Primary Care

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.

Is patient adherence responsible for health quality and safety?

Steve Wilkins, MPH

Patient

August 3, 2010

A while back I did in a post where I asked the question, What can patients really expect from their physicians today? In that post, I wondered at the fact that many patients still have a high degree of trust in their physician in spite of the quality and safety problems attributed to physicians in the press.

For example:

On average, US adults receive only 50% of recommended …
Read more…

Is patient adherence responsible for health quality and safety?

Pay specialists less to save primary care

Edward Pullen, MD

Health Policy

August 2, 2010

Since 1997 the number of US medical students choosing to go into primary care has decreased by more than 50%.

It seems that sources as diverse as the Obama Administration and the Wall Street Journal think that we should find a way to encourage medical students to choose primary care specialties in order to allow Americans to have the best and most cost effective care. This is very problematic when primary …

How adult smoking affects behavior in children

MedPage Today

Conditions and Diseases

August 1, 2010

by Nancy Walsh

Both maternal and paternal cigarette smoking can contribute to adverse chronic conditions — physical and psychological — in children, two large studies found.

Writing in the July issue of Pediatrics, Marie-Jo Brion, PhD, of the University of Bristol in England, and colleagues reported that children in two cohorts whose mothers smoked were more likely to have conduct/externalizing behavior problems than were those who had no prenatal tobacco exposure:

* British …

Watchful waiting is a powerful diagnostic tool

Michael Gonzalez, MD

Conditions and Diseases

July 31, 2010

Childhood is full of self-limited illnesses. Kids get sick and kids get better. The majority of childhood illnesses will get better on their own. Because of this, observation and “watchful waiting” is often the most useful diagnostic test at the pediatrician’s disposal.

Parents are often confused about the need for testing. Their experiences with adult medicine is typically full of lab tests and imaging studies. Unfortunately some parents equate the quantity …

What to do if your doctor quits and leaves medicine

Jan Gurley, MD

Patient

July 29, 2010

The news that Dr. Marcus Conant has quit practicing medicine is a blow to healthcare here in the Bay Area.

And a sad symbol of all that is wrong with healthcare – and in particularly, the way we treat primary care practitioners – in America today. It would be hard to find a doctor more symbolic of the best of medicine than Marcus Conant – a man willing to devote …

Let consumers decide if they want the patient centered medical home

Jaan Sidorov, MD

Health Technology

July 29, 2010

Is the Patient Centered Medical Home (PCMH) the panacea for all that ails health care?

Have we exhausted all the allegories related to the term “home?” The answer to both questions apparently is no, thanks to this American Journal of Managed Care article by Timothy Hoff titled The Shaky Foundation of the Patient Centered Medical Home.

Dr. Hoff appropriately shelves PCMH policy and looks at the topic with a market-based perspective. From …

Why patients are wary of the primary care medical home

Kevin Pho, MD

Physician

July 29, 2010

Say the words, “Patient-centered medical home,” and you’re bound to get a variety of opinions.

On this blog alone, there are a variety of guest pieces critical of the effort, saying it does not increase patient satisfaction, nor does it save money.

And that’s not good news for its advocates, who are pinning primary care’s last hopes on the model.

Medical homes hit the …

How the Massachusetts gift ban hurts primary care doctors

Kevin

Physician

July 29, 2010

by Kate Atkinson, MD

Six years ago, I organized a group of female healthcare practitioners for a women’s medical journal club. A multidisciplinary team of doctors and NPs from primary care and sub-specialties regularly attended monthly dinners. Invited speakers presented on a variety of topics and over the course of a meeting we exchanged insights while challenging each other on how best to manage our challenging patients.

Our group grew …

ADHD and how drugs impede meaningful help for children

Claudia M. Gold, MD

Medications

July 28, 2010

I recently received a call from a mother that made me both want to cry and scream out in frustration.

Several months ago I wrote a post entitled Drugs for Children May Silence Stories, in which I described a young boy who had suffered severe neglect as an infant. His adoptive parents had sought help from me when he was four, but when I recommended intervention for the whole family …

Obesity should not require specialists to manage

Arya M. Sharma, MD

Conditions and Diseases

July 28, 2010

Medical school trains us to deal with a wide range of medical problems.

No matter what our current practice or specialty, at some point during medical school we will have had to study and demonstrate our knowledge and competency in dealing with common disorders like diabetes, hypertension, depression, chronic pain and countless other ailments. In addition, we will have spent hours poring over much rarer disorders, conditions that many of us …

The way we practice primary care doesn’t make sense

Kenneth Lin, MD

Physician

July 27, 2010

You’ve probably had the experience of going to see a primary care physician and wondering about the many aspects of that visit that just didn’t make sense.

