Physicians writing on KevinMD about the primary care shortage, the fifteen-minute visit, panel size, what primary care is paid against procedural specialties, continuity, and the administrative load that has grown around the work. Four maintained records draw on this archive: Primary care: what physicians say, in their own words, Direct primary care: what physicians say, in their own words, Prior authorization: what physicians say, in their own words, and Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words.
For years the trend has been a continued critique about physicians and their bedside manner, or lack thereof. It is an important topic as we have moved from a time of paternalistic care to a collaborative model where patients and doctors work together to improve wellness for each individual. This is a patient-centered model, so that autonomy and lived experience is taken into account when making medical decisions. These …
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When are we going to start talking about patients’ bedside manner?
Fear is something that most of us have felt at one time or another. That feeling of being threatened, when you feel as though your current state is in jeopardy. It’s an instinctive reflex to flee or fight the threat. This instinct has been with us since our earliest moments on earth. Fear can be seen as a driver, too: that force that pushes us into making changes and responding …
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The psychology of fear: How to use it to your advantage
I have seen great leadership and bad leadership. As a leader, I have also made my share of mistakes, and I am sure I will make more. When I do, I will immediately take ownership of it, learn from it, and do all I can not to make the same mistake. However, there will be times I may not recognize my failure, as can happen with any leader. This points …
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My 10 Commandments of a Servant Leader
It was past midnight in the ED, and she was writhing on the bed, palms clutched over her abdomen. I pulled up a stool, notebook, and pen in hand. I was ready to listen to Mrs. Walker’s story. But I also felt a sense of dread rising: From a quick chart review, I knew that Mrs. Walker had 23 negative CT scans for abdominal pain within the last 18 months. …
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“Difficult” patients: Is it them or is it us?
I sat in a crowded auditorium listening to an attending at a renowned medical institution give a lecture. I didn’t know the answers, and shrouded in imposter syndrome, I avoided eye contact. The visiting medical student from Mexico answered the question, and the attending moved on. Another question came. Again, the medical student from Mexico answered. The attending chuckled and said, “OK, Cinco de Mayo,” an exaggerated emphasis on the …
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The daily micro- and macroaggressions of being an underrepresented minority in medicine
Providing primary care to patients with mental illness is a challenging task that requires highly skilled and experienced practitioners comfortable with the full array of biopsychosocial problems with which these patients present. For example, understanding the side-effect profiles of psychiatric medications and their impact on problems such as diabetes and other complex endocrinopathies requires highly evolved clinical skills.
Optimally, the successful care of these patients is best provided in close collaboration …
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Avoiding the pitfalls of integrating primary care into community-based mental health centers
Indian parents are perfectionists. This is what I had come to understand and believe, even before I had the vocabulary to define it. Perfection was the expectation. Not excellent, not superb, but perfection, and only perfection. After years of reflection, I don’t take issue with the expectation of perfection, but, rather, how I perceived it to be defined for me — a well-behaved, beautiful and academically successful girl who does …
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How to be a “good girl”: confessions of an (im)perfectionist
I will speak for myself to say that I completely identified with, and fully agree with, all the sentiments shared by Dr. Klingberg in “A breakup with primary care.” Still, from my own life experiences, and a 30-year career in primary care solo practice, I have been forced to believe that these sentiments are ultimately narcissistic and self-destructive.
Yes, primary care medicine has become thankless, oppressive, cruel, …
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A doctor’s life is absurd, but can it still be worth living?
I have been a physician for 26 years. I have been a fierce patient advocate throughout my entire career. It never occurred to me that physicians do not have the same rights of citizenship that the very patients I fight for do. I always thought I lived in a democracy. Medicine is not what it used to be. Articles relentlessly speak of physician burnout as though we are responsible for …
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A physician applies to law school. Here is her application essay.
You should like your doctor.
Whether or not you like your doctor matters. It matters because if you don’t like your doctor, you’re not going to be honest and forthcoming. Your doctor needs you to be honest and forthcoming to take good care of you. And you want good care.
But, realistically, you may not like your doctor. You figured that was OK. You probably don’t see your doctor that often and …
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You deserve a doctor who’s a good fit for you
Dr. Bernard Lown died February 16, four months shy of his one-hundredth birthday. The Dr. Lown we knew does not emerge from the long list of his many accomplishments, which include the invention of the DC defibrillator and cardioversion, the development of the modern (and when he described it, revolutionary) approach to the care of patients following myocardial infarction, and the founding of International Physicians to Prevent Nuclear War (which …
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In memory of Bernard Lown
“What do you want to be when you grow up?”
This question always confounded me when people would ask me this as a child. What is this “growing up” you speak of? And why do I have to be something? I’m so content with my LEGOs, books, and video games.
I was born in the United States to South Korean immigrants and raised with expectations to excel in school (which I did), …
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A physician’s search for meaning
A guest column by the American College of Physicians, exclusive to KevinMD.
There is a tremendous amount of anger raging in our society today.
The profound uncertainty posed by COVID-induced cataclysms and the cultural, civil, and political unrest we’ve experienced over the past year has significantly skewed our sense of normalcy and well-being. Thus, responding with …
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Doctors can get angry, too
How might I live differently if I really believed that I don’t need to earn security, dignity, and respect? I tell my children and my patients I believe these are inherent rights to which we are all entitled as human beings. But do I orient my life around these truths?
What would it mean if I believed my value was not inextricably wrapped up in my production of value …
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An act of faith: Choosing to move my actions into better alignment with my beliefs
“Dealing with my insurance company is making me sick.”
It wasn’t exactly her chief complaint, but it was one of the concerns raised by my patient at a recent office visit. In fact, it has become increasingly more common in recent years for patients to raise concerns about their insurance directly to me — their doctor.
Not only is dealing with insurance companies a time-sucking administrative burden for practices and an endless …
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My insurance company is making me sick
There are days I hate being a doctor. OK, let’s be honest—there have been weeks, and with the current pandemic, the whole past year has been an entire theme park of emotional rollercoasters. I think a better description would be to say that there are circumstances where I hate my role as a physician.
Being a doctor is my heart-song. It is my identity; it is my first true passion, it …
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Being a doctor is my heart-song
It pains me to write this. I am tired of pretending. I simply cannot do this anymore. I sincerely wish you well. I do hope our paths will cross again.
I first gazed at you, cautiously intrigued. Coquettish even. Butterflies fluttered when I thought of you. You left me longing for more details. You captivated my heart and mind. I became obsessed with you, wanting to understand your layers and complexities. …
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A breakup with primary care
I write this from the Midwestern United States. My home. A generally underserved region.
I’m a young doctor near the end of my training. My generation, I think it’s safe to say, has in large part bought into the general process of medical education, the natural progression through training, and the accompanying stressors and debts that are a typical part of the experience. Burn out, they say, is at an all-time …
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How can we encourage doctors to come home and serve well?
It’s been a rough and difficult year for us. Separation, desperation, depression, illness, and death are scattered among the months that have passed by. Hope, for the longest time, seemed non-existent. The COVID virus gave the world a “sucker punch,” leveling us all to the ground. Positivity test rates sky-rocketed, death rates at unacceptable levels. The days have been dark.
Faulty political power plays brought havoc upon our country when we …
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Doctors and patients continue to search through the overgrown forest of corporate health care
This week a patient, for whom I served as the primary care physician for over many years, died after an extended illness. I had the privilege of visiting her two days before her death, as she weakened and drew closer to her last breath. It was an opportunity to tell her good-bye.
We were close. She was very smart. She had an engaging sense of humor. She loved college basketball. She …
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Another lesson learned: This is what gratitude looks like
