We often speak of the importance of continuity of care, but there is confusion about what this really means.
When I first joined our small clinic twenty-five years ago, continuity was the reason every medical group in the five town area had its own night-call roster. This way, patients who called after hours could reach a doctor from their own doctor’s office. Even if the covering physician didn’t know the patient, …
Continuity of care starts with caring
by June Parker Beck
At age 73 I have definitely seen the evolution of the whole “doctor” experience, from Ob/Gyn, to pediatrician (have 5 children) to specialist, to internist.
I’ve learned to accept the fact that in this high tech age, we aren’t going to be chatting with our doctor about the grade school bake sale. The biggest lesson learned, however, was that if you are treated …
Doctors need to be aware of their office staff behavior
In addition to outlining patient’s medications, and teaching them what times of day to take the drugs that will help control their specific disease, pharmacists are now taking on a new role to address the growing healthcare needs and demands of Americans, according to a recent article in the New York Times.
For example, at Barney’s Pharmacy in Augusta, Ga., the pharmacy offers classes at the store for patients …
How pharmacists address the healthcare needs of patients
by Thomas Goetz
Enough about patients: What is a doctor to do?
In the past few months, since The Decision Tree book came out, I’ve had the privilege to talk with many doctors about the opportunity and challenge of engaging patients in their own health. Some physicians, not surprisingly, have been suspicious, and even hostile to the idea that patients have a …
How can doctors successfully engage their patients?
by Travis G. Bias, DO
Throughout my involvement in organized medicine, I’ve met friends who I hold in high regard, and colleagues for whom I hope to one day work. One of my favorites, a neurosurgery resident buddy of mine, claims specialists should be paid more than primary care physicians. But, I am a third-year family medicine resident, preparing to enter the practicing world. And …
How to meet the primary care demand in the next decade
by Ruben J. Rucoba, MD
Has it come to this? Do we really need, as a profession, to measure ourselves against others like a bunch of schoolboys? After reading Dr. Son’s article, “Does being a lawyer or journalist stack up with being a physician?”, I feel compelled to reply.
As a practicing pediatrician, I, too, feel the nobility and privilege of my profession, and count myself lucky …
A physician’s worth doesn’t need a professional hierarchy
We at the Los Angeles County/USC Medical Center are generally credited with having created the “Panic Value” or “Critical Value” laboratory reporting system in 1969.
A Panic or Critical Value is a laboratory finding at such variance with normal as to be life-threatening if something is not done quickly, and for which there is a corrective action that can be taken.
We determined that it was the laboratory’s responsibility to recognize such …
Is the critical value reporting system truly life saving?
Something happened to the public perception of health and medicine in the 1970s. People began to adopt — and financial interests and the media began to profit from – “healthy lifestyles.”
This was not without consequences.
• Americans became increasingly preoccupied with diet, exercise, and health habits.
• There was a big uptick in the use of alternative “medicine” and stress reduction practices – acupuncture, chiropractic, herbalism, naturopathy, nutritional therapies, yoga, massage, biofeedback.
• …
How a tyranny of health is bad for both patients and physicians
An excerpt from CyberSafe: Protecting and Empowering Digital Kids in the World of Texting, Gaming and Social Media.
by Gwenn Schurgin O’Keeffe, MD, FAAP
Screen Time and Childhood
Have you ever tried to go “screen-less”? I often tell the story of taking my girls to New York City on an April vacation, looking forward to Turnoff Week. This is a semiannual event that encourages families to flip off the screens …
Protecting kids in the world of social media, a Cybersafe excerpt
The rise of the e-Patient movement has the potential to change the practice of medicine, in my opinion, for the better. e-Patients demand to be taken seriously, to be “equipped, enabled, empowered, engaged, equals, and emancipated.”
My recent post on KevinMD.com suggested the need for e-Doctors as well, in response to the growth of the e-Patient movement.
So how do you become an e-Doctor? I believe you, and I, need to be equally …
I don’t think there is anything nobler than being a physician. In it’s most prime form it is service to life’s most basic needs.
Certainly there are professions and lives with similar dedication. But lawyers and journalist I can’t reasonably place amongst them. This from someone who favors liberty and transparency in society above most else; certainly things that lawyers and journalists can help foster.
And yet, for all the respect thrown …
Does being a lawyer or journalist stack up with being a physician?
“How many staffers should we have per doctor?” was the opening question in a recent column. We looked at the impact of staff on provider productivity and ultimately practice profitability as an approach to address that question.
In that piece, we focused primarily on clinical staff, but in this column, we’ll dig even deeper into medical practice operations, looking at the way a practice utilizes nonclinical support staff for traditionally …
How medical practice operations impacts productivity and profitability
I can’t remember which lecture it was, or even just when in my first two years of medical school the lecture was given, but I do remember how the concept struck me as really important.
The gist of the message was that the timing of onset of a patient’s symptoms is a key part of understanding the nature of the patient’s diagnosis. Symptoms from a neoplasm come on gradually, tend to …
How time can be used as a diagnostic tool
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I was recently scanning an online forum about pediatric health concerns. (What can I say? I sometimes need inspiration.) One thread within the forum was significantly longer than any other. Parent after parent posted about how they had noticed a knot on their infant or toddler. This concern parallels what I see in practice. An unexplained knot on the head is a common reason parents bring their child to be …
When parents should be concerned about a lump on their child
“What does it take to be good at something in which failure is so easy, so effortless?” asks Atul Gawande in his book, Better. For medical students who will soon have responsibility over people’s lives, it’s a daunting question. It draws out our fears of messing up and making mistakes. Of getting a lower grade than our peers on a Structure Function exam. Of answering a question incorrectly and embarrassing …
How to foster a cycle of excellence in medicine
One of my docs was telling us about a patient’s experience at another practice. Apparently, the parent was at her wits end with her crying baby. She called the on call doctor to ask for advice and the doctor told the patient, “your baby has colic’s; turn on the vacuum and stop calling.”
It turned out the baby had some gastric condition (not colic) and needed treatment. The patient ended up …
Why doctors have poor customer service
by Stephen R. Blumberg, PhD
As a panic disorder specialist, I take an active responsibility in helping my patients feel confident that their physical complaints have no organic etiology.
My day is filled with my patient’s reporting symptoms of heart palpitations, shortness of breath, chest pressure, rubbery legs, lightheaded feelings, inner trembling, numbness and tingling in the extremities, lump in the throat, knot in the stomach and head pressure, to name …
Early diagnosis of panic disorder can improve quality of care
To screen or not to screen? That is not the question.
The question is not whether to screen, it is why, what, where, when, how, and how much, how often, and at what cost for what benefit.
Patients and physicians must and do screen. The issue is cautious appropriateness. Self-screening by patients is easy, free, and fundamentally harmless. Look at your skin for potential melanomas, be alert to warning symptoms of a …
Patients and physicians should screen for cancer, but cautiously
Peter Orszag wants doctors to work weekends.
The former director of the White House Office of Management and Budget wrote as much in this past weekend’s New York Times:
Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or …
Doctors should work weekends, and how reformers alienate physicians
My wife and I were invited to dinner at the home of one of my daughter’s friends. My daughter is a graduate of the International Baccalaureate program of Murphy High and her friends tend to be interesting.
This particular friend is majoring in pre-med and has parents who immigrated from Vietnam following the fall of Saigon. As is usual when one has a physician dinner guest (and perhaps when one doesn’t) …
Our love affair with technology holds primary care back
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