011

by Curt Graham, MD

Never in the history of medicine have doctors faced such a ruthless gauntlet of threats, financial debts, and practice restrictions than they do today.  These factors, among others just as crucial, don’t begin to tell the story about why 40% of medical doctors readily admit to intense frustration in their practices, in addition to the percentage of doctors quitting medical practice completely.

They’re not retiring.  They’re adapting.  Extended …

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Medical practice career choices commonly become medical business failures

How physicians should deal with angry patients

Physician
June 21, 2011

I highly recommend you take a look at “10 Dumb things you do at the doc’s office.”  Be sure to scan the article, but what you really need to look at is the comments, all 700+ of them.

While by no means a representative sample of how we think about physicians, there is a clear pattern to the comments.  A lot of people feel disrespected by their doctors, …

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How physicians should deal with angry patients

Shifting procedural work to midlevel providers

Physician
June 21, 2011

It is entirely clear that too few medical graduates go into primary care.

Although the number of family physicians is increasing modestly, there are very few internal medicine residents becoming primary care doctors. This year there will be only about 200 new internal medicine doctors entering the workforce from training programs, which will not even begin to cover the attrition of older and more efficient physicians, and due to improvements …

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Shifting procedural work to midlevel providers

Why the AMA is in decline, and should doctors care?

KevinMD
June 20, 2011

The American Medical Association recently released its membership numbers, and they’re declining.

According to MedPage Today, the AMA “saw another steep drop in its membership in 2010 — this time losing about 12,000 members or 5% of its total membership.”

It’s been well publicized that the AMA only represents a minority percentage of physicians, depending on what you read, it’s between 20 and 30%.  But it seems many physicians have little …

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Why the AMA is in decline, and should doctors care?

A good history is integral to practicing good medicine

Physician
June 20, 2011

Have you ever gone to the doctor’s office and forgotten what you were going to say or felt like you didn’t have the answers to any of the doc’s questions? Have you ever gone in to an appointment thinking, “I have pain and I am sure an MRI will show the cause,” but your doctor seems to insist on asking you a million questions about your symptoms and doesn’t Read more…

A good history is integral to practicing good medicine

The best diagnostic medical device is right in your own home

Patient
June 20, 2011

What is the year 2011’s best diagnostic and therapeutic medical device?

Is it the PET scan with special bells and whistles to detect early Alzheimer’s?

Is it the robotic surgery that reams out the worst prostate cancers remotely?

Is it the Total Genomic Analysis that predicts what your genetic future holds?

Is it the GI endoscope that checks out your innards from stem to stern?

Is it the latest drug-eluting stent that promises to …

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The best diagnostic medical device is right in your own home

How physicians not adhering to clinical guidelines may be punished

Physician
June 18, 2011

The Justice Department decided to weigh in on the topic of clinical guidelines.

As if to underscore Dr. Rich’s assertion that “guidelines are no longer guidelines,” the Federal government has raised the prospect of fining your doctor and/or sending her to prison for the crime of not strictly following guidelines of care.

As reported by MedPage Today:

“Federal prosecutors are looking into physicians’ prescribing practices relating to implantable cardioverter defibrillators …

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How physicians not adhering to clinical guidelines may be punished

Let’s stop the war between breastfeeding and formula feeding

Patient
June 17, 2011

I am all for breastfeeding.  Without doubt, breast milk is incredible stuff.  And it’s free.  Who complains about free?

Nevertheless, somewhere along the way, the campaign for breastfeeding has spun out of control.  The topic has morphed into yet another competition in the arena of parenthood.  Mothers boast about breastfeeding.  Mothers compare how long they nurse.  Mothers compare how much milk can be pumped in one sitting.  Mothers are made …

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Let’s stop the war between breastfeeding and formula feeding

Pro-actively improve quality, rather than reacting to liability concerns

Physician
June 16, 2011

Over the past year I have been involved in many discussions with doctors, healthcare executives, elected officials, plaintiff and defense attorneys and others about healthcare reform. Bottom line: There is no consensus what the future holds.

