I moved to Florida three months ago to take a job as a primary care nurse practitioner in a clinic for the underserved and uninsured. This position followed four years spent as a home-visiting nurse practitioner working with high acuity, chronically ill patients in the Boston area. I didn’t realize it would be such a transition to go back to taking care of patients in the clinic setting after spending …
Defining the patient’s goals of care
January of 2010 initiated me into the life of a chronic pain patient. For sixteen months I plunged into a diagnosis journey that brought with it ten misdiagnoses by eleven respected physicians, fifteen procedures and tests, twenty-two medications and crushing pelvic pain.
People have asked me if I am angry about it all; the misdiagnoses, prolonged pain, time spent, needless tests and sometimes painful procedures. Anger is not the presiding feeling, …
Doctors might not really have a grasp on the art of diagnosis
Once upon a time, I was a newspaper journalist: I chased down sources and sweated over deadlines. Then, in mid-career, I switched to doing marketing and communications for a regional healthcare system. This consisted of a large hospital and many outpatient clinics, including a community cancer center.
Because I handled communications work for the cancer center, I also had a seat on the cancer committee — an oversight group of oncologists, …
We really need to give our outpatients palliative care
For at least two decades doctors, caregivers, the people they care for, and advocates have deplored the term patient or have been exposed to the arguments of those who deplore it. “Patient” has few defenders in an age in which Western consumers of health care insist on an equal voice in the management of their afflictions, and loathe ceding all power to those who are dispensing relief. This blog recently …
4 linguistic reasons to leave patient alone
Much is being made of the meaningful use requirement to use secure online messaging to communicate with patients about relevant health information. The new Stage 2 measure requires that more than 5% of unique patients seen by the eligible professional during the reporting period were sent a secure message using the electronic messaging function of certified EHR technology.
But to meet that goal, we have to get our patient population engaged …
How to improve patient engagement
I am not a disease.
Although when I enter your hospital, or office, or outpatient center, you may refer to me as one. You may lump me together with an odd set of symptoms, or signs. You will define me with those antiquated terms. You will pretend that you will know how I, my body, will react when placed under certain stressors. You will prescribe treatments for my disease, and yet …
I am not a disease, I am not a checklist
Remember the figure-ground drawing from psychology 101 that demonstrates (ahem) “how edge assignment designates perceptual groupings?” I always just thought it was cool how you could look at the picture of a vase and blink and — whoa, Nellie — now you saw two people face-to-face.
I’m concerned that the frantic drive toward evidence-based medicine as a strategy for quality improvement and …
Incorporating patient preferences into evidence based medicine
There’s an elephant in the room, one that’s preventing patients from getting the most out of their visits to the doctor — and the name of that elephant is embarrassment.
It’s not unusual to feel uncomfortable about some of the more intimate aspects of your health, but too often this discomfort turns into outright embarrassment. This embarrassment can lead to omissions, which in turn make it impossible for your doctor to …
3 tips to overcome embarrassment in the doctor-patient relationship
An excerpt from Second Firsts: Live, Laugh, and Love Again.
I spent nearly 4 years in the waiting areas and patient rooms of cancer hospitals. I was not the one with cancer but my husband was. He was diagnosed with stage IV colon cancer.
He was only 31 years old.
I remember …
Can doctors help patients live fully after a medical diagnosis?
While recently confronted with a cancer scare and several months of inconclusive diagnostics, I found myself thinking about how I want to die.
Following some reading, my first answer was to die at home, with control over my care, and without substantial pain, views that are widely shared by others. But the more I thought about this, the less satisfactory the answer seemed.
For instance, being at home was never of high …
Second thoughts about how to die
Imagine your spouse, parent, or best friend gets a left ventricular assist device (LVAD). This is a mechanical device put into their chest. A wire sticks out of their body and connects to a bunch of different electronic pieces you’ve never seen before. You’re in charge of making sure this wire stays clean. If it doesn’t, it could mean infection and possible death. So, you know. It’s kind of a big responsibility.
Of …
The emotional health literacy block
Outsourcing work to cheaper workers is a common strategy of corporations. It has largely escaped the public’s notice, however, that much of this new labor force isn’t located in Southeast Asia, but is rather found here in the U.S. and is virtually free. It is we, using our laptops and smartphones to perform tasks once carried out by knowledgeable salespeople and service representatives.
This was particularly salient to me this week: …
The chronically ill are those who need online services the most
My daughter loves her career as a probation officer. She is very good at what she does, and finds the work both challenging and rewarding. Yet her client case load includes some of the most unsavory of individuals, found guilty by the courts of child abuse, domestic violence, sexual assault or worse, many of them living with added complexities like addictions or mental health issues. She’s been insulted and screamed at by …
Physician burnout: Don’t blame the patient
As a healthcare writer, I often spend large chunks of the day reading about medical conditions. I often joke when starting work that it’s only a matter of time before I notice signs of the condition in myself. I remember being convinced I had gallstones for a while until I finished working on a gallbladder surgery multimedia program. Suddenly, the symptoms that had been preoccupying me for several weeks vanished.
I …
What does it mean to be a good patient?
In the world of health care, as in most enterprises where we must interact with one another for mutual benefit, we need words to describe one another. And the words we have for us people who use/need/want health care frankly don’t cut the mustard.
We need a new one.
The French gave us tasty food, the Statue of Liberty, and the wonderful phrase, “le mot juste.” Translated literally, it means “the exact …
We need a new word for patient
Recently, both my husband and I came away from a conversation with my doctor positive that we understood my new weight gain plan. Funny thing: Each of us recalled a different plan. I am always struck by how our memories of the words spoken by my doctor can be so dissimilar. No, not all of them, but enough of them to be wary of going to any appointment without a …
Is the time right for e-caregiving?
The cold ultrasound probe pressed uncomfortably onto my abdomen. “It looks like an ovarian cyst,” the pleasant technician told me, “But of course we’ll run it by the radiologist.”
For the past few months, I had felt a dull, heavy pain in my right lower quadrant that sharpened when I coughed. I’d put off having it checked during my busy schedule as a third year medical student. However, the nagging knowledge …
I felt abandoned by the system to which I had committed my career
We never know how high we are
Till we are called to rise.
-Emily Dickinson
It could be suggested that the “good death” is falsely named in the field of thanatology and in the popular press. It implies an ideal state, one which of course we cannot have. Never agonize over ideals when the problem is as urgent as death. Perhaps it should be renamed “the good-enough death,” one that is …
There is a cure beyond saving a life or the curing of an illness
One of my doctors always asks if he can examine me before he starts. He identifies each body part he is going to touch as a question. I feel like I can always say, “No ear exam today, thank you.” Or alternately, “I’ve been having a little pain in my left ear. Can you check it?”
Tiny point. Subtle. But by merely asking me, my doctor signals that I am not …
How choice can drive patient engagement
My right eye had a blackout in September 2010 when I stepped onto our deck. I didn’t pay much attention to this episode as my vision zoomed back into focus within seconds. But several months later, my eye was playing tricks with me when the only way I could read was with my right eye closed.
Back in 1981, I had lupus though I didn’t know it at the time. My …
A love affair between big healthcare and big insurance companies
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