Patients and caregivers writing on KevinMD about the experience of illness and the health care system from the other side of the exam table: navigating care, the doctor-patient relationship, being heard, and what patients want physicians to understand. Physicians who have become patients write here too. For the record of what pain patients and physicians have said to each other about opioids and chronic pain since 2007, with patient authors cited at the same weight as physicians, see Opioids: what physicians and pain patients say, in their own words. For what patients, families, and physicians have said about dying, hospice, and the decisions families face at the end of life, see End of life: what physicians say, in their own words. For what women and the physicians who treat them have said about pregnancy, menopause, and the conditions dismissed for years, see Women's health: what physicians say, in their own words. For what physicians have said about consent, honesty, and who decides, see Medical ethics: what physicians say, in their own words.
We have all seen people exhibit flagrantly unhealthy behavior. Some of us–though we’d never admit it–derive a certain, smug satisfaction by observing them. At least I don’t do that!
Somewhere in the course of our daily lives though, most of us do exhibit behavior that suggests at least some disregard for our health. We don’t change our diet, though we know we should. We don’t floss, take medications as prescribed, or …
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Explaining human motivation towards unhealthy behavior
There is a saying in psychiatry, “even bad therapy is good therapy.”
I always thought this was a terrible thing to say, but really, there’s some truth to it. The basic tenet of therapy is that a person is able to vent their feelings with an objective third party. Depending on how good the therapist is, he or she will be able to help that person process their feelings in …
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Who benefits most from psychological therapy?
Thump.
There is a strange sound emanating from the hallway. It’s more of a series of sounds, of thuds, punctuated by an odd, louder noise. The hallway is narrow, not much room for a five-year-old to create too much havoc. I close my eyes, and as I try to visualize the corresponding sequence of events the rhythm is interrupted by a much louder sound and the house shakes. A child has fallen …
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Born premature, my sons have already endured a lifetime of hardship
I often refer to myself as a fireman pouring water on the flames that are burning my patients. Often, I view my patients as arsonists, pouring gas on the fire I am working to put out. Taking personal responsibility is a critical component of success in any of life’s ventures. While my patients are very responsible business and family men and women, they often take no responsibility for their …
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A contract for patient responsibility
The elderly population can be fun to take care of (they have more stories than you have time to hear), or they can be a handful in regards to all of their chronic complaints and numerous medications. But then, there are those senior citizens that come into clinic and tell us, “I don’t need to take medications, I haven’t taken medications my whole life, and look at where it’s …
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How elderly patients can be stubborn to their own detriment
An estimated 60% of American bankruptcies result from overwhelming medical costs. My uncle’s tale illuminates the dual tragedy of suffering catastrophic illness and being uninsured.
The 2008 recession claimed my uncle’s job, health benefits, and assets, except for a small inheritance. By 2009 he found work (but not health coverage) as a consultant.
One day he noticed that his eyes were yellow. He emailed a photograph, and I immediately recognized jaundice. I …
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The dual tragedy of suffering catastrophic illness and being uninsured
I read an interesting article by Jason Luban, a licensed acupuncturist, on why so many patients flock to alternative practitioners. Mr. Luban brought up an interesting question, “What is health?”
Is health simply the absence of disease? If it is, there certainly aren’t very many healthy patients in my neck of the woods. Most of the patients I take care of have something that’s not quite right. I only know one perfect …
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Defining what health truly is
I remember joking with Dad about how he’d outlive us all. He had gone vegetarian 10 years before I was born, never smoked, took vitamins, and asked for a designated driver after his annual Heineken at the neighbor’s Christmas shin-dig. He flossed, wore a seat belt, and looked forward to annual physicals. If I tried leaving our Michigan house in the winter with more than 3 inches of skin exposed, …
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Asking patients about their health care financial concerns
As a graduate student in the health field I often get phone calls from various family members and friends asking what I happen to know about different drugs, procedures, and devices. I was having one such conversation with my younger sister last spring. She had just completed her undergraduate education, started a new job, and was very proudly financially self-sufficient for the first time.
We were talking about birth control. Her …
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An incorrectly coded $1,000 billing error
Between the cracks is a frightening place to be.
During the course of trying to improve our family’s financial stability, my husband and I were blind-sided by one hidden detail: We’d face $10,000 in costs to continue my husband’s serious medical treatment because we found ourselves unexpectedly without coverage for 30 days.
This was money we simply did not have. We had been prepared to foot the full bill for good health …
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Slipping through the cracks in our health care system
I’m really miserable and need that 5 day antibiotic to get better faster.
Ninety eight percent of the time it is a viral infection and will resolve without antibiotics.
But I can’t breathe and I can’t sleep.
You can use salt water rinses and decongestant nose spray.
But my face feels like there is a blown up balloon inside.
Try applying a warm towel to your face.
And I’m feverish and having sweats at night.
Your temp …
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A real doctor will first do no harm
All day I badger and cajole my patients to take better care of their bodies:
“We really need to get some of this weight off, Mr. Jones.”
“This blood sugar level means diabetes is right around the corner – it’s time to get serious about changing your diet, Ms. Smith.”
“This blood pressure reading tells me that you’re not getting enough exercise, Bill.”
I’ve got pills for everything, it seems. I just wish I …
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How diet and exercise beat high blood pressure
Whether your office has wireless access or not, there will be patients texting, surfing the Internet, Facebooking, and otherwise engaging with the outside world on their smartphones while in your office.
These smartphones have another function: the ability to record audio or video. It is understandably tempting for patients to record consent discussions, medication and follow-up instructions, and other physician or staff interactions.
Recording a medical discussion via video or audio is …
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Should patients be allowed to record their office visit?
Much as war begets both high-profile losses and the unsung wounded, two ranks of casualties lay fallen, rent financially by medical treatment.
First are those of headlines, injured mortally, or nearly so, by insurmountable debt. Such wretched tragedy serves notice to all that a singular turn of fate may lead one swiftly to financial ruin.
Less-celebrated are members of the second order, surviving but spending more than requisite for their care. In contrast to the …
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A physician responsibility for the financial health of patients
If you are a practicing physician then it probably already happened to you more than once. Mature and responsible patients tend to Google their symptoms, medication and illnesses on the web – a phenomenon commonly referred to as cyberchondria. Nine out of ten women more or less decide which oral contraceptive they will take and not the doctor does. She will just let the doctor know whether his choice …
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How a Google printout can strengthen your relationships with patients
Ten years ago this summer, my husband and I flew from California to Paris, planning to immerse ourselves in Parisian culture for three weeks. The second day there, I got sick with what appeared to be an acute viral infection. I spent most of those three weeks in a Parisian bed. Ten years later—I’m still sick. I didn’t research what I should …
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10 tips from 10 years sick
Rest in peace. These words are a common theme at funerals honoring loved ones. But many people die with no one claiming their bodies. For example, at hospitals there are unclaimed bodies of patients and the unborn. Corpses are found abandoned often in police cases. Mortal remains can go unclaimed due to insufficient funds for burial or cremation, insufficient concern for the deceased, and lack of available or known family …
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Hold funerals for unclaimed dead bodies
There is no “alternative medicine.” There is only medicine:
- Medicine that has been tested and found to be safe and effective. Use it; pay for it.
- And, medicine that has been tested and found to be unsafe or ineffective. Don’t use it; don’t pay for it.
- And, medicine for which there is some plausible reason to believe that it might be safe and effective. Test it and then place it into one …
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The effect of therapeutic touch is based on pure chance
