The wards had an odd sanguine feeling that day. The large glass pane doors were streaming a glow from the summer outside, and all was right because I had actually managed to have a lunch break. The High Care Ward is where the most intense monitoring is done so that we doctors can observe suffering in slow motion. I can’t remember what brought me there but in the first bed …
Marcie transitioned to my care when she turned sixteen. She felt too grown up now to be in the same waiting room with “kids” at the children’s clinic. But she wasn’t doing well.
Her pediatrician had suspected the problem shortly after birth. She wasn’t growing normally, had nasal congestion, and more respiratory infections than usual. A sweat chloride test was ordered which was positive. The diagnosis was cystic fibrosis (CF). The …
Discussing end of life issues with a teenager
During my transition from public to private health, I have indeed noticed some interesting differences that have forced me to practice medicine a perhaps a tad differently. One big surprise: in private health, I have to admit that I have been pretty astounded to see that my patients quite heavily rely on the Internet before they even come to see me for their given ailments.
In public health, some of my …
5 tips to evaluate medical websites
In May of 2001, I got sick with what the doctors thought was an acute viral infection. But I didn’t recover. As the months went by and I didn’t get better, I felt as if I’d entered a parallel universe that I didn’t know existed. One reason this universe is largely invisible is that many people living with chronic pain or illness don’t look any different from those around …
The challenges of living with invisible pain or illness
“By the time you see the doctor, you’re either dead or you’re better,” my mother-in-law told me. She had to have multiple tests, all with long waits to get the appointments and the results, before her health insurer would allow her to make an appointment with a specialist.
“Waiting is the bane of the medical system,” a former student, an R.N., concurred. Advances in medicine and technology have improved medical outcomes, …
Waiting is the bane of the medical system
Every once in a while, I come across a new concept or technology application that really captures my imagination.
This was the case when I became aware of an enterprise whose core business is patient-physician communication.
What patients actually say to their physicians — and what physicians actually say to their patients — is largely unknown.
A company called Verilogue ventured into this previously uncharted territory and began to audio record patient-physician interactions.
To …
What patients actually say to their physicians is largely unknown
The doctor/patient relationship is certainly changing and evolving. A term I hear a lot today is: “patient engagement/activation.” Why is this concept so important and what does it mean? What can physician executives do to make it easier for our patients to become engaged and activated?
Judith Hibbard has pioneered the study of patient engagement, and she noted that one needs knowledge, skills, and emotional support to actively engage in one’s …
Physicians should embrace patient engagement
It’s never so obvious to me that there’s a big essential difference between men and women as when we take a family trip to Target.
First, when you’re holding a small baby or even an older baby or even a preschooler, you get a lot of attention. People love to look at small babies. And by “people,” I mean “women” only. When I walk around with the baby, women are constantly …
The difference between male and female patients
Of all possible times, it happened during Ramadan. The test of faith would be extreme.
Azka was the first of four children born to Persian parents in a small town thirty miles outside of Tehran, Iran. Being devout Muslims, her father chose the name Azka in part because it meant “pious”. His wife later revealed to Azka that he also liked how the name rolled off the tongue when spoken in …
A test of faith during Ramadan
Suffice to say, as a physician, I’m not germ phobic. If I were, I wouldn’t work as a health care provider in the “culture media” of an ambulatory care clinic. I certainly respect the pathogens I come in contact with daily, along with the host who harbors them. For the most part, the virus and the patient know I don’t have much effective artillery to fight back with and my …
Handshakes during viral outbreaks
While body language can be interpreted in many ways and it’s not an exact science, it is often possible to read body language and have a basic understanding of a persons mood or dispositions and the rapport that people have with each other through observing non-verbal communication. This issue focuses on reading everything that hands can tell you and ways to use your hands to influence interactions with others.
What’s …
Use body language to improve your patient encounter
The Dr. Oz show recently featured a scary show about deadly arsenic in apple juice. On his own web site, he trumpets “Dr. Oz’s Extensive National Investigation,” and claims “After testing dozens of samples from three different cities in America, Dr. Oz discovered that some of the nation’s best known brands of apple juice contain arsenic.”
His show further claimed that based on his independent testing, many brands of apple juice …
Why Dr. Oz is wrong about arsenic and apple juice
I recently had some physical therapy for a minor injury. Since the office forgot to charge my co-pay the first time I went in I received a so-called Explanation of Benefits (EOB) from my insurance carrier, BlueCross BlueShield of Massachusetts. EOBs are a holdover from the mainframe era: arcane, inflexible reports that are hard to interpret. They may have done their job in the day when their only purpose was …
What does the Explanation of Benefits really mean?
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Last month, vegan couple Jade Sanders and Lamont Thomas’ appeal of their life in prison sentence was overturned. The couple reportedly starved their 6 week old to death by feeding him only soymilk and apple juice. When reading this, so many questions arise. How could they not know their child was starving? Where was their support? Were they truly negligent? And what happened to all the systems in place to protect children?
In an …
The United States lacks postpartum support for mothers
A couple of years ago, a frail 88 year old Filipino woman came into the emergency department of my hospital complaining of confusion and weakness of her left arm. Her blood sugar level was extraordinarily low, so low that she would have died had she not received immediate treatment.
The emergency room doctors treated her by injecting her with sugar, and then called the team of internists on call to admit …
Hospital discharge summaries are a health literacy issue
Irrational exuberance was a term once used to describe the stock market before the last crash. It also seems an apt description for much of the talk these days about empowered health consumers.
To be sure, patients today have unprecedented access to health information. Patient decision-support tool can be found on just about every provider, payer and self-insured employer website. Consumers can go to any number of websites to find …
Top 5 myths about empowered patients
I caught the tail end of a recent #hcsm (health-care social media) tweetchat and it looked to be a good one. I saw a few comments about teaching bedside manner and whether it’s a thing of the past (oh, how I hope not). It occurred to me that sharing a real-life story could be instructive.
I put on a brave face when I got a mastectomy for stage 0 DCIS …
Is teaching bedside manner a thing of the past?
By now you’ve probably seen the internet jokes that compare the mammogram experience to having your breast squashed in a refrigerator door. A few years back, I joined the club of women who have our annual mammograms, and I can’t say that I disagree with the imagery of the jokes. However, the benefits of early detection far outweigh the discomfort, so I’m willing to put up with it.
I’d like to …
Practical tips for a more comfortable mammogram
Patients and friends tell me it’s sometimes difficult to decide exactly what symptoms merit a doctor’s appointment. I find that it helps to think of three basic categories of visits. One category is the all-important annual checkup, which assesses and promotes overall health and can detect signs of early disease. Another category is the follow-up appointment to track chronic conditions or recovery from a major illness.
But the third category …
When to see a doctor if you have a new symptom
Amid the buzz about whether medical students should be sued and the bill currently debated in Arizona (a state which finds itself in the spotlight more than usual these days), I noticed some commentary from several people who do not think they would like a medical student on their case. Sometimes patients do refuse to be cared for by medical …
You may benefit from having a medical student care for you
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