Primary Care
The slippery slope of utilization management
“The patient has a severe infection of the hand and is not improving on the current antibiotics,” I explained to the medical director at the insurance company.
“I understand. However, the patient has no elevated white count or fever, and I cannot get it to meet the criteria, so I will have to deny the necessity for the patient to stay in the hospital,” she explained.
I felt my voice rising and …
Let doctors in recovery be able to recover their careers
The stigma of addiction is alive and destructive in Nebraska. I can speak to the truth of this statement because I am an opioid addict in recovery. And if you happen to be a physician like I am, you better be prepared to have your profession and life destroyed. The Nebraska Medical Board and our legal system aggressively work to punish, not heal. This article intends to use my story …
The elephant in the room: end-of-life discussion with patients
I have been at my current hospital for 12-plus years now. Like many of you, I have gotten to know some of my patients very well. I have known some of them since I first started out here. We talk about my dogs and cows, our newest grandkids, and politics if we feel adventurous. This is an extraordinary relationship built on the intangible magic generated over time, known as rapport …
Amazon vs. Apple: Only one will rewrite the rules of health care
Big Tech has had a surprisingly small impact on U.S. health care, so far.
Artificial intelligence, for example, outperforms physicians in many complex tasks (like reading mammograms and analyzing chest X-rays), yet AI remains woefully underused. Meanwhile, many have tried to spur operational efficiency using big-data analytics, but care delivery remains as inconsistent and ineffective as ever. Perhaps the most telling example of Big Tech’s struggles in medicine: 9 in 10 …
Literacy and patients’ understanding of health education
In my first bioethics class, the components of health education (HE) were just being developed, and despite the passage of time, full understanding remains elusive as HE proved far more complex than originally conceived. We learned, simplistically, by present standards, that the provider (MD, DO, PA, NP) only needed to deliver information at a patient’s level of understanding, and the patient would provide a reasoned response. The constant over the …
I will not sell my soul to modern medicine: Curing physician moral injury
Something is wrong. You can feel it, but you cannot put your finger on it. You go through the motions daily, but your joy is gone-its soul-sucking. Your patients sense it too. They used to love coming to see you, but now they see the changes. The light has gone out of your eyes. You used to love your job, but now it feels like a burden. This is not …
The nicest patient I’ve ever met
The nicest patient I’ve ever met was Mr. Harris.
I first met him in the ED with his son and daughter by his side, noticing a foley bag filled with bright red blood.
He was an elderly gentleman with ALS and was brought by his children for hematuria and blood clots overnight. Never happened before, and we were all unsure of the cause. Urinalysis soon showed likely UTI, so we started antibiotics. …
Football pervades our society so we must be prepared to deal with it
It’s not that I hate football; truly I don’t. I try hard to get into it. I scan the sports page to become familiar with names, rivalries, predictions, and opinions. I tune in to Sports Extra on Sunday nights for the weekend analysis and wrap-up. I watch the introduction to televised games for the opening excitement and colorful background of the teams. I’ve enjoyed a few episodes of Hard Knocks.
Why …
How this primary care doctor found his dream practice
Eleven years ago, I escaped the drudgery of the corporate medicine hamster wheel to set up a solo family practice where I could be my own boss and practice medicine my way.
After 38 wonderful years as a family doctor, I am ready to retire. I hope to gift my practice to a doctor eager to be independent, well compensated, and enjoy a balance between work and life.
Who might be the …
As doctors, caring is our poetry
Poiesis is a Greek term that evolved into the word poetry in English. According to Wikipedia, in philosophy, poiesis is “the activity in which a person brings something into being which did not exist before. Etymologically derived from the ancient Greek term which means to make.” The word is used as a suffix, as in the biological term hematopoiesis, the formation of blood cells.
In the book All Things Shining, Hubert …
You need to ask these questions to teens starting hormone therapy
In medical practice today, we have all types of providers in charge of birth control counseling and treatment: medical doctors, nurse practitioners, registered nurses, licensed vocational nurses, and even medical assistants who report to their licensed providers. Having a standardized questionnaire that all providers can easily use and incorporate into their practice would help safeguard against regretful avoidable mistakes. Taking a good history is cheap. Health care costs for strokes …
The recent closing of Amazon Care shows the magnitude of the challenge in changing health care
Amazon recently announced plans to shut down Amazon Care, an in-home and virtual health care service.
The reasons cited were attributed to a significant overlap of services with the One Medical chain of clinics, which Amazon purchased in July of this year for 3.9 billion, as well as Amazon Care not being a complete enough offering for large enterprise customers for which it was targeting.
This is the third health …
ADVERTISEMENT
Use connectivity to rise above our individual and collective challenges
With so much disconnect in our world right now, it can be a challenge for some to find ways to stay connected to meaningful things, people, places, and events. I won’t belabor my own list of disconnectedness, but I imagine many of your lists are much longer than you are accustomed to.
