I am scared as I sit down to write about our journey as a small practice as we fight along with the rest of the world against the unthinkable force of nature in the form of a COVID-19 pandemic. My small primary care practice is only two years old. In a time when medical practices are already dying, the financial consequences of social distancing as a response to COVID-19 can ...

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The COVID-19 pandemic has threatened our physical and mental health and the very fabric of society. Social isolation has devastating consequences on small businesses, but it has also opened doors to remote business opportunities in the virtual world. Medicine has long been ready to launch telemedicine. However, bureaucratic red tape has prevented this from happening in real-time. Archaic regulations have stifled growth. However, necessity is the mother of ...

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It took a 125-nanometer virus only a few weeks to move American health care from the twentieth to the twenty-first century. This had nothing to do with science or technology, and only to a small degree was it due to public interest or demand, which had both been present for decades. It happened this month for one simple reason: Medicare and Medicaid started paying for managing patient care without a face ...

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Much is written about the advantages for primary care physicians and patients of working within a retainer model, direct primary care, concierge-type care model. Little is written about the downside or disadvantages. It is time to shine a light on the benefits and challenges of concierge and standard models through an experienced lens, particularly as drivers of burnout and the primary care shortage loom so large. The phase of a ...

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I am a geriatric psychiatrist and am an osteopathic physician. The art of touch is a major part of my practice. I am the medical director of an inpatient geriatric facility. The patients that I see on the unit are typically suffering from dementia with behavioral disturbance. They are often agitated and anxious. For me, touch is an integral part of their care and healing. I find that when interviewing these ...

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First, do no harm. For physicians, these are hallowed words. Within religion, they are akin to the Golden Rule and are, in fact, quite similar. In the realm of ethics, Kant’s categorical imperative, to only do what you would have seen done universally to all people, comes to mind as a suitable comparative axiom. Other professions have curious and interesting maxims as well. In politics, when you strike at a ...

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Seven years ago, I vividly recalled a patient saying, "It needs to be as easy to schedule with you as OpenTable." For most health care systems, this request is now a reality. Yet, how far has the restaurant metaphor moved into patient expectations? Recently on a closed Facebook physician group, a post discussed how to convince patients they do not benefit from antibiotics when they have a respiratory virus. One theme ...

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There is constant tension to remain on-time working in a primary care clinic, seeing patients every twenty minutes back-to-back.  It takes an incredible ability for the front desk staff, medical assistants, and the physician to be able to keep this flow running smoothly only to have it be derailed by the late patient who does not understand how their actions affect everyone else after them. I currently work in a system ...

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“So, the next step in the history taking process is to define the pain. You start this by asking for site, with questions like, “Where are you experiencing the pain? Can you pinpoint the site or is it more general? Does the pain radiate (spread anywhere)?” And if the pain is on one side of the body, remember to ask about the other side – this is important. Got ...

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Currently, in America, there are only three legal groups of prescribers, the physicians (which include MDs, DOs, DPMs), the nurse practitioner (NPs), and the physician assistant (PAs). The first class of physician assistants, in 1965, was also the year of the first class of nurse practitioners. Today there are nearly 300,000 NPs In America and 123,000 PAs. PAs are outnumbered almost three to one, and the trend, with the rapid rise, and ...

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“I wish this were not the case, but I am concerned that your disease is getting worse, and your time may be very short.” “I know you are angry and upset at how you were treated -- I will do my best to make sure that does not happen again.” “I am sorry, but I cannot write a prescription for your pain medication.” “I know you are confused -- I will try to ...

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In medical school, physicians learn how to diagnose and treat medical conditions. We learn about all the different presentations and revel in catching a complex or rare diagnosis. In essence, we learn to categorize disorders based on a cluster of symptoms and match them with appropriate treatment plans. Of course, you want this quality in your physician. This system works well until you enter independent practice and learn quickly that patients ...

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During a particularly long stretch of being on call, of spending my days caring for patients, documenting in the EMR, and sleeping - I was spent. I felt like a horrible doctor. The blooper reel of my medical misadventures ran through my mind – the patient who decompensated before I got to the room, the emergent decision I made, and later regretted, the moments where my patience and compassion waned amidst ...

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This is not the career path I set out to practice when I left medical school; in fact, it's a career path that didn't even exist. But after making a number of lifestyle choices this is where I find myself today. I am sitting writing this article from the hot, tropical lowlands of Colombia, on the site of Pablo Escobar's Hacienda where, in a few hours, I will ...

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“What diagnosis do you want to use for those ear drops you sent on Mr. Johnson,” Jenn texted me. “ICD-L21.8 for seborrheic dermatitis?” Sigh. Welcome to prior-authorization hell. These are generic ear drops I ordered for presumed fungal infection of the external ear. The cash price for the drops is $15 for a 10-milliliter bottle (I checked before prescribing them). “No,” I responded, “it would be ICD-B36.9 for otomycosis.” (translation: ear fungus) Jenn ...

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It is a special group, a mish-mash of medical professionals all with a common purpose: Honing the ability to practice medicine in a more empathetic and compassionate manner, which will benefit both the patient and the professional alike. All meet to share viewpoints, share feelings, share the"what might have been." Sessions are first given over to close examinations of selected prose, poetry, art, or music. Reflecting upon what is placed before them, ...

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Family medicine — something I devoted my life to and believe in — is being undermined by local doctors and hospital administrators. And I would move, but it seems to be a national trend as well. It's more cost-effective to hire NPs and turn a blind eye to the difference in education and training ... you get what you pay for. So after 13 years of college and 25 years of ...

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For whatever reason, being 35,000 feet in the air makes me reflective. During one flight, I had a flurry of thoughts, and the reason I decided to get into this whole mess of direct primary care spilled out of me. I want to share it here because if you don't know why -- or you can't convey why -- you're doing something, what's the point in doing it? In line with ...

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As I enter the exam room, I hear, “Don’t get old honey!” As a physician caring for a large population of geriatric patients in Florida, I hear this approximately five times a day. To this statement, I always reply, “There’s no alternative, though!”  I also try not to get offended by repeatedly being called “honey.” Although I am waiting to someday state; “it’s Doctor Honey.”  Usually, my level is offense is ...

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In December of 2011, I made a career move that changed my life. My life as a surgeon was getting stale. Doing the same old thing for two decades was getting old, and I was looking for something to breathe new life into my surgical practice. I decided to look into doing a short term medical mission. I thought it would be fun and rewarding to travel to a new place ...

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