May 4th, 2011 by Davis Liu, M.D. in Primary Care Wednesdays
Tags: Electronic Medical Records, Extinction, Family Medicine, Ideal Medical Practice, Kaiser, NYT, Primary Care, Solo Practice
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The New York Times recently published an article titled the Family Can’t Give Away Solo Practice wistfully noting that doctors like Dr. Ronald Sroka and “doctors like him are increasingly being replaced by teams of rotating doctors and nurses who do not know their patients nearly as well. A centuries-old intimacy between doctor and patient is being lost, and patients who visit the doctor are often kept guessing about who will appear in the white coat…larger practices tend to be less intimate”
As a practicing family doctor of Gen X, I applaud Dr. Sroka for his many years of dedication and service. How he can keep 4000 patients completely clear and straight in a paper-based medical system is frankly amazing. Of course, there was a price. His life was focused solely around medicine which was the norm of his generation. Just because the current cohort of doctors wish to define themselves as more than their medical degree does not mean the care they provide is necessarily less personal or intimate or that the larger practices they join need to be as well. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
April 27th, 2011 by Dr. Val Jones in Opinion, Primary Care Wednesdays, True Stories
Tags: High Cholesterol, Hypercholesterolemia, Internal Medicine, Obesity, Obesity Counseling, Primary Care, Weight Loss
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A friend of mine is in great physical shape but her husband (we’ll call him “Mr. B”) has gained 40 pounds since they were married five years ago. He also has familial hypercholesterolemia, and several of his relatives have had heart attacks at young ages. Mrs. B is distraught – she is worried about her husband’s health, and has tried to gently nudge him towards healthier eating habits and regular exercise (as well as taking a statin for his cholesterol). Unfortunately, the nudges were received as nagging, and a wedge has formed between them in their relationship.
Last week my friend planned a trip to a primary care physician in the hopes that he would educate Mr. B about the dangers of being overweight and not treating his high cholesterol. “Surely Mr. B will listen to an expert” she thought, “then perhaps he’ll realize that he has to change his behavior.”
Unfortunately, the primary care physician didn’t offer any health counseling to Mr. B. Not only did he not mention that Mr. B should lose weight, but he didn’t provide any warnings about the dangers of untreated, very high cholesterol levels. He merely reported that Mr. B’s total cholesterol was 300, and that a statin was indicated.
Mrs. B was crestfallen. She was depending on the physician’s authoritative input to help her come up with a strategy to steer her husband towards better health. Now Mr. B was left with the impression that things were more-or-less ok, and that his wife’s concerns were exaggerated. Read more »
April 13th, 2011 by BobDoherty in Health Policy, Opinion, Primary Care Wednesdays
Tags: Accountable Care Organizations, ACOs, Cynicism, EMRs, HIT, Internal Medicine, Meaningful Use, P4P, Primary Care, Primary Care Models
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When I talk to internal medicine audiences around the country about the latest health policy flavor of the day – accountable care organizations (ACOs) – a typical reaction is skepticism trending toward cynicism. Many don’t quite get what ACOs are all about and certainly don’t want to be lectured about how they need to re-invent their practices. And they don’t buy the idea that ACOs will somehow save internal medicine primary care. The same can be said, perhaps to a lesser extent, about their reactions to PCMHs (Patient-Centered Medical Homes), P4P ( pay-for-performance), HIT (health information technology), MU (meaningful use), and the whole alphabet soup of other reforms being proposed to reform health care delivery and payment systems.
And who can blame them? Older internists have seen this all before, and the word has gone out from them to medical students and younger doctors not to trust policy prescriptions that promise to save primary care. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
October 13th, 2010 by AlanDappenMD in Better Health Network, Health Policy, Opinion, Primary Care Wednesdays
Tags: DocTalker Family Medicine, Dr. Alan Dappen, Empowered Patients, General Medicine, Internal Medicine, Participatory Medicine, Patient Empowerment, Patient Participation, Patient-Doctor Relationship, Primary Care
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No matter where one stands on appropriateness and advantages of each patient being involved in self-diagnosis and treatment of their own medical problems there are two inevitable conclusions:
• First of all, self diagnosis and treatment are as natural as breathing and as impossible to extinguish as thought itself.
• Secondly, given today’s healthcare system, there always will exist a dynamic tension between self-determination of the individual patient and the powerful healthcare system which often insists on patients falling back in line and complying with orders.
Few would argue against the need for a powerful alliance that embraces the benefits brought to the table by both the practitioner and the patient. Simplistically, the physician would carry the role of healthcare consultant and guidance while the patient ultimately becomes responsible for the choices. Read more »
October 13th, 2010 by SteveSimmonsMD in Better Health Network, Opinion, Primary Care Wednesdays, True Stories
Tags: DocTalker Family Medicine, Dr. Jerome Groopman, Dr. Steve Simmons, Dr. William Osler, General Medicine, Internal Medicine, Participatory Medicine, Patient-Doctor Relationship, Patients As Partners, Primary Care
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The famous late 19th and early 20th century physician, Sir William Osler, said that “a physician who treats himself has a fool for a patient.” How would he have felt about patients diagnosing and treating themselves? Would he have written in support of the Journal of Participatory Medicine or against it? I also wonder how he would have practiced medicine in the “information age” when many of our patients present with a diagnosis already made, right or wrong.
I recognize that bringing Dr. Osler into a discussion set in the information age is, perhaps, anachronistic. Yet I believe he still has something to teach the 21st century on the topic of patient participation. When he advised that “the first duty of the physician is to educate the masses not to take medicine,” he offered one of the earliest lessons on a physician’s role as educator.
He also said: “The great physician would treat the patient with the disease while the good physician would treat the disease.” For me, this marches lock-step with the reality of today’s patient as consumer and active participant in the doctor-patient relationship. Simply put, it is impossible to separate the patient from a pre-conceived and often well-researched opinion — correct or not. So to treat the “patient with the disease” requires me to think of my patient as an intellectual partner. Read more »
The New York Times recently published an article titled the Family Can’t Give Away Solo Practice wistfully noting that doctors like Dr. Ronald Sroka and “doctors like him are increasingly being replaced by teams of rotating doctors and nurses who do not know their patients nearly as well. A centuries-old intimacy between doctor and patient is being lost, and patients who visit the doctor are often kept guessing about who will appear in the white coat…larger practices tend to be less intimate”
