Primary Care

Four cases to test your malpractice IQ
I will highlight one case:

Early one afternoon, you examine a 4-year-old boy who has abdominal pain. His parents fear appendicitis, yet they report no fever, nausea, or vomiting. Your physical exam reveals no rebound tenderness or guarding, and the white count is normal. You conclude that it’s an upset stomach, but the worried parents aren’t satisfied. They want a referral to a …

Read more…

After New Orleans, a doctor ponders about the importance of the physical exam

“Most of us know, when we train as doctors in this country, that along with our phenomenal professional arsenals – our diagnostic tests, our imaging machines, our life-support systems, our wonder drugs and even our not-quite-wonder drugs – comes a certain dependence on the complex web of technical support.

Even in the kind of relatively …

Read more…

Stalking doctors in the hospital: A patient shares her frustration
“I understand that what with juggling office hours and visits to hospitalized patients, doctors have demanding schedules. But do they understand that when your loved one is in the hospital, the rest of your life doesn’t just go away? Hospitals operate on the premise that we, the family, must make ourselves readily accessible to the doctor – not by phone …

Read more…

Why primary-care is doomed, in a nutshell

“Medical schools across the nation are producing fewer primary care doctors. Today’s medical students instead are choosing niche surgical specialties, according to annual surveys by the Association of American Medical Colleges.

Most of those students are motivated by lifestyle goals, said Dr. Gilhooley, the medical director in Wilkes-Barre.

Family doctors usually work 10 to 12 hour days, often skipping lunch and …

Read more…

Doctors using Google part 2: A day in my life

A few weeks ago, I wrote about how I incorporated Google in my daily life, using it to help find ICD-9 codes, patient information handouts, and articles on the fly. It was well-received, so I decided to write further about how Google has become an indispensable tool in my practice. Physicians today can certainly benefit from …

Read more…

A bitter doc writes about the liability crisis

“There are two points that must be addressed. First is the ‘squeeze.’ As the Medicare budget disaster worsens, the government will threaten physicians more and more with penalties for ‘over-ordering’ and with charges of fraud. Doctors will be caught between threats from the government to order fewer tests, and patient and legal pressures demanding more.

The next point is a lack …

Read more…

A single question has been validated to screen for alcohol abuse

One question screens are tremendously helpful in busy primary care practice. That question is: “When was the last time you had more than five drinks in 1 day [or four for a woman]?”

A yes to four or five drinks in the past 3 months was considered a positive screen.

Turning of the tide? Some encouraging news for primary care

“The demand for internists and family physicians has rebounded after several years of decline, Merritt, Hawkins & Associates reported in its 2005 survey on recruitment trends.

Many health care employers are turning their attention back to primary care after focusing on specialties, according to the national health care search and consulting firm. Internal medicine and family medicine were among …

Read more…

The annual physical is useless – but we still do them

“Even though a panel of experts has thrown cold water on the automatic need to get an annual checkup, physicians and their patients haven’t always gotten the message, a new survey says.

The survey, published Monday, found that while there’s no evidence annual physicals for healthy people are useful, 65 percent of primary care doctors think they are …

Read more…

Patients in Massachusetts must wait more than six weeks on average to visit primary care physicians

Lack of primary care access is a major factor in emergency room overcrowding.

There simply aren’t enough hours in the day for many family doctors to deliver high-quality care to people with chronic conditions

Thanks for the news flash. One helpful recommendation: “Ostbye’s team set forth a number of suggestions to ameliorate the problem, including writing patient care guidelines with real-world conditions in mind.

‘There is a lot to be said for having guidelines, but it seems they are often written …

Read more…

retired doc’s thoughts on the recent compensation figures

“Delta also provides current average locum tenens bill rate per 8 hour day and, of course, they show a similar ordinal ranking. But it gets worse. While the internist, FP and ped all make $760 per day, the CRNA brings in $1,140 and a hospitalist makes $975. An internist has to sub specialize to make more than an anesthesia nurse.”


Read more…

Do patients want doctors who are on time, but rush appointments?

Reading these comments got me thinking – Where in the spectrum of waiting are you?

Are you, fellow physicians, the type who is always on time, every 15 minutes? Or do you spend as much time as it takes with each patient?

Do you, as a patient, want a physician who runs on time, every time? Or do you mind waiting 1 hour for a …

Read more…

Why retail clinics will fundamentally change primary care

More people are using walk-in clinics for primary care

“‘People are much more consumerist today,’ Dr. Lo said. ‘No one wants to wait two weeks to see a doctor. In fact, no one wants to wait an hour in my waiting room. People are much more concerned about getting things done on demand, and they have difficulty finding a primary care doctor who will see them promptly.'”

Sounds like primary care physicians are going through the same pains in Canada
“Family medicine is a tough sell. Patient needs are more complex than ever. They’re older and not coming through their doctor’s door with one ailment. Some have diabetes and heart disease. Others have had a stroke and are now battling cancer. These aren’t patients that can be seen and sent on their way at the end of …

Read more…

Big surprise – ER visits reach a record high

“At a time when the number of hospital emergency departments has been cut by 14 percent, visits to the ER reached a record high of nearly 114 million, according to Centers for Disease Control and Prevention data for 2003, the most recent data available . . .

. . . Many of the ER visits were made by elderly …

Read more…

Kevin, M.D. in the BMJ
Thanks for the kind words in the BMJ’s Netlines section:

Web logs or “blogs” are personal journals that are a burgeoning internet phenomenon, and many medical ones are springing up all the time. The “Kevin, MD Medical Weblog” is an enjoyable and frequently updated collection of reflections from a US based primary care physician. It has great links to various source materials.

Only 27 percent of IM residents are picking primary care careers
“Other studies have focused on why students are turning away from primary care disciplines and have found that declining reimbursement for nonprocedural care, the opportunity for a controllable lifestyle and a medical culture in which subspecialists are seen as more prestigious have played a big part . . .

. . . He didn’t think that would be …

Read more…

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’ …

Read more…

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 …

Read more…

338
pages

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories