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 problem with these specific words in health care

John Corsino, DPT

Health Policy

April 30, 2019

Words are powerful. So few symbols can evoke such deep feelings and rouse incredible emotion: “I have a dream.” Language is the achievement that makes us who we are. But while you, I and everyone else employ the same words to communicate shared ideas, what those words mean precisely to each of us — among the many views and opinions that make us unique individuals — can be very different.

I …

When is a check-up not a check-up?

Edward Hoffer, MD

Conditions and Diseases

April 26, 2019

Kaiser Health News told the story of a 69-year-old woman who went to a new doctor for her annual check-up, assuming it was covered by Medicare and was happy with the visit until she got a $400 bill.

Most Americans believe in “annual check-ups,” at which your doctor reviews your medical history, gives you a thorough physical and orders lab tests. The actual value of such visits has been questioned, but …

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When is a check-up not a check-up?

Sorry doctors, you’re nothing special

Irene Tien, MD

Physician

April 25, 2019

When I was a child, I knew I would become a doctor. I liked science and taking care of people. We diagnose medical problems and prescribe treatment plans. Some of us perform surgeries and some focus on keeping you well. Despite this, I’m nothing special, and neither are you, my physician colleagues. Let me explain why by first taking a brief step back into the history of American health care.

Since …

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Sorry doctors, you’re nothing special

The physician who is a poor conversationalist

Christopher Johnson, MD

Physician

April 23, 2019

This article concerns what I call the poor conversationalist. There are several common versions of this, and all of them have corresponding parallels in nonmedical settings. Often the most basic difficulty is one of manner. A good conversationalist is a person who, no matter what he is thinking, outwardly projects an air of interest in what the other person is saying. The doctor who acts distracted, hurried, or even uninterested …

What do we want our health care system to look like?

Fred N. Pelzman, MD

Health Policy

April 22, 2019

I think the time has come for us all to do a little more than put our 2 cents in.

Our health care system is a mess, and while many of us fighting in the trenches and taking care of patients are working to make things better (despite the best efforts of much of the rest of the system), the challenges and …

In the era of team-based care: Some decisions have to be made alone

Hans Duvefelt, MD

Physician

April 16, 2019

There is a lot of talk about team-based care nowadays, and I had seen some shining examples of that, most recently when a patient at my clinic had a suicide in the family.

But at the same time, there are so many decisions – judgment calls, really – that we make every single day where there isn’t anywhere near enough time to involve team members.

I talk to patients all the time …

Medical education fails trainees interested in primary care

Scott Hippe, MD

Physician

April 16, 2019

“She is meant for more than just primary care,” mused an attending on my internal medicine rotation in medical school. He was referring to a particularly adept resident with whom we were working. This resident was planning on practicing clinic-based general internal medicine. I wasn’t sure why this attending disclosed his thoughts regarding this resident to me, but the implication was clear: “primary care” — whatever is meant by the …

Telemedicine and access: Leave no patient behind

Aditi U. Joshi, MD

Health Technology

April 15, 2019

Telehealth, using video to have an acute medical care visit, puts some of the power of choice back into our patient’s hands. To best frame telehealth and its use cases, the National Quality Forum published a report in 2017, outlining the following four buckets which I find especially useful with evaluating programs and interventions:

access
cost savings
effectiveness
experience

This post is specifically about access and telehealth. I’m an emergency physician …

5 ways to address the issues of direct-to-consumer health products

Anna Wexler, PhD and Steven Joffe, MD

Physician

April 11, 2019

Health products are increasingly moving from the realm of the medical professional to the consumer. Direct-to-consumer (DTC) versions of teeth alignment kits, genetic tests, hearing aids, heart-rhythm monitors, neurostimulation devices, and mental health tools are already on the market, causing professional organizations of dentists, geneticists, audiologists, cardiologists, neurologists, and Read more…

5 ways to address the issues of direct-to-consumer health products

When doctors are poor explainers

Christopher Johnson, MD

Physician

April 10, 2019

A physician, like anyone, can be a poor explainer of things for several reasons, but foremost among these is the tendency to use medical jargon. This is not a problem unique to doctors. When I take my car in for repairs, I often must ask the mechanic to explain what is wrong in a way I can understand. I have a rudimentary understanding of what the various parts of the …

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When doctors are poor explainers

Work-life balance is hard. Here’s how this physician does it.