There is no question that reform is necessary to avoid absolutely bankrupting the country. However, the recent legislation is a work in progress, not yet an achievement. A change in congressional leadership could derail, …

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Pro-actively improve quality, rather than reacting to liability concerns

Unnecessary screening tests for asymptomatic adults

Physician
June 16, 2011

I rarely get sick and have no known disease. I’m fit as a fiddle for an aging male. I jog four times a week and have strong vital signs (blood pressure is 120/70). I have no family history of heart disease.

Besides complying with adult screening recommendations and vaccines, I only see a doctor when I have a persistent cold or sore throat.  I fear going to a doctor because …

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Unnecessary screening tests for asymptomatic adults

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Docs vs Glocks, and the slippery slope of HB 155

Physician
June 16, 2011

by Mona Mangat, MD

“We take our children to pediatricians for medical care — not moral judgment, not privacy intrusions.”

This quote by an NRA lobbyist troubles me. The statement reveals degradation in a sacred relationship – the physician-patient relationship.

This sentiment was prompted by a Florida pediatrician that refused to continue seeing a child after the parents refused to answer whether they kept firearms in the home. Governor …

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Docs vs Glocks, and the slippery slope of HB 155

We want our doctors to be perfect, but they’re human too

Physician
June 16, 2011

Though there are few subjects as immediate to my experience as that described in Gardiner Harris’s article in The New York Times, “More Doctors Say No to Endless Workdays,”  perhaps the truest indication of my opinion on the matter may be the fact that, upon first glance at the headline, I didn’t feel much need to read the rest of the article.  More doctors say no …

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We want our doctors to be perfect, but they’re human too

How a pediatrician advises parents on sleep training their children

Conditions and Diseases
June 15, 2011

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At some point, the novelty of a new baby wears off.

Waking up at two in the morning loses some of its appeal.  Parents often tell me that their baby does not sleep well.  I tell them how they can get their child to sleep through the night in just three nights.  I explain that learning to sleep is a training process, either …

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How a pediatrician advises parents on sleep training their children

Should academic physicians have the final word on acceptable practice?

Physician
June 15, 2011

The New York Times recently published an opinion editorial entitled “Squandering Medicare’s Money“in which Dr. Rita Redberg, professor of cardiology at UCSF, proposes that much of Medicare’s financial deficit could be reduced if the government did not spend “a fortune each year on procedures that have no proven benefit.”

To support her contention, Redberg cites several studies which indicate that many routinely performed tests and treatments …

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Should academic physicians have the final word on acceptable practice?

Physicians and their staff need to put on a consistent show

Physician
June 13, 2011

This past summer, I had a few parents complain to me about our staff. The parents wanted to let me know that they were treated nicely by the staff, but they had noticed things from the employees that they didn’t appreciate. They mentioned that the staff seemed annoyed and irritated, even bored at times and a bit disingenuous.

I wanted to investigate the issue before I reprimanded the staff. Things …

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Physicians and their staff need to put on a consistent show

How physicians derive evidence for their practices needs to change

Physician
June 13, 2011

I like to poke fun at real estate agents (please, forgive me if you are one, it is all in good fun).

My experience has been that, despite what I describe as my preferences, they always end up showing me what they have, even if it does not bear the remotest resemblance to what I need. This holds true for politicians, with this cardinal rule: always answer the question you want …

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How physicians derive evidence for their practices needs to change

Why doctors shouldn’t have to choose between medicine and family

KevinMD
June 12, 2011

For the past few Sundays, the New York Times has published provocative op-eds involving physicians.

The first tackled physician bullying.  Next was the cost of medical education.  And, most recently, the phenomenon of part-time, mostly female, physicians.

This is obviously a live-wire topic, sure to generate passionate commentary.

In the piece, anesthesiologist Karen S. Sibert goes over ramifications of part-time physicians.  …

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Why doctors shouldn’t have to choose between medicine and family

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