Primary Care

A physician investigates the American Board of Internal Medicine

Wes Fisher, MD

Physician

January 7, 2015

Is it medically professional for a non-profit organization to use physician testing fees to “choose wisely” a $2.3 million luxury condominium complete with a chauffeur-driven BMW 7-series town car? In my view, obviously not. To most people, such an action would conjure up images of hypocrisy, waste, and corruption.

After a review of public and tax records, it appears to me this is exactly what has happened.

Background

In 1999 for reasons that …

A prescription to treat polyprovider syndrome

P. J. Parmar, MD

Physician

January 4, 2015

In the United States, we train health care providers on poor people. This is no secret — most medical schools and residencies are in lower income areas. If you have Medicaid or no insurance, you are more likely to find care in an office or hospital where medical students, residents, nursing students, and other trainees rotate; Blue Cross patients don’t let interns watch their childbirth. Even though my residency emphasized …

How the kind, humble physician met his demise

Jordan Grumet, MD

Physician

December 30, 2014

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There once was a kind, humble physician who worked for years in an office building across the street from the hospital, toiling day to day to take exceptional care of his patients. He was open and deliberate, calm and thoughtful. He himself hired every secretary and medical assistant, every nurse, and biller. His staff formed a protective family who fiercely advocated …

Dear HMO, I don’t want your money

Victoria Dooley, MD

Physician

December 24, 2014

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Dear HMO,

As I prepare to #getcovered or #staycovered, I realize that as a physician, I have an advantage in that I know what specific types of insurance plans would best fit my needs. Unfortunately, this is not the case for many Americans. Most importantly, I know to avoid signing up for certain health maintenance organizations (HMOs). Although I am a strong …

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Dear HMO, I don’t want your money

Don’t quit medicine. Here are 5 reasons why.

Suneel Dhand, MD

Physician

December 18, 2014

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There’s been a lot of talk recently about low morale and disgruntlement among doctors. A recent article on focused on a list of reasons when doctors know it’s time to quit. I found the article a bit sad and unfortunate, but I’m sure the feelings behind it were sincere.

Another excellent article in the Wall Street Journal last week extensively discussed the factors behind …

Medicine is complex, but doctoring is viewed as being simple

Hans Duvefelt, MD

Physician

December 14, 2014

I keep six honest serving-men
(They taught me all I knew);
Their names are What and Why and When
And How and Where and Who.
– Rudyard Kipling

Medicine has become a very complex, multifaceted science, ranging from pharmacogenetics to psychoneurobiology. Doctoring, however, is increasingly viewed as so simple that you don’t actually have to be a doctor to know how it should be done.

What else could explain why IT people tell doctors what “workflows” …

A doctor goes networking, and is horrified by what she finds

Abigail Schildcrout, MD

Physician

December 11, 2014

I was invited to a “networking party.” I went. I was horrified by what transpired there. And disgusted. And felt blindsided. And angry. And blown away by the prevalence of what I couldn’t decide was greed, ignorance, or an unseemly combination of the two. And what magnified the intensity of my repulsion was the fact that a large proportion of the people involved have the …

After residency: I’m scared to practice outpatient medicine

Rebecca Crow, DO

Education

December 3, 2014

As a graduating senior resident I’m scared to practice outpatient medicine. In a community of patients and physicians crying out for primary care doctors, what are we doing at a training level to foster and promote confidence and independence at doing this?

Many bright eyed freshly graduated medical school students enter residency understanding the need and embodying the hope of pursing outpatient …

Why teaching anatomically correct words matters

Natasha Burgert, MD

Physician

December 2, 2014

As a doc, I need to take care of the whole child. I do this with respect for every kiddo; and with their parent’s consent, presence, and permission. Sometimes the job includes discussing or examining a child’s genitals.

In the past, it was not thought of as appropriate to allow children to speak openly about sensitive anatomical areas (“private parts.”) Growing up as kids, we may have …

Two patient result letters: Which one did this physician send?

Lucy Hornstein, MD

Physician

December 2, 2014

Middle-aged lady, twenty pounds overweight.

Doing everything I can, doctor. Everything imaginable. Diet: I eat practically nothing. Exercise: all the time! Weight Watchers doesn’t work. Jenny Craig, South Beach, the Zone; I’ve tried it all. Nothing works. Have to lose weight. Have to lose weight.

Yada, yada, yada.

