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.

Pay close attention to what doctors say to patients

Patient
December 20, 2010

In a report from the Archives of Internal Medicine, it was reported that most hospitalized patients (82%) could not accurately name the physician responsible for their care and almost half of the patients did not even know their diagnosis or why they were admitted.  Of the physicians, 67% thought the patients knew their name and 77% of doctors thought the patients “understood their diagnoses at least somewhat …

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Pay close attention to what doctors say to patients

Giving children probiotics

Conditions and Diseases
December 18, 2010

I’m becoming more of a believer in giving children probiotics. Not for everything and not for everyone; I really don’t think we should put them in the water.

Probiotics, essentially live “good” bacteria we use to supplement our diet (usually Lactobacillus Acidophilus in the US), are becoming more and more available and recommended by more and more physicians. The role microbes play in our health is a hot …

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Giving children probiotics

An ice cream label as a health literacy tool

Patient
December 16, 2010

When is an ice cream label a health literacy tool?

When Dr. Barry Weiss decided to use an ice cream label as a tool to asses whether we (patients) are able to understand medical instructions. Funded by Pfizer-backed Clear Health Communication initiative, Weiss’s research resulted in the creation of “The Newest Vital Sign.”

A health literacy assessment tool, with findings published in the Annals of Family Medicine.

However, the document, Why …

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An ice cream label as a health literacy tool

A physician story of addiction and recovery

Physician
December 16, 2010

by an anonymous physician

I am a physician now in recovery.

I don’t like that term. The correct thing to say is, I am sober.  I am going on a year sober without any problems. Recovery suggests some disease state and I don’t think it is that simple.  It also suggests an ongoing daily struggle or effort to remain sober, and I don’t find that the case, either.  I know this …

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A physician story of addiction and recovery

A poetry reading at Bellevue Hospital

Physician
December 14, 2010

The waiting area in Bellevue Hospital was full. Every chair was taken. But the people kept streaming in. More chairs had to be brought in. It wasn’t clear if the room could accommodate everyone.

This wasn’t the emergency room or the clinic waiting area, however. It was the scene of the Bellevue Literary Review poetry and prose reading. More than 100 people poured into Bellevue Hospital on a Sunday evening to …

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A poetry reading at Bellevue Hospital

Quit smoking in 2011: 5 steps you need to know

Conditions and Diseases
December 14, 2010

by Paul M. Cinciripini, PhD

If you smoke, quitting the habit is the best New Year’s resolution you could make — and keep — in 2011. That’s true even if you’re just a social smoker.

A new report from the Surgeon General shows that even occasional smoking and secondhand smoke cause immediate damage to the body.

The good news is that people who stop smoking before age 50 cut their risk of dying …

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Quit smoking in 2011: 5 steps you need to know

Physician time should be considered a resource

Physician
December 13, 2010

Being a physician always has been a busy job.

This is especially true for primary care physicians who set as their goal the delivery and coordination of comprehensive care for patients. Achieving such a goal requires availability, a broad spectrum of medical knowledge, effective use of the local health care system, and attention to both the “big picture” and the details of a patient’s life and …

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Physician time should be considered a resource

Obesity patients are not victims

Conditions and Diseases
December 13, 2010

Call it the McVictim syndrome. Too many pundits, public health experts and politicians are working overtime to find scapegoats for America’s obesity epidemic.

In his latest book, former FDA Commissioner David A. Kessler argues that modern food is addictive. In it, he recounts how he was once helpless to stop himself from eating a cookie. In a paper in this month’s Journal …

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Obesity patients are not victims

Accountable care organization (ACO) and medical home differences

Health Policy
December 13, 2010

by Kevin Fickenscher, MD

In the great healthcare alphabet soup, it’s easy to lose sight of the differences between proposed solutions for making healthcare more efficient and effective.

Rather than tackling payment reform in isolation of care delivery, Accountable Care Organizations (ACOs) and Medical Homes offer a consolidated approach to both issues. While the models are still developing, various pilot programs are being implemented around the …

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Accountable care organization (ACO) and medical home differences

How to find and treat lice in children

Conditions and Diseases
December 12, 2010

“Dr. Roy, you’ve got to help me!”

The most heartfelt pleas I ever hear from parents are for three things:

  • The three year old who won’t use the potty—so can’t register for school.
  • The 15 month old who still isn’t sleeping through the night.
  • The school-aged girl(s) with recurrent lice.

Parents hate the idea that their child has lice. They’re icky, they’re crawly, and even talking about them makes everyone in the room start scratching. …

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How to find and treat lice in children

The secret to better healthcare is the primary care physician’s brain

Physician
December 10, 2010

When I first stared hearing about the Patient-Centered Medical Home (PCMH) concept, I perceived it to be a euphemism.

