Primary Care

The problem of conflicting professional medical guidelines

Physician
June 5, 2012

Guidelines for care increasingly help guide medical decision-making. If you’ve followed top health news over the past several years you’ve read conflicting statements about the utility of various medical procedures and tests. As a general internist I’ve devoured these reports with particular interest trying to wade through bias to formulate views that I believe will be of most benefit to my patients.

Recently I put together a talk about recommendations for …

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What does a perfect pediatrics practice look like?

Physician
May 15, 2012

I had a phenomenal day in clinic yesterday. Imperfect for sure but inspiring, connected, and busy. I felt useful and like anybody else, that feels so good to me. Productivity can be defined in various ways and yesterday I fulfilled my personal definition. I wrote an email to a friend and cardiologist this morning where I said, “But I must say, it’s a sincere fortune to be a doctor some days. Yesterday …

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Primary care requires more than knowledge

Physician
May 11, 2012

“You are too smart to do primary care.”

I have heard this far too many times, directed at me and at others seeking career advice.  There are many reasons for the shortage of primary care doctors in the U.S., but at least part of it is this.  Smart, capable, successful trainees are discouraged from choosing primary care.  It is perceived as a less prestigious pathway than specializing.

The knowledge base of primary …

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The implications of provider versus doctor

Physician
April 13, 2012

I am used to being called a “medical provider” instead of a doctor or a physician these days, but it makes me think about the implications of our choices of words. The word “provider” was first used in non-medical contexts over 500 years ago. It is derived from the Latin providere, which means look ahead, prepare, supply.

“Medical provider” is part of the Newspeak of America’s industrialized medical machine. …

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When it comes to medical care, honesty is essential

Physician
April 9, 2012

Have you ever said, “I’m going to be perfectly honest with you” or something to that effect?  Have you ever had someone tell you that they were going to be perfectly honest with you?  Have you ever thought about what statements similar to these really mean?  You should.

Trust is an earned commodity and hard to get back once lost.  “Doc, I’m going to be perfectly honest with you” means that, …

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When doctors are called providers

Physician
April 7, 2012

Impersonal and self-absorbed as Manhattan may be, it’s still embarrassing to cry on West 32nd Street.  I looked for a store, any store, and ducked inside.  The pace of my steps and angle of my head as I buried myself into a back corner, thumbing through pants twice my size, gave me away.  A store clerk walked over and asked if I was okay.  I knew I’d have to meet …

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8 reasons why I love my patients

Physician
April 6, 2012

A few months ago, I came out with a post on why I love my own doctor. Today I want to celebrate my patients, both past and present.  For me, without the experience I have had over the past 14 years, I would not have enjoyed medicine quite as much as I do.

What I like the most about medicine is the ability to interact with people. That’s what clinical medicine is all …

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10 strategic questions to ask yourself about the future of health care

Policy
March 19, 2012

Today and for the next few years the weather of this industry will be dominated by pervasive, discontinuous change. Structures, revenue streams, relationships of every level: All are shifting in fundamental ways. Specifically, the weather will be driven by:

i) invention and propagation of new business models;
ii) shifting risk onto both the provider and the patient, accompanied by building of new risk-based relationships, contracts and alliances;
iii) smart primary care coming to …

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Why this pediatrician quit medicine

Policy
March 17, 2012

There are an awful lot of reasons that led up to my eventual resignation from a career in primary care medicine.  I don’t know that any one of them is more important than the other (it really just depends on which day you ask me).  One that stands out for me though as a universal problem shared by millions is Managed Health Care, and the imposition it has posed on …

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Is it necessary for a doctor to examine you on each visit?

Physician
March 5, 2012

A tug-of-war is going on in medicine right now between the past and the future. The present is confused and very unsure of itself.

Though I could be writing about health care in the U.S and the looming Supreme Court battle over the new health care law, I’m actually raising a much more intimate issue: Whether your doctor touches (examines) you or not.

Many pundits have weighed in on whether the …

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Doctors need to stop being so complacent

Physician
February 24, 2012

Four brutally honest declarations:

1. I can perfectly decide what is best for myself, my family, my patients, and my practice. I don’t need outside guidance telling me how to lead.

2. I decide what works best on my terms to practice the best medicine.

3. I will succeed and lead because I am focused on my goals just as much (if not more) than my patient’s goals.

4. My goal is to make …

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Advice to prospective family medicine residents

Education
February 7, 2012

I don’t like selecting colleagues through the Match. The process was established to allow students to get the best opportunity available and I feel that our program (and our patients who rely on our trainees to provide care) is in jeopardy every year. It always turns out better than I anticipate, so I shouldn’t complain. However, we have to interview 60 prospective residents to fill our six slots so …

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Diagnosing an illness is an art

Physician
January 27, 2012

Diagnosis is the foundation on which all care and treatments rest.  If the diagnosis is wrong, most probably so is the treatment.  Diagnosing an illness is an art.  A diagnostician needs to be one part scholar, one part detective, and four parts artist.  He has to be a good listener, open minded, and capable of assimilating a large amount of sometimes confusing data into an accurate picture of a disease …

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Doctors: Don’t be ashamed about going bankrupt

KevinMD
January 5, 2012

Are doctors really going broke?

According to this piece from CNN Money, some are: “Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat. But some experts counter that doctors’ lack of business acumen is also to blame.”

That’s all entirely true.

Pressure on reimbursement, combined with a lack of …

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Our healthcare system is unfair and unbalanced

Policy
January 5, 2012

About six weeks ago, while in clinic, I developed pain in my stomach — specifically, in my right upper quadrant, just below the ribs.  I had experienced this a few times before, but this time it seemed more persistent than usual.  Following the rule that physicians make the worst patients, I kept working through it until my nurse told me I looked poorly, and made me see my own primary …

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Should healthcare providers hug their patients?

Physician
January 3, 2012

Imagine this scenario. You are a male health care provider and you complete an evaluation of a woman close to your age. You establish good rapport as you always do, she laughs at some of the same jokes you make with all patients, and she expresses delight that you are listening to her problems (unlike those other providers she says she has seen), feels you are helping her, and is …

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How political correctness interferes with healthcare

Physician
December 14, 2011

Political correctness and sensitivity training are interfering with medicine and healthcare. In a recent article published in the journal, Pediatrics, a group of researchers published their findings regarding parental perceptions of the terminology that doctors use to describe childhood obesity (ages 2 to 18). The researchers found that it was undesirable to use the term “fat,” “obese,” or “morbidly obese” because they were stigmatizing, blaming, and the least motivating to …

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Young doctors don’t see value in primary care careers

Physician
December 5, 2011

In my new role as one of the directors of an internal medicine training program, I help select new interns out of medical school for the three year training stint of residency.

At the end of residency, many graduates go on to subspecialty fellowships, another two to four year period of intensive training in fields like cardiology, nephrology, critical care etc.

For those that don’t choose a subspecialty, one choice remains: traditional …

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Are doctors given more responsibility than they can handle?

Physician
December 5, 2011

Doctors inevitably come into spotlight, being at the front end of health care delivery. Sometimes seen as guardian angels restoring health and life, other times, greedy minds sucking resources while they carelessly harm and kill patients to fill their wallets. After experiencing, observing, and hearing from others like me, I wonder if doctors are given more responsibility than they can handle, often attributed more aura than they deserve and frequently …

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