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.

How to improve doctor patient communication

Patient
February 22, 2011

When I was a medical student on my first clinical rotation, obstetrics, I was criticized for not using enough medical jargon when I spoke to the patients.

I took that criticism as a compliment and have always attempted to speak clearly and without too much “inflation” of my terms. In my opinion, the more clearly we physicians communicate, the better will be our patients’ understanding of their ailments.

The important topic of doctor-patient communication led a …

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How to improve doctor patient communication

Why more primary care may not improve health care quality

Health Policy
February 22, 2011

The emphasis on primary care as the “key” to lifting the quality of U.S. healthcare may be exaggerated according to a report by Dartmouth’s Institute for Health Policy & Clinical Practice.

“Primary care forms the bedrock of a well-functioning, effective health care system,” the researchers observe. But– and this is an important caveat- “simply increasing access to primary care, either by boosting the number of primary care physicians in an area …

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Why more primary care may not improve health care quality

How powerful a few words can be in the exam room

Physician
February 21, 2011

Recently, I was reminded of the power of wellness. From the other side. And it came wrapped up in sound. Five words, to be precise.

I was instantly reminded how powerful a few words can be in the exam room.

We all want to feel wellness. The freeing kind, as in the way you feel when towered over by big objects. You know what I mean, the wide open wellness you feel …

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How powerful a few words can be in the exam room

Every patient is an immigrant in the doctor’s office

Patient
February 21, 2011

One of my favorite conferences is The Conference on Practice Improvement hosted by the  Society of Teachers of Family Medicine (STFM) and American Academy of Family Physicians (AAFP).

For all the upset and negativity there seems to be toward doctors, these family docs are in it — each and every one that I’ve met — for the good of their patients.  And that is why I think every one of them …

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Every patient is an immigrant in the doctor’s office

Why Watson makes board certification exams obsolete in medicine

KevinMD
February 17, 2011

Like most everyone else, I took a break from my evening chores the past few nights, and watched Jeopardy!

IBM’s super-computer, Watson, was taking on Jeopardy! phenoms Ken Jennings and Brad Rutter.  [SPOILER] The computer won handily.

After watching, I began to study for my upcoming board re-certification exam.

But, then, I wondered.  Why?

In the New York Times, applications for Watson are …

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Why Watson makes board certification exams obsolete in medicine

Let Me Down Easy and facing illness and death

Physician
February 17, 2011

Every illness is unique, and every person faces illness in his or her own way.

Anna Deveare Smith, in her one-woman Broadway show “Let Me Down Easy,” slips into the persona of twenty individuals who have faced an aspect of illness or death. In ninety minutes, Deveare Smith takes the audience on an existential scavenger hunt, allowing us to observe, and occasionally pluck, insights from this gathering of individuals.

These individuals do …

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Let Me Down Easy and facing illness and death

Teamwork helps doctors with patient safety

Physician
February 15, 2011

One of the central tenets of the patient safety movement is that modern medicine is a team sport. Unfortunately, its players – particularly physicians – were trained and socialized to be free-spirited individualists. We need the Celtics of the 80s; what we have is a collection of young John McEnroes.

While this theory has been generally accepted, there is less agreement regarding how to change things. When I speak about Read more…

Teamwork helps doctors with patient safety

Why physicians should sell their practice

Physician
February 15, 2011

There are many reasons to sell your practice. Physicians attempt to sell their practices for various reasons. Some physicians are reaching the age of retirement, while others are looking to add a partner, who, in time will take over the practice as a whole.  Whatever the reason, attempting to get a quality price for the practice can, at times, be a challenge in this current …

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Why physicians should sell their practice

Your physician may be thinking about suicide

Physician
February 15, 2011

Very few of us are untouched by the tragedy of suicide. Whether in our own family, through friends, or one of our colleagues, most of us have been affected by suicide.   We are often left alone, with the painful questions,

“Why?”

“What could we have done differently?”

Now we learn from a study by Shanafelt et. al, in the Achieves of Surgery, that one in 16 surgeons had suicidal ideations in the …

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Your physician may be thinking about suicide

How to become a licensed, board certified doctor

Physician
February 12, 2011

I am licensed to practice medicine and surgery in Georgia. But that doesn’t mean I should, or that you ought to let me—at least not the surgery part. I’m actually pretty good at carving a turkey, but that’s pretty much the only kind of surgery that I’m qualified to do.

