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 …
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 …
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 …
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 …
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 …
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. …
“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 …
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 …
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 …
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 …
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 …
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 …
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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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 …
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 …
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 …
An excerpt from When We Do Harm: A Doctor Confronts Medical Error.
One of the selling points for the electronic medical record (EMR) was that it would be a boon for patient safety. Just having all the medical records in one place is a monumental improvement over …
In a perfect world, an electronic medical record would aggregate a patient’s medical information from all health care providers into a single, comprehensive record that could be easily accessed by any provider with the patient’s permission. This information could reduce the risk of medical errors, duplicate testing, and inappropriate treatment and the associated cost of these mistakes. It could also be lifesaving in the event of a medical emergency that …
I never expected to find myself in this position. Ironically, I, a family medicine physician, in a world grappling with a pandemic, became underemployed for the first time since high school. A unique set of circumstances led me to this situation, but it turned out to be far more challenging for me emotionally than I expected.
At the end of 2019, I made a decision to leave my regular job as …
“Your patient just had their 6th no-show, this exceeds our policy limit, please call to investigate barriers to care, also we recommend formal dismissal from the clinic.”
The message regarding one of my obstetric patients was waiting when I opened my inbox this morning. In our primary care office, we have a policy regarding “no-shows”: Patients who miss a scheduled appointment without calling ahead to cancel or reschedule. Three strikes and …
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