Primary Care

Why some physicians thrive and some struggle to survive

Policy

May 15, 2018

I’m sitting in the waiting area across the endoscopy room of a major hospital. Mindless talk show TV runs in the background. Patients are waiting patiently. They anxiously look up every now and then from their phones towards the reception desk.

It’s a scene I’ve experienced for years while working in health care while waiting for doctors.

But there’s something different in the air now.

Patients, like those around me, will encounter a …

How this physician became a financial advisor

Blake McGowan, MD

Finance

May 14, 2018

Growing up with a father who is a physician made for a natural draw to medicine. However, as young people are prone to do, I did my best to rebel. Early into my undergraduate career I proudly announced to my father that I had decided to go to law school. And perhaps to dig the needle a little deeper, I told him I planned on going into medical malpractice, on …

When a physician gets yelled at

Jordan Grumet, MD

Physician

May 4, 2018

It was not so much the words as the overall tone of the interaction. The doctor-patient relationship had been generally affable. There was the usual exchange of pleasantries over the years. Questions about family, children, and grandchildren. It was a good relationship — until Harvey got sick, that is.

Originally, there was weight loss and fatigue. The initial physical exam and slew of testing showed nothing but a frail, cachectic, middle-aged …

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When a physician gets yelled at

Your patient has judged you 7 seconds after meeting you

Suneel Dhand, MD

Physician

May 3, 2018

A doctor is working down their long list of patients, powering through the day, striving to use their skills to get them better. Some of the patients will be follow-ups who they already know; others will be brand new patients, who they are meeting for the first time. Of course, the job of any doctor is first and foremost to heal their patient in whatever way they can. That’s what …

When preventive care becomes upselling in medicine

Hans Duvefelt, MD

Physician

May 2, 2018

For many years, I’ve held a brief huddle with my team every morning to make sure we are ready for the day: Anybody with complex problems coming in today? Anybody who’s been in the ER? How is Mrs. Jones’s husband over at the nursing home, is she worried about his condition? Where can we squeeze in more add-on’s?

Now other people have tried to hijack the word “huddle” for a completely …

Why is it difficult to be a doctor?

Peggy A. Rothbaum, PhD

Physician

April 30, 2018

As part of the interview for my book, I asked why it is difficult to be a doctor. Some of it has to do with integrating information and making decisions.

“The public thinks that we know more or can do more than we can. Ultrasounds don’t mean it’s a perfect baby. All of the tests and technology moves so fast that we don’t know what we see.” A doctor explained, “You cannot know …

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Why is it difficult to be a doctor?

Are you an artisan or just a medical professional?

Charles Dinerstein, MD, MBA

Physician

April 28, 2018

Take a moment to ask yourself the following:

1. Did I come to practice medicine because it was a calling, rather than a possibly lucrative career path?
2. Do I consider the practice of medicine primarily an art, a craft and the consistent application of evidence-based care?
3. Do I respond to inner measures of prideful work more than the appeal of external motivators?
4. Are there lines that cannot be crossed, even if …

Oh, are you a nurse? The physician gender bias

Karen Tran-Harding, MD

Physician

April 26, 2018

A man and a woman step into an elevator wearing the exact same hospital scrub uniforms. The man’s pager suddenly starts beeping, and the stranger in the elevator says to him, “Do you doctors really still use pagers?” The stranger then notices the women next to him and asks her, “Oh, are you a nurse?”

It’s something that has happened to every female physician. It’s not that we mind getting mistaken …

My first objective structured clinical examination

Johnathan Yao, MD, MPH

Education

April 20, 2018

After a semester of studying and taking written exams, we had our first OSCE in medical school. An OSCE — or an objective structured clinical examination — is the real deal. Instead of filling out multiple choice boxes, we instead work with a real human being, which for me is a welcome change.

The actor is given a script with their unique condition and story — it’s a simulation of what …

Independent practice: Nurse practitioners respond

Rebekah Bernard, MD

Policy

April 17, 2018

Shortly after the publication of “Independent practice: Both nurse practitioners and physicians should be outraged,” the nurse practitioner (NP) leadership responded with a press release, denouncing the concerns that were cited, calling them “rhetoric.”

But in contrast to this criticism from the political end of the NP spectrum, I was inundated by emails from working NPs across the country in support …

The human touch in medicine: good or bad?

