primary care medicine
Serving Patients Through a Screen
Years ago, when telemedicine first edged into my clinical consciousness, I pooh-poohed it as a second-rate simulacrum, valuable perhaps for rural communities lacking access to specialists, but otherwise hardly worth the crinkly exam paper it was replacing. I’ve staked my entire career on the irreplaceable value of the connection between patient and clinician. But I’ve changed…. More
Access to Primary Care
“Doctor, it’s taken so long to get this appointment with you!†This is the opening line of so many medical visits, and I find myself constantly apologizing to my patients on behalf of our system. After the pandemic-induced lull in routine medical care, we’re right back where we started—doctors booked for months, patients struggling to get appointments. More
Taking Stock of the Second Covid Surge
As the pandemic raged from the winter surge through to the spring slog, my Postmortem folder lit up with a dispiriting regularity. I opened it with dread as it revealed which of my patients had perished that week. More
Covid Diary (The New Yorker)
During March and April of 2020, New York City experienced the Covid surge that many other localities faced later. I kept a journal during these frightening weeks, talking with my colleagues and patients at Bellevue, as we grappled with how we could manage primary-care medicine during a pandemic. More
Just a “Regular” Doctor
“What’s your specialty?†This question continually flummoxes me. This is the moment that I experience a brief surge of envy toward my cardiology and dermatology colleagues who have simple one-word answers to this question that any lay person can understand. More
A Doctor in the Neighborhood
There aren’t any ethical guidelines about where a doctor should live or how she should behave when she and her patient are in line at the grocery store. More
The “Mall-ification” of Health Care
Retail health clinics have exploded over the last 10 years, and now it seems like every other big box store, supermarket and shopping mall has its own clinic. More
The Physical Exam as Refuge
There are few situations where we expect to disrobe and have our bodies touched by relative strangers. But the physical exam is often the first moment that patients and doctors can talk directly, without the impediment of technology. More
Doctor Priorities vs. Patient Priorities
The patient cheerfully admitted that he hadn’t been paying attention to his diabetes for the last few years. He’d stopped taking his medicine, stopped seeing his doctors, stopped thinking about the disease altogether. What happens when the patient’s priorities and the doctor’s priorities conflict? More
Lots of New Patients, Too Few Doctors
Getting a primary care doctor is hard these days, and will only get harder as more people get insurance via the ACA. This is a “problem” that we should welcome, since it means that more Americans will have access to care. But it won’t be an easy problem to solve. Here are some ideas that are being discussed. More
Medical Check-Ups: Waste of Time?
A new report concluded that general health checkups for adults did not help patients live longer or healthier lives. So is it time to scrap the annual medical check-up? More
Monday
Maybe it was simply human nature that no one wanted to be sick on weekends. Or admit to it. Or do something about it. Whatever the reason, Mondays were always the days of reckoning: weekend walls of denial came crashing down, weekend indiscretions faced their due, weekend warriors paid their price in blood. Admissions poured into the hospital. It was as though the map of Brooklyn had been curled up like a cone and all the human wreckage and misery funneled down to the tip where East Memorial Municipal Hospital sat, as it had for the past century since it opened, with its doors flung widely and indiscriminately open. More
A Day in the Clinic
8:30 a.m. Doing intakes—interviews with new patients to the clinic. First one is Carola Castaña, a petite thirty-five-year-old Brazilian who immigrated to the United States three months ago. She folds her hands in her lap as I begin to take her history. She understands my questions better if I ask in Spanish rather than English, but her Portuguese replies are Greek to me, so she struggles to answer in English. More
Neuron Overload
Sometimes it feels as though my brain is juggling so many competing details, that one stray request from a patient—even one that is quite relevant—might send the delicately balanced three-ring circus tumbling down. One day, I tried to work out how many details a doctor needs to keep spinning in her head in order to do a satisfactory job, by calculating how many thoughts I have to juggle in a typical office visit. More
ERs for Primary Care
George Bush once famously (or infamously) commented that health care is indeed available for all: You just go to the emergency room. More
