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.

How should doctors discuss healthcare reform with patients?

Kevin

Health Policy

November 10, 2009

Originally published in HCPLive.com

Physicians are increasingly bringing their views on healthcare reform into the examination room. Others are distributing flyers or taping up signs in the office. Given that healthcare reform has become such a contentious subject in the United States, it is not surprising that conflicts have arisen between physicians and patients who hold different views.

The St. Petersburg Times …

Doctors and patients need to learn to live with health insurance companies

Kevin

Health Policy

November 10, 2009

by Marie Cooper

Consider two patients with the same managed care plan.

One has multiple sclerosis and receives an infusion of Tysabri every month. It needs pre-certification. The requirements are black and white. The patient qualifies if they have relapsing/remitting MS and have failed other therapies. The drug costs $2,000, the infusion center is another $1,000. The infusion center is a contracted provider that has …

How the health care system is corrupting doctors

Kevin

Health Policy

November 7, 2009

Originally published in HCPLive.com

by Jeff Brown, MD

I had the same reaction . . . shock at seeing an almost obscene claim about our profession in a national newspaper. But it got me thinking, which no doubt was its intended purpose. While we are thinking and feeling our way through this wide-ranging debate on health care, we might as well examine …

Support for the patient centered medical home in the House health reform bill

Kevin

Health Policy

November 6, 2009

by Thomas C. Bent, MD

As the House of Representatives prepares to vote on its historic health care reform bill on Saturday, family physicians are heartened to see the support it gives to the emerging new model of care, the patient centered medical home.

The House bill is good news on many fronts. It would provide health insurance coverage for some 96 percent of Americans and would reduce the federal deficit by …

Vaccines do not cause autism in children, whether or not they have inborn errors of metabolism

Kevin

Conditions and Diseases

November 6, 2009

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

Vaccination does not appear to cause autism or other health problems in children with inborn errors of metabolism, a researcher said here.

In a retrospective analysis, children with such conditions were not more likely than normal children to visit emergency rooms or need hospital care after vaccination, according to …

Clostridium difficile infection is spreading from the hospital to the community

Kevin

Conditions and Diseases

November 5, 2009

Originally published in MedPage Today

by Charles Bankhead, MedPage Today Staff Writer

Clostridium difficile infection has spread from the hospital to the community but has proved manageable thus far.

From 1991 to 2005, the incidence of community-acquired C. difficile in Olmsted County, Minn., quadrupled but still remained less common than the hospital-acquired gastrointestinal infection, Sahil Khanna, MD, of the Mayo Clinic in …

Diagnosing and treating disease is only a small part of a doctor’s job

Danielle Ofri, MD, PhD

Physician

November 4, 2009

If asked what a doctor does, most people would probably come up with the standard description of diagnosing and treating disease, usually while wearing an ill-fitting white coat. Before I entered practice, even during my medical training that probably would have been my answer too.

But my years in the trenches of real medicine have altered that definition greatly. I do spend time doing the things I learned in medical school …

How long should children stay out of school after H1N1 flu?

Kevin

Conditions and Diseases

November 4, 2009

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

Children appear to shed particles of the H1N1 pandemic flu virus longer than adults do, which may have implications for how long they stay out of school, a researcher said here.

The finding comes from an analysis of an outbreak in a Pennsylvania elementary school in May and June, …

H1N1 vaccine adverse events, and how to reassure patients

Kevin

Medications

November 3, 2009

Originally published in MedPage Today

by Crystal Phend, MedPage Today Senior Staff Writer

Failure to account for background rates when considering adverse events from pandemic H1N1 flu vaccination could spark public panic, researchers cautioned.

Coincidental cases of dramatic events including sudden death, Guillain-Barré syndrome, and spontaneous abortion can be expected to boost the true incidence of adverse events after immunization, said Steven …

Is the impending physician shortage worse than we thought?

Kevin

Health Policy

October 31, 2009

Originally published in MedPage Today

by Charles Bankhead, MedPage Today Staff Writer

The physician workforce in the U.S. is growing smaller and younger, according to data from the Census Bureau, but conflicting estimates make it difficult to determine just how many doctors are out there — and how many the nation will need.

