How this primary care doctor found his dream practice | THE BEST OF The Podcast by KevinMD
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How this primary care doctor found his dream practice
Corporatization of medicine?
The administrative role in medicine has grown exponentially over the past four decades. Doctors are required to work harder and harder, spending less and less time with patients and diverting revenue to overhead, and the result has. Corporatization results in doctors spinning the hamster wheel as fast as they can, but they're needing to get patients in and out of the office rapidly.
And that has resulted in a terribly erosion of the therapeutic alliance between doctors and patients.
Life in a micropractice?
In the previous practice, we had 20 minutes for a new patient and 10 minutes for a routine visit. I allot 55 minutes for a new visit or an annual check-in in my practice. And 25 minutes for a routine visit. I also buffer every appointment, so after every appointment, there are five minutes during which time I can address faxes, answer phone calls, and call pharmacies to address prescriptions.
The bottom line is 99 percent of the time, I have plenty of time to address my patient's needs. Be cordial and set up a follow-up if appropriate. In sum, I'm not time pressured.
John Machata is a family physician.
?? FULL EPISODE → https://www.kevinmdpodcast.com/how-this-primary-care-doctor-found-his-dream-practice/
Top questions doctors ask health care attorneys
Doctors are running businesses with people
I think doctors sometimes forget that they're running a business with people. And so anytime you're dealing with human beings, you're going to have some tension and some stress, and you need to know, are you classifying them correctly, and what do you do when they file an employment discrimination case?
And how do you deal with employment, labor, and employment issues as they pop up? Because a lot of times, doctors say, “I want them gone. I'll fire them. I don't have time. I'm running a medical practice.” Like somehow they're immune from having interpersonal conflict with their staff.
Negotiate all contracts?
I feel like a lot of systems, especially hospital systems, are telling doctors there's no negotiating. You just sign it, you DocuSign it. I disagree because I always get changes, and it's always about leverage. And so I always talk to my docs about what leverage you have. Because trust me, they want you, they will move, and you don't want to sign an agreement that's unreasonable.
Amanda B. Hill is a health care attorney.
KevinMD on the Co-Learning Clinician podcast
Breaking down physician silos?
There is no more physicians' lounge anymore at the hospital. You have hospitalists, and then you have outpatient physicians, and we never see each other. In fact, I'm an outpatient primary care physician. I don't know the last time I rounded in a hospital. It must have been 15 years ago. And that's a stark contrast to what I grew up with in residency, where there'll be a lot more camaraderie. You'll see your colleagues every day. You could commiserate in person, but now that you're out in practice, everyone is so siloed, and I think what I do on KevinMD brings physicians together, so they can share these stories.
Normalizing physician burnout
60 percent of physicians are burned out. They would share and write their story on KevinMD, and then other physicians would chime in to comment and say, “I feel that way too. This is my story.” And then they'll share their story in a comment. And that normalizes burnout, right?
Before, burnout would be a taboo topic, but then you have everyone talking about it, and then everyone realizes, “I'm not the only one going through this.” And then, they each share their stories. And not only does it normalize it, but it also offers a level of support that physicians can offer to each other.
Kevin Pho, M.D. is interviewed by CMEfy 's Brian D. Cohen, MD on the Co-Learning Clinician podcast.
Science impacts our lives more profoundly than we appreciate
When patients don’t feel heard?
When patients don't feel heard, and that's often the case when we as physicians have very little time to see them and they are confused about the type of information, or they don't feel heard because they don't really have the time they would like with their physician. When that happens, they are going to find information from sources they can understand.
And what concerns me is that when people do that, they may actually go to something that feels good. They may go to somebody who has a consistent message, but that message may be completely wrong, and it may not be conducive to their health in the long run.
What is lifestyle medicine??
Lifestyle medicine is the medical specialty that uses evidence-based lifestyle and therapeutic intervention as a primary approach to prevent, treat, and often reverse the chronic diseases that are so common today.
And it does that by addressing the root causes. It looks at the whole person and enables people to adopt and sustain healthy habits to improve their health and quality of life.
