Primary Care

Adding more team members is the wrong answer to decreasing physician burnout

Physician
October 5, 2022

I recently read an article about reducing physician burnout written by a health care consultant who proposed the creation of an enhanced medical scribe, or “team care assistant” (TCA). According to the article, the TCA obtains the patient’s medical history through “template-driven questions about the chief complaint.” After obtaining the history, the TCA then calls the physician into the exam room to present their findings. The article …

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The reality of being a physician and a son at the same time

Physician
October 4, 2022

On February 25th, 2022, my father was placed on oxygen a week after I had surgery for a torn Achilles. He was facing his first idiopathic pulmonary fibrosis (IPF) flare. I knew this day would come; it was only a matter of time. I’ve seen and cared for patients who have faced IPF, but it hit home that our lives would drastically change.

As I concluded the video visit with his …

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It is a gift to be on a team where people think differently

Physician
October 1, 2022

You may just think differently. Not wrong.

It is a gift to be on a team where people think differently.

However, some leaders want people to all to think like them. And they become upset and frustrated when you think differently.

So we step back and observe why they may be frustrated. We may observe in ourselves why their opinion and approval matter so much.

The discomfort may push you to abort your own …

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Difficulties navigating the health care system are causing many Black and brown kids to fall through the cracks

Policy
September 29, 2022

A recent JAMA Pediatrics study confirmed what I see in practice as a pediatric primary care psychologist in Texas, one of four minority-majority states. The study reported alarming gaps between Black and Hispanic kids compared to white kids in attendance at primary care wellness visits—important appointments where children and parents can receive preventative and developmental services, timely immunizations, and answers to common questions. …

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A physician’s reflections with certainty in medicine [PODCAST]

Podcast
September 28, 2022
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“Lacking a supreme being in which to place our faith, my wife and I decided to make the most difficult decision of our lives and discontinue life support. I still wonder if we made the right decision, …

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The slippery slope of utilization management

Policy
September 28, 2022

“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 …

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Let doctors in recovery be able to recover their careers

Physician
September 26, 2022

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 …

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The elephant in the room: end-of-life discussion with patients

Physician
September 26, 2022

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 …

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Amazon vs. Apple: Only one will rewrite the rules of health care

Tech
September 25, 2022

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 …

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Literacy and patients’ understanding of health education

Conditions
September 24, 2022

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 …

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The nicest patient I’ve ever met

Physician
September 21, 2022

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. …

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Football pervades our society so we must be prepared to deal with it

Conditions
September 19, 2022

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 …

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How this primary care doctor found his dream practice

Physician
September 18, 2022

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 …

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As doctors, caring is our poetry

Physician
September 17, 2022

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 …

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You need to ask these questions to teens starting hormone therapy

Conditions
September 17, 2022

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 …

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The recent closing of Amazon Care shows the magnitude of the challenge in changing health care

Tech
September 13, 2022

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 …

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Physicians did not go to provider school

Physician
September 8, 2022

“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 …

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