Primary Care

Lifestyle matters for specialties that want to survive

KevinMD
December 2, 2010

Medical students today consider lifestyle an essential criteria when choosing a specialty.

It’s become a cliche that most are looking towards the ROAD (radiology, ophthalmology, anesthesiology and dermatology) to happiness.

There’s been some recent media attention at how women are lured to specialties that offer a greater balance between their family lifestyle and professional demands.

Claudia Golden, a Harvard economics professor, recently noted that,

high-paying careers that offer more help in balancing work …

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Taking a multivitamin, vitamin D and fish oil every day

Conditions
November 17, 2010

There is very little doubt that if we eat the diet we were designed to eat and spend adequate time in the sun that we will get most if not all the nutrients we need.

That’s the ideal, but not the reality for a lot of us.  I was recently advised by a group of physicians who are experts in the area that it is reasonable, and probably preferable, for adults …

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Why patients are leaving our practices

Physician
November 9, 2010

She was like … Superwoman. A strapping medical visionary probably in her forties. Gray long coat falling below the knees. She strode confidently down the hallway towards the elevator, a father hurrying beside her with his young lanky daughter cradled in his arms. The girl’s head nuzzled into her father’s shoulder. She was old enough to walk by herself…but clearly she was sick. Unable.

Undoubtedly they were headed from the medical …

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Why total body scans are a scam

Conditions
November 7, 2010

Folks across the country are paying hard cash for total body scans, abdominal aortic aneurysm testing, CAT coronary artery scans and carotid artery evaluations to prevent disease or find important lesions early. It’s a seductive argument, and it’s a scam.

Ordinary patients don’t understand about pre-test probability and positive and negative predictive values. Indeed, all physicians were taught to consider Bayesian theory when ordering diagnostic tests. This is very tough concept for …

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A physician seeing the husband and wife together

Physician
October 27, 2010

As a medical provider, while seeing a husband and wife, or a couple, regardless of gender, one comes across several situations that  may be considered difficult to handle and that require a good deal of tact and confidentiality.

This is the case with seeing a husband and wife or (couple), together, for an examination. Ultimately, it depends on the rapport that the couple shares. If they …

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When parents should be concerned about a lump on their child

Conditions
October 8, 2010

I was recently scanning an online forum about pediatric health concerns. (What can I say? I sometimes need inspiration.) One thread within the forum was significantly longer than any other. Parent after parent posted about how they had noticed a knot on their infant or toddler. This concern parallels what I see in practice. An unexplained knot on the head is a common reason parents bring their child to be …

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Why doctors have poor customer service

Physician
October 7, 2010

One of my docs was telling us about a patient’s experience at another practice. Apparently, the parent was at her wits end with her crying baby. She called the  on call doctor to ask for advice and the doctor told the patient, “your baby has colic’s; turn on the vacuum and stop calling.”

It turned out the baby had some gastric condition (not colic) and needed treatment. The patient ended up …

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Doctors should work weekends, and how reformers alienate physicians

Policy
October 5, 2010

Peter Orszag wants doctors to work weekends.

The former director of the White House Office of Management and Budget wrote as much in this past weekend’s New York Times:

Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or …

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How much staff should a doctor have?

Physician
October 1, 2010

“How many staffers should we have per doctor?” That’s a question I’m asked at almost every seminar I present. Of course, like many good consultants, I almost invariably respond “it depends.”

One of the factors that needs to be considered is what jobs we’re talking about — clinical or front office. It’s staffing in the clinical area that will do most to enhance a physician’s productivity, so that’s what we’ll focus …

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Why good doctors give useless answers

Physician
September 27, 2010

Before he tells you how to get a straight answers from physicians, Doctor D is going to stall for time by explaining why doctors give vague answers.

Why would a good doctor give useless answers?

1. There is an answer, but your doctor doesn’t know it. Don’t be hard on doc for this one. There is no MD in the world that knows the entire breadth of medical knowledge. Some docs pretend …

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What’s the difference between family practice and med-peds?

Physician
September 26, 2010

I like Dr. Rob, the one with the distractible mind. And although I thoroughly agree with the stance he takes in his recent post against cholesterol screening in kids, I must take issue with his opening statement:

I have a unique vantage point when it comes to the issue universal cholesterol screening in children, when compared to most pediatricians.  My unique view stems from the fact that …

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10 reasons why doctors over-order tests

Conditions
September 24, 2010

by Neel Shah, MD

What are the top reasons doctors over-order tests?

1. How we’re taught. Doctors are taught to consider whether a procedure is safe and whether it’s likely to work. We’re almost never taught to consider cost — it’s considered taboo.

2. Trying to do our best for the patient. We’re worried. Often we over-order because of our personal risk aversion.

3. Pre-emptive ordering. For residents, who do much of …

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Social anxiety assumptions and their solutions

Conditions
September 20, 2010

Social anxiety refers to the fear of being around people due to the threat of embarrassment.

People who are socially anxious frequently freeze and are unable to seek the very company their hearts desire.  They may make adaptations: they may decide that they “hate” being around people; they may isolate and play video games; they may absorb themselves in their work, but no matter what they do, this anxiety always exists …

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How doctors can cope with stress

Physician
September 10, 2010

by Walter van den Broek, MD, PhD

Often I ask my residents that if you can’t take care of yourself, how do you expect to take care of your patients?

Or in another way: the only difference between God and a doctor is that God knows he’s not a doctor. These sound like cliches but there is some truth in them. In short, doctors are just ordinary people …

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Most doctors don’t like prescribing pills

Physician
September 3, 2010

I am a medical doctor.  I am also called an allopath, someone who practices “Western medicine.”

We allopaths like data, proof, science, randomized, double-blind, placebo-controlled trials.  We want to know the “mechanism of action.”  We want someone to prove that yoga or medication or some procedure actually helps your depression or blood pressure or back pain and that these treatments are safe before we prescribe them.  We feel more confident about …

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Positive reinforcement can motivate preventive behaviors

Physician
August 24, 2010

Eating right, exercising, avoiding the sun or using sunscreen, moderating alcohol consumption, abstaining from tobacco use, getting mammograms, Pap smears, colonoscopies—almost every measure we’re asked to take to safeguard our future health is difficult.  It’s a strange paradox that we have to work in some way, to expend energy, and experience discomfort of some kind in order to gain benefit in life.

Wouldn’t it be nice if the most pleasurable things …

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Medicine is an old profession, but not the oldest profession

Physician
August 22, 2010

Medicine is a very old profession. Ancient and honorable. Sadly, for the vast majority of recorded history, honor was pretty much all it had. The Hippocratean ideals of “first do no harm” and putting the patient first and all held special importance when medicine truly had nothing to offer. Make no mistake: up until the last two centuries, the vast majority of what passed as …

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Why family medicine and internal medicine should not merge

Physician
August 21, 2010

Recently, I had a discussion with a prominent academic family physician.  I had last seen him 37 years ago when he was getting ready to graduate from medical school and I was a new medical student.

We had a wonderful discussion and agreed to disagree about merging primary care.   Long time readers know that I dislike the term for the tasks that outpatient internists do.  Most of the push for merger …

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Stop calling doctors fleas and teaching professionalism

Physician
August 15, 2010

At the recent AAMC meeting on how to integrate quality into teaching hospitals, the question that kept popping up from speaker after speaker was how to address the fact that doctors in teaching hospitals don’t get along.

Unfortunately, all the specialty bashing that takes place prevents the adoption of a team based culture necessary to advance quality and safety.  As one speaker highlighted, how can we really start to address this …

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