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.
Along with millions of Americans, I’ve tried to comprehend the tragic shootings in Tucson, reaching deep within myself to find compassion for a young man who has forever changed the world for himself and so many others through his actions.
For those of us who assess, diagnose and treat college students struggling with mental illness while trying to succeed in their academic pursuits, the events leading up to his impulsive killings …
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Mental illness in the college student
Here are five things that you should have on your 2011 To-Do list.
1. Start electronic prescribing. What have you been waiting for? The EMR/EHR? (See number 4 below.) Electronic prescribing can work in a stand-alone (no EMR/EHR) environment. Work flow can be modified, and you will benefit tremendously with additional nurse time available to you after the nurses realize how much phone time they save each day.
Ask your current practice …
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5 ways to improve your medical practice in 2011
Oh, those Millennials.
Also called “Generation Y,” this is the American demographic group born during and after the ’70s, that was vicariously raised by “learning is fun” Sesame Street and became accustomed to getting awarded for any effort. They don’t know about bomb shelters, walking to school, tape decks or having to get up to change a TV channel. Well, they’re now entering the workplace and their informality, disregard for rank, …
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How Millennial physicians will impact disease management
by mdstudent31
One of the hot topics occurring in the health care debate deals with figuring out appropriate leaders of the Patient Centered Medical Home (PCMH). With the recent report by the IOM advocating for independent practice by nurse practitioners, many physician groups, including the AAFP and AMA, have come forth with strong statements advocating against the IOM report and independent practice by CRNPs.
A recent editorial …
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Worsen the nursing shortage with more nurse practitioners?
Either as a patient or as a physician there’s a very high chance that you’ve ever got your hands on a simple blood test.
These range from very basic ones to complex ones with multiple pages and are substantial to any cinlical evaluation. Blood tests are probably one of the most performed tests in a clinical environment with direct patient contact. Also, if you’ve ever seen a typical blood test from …
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Your blood test and the need for better designed results
As a family physician, I’ve found that patients’ individual health beliefs often play a big role in important decisions such as starting a new medication or undergoing an invasive test or procedure.
Some patients were more willing to endure potentially risky procedures in order to learn their diagnosis quicker, for example, while others preferred “watchful waiting,” or monitoring symptoms that were unlikely to be a sign of anything serious. Unfortunately, in …
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Individual health beliefs play a role in medical decisions
Have you ever been frustrated by an unproductive or inopportune visit with your doctor that wasted your time and money?
Here are a few tips to keep that from happening again.
The problem
Many visits with healthcare providers are poorly timed and less productive than they could be. Why? Because nobody is looking out for you between visits. It’s not that your doctor doesn’t care. He or she is simply too busy with …
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Save time and money with your visit with healthcare providers
by Tayson DeLengocky, DO
There has been a growing public interest in complementary and alternative medicine (CAM) in recent years. Osteopathic manipulative therapy, a form of physical manipulation of the body for improvement of health and body function, has been designated as complementary and alternative medicine (CAM) by the National Institutes of Health (NIH).
According to data reported in 2007 by the National Institutes of Health’s National Center for Complementary and Alternative …
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Alternative medicine and osteopathic medical education
When it comes to football season, it’s time to think about sports injuries. We frequently have children admitted to the PICU (or to what we call the intermediate or step-down unit) for observation, typically overnight, who have struck their head. They have had concussions. What is a concussion, and what does it mean for the child?
The term itself is centuries old, but even thirty-five years ago, when I was in …
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What is a concussion, and what does it mean for the child?
At the end of a busy afternoon, Mrs. MJ was exactly the kind of case I needed.
Two of my patients had come in late but needed to be seen and another was acutely short of breath and refusing to be admitted to the hospital. The chaos had put me almost an hour behind schedule, and I still had to return to the wards to round on my cancer patients. Fortunately …
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Obesity and the crossroads between relative health and medical illness
by Matt Adamson
There are a number of care models now being explored to improve the manner in which healthcare can be delivered. Let’s take a quick look at a few of the well known options:
Accountable Care Organization (ACO): The ACO model has the ability to provide, and manage with patients, the continuum of care across different institutional settings, including at least ambulatory (outpatient) and inpatient …
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Optimization of the new PCMH neighborhood
by Brian Jackson, MD and Brian Shirts, MD, PhD
We’ve heard a lot of talk lately about personalized medicine (i.e., using advanced diagnostics to guide customized therapy).
A great deal of research is going into creating new molecular and genetic tests. But whether the health care system is prepared to actually generate value from these advanced diagnostics remains an open question. Our group’s research, presented in …
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HPV test: Doctors are still not following testing guidelines
Generally, Alzheimer’s disease is diagnosed only after patients have progressed to major levels of cognitive impairment that results in substantial problems in daily functioning. But the brain changes that result in cognitive impairment start years, if not decades, before patients become symptomatic. So, wouldn’t it make sense to try to diagnose Alzheimer’s Disease in patients who have the brain changes, before they have clinical symptoms?
The answer would be yes if …
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Alzheimer’s disease diagnosis criteria: A critical review
An interesting article in JAMA by Drs. Jain and Cassel referred to the British economist Julian Le Grand who suggested that public policy “is grounded in a conception of humans as knights, knaves or pawns.”
Basically, are we motivated by virtue, by self interest or are we just passive victims? The authors suggest that this is a good question not only for physicians to contemplate but …
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Are physicians motivated by virtue or are they passive victims?
In my opinion, people are often too embarrassed to see their doctor about sexually transmitted infections (STIs)—in my opinion.
“In my opinion” is one of the most dangerous phrases in science. But when in comes to attitudes toward STIs, the data are scarce. STI’s are very much a “behavior”-based disease, so knowing what attitudes prevail can help us design effective prevention strategies. Attitudes toward HIV have been …
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Disconnect between knowledge of STIs and behaviors to reduce risk
Doctor D has dodged some questions in his career, but he has also been on the receiving end of some non-answers and can attest to their usefulness on the patient’s side of things.
How can a doctor dodging a question help the patient?
Let me tell you a story:
Doctor D’s son Little D was born with a very rare genetic condition which required he see an expert at a big university. As …
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Can a doctor dodging a question help the patient?
The many benefits of utilizing virtual assistant in the physician’s office have become clear to many. Physicians report greater job satisfaction, patient retention and cost-efficiency as some of the most obvious areas impacted by the use of virtual assistants in their practices.
Physicians preparing to shift some of their staffing needs to a virtual assistant or virtual assistance company have many questions and concerns that will be addressed by the person …
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Employing a virtual assistant in your medical practice
I love computers. Really, I do. Despite my oft-repeated claims about the shortcomings of electronic medical records in their current form, I do believe that information technology has the potential to be of great help to me and other physicians in providing quality care to Americans.
Stop laughing. I really mean it.
I do not believe, however, that IT best serves the medical needs of our patients when …
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A modest proposal for a truly useful EMR
I sat at the checkout desk in my practice last week for the first time and as always, it was a revelation. If you haven’t worked your check-in and check-out desks recently, I highly recommend it.
An insured patient that I checked out was shocked when I said the charge for her visit was $100. She said, “But he was only in …
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Your 10 minute office visit needs 8 people and 45 minutes of work
I sat at home with a sense of relief. I had just finished my first month of residency – a grueling inpatient hospital month where I was pushed to new limits.
I now finally had my first “golden weekend” (meaning I had both Saturday and Sunday off). More importantly, I had survived my first month without any patient deaths on my service. Given how sick people are when they come to …
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Measuring health outcomes is important but needs caution