Erin McAdams, MD

Physician

April 8, 2019

Work-life balance is hard, and that’s true for so many career options both in and out of the medical field. The topic is something that you consider as you choose a career path. It’s something that you struggle to achieve and maintain as you train for your job, and as I have found out over the past eight months, something that you have to invest energy into after finishing training …

What do we do when guidelines come crashing into the real world?

Fred N. Pelzman, MD

Physician

April 8, 2019

Every day, as we care for our patients, we are placed in a unique position, where we are armed with the world of literature, randomized controlled trials, society recommendations, national screening and practice guidelines, and more, working to prompt us to try and do what’s best for each patient in a vast array of clinical situations.

And patients come to us armed …

Our doctors are feeling the emotional burden of the state of health care

Michele Luckenbaugh

Patient

April 5, 2019

Death is an inevitable part of the journey of life. We all have experienced its effects: the death of a family member, the death of a friend or those special individuals who we might have barely known but who left an indelible mark upon our consciousness of living.

I will share with you a remembrance of someone who was loved very much by all who knew her and who left the …

Policymakers: Put down your carrots and sticks. They will not work.

W. Ryan Neuhofel, DO, MPH

Health Policy

April 5, 2019

As a family physician in the trenches, I routinely see blatantly poor medical care in the history of my new patients. Far too many people get unwarranted medications and tests, while important things go unrecognized or unaddressed. This paradox is maddening.

We must do better.

To this end, policymakers have developed programs to promote “quality” and “performance” among clinicians. The main approach has been altering payments to serve as financial incentives and …

It is time for physicians to reclaim the power of touch

Adrienne Youdim, MD

Physician

April 4, 2019

I have three kids — all with very different temperaments and different personalities. Sometimes I use the term superpower to identify and cultivate their strengths and greatest attributes. I have always believed that my superpower is connection. It is a value I hold dear and a quality that has allowed for authentic alignment in my work as a physician. Connection underlies the strength of a secure therapeutic relationship and enhances …

What caring for 6 generations can teach new doctors

Steven Kamajian, DO

Physician

March 30, 2019

“Hi, Doctor Kamajian! I finally got health insurance that I can use to come to see you with my son.”

I looked at the chart and realized it had been three years since I had seen her very familiar face. So, before the exam, we chatted and got reacquainted. It is remarkable what family doctors remember about their patients. This is not an unusual conversation.

Patient: I have a new job. I took …

6 essential tips (and more) that I never learned in medical school

Annette Chavez, MD

Physician

March 28, 2019

1. Cover your patients

It was my first year of practice. One day I saw a new patient, a 25-year-old man with hemorrhoidal pain. My nurse told him to disrobe and put on a lap sheet. When I entered the room, I was surprised to see that the young man was sitting on the exam table, naked from the waist down. The lap sheet sat neatly folded on the table behind …

How Big Medicine is hurting patients and putting small practices out of business

John Machata, MD

Health Policy

March 27, 2019

Recently the CEO of a large health care network stated: “Market forces don’t apply to health care.”

Of course, economic and political forces apply to health care. Big Medicine’s most powerful entities (insurers, hospitals, medical schools, pharmaceutical companies, pharmacies, and government agencies) formulate health care policy to enrich themselves at the expense of patients and small, independent medical practices.

As an independent family doctor, my practice’s existence is in jeopardy. Small physician …

A physician’s secret to restore joy in the exam room

Omar Bukhari, DO

Physician

March 27, 2019

As someone who has been in the medical field for nearly ten years, I have had the opportunity to follow many physicians. I started off shadowing physicians, standing behind them as they would speak to patients in their rooms.

Now, as a resident physician, I spend hours and hours each week in the clinic seeing my own patients. Every week, I read about burnout and how it affects fellow physicians deal …

The patient-clinician relationship matters. To all of us.

Quinn Bensi, MD

Physician

March 26, 2019

“The patient-clinician relationship is dead.” Those of us in health care hear this refrain constantly these days, coming at us from all angles. We feel it in the wall that goes up when we turn from our patients to our computer screens. We infer it in administrative meetings in which we are told once again to get our numbers up, or when yet another physician is let go, technically “without …

Primary Care

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