Why is it so important for me to arrive on time when, in reality, I won’t be called back until half an hour (or more) later? What’s the point of waiting for another 20 minutes in a chilly examining room for the doctor …

Chronic illness needs to be managed at home, not at the hospital

Shantanu Nundy, MD

Conditions and Diseases

July 25, 2010

“You know, what Mr. HD really needs is for his mom or somebody to chain herself to him…” [the ICU team laughs] …

“But seriously, he needs to be watched over, he needs to be talked to. He needs someone to give him his medications, someone to take him to his appointments, someone to take care of him. With that somebody he can live for years to come. Without that somebody …

Paying cash to doctors affects the treatment plan

Jay Parkinson, MD

Physician

July 24, 2010

If we really want to find out how to damn near perfectly manage any medical problem as efficiently and cost-effectively as possible, we should be studying how doctors manage the medical problems of the cash-paying doctors they see in their own practice.

Read part one here.

My visit with Dr. Grubman was fairly simple. We discussed allergy shots and how they could possibly help significantly with my dust allergy. Since I always …

Talking with patients about their impending death

Kevin

Patient

July 23, 2010

by Brad Stuart, MD

The emergency department phoned my office right before lunch.

I was on call for our general IM group, so when I was done with my morning schedule I walked across the street to the hospital. Greg, my partner’s 38 year old patient, was a woodworker admitted with fever, chills, cough, a sharp pain in his right side, and a WBC of 18,000. On the chest x-ray, I …

Viagra for muscular dystrophy and publicity for accidental insight

Jeoffry B. Gordon, MD, MPH

Conditions and Diseases

July 22, 2010

by Jeoffry B. Gordon, MD, MPH

As a family doc in practice for over 30 years I have been always tried to conceptualize disease states beyond the standard text book parameters.

Thus I was elated by the prospect of discovering a new beneficial treatment for muscular dystrophy when 5 years ago I gave some Viagra to a 57-year old patient of mine with limb girdle muscular dystrophy for the usual purpose. In …

How can doctors minimize unnecessary testing?

Robert Centor, MD

Physician

July 21, 2010

A recent comment raised a minor controversy about the strategy of minimizing tests. I actually do not think that the disagreement is that great, but I feel like exploring the issue.

This is the sentence that triggered the comment, courtesy of primary care physician Rob Lamberts:

Order as few tests as possible. No test should be ordered for informational purposes only; the question, “What will I do with these results?” should always …

Read more…

How can doctors minimize unnecessary testing?

Can Shrek and Dora combat the junk food epidemic?

MedPage Today

Potpourri

July 21, 2010

by Michael Smith

Can Dora the Explorer help kids find a taste for carrots?

It may be possible that licensed characters such as Dora, Shrek, and Scooby-Doo can tilt the balance away from junk food and toward healthy snacks, according to Christina Roberto, MS, and colleagues at Yale University.

In a study of 40 preschoolers, the presence of a licensed character on a package influenced the children’s perception of taste and their preference …

Participatory medicine and evidence from medical journals

Dave deBronkart

Patient

July 20, 2010

I’ve only been studying healthcare for two years and I hesitate to be overly assertive.

But I have, finally, reached the point where I feel confident in citing cases where people are simply being unscientific: ignoring evidence. That’s always hazardous, and it becomes insidious when it’s caused by a blind, unquestioning belief in our institutions.

Case in point:

Julie Thoren is an active practitioner of Participatory Medicine who’s seen first-hand the tremendous value …

Prior authorization required by health insurers impedes primary care

Kevin

Physician

July 19, 2010

by Charles R. D’Agostino, MD

It strikes fear in the hearts of doctors across the country; it is not the deadly Ebola virus or a new strain of cancer, but its malignancy is equally apparent.

It is the dreaded “PA”, which is insurance-speak for “prior authorization” and it seems that no matter which way we turn it appears, standing between our patients and the care they need.

To their credit, PAs are truly …

A new primary care payment model with health savings accounts

Kevin

Health Policy

July 18, 2010

by Charles Smith, MD

Everybody seems to be dissatisfied with the current model of primary care.

Concierge and retainer practices are all the rage, but they serve too few patients. While some highly integrated systems (Mayo Clinic, maybe Kaiser Permanente) may be thriving, they are difficult to replicate. Most primary care physicians are demoralized by a system that overburdens them with administrative hassles and liability while providing insufficient revenue to improve …

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