In a new Forbes article, David Shaywitz ponders whether patients are the best judges of physician quality. This is a very interesting question, not because the answer is elusive, but because the question itself is rather unusual, and may prove to be the harbinger of a new way of thinking about health care. The question raised by Dr. Shaywitz is not whether …
Who are the best judges of physician quality?
Just the other day I received a somewhat anxious-sounding phone message from a patient of mine, approximately 72 hours after her office visit with me, and about 24 hours after I had already gone over all of her lab results from the visit with her.
She sounded quite distressed, and said she’d received a message from someone, but could not really understand what they were saying. She said she was finally …
The dreaded post-visit calls: Are they worth it?
We were intimate.
As intimate as a doctor and patient can become. He had long outlived his wife and there were no children, no family, just friends. When he first came to me he was lively and active, but the years took their toll. Our visits became more regular. Every six months. Then every three.
His memory started to slip. Occasionally he would look at me suspiciously when something went wrong. His …
Sometimes doctoring reveals my failings as a human being
Dr. Daniela Drake writes an provocative and bold piece on the plight of doctors in America and the impact it has on patient care: “Why Your Doctor Feels Like a ‘Beaten Dog’.” Though health care is very bureaucratic with administrative paperwork, huddles, and hassles, her linkage of how patients were neglected as a consequence of the system doctors work in is weak.
She talks about Victoria, a teenager, who …
Not knowing what we don’t know: How can we help doctors?
Is your doctor a hammer and you’re a nail? Here’s some insider advice coaxing patients to be more wary and skeptical of medical advice. Should you trust your doctor? Absolutely. But you need to serve as a spirited advocate for your own health or bring one with you. Ask your physician for the evidence. Sometimes, his medical advice may result more from judgement and experience as there may not be …
Doctors are hammers. Don’t automatically be their nails.
Ebola virus is rampant in West Africa. So far, the death toll is around 2,296, which makes it one of the largest outbreaks ever. Ebola is what’s known as a hemorrhagic fever virus, and belongs to a large family of nasty viruses that are widespread around the world. There’s even one in the American Southwest known as hantavirus, that lives in a species of mice. Yellow fever, which killed so …
Ebola: Don’t forget the patients who are left behind
We speak of everyday decisions in terms of cost-benefit analyses. Many of our patients can’t afford a healthy meal, let alone a hefty hospital bill, thus making cost awareness increasingly relevant. But on the day that I met Mr. R., it wasn’t the financial aspects of his care that concerned me. I was thinking about the patient, his family, and two roads diverged in a hospital ward. I was thinking …
Cost-benefit analysis: A case where conservative management wins
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 72-year-old woman is evaluated in the emergency department for loss of consciousness. Her son, who brought her in, says she seemed confused and agitated when he spoke to her on the telephone less than 2 hours ago. The patient has an 8-year history of type 2 diabetes mellitus. She had strict …
MKSAP: 72-year-old unconscious woman in the ER
About seven years ago, the California Healthcare Roundtable and Health Affairs sat down to prepare a white paper on the emerging phenomenon of urgent care centers, and what it might mean for primary care. At the time the group couldn’t agree that urgent care (UC) was a disruptive innovation, but it seemed clear to all participants that it represented a threat to primary care: The …
Urgent care won’t replace primary care. Here’s why.
This is the story. Ebola emerged in 1976 and the last major outbreak occurred in 2007 in Uganda and D.R. Congo. Now we are experiencing the largest outbreak of Ebola ever seen with a death toll of 1,848 and number of infected of 3,707, but these are only the “confirmed” cases.
Ebola is affecting 4 countries in West Africa: Guinea, Liberia, Nigeria and Serra Lione, and while we have only seen …
Ebola needs an ice bucket challenge
We’ve gone through four dreadful pre-medical years of learning everything from the composition of atoms to how an apple exerts force when falling off a tree. We’ve taken a massive exam full of content mostly unrelated to our future field only to be put through four more years of intense medical education (and several additional massive exams). We’ve managed to receive a medical degree and have gone through at least …
“Studies show”: It’s time to ban the term
I sometimes wonder what I would do if I was told I had cancer. How much would I subject myself to in order to survive, or to achieve remission? As a parent, I can answer only that I would likely go through hell and back if it meant being there for my kids — to watch them grow up, graduate …
Two women, two cancers, two different pathways
After you’ve written on a blog for a long time, you begin to ask yourself why. Oh sure, there are the great opportunities for a single person to make a point, to act as a tiny tugboat trying to push a corporate mothership in a slightly different direction, but you begin to realize that there are very few times that actually …
ADVERTISEMENT
As every physician already knows full well, health care services delivered to the home rather than in an institutional setting are increasing, a trend destined to expand even faster in the decades ahead.
This shift is inevitable, thanks to our rapidly growing elderly population and the corresponding prevalence of chronic illness, along with the nationwide push for higher quality care at lower cost and dramatic advances in medical technology such as …
6 major myths about health care at home debunked
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
I recently heard a story on the news about a grandmother of eight who had gotten addicted to heroin after being prescribed an opioid painkiller, Oxycontin, for hip pain. It sounds extreme, but unfortunately to those of us in the pain medicine field, it’s all …
Curbing prescription pain medication abuse by working together
It is a beautiful day here in my little college town. The sun is shining and at 11 a.m. it is about 78 degrees with a barely perceptible breeze. People are out walking on Main Street and riding their bikes. The mountain nearby calls: I can go for a hike today with my dog and still be within 20 minutes or so …
This is what population health looks like
Many healers, teachers and parents have them.
At one point, I did, too. I had delusions. I thought I was a hero, a rescuer clad in a shiny white coat and wielding the sword of clinical wisdom.
I look back on those days with nostalgia and regret. I wish they’d lasted a little longer — my belief in my own medical grandeur and invincibility.
My most memorable patient changed that for me.
I remember how …
The best doctor I can be is one that is patient
What is HPV?
HPV stands for human papillomavirus, and these viruses are the most common sexually transmitted viruses in the United States. Most of the people who are diagnosed with HPV are young and sexually active. The rates of HPV infection are high because most people who have HPV do not know they are infected because sometimes the virus shows no symptoms. Most HPV infections show no symptoms, and resolve within …
A pediatrician answers your HPV vaccine questions
“He’d feel okay about not replacing the pacemaker’s battery when it ran down, he said. But turning it off, he said, would be ‘too active.’ Later he would tell me that it would have been “like putting a pillow over your father’s head.”
These are the words of Katy Butler in her book Knocking on Heaven’s Door – The Path to a Better Way of Death in which she writes about her …
Deactivating a pacemaker: Is it euthanasia?
Recently, Cisco chairman and CEO John Chambers told me that U.S. health care is at a tipping point. A positive one, he hopes, but the truth is no one knows for sure which direction the system will tip.
At the close of our interview, I asked Chambers what health care topic he’d like me to cover in the future. He asked me to …
5 health care megatrends to watch for
Get free updates delivered free to your inbox.
