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The Seduction Of Primary Care

Hey there, big, smart, good-looking doctor…

Are you tired of being snubbed at all the parties? Are you tired of those mean old specialists having all of the fun?

I have something for you, something that will make you smile. Just come to me and see what I have for you. Embrace me and I will take away all of the bad things in your life. I am what you dream about. I am what you want.  I am yours if you want me…

Seduce: verb [trans.] attract (someone) to a belief or into a course of action that is inadvisable or foolhardy : they should not be seduced into thinking that their success ruled out the possibility of a relapse. See note at “tempt.”

(From the dictionary on my Mac, which I don’t know how to cite.)

If you ever go to a professional meeting for doctors, make sure you spend time on the exhibition floor. What you see there will tell you a lot about our system and why it is in the shape it is. Besides physician recruiters, EMR vendors, and drug company booths, the biggest contingent of booths is that of the ancillary service vendors.

“You can code this as CPT-XYZ and get $200 per procedure!”

“This is billable to Medicare under ICD-ABC.DE and it reimburses $300. That’s a 90 percent margin for you!”

This is an especially strong temptation for primary care doctors, as our main source of income comes from the patient visit — something that is poorly reimbursed. Just draw a few lab tests, do a few scans, do this, do that, and your income goes up dramatically. The salespeople (usually attractive women, ironically) will give a passing nod to the medical rationale for these procedures, but the pitch is made on one thing: Revenue. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Patients Starved For Time With The Doctor

If you’re into health care consumerism, you’ll enjoy my guest blog post at CDHC Solutions magazine. CDHC Solutions focuses on consumer-driven health plans. Consumer-driven plans are a form of “high deductible” health coverage that is more popular than ever. For whatever you want to say about these plans, one thing is clear: They don’t solve the fundamental problem of patients not having enough time with their doctors.

Here’s a taste of what I wrote:

Researchers have been trying to pinpoint the impact of this time starvation on the quality of medical care, and they’re finding disturbing results. A recent study in the Annals of Internal Medicine found that because of time pressures and related factors, doctors deliver “error-free” care as rarely as 22 percent of the time. The researchers called this a “failure to individualize care,” which is a nice way of saying the doctors just weren’t paying enough attention to the needs of their patients.

Read the whole blog post here.

*This blog post was originally published at See First Blog*

How Patients Can Enhance Communication With Their Doctors

From Kevin Pho’s medical blog, KevinMD, a post archived from 2004, Pho talks about the struggles of communication between doctor and patient during the 15-minute office visit.

Pho sites a New York Times article that explains that more than two decades ago, research shows that patients were interrupted 18 seconds into explaining their problem (on average) and less than 2 percent got to finish their explanations.

Pho sites that he sometimes falls into the “interruption trap,” saying: “I think this is a natural progression to our managed care environment. Physicians are compensated by quantity of patients seen, and are kept to a strict schedule -– in most cases every 15-minutes.” Read more »

*This blog post was originally published at Health in 30*

“E-Visits” With Patients: For Greedy Doctors Or Not?

Dr. Wes (a cardiology blogger whom all should read) wrote a very compelling post about technology and the bondage it can create for doctors:

The devaluation of doctors’ time continues unabated.

As we move into our new era of health care delivery with millions more needing physician time (and other health care provider’s time, for that matter) –- we’re seeing a powerful force emerge –- a subtle marketing of limitless physician availability facilitated by the advance of the electronic medical record, social media, and smartphones.

Doctors, you see, must be always present, always available, always giving.

These sound like dire words, but the degree to which it has resonated around the Web among doctors is telling. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

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