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.

How doctors can reduce unnecessary tests and treatments

Health Policy
May 14, 2010

Several years ago, when my wife directed the third-year Family Medicine clinical clerkship at a highly ranked medical school, she developed a popular workshop on the cost of health care that presented students with scenarios of patients who were either uninsured or underinsured and challenged them to provide cost-conscious health care by selecting medications and tests that were clinically appropriate and financially affordable.

Many students remarked that it was the only …

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How doctors can reduce unnecessary tests and treatments

Doctors are focusing on lifestyle when practicing medicine

Health Policy
May 14, 2010

An interview with Elizabeth Chase, MD, obstetrician-gynecologist in Dover, New Hampshire

Elizabeth Chase, better known as Betsy, is a close and enduring college friend of my son, Spencer. She is a solid, pragmatic, hard working obstetrician-gynecologist, with two sons, and an architect husband, who spends his time caring for their children and their house in Dover, New Hampshire. She represents many of changes that occur when women become full-time physicians. The …

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Doctors are focusing on lifestyle when practicing medicine

Added sugars worsen cholesterol levels

Patient
May 13, 2010

Added sugars hit a new low this week. A study published in JAMA found that people who consume higher quantities of added sugars have worse cholesterol profiles than those who consume less.

First of, what are added sugars? Added sugars simply put are sugars that are added into foods (in contrast to naturally-occurring sugars that you find in fruits). The JAMA article writes that added sugars are “defined as caloric sweeteners …

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Added sugars worsen cholesterol levels

Medical practice success depends on a strong clinical team

Physician
May 13, 2010

Although every day can bring surprises in a medical practice, you can develop a clinical team that can optimize the efficiencies of your operation and make it easier for you to see your patients.

There are three key areas that lead to provider frustration in daily operations: preparation and anticipation; the daily dance; and being in the moment. Address these, and your days should go more smoothly.

Preparation and anticipation

Are your charts …

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Medical practice success depends on a strong clinical team

Activities for family members with dementia

Conditions and Diseases
May 12, 2010

There is a lot of focus on what elders with dementia can’t do. But what about more discussion of what they can do?

When you see a patient with dementia, how do you help family members maintain meaningful interactions with their loved ones? I am sad to admit that I don’t do this nearly as well as I should. After all, this is not the type of thing we are taught …

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Activities for family members with dementia

Outpatient internal medicine needs a consultant track

Physician
May 12, 2010

I have spent most of the past 2 weeks on the road – first at ACP and this week at SGIM. I have talked with many internists, but several conversations have contributed to writing this post. Each of several leaders contributed to these ideas, but I will keep them anonymous so the innocent are protected.

Here are the main assumptions:

1. Internists by training excel in the care of complexity
2. Pursuing the …

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Outpatient internal medicine needs a consultant track

ABIM: Quality medical care needs more than strong systems

Physician
May 10, 2010

A guest column by the American Board of Internal Medicine, exclusive to KevinMD.com.

Imagine a sub-par doctor at a vibrant health system with care delivered and coordinated by skilled teams, using robust EHRs and other vital supports for physicians and patients. Now imagine an extremely talented, knowledgeable doctor at an underfunded community clinic. This clinic has no real computer system, …

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ABIM: Quality medical care needs more than strong systems

How PCOS can be diagnosed and treated in primary care

Conditions and Diseases
May 9, 2010

Hypothetical case scenario

27-year old female presents to the office with a complaint of irregular periods. Menarche was at age 15, and periods occur about 1-2 times a year. Breast development began at age 9, followed shortly by axillary & pubic hair. Growth spurt was at age 13. She’s been trying to get pregnant for the last one year now, and has never been seen before for her irregular periods.

On physical …

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How PCOS can be diagnosed and treated in primary care

MKSAP: A 21-year-old man is evaluated for painful mouth sores

Conditions and Diseases
May 8, 2010

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 21-year-old man is evaluated for painful sores in his mouth. Episodes of these sores have occurred two to three times yearly since he was 16 years old, and he believes they are associated with stress. They usually appear on the inside of his mouth as a single, round, painful lesion, lasting for 5 …

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MKSAP: A 21-year-old man is evaluated for painful mouth sores

Calorie counts in health reform is significant for patients

Health Policy
May 6, 2010

Counting calories as part of health care reform—who knew? But apparently it’s there on page 455 of the health-care reform act, according to Marion Nestle, Professor of Nutrition at NYU, writing in the New England Journal of Medicine. There will now be a national effort at posting calorie counts in chain restaurants.

