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.

Federal workers worried about a shutdown should do what doctors do

Edwin Leap, MD

Physician

April 10, 2011

I have a suggestion for all of those federal workers who were concerned about a government shutdown.

To all those who already have better insurance and better benefits than most in the private sector; for all those whose jobs pay more than equivalent private sector jobs for the same activities. Do what hospitals do. ‘Go to your jobs, and do the necessary work anyway.’

It is ironic, but hardly surprising, that the …

Differential diagnosis and treating patients as individuals

Stewart Segal, MD

Physician

April 7, 2011

I recently wrote about the importance of a differential diagnosis. Today I want to assume that you have a definitive diagnosis and discuss how we deal with that illness. First, some ground rules.

There are hundreds of medical texts and unlimited amounts of information on Google that help define an illness. They all portray the “textbook” description of how the illness should present, what symptoms …

What you need as a leader of your accountable care organization

Donald Tex Bryant

Health Policy

April 7, 2011

The Michigan Medical Group Managers Association had a conference recently in Mt. Pleasant, MI. The theme of the conference was “Medical Management: Coaching Your Team to a Winning Season.”

Two speakers—Lloyd Carr, former head football coach of the University of Michigan Wolverines, and Lou Rabaut, partner of law firm Warner Norcross & Judd—both delivered excellent lessons on leadership. Several of the …

Why does society frown on doctors earning a reasonable living?

Steven Reznick, MD

Physician

April 6, 2011

Recently, while jogging through my community, I had the pleasure of bumping into a former colleague and his brother who were out for their daily five mile walk.

Dr. G. had attended a local medical school, finished near the top of his class, and had gone on to do his internship and residency at the premier private hospital in Miami Beach, Florida. After completing his residency …

Myths devalue the image of primary care

Paul Fischer, MD

Physician

April 6, 2011

After an exciting and challenging day of caring for patients and teaching students, a third-year medical student on his family medicine rotation says to me, “I really like what you do, but I just cannot afford to go into family practice.”

I realized that by “afford,” he was referring not only to finances but also to the expectations of his parents, friends, and Read more…

Myths devalue the image of primary care

Caring for people is not always easy, but it is what makes us special

Jennifer Gunter, MD

Physician

April 5, 2011

My mom is sick. Because of what can only be described as my crazy family dynamics I did not find out for 24 hours that she was taken by ambulance to the hospital in septic shock from pneumonia.

She was hypotensive on arrival (not good) and pancytopenic (low white cell count, low hemoglobin, and low platelets – not good either). A CT scan showed multiple large, irregular lymph nodes in her …

Direct primary care and medical loss ratio will impact health insurers

Dave Chase

Health Policy

April 5, 2011

With my extensive health care background, many people have asked for my opinion during the health reform debate. My response has been that the only way to really “reform” the system is to blow it up and start over, which isn’t politically feasible.

After delving deeper into the current legislation, I believe that we are going to see something …

The Relative Value Scale Update Committee (or RUC) impact on health care

Brian Klepper, PhD

Health Policy

April 5, 2011

On Kaiser Health News, Barbara Levy MD, the Chair of the AMA’s Relative Value Scale Update Committee (or RUC), published a glowing defense of the RUC’s activities.

Her article extols the work of the 29 physician volunteers who, “at no cost to taxpayers … generously volunteer their time, supported by advisers and staff from more than 100 national medical specialty societies and health care professional organizations.”

She fails to mention that the …

Patients can lift doctors up during a challenging day

Linda Pourmassina, MD

Patient

April 4, 2011

I will be leaving my current practice in a couple months and starting work at a different clinic in a different city. This type of transition really brings to light how much I had really gotten to know patients on a personal level. This became surprisingly clear not too long ago.

One day, I saw a patient on my schedule that had historically required more of my emotional energy. We often …

Treatment of chronic pain puts doctors in a no win situation

Edward Pullen, MD

Physician

April 4, 2011

First do no harm.

Treat every patient with respect and dignity.

These are values I try to live by and incorporate into my daily work. Treatment of chronic pain is the scenario that puts me and every practicing primary care physician in a no-win situation regularly in the office. To try to make physicians feel more comfortable treating pain most states have tried …

The relationship between parents and pediatricians

Yolanda Wong, MD

Physician

April 1, 2011

It’s strange being on the other side for a change. I remember bringing my son to his first doctor’s appointment. A new mom. No stethoscope around my neck. No patient schedule, replaced instead by the constant grind of breastfeeding.

