August 16th, 2010 by KevinMD in Better Health Network, Health Policy, Opinion
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I’ve written previously that many doctors are finding the physical exam obsolete, and are favoring more technologically-advanced, and expensive, tests. In fact, I alluded to traditional physical exam advocates as “arguing for staying with a horse and buggy when cars are rapidly becoming available.”
In a recent piece from the New York Times, internist Danielle Ofri says we need to look past the lack of evidence supporting the physical exam. The benefits of touching the patient, and listening to his heart and lungs, cannot be quantitatively measured:
Does the physical exam serve any other purpose? The doctor-patient relationship is fundamentally different from, say, the accountant-client relationship. The laying on of hands sets medical practitioners apart from their counterparts in the business world. Despite the inroads of evidence-based medicine, M.R.I.s, angiograms and PET scanners, there is clearly something special, perhaps even healing, about touch. There is a warmth of connection that supersedes anything intellectual, and that connection goes both ways in the doctor-patient relationship.
Great point. Read more »
*This blog post was originally published at KevinMD.com*
August 13th, 2010 by DavedeBronkart in Better Health Network, Health Policy, Opinion, True Stories
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Next in our series on my experience with OpenNotes, a project sponsored by the Robert Wood Johnson Foundation’s Pioneer Portfolio.
This item has nothing to do with OpenNotes itself –- it’s what I’m seeing now that I’ve started accessing my doctor’s notes. In short, I see the clinical impact of not viewing my record as a shared working document.
Here’s the story.
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In OpenNotes, patient participants can see the visit notes their primary physicians entered. Note “primary,” not specialists. I imagine they needed to keep the study design simple.
So here I am in the study, going through life. Five weeks ago I wrote my first realization: After the visit I’d forgotten something, so I logged in. Read more »
*This blog post was originally published at e-Patients.net*
August 11th, 2010 by admin in Better Health Network, Health Policy, Opinion
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By John Henning Schumann, M.D.
The Patient Protection and Affordable Care Act (aka “Health Care Reform”) signed by President Obama in March will revolutionize primary care in the United States. By 2014 tens of millions of uninsured people will “enter” the system by being granted insurance, either through expansion of the Medicaid program or through mandated purchasing of insurance via state pools or the private market.
This alone will have a profound impact, straining the capacity of our already frayed system. Therefore, embedded in the law are funds to encourage growth and improvement in primary care: Incentives to encourage graduates to enter primary care fields (family medicine, internal medicine, and pediatrics) and practice in underserved areas (through scholarships and loan forgiveness), and money to re-format the way that primary care is practiced and paid for. Read more »
*This blog post was originally published at ACP Internist*
August 11th, 2010 by RyanDuBosar in Better Health Network, Health Policy, News, Research
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Office-based practices are focusing increasingly on patients 45 and older, reports the Centers for Disease Control and Prevention.
In 2008, those 45 and older accounted for 57 percent of all office visits, compared to 49 percent in 1998. Prescriptions, scans and time spent with the doctor also became increasingly concentrated on those middle aged and older, according to data from the CDC’s National Center for Health Statistics.
Also, physician visits increasingly concentrated on medical and surgical specialists and less on care provided by primary care practitioners for those ages 45 and older. Furthermore, for patients ages 65 and older, the percentage of visits to primary care specialists decreased from 62 percent to 45 percent from 1978 to 2008, while the percentage of visits to physicians with a medical or surgical specialty increased from 37 percent to 55 percent. Read more »
*This blog post was originally published at ACP Internist*
August 11th, 2010 by Lucy Hornstein, M.D. in Better Health Network, Health Policy, Health Tips, Opinion
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I like Dr. Rob, the one with the “distractible mind.” And although I thoroughly agree with the stance he takes in his recent post against cholesterol screening in kids, I must take issue with his opening statement:
I have a unique vantage point when it comes to the issue universal cholesterol screening in children, when compared to most pediatricians. My unique view stems from the fact that I am also an internist who deals with those children after they grow up on KFC Double Downs.
From Dictionary.com:
“Unique: existing as the only one or as the sole example; single; solitary in type or characteristics.”
Your med-peds training allows you to follow patients from birth to death (but no obstetrics or gynecology). You can care for all organ systems and all stages of disease (but without as much training in psychiatry). Congratulations! You’ve just (re)invented family practice (except for the above shortcomings). Oh, wait — that’s already a recognized specialty with its own residency programs, boards and everything like that, forty years now.
This misuse of the word “unique” is one of my pet peeves. “Unique?” I don’t think that word means what you think it means. After twenty years in practice, I agree that there probably isn’t much difference between what Dr. Rob does and what I do. After twenty years, I’m not even sure how much relevance remains from our “training.” Still, there remains a great deal of confusion about the very real differences between family practice and med-peds residencies. Read more »
*This blog post was originally published at Musings of a Dinosaur*
