We often speak of the importance of continuity of care, but there is confusion about what this really means.
When I first joined our small clinic twenty-five years ago, continuity was the reason every medical group in the five town area had its own night-call roster. This way, patients who called after hours could reach a doctor from their own doctor’s office. Even if the covering physician didn’t know the patient, …
Continuity of care starts with caring
New concepts need gimmicks. Proven concepts do not.
The phenomenon of using the internet to gather and share health information is now mainstream. It’s time to change how we talk about it, revising and maybe even retiring certain terms.
Some history to build our case:
In 1998, only about one-third of American adults had access to the internet. Harris Interactive published pioneering research about how internet users gather health information online, dubbing these …
Using the internet for health information is not the exception
by Diana E. Lee
Minnesota Vikings wide receiver Percy Harvin has been struggling with chronic migraines.
If you don’t follow football you may not have heard of him. But let me assure you he is a high profile player in the National Football League and an important component of the Minnesota Vikings’ offense. Harvin has dealt with migraines since childhood (like me), but almost …
How Percy Harvin struggles with chronic migraines
In addition to outlining patient’s medications, and teaching them what times of day to take the drugs that will help control their specific disease, pharmacists are now taking on a new role to address the growing healthcare needs and demands of Americans, according to a recent article in the New York Times.
For example, at Barney’s Pharmacy in Augusta, Ga., the pharmacy offers classes at the store for patients …
How pharmacists address the healthcare needs of patients
Learn the art of observation.
“The whole art of medicine is in observation… but to educate the eye to see, the ear to hear and the finger to feel takes time, and to make a beginning, to start a man on the right path, is all that you can do.”
– Wiliam Osler
One of my favourite books as a medical student was Michael Zatouroff’s Physical Signs in General Medicine, a book brimming …
The art of medicine is in observation
One of the most difficult family decisions can be whether to move an aging parent(s) out of their own home and into assisted living or even a nursing home. I’ve seen families face this dilemma numerous times. (After my psychiatry residency, I completed a geriatric psychiatry fellowship and also spent the first few years in practice consulting at nursing homes.)
Nobody wants to face this situation.
In fact, I’ve seen repeated instances …
Technology can help your aging parents
I can always use money. Regardless of what the public seems to think, doctors are generally not phenomenally wealthy.
So I hate turning business away. But tonight I refused a hospital consult. Why would I do that?
Because.
The consult was for an 88-year old lady with advanced Alzheimer’s Disease. Her sad life was reduced to lying in bed staring at the ceiling. The patient had been seen by 2 other neurologists during …
Let Grandma go with dignity, and a family’s inability to do so
You are now out of the Gray Zone, and you are now a member of an exclusive club.
But membership to this club comes at a steep price. Membership is not offered, it is not dependent on your income, title nor your social status. Membership is granted simply by surviving or living with a grave or potentially fatal illness or injury and realizing just how fragile life is and how quickly …
Surviving a potentially fatal injury and the fragility of life
I had been running late on another busy summer day. The type of day where you gain one step and lose two. Meetings and paperwork had filled up another summer morning. Baseball games, swimming practices, and soccer scrimmages had filled up another summer afternoon. And for this particular summer evening, I was scheduled to work an odd emergency room shift from eight p.m. to four a.m.
While driving to work, I …
A sweet and tender moment between a mother and daughter
by Keith Humphreys, PhD
When my friend Paul Costello left the Carter Administration, he wrote a funny New York Times article suggesting a special course for departing staffers:
There ought to be an “outward bound” course for White House employees facing exile. Must we face this cruel and unusual punishment cold turkey?
Maybe people were tougher back then – I personally would have collapsed five minutes into the first day of the …
How working in the White House breaks down your body
by Brian McMichael, MD
The NEJM recently published an interesting case in the ongoing series: “ A Request for Retrieval of Oocytes from a 36-year old Woman with Anoxic Brain Injury.” Usually these cases are diagnostic dilemmas. This one focused on an ethical dilemma at end-of-life.
