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.

A physician moving back and forth along the Teflon spectrum

Hans Duvefelt, MD

Physician

December 16, 2018

I guess I should take it as a compliment when patients come to see me after visiting a specialist and ask me a bunch of difficult specialty-related questions.

“Did you ask the specialist that?” I typically ask, and the answer will be a plain “no.”

I’ve seen it in action. Some doctors speak quickly, say a lot, and exude so much authority that it’s hard to stop and question them. There is …

Primary care today: There are several concerning trends

Sue S. Bornstein, MD

Health Policy

December 14, 2018

In 2006 Dr. Tom Bodenheimer wrote an article that was published in the New England Journal of Medicine entitled, “Primary Care – Will It Survive?” Dr. Bodenheimer spoke with great concern about patients’ growing unhappiness with their primary care physicians and physicians’ increasing frustration with their practice environments. The patient-centered medical home (PCMH) model entered the scene in 2007 -2008 with the lofty goal of fixing the ills of primary …

Doctor’s orders: Follow these 6 tips to avoid holiday stress

Sevitlana Safaei, MD

Conditions and Diseases

December 12, 2018

For many of us, “the most wonderful time of the year” is anything but. If we let the holiday season get the better of us, we can find ourselves overeating, overspending, and over-extending from now through New Year’s Eve.

Holiday stress has real health implications: The American Heart Association warns that the increased stress we feel this time of year can lead to significant coronary events. The American Psychiatric Association urges …

Too much of a good thing when it comes to medicine for older adults

John Muscedere, MD

Conditions and Diseases

December 11, 2018

Prevailing wisdom states that more is better — and it is no different when it comes to our expectation of medical treatments. With the help of the internet, patients and their families have come to expect intensive tests, treatments and therapies at every life stage.

But sometimes, too much treatment can do more harm than good. This is true in all ages but is especially relevant for older adults living with …

During this holiday season, be aware that some people are really suffering

Linda Girgis, MD

Physician

December 7, 2018

It’s that time of year again when retail outlets start counting down the days to Christmas and deck their stores with holiday cheer. For many people, this time of year feels magical. Yet for others, it is a consumer competition to buy the absolute best gift at the lowest price. While both these groups love the holidays in their own way, there is a third group for which the holidays …

6 ways to smooth the journey to value-based care

Andrew Snyder, MD

Health Policy

December 7, 2018

I have had the fortune — both good and bad — of being at the forefront of reforming physician reimbursement as an advocate for physicians. I’ve worked on models spanning private practice, group employment, faculty practice plans, and independent physician associations.

It’s been a bruising journey.

There were the old ways — relative value units (RVUs) and other tortured renditions of …

There’s a good reason why we don’t see patients’ joy in the office

DocG, MD

Physician

December 7, 2018

I like to think of myself as a relatively optimistic person. If you have ever met me in person, you might think that I have a pretty sunny disposition on life. And for the most part, I do. Since I write every day, however, there are times when my posts may start going negative. Not for an extended period, but long enough for my readers to wonder if am just a touch …

Give millennials what they need in health care

Sandra Worrell, MD

Physician

December 6, 2018

Another study reiterates what we already know: In droves, millennials are venturing away from the traditional model of securing a primary care provider and opting not to access health care “as usual.”

Still, too many physicians do little more than shake their heads over this. We wonder when millennials will figure out they need a medical home for the best possible care – especially when a medical emergency occurs.

But, guess what? …

Why your practice needs a makeover

Diana Anderson, MD, MArch and Keith Mankin, MD

Physician

December 6, 2018

The spaces where we live and work can exert both strong and subtle influences on the way our brains function. They can make us anxious, distracted, inefficient or tired, affecting not only our cognitive ability but also our emotional state, mental stability, and physical well-being. Clinical medical practice, like much of life in our society, is tethered to indoor space, so physicians, staff and patients alike are particularly prone to …

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Why your practice needs a makeover

The power of the tincture of time

Philip A. Masters, MD

Physician

December 6, 2018

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

I distinctly recall during residency a much older and well-respected clinical teacher periodically opining that what was needed in a particular patient case was “a dose of the tincture of time.”

