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.

Can house calls be revived under health reform?

John Schumann, MD

Physician

April 11, 2010

Beginning in the 1970s, the house call began a slow death. As the medical-industrial complex (MIC) burgeoned, with bigger hospitals and a surfeit of technology, it became incumbent on patients to come see us rather than us going to see you.

Yet there are pockets of house calls still left in the U.S.

For the geriatric age group, there has been growth in the care-at-home sector, especially for homebound elders. They can …

Retail clinics are starting to do more primary care

MedPage Today

Physician

April 9, 2010

by Joyce Frieden

Retail clinics aren’t just for strep throats any more; they’ll also be managing diabetes and other chronic diseases.

“It’s a new service strategy,” Sandra Ryan, CPNP, told attendees at a meeting on retail clinics sponsored by the Convenient Care Association and the Jefferson School of Population Health.

“We’re evolving our clinic offerings,” said Ryan, chief nurse practitioner officer for Take Care Health Systems, which operates retail clinics inside Walgreens pharmacies, …

AMA: Health reform victories for physicians and what still needs to be done

Kevin

Health Policy

April 8, 2010

A guest column by the American Medical Association, exclusive to KevinMD.com.

by J. James Rohack, MD

As our country turns the corner on the historic path toward health system reform, many physicians are left with questions as to how this new law will affect them and their patients.

The AMA has been an active participant in the health reform debate since …

Advance planning helps families cope with loss

Crystal Phend

Patient

April 8, 2010

by Crystal Phend

Advance planning improves end-of-life care for elderly patients and helps families cope with the loss, researchers found.

In a randomized trial, hospitalized patients over age 80 who were formally assisted with documenting their end-of-life treatment wishes and with designating a surrogate were almost three times more likely to have those wishes followed (86% versus 30% in usual care, P<0.001).

Family members of patients in the advance planning intervention reported significantly …

Preventive medicine may not always help patients

Amy Tuteur, MD

Physician

April 8, 2010

If there’s one thing everyone agrees on, it’s that preventive care is always a good thing. Well, I’m a doctor and I’m afraid of preventive medicine.

The theory behind preventive medicine is sound. It is better to treat prevent disease than to treat it. It is better to refrain from smoking and never get lung cancer than it is to treat lung cancer. It is better to refrain from alcohol abuse …

Chronic pain patients may have been disobedient children

MedPage Today

Medications

April 7, 2010

by Nancy Walsh

Children who are irritable or disobedient, or who steal or bully others, are at risk for chronic pain in middle age, a large prospective study found.

Youngsters who had persistent behavior problems at ages seven, 11, and 16 years had more than twice the risk of widespread chronic pain at age 45 as other children (RR 2.14, 95% CI 1.43 to 3.21), according to Dong Pang, PhD, of the …

Physicians increase revenue with better appointment analysis

Kevin

Physician

April 3, 2010

by Nikolaos I. Kakavoulis, MD

Physicians are working harder than ever to generate even a small increase in their income. Despite seeing more patients, average physicians net income between 1995 and 2003 has declined about 7% after adjusting for inflation, according to a national study from the Center for Studying Health System Change.

Why is this happening?

Now more than ever, physicians face an avalanche of complex rules, regulations, and administrative processes needed …

Children whose parents refuse vaccination may spread measles

MedPage Today

Conditions and Diseases

April 2, 2010

by Todd Neale

Children whose parents refuse vaccinations for them provide fertile ground for the spread of vaccine-preventable diseases, an investigation of a 2008 measles outbreak in San Diego demonstrated.

Although the rate of two-dose immunization against measles was 95% in the area, a single case of measles from a 7-year-old child returning from overseas sparked an outbreak that exposed 839 people and sickened 11 other children, according to David Sugerman, …

Insurance companies fail at rating physicians on cost

Emily P. Walker

Health Policy

April 1, 2010

by Emily P. Walker

A physician profiling method used by private insurance companies to steer patients toward lower-cost physicians isn’t reliable, researchers found.

According to a study published in the March 18 issue of the New England Journal of Medicine, 43% of physicians who are ranked as “lower cost” doctors according to a common formula used by insurance companies are not actually treating patients for any less than physicians with comparable …

Primary care is the loss leader of medicine

Kevin

Physician

March 30, 2010

Medicare’s sustainable growth rate, or SGR, has been the bane of doctors for years now.

