Primary Care

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.

The language of medicine can be complicated. Does it need to be this way?

Sarah Fraser, MD

Physician

September 14, 2019

Several weeks ago, I began my studies for a master’s degree in journalism. I’m continuing to work as a physician, but for the next two years, I’ll also be gaining knowledge in an important field: health communication.

I recall being a medical student and observing the different ways in which my supervising doctors spoke with their patients. Some doctors communicated clearly and were easily understood. Others used words that I had …

When physicians fear for their lives

Hans Duvefelt, MD

Physician

September 12, 2019

The receptionist interrupted me in the middle of my dictation.

“There’s a woman and her husband at the front desk. She’s already been seen by Dr. Kim for chest pain, but refuses to leave, and her husband seems really agitated. They’re demanding to speak with you.”

I didn’t take the time to look up the woman’s chart. This could be a medical emergency, I figured. Something may have developed in just the …

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When physicians fear for their lives

5 clinician concerns about OpenNotes

John Santa, MD, MPH

Health Technology

September 12, 2019

More than 200 health organizations have now implemented OpenNotes. Many more are piloting, are soon to implement — or have implemented, and we don’t know it! For more than three years I’ve been fortunate to represent OpenNotes to potential implementers, and I’m confident I’ve heard almost every clinician concern or anxiety regarding what might happen when patients read their own notes.

Here are the five most common concerns I’ve heard — …

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5 clinician concerns about OpenNotes

Clinical practice guidelines have problems, but they’re not broken

Kenneth Lin, MD

Conditions and Diseases

September 10, 2019

A Health Affairs blog post titled “Fixing Clinical Practice Guidelines” echoed several concerns I’ve discussed previously: practice guidelines are being produced in abundance but often have variable methodological quality, financial conflicts of interest that threaten objectivity, and/or poor applicability to the clinicians and populations for whom they are intended. To address these problems, the authors reasonably suggested restoring funding for AHRQ’s National Guideline Clearinghouse and …

A slow death by charting

Erin O'Laughlin, DO

Health Technology

September 10, 2019

It’s 10 p.m.

Seven days before Christmas.

I’m sitting at work “finishing” up some charts.

I am suddenly overcome with anger.

What am I doing here right now at this minute? I am helping no one.

This work I’m typing away at — trying so hard not to scream — it’s hoops. Fucki*g hoops … for insurance companies. So I can beg them to pay me. Pay me pennies for the hard, good, compassionate, humanitarian …

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A slow death by charting

A resident physician graduates. What does she tell her clinic patients?

Tamra Travers, MD

Physician

September 10, 2019

“I’m graduating and leaving our clinic in June.”

Over and over again, in the months leading up to this transition, I break this news to my primary-care patients. I have developed many meaningful relationships with patients over my past three years of training as a family medicine resident in a large, urban health center in Manhattan.

But now it is time to leave and move on.

The fluorescent lights in an overly air-conditioned …

How can we address retention in the era of physician burnout?

Fred N. Pelzman, MD

Physician

September 6, 2019

As we’ve seen, the lives of those working in the health care system has become overwhelmingly challenging, burdened by all of the excess nonmedical stuff that has been added into our lives as we try to take care of patients.

From prior authorizations, to clicking in the electronic medical record, to endless streams of regulatory requirements, to the continuous onslaught created by …

Here’s what true grit looks like in health care

Johanna Vidal Phelan, MD, MBA

Physician

September 5, 2019

As a medical director and practicing physician, I count myself fortunate to meet and engage in meaningful conversations with many health care professionals throughout the state of Pennsylvania. Recently I was both humbled and inspired when I visited with a group of primary care physicians who operate their private practice in a rural community. These doctors are not only staunchly committed to serving a community that so desperately needs them, …

A primary care physician’s decisions are questioned and second-guessed daily

Steven Reznick, MD

Physician

September 3, 2019

A 67-year-old woman with a high-stress job had a vigorous disagreement with her neighbors last week. She developed severe substernal chest pain and called 911 fearing a heart attack. She is thin, has never smoked, has normal blood pressure and normal cholesterol. She is not a diabetic and runs on a treadmill for two hours at five miles per hour with an elevation for two hours four times a week. …

Doctors have little clue about what actually goes on in their colleagues’ offices

Michael Kirsch, MD

Physician

August 30, 2019

When I meet patients in the office, our conversations do not focus exclusively on the medical issue at hand. Of course, if you come to see me with a stomach ache, at some point, I will direct the dialogue toward your abdomen. Often, our conversations are far removed from livers and pancreases, and deal with more personal vignettes and anecdotes. Why does this happen? First, I enjoy it; and secondly, …

