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.

An ACO primer and get started on forming an Accountable Care Organization

Donald Tex Bryant

Health Policy

January 5, 2011

In early 2011 Department of Health and Human Services will be issuing guidelines for the formation of Accountable Care Organizations (ACO’s) for CMS (Medicaid and Medicare).

I know of several organizations looking into this type of organization as they anticipate the new guidelines. There seems to be great anticipation of the guidelines in various health care publications that I have recently read. On December 18, 2010 on the Health Affairs website …

Government and health insurance intrusion penalizes efficient doctors

Jordan Grumet, MD

Health Policy

January 4, 2011

I wish I knew how to express myself. I wish I knew how to put this into words. How the direction of things has just become depressing. How each day makes me wonder how we got to where we are today. And I think back. Back to the beginning.

I think back to my childhood. And how I looked up to my father … the physician. How he died when I …

Start thinking about health literacy in a broader framework

Hilary Seligman, MD

Patient

January 4, 2011

I have a patient who I will call Antonia.

Antonia is in her early 70’s. She came to the United States from Guatemala many years ago, but never learned to speak much English. This doesn’t cause her much of a problem; her community is small and tightly-knit, so she doesn’t have much need to speak English in her home or her neighborhood. And she has a large family—children and grandchildren and …

Pain contracts threaten the doctor-patient relationship

Kevin Pho, MD

KevinMD

January 4, 2011

Doctors today are wary about treating chronic pain.

One of the main worries is precipitating fatal opioid overdoses. Indeed, according to the CDC, and reported by American Medical News, “fatal opioid overdoses tripled to nearly 14,000 from 1999 to 2006 … [and] emergency department visits involving opioids more than doubled to nearly 306,000 between 2004 and 2008.”

Requiring chronic pain patients to sign pain contracts is a way to mitigate this risk.

But …

Protecting health care professionals who act based on their conscience

Kevin

Patient

January 4, 2011

by Child of the Ocean

I recently came across an interesting article titled “Conscientious Objection Gone Awry — Restoring Selfless Professionalism in Medicine” by Julie D. Cantor, M.D., J.D., in the New England Journal of Medicine.

This article argues against a rule, the Provider Refusal Rule, from the United States Department of Health and Human Services (DHHS) that legally protects health care professionals who act based on …

Medical care and airlines – should there be a difference?

angienadia, MD

Patient

January 3, 2011

A recent article by Pauline Chen features a group of primary care physicians at Tufts Medical Center in Boston, who have created a concierge practice that funnels income into the traditional general medical practice that sees less-advantaged patients.

Surveys (performed by the medical center itself) found that patients rated the quality of interactions with their doctors similarly regardless of their affiliation. The only significant differences in responses had to …

An automated call center for your medical practice

Peter J. Polack, MD

Physician

January 3, 2011

Having an answering service is essential for the typical medical practice. But what about your regular call center? Do your front desk personnel answer the phone? Do you have a dedicated receptionist? Or a formal call center?

Outsourcing services seem to be on the rise and medical practices are beginning to realize some cost savings just like other businesses.

The trade-off of course can be the perception of less personalized service. Some …

Is the media responsible for childhood eating disorders?

Claire McCarthy, MD

Patient

January 3, 2011

I really don’t want my children to be overweight. I know this because I see the consequences every day in my practice, consequences like high blood pressure, impending diabetes, or poor self-esteem.

At the same time, I really, really don’t want my children to have an eating disorder. I know this because I had one.

In college, I suffered from anorexia nervosa. I’m a little more than 5 feet 9 inches tall, …

Lessons learned from asthma therapy

Juliet K. Mavromatis, MD

Conditions and Diseases

December 31, 2010

As a kid I had allergies and asthma.

Because of this, for several years, my mother wrote a note excusing me from the 600 meter run in elementary school. My father took me to weekly allergy shots. At times I had eczema on my forearms and eyes, and according to my allergist, whose notes I later read, I had moderate allergic shiners (also known as dark circles under my eyes). My …

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Lessons learned from asthma therapy

Take responsibility for your own health

Peter J. Weiss, MD

Patient

December 30, 2010

An excerpt from More Health Less Care: How to Take Charge of Your Medical Care and Write Your Own Personal Prescription for Lifelong Health.

