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.

Vaccination and the killers of yesterday now overcome by modern medicine

Emily Gibson, MD

Medications

March 26, 2011

It’s only been a little over fifty years since vaccinations became routine for the childhood killers like polio, measles, mumps and whooping cough. People my age and older had no choice but to suffer through childhood infectious diseases given how effectively and quickly they spread through a community.

Most of us survived, subsequently blessed with life long natural immunity. Some did not survive. …

Guiding patients online is a new physician responsibility for the digital age

Kevin Pho, MD

KevinMD

March 25, 2011

The following op-ed was published on February 22nd, 2011 in AOL News.

If you woke up one day with an earache, you could call your doctor’s office for help. Or you could do what the majority of patients do today and Google what to do first.

Type “earache” into your Web browser and the results can vary wildly. Search engines can return results saying that an earache can be from the common cold, …

3 resident interviews for family medicine

Allen Perkins, MD

Medical Education

March 25, 2011

I interview approximately 60 prospective physicians for medical school over the course of the year and 40 physicians who are applying for the residency program. The pre-med students (almost all of whom are the age of my children) tend to have pretty good interview skills and are trying very hard to get into medical school (“I’ve wanted to be a doctor for as long …

EHR and the solo primary care physician

Margalit Gur-Arie

Health Technology

March 25, 2011

Recently, I went to see a doctor about an EHR. Dr. Greene (not his real name) is a typical solo primary care physician in a typical small town in the typical middle of nowhere. Four hours from the closest airport and miles and miles of winding roads, cow pastures and corn …

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EHR and the solo primary care physician

How can research capture the complexity of tiny moments?

Claudia M. Gold, MD

Patient

March 24, 2011

Recently, as I listened to leading researchers grapple with the question of how to design a feasible study of intervention for postpartum depression, I held in my mind an image of a particular moment in my office.

I was sitting on the floor with 10 month old Madison and her mother Nancy, who was struggling with postpartum depression. Nancy spoke of the strain Madison’s refusal to take a bottle and her …

Expand health care systems in a way that is professionally satisfying

Michael D. Shapiro, MD, MBA

Health Policy

March 24, 2011

You try to do the right things to sustain your business. You set high standards for delivery of quality care, follow the basic tenets of marketing, align your organization so that everyone in your firm “gets it,” avoid unnecessary expenses but identify important growth opportunities and prudently invest so that you remain competitive and serve your patients well. But can you afford investing in the assets you require to become or …

Engage employees in healthcare to enhance patient outcomes

Donald Tex Bryant

Physician

March 24, 2011

It is an axiom of business that employee engagement produces many positive results, no matter what the setting—manufacturing or service. This is true for healthcare as well.

Employee engagement produces a better product or service. In healthcare, engaged employees produce enhanced patient outcomes. When employees are engaged there is less turnover, which reduces training costs. Engaged employees are problem solvers.

How …

Can family medicine really be defined?

Kevin

Physician

March 23, 2011

by mdstudent31

Going into medicine from a suburban community in the northeast, I never really knew exactly what family medicine was as a specialty. I had heard of it before, but did not see it in action until going to undergraduate school in the middle of Pennsylvania. It was there when I began …

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Can family medicine really be defined?

How a patient support tool works to help patients and doctors

Ted Eytan, MD

Health Technology

March 23, 2011

When you go to see the doctor, how do they know (a) if you are due for any preventive health screenings like mammography or (b) if you have a chronic condition, if it is being monitored and managed?

And actually, not just if it is being monitored or managed, but are you able to achieve your life goals with good health? And what about …

Being a physician is not just about medicine

Kevin

Patient

March 23, 2011

by Sunjay Devarajan

“Mrs. Adams” slowly ambled into the family medicine clinic on a Wednesday afternoon. I immediately noticed her slight hunch as she made her way into the lobby.

“A case of back pain?” I thought to myself. “Perhaps an exacerbation of the scoliosis she’d had since childhood?” I shrugged my shoulders and carried on with my …

Accountable care organizations: The lost art of medicine?

