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.

Medicine claims the life of a physician heroine

Cory Michael, MD

Physician

July 28, 2019

Peg began internal medicine residency with altruistic goals. She didn’t want to become a specialist or seek personal financial wealth. She just wanted to help people. With a prior career related to her degrees in art history and sculpture, she had a unique way of truly embracing medicine as an art. Rarely spotted without a smile on her face despite long training hours in the hospital, she eagerly embraced taking …

Paltering: When the truth is used to deceive

Shannon Casey, PA-C

Conditions and Diseases

July 28, 2019

One evening in the clinic’s bullpen provider office, a colleague of mine wondered aloud how to respond to a difficult question a patient asked via patient portal message. A physician within earshot responded, “Just because someone asks you a question doesn’t mean you have to answer that question.”

I tried to empathize with where the physician was coming from. Surely after decades of practicing medicine, one might become weary of spending …

Scope of practice expansion: Patient safety is sacrificed for greater access

Suzanne M. Everhart, DO

Health Policy

July 24, 2019

When a patient seeks the care of a professional, they expect that person to be well trained, experienced, and constantly continuing their education. As an ophthalmologist, I completed a 4-year undergraduate program at Virginia Commonwealth University, 4 years of medical school training at The University of North Texas Health Science Center, a year of a rotating internship, and a 3-year residency program in ophthalmology at Tulsa Regional Medical …

Why we must embrace medical uncertainty

Philip A. Masters, MD

Physician

July 23, 2019

A guest column by the American College of Physicians, exclusive to KevinMD.com.

In the late 1800s, William Osler stated, “… if you want a profession in which everything is certain, you had better give up medicine.” He made this observation at a time when the science underlying health care was nascent, and little was understood …

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Why we must embrace medical uncertainty

Doctors, listen up! You’ll be a patient soon.

Michele Luckenbaugh

Patient

July 20, 2019

As I age, the probability of acquiring yet another health condition seems to, unfortunately, increase. There’s always one test or another that is on my to-do list, be it bloodwork, X-ray, MRI, or maybe a CT scan thrown in for good measure. I comply usually with a sense that it is for the benefit of my health, i.e., to enable my doctors to determine the best mode of treatment for …

Why doctors should never practice self-primary care

Deborah R. Alpert, MD, PhD

Physician

July 20, 2019

I am a mid-40s female rheumatologist. Fortunately, I consider myself to be fairly healthy; my diet and weight are OK, I run 30 to 35 miles per week, and my only medication is a low-estrogen oral contraceptive that I have been self-prescribing for years. Work and life are busy, and my health maintenance could be better. I have been getting regular mammograms since age 40 (some self-prescribed), maybe I see …

Medicine is my passion. I love my job, but I am human.

Kacey Gibson, DO

Physician

July 19, 2019

I am a small-town family physician, and I am blessed enough to be living my dream.

You see, I have always wanted to be a doctor. I cannot think of one other occupation choice that has ever entered my brain. I have wanted this since I was four-years-old, and I can remember in vivid detail telling the world this was what I was destined to be.

So what happens when your dream …

Be Bowser, not Mario in your medical practice

Phil Boucher, MD

Physician

July 17, 2019

Anyone familiar with Nintendo’s Mario franchise is probably very confused by the title of this blog but stay with me here.

My kids have recently become obsessed with Mario. It’s brought back great memories from my childhood of playing Super Mario World on the Super Nintendo Entertainment System way back in the day and “Super Mario Bros.” before that.

As I’ve assisted my kids in defeating a boss here or there, I …

How technology ruined, and can save, the doctor-patient relationship

Robert Pearl, MD

Health Technology

July 16, 2019

Each year, Medical Economics surveys physician readers to find out what irks them most. Topping the latest list: insurance paperwork, followed closely by electronic health records (EHRs).

The reason is the same for both. Insurers and EHRs get between doctors and their patients.

When it comes to medicine’s computer problem, the obstacle is literal. Doctors sit behind a screen, focused on the EHR and not the patient. …

Patients: Take back your health information. Here’s how.

