CNN recently posted an article titled "Doctors Going Broke." It described several cases of independent physicians who are near bankruptcy although they once were quite well off. For instance, the article detailed the case of Dr. William Pentz, a cardiologist in a small group practice, who had to borrow money last month to make payroll. He and the other cardiologists have cut their salaries in order to meet overhead. Dr. ...
Posts tagged Primary care
Doctors lobby Congress to repeal the SGR
One of the things that I like most about my job is engaging with ACP’s physician leadership—the internal medicine doctors who dedicate enormous amounts of time, at great personal sacrifice, to represent the interests of our members and their patients.One of the things that I like least is when an ACP member (or non-member physician) caustically dismisses their efforts, usually because they disagree with some aspects of ACP policy. It ...
The foundation of medicine is care
I recently wrote that "diagnosis is job number one." In sports, there are times when two teams share the number one position. Each team competes to make it to the championship; and, ultimately, one team has to lose its top ranking.In medicine, care and diagnosis share the number one spot, working together toward a common goal: to promote health. Some would say that, without care, the diagnosis is worthless. Certainly, ...
Patients in the waiting room do not know why doctors are running late
I hate running late. I prefer to arrive five minutes early for any meeting. I was that compulsive student who always turned in papers before they were due. Now I turn in conference abstracts, grant applications, and even poetry contest submissions, well before their deadlines. Unfortunately, timing is not always in my control.I particularly hate running late in clinic. I want to see all my patients on time. It is ...
Advice to prospective family medicine residents
I don’t like selecting colleagues through the Match. The process was established to allow students to get the best opportunity available and I feel that our program (and our patients who rely on our trainees to provide care) is in jeopardy every year. It always turns out better than I anticipate, so I shouldn’t complain. However, we have to interview 60 prospective residents to fill our six slots so ...
How I approach ovarian cancer screening with patients
Ovarian cancer screening clearly touches a nerve.No one doubts that ovarian cancer is a devastating diagnosis, often found when the disease is at an advanced stage. Tests to look for the disease, such as the transvaginal ultrasound or the CA-125 blood test, are not specific enough. That leads to false positive tests that necessitate more studies that may not ...
The pitfalls of email communication with patients
A recent article in the Wall Street Journal reviewed the emerging role of email in healthcare, arguing that doctors should more aggressively offer their patients the option to communicate with each other through email. Unlike other professionals in the United States, doctors have generally resisted the adoption of email into their practices. But according to the WSJ article, email can result in many benefits to both the doctor and patient. ...
ACP: Medical ethics should be a daily aspect of care
A guest column by the American College of Physicians, exclusive to KevinMD.com.Is medical ethics an important aspect of real world medical practice today? Or a quaint notion for the history books based on mom and apple pie generalisms?For the patient and for the physician in practice, medical ethics is -- or should be -- a daily aspect of care. ...
How to avoid HMO gatekeeper problems in medical homes
There's a great deal of planning and testing of new models of care and delivery to respond to healthcare's ever increasing costs. We've all heard about Accountable Care Organizations (ACO) and medical homes. The common concern is that they become a repeat of HMOs with the accompanying misaligned incentives undermining their effectiveness. An exciting new medical home model is rapidly expanding that avoids the dreaded "gatekeeper" that was the undoing of ...
Real life financial implications of medical student debt
As a non-traditional student who entered medical school in my early thirties, I was aware that sacrificing prime earning years would impact my finances. Now in the third year of medical school and considering various career options, I paused to evaluate the financial implications of my student debt and my life goals.The common refrain from attending physicians and the school administration was "follow your heart, it will all work out ...
Identical twins with different ideas about healthcare
Jack and John are identical twins, but have varying interests in life. One day Jack, 43-years old, decides he has had enough of these headaches and calls his family doctor and asks what he should do. He is told that his doctor can see him in 4 days and to take some over the counter ibuprofren. And to definitely go to the ER if the headaches worsen.John, who has also ...
Are physicians addressing the root causes of health problems?
While in residency, I took care of a toddler who was hospitalized following an anaphylactic reaction. During a diaper change at home the child suddenly developed lip swelling and severe difficulty breathing for no apparent reason. The child was urgently brought to the hospital by ambulance and initially treated in the emergency room. By the time I met her on the inpatient floor her breathing and swelling had significantly improved. ...
Be aware of your food choices, especially when pregnant
I come back into the exam room, keeping my best poker face, sit down and turn to face her. She’s on the edge of her seat, nervous and barely able to contain herself, maybe not even sure which answer she wants.
“Congratulations,” I say. She lets out her breath and smiles, huge.“Thanks!”Once the adrenaline settles down and she can hear me again, ...
Diagnosing an illness is an art
Diagnosis is the foundation on which all care and treatments rest. If the diagnosis is wrong, most probably so is the treatment. Diagnosing an illness is an art. A diagnostician needs to be one part scholar, one part detective, and four parts artist. He has to be a good listener, open minded, and capable of assimilating a large amount of sometimes confusing data into an accurate picture of a disease ...
Physicians have a natural role as advocates
As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to. At those times, in particular, we evaluate their health in the context of relationship, family, and workplace. Having practiced family medicine for so many years, and now in counseling medicine, I have had the responsibility of advocating for my patients with their health insurance companies, within their families, ...
Why more primary care doctors are referring patients to specialists
According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever before. In fact, the rate almost doubled in the 10-year period between 1999 and 2009.This drives up the cost of care, as specialist consults tend to be more expensive than primary care visits. Furthermore, specialists tend ...
There is scope for harm when ordering tests
As the world speeds up we tend to assume that newer must be better. In some instances it is but when it comes to health, less so than one might expect. The other tendency is to overlook simple solutions and go to complicated, and often expensive ones.In medical practice there is one step even before considering what to do with a given problem and that is whether there is a ...
A lack of incentive for medical schools to train primary care doctors
A social media movement is happening before our eyes with action starting to take shape. The #occupyhealthcare movement has begun within to the blogosphere and through various areas of social media by storm.What does the #occupyhealthcare movement mean to me? My main focus in advocacy for family medicine is the production of an adequate primary care workforce distributed adequately to best serve our country. Those close to me also ...
When patients see their medical record
Traditionally, the patient chart stayed in the doctors office and rarely did a patient get a glimpse of anything in the record. Photocopying the chart is expensive and no physician would let a chart leave her office because the record must be held safely for a minimum of 7 years. Now more and more offices are doing away with clunky paper charts and electronic medical records are becoming the ...
Stories help the public make sense of evidence
Recently, I presented Family Medicine Grand Rounds at Georgetown University School of Medicine on resolving conflicts between screening guidelines. During the question and answer session, Department Chair James Welsh, MD asked how evidence from carefully conducted clinical trials can possibly overcome powerful emotional stories of "saved lives."I answered that evidence-based medicine's supporters must fight anecdotes with anecdotes. For every person who believes his or her life was extended by a ...
