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.
As a whooping cough epidemic hits California, you may be asking yourself, “hey, weren’t we all vaccinated for that?” Even as the headlines imply a Victorian-level outbreak of hacking and coughing, perhaps you’re looking around and wondering where, exactly, this epidemic is located. And what you should know about whooping cough to protect you and yours.
Here are some fun, weird, and sometimes worrying tidbits to know about whooping cough. Pass …
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Whooping cough and pertussis tips you need to know
Recently while cleaning out my office in anticipation of my new job, I discovered that I had unknowingly been witness to an historic moment in child psychiatry. I found a binder from a course I had taken in June of 2001 sponsored by Harvard Medical School on Major Psychiatric Illnesses in Children and Adolescents.
Though I did not remember until I looked at my scrawled notes in the margins, on Saturday …
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Too many young children are medicated with powerful drugs
Assumptions are ubiquitous. Neither patients nor physicians are exempt. Sometimes they are justified, other times entirely misguided.
Webster’s defines “assume” as “to take as granted or true.” The cliché’s have probably always existed: Doctors are greedy and paid too much, and are uncaring. Some patients believe doctors do care and that their doctor actually likes them. That’s an assumption too. Some assumptions are newer. Patients assume doctors will substitute their prescription …
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Assumptions in medicine can inhibit care
The following op-ed was published on July 18th, 2010 in USA Today.
A new patient recently said he was referred to me after his last doctor had left medicine. His old doctor always looked unhappy and burned out, he noted.
Burnout affects more than half of doctors, according to researchers at the University of Rochester School of Medicine. Beyond mere job dissatisfaction, these doctors are emotionally exhausted to the …
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Burnout in doctors and stressed physicians hurt patients
by Robert Graham, MD
As the nation works to reinvigorate primary care, a lot is riding on the medical home.
Some see it as an answer to a fragmented health care system that is not responsive to patients’ needs for coordinated, comprehensive care. Others have invested in it as a vehicle to improve both the quality of care and control costs. While we work to address …
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Implementing patient centered medical home pilot projects
Eating right, exercising, avoiding the sun or using sunscreen, moderating alcohol consumption, abstaining from tobacco use, getting mammograms, Pap smears, colonoscopies—almost every measure we’re asked to take to safeguard our future health is difficult. It’s a strange paradox that we have to work in some way, to expend energy, and experience discomfort of some kind in order to gain benefit in life.
Wouldn’t it be nice if the most pleasurable things …
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Positive reinforcement can motivate preventive behaviors
Have you ever read what your physicians and nurses have written in your medical chart? If not, would you want to?
The OpenNotes project is a recently launched observational research study that involves 100 primary care doctors and about 25,000 patients. Lead author Dr. Tom Delbacoa, a primary care physician at the Beth Israel Deaconess Medical Center, poses the research question succinctly: “After a year, will the patients and doctors still want to continue sharing notes?”
In the study, …
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Why OpenNotes and access to the medical chart is important
If doctors need to listen to patients to figure out what’s going on, patients need to tell doctors what’s going on. Why is that so hard sometimes? It’s hard to speak up when you feel rushed, but have doctors ever done other things that made it harder for me to talk to them?
Sometimes doctors blame the patient
Years ago I got a terrible abdominal pain. I could only explain that it felt like …
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How patients can stop doctors from blaming them for their health
The New England Journal of Medicine recently published a troubling article on acupuncture, which was ably deconstructed by Dr. Mark Crislip. This incident has reignited a discussion of what, exactly, “placebo” is.
A common argument is that placebo is like any other intervention, something that can be intentionally harnessed for the benefit of patients. This is both true and overly simplistic.
First, we must review what “placebo” …
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Is placebo a therapy, like surgery or medication?
Medicine is a very old profession. Ancient and honorable. Sadly, for the vast majority of recorded history, honor was pretty much all it had. The Hippocratean ideals of “first do no harm” and putting the patient first and all held special importance when medicine truly had nothing to offer. Make no mistake: up until the last two centuries, the vast majority of what passed as …
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Medicine is an old profession, but not the oldest profession
Recently, I had a discussion with a prominent academic family physician. I had last seen him 37 years ago when he was getting ready to graduate from medical school and I was a new medical student.
We had a wonderful discussion and agreed to disagree about merging primary care. Long time readers know that I dislike the term for the tasks that outpatient internists do. Most of the push for merger …
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Why family medicine and internal medicine should not merge
Everyone understands the need for a robust primary care workforce in making healthcare more affordable and accessible while keeping those in our care healthy. With the aging of America and healthcare reform, even more Americans will need primary care doctors at precisely the same time doctors are leaving the specialty in droves and medical students shun the career choice. So as a practicing primary care doctor, I’ve watched with …
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Americans will need doctors but physicians are leaving primary care
It is not a secret that large sums of money have passed from the pharmaceutical and device manufacturers into physicians’ hands.
This money has been paid not only for such socially beneficial pursuits as research and consulting, but also for lavish gifts and junkets. And interestingly, despite disingenuous assertions to the contrary by many a stake holder, these gifts generated a return on investment — surprise! It turns out that the …
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Gifts and money influence physician prescribing
by Pepi Granat, MD
Yesterday, and every day, in my office we had one or two patients we call our “Oldie Goldies”.
People who have been with us since 1971 when I opened my practice, 39 years ago. People whose progress, medical and personal, I’ve shared, and who share mine. We know their parents, kids and cousins either because they call us in crisis, or they’re our ongoing …
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Family doctors cannot be obsolete, for patients’ sake
One of the advantages of marrying an immigrant is having intense exposure to another culture. My wife’s Russian heritage, and her family, have enriched my own life immeasurably. The trip that I took with her and my brother to Russia in 1990, where she served as our personal translator, was unforgettable.
During the early years of our relationship, I heard stories about her family that seemed incredible to an American like …
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Physicians should not be used for FDA ad enforcement
Recently I had an interesting conversation with a few young doctors regarding the new health care reform that had been passed in the United States. One future specialist asked me why primary care doctors should receive more money than they have in the past.
And this is an important question that I think sheds light on the suboptimal state of our current health care system. It is important to specialists because …
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Why primary care is like air traffic control
Can the field of family medicine truly become monotonous?
I never thought I’d ever find myself in a repetitive routine when selecting family medicine as my specialty. I spent eleven years after high school studying what I know. How can eleven years of material really become mundane? In a way, it’s a great thing – it means I am feeling comfortable and confident in my job.
And I am fortunate enough to …
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Teaching family practice residents is rewarding
Great doctors listen to their patients.
They start out by asking open-ended questions, and unless patients get too far off-track, they don’t typically interrupt them. Despite having limited time for appointments, they have an unhurried manner. They make eye contact with their patients and do not bury their heads in charts and computer screens. Their patients leave their appointments feeling respected and heard.
Of course no doctor is likely to be able …
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The emotional state of doctors can affect patient care
At the recent AAMC meeting on how to integrate quality into teaching hospitals, the question that kept popping up from speaker after speaker was how to address the fact that doctors in teaching hospitals don’t get along.
Unfortunately, all the specialty bashing that takes place prevents the adoption of a team based culture necessary to advance quality and safety. As one speaker highlighted, how can we really start to address this …
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Stop calling doctors fleas and teaching professionalism