Bob Baker is a patient of Dr. Lisa Martin. Bob works as an engineer for a Fortune 500 company that holds major commercial and Department of Defense contracts. He’s 45 years old and happily married with two college-age children. Bob’s lifestyle is stressful. He travels …

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Take responsibility for your own health

Health care economics and the relationship between doctor and patient

Maggie Kozel, MD

Patient

December 29, 2010

I used to practice pediatrics. It has been several years since I decided to leave medicine, but people still ask me about it, and I find myself offering neat explanations between gulps of coffee. Of course, the full truth is much more complicated. The full truth has as much to do with our health care system and our culture as it does with me.

My journey in pediatrics was not entirely …

Your attention deficit disorder may be an anxiety disorder

Srini Pillay, MD

Conditions and Diseases

December 29, 2010

Are you one of those people who simply cannot concentrate for long enough? Do you find that no sooner than you start doing something, that your attention is scattered all over the place? Do you find that you log onto your computer and within minutes are surfing every possible tangential site that you find?

Your problem may not be a problem with your attention. In fact, it may be that the …

How American physicians should be paid

George Lundberg, MD

Health Policy

December 29, 2010

How do you think American physicians should be paid?

I think many of the current methods are insane. Case in point:

In the 1980s, during a meeting of the board of trustees of the American Medical Association, I experienced sudden unexpected unilateral loss of hearing. You might say that was lucky. But I was scared and went right to my ENT’s office.

He looked in my ear and extracted a large wad of …

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How American physicians should be paid

Are chaperones a hindrance to patient privacy?

Joel Sherman, MD

Patient

December 28, 2010

Chaperones are increasingly recommended for routine use in Western medicine. There are semi-official recommendations in both the UK and USA. The AMA has long had this.

The rationale for using chaperones is twofold. In theory their primary purpose is to protect, comfort and assist the patient. In reality though, the usual purpose is to protect the physician against claims of sexual assault or harassment.

Preferably, chaperones should be real professionals, ideally …

Reduce phone calls in your medical practice

Rosemarie Nelson

Physician

December 28, 2010

A physician approached me at the end of a talk on optimizing practice efficiency and improving service to patients and said, “I dream of an office with no phones.”

Do you have days where the phones are ringing off the hook? Or the phone message forms in your in-box seem to be reproducing? Maybe it’s been one of those days when you can never get your nurse’s help because she’s been …

Patient complaints do not fit the primary care office visit

Kevin Pho, MD

KevinMD

December 28, 2010

Primary care physicians often have to see patients with a litany of issues. Often within a span of a 15-minute office visit.

This places the doctor in the middle of a tension — spend more time with the patient to address all of the concerns, but risk the wrath of patients scheduled afterwards, who are then forced to wait.

And, in some cases, it’s simply impossible to adequately address every patient question …

A surge in demand for physicians from newly insured patients

Glenn Laffel, MD, PhD

Health Policy

December 23, 2010

The Affordable Care Act is the most important piece of federal health care legislation since the Social Security Act of 1965 established the Medicare program. It assures that 32 million Americans will have access to health insurance for the first time. But who will care for these people?

Our health care system was plagued by a severe and worsening physician shortage even before the new law took effect. In fact, a …

Say goodbye to your patients the right way

Jill of All Trades, MD

Patient

December 23, 2010

When I realized that I would be moving to a different county within Southern California and would have to change jobs, I knew it would be inevitable that I would have to say goodbye to my patients. I was dreading this. I mean, really dreading it. I don’t like goodbyes. I feel as though I am breaking up, and in a way I am.

Like any other relationship, my patient-physician relationships …

Solve the obesity crisis to ensure our country’s financial stability

John Mandrola, MD

Patient

December 22, 2010

If I was Surgeon General, I would follow the lead of our country’s first Mom.

This is serious folks.

We, as an American society, need to solve the obesity crisis. Not just for our physical health, but for our country’s financial stability.

Reducing the spiraling costs of health care is wanted by all. So far, prevention of the diseases which contribute most to our health care costs, (heart disease, cancer and orthopedic issues, …

Physicians need to take responsibility for their actions

Jeffrey Knuppel, MD

Physician

December 21, 2010

As the saying goes, when you’ve got a hammer, everything looks like a nail. Send a patient to a surgeon, and he very well might get surgery. Send a patient to a psychiatrist, and he very well may end up on psychotropic medication.

As physicians, we need to take responsibility for our own actions. We should not prescribe or perform procedures unnecessarily. However, even if we are responsible for our own …

Primary Care

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