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.
I have been genuinely blessed by my career in medicine.
When I started medical school, I was living through a very rocky time, dealing with severe, at times suicidal depression. I was working through an outpatient alcohol and drug rehabilitation program, and I was about 40 pounds overweight. I had grown up with a very negative and fatalistic attitude toward life which resulted in chronic misery and a number of personal …
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A community of healthy seniors inspires this physician
by Rosemarie Nelson, MS
Everyone is trying to “do more with less” and concerns about the economy add fuel to that fire! But, when done with purpose and thoughtfulness, you can manage vendor relationships so that you’ll deliver successful negotiations that will get the most bang for the buck for any medical practice, small or large, multispecialty or single specialty.
Preparation and setting objectives well before contract …
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How your medical practice can manage vendor relationships
For five years I worked at GlassHospital’s Student Care Center.
I don’t get no respect, neither.
One of the great things about GlassHospital is that it sits on the campus of a well-known and fairly well-respected former Big Ten university.
Like all colleges and universities, our place acts in loco parentis to the students that grace its campus. This means responsibility for our students’ health and well-being.
I loved working at the Student Care …
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Working at the student care center in college
Viral upper respiratory illnesses, or common colds, are by far the most frequent illness I see in my office.
It is called the common cold because it is, well, common. I typically can make the diagnosis with a high degree of certainty based on the pattern and the timing of the symptoms. Deciphering cold symptoms and knowing when to worry is what a pediatrician does more often than anything else, and …
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Colds teach the immune system how to fight future viruses
As I have written before, the Teaching Health Center is seen as a way to move education into the community (using Community Health Centers as a training resource) and out of the Academic Health Center.
Currently, 20 million Americans receive care in a CHC. They serve Americans who are unable to obtain access through more traditional means, either because of location (the community will not support traditional healthcare) or socioeconomic …
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Will primary care be saved by the community health center?
A recent study published in the journal Sleep Medicine revealed that most child psychiatrists prescribe medication for sleep at least once a month, despite the fact that no sleep medications are approved for use in children. The study was funded by Sanofi-Aventis, makers of Ambien.
Managing sleep is one of the greatest challenges of being a parent. It represents the first major separation and can be fraught with complex ambivalent feelings. …
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Routine use of sleep medication for children
There is very little doubt that if we eat the diet we were designed to eat and spend adequate time in the sun that we will get most if not all the nutrients we need.
That’s the ideal, but not the reality for a lot of us. I was recently advised by a group of physicians who are experts in the area that it is reasonable, and probably preferable, for adults …
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Taking a multivitamin, vitamin D and fish oil every day
First aid is defined as the immediate care given to an acutely injured or ill person. It can literally be life-saving so it behooves all of us to know some basic principles.
What follows are some rules that cover common conditions and general practices:
- Don’t panic. Panic clouds thinking and causes mistakes. When I was an intern and learning what to do when confronted with an unresponsive patient, a wise resident advised …
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First aid rules that everyone needs to know
I like reading Maggie Mahar’s Health Beat.
She usually gets it, from the function of insurance to the complexities of assorted payment systems, I get the sense that she is generally rational when it comes to paying for health care. This doesn’t mean there aren’t times when she gets it wrong. Her embrace of primary care provided by nurse practitioners shows a truly spectacular …
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Preventive care as a cost saving measure is a fallacy
This item has nothing to do with OpenNotes itself – it’s what I’m seeing now that I’ve started accessing my doctor’s notes. In short, I see the clinical impact of not viewing my record as a shared working document.
Here’s the story.
In OpenNotes, patient participants can see the visit notes their primary physicians entered. Note – primary, not specialists. I imagine they needed to keep the study design simple.
So, …
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Patients seeing the visit notes their primary physicians entered
She was like … Superwoman. A strapping medical visionary probably in her forties. Gray long coat falling below the knees. She strode confidently down the hallway towards the elevator, a father hurrying beside her with his young lanky daughter cradled in his arms. The girl’s head nuzzled into her father’s shoulder. She was old enough to walk by herself…but clearly she was sick. Unable.
Undoubtedly they were headed from the medical …
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Why patients are leaving our practices
When my oldest son was 13 he began to do poorly in school. He often forgot to do his homework, or he did it but forgot to hand it in. He had difficulty paying attention during tasks, was extremely disorganized, and his teachers said he was easily distracted. They suggested that his behavior fit with many of the symptoms of attention deficit hyperactivity disorder (ADHD), but since this was mostly …
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Is your child’s behavior due to ADHD?
Having more primary care physicians doesn’t necessarily improve the quality of care.
That may come as a surprise to regular readers of this blog, but that’s one of the findings that came from a recent analysis of the Dartmouth Atlas.
As reported by the WSJ’s Health Blog,
having regular primary-care visits isn’t a guarantee of receiving recommended care. There was “no relationship” between rates of breast cancer screening for women age 67-69 …
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Primary care private practice will die, will patients benefit?
My colleagues at the Advisory Committee on Immunization Practices (ACIP) are examining a proposed policy for hepatitis B vaccination for diabetic patients. If accepted, this would be the next in a series of baby steps expanding hepatitis B vaccine recommendations for adults. While we are taking these baby steps, HBV incidence rates among U.S. adults remain pretty flat, and they haven’t changed much since 2006.
We know the vaccine works. We …
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Expanding hepatitis B vaccine recommendations for adults
Folks across the country are paying hard cash for total body scans, abdominal aortic aneurysm testing, CAT coronary artery scans and carotid artery evaluations to prevent disease or find important lesions early. It’s a seductive argument, and it’s a scam.
Ordinary patients don’t understand about pre-test probability and positive and negative predictive values. Indeed, all physicians were taught to consider Bayesian theory when ordering diagnostic tests. This is very tough concept for …
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Why total body scans are a scam
by Val Jones, MD
Vaccines have saved more lives than any other medical intervention in history. They are incredibly safe and effective and are well-tolerated by most people. In the US, the Centers For Disease Control and Prevention (CDC) carefully reviews all reports of adverse reactions that could be associated with vaccines. Over decades of review, they have found that the rate of …
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Vaccines and the diseases vaccination can prevent
I have made a big life-changing, evolutionary decision: I am leaving my job with public health. It was not an easy one. It isn’t because I don’t love my job greatly; because I do. In fact, I feel like the queen of the jungle, leaving her subjects. It’s not easy to let go.
My reasons for leaving have nothing to do with the job itself, but have everything to do with …
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Grateful for a medicine career in public health
Patients’ gender preferences for medical care are a factor that we all know exists yet most physicians prefer to ignore it in daily practice hoping that modern medicine is gender neutral. Forty plus years ago when I started in medicine this wasn’t a consideration. Nearly all physicians were men and nurses were women. Patients simply had no choice. Male physicians felt entitled to see all comers and present day women …
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Patient gender preferences for medical care