The Case
A 36-year-old woman, in overall good health taking oral contraceptive pills (OCPs), was on a prolonged international flight, and …
Searching for solace while balancing the care of patient
An excerpt from CyberSafe: Protecting and Empowering Digital Kids in the World of Texting, Gaming and Social Media.
by Gwenn Schurgin O’Keeffe, MD, FAAP
Screen Time and Childhood
Have you ever tried to go “screen-less”? I often tell the story of taking my girls to New York City on an April vacation, looking forward to Turnoff Week. This is a semiannual event that encourages families to flip off the screens …
Protecting kids in the world of social media, a Cybersafe excerpt
October is breast cancer awareness month. There are pink ribbons and wristbands to wear, pink products to buy, and pink races to run — all to improve awareness about screening and raise money for a cure. And rightly so, because breast cancer affects 250,000 American women every year.
Fewer people know that October is also intimate partner violence awareness month. Purple is the color representing the more than 1.3 million women …
Intimate partner violence an epidemic of grave proportion
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One of the most common complaints that I hear from people attempting to lose weight is, “I don’t know how to deal with my triggers.” Most of us have had the experience of eating just one bite of something and suddenly wanting to devour the entire thing. Sometimes we do, even though we know we won’t be happy with ourselves when we finish.
I am familiar with the experience of insisting …
Deal with your triggers when trying to lose weight
There is a white board in every patient’s room. This is used to keep patient oriented and provide them with basic information. You would see some data on it, most of the time there is a date scrolled on it, name of the nurse and maybe physician’s name.
I recently read an article “Getting the most out the humble white board” by Deborrah Gesenway. This is an excellent read …
Using a white board as a patient tool
[Editor’s note: Please visit part 1 of Dr. Harpham’s take on OpenNotes.]
“Our” Chart
Does the opportunity for patients to read their medical charts help or hurt patients’ ability to become Healthy Survivors?
Open notes can facilitate Healthy Survivorship for some patients.
Unfortunately, other patients may learn something about their condition that makes it more difficult to get good care or live as fully as possible. Or they may experience feelings that threaten the physician-patient bond. …
How open medical charts help Healthy Survivorship
POLST stands for “Physician Orders for Life-Sustaining Treatment”. It is a next generation replacement for an Advanced Directive and DNR (“Do Not Resuscitate”) order. Advanced planning documents turn out to be less than useful, especially in urgent care settings, and many patients receive more aggressive care than they might want because universal, transferable physician orders are unavailable or, simply, not applicable because a patient is in a different care setting.
The …
POLST and the next generation of the “Do Not Resuscitate” order
I was a third-year medical student in the first week of my obstetrics rotation. The obstetrics program was known to be high-pressure, its residents among the best. Mostly women, they were a hard-core group–smart, efficient, motivated–and they scared the heck out of us medical students.
I remember the day clearly: Not only was I on call, but I was assigned to the chief resident’s team. I felt petrified.
We’d started morning rounds …
The day that medicine broke her and destroyed her innocence
An excerpt from The Twenty-Four Hour Mind: The Role of Sleep and Dreaming in Our Emotional Lives.
by Rosalind D. Cartwright, PhD
We live in a culture that values speed; fast foods, fast cars, fast service, and fast decisions.
All of this takes a toll. Fast food is blamed for the epidemic of obesity, fast cars for motor vehicle accidents, and the wish for fast service and decisions …
Heavy sleep debt extracts a price for patients
There’s a lot of evidence that to prevent many serious health conditions, including diabetes, obesity, heart disease, and stroke, making healthy lifestyle changes are just as good, if not better than, taking medications. Lifestyle changes may consist of stopping unhealthy behaviors such as tobacco and excessive alcohol use, or starting healthy behaviors such as moderate daily exercise and eating adequate amounts of fresh fruits and vegetables.
As anyone who has ever …
Using Twitter and mobile apps to make healthy lifestyle changes
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