In 1978, the Institute of Medicine published A Manpower Policy for Primary Health Care: Report of a Study where they defined primary care as “integrated, accessible services by clinicians accountable for addressing a majority of heath care needs, developing a sustained partnership with patients, and practicing in the context of family and community.”
The four main features of “good” primary care based on this definition are: 1. First-contact access for new medical …
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Quality measures began as tools to quantify the health care process, using outcomes, patient perceptions, and organizational structures associated with the provision of high-quality health care. Overall, the goals should focus on delivery of care that is effective, safe, efficient, and equitable. Did you notice a particular word missing? Yes, I missed the word physician too, because they have been left out of the conversation entirely.
Measuring quality health care by …
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My thoughts settled on the Frank Sinatra song, “My Way,” when asked about necessary resources for rural health care to survive. Seven years ago, my father and I changed office buildings. We closed the office that Friday to allow three full days to get settled. However, we ended up seeing sick patients in the parking lot (seriously), while the movers were loading up the truck.
“All we need is a stethoscope, …
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Why must we keep repeating history?
NCLB significantly increased the federal role in education by holding schools accountable for the academic progress of all students. NCLB held teachers responsible for education of children; MACRA-proposed changes will hold physicians responsible for the medical progress of our patients. The largest problem with this approach is students and patients go home each day to whatever environment in which they live. Neither teachers nor physicians …
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Recently, physicians in small private practices and rural areas breathed a collective sigh of relief. There is a possibility the implementation of changes to physician reimbursement (known as MACRA) could be delayed. Thank you, Mr. Slavitt, for listening. I am grateful to Orrin Hatch (R-UT) and Ron Wyden (D-OR) for keeping our rural needs in mind. We have a window of opportunity for rural health care to survive, but we …
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Small, independent private practices are closing, increasing numbers of physicians are retiring, and fewer medical school graduates are choosing primary care. The old-fashioned practice my father and I have built is a dying entity. Parents say coming to see us for an appointment feels more like a visit with a friend than a medical encounter. I am fighting for the survival of primary care practices. MACRA proposed reimbursement will decimate …
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This story has been on my mind for many years, but each time I have sat down to write it, the words would not fall into place.
The other day, a family mentioned having their “rainbow baby” referring to a child born after a tragedy. To me, rainbows symbolize that even after the roughest storm, things can get better. To see a rainbow, there must be moisture, like falling rain, in …
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To the American Board of Pediatrics:
I took and passed my recertification exam in Washington State last fall and would like to express my sincere gratitude to your organization for setting up more hoops for pediatricians to jump through under the guise of helping us stay up-to-date. The first hurdle was the exam application and the second was the testing day experience, which was one of the most humiliating of my …
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“Someone else will lend a helping hand,” a physician told me once, when asked to help with an emergency in public. As a PALS instructor for more than a decade, I have always responded when possible. In the last decade, there have been three in-flight emergencies, two elderly individuals who passed out in church, and a host of other less serious maladies. A week ago, I discovered the best reason I …
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Physicians today are not held in the same high esteem as they used to be. We are often portrayed as callous, intolerant, clutch-fisted, know-it-alls who schedule patients around our daily golf game. (For the record, I do not play golf.) Physicians are accomplished in the application of science, but we are not experts in public relations.
We are human beings: mothers and fathers, sisters and brothers, sons and daughters. Like everyone …
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Physicians are accustomed to seeing patients at the end of their lives. It is difficult to let families know they may lose their loved one. Clinicians are often accepting of patients DNR orders before family members are ready. This story is about a time where the health care team was ill-prepared, yet a parent made the difficult decision to discontinue intervention. It taught me an unforgettable lesson.
During the first ICU …
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During our dermatology section in medical school, a classmate recounted having had Henoch-Schonlein purpura as a child. Over a holiday break, he visited his primary care physician and asked if he could review his records out of curiosity. His family physician pulled out the index card that served as this man’s medical record. Yes, you read that correctly. It was not a chart or computer printout; rather a 4 x …
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At 6 a.m. one morning, I was playing tennis at our local athletic club a few months ago. Sam, working at the front desk came running down onto the courts. “There is an emergency and a woman on the phone says she needs your help.”
I will be honest; I panicked a little. My husband was home asleep as were my four children. My thoughts as I raced up two flights of stairs …
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Medicine can wear down our hearts and souls. My journey in pediatrics has been filled with many rewarding experiences but haunting ones as well, like this one from my third year of residency. By that final year of training, I was no longer certain medicine was really the right choice for me. I was struggling with the notion that after almost 11 years of education, the destination was not quite …
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I am going to confess that I am my children’s pediatrician. I have given them every vaccination they have ever had and probably would not trust another provider to do it. I endorse the vaccination schedule recommended by the American Academy of Pediatrics; I believe it is safe and prevents disease. I completed medical school and three years of pediatric training that helped shape this belief. I have seen death …
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Physicians have one of the highest rates of suicide of any profession: nearly twice the rate of the general population. 400 physicians commit suicide each year in the United States. The stress of being a doctor is constant and unrelenting. The majority of us are perfectionists with a strong work ethic: your classic Type A personality. Maybe we set ourselves up for failure and then cannot accept when it inevitably …
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