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.

Food is an essential part of a doctor’s success strategy

Susan Biali Haas, MD

Physician

February 3, 2011

Nutrition fascinates me – I’ve been studying it for over twenty years and have a university degree in Dietetics. These days I’m particularly interested in the secrets of high-performance eating; the busier and bigger my life gets, the more I need to be on the ball. Food is an essential part of my success strategy. Put another way: if I didn’t know how to eat right for my brain, I’d …

Why the time is right for collaborative care

Kevin

Patient

February 3, 2011

by John Mooney

A recent study conducted by Dove Press Patient Intelligence Journal asked this question of patients: “Have you ever asked your physician to prescribe something different than the original recommendation?” Thirty-four percent of the respondents indicated that in fact they had. Perhaps even more interesting: of that 34 percent, 69 percent of the doctors agreed to prescribe the alternative drug when asked. Why is this important? The health …

Should doctors give marriage advice?

Randall S. Bock, MD

Patient

February 2, 2011

Doctors have no trouble or compunction giving these good pieces of advice:

stop smoking
lose weight
eat less saturated fat
wash your hands
vaccinate
schedule your mammogram
get a colonoscopy

These all likely can augment both life quality and expectancy.

Do doctors, then, (in appropriate situations obviously) go the extra mile and tell a patient to get married? There are reasonable reports church-going adds to longevity, but with sensitivity to broaching religious beliefs, doctors may be reluctant to suggest …

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Should doctors give marriage advice?

Marcus Welby and the relentless growth of specialization

Jan Henderson, PhD

Physician

January 31, 2011

In the very first episode of the TV series Marcus Welby, MD, our hero delivers an after dinner speech to a group of young interns. As he’s introduced, he hastily scribbles the title of his talk and hands it to the hospital director: “The future of the general practice of medicine, if any.” The year was 1969.

In his introduction, the director somewhat tactlessly remarks that many “eminent specialists” have addressed …

Help your doctor formulate an accurate differential diagnosis

Stewart Segal, MD

Conditions and Diseases

January 31, 2011

Last night, I turned on “House,” a TV show about a physician who is in charge of a team of highly specialized diagnosticians. Every week the team solves a difficult to diagnose medical case by working through an exhaustive differential (DD) diagnosis list. While the show is absurd to the extreme (as the team of physicians almost kills the patient each week), eventually the correct …

Patient advocacy is essential in health insurance appeals

Steven Reznick, MD

Patient

January 30, 2011

An active 61 year female, who has been in my practice for 30 years, developed strange aches and pains and abdominal symptoms. My evaluation turned up nothing.

I then asked for help at the University of Miami rheumatology and gastroenterology divisions. With the help of a brilliant local gastroenterologist and rheumatologist, and after a trip to Johns Hopkins Medical Center and the Mayo Clinic, collagenous …

Integrity, discipline, respect: Using kung fu to control your eating

Melanie Lane, MD

Conditions and Diseases

January 28, 2011

About seven months ago, I began training kung fu with my family. Our classes are intense and require the students to really pull out our personal best. Periodically our instructor will remind us by shouting out, “Train like a black belt!” when she catches us being sloppy or less than enthusiastic. Her exclamation inspires me to squat a little lower in my horse stance, amps up my intensity, and focuses …

What’s next for doctors if pay for performance fails?

Kevin Pho, MD

KevinMD

January 28, 2011

I recently pointed to a BMJ study concluding that pay for performance doesn’t seem to motivate doctors. It has been picking up steam in major media with TIME, for instance, saying, “Money isn’t everything, even to doctors.”

So much is riding on the concept of pay for performance, that it’s hard to fathom what other options there are should it fail. And there’s mounting evidence that it will.

Aaron Carroll, a …

Seeing a family physician at work is valuable for medical students

Edward Pullen, MD

Physician

January 27, 2011

I recently headed off to a reception for students from the new Pacific Northwest University of Health Sciences in Yakima, WA who are spending their third year of osteopathic medical school in Puyallup, WA doing rotations with the physicians in our community. I’ve had a student with me recently, and it brings back memories of my third year in med school, and how things have changed. It also leads me …

Electronic medical records and pay for performance don’t improve care

Kevin Pho, MD

KevinMD

January 27, 2011

Electronic medical records and pay for performance are among the ways health reformers are going to improve patient care.

It’s a fundamental shift in how doctors practice, with more practices adopting expensive EMRs. And with the advent of Accountable Care Organizations, doctors will soon be compensated in part by quality measures.

But will they work? Well, the jury’s still out.

Two articles caught my eye recently.