There are many ways to improve the overall health of Americans, but tackling obesity is surely one of the …

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Calorie counts in health reform is significant for patients

Social networking impact on patients, doctors, and non-profits

Social Media in Medicine
May 6, 2010

In its current listing of online social networks, Wikipedia presents 156 major, active websites. A neighboring link to view “now-defunct” sites accompanies the listing — a subtle reminder of the Internet’s competitive and volatile environment where promising endeavors rise and fall overnight.

But although the popularity of a specific website may fade with time, the practice of online social networking is here to stay.

In its simplest form, online social networking is …

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Social networking impact on patients, doctors, and non-profits

Maternal death rates improve but hurts fund raising

Health Policy
May 5, 2010

by Mike Himowitz

When you’re advocating for a health cause, can good news be bad news?

It’s entirely possible — when science threatens fund-raising, and at the worst possible time.

Consider a study of worldwide maternal death rates by a team from the University of Washington that appeared online recently in The Lancet.

The group, led by Christopher Murray, of the school’s Institute for …

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Maternal death rates improve but hurts fund raising

Health reform may mean meaningful changes for physicians

Health Policy
May 4, 2010

Jim called me late on a fall afternoon to report our mutual friend was in the local emergency room. “It looks like he had a stroke”. I immediately asked to speak to the ER doctor for the results of the CAT scan I knew would have been done. There were two metastatic tumors in the brain.

It has been over two years since my friend died. He was among the millions …

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Health reform may mean meaningful changes for physicians

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Problem list problems with electronic medical records

Health Technology
May 4, 2010

In family medicine it has been common to keep a “Problem List” in patients’ paper charts. Usually placed on the left hand side, on top of the Medication List, it has given doctors like me an instant thumbnail sketch before considering the specifics of each patient’s visit for that day.

A typical Problem List would include diagnoses like diabetes, hypertension, high cholesterol or rheumatoid arthritis. It would list prior surgeries, like …

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Problem list problems with electronic medical records

Avoiding the ER and arranging a direct admit is not easy

Physician
May 4, 2010

Are emergency departments solely responsible for the bulk of unnecessary tests?

Most would like to believe so, but emergency physician Edwin Leap says that’s not the case.

He cites an instance involving a primary care doctor and hospitalist:

Local physician, who does not admit to the hospital, sees patient in the office. Patient has uncontrolled hypertension and is having some chest pain and shortness of breath. Local physician contacts hospitalist. …

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Avoiding the ER and arranging a direct admit is not easy

Physician supply trends for primary care doctors and specialists

Health Policy
April 30, 2010

Health care reform continues to be a key political topic of discussion in the U.S. Physician supply and specialty training are important elements in designing an efficient system that provides the highest quality of care.

To understand where U.S. physician supply and specialty training is headed, I examined the U.S. trends from 1990 to 2007 (latest year data is available).

Physician supply has been growing during this period. In 1990, there were …

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Physician supply trends for primary care doctors and specialists

Internal medicine is dead, will concierge physicians thrive?

Physician
April 29, 2010

by Steven Knope, MD

For the last several years, writers in the New England Journal of Medicine and the Journal of the American Medical Association have authored doomsday editorials about the prognosis of primary care medicine. There has been much discussion about the fact that internists and family practitioners cannot keep pace with rising overheads and falling reimbursement under the traditional third-party payment system.

Paraphrasing a recent …

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Internal medicine is dead, will concierge physicians thrive?

Hospital practice can come with pitfalls for doctors

Physician
April 28, 2010

I read recent New York Times and KevinMD.com items about the migration of doctors to hospital-owned practices. The benefits are obvious: guaranteed salary, regular hours, malpractice coverage, paid benefits, school loan repayment.

I worked for a hospital system in a small suburban practice in a large Midwestern city for almost four years. I did indeed enjoy the subsidized salary. Who can argue with vesting? I had a terrific group …

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Hospital practice can come with pitfalls for doctors

Primary care is burdened by excessive paperwork

Physician
April 28, 2010

by Charles R. D’Agostino, MD

We’ve all seen the headlines –- “Primary Care Physicians Becoming a Scarce Breed”, “Wait Times for Appointments Increasing”, “Primary Care in Crisis” –- and have heard the pundits pontificating on the deteriorating state of primary care.

But rarely do we hear what’s happening from physicians on the front lines, those actually seeing patients. Consequently, with direct access to the primary care trenches, replete with an overworked …

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Primary care is burdened by excessive paperwork

Questions for doctors are powerful patient tools

Patient
April 27, 2010

by Toni Bigby

Our Federal Government is investing in a consumer education campaign called, “Questions are the Answer.” The idea is to encourage people to watch out for themselves a little better and be their own advocate by asking their doctors questions like, “Why do I need this surgery?” and “Are there any side effects from this drug?”

Why are we as health care consumers, who collectively spend trillions of dollars each …

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Questions for doctors are powerful patient tools

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