Primary Care

A doctor’s compassion for pain gets him in trouble
“Dr. J. Howard Shegog is a ‘simple man who got confused between compassion and value (of care), and it went haywire,’ said a nurse who testified Thursday in the Newport News internist’s hearing before the state Board of Medicine . . .

. . . Welsh said she worked with Shegog for six years and saw his clientele of ‘drug-seeking’ …

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A physician was successfully sued for not following a pancreatic mass that turned out to be cancer

The importance of followup: A physician was successfully sued for not following a pancreatic mass that turned out to be cancer

“On June 9, 2003, Herman Darrell Storms and his wife, Shirley Storms, filed suit against Dr. Thomas J. Moore, Dr. Karl Heinss, and Baptist Regional Medical Center (BRMC) alleging that on April 4, 2000, Storms was admitted to the hospital under the care of Moore and Heinss, and that …

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Happy 1st year!

My humble medical blog is 1-year old today. What started out as an experiment has turned into a rewarding (and a bit time consuming) hobby. I’ve never thought there were that many people interested in what I had to say.

The blog has come a long way since the inaugural post. A lot of hot topics have been debated and discussed here: emergency room …

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The worse the economy, the lower the interest new doctors have in going into a primary care specialty

Sticker shock: A couple from Australia learns the hard way about life without health insurance
“A week later we saw an orthopedic specialist for a follow-up examination. That appointment, which included X-rays, cost $US480 ($615).

Then came the bad news. The wrist would need to be operated on. They could do it next week, but first, a check-up by a ‘primary care physician’ was needed.

This ‘internist’, …

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A shortage of primary-care physicians is an obstacle to universal health coverage in Vermont

“‘If the state reimburses similar to Medicaid – currently Medicaid pays about 53 percent of what Blue Cross pays – you will not attract physicians to Vermont,’ he said. ‘But if a new state-administered plan provides adequate reimbursement Â… it could make Vermont an attractive place to practice.'”

The bottom-line is money. Physicians will …

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The demand for concierge practices isn’t there

“Doctors and health care researchers aren’t sure why more patients aren’t joining faster. With insurance premiums skyrocketing, working-class and middle-class people may not want to pay more for medical care. And, even for those who can afford the fees, people may not be as unhappy with medical care as doctors believed, especially if they’re healthy, as are most patients of primary care doctors.”

Primary care internal medicine programs are being phased out

Another sign that new medical graduates are shunning primary care.

Health Care Renewal agrees that our primary care leaders are out of touch with the real world

“In summary, primary care is under siege by progressively rising costs and lower reimbursement. Since this seems to be public knowledge, it shouldn’t be surprising that medical students are increasingly going into other fields. What is surprising, and troubling, is that leaders of major medical organizations either fail to recognize how hard …

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Bard-Parker asks: “Can the availability of fellowships leading to high-paying specialist postitions explain how IM and Pediatrics outperform FP?”
The answer is yes. Consider the following rant from an unhappy FP:

Finished FP Residency in 1992. The worst decision I ever made in my life was Family Practice! For the last 16 years or so I have have watched it continually decline in every single way. My …

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Medicare doesn’t get it

“Spending grew as doctors saw patients more frequently, did more tests and provided more in-office drugs than expected.

In addition to increasing premiums, the higher-than-expected spending on doctor services last year might hamper physician efforts to win a pay increase instead of a cut from Medicare next year.”

This is a no-win situation for everyone involved. The government is blaming the physicians …

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People who rely on their primary-care doctor to coordinate their health-care needs fare better than those who don’t
“In addition, having a long-term relationship with a doctor resulted in fewer hospitalizations and other reductions in health-care costs, the researchers found.”

The future of primary care: the ACP responds

A few days ago, I wrote about how the our leaders in primary care were out of touch with what drives medical students’ career choices:

That’s all well and good, but perhaps primary care needs to appeal more to the bottom-line. It has been shown that a better lifestyle is a priority in today’s medical students, which is evident by more and more taking the R.O.A.D. to happiness. In …

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Leaders in medicine are trying to figure out how to make primary care attractive to students and residents once again
“AAMC has formed a group to consider broad issues around improving chronic care, including how a change in emphasis could be one way to attract more students into primary care. This group started its work last fall and is expected to produce a proposal sometime this year, Dr. Whitcomb said.
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Are testicular biopsies necessary for the diagnosis of testicular cancer?

Man sues over “botched” testicular surgery: Another frivolous lawsuit?
“A man is suing a hospital and one of its surgeons, claiming one of his testicles was wrongly removed during surgery.

Danny Curtis claims the surgeon at Kern Medical Center did not conduct a biopsy before arranging urgent surgery to remove a testicular tumor in July 2004, according to the lawsuit filed in Kern County Superior Court.”

I …

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Bill Frist writes about a utopian future of medicine in ten years

“I would like you to meet a patient from the year 2015. He lives in a world in which years ago America’s leaders made tough but wise decisions. They built on the best aspects of American health care and unleashed the creative power of the competitively driven marketplace. These changes resulted in dramatic improvements to the U.S. …

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Why ideal primary care isn’t possible if medicine is a business

A few months ago, the NEJM published an article outlining The Future of Primary Care Medicine. That article drew several responses. The first states that the “ideal” primary care setting outlined in the article is not grounded in today’s reality:

To the Editor: Whitcomb and Cohen and Fincher (Aug. 12 issue) call for changing the training settings for students and residents in primary care to reflect the …

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Should you go to a chiropractor for a headache, backache or neck pain?

Back pain, neck pain, and headache are common office visits I see in primary care. Today, I read an article put out by the American Chiropractic Association:

A new survey showing that nearly half of all Americans are concerned about the safety of the medical care they receive should send a strong signal to the health and insurance industries that safer non-drug, non-surgical treatments should be considered whenever …

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Doctors should return test results faster

“In many ways, uncertainty is the worst disease in the world . . . the not-knowing can be worse than knowing the worst.”

How true. Sheer volume of paperwork sometimes causes delay. As a primary care physician, I receive every single lab and X-ray test for my patients, whether they were ordered by me or not. This can number to over …

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Procedure and revenue-building workshops

I received a pamphlet the other day from Empire Medical Training, touting Medical Procedures for the Primary Care Physician. They have various procedure-based workshops, such as pain management, cosmetic procedures, and dermatologic procedures. It all sounds great – certainly adding some procedures will increase the amount of variety I see every day. I’m thinking of doing a pain management workshop – they train you in …

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