The census survey showed 67,000 fewer physicians than estimates based …

Implementing an EMR or health IT system is harder than it looks

Robert Wachter, MD

Health Technology

October 31, 2009

In 2001, when my colleagues and I ranked nearly 100 patient safety practices on the strength of their supporting evidence (for an AHRQ report), healthcare IT didn’t make the top 25. We took a lot of heat for, as one prominent patient safety advocate chided me, “slowing down the momentum.” Some called us Luddites.

Although we hated to be skunks at the IT party, we felt that the facts spoke for …

Health reform ignores primary care doctors at its own peril

Richard Reece, MD

Health Policy

October 30, 2009

I would like to introduce you a remarkable article by Edward J. Volpintesta, MD, a 65-year old solo primary care doctor in Bethel, Connecticut. Dr. Volpintesta is a veritable writing machine and has been published in The Wall Street Journal, the New York Times, medical journals, and other publications. His articles cry for a deeper understanding of primary care dilemmas.

In the October issue of Connecticut Medicine, Dr. Volpintesta hits the …

Are doctors getting enough skin cancer exam training?

Kevin

Conditions and Diseases

October 30, 2009

Originally published in MedPage Today

by Nancy Walsh, MedPage Today Contributing Writer

Opportunities to learn how to perform skin cancer examinations during medical training are inadequate, a survey of residents found.

More than half (55.3%) of residents said that they had never observed a skin cancer examination, 75.8% said they’d never been taught to perform one, and 57.4% had never practiced doing …

ACP: How to fix the primary care problem in health care

American College of Physicians

Physician

October 29, 2009

The following is part of a series of original guest columns by the American College of Physicians.

by Steven Weinberger, MD, FACP

Many would argue that lack of universal coverage is the primary problem with health care in the United States, accompanied by the logistical and financial difficulties of obtaining coverage for someone with a pre-existing medical condition. Others would argue …

An obsession with making money can be a sign of physician burnout

Kevin

Physician

October 29, 2009

Originally published in HCPLive.com

by Jeff Brown, MD

Physician burnout has a tremendous effect on the financial bottom line and is far more common than docs want to talk about.

When I say the bottom line, I am referencing studies that have been done on “workaholics,” another softly defined term, that show in spite of increased hours and apparently focused activity, productivity in …

This is why children need the H1N1 flu vaccine

Crystal Phend

Medications

October 28, 2009

by Crystal Phend, MedPage Today Senior Staff Writer

The pandemic H1N1 influenza virus continues to disproportionately attack the young, the CDC warned.

Children and adults under age 25 have accounted for 53% of hospitalizations for laboratory-confirmed H1N1 and 23.6% of related deaths since Sept. 1, the agency reported at a press briefing.

Seniors, on the other hand, have accounted for just 7% of …

Have drug companies really curbed gifts to doctors at medical conferences?

Kevin

Medications

October 27, 2009

by Roberta Friedman, PhD

Banning pharmaceutical companies from handing out token items to doctors at conferences is so tip of the iceberg.

I have tales to tell of conferences past, where the excesses were beyond farcical. As a medical reporter covering such meetings, I have seen everything. When my kids were young, I enjoyed roaming the floor of the exhibit hall along with the docs, collecting such swag as bouncy balls that …

Is the newest, long-lasting insulin necessarily the best?

Kevin

Medications

October 27, 2009

Originally published in HCPLive.com

by Anita Ramsetty, MD

We are very fortunate to have a number of newer insulins available for our patients.

For years we had animal insulins only. NPH and Regular, then we had Ultralente. The development of analog insulins marked the upswing in technology that we would sustain for a period of time. The most recent big blip in the …

What does H1N1 pandemic flu as a national emergency mean?

Kevin

Conditions and Diseases

October 27, 2009

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

President Barack Obama’s declaration that the H1N1 pandemic flu is a national emergency doesn’t mean the course of the outbreak has changed, health experts said.

But as the volume of cases increases, the declaration allows doctors and hospitals more flexibility in handling the expected surge in patients, they said.

“I …

The high cost of hiring, and firing, a doctor

Kevin

Physician

October 26, 2009

Originally published in HCPLive.com

by Jeff Brown, MD

One area we need to look at is the surprisingly high costs of hiring and firing people who work with us. And as always, I rebuke our training programs for their ostrich-like attitudes, ignoring how important managerial and organizational competence is to the quality of medicine that we practice.

We know that recruiting a …

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