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.

Why medical students need more continuity of care training

Nathaniel Fleming

Medical Education

February 18, 2019

One of the major challenges of being on medical school rotations is the necessity of changing rotations every four weeks, and how adapting to each new specialty feels like going through the first day of school all over again.

I want to share my experience on other side of the coin. About a year ago, I started participating in Stanford’s Continuity of Care program, a clerkship in which I am excused from …

Healers: Peel away the layers

Michele Luckenbaugh

Patient

February 16, 2019

The mud is deep and thick and black. The smoothness of its surface is deceiving, drawing me closer to it with promises of contentment. It lures those who dare to tread upon it into its hidden depths. Hopes are dashed as one struggles for freedom. It is tenacious: Lift one foot upward and the other sinks deeper into Mother Earth. A sense of futility in escaping its grasp erodes the …

Read more…

Healers: Peel away the layers

A physician defends Ayurveda: Is it the original personalized medicine?

Madhuri Sharma, MD

Conditions and Diseases

February 16, 2019

As more patients and clinicians are searching for holistic approaches to health care, Ayurveda, or the traditional medical system of India, has been gaining popularity in the Western world. Unfortunately, many allopathic physicians still view this system as “quackery” because of its focus on the “intangibles” of health. However, Ayurveda has contributed immensely to the foundations of modern medicine, which many may not know. Sushruta was an Indian scholar and …

CMS risks ACO success by forcing move to another track

Manish Naik, MD

Health Policy

February 13, 2019

Like many accountable care organizations, Austin Regional Clinic (ARC) in Texas is building a record of success on the Medicare Shared Savings Program’s (MSSP) so-called “Track One.” Now looming, however, is an automatic transfer of ARC to the MSSP’s riskier “second track” after years of hard work implementing our value-based, population health treatment model.

On the first track, ARC and other ACOs assume “upside risk,” getting rewarded for taking on overall …

@HIMSS, physicians don’t want hype. They just want sensible EMR solutions.

Troy Russell, MD, MPH

Health Technology

February 13, 2019

A few years ago, I wrote a KevinMD blog post about how cumbersome it was to complete notes in the electronic medical record (EMR). I proposed a solution in our residency clinic but encountered resistance in the adoption process that eventually led to its abandonment. For someone just trying to solve a problem, it was very frustrating, to say the least.

Despite the advances in the past …

Why increasing patient volume won’t work

Fred N. Pelzman, MD

Physician

February 12, 2019

Once again, we find ourselves stuck between a rock and a hard place.

Increasingly, providers are being pressured to improve access for our patients, which we certainly think is a good thing. We want our patients to come in, whether it’s for their annual physicals, for ongoing routine management of their chronic health conditions, or for acute issues best handled in the …

How many beers is too many?

Mariam Alam, MD

Conditions and Diseases

February 10, 2019

“I drank beer with my friends. Almost everyone did.”

Alcohol has become constitutional to American culture: “grabbing a drink” after work, happy hour, cheers before meals, on New Year’s, or just because. Our society’s normalization of drinking creates a slippery slope toward excessive alcohol use. Unhealthy alcohol use is rampant: one in six Americans drinks excessively four times a month, according to the Centers for Disease Control (CDC). Almost thirty percent …

Read more…

How many beers is too many?

Twitch, Fortnite, and the emergence of eSports medicine

Lindsey Migliore, DO

Physician

February 8, 2019

Here is a simple question: In terms of social media engagements, who is the most popular athlete in the world?

Super Bowl sensation and apparent immortal Tom Brady? Nope.

Philanthropist Lebron James? Not even close.

International superstar Cristiano Ronaldo? It used to be.

Tyler Blevins.

For those of you now drawing a blank, unable to conjure up a face to fit the name, go ask your kids if they have ever heard …

The secret to making AI work for physicians

Brandon McCutcheon, MD

Health Technology

February 7, 2019

If you are a physician or know a physician or have ever visited one, chances are you have probably heard them complain about technology in health care. More to the point, they are likely to be complaining about the one piece of technology that affects their lives minute-to-minute: the electronic health record (EHR). To get a sense of how central EHRs are to our daily routines, consider that physicians now …

Practice at the top of your license: What does that really mean?

Philip A. Masters, MD

Physician

February 5, 2019

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

Much has been discussed in recent years around the concept of “practicing at the top of your license.” But what does this really mean?