The first, from the WSJ’s Health Blog, reports …

Solving the puzzle of patient compliance

Dennis Grace

Patient

January 27, 2011

by Dennis Grace

I recently received a message from the Center for Connected Health. I must admit the opening of the letter really put me off. It asked:

How do you solve the puzzle of patient compliance?

I responded to the gentleman who sent the invitation with:

Well, you might start by calling it something less offensive. Patient compliance? The phrase assumes “patient” as direct object rather than subject of participatory medicine. We …

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Solving the puzzle of patient compliance

EHR implementation in the ambulatory or hospital setting

Robert Rowley, MD

Health Technology

January 27, 2011

Adoption of electronic health records (EHR) systems remains a challenge, both for hospitals as well as for physicians in ambulatory practice. The process of adoption, implementation, and meaningful use of EHRs (let us keep in mind) is actually quite different between those two setting.

Much has been written concerning EHR adoption within hospitals. Much of the experience in computerized physician order entry (CPOE) comes from hospital EHR adoption, and many of …

Palliative care can lead to higher quality of live and longer survival

John Schumann, MD

Patient

January 25, 2011

Every once in awhile amidst the weekly deluge of medical articles comes a show-stopper that has the potential to change the way we practice.

Rarer yet is the article that not only changes how we practice, but calls into question why we do what we do.

This recent article from the New England Journal of Medicine is just such an article. Before you bolt, let me simplify it for you.

Here’s the …

Formula and the placebo effect on your baby

Michael Gonzalez, MD

Patient

January 25, 2011

You are a new parent. Your infant is gassy, fussy, spitty, and does not sleep much. In other words your infant is a normal baby. You are stressed, and like any good parent, you want to fix what “ails” your infant. As you stroll down the baby aisle at the grocery store, you see labels that tout words like gentle, comfort, and restful. Formula manufacturers are brilliant. They know their …

Depersonalization of the patient and the loss of compassion

Wendy S. Harpham, MD

Physician

January 25, 2011

A common complaint about modern medicine is the depersonalization of the patient and the loss of compassion.

So let’s take a look at compassion.

Compassion is derived from the Latin “cum” (together with) and “patior” (suffer). From the perspective of clinicians, compassion is defined by two concurrent emotions: (1) a feeling of deep sympathy and sorrow for another who is stricken by medical misfortune accompanied by (2) a strong desire to relieve that …

What your medical office can learn from Norman Rockwell

Brandon Betancourt

Physician

January 24, 2011

This past summer I got a chance to visit Washington DC. While I was there, I saw a Norman Rockwell exhibition at the Smithsonian American Art Museum. As it turned out, the exhibition was the private collection of George Lucas and Steven Spielberg. The exhibition highlighted Rockwell’s masterful storytelling.

I didn’t know much about Norman Rockwell before that day. I knew he was a famous American painter and I had seen …

Guns and why doctors should partner with the National Rifle Association

George Lundberg, MD

Health Policy

January 24, 2011

Is there anything that we physicians can and should be doing to help with the huge problem of gun violence in America?

We all know it is nuts to sell guns and ammo to nuts, yet as a country we do it every day.

We all know that, in contrast to rifles and shotguns, the only moving targets for hand guns are people; that the Congress and president in this century legislated …

Should obesity be classified as a brain disease?

Michele R. Berman, MD

Conditions and Diseases

January 23, 2011

Many of our most popular stories are about diets and weight management.

Did you know that some psychologists and psychiatrists would like to classify obesity as a brain disease? The reason for this is that there is mounting evidence that food, or certain types of food, can trigger the same addictive effects in the brain as drugs like heroin and cocaine. There is also substantial evidence that some people lose control over …

Are parents to blame for childhood obesity?

Dr. Joe Kosterich

Patient

January 21, 2011

Childhood obesity is a problem. It is a function of the foods children eat both at home and at school. The people responsible for feeding children are parents not advertisers. Running the line that it is all to do with advertising allows adults to run a “Johnny told me to” line, which would not be accepted as an excuse from a child.

It is not about blaming parents. It is about …

Menopause and cancer: What women should know

Therese B. Bevers, MD

Conditions and Diseases

January 21, 2011

Menopause often brings more than physical changes. It also may bring uncertainty about cancer risks and cancer prevention.

Below, I’ve compiled some of the questions I frequently hear from patients about menopause and cancer. I hope these answers will help other women start informed conversations with their doctors about menopause-related concerns.

How does menopause affect a woman’s cancer risk?

Menopause does not cause cancer. But your risk of developing cancer increases …