Primary Care

Why physicians are hesitant to take Medicaid patients

Peter Ubel, MD

Policy

November 18, 2013

In an earlier post, I presented some data on which kind of physicians in the United States are most and least likely to see new patients who receive Medicaid, the state/federal program to pay healthcare costs for low income people. Now a recent study lays out some reasons why many physicians are so reluctant to see such patients.

Not surprisingly, it starts with low reimbursement rates. Medicaid pays about 61% …

Doctors need to remember that they need to be human first

David L. Katz, MD

Education

November 14, 2013

In medicine, we pledge: primum non nocere. First, do no harm. But before we can do no harm as doctors, we need to be doctors. And before we can be doctors, we need to be human beings. Being a doctor is a great privilege, but it is a subordinate privilege. Being human comes first.

I distinctly recall the time in my medical education when I realized I was becoming more medical …

3 words that define a philosophy of care

Rob Lamberts, MD

Physician

November 12, 2013

To what end?

Those three words have become something of a mantra, a mission, a philosophy of care.

To what end do I prescribe a medication?
To what end do I make a diagnosis?
To what end do I order tests?
To what end am I documenting?
To what end is there a patient record?
To what end do I send a person to a specialist?
To what end do patients need to come to see me in …
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3 words that define a philosophy of care

Understanding the intersection of health care and social services

Elizabeth H. Bradley, PhD and Lauren A. Taylor, MPH

Policy

November 10, 2013

Providers in all parts of the health care system recognize that troublesome social conditions drive much of their work and costs. Major challenges in people’s social circumstances — layoffs, foreclosures, accidents, violence — can create horrific health care needs, many of which become chronic and carry high price tags. These extreme needs are omnipresent in the nation’s hospitals, which care for about 37 million admissions at a medical expense of …

How a letter of intent can help with physician recruitment

Bo Claypool

Physician

November 9, 2013

As someone who has recruited a very large number of physicians over the years, I am quite sold on the benefit of a “letter of intent” or “LOI” as a tool for physician recruitment.

While physicians are highly familiar with medical/surgical concepts and while many are in no way intimidated by dissection within the human body, many to most are not qualified or really desirous of dissecting a complex legal document …

JAMA removes cover art, and why that matters

Jeffrey M. Levine, MD

Physician

November 6, 2013

JAMA_beforeafter1a

Beginning in 1964 the Journal of the American Medical Association (JAMA) started publishing full color images of art on its cover accompanied by insightful essays. JAMA’s former editor, George Lundberg, wrote that this was part of an initiative to inform readers about nonclinical aspects of medicine and public health, and emphasize the humanities in medicine. Now after almost 50 years of covers …

Should smokers pay higher health insurance premiums?

Carol Duh-Leong

Policy

November 4, 2013

While the Affordable Care Act ends the era of denying people with pre-existing conditions access to health care, it allows insurance companies to charge tobacco users up to 50% more for their monthly premiums. Tobacco use for this purpose is defined as any self-reported tobacco use four or more times a week within the past six months. There are excellent intentions behind this policy — smoking is the number one …

Why I recommend LinkedIn to physicians

Kevin Pho, MD

KevinMD

October 31, 2013

linked in for doctors

When I talk to physicians about dipping their toes into the social media waters, I advise starting with LinkedIn. Spend about 45 minutes or so and create a LinkedIn profile, which is essentially a digital translation of your CV. LinkedIn profiles get ranked highest among the social media platforms, and can push down the influence of …

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Why I recommend LinkedIn to physicians

Self-preservation: Why I abandoned clinical practice

Diane W. Shannon, MD, MPH

Physician

October 25, 2013

When I introduce myself as a physician who left clinical practice, non-physicians ask me why I left. They’re generally intrigued that someone who sacrificed many years and many dollars for medical training would then change her mind. But physicians, almost universally, never ask me why I left. Instead, they ask me how. They call and email me with logistical questions, wanting to learn the secret of how I managed the …

A new tagline for direct primary care

Rob Lamberts, MD

Physician

October 21, 2013

He seemed a bit grumpy when he came into the office. I am used to the picture: male in his early to mid-forties, with wife by his side leading him into the office to “finally get taken care of” by the doctor. Usually the woman has a disgusted expression on her face as he looks like a boy forced to spend his afternoon in a fabric store with his mother. …

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A new tagline for direct primary care

Why doctors need to be more like Malcolm Gladwell

Kevin Pho, MD

KevinMD

October 17, 2013

In case you haven’t heard, Malcolm Gladwell recently released his book, David and Goliath. I’m just about finished reading it.