Kevin

Health Policy

March 22, 2011

by Sharolyn Rhees Medina, MD

It’s no secret that healthcare’s inevitable move toward accountable care organizations (ACOs) has many physicians feeling a bit …nervous. Admittedly, most physicians are creatures of habit who fiercely defend their individual approach to patient care, focus on cures not cost, and dread the concept of “cookbook medicine.”

And under the ACO model, physicians …

Doctors should ask the people what they want for health care

Pamela Wible, MD

Patient

March 22, 2011

Americans typically rely on elected officials to uphold the will of the people. Now physicians—traditionally confined to exam rooms—are taking direct action to fulfill community needs.

In 2004 I decided to meet face to face with citizens in my hometown. I thought, “Why wait for legislation? I’m a board-certified physician. What’s stopping me from serving the public?”

So I led town hall meetings and invited ordinary citizens to create the clinic of …

Family physicians who care for underserved patients

Kenneth Lin, MD

Physician

March 21, 2011

One of the ugliest incidents in my career occurred during my faculty development fellowship year, when I spent two days each week seeing patients at several federally qualified community health centers in inner city Washington, DC. Midway through the year, I was transferred from a health center that served an African-American population to one serving a mostly Spanish-speaking clientele.

Nearly all of the permanent Read more…

Family physicians who care for underserved patients

Concierge and primary care medical home hybrid model of care

Mark W. Browne, MD

Health Policy

March 21, 2011

As a consultant, I spend a lot of time on airplanes and subsequently get to meet a new “person in the next seat” almost every week. Once the small talk is over, the conversation is nearly the same every time. “Oh, you work in healthcare! What do you think about all of this reform stuff anyway? Is there an answer?” I’m always very cautious how I frame my answer. As those …

Osteopathic medicine and the growth of D.O. graduates as physicians

Tayson DeLengocky, DO

Physician

March 18, 2011

by Tayson DeLengocky, DO

The landscape of healthcare delivery has changed so drastically over the past three decades with the proliferation of allied health professions, increased in medical specialization, managed health care, and technology advancement.

The direct doctor-patient relations have been relegated to the relations between healthcare providers and patients, in which doctors are only participants among other healthcare givers. A healthcare consumer, patient, can be easily further confused when visiting medical …

Supportive physicians and management to implement an EHR

Ron Sterling

Health Technology

March 18, 2011

From Medicare/Medicaid incentives to EHR industry ads, it is hard to cut through the hype and determine if your practice is even ready to try to select and implement an EHR.

Implementing an EHR is a transformational exercise for any practice that requires redesigning every aspect of charting, clinical workflow and interaction with patients. However, in too many cases, practices approach EHR …

Cancer patients get better care than patients in primary care

Shantanu Nundy, MD

Physician

March 17, 2011

Why do my patients with cancer get better care than my patients in primary care? As the senior resident on my hospital’s inpatient leukemia service recently, this question troubled and intrigued me daily.

Despite the sheer complexity of treating leukemia (administration of chemotherapy, bone marrow biopsies, stem cell transplantation), the resources required (transplantation routinely costs $1 million), and the severity of the illness …

Match Day 2011: Family medicine grows, but enough to save primary care?

Kevin Pho, MD

KevinMD

March 17, 2011

Match Day marks one of the most important days in a medical student’s career.

A computer algorithm “matches” prospective doctors with the residency program they’re destined go to.

It’s also a look at the future trends for various specialties. With a major part of health reform about to be implemented, one naturally gravitates towards primary care, where there currently is a …

The National Health Service Corps impact on primary care doctors

Kohar Jones, MD

Physician

March 17, 2011

Before I had even begun medical school, I already knew that I would enter primary care when I finished. I had successfully applied for and received a scholarship from the National Health Service Corps Scholars program. By the time I graduated, I knew that after my three years of residency training, I would practice in an underserved area for at least four years, one year of service to America for …

Label the interaction as difficult, not the patient

Maria Yang, MD

Patient

March 17, 2011

Kevin Pho, at KevinMD.com, posted a commentary about encounters with “difficult patients.” He correctly notes that physicians themselves contribute to these interactions. To reduce the likelihood of these encounters, he suggests that physicians would benefit from more training in “psychosocial skills.”

Kudos to Kevin for adjusting his own language by the second sentence of his post: He makes the distinction between difficult patient and difficult encounter.

A vital step in decreasing …

Primary Care

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