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.

Reader take: Patients should be allowed to access their entire medical record

Kevin

Health Technology

April 28, 2009

The following is a reader take, in response to a post on whether patients should own their medical records, by an anonymous nurse.

Dear Dr. Pho,

I wish to respond to your position on patient access to their medical records both as a patient and a nurse.

If a doctor or other health professional believes their documentation would be inappropriate or too sensitive for …

How the primary care doctor shortage threatens Obama’s health reform plan

Kevin

Physician

April 27, 2009

Top story in The New York Times.

Excellent.

There’s hope that maybe, just maybe, we’re getting through to the decision makers in Washington.

The article itself is old news to regular readers of this blog, and regurgitates many of the arguments impeding health reform, as well as the problems in solving them.

“Obama administration officials, alarmed at doctor shortages, are looking for ways to increase …

Op-ed: Not all screening tests lead to early, better treatment

Kevin

Conditions and Diseases

April 23, 2009

The following op-ed was published on April 23rd, 2009 in the USA Today.

As a primary care doctor, it’s heartening to hear President Obama call for “the largest investment ever in preventive care.” That means more people, for one, will be undergoing tests to screen for various forms of cancer. But this might be one of those cases where what sounds like common sense is actually more …

6 top medical comments, April 19th 2009

Kevin

Uncategorized

April 19, 2009

Here are some of the more interesting comments readers have left recently.

1. Manalive on quality measures:
It is almost always a leap of faith to apply evidence-based guidelines to the frail elderly, to patients with many medical problems, to alcoholics, to the poorly insured — in short, to a large percentage of my practice. Accordingly, I have been on the wrong end of too many …

Read more…

6 top medical comments, April 19th 2009

5 top medical comments, April 12th 2009

Kevin

Uncategorized

April 12, 2009

Here are some of the more interesting comments readers have left recently.

1. Dr. Gwenn on limited health literacy:
For us to do a better job with patients and teach them to be better advocates for themselves, we need more time – plain and simple. At the same time, patients need more community supports to understand the complex health world and build the skills they need …

Read more…

5 top medical comments, April 12th 2009

Most hospitalists are good, but some, like these ones, aren’t

Kevin

Physician

April 1, 2009

It’s a well known phenomenon that hospitalists are taking over inpatient medicine.

And no wonder, the payment system strongly discourages newly minted doctors to practice outpatient medicine, and the demand that hospitals have for inpatient physicians is surging at an unprecedented rate.

It’s a good time to be a hospitalist, but, as this reader writes to me, that may lead to an increasingly variability in the quality …

Nighthawks, dayhawks, and the demise of the American radiologist

Kevin

Physician

March 29, 2009

More hospitals are resorting to so-called “dayhawk” radiology services to read their x-rays.

It’s modeled after the “nighthawk” model, where radiologists (via Shadowfax), in some cases as far away as India, remotely read films in the middle of the night.

Now, the phenomenon is happening during business hours as well, which according to radiologist Giles W. L. Boland, means that “some radiologists can no longer assume long-term …

Op-ed: Unbiased research for doctors is good medicine

Kevin

Health Policy

March 26, 2009

The following op-ed was published on March 26th, 2009 in the USA Today.

As a primary care doctor, I am frequently faced with decisions where the choice is not always clear. Do the latest, more expensive drugs work better than the less costly, older medications? Will ordering an MRI help me treat a patient’s lower back pain? Often, the answer to these questions is, “I’m not sure.”

Because …

Why do I need a rectal exam, and what can doctors find with the gloved finger?

Kevin

Conditions and Diseases

March 6, 2009

Have you ever wondered why doctors have to perform a digital rectal exam?

Well, look no further, as primary care doctor Rob Lamberts gives us the answers discerning readers demand.

