How do you judge how good a doctor is? By personal interaction? By what relatives and friends say? By whether he or she is on time when you go for your visit? By doctor rating websites on the Internet? By patient satisfaction surveys conducted by doctors themselves or rating agencies?
Or do you do it by the numbers? The federal …
How judging doctors by the numbers may be meaningless
Laryngeal sensory neuropathy (LSN) is a recently described condition felt to cause a chronic cough in patients when treatment for everything else (allergies, asthma, reflux, etc) has been evaluated and managed.
Treatment for this condition is with neuropathic medications including Neurontin, Elavil, Lyrica, nortriptyline, etc.
In the past few months, I have seen a few patients referred to me with chronic cough treated with these medications with minimal or no improvement. All …
Chronic cough from laryngeal sensory neuropathy (LSN)
“You know, what Mr. HD really needs is for his mom or somebody to chain herself to him …” [the ICU team laughs] … “But seriously, he needs to be watched over, he needs to be talked to. He needs someone to give him his medications, someone to take him to his appointments, someone to take care of him. With that somebody he can live for years to come. Without …
People live and die by their chronic illnesses by what they do at home
Physicians used to take care of patients at their homes.
Through the 1960s, patients would make a phone call and the doctor would arrive at the doorstep, black bag in hand, eager to serve. This changed in the mid to late-1960s as doctors developed group practices and as medical care expanded to include technology-based studies and specialty referrals, and thus became more hospital-centered. Prior to World War II, 40 percent of …
How house calls benefit patients and physicians
Almost every Sunday night, I walk to this one restaurant in my neighborhood for some comfort food (we’re creatures of habit aren’t we?).
I pass a church on my way where an Alcoholics Anonymous meeting is held almost every night. As I walk through the crowd of smokers, I look at them and they look at me. They don’t know that I know they’re recovering addicts. And they put a smile …
Bad lifestyle isn’t a medical issue, it’s a social one
There is a critical gap in the supply of primary care physicians in the U.S., and it should come as no surprise that our existing primary care delivery and payment models are at the heart of the issue.
The traditional primary care model — medical care provided by a physician and a small support staff, often without benefit of health information technology (HIT) — was developed at a time when the …
Explaining the critical gap of primary care physicians
Boston Medical Center has provided care to the underserved and Medicaid population in Boston for almost 150 years. And what’s happening to the venerable institution is gut-wrenching to read.
I trained at Boston Medical Center (BMC), completing my internal medicine residency there in 2002. A recent write-up in Boston Magazine highlights the financial trouble the hospital is going through:
Boston Medical Center is almost broke, perilously close to what …
Boston Medical Center gets screwed by the Massachusetts government
I’ve worked in hospitals since I was 16 years old — 42 years ago now. I was first an orderly, then a nurse’s aid, then a practical nurse, and a finally a surgical technician before I became a physician.
When I started, female nurses wore caps, the details of which identified which nursing school they had graduated from, as well as a pin that gave the same information. They wore starched, …
Nurses expect to be called by their first names, should doctors follow?
Dealing with an incurable illness or terminal condition is an inevitable reality of the practice of medicine. Not uncommonly, especially in the intensive care unit, we care for the patient with no chance for recovery and survival. Keeping that patient comfortable and allowing him or her to die with dignity becomes the priority of care.
Occasionally, I hear requests from the family members of the dying patient – “Can you give …
Keeping the terminal patient comfortable is the purpose of comfort care
A few years ago, a patient of mine was diagnosed with lung cancer. A metastatic work up revealed a small mass in his liver that had the radiographic appearance of a benign liver cyst. But in the setting of a newly diagnosed lung cancer, we couldn’t be sure it wasn’t a metastatic lesion, so we decided to biopsy it. Due to scheduling issues, we couldn’t get it done for seven …
Using denial to control a patient’s anxiety
by Brad Stuart, MD
Atul Gawande’s brilliant essay in the New Yorker sums up the dilemma we face, whether we’re patients, families, and/or clinicians, as we near the end of life. His point is that we have to face it together:
“People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say …
Confronting the fear of death takes preparation
As an e-Doctor, one with some IT literacy, I welcome the e-Patient movement.
I think patients should be equipped, enabled, empowered, engaged, equals, and emancipated, as Wikipedia explains. The link also adds “and experts” and here I have a problem, not because I don’t think patients should have access to knowledge or know a lot about their own disease, but because knowing one pattern of pathology, i.e. your own, does not make you an expert.
No more …
Are e-Patients expert in their own diseases?
Even as a medical student, I’m already complicit in exacerbating the problem of the high cost of health care.
It hit me one day, during my medicine rotation. We were working up a patient, and I was ordering tests with my resident. The patient had liver disease and perhaps some ascites.
He came in for another issue, and this wasn’t of primary concern to us, and we really wouldn’t have …
How a medical student can exacerbate the high cost of health care
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It just shouldn’t be hard to get a refill on the medicines I’m taking:
Simple, right?
Note that this is about my old pharmacy, not the new one. For quite a while the pharmacy had been having difficulties, which is why I never trust the pharmacy. Between the distance and the frustrations I had dealing with them, …
Can a pharmacy profit from gouging patients without insurance?
Today we mostly have prepaid medical care insurance with some co-pays and deductibles – both with commercial insurance and with Medicare.
In other words, our insurance covers essentially everything from basic and routine care to the catastrophic. And the insurance pays out based on units of care – a visit, a test, a procedure, a hospitalization, a prescription. This creates a system in which providers (physicians, …
A system based on units of activity encourages more units of care
Vitamin D is a fascinating molecule with a fascinating story.
Historically, “vitamins” were defined as chemicals that humans required from their environment that were “vital” to human health. These chemicals were needed only in very small amounts to prevent disease; an absence of a particular vitamin in the diet led to a specific deficiency disease: vitamin C, scurvy; thiamine, beri beri. Other vitamin deficiencies were found …
The story of vitamin D and its association with other diseases
by Edward Stevenson
One of the things that drew me towards medicine was the fact that I personally value health and the sense of well being.
I would expect that if I inquired of my colleagues that a similar statements of values would echo this fact. Yet despite this near universal affirmation of value for health and well-being, a considerable amount of hypocrisy exists in the …
Health and well-being hypocrisy in the health care industry
Before he tells you how to get a straight answers from physicians, Doctor D is going to stall for time by explaining why doctors give vague answers.
Why would a good doctor give useless answers?
1. There is an answer, but your doctor doesn’t know it. Don’t be hard on doc for this one. There is no MD in the world that knows the entire breadth of medical knowledge. Some docs pretend …
Why good doctors give useless answers
One thing I have learned by being active in the obstetrics and birthing blogosphere is that there are a whole lot of people out there that think that most cesarean deliveries are unnecessary. While most of them will admit that some cesareans are medically required, its pretty rare that the ones that have had a cesarean looks at their cesarean that way.
A popular term bandied about is “Unnecesarean”, a catchy …
Why unnecessary cesareans is a misnomer
I like Dr. Rob, the one with the distractible mind. And although I thoroughly agree with the stance he takes in his recent post against cholesterol screening in kids, I must take issue with his opening statement:
I have a unique vantage point when it comes to the issue universal cholesterol screening in children, when compared to most pediatricians. My unique view stems from the fact that …
What’s the difference between family practice and med-peds?
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