Part of a series. Here is a model for the delivery of primary care which offers certain rights balanced by responsibilities for patient, provider and insurer alike. First the rights of each party. As a patient, you deserve a high level of care in a satisfying manner without frustrations. The insurer and your employer want to see the total cost of health care come down. The physician wants the satisfaction ...

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Part of a series. I have advocated in this series of posts on direct primary care in one form or another (i.e., membership, retainer-based, concierge and various other incarnations and conceptions) because it works well for both patients and primary care practitioners. Direct primary care allows the doctor the opportunity to give the type of outstanding care that each of us needs, whether currently healthy or beset with multiple ...

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Part of a series. Primary care needs to change. That change will need the concerted efforts of patients, doctors, and other constituents. Many are cynical and believe that no worthwhile change can ever occur; others are simply resigned. But optimism can be realistic with intense advocacy and simply taking the initiative to make change. This may surprise you, but change will only happen when patients along with doctors become ...

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Part of a series. Among Medicare recipients, those discharged from the hospital incur about a 20 percent risk of an unplanned readmission within 30 days. The number is higher for some conditions such as heart failure. This is the result of a terribly dysfunctional health care delivery system. Of course some patients will need readmission; the number can never be pushed down to zero, but 20 percent is appalling. Why ...

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Part of a series. You know the serenity prayer, written by Reinhold Niebuhr in about 1940:

God, grant me the serenity to accept the things I cannot change, The courage to change the things I can, And the wisdom to know the difference.
I saw an elderly woman in the hallway recently with the prayer framed and done in needlepoint by her daughter. It was very beautiful, and it got me to thinking ...

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Part of a series. We tend to think of the primary care physician (PCP) as the one who does the simple stuff, a doctor who is a mile wide and an inch deep in knowledge and experience. That is a false impression. By education and experience, the PCP is actually a chronic disease specialist. That is, provided the PCP has the time to care for his or her patients with ...

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Part of a series. Urgent care clinics provide a useful service to the community, but their days may be numbered with survival questionable resulting from intense competition from the chain pharmacies and soon from Walmart. Urgent care companies began to proliferate 30 years ago but have gained traction in recent years as emergency room wait times rapidly lengthened. Urgent care is less expensive than the ER, is open 24/7 or ...

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Part of a series. “It is all about vigilance and caring. Our aim is to put the caring back into health care and we are serious about that. Our standards are not how many patients did you see today but how much quality did you dispense today,” Dr. Greg Foti told me about the clinic where he works in downtown Baltimore, MD. Individuals that have multiple chronic illnesses compounded by ...

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Part of a series. Readers of my posts know that I am a strong advocate for primary care and for granting the PCP added time per patient. Older patients in particular with both their many impairments and chronic illnesses need more time per visit. Here is an approach by a continuing care retirement community developer/manager to assure that the PCPs have adequate time for each resident, most of whom ...

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Part of a series. PCPs in the current reimbursement model are obliged for business reasons to see many patients per day which, of course, means less time per patient. PCPs are frustrated, and patients are less satisfied. With less time, it is hard to build a strong doctor–patient relationship and without it there is less opportunity to build trust. Readers of my posts at KevinMD know that I ...

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