December 2nd, 2009 by AlanDappenMD in Primary Care Wednesdays
Tags: Dr. Alan Dappen, Primary Care, Primary Care Wednesdays
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Last week, I introduced the key characters in the parody of family medicine which I entitled, Trapped in Family Medicine. Can This Marriage Be Saved.
As the scene opens, we see a typical day in the waiting room of a family practice: the primary care physician (PCP) is 45 minutes behind schedule. The room is packed with frustrated patients who glare accusingly at the receptionist, transferring their feelings of resentment to her for this routine and expected predicament.
Every few minutes someone storms to the front desk, demanding: “How much longer will it be before I’m seen?” … “My time is valuable.” …“I’ll send the bill for my time to PCP and see how he likes it!”…“What makes the PCP so special?”… “This wait happens every time I come and I’m not waiting anymore!”
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November 25th, 2009 by AlanDappenMD in Primary Care Wednesdays
Tags: Dr. Alan Dappen, Primary Care, Primary Care Wednesdays
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Prologue
This is not news: your primary care provider (PCP) has been listed on the endangered species list. Harvard Medical School has decided to no longer train primary care physicians – they are too quaint and old fashioned. Estimates show that for every seasoned PCP leaving primary care (which they are doing in larger numbers), it will take 1.7 PCPs to replace them due to expectations of shortened work hours and believing that life style and balance are deservedly theirs over a grinding 60+ hour work week.
Nothing PCPs do to reinvent ourselves frees us from the singular patient question on which the entire primary care patient-doctor relationship hinges: “Doc, are you still a ‘preferred provider’?” Perhaps it’s time to reconsider the plight of the PCP and even our day-to- day health care under a “family system” lens and re-examine the relationships from the perspective of the family therapist.
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November 18th, 2009 by AlanDappenMD in Primary Care Wednesdays
Tags: DocTalker Family Medicine, Dr. Alan Dappen, Healthcare reform, Primary Care
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When I think of the plight of primary care practitioners, particularly in the light of today’s discussion of healthcare reform, I often think of a Dr. Seuss book. My mother read it to me as a child recovering from the chicken pox. I read it to my two sons when they were young. And I encourage you to read it too, even if you’re an adult. The book is entitled Thidwick The Big-Hearted Moose. To me, this 1948 story almost perfectly mimics the overburdened lives of primary care physicians and the innumerable squabblers who’ve come along for the ride in the misguided world of healthcare.
For those who haven’t read Thidwick, here’s a recap of the story: Thidwick is a kind “big hearted” moose blissfully grazing with the rest of his herd on Lake Winna-Bango, minding his on business. One day a Bingle Bug asks if he can ride upon Thidwick’s enormous antler rack for free. Read more »
November 4th, 2009 by SteveSimmonsMD in Primary Care Wednesdays
Tags: DocTalker Family Medicine, Dr. Steve Simmons, Patient-Centered Care, Patient-Doctor Relationship, Primary Care, Primary Cere Wednesdays
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During the past several weeks, I have diagnosed several patients with novel H1N1 influenza infection with my diagnostic opinion occasionally backed by a positive flu swab. When my wife, an ER doctor, fell ill I suggested she had novel H1N1 infection and went on to advise some of my family, friends, and neighbors of the likelihood that they too had H1N1. Yet when it was my turn to suffer with fever, body aches, headache, sore throat, and malaise one word seemed best able to convey how I really felt: swine.
My symptoms began four days after having the H1N1 shot and almost immediately after putting my children to bed following a fun but rainy Halloween night. It would have been nice to blame the rain or the flu shot for my suffering but I knew better. Unable to sleep I found myself ruminating over an aphorism I first heard as a third year medical student, spoken by a man who lives in my heart as my mentor. Read more »
October 28th, 2009 by SteveSimmonsMD in Primary Care Wednesdays
Tags: DocTalker, Dr. Steve Simmons, Healthcare reform, Pay For Performance, Payment, Primary Care
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Over 25 years ago I witnessed a crime, committed by my family doctor. I was waiting to pay for my visit when an elderly, dignified, but obviously poor woman pulled out her checkbook, clicked open her pen, and asked, “How much do I owe?”
The receptionist’s answer piqued my interest and admiration, “The doctor said no charge, we’ll just bill your insurance.” I still remember the gratitude conveyed by her body language as she said, “Thank him for me,” returned her checkbook to her purse and left. Naïve to the complexity involved in medical billing, I was unaware that anything wrong had been done and did not resent having to pay for my office visit since our family could afford to pay; however, he eventually served time in jail for what I have always considered crimes of compassion. Perhaps I lack the details of his legal case to properly consider his actions but I’ll never forget the respect shown him by my home town in rural Tennessee after his time had been served; my family among many he continued to care for. Read more »