To encapsulate, this is the reason for Medicare’s annual threat to cut doctors’ fees by 20% or more, only to be staved off at the last minute.

Emergency physician Shadowfax has a nice take on it, explaining why it has devastated primary care:

Primary care has many fixed expenses in addition to those we bear: they pay …

Read more…

Primary care is the loss leader of medicine

Patient questions during doctor visits are uncommon

Steve Wilkins, MPH

Patient

March 27, 2010

Ask your doctor. I think most of us would agree that is good advice, at least up to the point that we find ourselves sitting half naked on an exam table in our doctor’s office. Then the doctor walks in and for some reason many of us just “clam up.”

Patient question-asking during the primary care office visit was and continues to be an “index” of patient health information …

Guilt used in a positive manner can help with parenting

Claudia M. Gold, MD

Patient

March 27, 2010

In my pediatric practice, it is not uncommon for a mother, given the time, to move quickly away from telling me about her child’s behavior problem, to talk about herself, sharing vivid stories of emotional distress from her own life. I may suggest that this distress could make it difficult for her to deal with the challenging behavior of her child.

Rather than finding this statement helpful, she might collapse back …

Primary care access isn’t guaranteed by health insurance

Matthew Mintz, MD

Physician

March 26, 2010

An excellent article appeared recently in the Washington Post, entitled, “Having health insurance doesn’t ensure it will be easy to find a doctor,” where a young, otherwise healthy and insured woman discusses her extreme difficulty in finding a doctor in Washington, DC who will see her.

“I was just 23, basically healthy and, most important, insured. So I pulled out my computer, looked up the UnitedHealthcare list of pre-approved doctors …

Archeology skills work in medicine

Edwin Leap, MD

Patient

March 23, 2010

I’m becoming an amateur archeologist. The hilltop where we live is strewn with arrowheads and bits of Native American pottery shards. I have slowly, surely, trained my eye to find them. There is little flint here; so most of the pieces I find were made of quartz. (Hard to work with, but remarkably beautiful and almost always a brilliant white.)

My kids and I walk the red-clay paths and look down …

Read more…

Archeology skills work in medicine

Dance healed this physician and helped with burnout

Susan Biali Haas, MD

Physician

March 18, 2010

Ten years ago, I was an Emergency Medicine Resident and wanted to die. Today, I’m a general practitioner in part-time practice and am in love with life. What made the difference? I signed up for a dance class.

Reports on physician burnout list the personality traits that set us up for trouble: we’re excessively conscientious, feel overly responsible, want to please everyone, and function on an extremely high level – even …

Physical exam evidence and whether it’s still useful

Zackary Berger, MD, PhD

Conditions and Diseases

March 15, 2010

A number of respected physicians have called for a renewed emphasis on the physical exam. Perhaps most prominently, Abraham Verghese has joined with colleagues at Stanford University to publicize the Stanford 25, a list of physical-exam maneuvers that they hold should be required of internal medicine residents.

These calls reflect in part the fear that checklist medicine will lead to doctors’ obsession with what Jerome Groopman calls the “iPatient” (the …

PSA screening for prostate cancer debated in Congress

Kevin

Conditions and Diseases

March 14, 2010

Originally posted in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

A day after the American Cancer Society (ACS) released updated prostate cancer screening guidelines, the group’s chief medical officer was before Congress urging the government to fund research into alternative screening methods for prostate cancer.

Otis Brawley, MD, an oncologist and chief medical officer for the ACS, told the House Oversight …

Autism in children can be missed early in life

Kevin

Conditions and Diseases

March 11, 2010

Originally published in MedPage Today

by Chris Emery, MedPage Today Contributing Writer

The symptoms of autism tend to emerge in children after six months of age, with a loss of social and communications skills that is more common and more subtle than previously thought, according to a new study that questions previous assumptions about the progression of the condition.

At six months, …

Primary care needs to be valued first before it can be saved

Toni Brayer, MD

Physician

March 9, 2010

I went to my physical therapist yesterday for knee treatment and we talked about the fact that Blue Cross is cutting their reimbursement to the point that the cost of providing care will not even be covered. All I could do was lament with him and listen.

One insurer even told him (the owner of the business) to just “make the sessions shorter and don’t give as much care.”

Clearly the insurance …