I have a BHAG (Big Hairy Audacious Goal).I want people to hear "family medicine" and know that it refers to a medical specialty dedicated to providing relationship-based, patient-centered health care.I want people to know that family docs take care of a lot of complicated, challenging diseases - and not usually in isolation. Our patients have high blood pressure, complications from type 2 diabetes, congestive heart failure, depression, chronic kidney disease, ...
Posts tagged Primary care
The primary care doc fix is in
Matthew Mintz, MD recently shared how primary care doctors are set to lose more than half of their salary. It's well documented how primary care has faced a number of challenges with half of primary care physicians saying they'd leave medicine if they could as was mentioned in an earlier piece. There's talk of a "doc fix" as physicians believe the debt ceiling deal is ...
The fifties woman has many reasons to get better
"51-year old female presents today with ..."Funny, the vast majority of my clinical notes last week began with that phrase, give or take a year or two. Women in their fifties who saw me in the clinic, who I spoke to via television in my telepsychiatry practice, or who I interacted with in some other way. It struck me as odd that so many women of similar age came to ...
Let physician assistants be part of the primary care answer
There has been so much change in medicine, physicians are leaving primary care, and new ideas are being bantered about such as patient centered medical homes (PCMH) and accountable care organizations (ACO), in an attempt to try to address the problem. To add to this strain, is the knowledge that medicine is going to have to be ready to absorb thousands of additional patients in the near future ...
Advance planning should be a public health issue
"Medical training rarely deals with helping the dying patient find peace and comfort. In fact, most physicians are uncomfortable with the entire subject. I believe it is one of the most neglected aspects of medical care. I have spent my career as a pulmonary and critical care physician, and I have cared for thousands of dying patients. In many cases, both the patients and I knew that they were dying. ...
MKSAP: 38-year-old woman with increasingly frequent headache
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 38-year-old woman is evaluated in the office for a 10-month history of increasingly frequent headache. The headache is often worse in the morning on awakening. She has recently started keeping a headache diary, which reveals episodes on approximately 25 days of each month. The ...
The possibility of zebras in primary care
It is critical for physicians to share unusual patient diagnoses that present to clinic with routine type symptoms. In a hospital setting, these are cases for discussion and debate at Grand Rounds. In a primary care setting, we do case reviews when we can with informal sharing for the purpose of teaching and learning. The bottom line, whether in a formal academic setting, or an informal setting around the lunch ...
How medications are like vehicles
I usually cringe when I see a pharmaceutical company ad on TV. I think most pharma commercials do more harm than good. The ads scare patients out of taking medications they need.Actor: Do you have uncontrollable diarrhea? I did, and then my doctor prescribed “No-More-Poop!” Now I feel great and don’t have to worry about embarrassing accidents.Commentator: Clinical studies done at a leading university prove that “No-More-Poop” cures 99% of ...
Taking the knife to doctor-drug company relationships
With health care industry reaching unsustainable lows, media attention is on physician's relationship with the pharmaceutical industry. A Google search will give results that paints doctors as culprits, leading to a prejudiced opinion where doctors are thought of as co-conspirators with drug companies. This article teases this tainted relationship, from a typical doctor's perspective.Pharmaceutical companies have strategies not only to survive, but also to grow with general public investing in ...
How political correctness interferes with healthcare
Political correctness and sensitivity training are interfering with medicine and healthcare. In a recent article published in the journal, Pediatrics, a group of researchers published their findings regarding parental perceptions of the terminology that doctors use to describe childhood obesity (ages 2 to 18). The researchers found that it was undesirable to use the term "fat," "obese," or "morbidly obese" because they were stigmatizing, blaming, and the least motivating to ...
Health quality requires looking at our caregivers
Sonia struggled to express herself through broken English. Her lively facial expressions and exuberance betrayed by her inability to string the words together fluently. One hand gesticulated widely while the other rested gently on the elderly woman's hair.She somehow managed to coo quietly in her companions ear, calming her, as she continued the conversation with me. Sonia's eyes opened and closed in an exaggerated blinking manner as she questioned me ...
Why patient complaints are an opportunity
I have not always been excited to hear patient complaints. As a younger manager I absolutely dreaded when a patient wanted to speak to me. I felt that I had little to offer a patient who expressed anger or frustration with something that had happened and I was very impatient to get past the complaint and get back to my “job.”Now, I can’t wait to hear patients’ complaints. Complaints ...
The myth of physician omniscience
How is a doctor allowed to mess around with body parts he doesn't understand?If doctors were required to understand everything we touched we wouldn’t be able to touch you at all!The human body is still a deep mystery. Doctors understand more than most people, but what we know is still a vague approximation. Just because our educated guesses often work out well doesn’t mean we have any idea what’s actually ...
Doctor, Google thyself
Have you ever Googled yourself or your practice? Did you know that you have an ever growing online reputation? Whether you know it or not, doctors have an online presence. When you type your name in a search engine you may be surprised by what you find. Everything you do professionally creates a digital footprint. If you are involved in social media then you are contributing to your online reputation. ...
What physicians can learn from the Penn State scandal
The investigations about the Penn State sex abuse scandal are still unfolding. Revealing the truth is up to justicia now. Meanwhile we can learn an important lesson about professionalism.It seems to me as if a few very powerful people put the Penn State brand above children and covered up the raping of young boys within the Penn State facilities. I assume that several people at the top of the Penn ...
Primary care doctors are set to lose more than half of their salary
Fortunately, the 27% reduction in Medicare payments to physicians that is set to take place in a matter of weeks unless congress acts is getting some press. Fox News published a piece recently, as did the Washington Post. Writer Merrill Goozner breaks things down nicely in his article, "Is There a Doctor Fix in the House ... and Senate?"However, one thing that seems to be getting confused in all ...
Good doctor qualities for your aging parent
As we get older, having a good doctor in our corner becomes incredibly important.And you don’t want just any doctor for your parent. Smarts, signs of basic compassion and a few other things are essential for the relationship to work.Good doctor quality #1: Listening skillsPicture it: Your Mom’s doctor’s office. 10am Tuesday. She reaches into her pocket for her list of three concerning symptoms she plans to mention, if she can ...
Find a physician, not a general
"Superior doctors prevent the disease. Mediocre doctors treat the disease before evident. Inferior doctors treat the full-blown disease." -Huang Dee Nai-Chan 2600 BC; 1st Chinese Medical Text.Not only does my work in integrative medicine have me on the front lines of big pharma-created "syndromes", like chronic fatigue, fibromyalgia and irritable bowel (these are real for patients, but are not formal syndromes), but I get to see the worst of our sickcare system. I ...
Young doctors don’t see value in primary care careers
In my new role as one of the directors of an internal medicine training program, I help select new interns out of medical school for the three year training stint of residency.At the end of residency, many graduates go on to subspecialty fellowships, another two to four year period of intensive training in fields like cardiology, nephrology, critical care etc.For those that don’t choose a subspecialty, one choice remains: traditional ...
Are doctors given more responsibility than they can handle?
Doctors inevitably come into spotlight, being at the front end of health care delivery. Sometimes seen as guardian angels restoring health and life, other times, greedy minds sucking resources while they carelessly harm and kill patients to fill their wallets. After experiencing, observing, and hearing from others like me, I wonder if doctors are given more responsibility than they can handle, often attributed more aura than they deserve and frequently ...