Oh look: A few years back I diagnosed you as hypothyroid and gave you some Synthroid. …

Medicare will pay for care coordination. Should doctors take the money?

Richard Hodach, MD, PhD

Policy

December 1, 2014

CMS recently announced it would begin next January to pay physicians for care coordination activities. It’s about time. As physicians have been saying for some time, any payment system that hopes to encourage value (better patient outcomes) has to start by paying physicians to coordinate the care of their patients. When physicians follow up on referrals or communicate with patients outside of the office, healthoutcomes improve, costs shrink and the patient …

Consider the lipstick sign in your next physical exam

Elizabeth Horn, MD

Conditions

December 1, 2014

The lipstick sign is an underutilized physical examination finding which can assist in the evaluation and assessment of the elderly female patient. While poorly applied lipstick can result in considerable embarrassment and anxiety in this patient population, those who present with properly applied lipstick demonstrate mastery of multiple domains of functioning.

Fine motor skills and concentration can be correlated with a positive …

What a messy house has to do with medicine today

Abigail Schildcrout, MD

Physician

November 25, 2014

I spent this past week worrying that my in-laws were going to divorce me. For sure. No getting out of it this time.

I do not keep a neat house. There are piles everywhere. Piles of books. Piles of papers. Piles of clean-but-unfolded laundry. Piles of mail. Piles of music. Piles (believe it or not) of instruments. Piles of shoes. Piles of …

It’s time to tell fast medicine to slow down

Richard Gunderman, MD, PhD

Physician

November 11, 2014

Americans tend to like fast things: instant coffee, sports cars, and speed dating. Many share a fascination with record holders, such as the world’s fastest runner or texter. And increasingly, the same goes for medicine. The number of minute clinics is exploding. Some emergency rooms now post their current wait times on roadside billboards. And increasingly, physicians and other health professionals …

When you can’t share experience: The power of listening

Abigail Schildcrout, MD

Physician

November 11, 2014

I just recently attended a meeting where there was a panel discussion on caring for Holocaust survivors. The person who opened the meeting spoke about how she felt inadequate when dealing with this population because she had no personal place of reference — she had no family members who died during the Holocaust, and so she couldn’t truly understand what the survivors went through.

I have a different thought.

Although every experience …

Fall in love with medicine again

Starla Fitch, MD

Physician

November 11, 2014

An excerpt from Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine.

A doctor’s self-worth can be tied up with a lot of issues.

How well can we make a diagnosis?

How elegantly can we perform the surgery?

How happy are our patients? Our staffs? Our families?

How many articles …

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Fall in love with medicine again

5 ways to increase your EMR efficiency

Brian Anderson, MD

Tech

October 28, 2014

One of the major reasons that health care providers resist implementing an electronic medical record (EMR) system is the belief that using it will decrease provider productivity, reducing the number of patients they can see and therefore reducing practice revenue.

However, an EMR that is designed around a streamlined workflow can enable providers to work faster and more efficiently. Having an EHR and vendor that can give you ongoing visibility and …

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5 ways to increase your EMR efficiency

Why your doctor won’t refill prescriptions over the phone

Michael Kirsch, MD

Meds

October 13, 2014

Giving prescription refills is not quite as fun as it used to be. Years ago, we doctors would whip out our prescription pads — often sooner than we should have — and we’d scribble some coded language that pharmacists were trained to decipher. I’m surprised there were not more errors owing to doctors’ horrendous penmanship. On occasion, the Food and Drug Administration (FDA) would require a pharmaceutical company to change …

Why do doctors still use pagers?

Fred N. Pelzman, MD

Physician

October 12, 2014

I was on call last night.

Don’t get me wrong, this is not as bad as it sounds.

With over 20 partners sharing evening call, and residents getting the calls first, we do not have it bad at all. And certainly nothing like my obstetrician friends, who seem to go in every time they are on call for labor and delivery and then …

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Why do doctors still use pagers?

The problem with primary care residency programs

Susan Putnins

Education

October 8, 2014

“I’ve been with my doctor for years and years,” an elderly man, voice hoarse but lilting with fondness for his caregiver, told a nurse in the primary care clinic where I was waiting to see a doctor. “He’s fantastic.”

I was coming to the clinic for a follow-up appointment about an injury for which I’d been seen a few months prior, but neither the initial appointment nor this follow-up were with …

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