Don’t let the license fool ya, I’m no surgeon. So what, exactly, does a doctor have …

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How to become a licensed, board certified doctor

A $20 co-pay and the value of an office visit

Patient
February 11, 2011

‘Tis the season for upper respiratory infections, and since I couldn’t tell if what I had was garden-variety crud or crud that needed antibiotics, I went to the doctor. I handed over my $20 co-pay at the reception desk, where they have an electric candle burning, a tradition when a soldier is off to war. Their soldier is my family doctor, who’s in Afghanistan as a colonel with the Army …

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A $20 co-pay and the value of an office visit

Does screening and treating high cholesterol save money?

Conditions and Diseases
February 10, 2011

A commenter (I believe a physician) on one of my posts wrote the following: “I can prevent heart attacks and strokes (caused by atherosclerosis – “blockage”) in people (minimal cost) who have no symptoms. If I wait for their heart attack or stroke – it costs a whole lot more.”

The implication is that screening and treating high cholesterol saves money in the long run. Unfortunately, the truth is the opposite. …

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Does screening and treating high cholesterol save money?

What is job satisfaction for physicians?

Physician
February 10, 2011

“I can’t get no satisfaction,” sang the Rolling Stones. And so it goes for many of the physicians who contact me.

I was struck by the fact that the word “satisfaction” in connection with work was used in two separate conversations with physicians recently.

It got me curious.  Just what is job satisfaction?

How is it defined by the folks who study this kind of stuff?

And why is it so hard to come …

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What is job satisfaction for physicians?

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Ode to a family practice mentor

Physician
February 9, 2011

“Doctor Pete” was fifty-one when I started my residency in family medicine. “Family practice” we called it then, and I think I liked that name of our specialty better. It implies continued learning and brings to my mind visions of practicing a down-to-earth craft.

I had interviewed with his predecessor the summer before and was really impressed with him and the program. I ranked it as my first choice in the …

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Ode to a family practice mentor

Integrating doctors and hospitals may worsen cost control in health reform

KevinMD
February 8, 2011

Health reformers propose the proliferation of integrated health systems, like the Mayo Clinic or Kaiser Permanente, which, according to the Dartmouth Atlas, lead to better patient care and improved cost control.

To that end, Accountable Care Organizations have been a major part of health reform, changing the way health care is delivered.

Never mind that patients may not be receptive to the new model, but the creation of these large, integrated physician-hospital …

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Integrating doctors and hospitals may worsen cost control in health reform

Physicians love a CIO who lets them focus on patients, not technology

Health Technology
February 8, 2011

by Donald Burt, MD

Many hospital CIOs face an uphill battle winning the hearts, minds and fingers of physicians. It’s not because doctors are technology phobic. Quite the opposite: physicians are some of the most ravenous consumers of new information technology.  Smartphones and tablets are becoming as ubiquitous as stethoscopes at many hospitals.

The truth is doctors are happy to make screen touches, mouse clicks and keyboard strokes if the application is …

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Physicians love a CIO who lets them focus on patients, not technology

The AIDS crisis in Zambia

Conditions and Diseases
February 7, 2011

Wednesday, December 1st was World AIDS Day — a day to raise awareness for the ongoing AIDS pandemic around the world and to remember the past. As a trainee intern I spent 3 months in Zambia, a time that really opened my eyes up to what AIDS was doing to the world.  Much has changed since then, antivirals have arrived in Zambia for instance, yet the disaster continues: 1 in …

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The AIDS crisis in Zambia

Discussing smoking habits with patients

Physician
February 6, 2011

I saw two patients recently that really made me scratch my head.

The first was a 15-year-old girl who was smoking a pack of cigarettes daily and had been for 3 years; the other was a 26-year-old man who smoked 1.5 packs daily for 10 years and had recurrent oral ulcers and bleeding gums. In sitting and talking with these two patients, it became blatantly obvious that the risks of tobacco …

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Discussing smoking habits with patients

ProPublica’s Dollars for Docs: Strengths and weaknesses

Medications
February 6, 2011

The non-profit media organization ProPublica last year announced a new website/database called Dollars for Docs. It lists cash payments made to 17,000 U.S. doctors by seven large drug companies.

I’ve been browsing through the database and I have some thoughts about its strengths and weaknesses—and how it might be useful for patients.

First, here’s what these journalists did. Rather than waiting for the provisions of the Physician’s Payments Sunshine Act …

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ProPublica’s Dollars for Docs: Strengths and weaknesses

Why is there a gender gap in physician salaries?

Physician
February 3, 2011

Some research studies just contain too many revelations to not share with the world. The Health Affairs study on the pay gap between newly-trained male and female physicians is just such a study, demonstrating conclusively that:

1. The gender gap in physician salaries is not related to specialty choice or work hours. No matter where women are choosing to work (solo practice vs. hospital, city vs. rural), which specialty they choose …

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Why is there a gender gap in physician salaries?

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