A recent medical experience motivated me to write about this …
Physicians did not go to provider school
“If both of you are the same, then one of you is unnecessary.”
That’s one of my brother-in-law’s favorite quotes, and I think it’s applicable to the ongoing debate for physicians to be called “physicians” instead of “providers.”
When you think about what’s been happening in health care, physicians, physician assistants, and nurse practitioners are advertised as equivalent.
How is this equivalence being promoted? By lumping us all into the same category called …
A scientific lens on life and intuition
An excerpt from On the Path to Health, Wellbeing, and Fulfilment.
Scientific research provides us with answers, and in return gives us other questions. And, when its reach is recognized, it inevitably instills a sense of awe and wonder.
What science has given us, among other things, is …
ADVERTISEMENT
A personal story about trying new things
You’ve got to understand that I don’t like anything being thrown at my face.
Seriously.
This fear goes back to my childhood in Ontario, Canada, when after school in the winter, the neighborhood kids got together to play hockey. Our back yards abutted on a park which had a big field that, come winter, was iced over by a local parent late at …
How to make primary care rotations more appealing for students [PODCAST]
Subscribe to The Podcast by KevinMD. Catch up on old episodes!
“It is time that every health profession school specifies their criteria for optimal teaching primary care practices and for the training that would optimize their students’ experience. It is time that we, as primary care physicians, advocate …
How whole-person care can make us better healers
My patient at a pain clinic on a military base in Virginia carried the deep wounds of war on his face. Not physical scars, but a sallow, slack complexion and a hollow-eyed look of exhaustion and defeat. A veteran of the war in Afghanistan, he had long been suffering from anxiety, depression, and other complications of PTSD, although his presenting complaint was back pain.
The patient, whom I’ll call Sergeant Carlson, …
ADVERTISEMENT
How writing a letter on Substack might recharge your life in medicine
“The good life is ever-changing, challenging, devoid of regret, intense, creative, and risky.”
-Friedrich Nietzsche
One year ago, bruised and battered like any physician practicing in this pandemic, I decided to double down on weariness and start writing a medical letter on Substack. I’ve been writing about once a week, with subjects ranging from the newest coronavirus variant of concern, to a reflection on the hidden strengths in frailty, to the pleasure …
Past Week
-
Why tracking cognitive load could save doctors and patients
-
Physician patriots: the forgotten founders who lit the torch of liberty
-
The hidden cost of becoming a doctor: a South Asian perspective
-
How medical culture hides burnout in plain sight
-
Why fixing health care’s data quality is crucial for AI success [PODCAST]
-
How the 10th Apple Effect is stealing your joy in medicine
-
Past 6 Months
-
What’s driving medical students away from primary care?
-
Make cognitive testing as routine as a blood pressure check
-
How dismantling DEI endangers the future of medical care
-
How scales of justice saved a doctor-patient relationship
-
A faster path to becoming a doctor is possible—here’s how
-
The broken health care system doesn’t have to break you
-
Recent Posts
-
How doctors can stop frivolous lawsuits before they start
-
An effective treatment using an effective care delivery model: Using telehealth to treat adolescents with obesity with GLP-1 medications
-
How the 10th Apple Effect is stealing your joy in medicine
-
How medical culture hides burnout in plain sight
-
How functional precision oncology is revolutionizing cancer treatment [PODCAST]
-
Why tracking cognitive load could save doctors and patients
-
Subscribe to KevinMD and never miss a story!
Get free updates delivered free to your inbox.
95
pages
Past Week
-
Why tracking cognitive load could save doctors and patients
-
Physician patriots: the forgotten founders who lit the torch of liberty
-
The hidden cost of becoming a doctor: a South Asian perspective
-
How medical culture hides burnout in plain sight
-
Why fixing health care’s data quality is crucial for AI success [PODCAST]
-
How the 10th Apple Effect is stealing your joy in medicine
-
Past 6 Months
-
What’s driving medical students away from primary care?
-
Make cognitive testing as routine as a blood pressure check
-
How dismantling DEI endangers the future of medical care
-
How scales of justice saved a doctor-patient relationship
-
A faster path to becoming a doctor is possible—here’s how
-
The broken health care system doesn’t have to break you
-
Recent Posts
-
How doctors can stop frivolous lawsuits before they start
-
An effective treatment using an effective care delivery model: Using telehealth to treat adolescents with obesity with GLP-1 medications
-
How the 10th Apple Effect is stealing your joy in medicine
-
How medical culture hides burnout in plain sight
-
How functional precision oncology is revolutionizing cancer treatment [PODCAST]
-
Why tracking cognitive load could save doctors and patients
-