The most common definition is that each medical professional’s routine activities should utilize the full extent of their education, training, …

A physician’s ex-business partner is in prison. Here’s what this doctor learned.

Anonymous

Physician

February 5, 2019

When I was a third-year resident, I was invited to join a practice owned by a doctor who had once been my chief resident. This was considered by all of my fellow residents to be the plum job in town, and I was thrilled. The doctor, whom I shall call “John,” was smart and funny and had a huge practice that he had purchased from a retiring physician. We figured …

It’s time to update the stethoscope

Davinder Ramsingh, MD

Conditions and Diseases

February 5, 2019

Perhaps the most important aspect of a physician’s role is our diagnostic capabilities. Truly, if we cannot identify and diagnose a patient’s pathology with reasonable accuracy, we cannot effectively treat them and may even cause greater harm.

Let’s look back. The year is 1816, and you are a physician evaluating a patient with shortness of breath. The common practice of the time was direct auscultation by placement of the practitioner’s ear …

Read more…

It’s time to update the stethoscope

How one insurer’s mistake wrecked a practice’s quality score

Fred N. Pelzman, MD

Physician

February 3, 2019

To do the math right, you have to get your numerator and denominator correct, or else things just don’t work.

Recently, in the midst of a large patient safety and quality improvement project trying to bridge gaps in breast cancer screening among our patients, we discovered that one of the large databases of patients who were attributed to us contained innumerable …

Direct primary care physicians are not concierge doctors

Rebekah Bernard, MD

Physician

February 1, 2019

I recently received a scathing email criticizing an article I wrote about the care of patients in underserved areas. “Should you really even get to write articles about poor, underserved populations when you run a concierge practice?” the author wrote. “This is called hypocrisy. You are what is wrong with the medical field.”

What the author of this email didn’t know was that I spent six years working for the underserved …

Doctors: Never forget the importance of eye contact

Suneel Dhand, MD

Patient

January 29, 2019

Eye contact is one of the most basic mammalian traits that signals an interaction. Anybody who has a dog or cat at home sees on a daily basis how much animals value eye contact (and with dogs, it signals you’ve lost the battle!). In the case of health care, during frequent emotional exchanges between two human beings, it naturally follows then that simple eye contact has to be at the …

Geriatric medicine is a calling

Nicole Clark, MD

Physician

January 29, 2019

Often people (mostly residents and medical students) ask why on earth did I choose to do a geriatric fellowship? My response is because it is the medicine of the future. While we are all aging, the fastest growing age groups are those born between 1946 to 1964. The Baby Boomers. The Silver Tsunami. The Grey Hoard. Call it what you will, but estimates are that by 2060, 98 million (24 …

Read more…

Geriatric medicine is a calling

Sometimes, the biggest challenge to eliminate health disparities is geography

Hans Duvefelt, MD

Physician

January 29, 2019

Driving north in a snowstorm Tuesday of Thanksgiving week I certainly took my time. I left after our Suboxone clinic wrap-up conference, around 7:30 p.m., and arrived at my unplowed driveway in Caribou about 1 a.m.

On the way up, I saw two ambulances, one from Caribou and one from Presque Isle, on their way back home from Bangor. I’ve got a large SUV with all-wheel drive and studded Finnish snow …

Are clinically integrated networks a cure for checkbox medicine?

Jaan Sidorov, MD

Health Policy

January 28, 2019

Years ago, I was contacted by a health plan about an elderly nursing home patient who had not been screened for osteoporosis. While brittle bones are a big problem in skilled nursing settings, the real problem for this health plan was its low HEDIS score for “osteoporosis testing and management.” Because of the underlying financial stakes and the marketing advantages that …

The problem with abbreviations in the medical record

Fred N. Pelzman, MD

Physician

January 28, 2019

Several patients seen in our practice recently were significantly and dramatically transformed by the electronic health record (EHR). And not in a good way.

Take, for instance, the patient whose outside chart was reviewed when she showed up in our office for a follow-up appointment after an emergency department visit.

The notes from the emergency department providers, including a scribe and the …

Do huddles really help in primary care?

Hans Duvefelt, MD

Physician

January 25, 2019

I’ve huddled since before we used the word for it: You want to be prepared for the patients coming in that day. “Followup MRI” – did they have it and what did it show? “Ankle pain” – do we have X-ray today? “Eye pain” – be sure to check her acuity and put her in a windowless room, and did the new fluorescein strips come in? All fast-paced, to the …

Read more…

Do huddles really help in primary care?