primary care


Caring for Nursing Home Patients under Medicare

What drove me crazy about practicing medicine in a nursing home wasn’t the patients, although with their many medical problems often including cognitive impairment they were a challenge; and it wasn’t the families, though with their anxiety and attentiveness and sometimes their guilt they were an even greater challenge. What drove me crazy about nursing […]

Call the Concierge

My mother recently got a letter from her doctor informing her that he is going into “concierge medicine.” If she wants to keep him as her doctor—and she does (she’s 88 and has known him for years)—she will have to sign up for his new plan, paying a retainer fee of $3500 a year on […]

How Patients Can Assess the Quality of Their Outpatient Care

Even before I launched my geriatric consultation practice, I found myself often poring over another doctor’s outpatient notes, trying to explain to a patient what the other doctor was doing. Not every patient had questions and concerns about what their other healthcare providers were saying, and doing, but a fair number of them did. And […]

A Proposal That Just Might Solve the Primary Care Crisis: Meet the 35 Hour Work Week

In March, The Health Care Blog published a truly outstanding commentary by Jeff Goldsmith, on why practice redesign isn’t going to solve the primary care shortage. In the post, Goldsmith explains why a proposed model of high-volume primary care practice — having docs see even more patients per day, and grouping them in pods — […]

Reimagining Geriatrics

A little over a year ago, I found myself burning out and realized that my work life was unsustainable.  I’d been working at a Federally Qualified Health Center, and had become the site’s medical director a few months before. I was practicing as a primary care doc, trying to improve our clinical workflows, problem-solving around […]

Avoiding Unneeded Tests

In my previous post, I talked about medical tests and how “normal” and “abnormal” results do not always correlate to healthy or sick.  The bottom line from that discussion is that while tests are essential to diagnosing illness, they are fallible. Put another way, if you do enough testing on anyone, some tests are bound […]

What Patients Should Know About Medical Testing

The next two posts are about medical testing, something to which we are more and more subject as we get older.  It seems rare these days to visit a doctor’s office and not come away with a handful of requisitions for some kind of medical test. This is especially true as we get older.

Learning from my Mother’s Hospice Care

My mother has been in hospice care for the past five months, after three months of almost daily visits with doctors and recurrent visits to the emergency room, and pointless hospital admissions fraught with tests designed to diagnose problems which would require surgeries that she could never survive.

Do We Need Less Technology, or More?

As a practicing outpatient geriatrician, I generally embrace the principle that less is often more. But is this the approach we should take towards technology and the health care of older adults?