For those less familiar with more historic terminology, a tincture is an alcoholic …

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The power of the tincture of time

When physicians don’t enjoy the holidays, it’s a wakeup call

Stephanie Wellington, MD

Physician

December 5, 2018

As the holidays approach, this time of year can be filled with mixed emotions for high-achieving medical professionals who find themselves in the hospital, clinics, and practices caring for patients instead of spending time with loved ones. It can be more hectic than ever as doctors try to be all things to family and friends while still carrying a full patient load.

Personally, I learned the hard way that this is …

What medicine can learn from Disney

Tyson Schwab, MD

Physician

December 5, 2018

When I was a young child, like most children, I loved Disney. However, my fascination with Disney did not involve the exhilarating theme parks, characters or delicious foods. As a young boy, I was captivated by the Disney culture, the multifaceted business model and the life and legacy of Walt Disney. During the past two decades, I have continually studied these complex concepts. Concurrently, I was pursuing a scientific education …

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What medicine can learn from Disney

Patients are not passengers

Christopher Noll, RN, MSN

Patient

December 5, 2018

Health care safety efforts have long focused on improving the behavior of providers and improving the systems of care. A proven model of safety is in the airline industry. There are undoubtedly many parallels between airline safety and health care working toward common goals. This work should continue in both industries to ensure the safety of the people they serve.

The airline safety model, though, can only look at health care …

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Patients are not passengers

It’s the little things that can make or break the doctor-patient relationship

David Penner

Patient

December 4, 2018

“The dermatology profession exists for the primary purpose of caring for the patient. The physician-patient relationship is the central focus of all ethical concerns.”
– American Academy of Dermatology, Code of Medical Ethics.

The doctor-patient relationship is one of profound importance and complexity. And while doctors in training often receive quality mentorship regarding their chosen specialty, many lack good mentors to guide them in the art of the doctor-patient relationship. This is …

Asking primary care clinicians to work harder isn’t a solution

Fred N. Pelzman, MD

Physician

December 3, 2018

“Sorry Dr. Pelzman, just one exam room today.”

This is how our medical technician greeted me as I arrived for my Wednesday morning practice session earlier this week, with a full panel of patients on the schedule set to see me over the next few hours.

Most of them were my own patients, well known to me, but a few were new patients who had been referred by colleagues in our institution, …

The pitfalls and opportunities of rural health care

Liz Hills, DO

Physician

December 2, 2018

My medical school is located in Harrogate, Tennessee, a town of 4,000. That’s considered rural. My residency is located in Casper, Wyoming, a city of 60,000. There were some community attendings there that considered that rural. I live and practice in a town of 200. The closest hospitals to me are 40 minutes to one hour away. The roads are dangerous and frequently close in the winter, and winter lasts …

Computers are the modern stethoscope

Lisa Masson, MD, MBA

Physician

November 29, 2018

I wrote this a decade ago:

It is a brave new world. I have used an electronic health record in my office for ten years. With a click of a mouse, I can show you how your blood pressure has varied over the last ten years. I can graph your hemoglobin, track your diabetes or tell you if that was the medication we tried last time.

But with every two steps forward, …

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Computers are the modern stethoscope

How to get the doctor to really see you

Michael L. Millenson

Patient

November 28, 2018

Doctors are regularly deluged with advice on how to engage patients. But how can you, as a patient, get your doctor to engage with you as a person truly? Your health — and even your life — could depend upon it.

A perceived absence of empathy can significantly harm physical and mental well-being. At a recent Society for Participatory Medicine (SPM) conference (I’m a member), three …

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How to get the doctor to really see you

3 ways pharmacists can change your prescribing habits

Alex Barker, PharmD

Medications

November 28, 2018

As the health care landscape evolves, health care provider roles continue to shift.

Industries recognize the power of collaboration and the strength of communication between different providers; among those, the pharmacist and the physician.

Unfortunately, doctors and pharmacists have historically had strained relationships. In many cases, communication suffers, which can lead to adverse drug events (ADEs), or harm caused to a patient as a result of medication exposure.

It’s worth noting, though, that …

What is the fundamental dilemma in medicine?

Grady Kaiser, DO

Physician

November 27, 2018

In observing trends among my patient encounters, to me, there appears to be a distinct difference in clinical encounters between more “holistically-minded” patients and more “traditionally-minded” patients, for lack of better terms. One is not necessarily better than the other. There are definite benefits and risks associated with either group. Whereas the “holistically-minded” tend to see western medicine with some degree of skepticism, the “traditionally-minded” tend to be comfortable with …

Primary Care

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