What chaos theory has to do with family medicine Open a new browser tab and check your favorite weather forecast website or app. Right now. How many days in the future does it go? Seven? Maybe even 10? Look at the current forecast for the 7th day out from today. Do you trust it to accurately predict the weather for that day? Why? Or why not? Have you ever wondered why they can’t ...

Read more...

Primary care fits some medical students. Heres one. One of the top students at one of the nation’s largest medical schools, Ishan Gohil has made an unusual -- and to many of his colleagues -- inexplicable decision.  Instead of seeking to train in one of medicine’s most highly specialized and competitive fields, he says, “I elected to pursue a career in family medicine.”  Many view his choice of primary ...

Read more...

It seems like every few days we get a message in the in-basket of our electronic health record (EHR) about a new type of message that we will be receiving in our in-basket. They call these messages "system notices." OK, maybe that's an exaggeration, maybe not every few days, but the different types of in-baskets and all the information we are bombarded with is getting out of control. As users of electronic ...

Read more...

Illness is the night side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place. - Susan Sontag, Illness as a Metaphor Words are important. ...

Read more...

Need better care coordination? There’s a toolkit for that.A guest column by the American College of Physicians, exclusive to KevinMD.com. Care coordination seems to be the rage these days. It is mentioned in most discussions of new delivery and payment models such as the patient-centered medical home (PCMH) and accountable care organizations. The concept is not a new one; primary care physicians have been coordinating care ...

Read more...

Patients: Accept your fate as a hamburger Most of the doctors I know went into medicine because they really truly wanted to help people. But medicine, long honored as a calling as well as a profession, is facing some tough new challenges. Many doctors are disillusioned or simply burnt out. Others have accepted their fates as interchangeable provider units. The name of the game today is efficiency -- i.e., ...

Read more...

What primary care can learn from the financial service industry Man looks into the Abyss, and there's nothin' staring back at him. At that moment, man finds his character, and that's what keeps him out of the Abyss. - Lou Mannheim (Hal Holbrook) in the movie, Wall Street We hear reform ideas all the time: Primary care physicians need to work at the top of license, physicians need to work in teams, health ...

Read more...

When a doctor cries The calls came simultaneously.  One from the hospital and the other from a nursing home.  Two deaths separated by fractions of a second.  My heart swelled.  For a moment.  The pile of papers on the desk softly whispered.  My mobile howled jealously vying for my fragile attention.   I could feel the emotion drain as I turned back to the task ...

Read more...

Its time to tell fast medicine to slow down Americans tend to like fast things: instant coffee, sports cars, and speed dating. Many share a fascination with record holders, such as the world’s fastest runner or texter. And increasingly, the same goes for medicine. The number of minute clinics is exploding. Some emergency rooms now post their current wait times on roadside billboards. And increasingly, physicians and other health professionals ...

Read more...

I just recently attended a meeting where there was a panel discussion on caring for Holocaust survivors. The person who opened the meeting spoke about how she felt inadequate when dealing with this population because she had no personal place of reference -- she had no family members who died during the Holocaust, and so she couldn’t truly understand what the survivors went through. I have a different thought. Although every experience ...

Read more...