Primary Care

A physician tells a health insurance CEO what she really thinks

Physician

August 24, 2016

I graduated medical school in 1995. I believe in a single-payer health system. I am about championing for my patients. I left a salaried position in academic medicine to go an underserved area of rural Maine and start a practice. This is the letter I wrote to the CEO of a large health insurance company recently.

Dear Mr. CEO,

My name is Cathleen Greenberg London. I am a family medicine physician who …

A reminder that life is indeed too short

Neha Sharma, DO

Physician

August 19, 2016

I recently took care of a young patient whose case left an impact on me. When I admitted him, he was fighting a lost battle with cancer.

A few months prior to admission, he had been experiencing new headaches. When he sought medical attention, he was diagnosed with an extremely aggressive brain tumor that had spread to his spine, and was given a very poor prognosis.

Unfortunately, his condition deteriorated quickly thereafter, …

Doctors experience the world differently

Starla Fitch, MD

Physician

August 18, 2016

I was in the break room at the hospital scarfing down a power bar between three-hour cases. The truth is, I was multi-tasking: eating, writing on a chart, and checking my email on my phone.

I had received an email from a businesswoman, whom I have known for a few years. She wanted to know if I wanted to join her for lunch next week.

I had to laugh out loud.

The rest …

Social determinants matter most to a person’s health. Here’s one story.

Franklin Warsh, MD, MPH

Physician

August 7, 2016

To close out my first week of medical school, the class was treated to a talk by a stuffy but soft-spoken lecturer on the relationship between poverty, education, and poor population health. “Social determinants of health,” he labeled them, a clunky and unwieldy term if ever I’d heard one. In those days, audiovisual aids consisted of an overhead projector for black-and-white transparencies. And boy did that talk have transparencies. Chart …

What I learned from the 2 Mikes, and why physicians should be like them

Scott Krugman, MD

Physician

July 27, 2016

They were both named Mike. Both were superstar physicians and educators at MedStar Health. Both had a wife named Pam, a son, and a daughter. And both died untimely deaths within a year of 50 at the mid-point of their ascending careers, 18 months after being diagnosed with cancer. I don’t believe they knew each other, but having worked with each of them, they will be forever linked in my …

What we can learn from old school physicians

Suneel Dhand, MD

Physician

July 23, 2016

The term “old school” in many facets of life has negative connotations. We live in a modern, technologically advanced and fast-paced world — and there’s no room for certain people who appear to hold us back.

Last year I wrote an article about an experience I had with an “old school” physician. That experience really caused me to reflect on the situation the medical profession finds itself in, and …

The art of taking an excellent medical history

Robert Centor, MD

Physician

July 21, 2016

The art of eliciting the medical history requires medical knowledge, cultural knowledge, and many “people skills.” History taking is not science, but rather, art, because it requires interpretation and clarification. Patients with the same symptoms express them differently. A major feature of the art of medicine involves learning how to interpret different descriptions of the same phenomenon.

A few examples might clarify these concepts.

The patient tells you that they have chest …

I have seen both worlds, and the naturopathic one is terrifying

Britt Marie Hermes, ND

Physician

July 20, 2016

I find it amusing to be accused of being an unsuccessful practitioner of naturopathic medicine. I graduated with high grades from Bastyr University. I landed a highly competitive naturopathic residency. Had I remained in practice, I would currently be eligible to take the naturopathic pediatrics “board-certification” exam offered by the Pediatric Association of Naturopathic Physicians.

I was making decent money at my practices in Seattle and Tucson. By all accounts, I was …

There are limits to what a careful physician can do

James C. Salwitz, MD

Physician

July 15, 2016

Sometimes, I think that that guiding principal of the medical profession, “first, do no harm,” is hopelessly out-of-date. Clearly, a physician should understand her limits, and never should she give care, which hurts, more than helps. Nonetheless, this axiom implies that the doctor is in control, and decides the treatment. Some of the time, a modern motto, which recognizes the true position and limits of the modern doc, might be, …

The end of residency means difficult goodbyes

Anne Toledo, MD

Physician

July 6, 2016

“It is easy to see the beginnings of things, and harder to see the ends. I can remember now, with a clarity that makes the nerves in the back of my neck constrict, when New York began for me, but I cannot lay my finger upon the moment it ended.”
– Joan Didion, Goodbye To All That

So it feels at the end of residency. Of course, there is a graduation date. …

We need to show empathy for patients who miss their appointments

Jessica M. Yeatermeyer, MD

Physician

June 29, 2016

I have a love-hate relationship with the no-show patient. Like most doctors, I’m a reasonably good multitasker, adept enough at charting while emailing while waiting on hold with insurance companies and planning what to prepare for dinner when I get home. But there are days, more than I’d like to admit, when I feel like I need just a little bit more time, and I find myself compulsively refreshing my …

Some doctors do it for the money. Here are some reasons why.

