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.
POLST stands for “Physician Orders for Life-Sustaining Treatment”. It is a next generation replacement for an Advanced Directive and DNR (“Do Not Resuscitate”) order. Advanced planning documents turn out to be less than useful, especially in urgent care settings, and many patients receive more aggressive care than they might want because universal, transferable physician orders are unavailable or, simply, not applicable because a patient is in a different care setting.
The …
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POLST and the next generation of the “Do Not Resuscitate” order
“How many staffers should we have per doctor?” That’s a question I’m asked at almost every seminar I present. Of course, like many good consultants, I almost invariably respond “it depends.”
One of the factors that needs to be considered is what jobs we’re talking about — clinical or front office. It’s staffing in the clinical area that will do most to enhance a physician’s productivity, so that’s what we’ll focus …
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How much staff should a doctor have?
How do you judge how good a doctor is? By personal interaction? By what relatives and friends say? By whether he or she is on time when you go for your visit? By doctor rating websites on the Internet? By patient satisfaction surveys conducted by doctors themselves or rating agencies?
Or do you do it by the numbers? The federal …
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How judging doctors by the numbers may be meaningless
Physicians used to take care of patients at their homes.
Through the 1960s, patients would make a phone call and the doctor would arrive at the doorstep, black bag in hand, eager to serve. This changed in the mid to late-1960s as doctors developed group practices and as medical care expanded to include technology-based studies and specialty referrals, and thus became more hospital-centered. Prior to World War II, 40 percent of …
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How house calls benefit patients and physicians
There is a critical gap in the supply of primary care physicians in the U.S., and it should come as no surprise that our existing primary care delivery and payment models are at the heart of the issue.
The traditional primary care model — medical care provided by a physician and a small support staff, often without benefit of health information technology (HIT) — was developed at a time when the …
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Explaining the critical gap of primary care physicians
by Brad Stuart, MD
Atul Gawande’s brilliant essay in the New Yorker sums up the dilemma we face, whether we’re patients, families, and/or clinicians, as we near the end of life. His point is that we have to face it together:
“People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say …
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Confronting the fear of death takes preparation
by Edward Stevenson
One of the things that drew me towards medicine was the fact that I personally value health and the sense of well being.
I would expect that if I inquired of my colleagues that a similar statements of values would echo this fact. Yet despite this near universal affirmation of value for health and well-being, a considerable amount of hypocrisy exists in the …
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Health and well-being hypocrisy in the health care industry
Before he tells you how to get a straight answers from physicians, Doctor D is going to stall for time by explaining why doctors give vague answers.
Why would a good doctor give useless answers?
1. There is an answer, but your doctor doesn’t know it. Don’t be hard on doc for this one. There is no MD in the world that knows the entire breadth of medical knowledge. Some docs pretend …
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Why good doctors give useless answers
I like Dr. Rob, the one with the distractible mind. And although I thoroughly agree with the stance he takes in his recent post against cholesterol screening in kids, I must take issue with his opening statement:
I have a unique vantage point when it comes to the issue universal cholesterol screening in children, when compared to most pediatricians. My unique view stems from the fact that …
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What’s the difference between family practice and med-peds?
Doctors, both generalists and specialists, have constraints on their time. New practices and new approaches need to happen in order to maximize everyone’s time. In addition to bringing your co-payment, you should “invest” in the visit and do your part, so that by the time the visit has ended, a successful plan of care is developed.
Here are some helpful tips to make the most of your medical appointments.
Doctor appointment tips every patient can use
by Neel Shah, MD
What are the top reasons doctors over-order tests?
1. How we’re taught. Doctors are taught to consider whether a procedure is safe and whether it’s likely to work. We’re almost never taught to consider cost — it’s considered taboo.
2. Trying to do our best for the patient. We’re worried. Often we over-order because of our personal risk aversion.
3. Pre-emptive ordering. For residents, who do much of …
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10 reasons why doctors over-order tests
Grandmother Pat LaColla, 82, was lured by the hype—”get in shape without setting foot in a gym”—when she bought a pair of Skechers last year, wincing at the $100 price tag. Toning shoes like those she bought are the newest craze in athletic footwear, projected to grow 500 percent to become a $1.5 billion market this year.
Although the designs vary, toners typically have strongly curved, thickened soles. From the moment …
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Are toning shoes safe or effective?
You probably saw the July press reports: balmy tropical breezes, azure surf, cerebral plaques and tangles, and new criteria for Alzheimer’s.
Who could deny an opportunity to spend some time at the best non-oil-spoiled beaches for those who toil at the benches and bedsides for Alzheimer’s victims — and on taxpayer money yet.
It seems to me like, just as human hip and knee joints and premolars and molars are not preprogrammed …
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Why the expansion of Alzheimer’s may not be helpful
For years, we have heard (and I have often said) that an average of 36,000 Americans die from influenza annually.
This figure is based on data from 1990-1999. Now the CDC is telling us that the range of annual deaths is too wide to continue using that single number. Based on a lot more seasons (1976-2007), the average is closer to 24,000 with a range of about 3,300 to …
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Prevention is the best influenza protection
The most visible impact of Affordable Care Act is surely the expansion of health insurance coverage to 30 million uninsured Americans, but a lesser known provision in the overhaul will have far-reaching implications as well.
The provision catapults the US Preventive Services Task Force (USPSTF) from an obscure agency that produced unenforceable guidelines about screening and preventive services into one whose recommendations directly impact reimbursement.
According to the terms of the new …
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Health reform vaults the USPSTF into prominence
Social anxiety refers to the fear of being around people due to the threat of embarrassment.
People who are socially anxious frequently freeze and are unable to seek the very company their hearts desire. They may make adaptations: they may decide that they “hate” being around people; they may isolate and play video games; they may absorb themselves in their work, but no matter what they do, this anxiety always exists …
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Social anxiety assumptions and their solutions