Just as interesting as the book are its reviews. In a recent post from Slate, Gladwell himself responds to the criticism. He freely admits that his books should not be held as pinnacles of academic rigor, but should be considered “intellectual adventures stories.”

He further elaborates on the power …

Patient engagement is the blockbuster drug of the century

Dave Chase

Policy

October 16, 2013

Historically, the “do more, bill more” fee-for-service model of healthcare measured success by increased billings. In the fee-for-value era, we need a new framework for assessing healthcare results. Quality indicators are logical but they are mostly geared towards measuring actions taken. We can borrow a concept from the energy sector for an additional metric. We need a concept for removing waste and unnecessary care that could be inspired by a concept …

Hostile dependency: The real reason for physician burnout

Wes Fisher, MD

Physician

October 14, 2013

A piece recently appeared in the New York Times entitled “Who Will Heal the Doctors?”

The piece is written by Donald Borstein and I encourage all to read it. Mr. Bornstein offers a solution to the doctor burnout problem in health care, a course called “The Healers Art,” now being promoted in US medical schools that uses “mindfulness” as his means of creating compassionate, caring doctors as a way forward.

I should say …

How can we revise the patient medical record?

Fred N. Pelzman, MD

Physician

September 22, 2013

So what exactly do we want a patient-centered medical record to look like?

What is the point of a patient’s medical record? Historically it has served many functions. Perhaps the time has come to reassess what it needs to be, what it can and should be.

If a healthcare provider from one or two generations ago were to look into a patient’s chart today, would they recognize what they saw? Would they …

This is the grim reality of starting a private primary care practice

Davis Liu, MD

Physician

September 20, 2013

She was the first Michigan Wolverine I met who taught me their college fight song “Hail to the Victors,”and demonstrated their rabid pride anytime football or basketball season rolled around. (If you know people from the University of Michigan, you know what I mean). She was also one of the smartest and hardest working doctors in our family medicine residency program and one of our two chief residents.

So …

The difference between health care and disease management

Natasha Deonarain, MD, MBA

Physician

September 14, 2013

It’s no secret that America is suffering from a huge crisis in healthcare. As we watch the sun rise on Obamacare, doctors, patients, insurance executives, hospitals, small businesses and legislators alike stand agape. No one seems to have found a simple, logical solution.

The solution is in fact very simple. It’s so ridiculously simple, it might make one laugh. And, believe it or not, it’s also amazingly cheap.

But because of its …

Use visual aids to teach patients and improve decision making

Peter Wei

Conditions

September 8, 2013

We all know that physician-patient communication is important. Poor communication, not deficient clinical skill, is the primary driver of malpractice suits; conversely, good clinical communication alone can improve patient outcomes. For example, patients of physicians with superior communication skills have been shown to have superior blood pressure control. Fortunately, physicians generally recognize the significance of good communication, and often take the time to ensure that it happens. Yet there …

What health care in the United States can learn from Nepal

Brad Wright, PhD

Policy

September 5, 2013

Beautiful Nepal Photos (10)

In the US, many health care woes are blamed on the federal or state government. Whether there is too little oversight and lack of transparency or too much interference and regulation, it seems that policy and politics often end up getting blamed for health care system troubles. But what happens when one lives in a country with no functioning …

What conditions are more amenable to watchful waiting?

Edward Pullen, MD

Conditions

September 3, 2013

Watchful waiting has become a term often thought of as an alternative to surgery, radiation, or other interventions for early stage prostate cancer. Watchful waiting is actually a viable option for many other conditions too.

Most Mom’s know that tincture of time with watchful waiting lets their children have the opportunity to recover without intervention for many minor injuries and illnesses without exposing them to the risks associated with antibiotics or …

The hubris of medicine has to end

John Mandrola, MD

Physician

September 3, 2013

I used to think medicine would get easier over time. It makes sense, right? You see patterns, you learn how treatments work, and you just get to know stuff. Experience should make it easier to diagnose and treat.

That’s not been the case for me. In fact, it’s closer to the opposite. In the exam room, as I look up to the patient from my stool, and before I stand at …

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The hubris of medicine has to end

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