Direct primary care: Setting the record straight Since starting a direct primary care (DPC) practice nearly three years ago, I've become accustomed to skepticism and even the occasional criticism. Given the status quo, I understand it's difficult for some to envision a model that could be better for family physicians and our patients than traditional fee-for-service practice. Two common concerns about DPC have emerged during my conversations with fellow ...

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I keep six honest serving-men (They taught me all I knew); Their names are What and Why and When And How and Where and Who. - Rudyard Kipling Medicine has become a very complex, multifaceted science, ranging from pharmacogenetics to psychoneurobiology. Doctoring, however, is increasingly viewed as so simple that you don’t actually have to be a doctor to know how it should be done. What else could explain why IT people tell doctors what “workflows” ...

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Ways to reduce administrative burdens on physicians Ways to reduce administrative burdens on physiciansA guest column by the American College of Physicians, exclusive to KevinMD.com. One of the American College of Physicians’ priority areas for the current fiscal year is to “Help ACP members experience more joy in their professional lives.” This includes decreasing what is known as the “hassle factor” ...

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t’s been a fascinating week or so listening to everyone weigh in on which response they thought I sent to my patient. The general consensus, unsurprisingly, was that the first was far too cheeky -- not to mention insulting -- to effectively convey the necessary information.  The second, of course, was the one I send every day, day in and day out. Just this once, circumstances conspired to allow me to send ...

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Is there really a doctor shortage, and what can we do about it? There is controversy about whether or not there will be a doctor shortage in the near future. I wonder why there is so much speculation. The Association of American Medical Colleges estimates that we will be short 90,000 physicians by 2020 and 130,000 physicians by 2025. If things stay as they are now, of course there will be a shortage. The ...

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A doctor goes networking, and is horrified by what she finds I was invited to a “networking party.” I went. I was horrified by what transpired there. And disgusted. And felt blindsided. And angry. And blown away by the prevalence of what I couldn’t decide was greed, ignorance, or an unseemly combination of the two. And what magnified the intensity of my repulsion was the fact that a large proportion of the people involved have the ...

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One of my residents presented some research that she had completed under my supervision. Since I left the staff of the U.S. Preventive Services Task Force four years ago, it has been my sense that the Task Force has substantially lowered its evidence "bar" for recommending a preventive service, an impression confirmed in private discussions with colleagues who closely follow the group's activities. In a JAMA editorial published last year, Drs. ...

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My dad was a wonderful guy who could fill the room with his personality.  He grew up during the Great Depression and was a World War II veteran.  I was thinking of him recently while considering how much health care delivery has changed in the last 100 years. When asked about his health, my dad would always say, “I feel great.  I don’t have any aches or pains.”  This is telling. ...

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Don’t look back to how medicine used to be Is it just me, or is the world of medicine getting way more complicated? Sometimes I long for the good old days of practicing medicine. First, the hospital switched over to electronic medical records, which required us to to attend Saturday morning classes to learn how to tell the nurses our patients could go home after surgery. Next, our office got an insurance memo ...

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We must listen to and assist all young victims of sexual assaults Recently, allegations have been spread by women who claim that as teenagers, they were sexually assaulted by Bill Cosby. Some have not made any mention of these crimes until decades later; while others have said that they did report the allegations at the time of the assault, but were not believed. Due to Cosby’s notoriety as a celebrity, this has fueled ...

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