What to consider before undergoing stem cell treatment or banking stem cells

Miles J. Varn, MD

Conditions and Diseases

August 30, 2019

It can be difficult to tease out the evidence-based science amidst the claims of successful adult stem cell-based treatments for a range of health problems from joint pain to Parkinson’s disease, macular degeneration, and spinal cord injury. Even a number of well-respected medical centers now offer patients regenerative medicine treatments that use the patient’s own fat or bone marrow cells or extracts created from platelets in their blood. …

The sensitive topic of physical contact during exams

Hans Duvefelt, MD

Physician

August 29, 2019

Touch is a sensitive thing. No pun is intended here, but whether and how we touch our patients deserves our careful thought and deliberation.

So much interpersonal contact these days is virtual, with emojis, abbreviations and whole words thrown around as substitutes for human contact. Think XOXO and, “hugs and kisses.” And when people do touch in our health care environment, it is often with gloves, even for simple fingerstick blood …

More than three hours late, but somehow still on time

Tasia Isbell, MD, MPH

Medical Education

August 28, 2019

The sound of a clock, hung haphazardly on a colorless cold wall, ticks repetitively — tick, tick, tick. Time continues to pass as my appointment scheduled for three hours ago seems like it will never come. I scheduled this appointment three months ago, and here I sit three hours later. The irony bounces around the room to the sound of the clock ticking. Tick. Tick. Tick.

A door squeaks open.

Just my …

A physician’s first telemedicine video visit

Fred N. Pelzman, MD

Physician

August 22, 2019

I just did my first telemedicine video visit.

The concept seems so strange, the idea of carrying out an “office visit” without the patient actually being in the office.

Right now we have it structured so that when a patient calls up requesting to see me on a day when I am already fully booked (or, as is usually the case, overbooked), …

Tell your patients these family health tips when they’re headed to a theme park

Johanna Vidal Phelan, MD, MBA

Physician

August 22, 2019

This summer, not unlike many families across the country, we were fortunate enough to visit a theme park while celebrating our break from another challenging school year. Being a mother and a pediatrician, I must admit how concerned I was to witness the number of children with obesity attending the park.

While we waited in line for the various rides, I couldn’t help considering how best to advise families on making …

Adopting the DoorDash model to health delivery

Jeffrey A. Oster, DPM

Health Technology

August 21, 2019

I was reading an article in The New York Times entitled, “The Rise of the Virtual Restaurant.” More and more people, particularly in urban settings, are using apps like Uber Eats, Grubhub, and DoorDash to bring fresh, warm food directly to their doorsteps. Mr. Lopez, the virtual restaurant owner featured in the article, had no chairs, no tables, and no menus. His virtual restaurant was actually four restaurants in one that were …

Communicating honestly with patients about uncertainty

Kunal Shetty

Medical Education

August 20, 2019

When looking at the way medical education and patient care is delivered, there is no question that there is a culture of “knowing.” From the moment a pre-med enters high school, they are bombarded with tests that assess knowledge. This extends throughout medical training, where the development of an assessment and plan in residency is paramount in the transition to an attending physician who must make autonomous decisions for their …

It’s time for physicians to bring clarity to their lives

Stephanie Wellington, MD

Physician

August 20, 2019

I meet doctors in different arenas: clinical settings, conferences, and referrals. I am noticing a trend. We are keenly aware of what we do not want in medicine. We talk about physician burnout and its impact on doctors’ lives. We know firsthand the effect the EMR has on the doctor-patient relationship as doctors spend less and less time in direct patient care activities. And we are learning how to navigate …

Convincing patients to stop cancer screening isn’t always easy

Nancy L. Schoenborn, MD

Physician

August 19, 2019

During my training to become a primary care physician, the importance of preventive cancer screening was ingrained in me. The idea of catching cancer at an early stage so we can better treat it made intuitive sense. But as I’ve learned over the years, the simplicity of this concept can obscure its limitations and make it difficult …

What is low-value care, and why does it matter?

Edward Hoffer, MD

Physician

August 19, 2019

Doctors and policy wonks hear a lot these days about “low-value care.” What exactly is that, and should you care?

The term refers to tests, medications, and procedures that add little to a patient’s health or well-being but which cost them or the system more money than any benefit warranted. Some of the earliest research that looked at this was done at Dartmouth, where they found enormous variations in the cost …

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