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.
Doctors and nurses are leaders in health care. Being a great leader means having a clear vision, mission or goal. It means being committed, and knowing how to listen and communicate, but it involves much more. It’s about having heart, empathy, and an uplifting spirit.
I value and respect a well written post by Thomas Goetz, author of The Decision Tree: Taking Control of Your Health in the New Era of …
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Deeply connect and engage your patients with empathy
What does it cost to improve operational efficiency using technologies and outsourced services?
For some physicians, the first reaction to every new service or technology is that it’s going to “cost too much.”
And you get pitches for plenty of new services:
* Your clearinghouse vendor or your billing manager wants you to push all your claims, even the claims you can file directly at no cost, through the clearinghouse for efficiencies.
* Your …
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Use technology and outsourced services to improve practice efficiency
Dr. Ryan Flesher was working his usual shift in the emergency department that night in July of 2006. The hospital was short-staffed, per usual, and patients continued streaming through the revolving doors. Neither the people at the front desk nor the nurses saw Dr. Flesher slip quietly down the hall that night.
The following is a true story that occurred well before healthcare …
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Doctors are quietly opting out of medicine
Something recently stopped me in my tracks.
A study published in Pediatrics recently found that 65% of parents to 3 year-olds said they had spanked their child within the last month. Sixty five percent? The number surprised me. If you’d asked me to guess, I would have said 20-25%. Talk about way off. Another reminder of how much I have to learn.
The study evaluated risk factors, including domestic violence and intimate …
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Spanking your kids and corporal punishment
Though I’ve spoken about breast cancer for Susan G. Komen for the Cure (emphasizing the importance of early screening and detection), until recently I had never had a mammogram. In my training I’d been taught that mammograms weren’t that accurate or useful in women under 40 (our health system’s protocols reflect that), so I got regularly checked by my physician whenever I had a physical and otherwise was waiting until …
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What would you do if you had a year left to live?
I understand the frustration and anger in CNN Senior Medical Correspondent Elizabeth Cohen’s new book, The Empowered Patient. I agree that all of the horrible patient stories should have never occurred. As a practicing primary care doctor who has witnessed near misses and bad medical outcomes affect family members, I too wrote a book encouraging patients to be informed and engaged about their care.
The problem is that The Empowered …
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Is The Empowered Patient too adversarial?
In Quality Measures and the Individual Physician, Danielle Ofri, MD, PhD questions the usefulness of feedback report cards for individual providers. She states, “Only 33% of my patients with diabetes have glycated hemoglobin levels that are at goal. Only 44% have cholesterol levels at goal. A measly 26% have blood pressure at goal. All my grades are well below my institution’s targets.”
It would be better for Dr. Ofri’s patients if …
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Doctors should embrace feedback and learn from it
by Jon Meyer
Looking at the industry response to the recent study released by the Center for Studying Health System Change, Physicians Slow to E-mail Routinely with Patients – Issue Brief No. 134, it appears that a piece of the puzzle is missing. Both the study, and the analysis, put the physician at the center of the email debate. In reality, about 30% of a medical practice’s communication is from the …
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Physician email implementation inertia
Oncology is the area where the health care cost conundrum is coming into sharpest focus. Theoretically, who wouldn’t spend whatever it takes to cure a life-threatening disease? And yet practically the costs of new treatments are so high, and the improvements usually modest enough, that when it comes right down to it costs are becoming a real issue for patients and doctors.
An interesting article in the Journal of Clinical Oncology …
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Comparative effectiveness research needs to be taught to doctors and patients
Doctors: if you’re sick, don’t go to work.
The stereotype of doctors is that they go to work, despite whatever symptoms ail them. Calling in sick places strain on colleagues. Especially in residency, where team members are expected to pick up the slack.
In a recent column, the New York Times’ Pauline Chen discusses the image of self-sacrifice that a sick doctor going to work portrays:
Hacking, febrile or racked with the …
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Sick doctors who work are doing more harm to their patients than good
Patients want a quick fix. Society wants patients to have a quick fix, so that they can quickly return to their usual performance at work and home.
Patients still have shame about seeking help from a psychiatrist or other mental health professional. So they ask help for their depression from their primary care physician. The PCP feels an emotional pressure to provide the quick fix in that 15-minute appointment – the …
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How an antidepressant can hurt your patient
As a medical provider, while seeing a husband and wife, or a couple, regardless of gender, one comes across several situations that may be considered difficult to handle and that require a good deal of tact and confidentiality.
This is the case with seeing a husband and wife or (couple), together, for an examination. Ultimately, it depends on the rapport that the couple shares. If they …
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A physician seeing the husband and wife together
Authors of a recent study from the Archives of Internal Medicine are unlikely to endear themselves to specialists.
As reported by Reuters, and provocatively titled, Do specialist doctors make too much money?, the study gives a per-hour breakdown of how much doctors make.
I think this is a good approach, since annual salary figures do not account for the number of hours doctors work — and in the case of primary …
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Specialist and primary care pay per hour
by Anar Mikailov
By now it is common knowledge that primary care is an undesirable field for newly graduating medical students.
Additionally, many current primary care physicians are closing shop and either enter early retirement or seek non-clinical professions. According to the American Academy of Family Physicians, the 2010 Residency Match showed that 1,184 U.S. medical grads chose Family Medicine, less than half of the available positions …
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Technology empowered direct pay primary care
by Ali Khan, MD
“So, why didn’t I take the ROAD again?”
It’s a question that I regularly hear from many of my co-residents in internal medicine – and no, we’re not questioning our travel routes to the hospital.
We all know why we chose internal medicine: the intellectual challenges inherent in treating across organ systems, the excitement of primary scientific investigation and diagnosis and the like. As we …
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Will a higher demand for generalist doctors save primary care?
by W. Gregory Feero, MD, PhD
Recent high-profile articles in the lay press have criticized the lack of immediately tangible health benefits from genomics research investment.
Expectations for immediate clinical benefit from genomic discovery, fueled by both scientists and the media, have outstripped even the blistering pace of genomic discovery. The gap between discovery and application is particularly notable in general medical practice, where only a …
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Few health benefits from genomic discovery
