The federal health reform bill included a little-noticed clause allowing for Direct Primary Care (DPC) models to be a part of the state health exchanges. I believe this will fundamentally alter the health insurance market and is leading to what I call a "Do it Yourself Health Reform" movement. That little-noticed clause (item #3 in 1301(a) of HR 3590) should have the effect of massively ...

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"Doc, it’s only $10.  I can’t believe you’re throwing me out of the practice for a measly $10.  You, docs, are all the same.  It’s all about the money!" Unfortunately, the money is important.  It costs money to keep a practice running.  It costs money just to collect the money owed to the practice. So, let’s look at some simple facts.  Your physician’s office is one of the few places where you ...

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I read an article in my local newspaper the other day that gave me reason to pause. The State of Florida intends to hand over 3 million Medicaid patients to managed care companies who will reduce payments to physicians and hospitals. In exchange for accepting these low payments for professional services, doctors are guaranteed through pending legislation that no matter what egregious errors they make, the patient will ...

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Osler said that exams were something of a menace to the true student of medicine:

“Perfect happiness for student and teacher will come with the abolition of examinations, which are stumbling blocks and rocks of offense in the pathway of the true student.” — William Osler, from Aequanimitas, 3rd edition, 1932.
Perhaps this is because no examination can be passed by knowing the subject matter alone. One must also master the "hidden curriculum," ...

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I was driving into work recently listening to the radio and heard one of the fancy ads that our hospital has been airing over the last few years of it's "Good People, Great Medicine" campaign. The ad was talking about getting results for a patient recovering from a heart attack. Around central PA, this patient is far too common. And listening to the ad brag about how quickly this ...

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Like many states, Texas is facing a fiscal crisis caused by decreased revenue from the economic recession and skyrocketing health care costs. Even without the expansion of publicly financed health insurance mandated by last year's health reform law, the percentage of the state budget devoted to Medicaid expenses is projected to rise from 28 percent to 46 percent by 2020, even faster if the law withstands current constitutional ...

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Nothing makes a physician feel older (or should) than realizing that he/she just started a discussion with a younger colleague, fellow, resident or student with the sentence "When I was in training ... " In a recent article in the health section of the New York Times, Gardiner Harris skillfully depicts the culture gap between younger and older generations of physicians. Using a ...

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Lets face it -- the system of primary care medicine in the United States is broken. Even in Boston, the mecca of medicine, patients struggle hard to find an accessible doctor. And when they finally land an appointment, their well-intentioned internist, pediatrician or family physician often seems overworked, rushing from patient to patient, with little time to really listen to details. As a primary care family physician for 20 years, ...

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When I recommend that a patient needs coronary angiography (synonyms: heart catheterization, coronary angiogram, cardiac catheterization, or simply “cath”) I take a moment to bring up the risks of the procedure—complications that include the rare likelihood of stroke or heart attack (less than one in a thousand), a reaction to the dye, and bleeding at the arterial access site (most often the femoral artery in the ...

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When I completed my overnight shift and left the medical ICU the morning of July 1, I raised my arms victoriously. I uttered, "Finally, internship is done!" I may have been one of the last to speak such words. As of July 1, 2011, intern year forever changed. In the world of medicine the first year of residency, or intern year, is when doctors earn their stripes. Traditionally it is ...

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