Primary Care

An EMR frustration that is still torturing us

Tech
September 18, 2020

I have written, or more accurately ranted, about electronic medical records (EMR) systems throughout this blog. While the systems have clearly improved since their mandatory introduction into the medical universe, they have still not delivered on many of their promises.

Of course, EMR has brought tremendous advantages to the medical profession, and we are all grateful for the technology. But this progress has exacted a cost. Many of them are clumsy …

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So you want to be a doctor? Here are 10 myths debunked.

Physician
September 10, 2020

I’m glad you’re looking at a career in medicine. I hope you will be happy with your choice forever. To help you out, these are a few myths I wish somebody told me about when I was in your shoes.

1. You’ll be rich. You likely won’t. After two decades or so of med school and residency, you’ll be paying back student loans with exorbitant interests for a few more decades …

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Intentions don’t sanitize impact

Physician
September 7, 2020

While there are certainly instances of malicious intent in thoughts, feelings, and actions, most people operate with the intent to do good, be good, offer good to the world – but what we do isn’t always received in the way we set out to offer it.

In the words of Oscar Wilde, “No good deed goes unpunished.”

It can be frustrating and even paralyzing to consider this consequence, resigning us to, “What …

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Direct primary care: Great for some doctors, but challenging for patients

Policy
September 3, 2020

The COVID-19 pandemic and the consequent drop in patient visits have led some observers to conclude that primary care physicians would be better off financially if they were capitated than if they were paid fee for service. If they received a fixed amount of money per health plan member per month, they’d have a guaranteed income stream regardless of how many patients came to their offices.

However, a growing number …

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An alternative to the current model of primary care

Physician
August 26, 2020

What does a primary care visit look like from the patient’s point of view? I often wonder this myself, as a resident physician currently seeing patients at an FQHC in Austin, Texas. A brief look at the process reveals an often tumultuous ordeal for patients and providers alike.  Consider the following steps: Finding an available appointment day and time in an overbooked schedule, requesting time off from work in order …

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A medical student’s experience at an urban free clinic

Education
August 22, 2020

During my first year of medical school, a professor in my clinical skills course shared a timeless adage in medicine: “If you listen closely enough to the patient, they will tell you the diagnosis.” I accepted this statement as a fact of medicine – if I could develop astute history taking skills in my first year, this skill would serve me well throughout my medical training. However, when I volunteered …

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Why gardening is the best medicine

Physician
August 18, 2020

My first glimpse into the power of urban gardening was not through bucolic farmer’s markets or verdant nurseries, whose beauty I only came to after medical school. My introduction was in our small suburban backyard of clay soil. My dad planted silvery, wild-armed globe artichokes, because they could produce flower buds and leaves we could eat, to improve our digestion. That glimpse was enough to ignite my curiosity about homegrown …

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How physicians can find jobs in the pharmaceutical and biotechnology industries

Physician
August 18, 2020

Fifteen years ago, my career path took a detour. As a two-physician household, we were managing my husband’s match and my job interviews in the cities he was considering.  Boston, Milwaukee, and Los Angeles – could you get any more diverse? Definitely, an awkward way to interview; hard to sell excitement when it was clear that it really depended upon “the match.”

Boston! As soon as we got the match results …

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How to recruit more students into family medicine

Physician
August 16, 2020

In 2019, a Policy One-Pager produced by the Robert Graham Center reported that the percentage of the active U.S. physician workforce in primary care practice declined from 32 percent in 2010 to 30 percent in 2018. Although family physicians represent 4 in 10 primary care physicians, in several states, a large percentage of family physicians are older than 55 years and anticipated to …

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4 ways to decrease your dread of being on-call

Physician
August 15, 2020

Have you ever been faced with an upcoming shift at work and felt an impending sense of doom? This type of anticipation can be a real killjoy. However, taking calls, working nights, weekends, and holidays is all part of the job, right?

Worst. Call. Ever.