Future Proof, MD

Finance

June 28, 2016

If you stay in medicine long enough, you will encounter physicians who seem to care more about the paycheck than the patient in front of them: think Dr. Farid Fata. You may find those colleagues revolting; I know I did. I despised these physicians and felt nauseated even to be in the same room as them. But as time went on, I realized that almost nobody starts a career …

How can patients accept cash-based practices?

Steven Reidbord, MD

Physician

June 22, 2016

A primary care physician named Ashley Maltz recently discussed advantages and disadvantages of a cash-based practice. I appreciate her evenhanded tone: She prefers this model yet expressed concern for patients who can’t use it. In the comments section, several physicians extolled the virtues of cash-pay, but patients were mixed. It’s attractive for those who can afford it, while it worries, and maybe angers, those who can’t.

I enjoy the personal and patient benefits of a mostly cash-pay psychiatric practice (I …

I’m a physician assistant. It’s time to stop the bitterness.

Wes Johnson, PA-C

Physician

June 13, 2016

I like to read. I always have, and I’m sure I always will. I read almost everything that I come across. I often find myself reading the articles on this site. Some I agree with and some I don’t, but I like that part of the site too. I read, and I learn and I’m informed, and I gain knowledge, but then something always seems to happen. I always wind …

This doctor was remembered for his devotion to patients. Was it enough?

Sudha Prasad, MD

Physician

June 12, 2016

Recently I attended the funeral of a prominent gastroenterologist in my community whom I knew socially as the father of my son’s friend. It was an untimely and rapid death due to pancreatic cancer. He left behind a young wife and four children, two of whom are in college. I would see him periodically at school functions; he would sneak into an event at the last minute and often struggle …

Physicians are society’s scapegoats

Kevin Haselhorst, MD

Physician

June 12, 2016

Dad had taken a turn for the worse, but my family was not ready to give up on him and consider end-of-life care. Nevertheless, choices had to be made. Would Dad be allowed to pass while in assisted living or have his life prolonged in a skilled-nursing facility? What kind of a doctor am I? When perceiving that a patient is dying, what type of physician neglects to intervene and …

Read more…

Physicians are society’s scapegoats

Thinking of starting a cash-based practice? Here are the pros and cons.

Ashley Maltz, MD, MPH

Physician

May 25, 2016

As an integrative medicine physician, I am often questioned about what I do and how I decided to diverge from the normalcy of allopathic medicine. I usually go into a short spiel about my love for thinking outside the box and creating solutions for patients that seek a kinder, gentler style of medicine; one that blends effective healing modalities from all over the globe with my traditional allopathic training.

Most people …

Your patient should get a health coach. Here’s why.

Nicole Calloway Rankins, MD

Physician

May 15, 2016

We are all familiar with the statistics. Chronic conditions like obesity, hypertension, and diabetes are present in our population at unacceptably high and costly levels. More than 78 million American adults are obese, and more than 1 in 20 is extremely obese. About 70 million U.S. adults have hypertension with only 52 percent having the condition under control. Just over 29 million Americans have diabetes and an additional 86 million …

Why the 15-minute doctor appointment is dangerous

Peter Pronovost, MD, PhD

Physician

May 13, 2016

How would you react if you sent your sputtering car to the auto mechanic, and they stopped trying to diagnose the problem after 15 minutes? You would probably revolt if they told you that your time was up and gave back the keys.

Yet in medicine, it’s common for practices to schedule patient visits in 15-minute increments — often for established patients with less complex needs. Physicians face pressure to mind …

The story of a man who was a very good cook

Mark E. Williams, MD

Physician

May 10, 2016

Once upon a time, there was a man who was a very good cook. He was just an ordinary man, but he had real culinary talents. He could create the perfect meal for anyone who came to see him in his modest café.

His maître d’ and waiting staff were warm and well trained, and the menu was designed specifically for the clientele of his eatery. He gave each person his …

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