David M. Mitchell, MD, PhD

Health Technology

July 16, 2019

Have you ever wondered why your personal health information essentially belongs to your health care provider or institution? I mean: why do they keep your information under lock and key, and you have to sign a release to get it? After all, it’s your blood that they just pulled out and tested, it’s your body they just shot up with X-rays or operated on — and you paid for these …

Our medical training has been outsourced

Katie Klingberg, MD

Physician

July 15, 2019

Reflexively, I often feel my breath catch, and my eyeballs roll ever-so-slightly when a patient leads with, “I saw on the internet …”

The precious minutes available to connect, inspect, and direct the management of their Google search are suddenly squandered by backtracking to reassure the bug bite will not turn into the bubonic plague!

Our medical training has been outsourced to Wikipedia and WebMD.

Today we all stand guilty believing we are …

The line between family member and personal doctor

Brian Vukelic, MD

Physician

July 12, 2019

I, like many physicians, am the only doctor in my extended family. To say that they are proud is probably an understatement. I’ve been a practicing physician for seven years now and yet my grandmother each time I see her greets me with, “There’s my doctor grandson.” I have worked quite hard to get to where I am, and I enjoy what I do. I, too, am proud to be the …

Why medical writing is essential to medicine

Steven Zhang, MD

Medical Education

July 11, 2019

I wasn’t as happy as I expected to be when I walked out of the hospital on my last day in medical school. But then again, there was little to celebrate — my last few patients had terminal cancer, a stroke, and end-stage liver disease from alcoholism. I signed off my patients to my resident, and so, my medical school career came to an unceremonious end. I thought to myself …

The art of off-label prescribing

Hans Duvefelt, MD

Medications

July 10, 2019

Some drugs are used for indications beyond their original FDA approved ones that make complete sense. I mean, if old seizure medications help nerve pain, it might be reasonable to try new ones for the same purpose if everything else fails.

Sometimes the broader use of a medication leads to additional FDA approved indications. One good example is bupropion, Wellbutrin, for smoking cessation. It even got a new name for that indication, Zyban, …

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The art of off-label prescribing

What to do with disparaging doctors

Christopher Johnson, MD

Physician

July 5, 2019

Doctors who disparage, or even ridicule, what parents tell them are, fortunately, rare. Nevertheless, sometimes parents may infer from what the doctor says or how he acts that he does not value what they are telling him, even though he did not mean to imply such a thing. All physicians have had the experience of overly touchy parents inappropriately assuming from our questions that we do not respect their ability …

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What to do with disparaging doctors

Why is it so difficult for Americans to make doctors’ appointments?

Peter Ubel, MD

Health Policy

July 3, 2019

Jill Ladkin was already having a terrible autumn. It began with a seizure that put her in the hospital with what seemed like scores of unfamiliar physicians attending to her state of health. The brain scan revealed a mass in the lining of her brain, a location usually signifying a benign tumor; but, given her seizure, the tumor was hardly what you would call a harmless growth. The surgeon had a theory of what …

In the age of EHRs, why are we still asking patients to fill out paper forms?

Fred N. Pelzman, MD

Physician

July 3, 2019

From the sublime to the ridiculous.

That’s sort of how my day went yesterday.

It started out with an early morning meeting with a colleague who has been implementing a telehealth program at one of our institution’s practices, learning about how they have been using this technology, some of the bumps in the road they’d hit, and how they’d been able to …

A key strategy to use for difficult conversations: Ask questions

Suneel Dhand, MD

Physician

July 2, 2019

No matter what profession you are in, having uncomfortable and difficult conversations is something you have to get used to. Tim Ferris said in his bestselling book, The 4-Hour Workweek (which I’d highly recommend), “A person’s success in life can usually be measured by the number of uncomfortable conversations he or she is willing to have.”

It could be with another colleague, a client or customer. Even in your personal …

Physicians are problem solvers and artists

Hans Duvefelt, MD

Physician

July 1, 2019

I keep thinking about the dichotomy between covering a lot of ground and getting to the point.

The other day I saw my bosses at one of my clinics stop in their tracks when I suggested that a lot of the things we are measured on as physicians could be turned into standing orders and simply get shifted off my plate. I have just created a letter that anybody can send …

Why patients should read their medical notes

Edward Hoffer, MD

Physician

June 26, 2019

For centuries, doctors felt that their notes were their property, and none of the patients’ business. This attitude slowly shifted, and the Health Insurance Portability and Availability Act (HIPAA) of 1996 put into law the fact that patients must be allowed to review and get copies of their medical records. Despite this, access to records has remained a daunting task for many. A study done in 2017 of 83 hospitals, …

Primary Care

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