I was just drifting off, entering the first phase of sleep when the whole body is relaxed, and you’ve entered that sweet twilight zone. …

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Fascia in primary care: When chest pain is not in your chest

Conditions
August 11, 2020

“Imagination is more important than knowledge. For knowledge is limited to all we now know and understand, while imagination embraces the entire world, and all there ever will be to know and understand.”
– Albert Einstein

“Mr. Thomas, are you OK? Sir, are you OK?”  It was a full clinic day, and I had just improvised a treatment on him.

I had met this patient, “Mr. Thomas,” only once before.  After meeting me …

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Doctors: Never pass judgment on the human being in front of you needing help

Physician
August 11, 2020

Oh, how we all learn and change with our experiences. It’s one of the greatest things in life that most of us (hopefully) are not the same person now that we were a few years ago. Looking back to when I first become a physician at the age of 22 (yes, that’s the typical age that most medical students across the world become doctors, because medical school comes straight after …

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Doctors are fleeing the medical field. Here’s why.

Physician
August 10, 2020

The first day I started work as an attending physician in primary care medicine, I knew I had made a terrible mistake. This was not the heroic, selfless, service-oriented job or the romantic life “as seen on TV” I had imagined.

Riddled with heavy school debt, despite my best efforts to join debt relief programs, I had a frustrating job with nothing but red tape and hurdles to jump over. And …

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There is endless profit potential to treat chronic diseases

Conditions
August 8, 2020

I have noticed several articles describing how antibiotic development has bankrupted some pharmaceutical companies because there isn’t enough potential profit in a ten-day course to treat multi-resistant superbug infections.

Chronic disease treatments, on the other hand, appear to be extremely profitable. A single month’s treatment with the newer diabetes drugs, COPD inhalers, or blood thinners costs over $500, which means well over $50,000 over an effective ten year patent for each …

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Is upspeak really that bad for women in medicine?

Physician
July 25, 2020

A few weeks ago, I was delighted when KevinMD accepted an opinion piece I’d submitted. But I withdrew it just before publication because, on reflection, I realized that I’d been wrong.

While sheltering in place during the COVID-19 pandemic, I’ve become an avid consumer of medical podcasts, such as those presented by JAMA and the New England Journal of Medicine. The opinion piece …

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Don’t be afraid to say “Black” when asking about someone’s culture

Physician
July 9, 2020

On the morning of George Floyd’s funeral less than ten miles from our medical center in Houston, I was avoiding the word “Black.” Despite wholehearted pride in the strong Black presence in our community health center’s physicians, staff, and patients, I felt a loss of words that Tuesday morning. There was simply too much pain, grief, and rage in our community.

I was thankful …

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Primary care is dying: Why that should scare every large employer

Policy
July 6, 2020

Primary care is on life support. COVID-19’s toll on American health care extends beyond the hospitals and medical workers besieged by infection. An equally insidious but less-visible crisis is engulfing primary care, the long-neglected foundation of our health care system. Given the role of America’s largest corporations in providing health care benefits, the C-suite should be on high alert.

As growing numbers of patients postpone appointments over concerns about …

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10 telemedicine billing questions and answers that are relevant right now

Sponsored
June 22, 2020

This article is sponsored by Medici.

Telemedicine has increased exponentially since the rise of COVID-19. It reduces COVID-19 exposure risk for both patients and providers. In many ways, telehealth has become an essential service for physicians and other health service workers. Still, with the rapid rise of the pandemic, many providers have difficulty navigating the billing side of …

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There’s a code for pain, but what’s the code for suffering?

Conditions
June 16, 2020

Opiates relieve pain and can transport people to their apparent happy place. So does marijuana.  Lyrica, the seizure-turned-pain medication, caused enough of a buzz in early study participants that it became a controlled substance. The anesthetic ketamine is now used for treatment-resistant depression.

Years ago, we had to be very specific about the location and classification of our patients’ pain. When pain then became a self-reported vital sign and chronic opioid …

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How MOC is contributing to the demise of physicians

Physician
June 5, 2020

Let me start by saying that I am a diplomate (i.e., “board-certified”) by the American Board of Psychiatry and Neurology. I was completely in agreement that to display competence in my specialty after four years of residency, I should pass the oral and written exams required by the ABPN, further to prove I have maintained my skills, I have always found it …

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