September 1st, 2010 by Davis Liu, M.D. in Better Health Network, Health Policy, Opinion
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Everyone understands the need for a robust primary care workforce in making healthcare more affordable and accessible while keeping those in our care healthy. With the aging of America and healthcare reform, even more Americans will need primary care doctors at precisely the same time doctors are leaving the specialty in droves and medical students shun the career choice.
As a practicing primary care doctor, I’ve watched with great interest the solutions for the primary care crisis. And I’ve been utterly disappointed.
Patients so far don’t like the patient-centered medical home (PCMH) as noted in Dr. Pauline Chen’s New York Times column. The changes recommended won’t inspire the next generation of doctors to become internists and family doctors. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
August 25th, 2010 by KevinMD in Better Health Network
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Abraham Verghese is a professor of medicine at Stanford University and one of the most articulate physician-writers today. He recently wrote an op-ed highlighting primary care’s plight, and focuses on the scarcity of time:
The science of medicine has never been more potent – incredible advances and great benefits realized in the treatment of individual diseases – yet the public perception of us physicians is often one of a harried individual more interested in the virtual construct of the patient in the computer than in the living, breathing patient seated on the exam table.Time is the scarcest commodity of all. Patients, particularly when it comes to their routine, day-to-day care, want a physician who has time to understand them as people first, and then as patients.
It’s been frequently discussed on this blog, with solutions ranging from paying physicians per hour to cash-only practices.
There’s no easy answer, and worse, money isn’t even the root of the problem. Often left unaddressed is the burnout that primary care doctors face, practicing in unpalatable environments where the doctor-patient relationship is obstructed by bureaucracy and paperwork. Read more »
*This blog post was originally published at KevinMD.com*
August 18th, 2010 by DrRich in Better Health Network, Health Policy, Opinion
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DrRich entered medical school 40 years ago with every intention of becoming a general medical practitioner, and indeed he became one. But after only a year in practice as a generalist, he found himself so frustrated with the frivolous limitations and the superfluous obligations that even then were being externally imposed on these supposedly revered professionals, that DrRich altered course and spent several years retraining to become a cardiac electrophysiologist.
(Electrophysiology is a field of endeavor so arcane as to be mystifying even to other cardiologists. DrRich hoped that the officious regulators and stone-witted insurance clerks would be so confused –- and possibly intimidated –- by the mysterious doings of electrophysiologists that they would leave him alone. Happily, this ploy worked for almost 15 years.)
Still, DrRich has always held general practitioners (now called primary care physicians or PCPs) in the highest regard, if for no other reason than these brave souls –- unlike DrRich himself, who cut and ran at his earliest opportunity –- have stuck it out. Read more »
*This blog post was originally published at The Covert Rationing Blog*
August 7th, 2010 by KevinMD in Better Health Network, News, Opinion, Research
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A recent study from the Annals of Internal Medicine found that doctors often discounted a patient’s social situation when making a medical diagnosis.
Lead researcher Saul Weiner “arranged to send actors playing patients into physicians’ offices and discovered that errors occurred in 78 percent of cases when socioeconomic concerns were a significant factor.”
Evan Falchuk, commenting on the results, provides some context:
It’s hard to expect even the most gifted clinician, trying to make it through yet another week of a hundred or more patient encounters, to get these difficult decisions right. Too much of the context of a patient’s care gets lost in the endless churn of patient visits that the health care system imposes on doctors.I suspect this is enormously frustrating for doctors, although it’s worse for patients. What the researchers call a failure to “individualize care,” a patient might call “not being paid attention to.” It’s a dynamic that anyone who’s been ill has probably seen firsthand.
These findings are entirely unsurprising. Read more »
*This blog post was originally published at KevinMD.com*
August 4th, 2010 by BobDoherty in Better Health Network, Health Policy, News, Opinion, Research
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When I was a much younger man I had a 1968 Chevy Impala. I loved its V-8 engine and spaciousness, but I paid a steep price for it. It consumed gas like a drunk on a binge. It was prone to breakdowns, usually in the left lane of a busy highway. Even as it consumed my limited financial resources, I couldn’t count on it to reliably get me to where I wanted to be. Yet I held onto it. One day, though, its transmission gave out, and I finally had to resign myself to buying a new, more reliable, more modern, and efficient vehicle. Yet to this day, I miss my clunker.
I am reminded of this when I think about the state of primary care today. Many of us are attached to a traditional primary care model that may no longer be economically viable — for physicians, for patients, and for purchasers.
We hold onto a model where primary care doctors are paid based on the volume of visits, not the quality and value of care rendered. We hold onto a model where patient records are maintained in paper charts in voluminous file folders, instead of digitalizing and connecting patient records. We hold onto a model that generates enormous overhead costs for struggling physician-owners but generates insufficient revenue. We hold onto a model that most young doctors won’t buy, as they pursue more financially viable specialties and practices. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
