I’m not a doctor. And sure, you know your patients better than I do. But, I have been a patient and as a patient, I know how we think. As someone who works in health IT helping to create software to better connect patients and providers, I like to think I have a hypersensitive pulse on what’s going on.
I know that as patients, sometimes we get frustrated trying to solve …
Feedback your patients wish you knew about portals
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
More needles … who wants that? You probably do! Nerve block anesthesia, also called regional anesthesia, requires localized numbing and additional needle sticks, but it has many advantages. Primarily, it can have a profound effect on your pain after surgery, and improve your rehabilitation and decrease …
Is nerve block anesthesia better for surgery?
As a life-long dedicated health care provider, caring about those in physical and mental need is always a presumed requirement of the field. You’re ill, I act. You’re hurt, I act. I care enough to help educate about prevention of injury and disease. I’ve sacrificed a great deal of comfort, sleep, and mental energy to care enough to help those in need — even for those who …
The boundaries of caring and empathy are moving targets
There’s been a lot of hype about the “Ban Bossy” campaign in the news lately, and the talk is all over the map. I was thinking about it in regards to health care, especially nursing, since nurses are notoriously “bossy,” or at least referred to as such.
I can remember being a nursing student and talking with a physician about a patient during my clinicals. He told me, “You …
Differences between banning bossy and true leadership in health care
I first heard about the ICD-10 when I was working at a small start-up, trying to develop an EMR for a string of dialysis clinics. It was always spoken of with a certain gravity, like the ominous visit from an aunt that nobody in the family likes, but feels obligated to see. Practical (read: business) people hate ICD-10. It’s giant and unwieldy. Doctors think it’ll be an excuse to bilk …
ICD-10 and the problem of interobserver variability
Recently, I gave a lecture entitled, “Treating Depression in Primary Care,” at an annual conference for physician assistants. I spent a good portion of the talk on the fundamentals that have been essential to me during my 15 years of practice. When things go awry in mental health care, the majority of the time it is because one or more of these fundamental principles was neglected.
My fear is …
The Ten Commandments of good psychiatry
I first met Carol* (name and identifying details have been changed) when she came to my clinic after a severe asthma attack had sent her to the intensive care unit. After a few days, she had been extubated and had acquired a new diagnosis: asthma. When she saw me in clinic, she felt better than she had when she had come to the hospital, but she continued to complain of …
Will bronchial thermoplasty for asthma be more widely used?
For more than a decade I’ve taught a seminar in dynamic psychotherapy to psychiatry residents. One tricky issue that arises every year is the apparent choice between conducting a “supportive” psychotherapy, versus an “analytic” or “insight-oriented” one. I developed a sailing analogy to clarify this issue, and to teach an important point about it.
Most patients appreciate emotionally comforting support. Many seek a therapist who will provide a listening ear, who …
The choice between supportive and insight psychotherapy
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 24-year-old woman is evaluated for increasing asthma symptoms. Her symptoms now require her to use her as-needed albuterol inhaler two to three times per week, and she has been waking up at night at least once a week with asthma symptoms that require her inhaler. She is still able to perform …
MKSAP: 24-year-old woman with increasing asthma symptoms
My third year of medical school cemented the passion for primary care I developed as a volunteer in a clinic for undocumented immigrants in San Francisco. Relationship building, continuity of care, and seeing the impact a primary care physician can have on a patient’s health all ignited my passion more than any angioplasty or neurosurgery ever could. But one question continued to nag me as I filled in the bubbles …
The choice between family medicine and internal medicine
I had the opportunity recently to participate in a Twitter chat on the topic of colorectal cancer awareness. The chat was intended to bring attention to a nationwide campaign called “80 by 2018” designed to increase colorectal cancer screening rates to 80% of the population over the next 4 years. If it is successful, we should see a decline in both incidence and deaths …
Don’t forget those where cancer screening didn’t make a difference
She looked at me, eyes pleading, telling me without needing to say a word: I am not lying to you. I am not crazy. I am not making this up.
I sighed. “We’ve done the work-up and know this is not your heart. I don’t think there are a lot more tests that can be run.” I studied her expression, trying to discern what she wanted to hear from me.
I’ve come …
Doctor and patient: Insecurity meets insecurity
Headlines soared recently with the CDC report that the number of children with autism diagnoses had increased by 30% in the past 2 years.
“Reality is there are many children who are having serious struggles because they can’t communicate well and have a hard time being with people,” Dr. Chuck Cowan clearly stated to me this morning. Like a bell on a quiet night, I feel parents need to hear this most: …
Is autism diagnosed more frequently? Making sense of a recent study.
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Primary care physicians (PCPs) have multiple frustrations today. The greatest frustration is “time, time, time.” From in-depth interviews with over 20 PCPs, everyone said that time or more correctly lack of time was the greatest frustration of their practice (or was previously if they now were in a practice that limited the patient number to a manageable level). Each knew that they could not give the …
Frustrations of the primary care physician should be a wakeup call
“I feel bad …” Amy whispered, then paused.
I’m a family medicine resident, and I was doing my gynecology rotation, which involved spending a few days at a Planned Parenthood facility. This was my first day. I’d been assigned a patient to shadow: a young woman named Amy, who was here to have a first-trimester abortion.
I’m a fan of Planned Parenthood’s work providing high quality, affordable contraceptive and gynecological care. In …
Sharing secrets with my grandmother
Most humans have spent most of human history nearly starving to death. So it’s no surprise that we spend a lot of time thinking about food. And it’s no surprise that food has acquired cultural, social, and religious significance in almost every society. Because food is so important, and because it’s nearly impossible for us not to ascribe powerful effects to anything important to us, every society imbues special health …
Is what we know about dietary fats wrong?
Hospitals are environments where emotions can run high. These emotions cross all boundaries and can affect physicians, hospital staff, patients and their families. Dealing with an “angry” patient is a common challenge that physicians face.
The first step for a physician encountering an angry patient is to remain calm and allow the patient to express his or her concerns. In my experience, “angry” patients can be viewed as falling into several …
4 reasons why patients may become angry
Projecting future physician workforce needs is a challenging calculation that must take multiple variables into account to avoid missing its mark. In the mid-1990s, the American Medical Association confidently predicted that the penetration of managed care would lead to a large “physician surplus” and convinced Congress to cap the number of graduate medical education (GME) positions subsidized by the Medicare program.
Two decades later, there is a widespread consensus that the U.S. is …
Problems with the proposed solutions to the primary care shortage
One of the most exciting things about working in patient safety and health care quality is that it’s not solely about advancing science or applying performance improvement methods. It is also about the excitement of being part of a social movement that is changing the culture of medicine — putting patients at the center of everything, sharing errors in the hopes of preventing future ones, and confronting hierarchies that stifle …
Introducing yourself to patients is a patient safety issue
So you think your medicine is natural. Ever wonder what’s inside? A product can be labeled “natural” if the main ingredient is from an animal, plant, or mineral. Arsenic, horse urine, and cow brain are natural. But are they natural for you? Here are four drugs whose origins may surprise you.
Insulin was discovered in 1922. Until the 1980s, all insulin was …
The shocking ingredient in natural medicine
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