Dana Corriel, MD

Physician

April 17, 2018

Humans need human touch

Patients sometimes need a shoulder to cry on. When I say that, I normally mean it on a completely figurative level.

However, at times, it needs to be interpreted differently. There are instances in a medical encounter where an actual shoulder could be of service — a physical crutch that takes off an emotional load — and that’s when the popular adage can be beneficially carried out in …

How physicians dress matters. Here’s why.

Suneel Dhand, MD

Physician

April 11, 2018

Anybody who has ever been to Europe, knows that fashion trends and the way people dress are very different from the United States, and generally more formal and fashion conscious (not to make a generalization — but it’s true). Growing up in England, every school has a uniform from an early age. (There are pictures of me wearing a tiny little shirt, tie, blazer, and hat to preschool when I …

A physician thanks those who made her who she is today

Maria Yang, MD

Physician

April 11, 2018

To the intern on the trauma surgery service when I was a medical student: Thanks for occasionally wearing leather pants to work. Thanks for smiling and having a sense of humor despite having to round on thirty patients. Thanks for teaching us medical students while running a significant sleep deficit.

To the internal medicine resident who wanted to become a cardiologist: Thank you for indulging me and telling me how you …

Why your physician wellness programs aren’t working

Larry DeLuca, MD, EdD, Kristi Grall, MD, and Matthew Freeman, MPH, DNP

Physician

April 9, 2018

The other day a colleague and I were discussing a topic to be presented at an upcoming conference: “How much wellness is too much wellness?” This got us contemplating. What exactly is “wellness?” Can you ever spend too much time pursuing wellness? Or is “too much wellness” merely a surrogate for a much bigger problem with the way we’re approaching wellness in the health care setting?

According to the 2018 Medscape …

The many benefits of self-rooming patients

Diane W. Shannon, MD, MPH

Physician

April 7, 2018

In 2017, the flagship multispecialty practice of Oregon Medical Group, moved into its new digs — a 46,000 square foot redesigned medical office building. Practice leaders and the 30-odd clinicians in six different specialties were committed to a coordinated patient experience. They wanted to ensure that patients could move smoothly between sequential visits with different care providers — on the same day. To this end, the group invested in a …

When you leave primary care, you leave people behind

Anonymous

Physician

April 4, 2018

“The ones you leave behind …”

That phrase often connotes loved ones who have lost a family member, friend or colleague through death.

I have thought of the same phrase often lately in a different context — one of increasing prevalence.

Here, I refer to the patients and colleagues left behind by the loss of a primary physician.

No one would begrudge the retirement of a physician who has served his or her patients …

How to do risk-adjusted diagnosis coding the right way

Betsy Nicoletti, MS

Policy

April 3, 2018

Medical practices with risk-adjusted contracts must sharpen their diagnosis coding. Practices that are part of accountable care organizations (ACOs) or that have risk-adjusted contracts with commercial payers have an economic incentive to accurately report the disease burden of their patients. In fee-for-service medicine, physicians are paid based on the fee schedule associated with a CPT code, and any modifier attached to that code. The diagnosis code establishes the medical necessity …

3 ways to better deal with negative interactions

Suneel Dhand, MD

Physician

April 1, 2018

Following a recent article about 3 things we need to be teaching more to our students, I received some good and thoughtful correspondence.

The part which seemed most interesting (for me as well to write) was about being more resilient. I wanted to expand a bit more on this, since I know people may have questions about what I do myself, to be a more resilient person. …

What should physicians look like? Should it matter?

Maria Yang, MD

Physician

March 28, 2018

I don’t remember her name, but I do remember her light brown hair, the simple nose ring that looped out of her left nostril, and the calm and centered presence she had with patients. She came across as unassuming, professional, and caring. We were both in medical school, though she was two years behind me. I admired how she treated people.

I don’t remember his name, but I do remember that …

The medical student who cries

Orly Farber

Education

March 25, 2018

I’m a default crier. I happy-cry, stress-cry, romantic-comedy-cry, regular-comedy-cry and, apparently, I even doctor-in-training-cry.

Crying is a tough response, especially for someone who wants to take care of sick patients. My default reaction poses challenges for my future career. I had my first taste of this when a patient actor brought me to tears. An actor? That’s ridiculous, you might think. It was all pretend and yet, I broke down. I’m …

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The medical student who cries

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