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Iris Schrijver is a lifestyle medicine physician and author of On the Path to Health, Wellbeing, and Fulfilment.
?? FULL EPISODE → https://www.kevinmdpodcast.com/science-impacts-our-lives-more-profoundly-than-we-appreciate/
Opioid-free orthopedic surgery
With my transition to opioid-free, I went from a mindset that this is a necessary evil for controlling pain for my patients after surgery so that they can achieve the outcome of having a repair or reconstruction to this is not necessary. And I approached my patients with that mindset to say, what's normal is that we don't use.
And we can use it, but the normal thing is not to use it. And if you have that buy-in based on the trust you've established with the patient, you can totally change their postoperative pain experience.
Michael Day is an orthopedic surgeon.
?? FULL EPISODE → https://www.kevinmdpodcast.com/opioid-free-orthopedic-surgery/
What anticipatory grief feels like
What is anticipatory grief?
I would describe it as pre-grief before death. Although the feelings may be very much the same. It's the waiting, it's the not knowing. And as I said, it's not talked about very often, so for me, it felt like, “What would happen today? Was anything gonna change? Would I have to call an ambulance? What do I have to get Bill to the hospital? Would the oxygen concentrator break, and I'd have to order a new one?” It was always that little bit in the back of my head, anticipating what might happen so that I could prevent it from getting really bad.
You are your own caregiver
You need to take care of yourself. You need to keep up with your medications and doctor's appointments and consider speaking to hospice nurses or therapists of some sort. Because you are going through as much as your loved one, only you're watching it on the outside. You need to be able to keep up your energy, which means you need to eat and take care of yourself.
I know that all sounds so easy, and it's not, but you are your own caregiver as well, and at some point, everyone in the world will become a caregiver. Even if it's just to an animal. You will be a caregiver and must watch out for your emotions.
Nancie Wiseman Attwater is the author of A Caregiver's Love Story.
?? FULL EPISODE → https://www.kevinmdpodcast.com/what-anticipatory-grief-feels-like/
A physician's remedy for stress, anxiety, depression, and burnout
A personal definition of burnout
My definition of burnout was this realization that I was in a situation that I was powerless to get myself out of. I was in a situation where I was powerless to help the people that needed me most at that given time. For the first time in my life, I wasn't able to clearly come up with the answers.
Wake up an hour earlier
If you feel as if you don't have time for yourself and your health and your fitness, set your alarm clock an hour earlier. I thought about that and thought, “That's crazy. I can't do that. I need my sleep. I had a late night. I was on call. I got called in at midnight for a food bolus action. I can't lose that hour of sleep, right?”
Wrong. Set my alarm clock an hour earlier, and maybe instead of binge-watching Netflix later into the night, I went to bed a little earlier, but with a much more restful sleep because I had worked out that day. My nutrition and diet just cleaned up radically, and physically and mentally following that, I was a very different person.
JOSEPH D. PIANKA, MD, INC. is a gastroenterologist and author of It’s All in Your Head.
?? FULL EPISODE → https://www.kevinmdpodcast.com/a-physicians-remedy-for-stress-anxiety-depression-and-burnout/
Let doctors in recovery be able to recover their careers
Recovery comes first?
Recovery has to be number one. If you want to get back to practicing medicine, everything will fall into place if you take care of that. Don't take your recovery for granted. If I took one pill, it'd be all over. I don't drink alcohol. I'm a Catholic;? I don't use communion wine, and I'm committed to that for the rest of my life. So, continue treatment. Continue recovery. Go to meetings. Stay in contact with other doctors that are going through this problem.?
Physicians with addiction?
To any physician that's suffering from this horrible disease, just know you're not alone. We all feel unique, isolated, and scared to death. And also, you didn't choose to become an addict. Narcotic addiction: These are very addictive medications. I had no idea that I could become addicted, so you're not alone. You can recover, and you can get your career back.
jeffrey fraser is a family physician.
?? FULL EPISODE → https://www.kevinmdpodcast.com/let-doctors-in-recovery-be-able-to-recover-their-careers/
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