Why doctors can sometimes be their own worst enemies

“I don’t have the time … I don’t get reimbursed for that.”  This is an all too common refrain from primary care physicians and practice managers when ever the subject of improving physician-patient communications comes up.

I get it.   Primary care physicians in particular are under tremendous pressure to produce.   Just imagine, physicians in small primary care practices spend about 3.5 hours per week just on dealing with insurance-related paperwork.  Then there’s keeping up with recommended treatment guidelines, journals, and IT issues and routine staffing issues — not to mention routine patient care, much of which they in fact don not get paid for.  Physicians do have it rough right now.

But doctors can sometimes be their own worst enemies.

via kevinmd.com

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Patient complaints do not fit the primary care office visit

by Kevin Pho, MD

Primary care physicians often have to see patients with a litany of issues.  Often within a span of a 15-minute office visit.

This places the doctor in the middle of a tension — spend more time with the patient to address all of the concerns, but risk the wrath of patients scheduled afterwards, who are then forced to wait.

And, in some cases, it’s simply impossible to adequately address every patient question during a given visit.

It’s a situation that internist Danielle Ofri wrote recently about in the New York Times.

In her essay, she describes a patient, who she initially classified as the “worried well”:

via kevinmd.com

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Men avoid the doctor, survey finds - Chicago Sun-Times

Almost half of men 18 to 50 don’t have a primary-care physician, and a third haven’t had a checkup in more than a year, a new survey shows.

About 40 percent of men in their 40s have never had their cholesterol tested, and 70 percent have never had a prostate exam, according to the national survey of 519 men commissioned by Esquire magazine.

“It’s a stereotype about men that they don’t like to go to the doctor, that they’d rather just go when there’s a problem,” says Esquire’s Ryan D’Agostino.

The survey found that 45 percent of the men surveyed didn’t have a primary-care doctor. Among other findings:

via suntimes.com

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7 Tests You're Not Having That Could Save Your Life

Your physician has you come in to his office and run on a treadmill while you're hooked up to an EKG. For the next 8 to 12 minutes, he'll evaluate your heart rate, breathing, and blood pressure as the intensity of the workout increases. When the stress test is over, he'll tell you whether you have coronary artery disease.

Here's news that might make your heart skip a beat: For women, there's a 35% chance the test results will be wrong.

Most often, the test reveals false positives, meaning healthy women are told they have heart disease. Less frequently but obviously far more dangerous is when the test fails to detect clogged arteries that could, in fact, cause a heart attack. Fewer men are misdiagnosed.

via health.yahoo.net

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More Patients Making Appointments Online As Doctors Embrace Web - Kaiser Health News

After relocating to Washington, D.C., Clint Morrison needed a doctor to follow up a tonsillectomy he had a few weeks earlier in California. But when he started calling specialists in his health plan’s directory, he struck out: they either weren't taking new patients or had no openings for several weeks.  

So in September Morrison went to a website called www.zocdoc.com. He could see doctors' appointment calendars and identify those that took his insurance and were located near his office. With a couple clicks, Morrison, 24, scheduled an appointment for the next day with Mark Dettelbach, an ear, nose and throat doctor. "It was painless," Morrison says of the experience.

Dettelbach's group practice is one of a growing number that allow patients to schedule appointments online — eliminating multiple calls, waiting on hold and increasing the likelihood of finding someone with an opening.

About 16 percent of family doctors used online scheduling in 2009, up from 6 percent in 2005, according to the American Academy of Family Physicians. Most are doing it on their own or through health systems where they work.

Several factors drive the trend. On the doctors' side, it's mostly the need to add patients and reduce overhead costs. They're also growing more comfortable with computers. About half of family doctors use electronic health records and 44 percent prescribe electronically, according to the academy.

via kaiserhealthnews.org

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Primary care needs more than 15 minutes for patients, KevinMD.com

Psychotherapy appointments have traditionally lasted 50 minutes with 10 minutes for paperwork. This has lead to the expression, “the 50-minute hour”.

More recently there has been talk of incorporating psychotherapy techniques in brief visits in primary care. The provoking title “The Fifteen Minute Hour” is from a book about addressing the emotional aspects of disease in primary care during brief appointments. The title and the concept seem relevant to much of what we do in my specialty.

In primary care we seldom spend more than 15 minutes at a time with an established patient. Yet we are required to cover infinitely more details and consider more outside authorities in every visit today than when I first started practicing medicine. Between health insurance and office administration, there are now many more mouths to feed from the office charges than there were then. Sometimes it feels like we are not alone in the exam room even for the short time we do have.

Except for doctors in concierge medicine or micropactices, most of us cannot change the amount of time we have with each patient. Even if we hope to change the system, the patients we see today deserve the best we can give them in today’s 15-minute visits.

via kevinmd.com

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Most Americans Take Doctor's Advice Without Second Opinion

Despite the advent of health websites and other widely available sources providing medical research and information, 70% of Americans feel confident in the accuracy of their doctor's advice, and don't feel the need to check for a second opinion or do additional research. Americans' confidence in their doctor is up slightly from eight years ago.

The latest results are from Gallup's annual Health and Healthcare Survey, conducted Nov. 4-7, 2010.

Older Americans are the most likely to be confident in their doctor's advice, with 85% of those 65 and older expressing confidence. This compares with 67% among those 50 to 64 and 65% among those under 50.

While one might expect that interest in a second opinion and doing additional research would be higher among Americans with college degrees or postgraduate education, that is not the case. There is little difference in confidence in one's doctor across the educational spectrum.

via gallup.com

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Doctors' house calls making a comeback - USATODAY.com

Dr. Ina Li walked down the seventh-floor hallway of a local apartment building recently, pausing at each door to check the number.

She finally found the one of her patient, Katherine Talmo.

It's easier for Talmo if Li, a geriatrician, comes to her. The 90-year-old doesn't get out nearly as much since she stopped driving nine years ago. But she is determined to stay in her home.

"If I was in a nursing home, I'd only live for one more year," she said. "But if I live at home, I'll live to be 100."

The notion of doctors making house calls harkens back to an era before HMOs, medical centers and outpatient surgery centers.

Those visits offer insights not available during a 15-minute office visit. Doctors learn more about a patient's lifestyle, eating habits, their ability to take medicine and exercise.

via usatoday.com

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Internal Medicine, Medical Specialties, Legal Nursing Consultants, Medical/Legal Consulting

Internal Medicine, Medical Specialties, Legal Nursing Consultants, Medical/Legal Consulting:"Doctors of internal medicine focus on adult medicine and have had special study and training focusing on the prevention and treatment of adult diseases. At least three of their seven or more years of medical school and postgraduate training are dedicated to learning how to prevent, diagnose, and treat diseases that affect adults. Internists are sometimes referred to as the "doctor's doctor," because they are often called upon to act as consultants to other physicians to help solve puzzling diagnostic problems."
http://www.legalnursingconsultant.org/internal

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