Simply by looking at the rectum, which by the way, indeed “takes some getting used to,” can lead to significant diagnostic findings. Furthermore, does tight sphincter tone matter? And should you be worried about the large hands …

Relative value units, and how the RVU payment system doesn’t allow doctors to practice good medicine

Kevin

Health Policy

March 5, 2009

For those who don’t know, every piece of work that a doctor performs is quantified and measured.

The base unit of physician work is known as the relative value unit (RVU). Most physician salaries are determined by the amount of RVUs a doctor produces in a given year, and in most cases, can range between$35 and $45 per RVU in primary care, depending on geographic location and …

Op-ed: Pads, pens, prescriptions

Kevin

Medications

February 26, 2009

The following op-ed was published on February 26, 2009 in the USA Today.

Have you ever noticed the pens, coffee mugs and prescription pads at your doctor’s office? Chances are, they were prominently adorned with the brand name of the prescription drug its company is touting.

The pharmaceutical industry has been giving these types of small gifts to doctors for years, in hopes of raising physician awareness of …

Read more…

Op-ed: Pads, pens, prescriptions

Op-ed: More coverage requires more doctors

Kevin

Health Policy

February 25, 2009

The following op-ed was published on February 25th, 2009 in The New York Times’ Room for Debate blog.

With the number of the uninsured having risen to 48 million Americans, clearly the need for reform is dire. But President Obama made no mention of who exactly will take care of these patients, even if they get insurance under a successful health reform initiative.

As a primary care physician in southern New …

Tom Daschle withdraws, and how that will impact health care reform

Kevin

Uncategorized

February 4, 2009

There’s no shortage of informed opinions on the Tom Daschle debacle, and how this will affect the chances of successful health care reform.

I don’t pretend to be a political pundit, so instead, here is a collection of selected insights from news sites and health policy blogs that I regularly read.

First off, the NY Times says it will likely halt the momentum for health reform, and …

The cost of chronic disease is the real health care crisis

Val Jones, MD

Health Policy

October 6, 2008

A guest post by Val Jones, MD.

On the eve of our second presidential debate, I had the chance to interview Dr. Ken Thorpe, Executive Director of the Partnership to Fight Chronic Disease (PFCD), about America’s healthcare crisis. Here’s what he had to say:

1. I was part of a press conference call with you and former Secretary of HHS, Tommy Thompson …

Hospitalists and the loss of continuity of care

Kevin Pho, MD

Health Policy

August 27, 2008

A reader writes:

I agree with you completely on the importance of having a physician functioning as the coordinator of care for a patient (I have always assumed that a primary care physician would do that) my experience has been that they resist that role. I have become my own and my wife’s primary care person because of that.

There are hospitals that discourage …

Humor in medicine: why laughter helps patients open up

Rob Lamberts, MD

Physician

April 25, 2008

The following is a reader take by Dr. Rob.

I don’t remember why he came to see me on that day. He was anxious on most of his office visits, so I had to spend most of my time dealing with his surplus of symptoms. As I walked in to see him on this day, he started rapidly hitting two fingers of against the top …

4 reasons doctors order unnecessary tests at checkups

Kevin Pho, MD

Physician

May 20, 2006

I’m happy that this study is getting some play in the media. Essentially, many of the “routine” tests done on a physical are not recommended (the whole concept of a “routine physical” is controversial – but that’s for another discussion). Merenstein concludes:

# 37 percent of checkups included a urinalysis.

# 9 percent of checkups included an electrocardiogram.

# 8 percent of checkups included an …

Read more…

4 reasons doctors order unnecessary tests at checkups

Is the physical exam dying in American medicine?

Kevin Pho, MD

Physician

February 8, 2006

I have written before that the physical exam is useless in American medicine:

This is why the physical exam is useless in American medicine – it cannot hold up in court. Clinical evaluation and judgment skills now needs to be supported with objective, and often expensive, tests. Here we have a case of three separate physicians who, in their clinical opinion, did not feel a CT scan was warranted. …

Read more…

Is the physical exam dying in American medicine?

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