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.

Why physicians are working fewer hours

Kevin

Physician

March 8, 2010

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

Physicians are working fewer hours than they once did, the result of a decade-long decline that coincided with lower fees for their services, a study showed.

After two decades of stable hours, a steady decrease began in 1997, according to Douglas Staiger, PhD, of Dartmouth College, and colleagues.

The decline coincided …

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Why physicians are working fewer hours

How doctors allow bias to affect patient care

Alex Lickerman, MD

Physician

March 5, 2010

Part three of a series. See also parts one and two.

Previously, I have suggested that patients should do their best to get their doctors as free from the influences of their biases as possible. In order to do that, patients (and doctors) need to recognize what forces are working against them.

Here’s what negatively influences a doctor’s decision making:

1. They fall behind in clinic. Your doctor may be naturally …

Becoming vegetarian can help fight high cholesterol

John Schumann, MD

Physician

March 5, 2010

I made a New Year’s resolution to become a vegetarian. Or a mostly vegetarian.

I’ve been thinking about it for a long time, but with young children who love meat and don’t have the broadest palates, I think it’s important to feed them protein any way I can get it in them.

Having passed 40, I’ve finally realized that I can no longer eat what I want with impunity. Further, as a …

Obesity treatment in family members should be contagious

Kenneth Lin, MD

Patient

March 4, 2010

The Framingham Heart Study is perhaps the most famous long-term medical study. As every medical student learns, starting in 1948, the lifestyle habits of thousands of residents of Framingham, Massachusetts were followed to determine important risk factors for cardiovascular disease.

It is because of this study that your physician can, with a few keystrokes, predict with great accuracy your risk of having a heart attack within the next 10 years and …

A nurse practitioner is valuable in hospice and palliative care

Kevin

Patient

February 28, 2010

by Patrice Villars

Recently, a physician colleague expressed her concern about signing routine hospice admission orders for her elderly patient with end stage heart failure. The routine ‘as needed’ (PRN) orders included phenobarbital, pentobarbital, haloperidol, lorazepam, and morphine. “The hospice nurses know more about this than I do, don’t they?” she said.

Yesterday, a longtime palliative care nurse told me she didn’t want to put her mother with end stage heart …

Value doctors as listeners to prevent primary care burn out

Claudia M. Gold, MD

Physician

February 25, 2010

A recent editorial in the Boston Globe addressed the dearth of primary care physicians. The piece concluded: “Federal funding for new residency slots should follow reforms that address the underlying reasons – principally money – that lead doctors to choose to specialize.”

Money is certainly important. But there is another obstacle to attracting primary care doctors that is more subtle, though perhaps equally important. Consider the following story.

Recently I had …

How doctors can improve patient interactions

Kevin

Patient

February 24, 2010

by Lockup Doc

Physicians learn a lot about many different topics, both in medical training and in practice. However, there are some life lessons that we never learn as well as when we become patients ourselves.

When I was 13 or 14 years old, I regularly interacted with 2 different physicians with disparate interpersonal styles. Little did I know then that these seemingly meaningless encounters would indelibly shape my own beliefs about …

What doctors do when they don’t know the answer

Alex Lickerman, MD

Conditions and Diseases

February 22, 2010

Part two of a series. See also part one.

Previously I’d discussed how most of the time diagnoses are relatively straightforward. But what do doctors do when a diagnosis isn’t immediately clear to them?

Likely one or more of the following:

1. Revert to “novice” thinking. Which, in fact, is completely appropriate. We’re taught in medical school that approximately 90% of all diagnoses are made from the history, so if we can’t …

Don’t fall into the dementia trap when treating a developmental disability

Kevin

Conditions and Diseases

February 16, 2010

by Lockup Doc

In addition to correctional psychiatry, I spend about half of my professional time treating patients with developmental and intellectual disabilities (mental retardation). The majority of my patients have severe or profound mental retardation and are completely nonverbal.

Over the years I have observed that when many of them are admitted to the hospital for acute medical or surgical problems, because they are severely cognitively and functionally impaired, they are …

How to better notify patients of their abnormal test results

Shantanu Nundy, MD

Patient

February 16, 2010

I just returned from vacation to find email messages from three patients inquiring about their recent test results.

