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 …
Much is written about the advantages for primary care physicians and patients of working within a retainer model, direct primary care, concierge-type care model. Little is written about the downside or disadvantages. It is time to shine a light on the benefits and challenges of concierge and standard models through an experienced lens, particularly as drivers of burnout and the primary care shortage loom so large. The phase of a …
There is constant tension to remain on-time working in a primary care clinic, seeing patients every twenty minutes back-to-back. It takes an incredible ability for the front desk staff, medical assistants, and the physician to be able to keep this flow running smoothly only to have it be derailed by the late patient who does not understand how their actions affect everyone else after them.
I currently work in a system …
Currently, in America, there are only three legal groups of prescribers, the physicians (which include MDs, DOs, DPMs), the nurse practitioner (NPs), and the physician assistant (PAs).
The first class of physician assistants, in 1965, was also the year of the first class of nurse practitioners. Today there are nearly 300,000 NPs In America and 123,000 PAs.
PAs are outnumbered almost three to one, and the trend, with the rapid rise, and …
This is not the career path I set out to practice when I left medical school; in fact, it’s a career path that didn’t even exist. But after making a number of lifestyle choices this is where I find myself today. I am sitting writing this article from the hot, tropical lowlands of Colombia, on the site of Pablo Escobar’s Hacienda where, in a few hours, I will …
“What diagnosis do you want to use for those ear drops you sent on Mr. Johnson,” Jenn texted me. “ICD-L21.8 for seborrheic dermatitis?”
Sigh. Welcome to prior-authorization hell.
These are generic ear drops I ordered for presumed fungal infection of the external ear. The cash price for the drops is $15 for a 10-milliliter bottle (I checked before prescribing them). “No,” I responded, “it would be ICD-B36.9 for otomycosis.” (translation: ear fungus)
Jenn …
As I enter the exam room, I hear, “Don’t get old honey!”
As a physician caring for a large population of geriatric patients in Florida, I hear this approximately five times a day. To this statement, I always reply, “There’s no alternative, though!” I also try not to get offended by repeatedly being called “honey.” Although I am waiting to someday state; “it’s Doctor Honey.” Usually, my level is offense is …
I recently wrote about my new type 1 diabetes diagnosis, the quest for affordable meds and supplies, and the subsequent financial savings found through transparent pricing outside of my insurance plan. I summarized that health care “coverage” is very expensive, whereas medical services may be found much more affordably.
My next step was to establish an ongoing primary care physician relationship.
I contacted one of the large medical …
Recently, my mother waited for over an hour for what turned out to be a 5-minute visit with her primary care doctor. Her doctor seemed rushed and stressed, her questions perfunctory, the management plan hurried. And then she was gone. “It’s like she didn’t even know I was there,” my mom relayed to me.
This is a physician who is thoughtful, intelligent, and kind, with excellent clinical instincts. After this visit, …
Calling.
I am awakened by the loud, screeching sound of my pager. I feel my heart race. I look at the clock.
It is 3:07 a.m. It’s cold in the room. I am shivering. I stand up quickly, instinctively. I feel the soreness of my feet for a brief moment, but push that thought aside and look quickly at my pager. It reads, “room 2309, death pronouncement”.
My heart sinks. She is mine—my …
An excerpt from Dottoressa: An American Doctor in Rome.
The great bidet mystery: What’s it for? Americans can live here for decades thinking Italians go to the trouble of installing bidets just so they can soak their feet. If they’ve read Henry Miller, they add so women can …
A guest column by the American College of Physicians, exclusive to KevinMD.
Engaging personally with our health care system either as a patient or family member is usually an eye-opening experience for most physicians. It provides a glimpse of what those under our care likely deal with on a daily basis while attempting to manage …
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Being a physician is an important role. It’s easy to forget the impact that you have on a patient just by being at their bedside.
It’s huge.
Have you ever been a patient? It’s an incredibly vulnerable experience.
You’re not really sure what’s happening and what is going to happen next.
People are really putting their faith in you to understand their needs and to ease their suffering. It’s a powerful thing to ease …
It is well known by now that a physician’s demeanor influences the clinical response patients have to any prescribed treatment. We also know that even when nothing is prescribed, a physician’s careful listening, examination, and reassurance about the normalcy of common symptoms and experiences can decrease patients’ suffering in the broadest sense of the word.
This has been the bread and butter of counselors for years. People will faithfully attend and …
He came to the office in search of help as many patients do, but the circumstances that compelled him to seek medical attention were all too similar to me. I’ve seen it time and again. He said that he couldn’t sleep at one visit. At another, his blood pressure was high.
At a visit after that, he’d share more information, and his wife would attend with him. He wasn’t making enough …
On a rare Sunday morning, I woke and had the time to make breakfast for my kids and their cousin, who’d stayed the night. My nephew said, “Thanks, Aunt Erin, I feel like I never see you.”
To which my oldest (10) stated very matter-of-factly, with no ill-intent: “That’s because she’s never home.”
Being a full time, private practice physician and mom to 5 kids, with a healthy social life, it’s extremely …
Talking to patients on the phone can be very efficient and quite rewarding, like when I called a worried patient today and told her that her chest CT showed an improving pneumonia and almost certainly no cancer, but a repeat scan some months down the road would still be a good idea. She told me she was feeling better, but still quite weak and that her sputum was still dark …
Kahlil Gibran writes, “In friendship or in love, the two side by side raise hands together to find what one cannot reach alone.” What types of outcomes can physicians and patients achieve in healing, living, and life when Gibran’s message is incorporated into the physician-patient relationship? Can humanism in medicine become even more humanistic?
“Humanism in medicine” is characterized by the Arnold P. Gold Foundation as respectful …
I think it’s time for physicians to end the assault on the clinical practices of PAs and NPs.
Are you worried about PAs and NPs taking your job? If you’re a good doctor, you should stop worrying. Great PAs and NPs are everywhere, and I think it’s time physicians embraced them.
PAs and NPs have excellent skills
My first rotation as a third-year medical student was in the emergency department. There was a …
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