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.
“If I’d known I was going to live this long, I would have taken better care of myself.”
-Eubie Blake
He leaned forward, energetically listening to my conversation with his daughter. There was more than one cancer treatment option. We reviewed everything and she asked what he could expect with either a major surgery or seven weeks of daily radiation treatments. Soon, both the father and daughter were peppering me with questions about …
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The different types of frail to consider before surgery
Today the patient is far different than the patient of a few decades ago. Patients can find healthcare information just as easily as a physician and many patients are taking a greater role in their healthcare and want to be involved in the decision making and work with the doctor as a team with the doctor being the captain of the healthcare ship. This new attitude has been referred to …
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Patients want and need to take a greater role in their medical care
Bullies are terrorizing residents in long-term care and assisted living facilities, senior centers, and retirement communities around the country. The first time I witnessed older adults bullying others was at a senior center where, after a great deal of resistance from members, the age for joining the center had finally been lowered from 62 to 55 years old. Most local senior centers had already lowered their membership age years …
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Bullies in older adult communities
I’ve noticed a certain dilemma that enters into therapy sessions with mothers over the years. Mothers often feel in a bind and sometimes this bind distorts the way they think about their lives … or is it that their thinking distorts the way they feel? The sequence of events generally runs like this – the strong urge to have a family – the joy of being pregnant – the horror …
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What a psychiatrist learned during therapy sessions with mothers
One of the many things I didn’t know about breast cancer before I got a front-row seat was just how many choices it entails. I didn’t realize that so much of the experience wouldn’t have clear-cut, yes/no answers.
You’re confronted by your first choice before you even know you have cancer. When my mammogram revealed suspicious specks, I was presented the choice of a stereotactic or surgical biopsy. I opted for the …
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The choices after getting diagnosed with breast cancer can be overwhelming
A good screening test is relatively inexpensive and noninvasive. In addition, effective treatment should be available if the disease being screened for is confirmed. Lastly, detecting the disease before a patient becomes symptomatic must be more beneficial than detection after the patient experiences signs or symptoms.
The latter point is often debated in prostate cancer screening, which is done by obtaining a serum prostate specific antigen (PSA) and performing a …
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The benefit of prostate cancer screening is controversial
Sports physicals are universally required in the U.S. on an annual or seasonal basis for students wishing to participate in sports. All states have requirements covering public schools. The reason for the exams is to ensure that the athletes can participate safely. These exams are not intended to replace a regular physical. There are no absolute standards for what should be included in these exams. Most would agree that …
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Sports physicals often includes no provisions for privacy
Medically speaking, what’s a guy to do when there is no right answer? My patient’s solution is often to ask me what I would do given his particular circumstance. He isn’t happy when I respond with, “I truthfully don’t know.”
In reality, I always know what I would do. I’d gather knowledge, see consultants, and explore every possible option to its fullest. Then, most probably, I would still not be …
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With cancer, sometimes there is no right answer
I hate the bouncy houses. I mean, I really hate them; I get a sick, nervous stomach when the boys are inside them. And it’s created a parenting perplexity for me. See the photo? I bet my HR is about 160 and my BP 150/90 (translation: high). I’m not kidding, I have a visceral and then flight-type response when the boys jump … it’s one of those instinctive parenting responses …
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Why this pediatrician hates bouncy houses
She was overwhelmed with grief when she walked into the room and saw her mother silently and peacefully dead in the hospital bed. Her death was expected, but as always, no-one is ever quite ready to let go. She started to wail loudly and speak directly to her deceased mother about the pain she was inflicting by dying.
She was compelled to hold her prayer beads and started to dance around …
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Embracing different cultures in the service of the dying
Starting a new job can be exciting, a new challenge, while embarking on a new journey. I have the opportunity to meet many new fellow docs, staff, and kind patients. However, I have to admit that it is a tad more challenging in the beginning when starting a new practice from scratch. I do miss the familiar patient faces that knew me and trusted my medical abilities without question. But …
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Patient tips for your first office visit
As a physician, and as an interventional radiologist, I consult with many patients. Similar to anyone who sees and talks with many people, I encounter a significant diversity of personality types, cultures and attitudes. One thing I have noticed is that each person has a certain level of expectation regarding their care, illness, and our potential interaction.
I have visited with many people who are simply happy to have someone …
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What is your expectation when you visit a physician?
Although filled to the brim with patients, hospitals were created to support doctors, not us patients. Historically, their organizational structure focused on doctors’ needs and doctors’ requirements. The concept of centering hospital care on patient needs and requirements is a relatively recent development.
How can a hospital switch from being provider-centered to patient-centered? Shifting such a complicated and cumbersome behemoth a full 180 degrees is a huge undertaking.
I believe it …
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What a hospital can do to be more comfortable for patients
In early February, my new patient was a middle-aged woman from here in Silicon Valley with a self-discovered 2 cm right breast mass. Her internist was all over this. She quickly had a core needle biopsy, was evaluated by one of our breast surgeons, and was referred to me for an opinion regarding pre-operative (neo-adjuvant) chemotherapy. I saw her …
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ASCO: Making e-visits work for cancer patients
Simply put, habits are hard to break and bad habits like smoking, drinking, sedentary lifestyle and overeating are making our population sick. Who in the healthcare system can tackle these issues before they manifest into chronic disease?
Doctors are trained to diagnose and treat, but they aren’t trained to help people change their behavior, nor should they be since most physicians, particularly general practitioners, are already severely overloaded. Nurses provide …
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Can health coaches help fix our healthcare system?
Jackson’s blood pressure was low, and this had the emergency room physician scrambling, barking orders. A nurse was busy at each arm, attempting to place large-bore IV’s so that fluids could be given rapidly and thus improve the low blood pressure. Other nurses were preparing strong antibiotics for immediate administration. An automated blood pressure cuff was attached to the left arm, inflating every 3-4 minutes with a characteristic grinding …
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The inevitability of AIDS and the presence of addiction
When working with a patient population with chronic and terminal illnesses, very often, stressful and difficult conversations take place frequently. Often the news is not good or not what the person wants to hear. Having the assessment skills and knowledge about how to read body language and react accordingly to manage the interaction in a positive way are important skills to have.
Here are 5 tips that can help you navigate difficult …
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Reading body language to help navigate difficult patient interactions