The first email was from a young man who had fainted and underwent Holter monitoring, a test that checks for abnormal heart rhythms. The second was from a woman I recently started on cholesterol-modifying therapy who wanted to know whether her recent blood work showed a satisfactory improvement in her cholesterol. The third …

Thoughts from a doctor attending a patient funeral

Dr. Charles

Patient

February 12, 2010

On the way to the funeral you wonder how you’ll be received by the grieving. Although you are confident that your care for the deceased was sincere, professional, and adept, you still question if others will so assume. There is silence in the car. This is a trip you make alone.

You manage a bitter smile as you recall stories the patient shared in unguarded moments, behind the door of a …

When doctors can’t figure out what’s wrong with a patient

Alex Lickerman, MD

Conditions and Diseases

February 10, 2010

Part one of a series.

The first patient I ever saw as a first year resident came in with a litany of complaints, not one of which I remember today except for one—he had headaches. The reason I remember he had headaches isn’t because I spent so much time discussing them but rather the opposite: at the time I knew next to nothing about headaches and somehow managed to end the …

Not enough patients receive vaccines and what doctors can do about it

Shantanu Nundy, MD

Medications

February 9, 2010

Imagine a world where consumers all knew about the latest developments in preventive health.

Earlier this month the Advisory Committee on Immunization Practices (ACIP) released the 2010 immunization schedules. Revised annually, the immunization schedules are what doctors in the U.S. use to decide who should be immunized against what diseases. Far from esoteric, the schedules pertain to every single person living in the United States. If the H1N1 pandemic and subsequent …

The power of a doctor’s choice of words in explaining CPR

Alex Smith, MD

Conditions and Diseases

February 8, 2010

Words have power. Language has power.

The words we use may comfort or shock, allay or provoke, sooth or batter. Words often imply layers of meaning that are not explicitly articulated, yet rest beneath the surface:

“I worry that time is short for you” (You are dying) (I care about you)

“I wish we could have done more” (Nothing would have changed her death) (I am on your side)

“I hope with you that …

How hypertension increases the risk of dementia

Kevin

Conditions and Diseases

February 7, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Another study has found that hypertension may contribute to increased risk of dementia, this time with evidence of actual brain abnormalities.

Data from an offshoot of the Women’s Health Initiative found that participants’ baseline blood pressure was strongly correlated with volume of lesions in their brains’ white matter, according to Lewis …

Why primary care doctors need to practice insurance free medicine

Matthew Mintz, MD

Physician

February 3, 2010

I never thought I would be in academic medicine for so long.

When I was hired about 12 year ago, I figured I would stay in academics for a few years and then join a private practice Internal Medicine group. Now, I can’t even fathom that idea. One of the reasons I have stayed at my institution for so long is that I love teaching and the academic environment.

However, a second …

How should pharmacy benefit managers (PBMs) and pharmacies communicate with physicians?

Kevin

Medications

February 2, 2010

by George Van Antwerp

In the pharmacy and pharmacy benefit manager (PBM) business, there are lots of reasons to reach out to a physician:

* Drug-drug interactions
* A chemically equivalent version of the drug prescribed is available
* A therapeutically equivalent version of the drug prescribed is available
* The prescribed drug is not covered
* A prior authorization is required
* The patient is required to try an alternative drug first (step therapy)
* The prescribed …

A comprehensive plan to fight obesity begins at an early age

Kevin

Conditions and Diseases

February 2, 2010

Originally published in HCPLive.com

by Jeffrey Gene Kaplan, MD, MS

In a given year in the U.S., 1/4th of US men and 2/5ths of US women attempt to lose weight, unfortunately, they often fail to keep the weight off.

Sobering statistics that we see all around us, particularly poignant in my office as a pediatrician. Clearly a multifaceted approach is required, but the most …

What doctors need to know about Google Android and Nexus One

Satish Misra, MD

Health Technology

February 2, 2010

The momentum and enthusiasm in the mobile technology world is, these days, clearly with Google.

The question for many people is whether to go with the reigning champion of the mobile device world (arguably Apple) or to take a chance on the challenger. The Nexus One, the flagship of the Android family of mobile devices, was unveiled to much fanfare in …

How to stop theft from your medical practice

Kevin

Physician

January 27, 2010

Originally published in HCPLive.com

by Ed Rabinowitz

There’s a great scene in the movie The Big Chill where the main characters are having a discussion on the topic of rationalizations. One individual comments that he doesn’t know anyone who could get through the day without two or three juicy rationalizations. That may be true. But when a rationalization involves taking things from the ofﬁce or workplace, and that ofﬁce just happens to …

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