For whatever reason, the concept of primary care or family medicine hasn’t resonated with politicians, corporate benefits managers, or the general public. To me “medical home” was just a warm fuzzy term that at least gave an unknowing listener a sense of the benefits of a strong relationship with a competent primary …

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The secret to better healthcare is the primary care physician’s brain

AMA helps physicians care for patients

Patient
December 9, 2010

A guest column by the American Medical Association, exclusive to KevinMD.com.

As the nation’s largest physician organization, the American Medical Association (AMA) is uniquely positioned to help physicians thrive in medical practice throughout the stages of their careers.

Because the AMA is led by physicians, we understand the many demands and rigors physicians face as they work to provide high-quality patient care, and we are proud to support  physicians in their …

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AMA helps physicians care for patients

Intuitive and algorithmic decision making and The Simpsons

Physician
December 9, 2010

One of the most popular Simpsons episodes ever – MoneyBART – succinctly describes the struggle between intuitive and algorithmic decision making in physical therapy.

This struggle, catapulted to prominence in 2002 with the publication of Flynn’s manipulation rule, is not unique to physical therapists.

Physicians, too, resist the influence of decision rules and adhere poorly to clinical practice guidelines.

Physical therapists share some commonalities with physicians in that we overestimate our …

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Intuitive and algorithmic decision making and The Simpsons

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Tricks for helping patients save money on prescriptions

Medications
December 8, 2010

As a primary care doctor, I have figured out many tricks for helping patients save money on prescriptions. Some of them I am sure you have never heard of, and others, well — you might have, but they bear repeating.

All of the prices quoted here are from Costco, unless otherwise specified.

1. Price compare between pharmacies. Can’t stress enough the potential differences in medicine prices between pharmacies. Generic medicine prices vary more than branded/trademarked …

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Tricks for helping patients save money on prescriptions

Implementing site changes with Plan-Do-Check-Act

Physician
December 8, 2010

Many healthcare organizations are contemplating making dramatic changes in the way they do business and treat patients.  Some of these are driven by the recently passed Accountable Care Act and the Tarp Bill.  They are planning on adopting electronic medical records, becoming Accountable Care Organizations or becoming Patient-Centered Medical homes.

Unfortunately, like many businesses, they will undergo a lot of stress and loss of resources in time and money in making …

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Implementing site changes with Plan-Do-Check-Act

Commercially funded CME programs and whether bias can be removed

Medical Education
December 7, 2010

The growing criticism of industry funded continuing medical education (CME) over the past several years has had a number of significant effects on the CME community. As the Accreditation Council of Continuing Medical Education (ACCME) annual report showed, from 2007 to the present, commercial support of CME dropped 29.3%, and the number of directly sponsored CME activities decreased over 7% between 2008 and 2009.

CME funding is extremely important …

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Commercially funded CME programs and whether bias can be removed

William Osler’s humor, and finding fun in medicine

Physician
December 7, 2010

In 1905 William Osler gave his farewell address as he prepared to leave Johns Hopkins for Oxford and England. After speaking to the assembled medical students about the tragic side of medicine he said:

The comedy, too, of life will be spread before you, and nobody laughs more often than the doctor at the pranks Puck plays upon the Titanias and the Bottoms among his patients. The humorous side is really …

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William Osler’s humor, and finding fun in medicine

$11,000 hospital bill from the emergency department

Patient
December 6, 2010

by Steve Sanders, DO

“What am I going to do now Doc?” asked Mike, a down on his luck, 29 year–old recently unemployed truck driver, as he handed me his hospital bill.

Mike was seen at our local emergency department on a Friday evening with complaints of indigestion. Earlier that day he and his wife Susan celebrated their second anniversary by splitting a store bought pepperoni pizza. …

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$11,000 hospital bill from the emergency department

Choose your primary care physician with particular care

Physician
December 6, 2010

I told a friend what I did recently to get in to see a dermatologist and she was shocked.

“You wrote a letter asking her to take you as patient?” “Wow!” “Yes,” I admitted. “I’d called her office for an appointment; she wasn’t taking new patients; I needed to resort to an over-the-top approach.”

You see, I’d researched her (ok, I Googled her) and after reading her background, schooling, and patient reviews, …

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Choose your primary care physician with particular care

Lifestyle matters for specialties that want to survive

KevinMD
December 2, 2010

Medical students today consider lifestyle an essential criteria when choosing a specialty.

It’s become a cliche that most are looking towards the ROAD (radiology, ophthalmology, anesthesiology and dermatology) to happiness.

There’s been some recent media attention at how women are lured to specialties that offer a greater balance between their family lifestyle and professional demands.

Claudia Golden, a Harvard economics professor, recently noted that,

high-paying careers that offer more help in balancing work …

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Lifestyle matters for specialties that want to survive

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