I knew it was just another routine newborn check for our pediatrician, but every maternal fiber in me believed that my son must be the cutest baby that ever walked through that clinic. …

How primary care will play a central role with health care reform

Kevin

Health Policy

March 31, 2011

by Jeffrey L. Cohen

Healthcare reform used to imply just regulatory change. As time marches on, it also implies market change. Most pundits agree that, whatever happens to the healthcare reform law, whether or not it is found to be unconstitutional, the healthcare business community is unleashed. Change is afoot!

If you follow my naysaying on the …

Wimpy Parent Syndrome, and allowing your child to get mad and cry

Michael Gonzalez, MD

Patient

March 30, 2011

I woke up in the middle of the night last night and I could not fall back asleep. I had a moment of brilliance laying there in bed. I had discovered a new medical disorder, Wimpy Parent Syndrome (WPS).

For years I have been seeing it in clinical practice, but have been unable to put my finger on exactly what was taking place. Then the idea of WPS came to me and everything …

A boxing fight physician experience

Steven Reznick, MD

Physician

March 30, 2011

I received a phone call from the Broward Sheriff’s Office Police Athletic League Youth Boxing Program asking if I would help them out and be the fight physician at their upcoming youth boxing tournament.

Their usual physician, a member of the Boxing Hall of Fame, had another commitment. However, he was willing to train me in advance and show me the ropes on the day of the event.

State law and the …

Read more…

A boxing fight physician experience

Accountable Care Organizations and the need to innovate

Kunmi Sobowale, MD

Health Policy

March 30, 2011

There is a lot of buzz over the creation of Accountable Care Organizations (ACOs) under the Patient Protection and Affordable Care Act (PPACA).

An ACO is a network of health care providers and hospitals that collaboratively manage patient care and prospective budgets. Perhaps the biggest draw of ACOs is the potential to create innovative ways to improve quality and decrease costs. To …

How physician practices can compete with retail clinics

Brandon Betancourt

Physician

March 29, 2011

A reader recently wrote to me: “Brandon, in our area, we’ve seen a few retail clinics pop up. What can we do as a practice to let patients know that visiting retail clinics is not in their best interest?”

We had along discussion. So I put together a summary of our conversation. Below is a rundown, more of less, of what I …

Does empathy mean giving patients what they want?

Steve Wilkins, MPH

Patient

March 29, 2011

Recently, KevinMD.com picked up my post on empathy or should I say the lack of it. I received some engaging comments.

One comment in particular caught my attention.

The contributor for some reason equated “being empathetic” with “giving in” to patient requests presumably during routine office visits. Here’s a direct quote:

Give the patients what they want! Antibiotics are OK for colds. The patients want them. So …

Read more…

Does empathy mean giving patients what they want?

How astroturfing disease affects patients

Marya Zilberberg, MD, MPH

Conditions and Diseases

March 28, 2011

One of the top hits that comes up on the Oracle of Googlius for “astroturf” is for the original company, now renamed SYNLawn, but still proudly stating, “We invented synthetic grass,” which is what astroturf is. More recently, this already synthetic term has become a verb, as in “astroturfing.”

My favorite of all credible information sources on the web, Wikipedia, has this to say about it:

Astroturfing denotes political, advertising, or public relations campaigns that are formally …

Read more…

How astroturfing disease affects patients

ACP: Benefits, harms, and quality in high value, cost conscious care

American College of Physicians

Health Policy

March 28, 2011

A guest column by the American College of Physicians, exclusive to KevinMD.com.

by John Tooker, MD, MBA, MACP

Last month, my KevinMD.com column introduced a concept paper published in the Annals of Internal Medicine by Owens and colleagues titled High-Value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate the Benefits, Harms, and Costs of Medical Interventions. …

Reductionism and daily medical practice

George Lundberg, MD

Physician

March 28, 2011

The results of the application of reductionism in modern biomedical research and practice has been nothing short of miraculous, but while wondrous for some things, reductionism alone is incomplete.

The basic premise of reductionism is that by breaking down (or “reducing”) complex biological or medical phenomena into their many parts, one is much more likely to understand a single cause and devise a cure.

Historically, the invention of the microscope, the defining …

Read more…

Reductionism and daily medical practice