Read e-book online Practice Under Pressure: Primary Care Physicians and Their PDF
By Timothy Hoff
Via ninety-five in-depth interviews with basic care physicians (PCPs) workingin assorted settings, in addition to scientific scholars and citizens, perform stressed offers wealthy perception into the typical lives of generalist physicians within the early twenty-first century--their paintings, stresses, hopes, expectancies, and values. Timothy Hoff helps this discussion with secondary info, information, and in-depth comparisons that seize the altering face of basic care medicine--larger numbers of more youthful, lady, and foreign-born physicians.
Read or Download Practice Under Pressure: Primary Care Physicians and Their Medicine in the Twenty-first Century (Critical Issues in Health and Medicine) PDF
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Extra resources for Practice Under Pressure: Primary Care Physicians and Their Medicine in the Twenty-first Century (Critical Issues in Health and Medicine)
This emphasis on both speed and numbers raises tensions in the practice of today’s primary care medicine; tensions that never existed for the generalist of 1970. For example, as greater numbers of patients with behavioral health issues present in the PCP’s ofﬁce, and the PCP’s reimbursement system is not set up to pay them adequately for this type of care, PCPs have four suboptimal 18 Practice Under Pressure choices before them: either attempt to provide appropriate care by spending time with the patient, thereby sacriﬁcing other ofﬁce visits and earning less money for the practice; attempt to provide more complex behavioral medicine within the conﬁnes of ﬁfteen- or twenty-minute visits that may produce lowquality care; offer “quick-and-dirty” prescription therapies to patients; or refer patients to behavioral health specialists who are in short supply causing delays of weeks or months before they are seen.
And there’s no blood test I can do for depression. There’s no approach to diagnosing it that doesn’t take some time and individualized approach to the patient. In the end, it’s really about listening to the patient, and ruling out other diagnoses. But it’s a real diagnosis. (Mick, family physician) An irony-in-the-making existed each workday for PCPs. To excel within the business model in which they now found themselves, and to be considered “good” doctors that could navigate a full patient load efﬁciently, they needed to develop personal styles and work behaviors that allowed them greater speed without sacriﬁcing their ability to get the primary patient diagnosis right.
To see how ingrained its acceptance was in the PCP psyche, all I had to do was listen to how several of the doctors in the study spoke about visits that might extend to twenty minutes or longer. For some, twentyminute visits were an unachievable luxury, coveted and capable of achieving higher-quality medicine. It seemed far-fetched that another ﬁve minutes with a patient could produce such differences in the quality of care. Others spoke deﬁantly of their own decisions to forfeit income in order to have longer visits with their patients, as if their choice to spend an extra ﬁve or ten minutes in the exam room was akin to making a signiﬁcant personal sacriﬁce.
Practice Under Pressure: Primary Care Physicians and Their Medicine in the Twenty-first Century (Critical Issues in Health and Medicine) by Timothy Hoff