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.

Nurses expect to be called by their first names, should doctors follow?

Patient
September 29, 2010

I’ve worked in hospitals since I was 16 years old — 42 years ago now. I was first an orderly, then a nurse’s aid, then a practical nurse, and a finally a surgical technician before I became a physician.

When I started, female nurses wore caps, the details of which identified which nursing school they had graduated from, as well as a pin that gave the same information. They wore starched, …

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Nurses expect to be called by their first names, should doctors follow?

Keeping the terminal patient comfortable is the purpose of comfort care

Patient
September 28, 2010

Dealing with an incurable illness or terminal condition is an inevitable reality of the practice of medicine. Not uncommonly, especially in the intensive care unit, we care for the patient with no chance for recovery and survival. Keeping that patient comfortable and allowing him or her to die with dignity becomes the priority of care.

Occasionally, I hear requests from the family members of the dying patient – “Can you give …

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Keeping the terminal patient comfortable is the purpose of comfort care

Using denial to control a patient’s anxiety

Patient
September 28, 2010

A few years ago, a patient of mine was diagnosed with lung cancer.  A metastatic work up revealed a small mass in his liver that had the radiographic appearance of a benign liver cyst.  But in the setting of a newly diagnosed lung cancer, we couldn’t be sure it wasn’t a metastatic lesion, so we decided to biopsy it.  Due to scheduling issues, we couldn’t get it done for seven …

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Using denial to control a patient’s anxiety

Confronting the fear of death takes preparation

Patient
September 28, 2010

by Brad Stuart, MD

Atul Gawande’s brilliant essay in the New Yorker sums up the dilemma we face, whether we’re patients, families, and/or clinicians, as we near the end of life. His point is that we have to face it together:

“People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say …

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Confronting the fear of death takes preparation

Are e-Patients expert in their own diseases?

Patient
September 28, 2010

As an e-Doctor, one with some IT literacy, I welcome the e-Patient movement.

I think patients should be equipped, enabled, empowered, engaged, equals, and emancipated, as Wikipedia explains.  The link also adds “and experts” and here I have a problem, not because I don’t think patients should have access to knowledge or know a lot about their own disease, but because knowing one pattern of pathology, i.e. your own, does not make you an expert.

No more …

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Are e-Patients expert in their own diseases?

Health and well-being hypocrisy in the health care industry

Patient
September 27, 2010

by Edward Stevenson

One of the things that drew me towards medicine was the fact that I personally value health and the sense of well being.

I would expect that if I inquired of my colleagues that a similar statements of values would echo this fact. Yet despite this near universal affirmation of value for health and well-being, a considerable amount of hypocrisy exists in the …

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Health and well-being hypocrisy in the health care industry

What to say to a person who is sick

Patient
September 25, 2010

When I ran into Paul S. not knowing he had cancer, I barely recognized him and struggled with what to say. “What happened?” didn’t seem appropriate, although it was my initial reaction. I believe I said, “I barely recognized you,” which was true. I’ve been in many situations where I wasn’t sure what to say to someone who was ill or in distress; I wanted to be supportive …

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What to say to a person who is sick

The $100 question about patient empowerment

Patient
September 24, 2010

by Devin Gross

Here’s a question. It’s not a 5¢ or $5 question that anybody can solve on their own without much thought or effort. It’s a $100 ask-an-expert or think-about-it-for-a-second question.

What’s the point of patient empowerment?

Much of the current discussion of empowerment deals with patients who for one reason or another have had to fight for their care. CNN’s Elizabeth Cohen opens her book, …

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The $100 question about patient empowerment

Are toning shoes safe or effective?

Patient
September 23, 2010

Grandmother Pat LaColla, 82, was lured by the hype—”get in shape without setting foot in a gym”—when she bought a pair of Skechers last year, wincing at the $100 price tag. Toning shoes like those she bought are the newest craze in athletic footwear, projected to grow 500 percent to become a $1.5 billion market this year.

Although the designs vary, toners typically have strongly curved, thickened soles. From the moment …

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Are toning shoes safe or effective?

Tips for patients during an emergency department visit

Patient
September 23, 2010

An excerpt from Treat Me, Not My Age: A Doctor’s Guide to Getting the Best Care as You or a Loved One Gets Older.

by Mark Lachs, MD

Over my twenty-five-year medical career, the route by which people are admitted to the hospital for an overnight stay has subtly evolved in ways that most patients (and even many doctors) may not realize. Specifically, the proportion of patients who …

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Tips for patients during an emergency department visit

Why answering a cell phone during an office visit is a problem

Patient
September 19, 2010

Here is an unfortunate, but almost daily not-so-secret occurrence in my practice:

I am in the midst of an intricate follow-up visit with a rather complicated patient with diabetes, high cholesterol, and high blood pressure. I am feeling as though I am a CIA agent in a rather mission impossible assignment: she is here for lab results, is complaining of low back pain, and presents with an elevated blood pressure of …

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Why answering a cell phone during an office visit is a problem

Is it the doctor’s fault if an obese patient cannot lose weight?

Patient
September 19, 2010

I need help.  In dealing with obesity as a medical problem, that is.

I am pretty solid at arrhythmia management, but as an obesity doctor, not so much.  If I was the teacher, and my obese patients were the students, I would surely be fired for poor student test performance. At least, if the core measure was the patient’s BMI.

If a student does poorly on an achievement test, is it the student’s …

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Is it the doctor’s fault if an obese patient cannot lose weight?

Talk to your own doctor when hearing advice on the radio

Patient
September 14, 2010

by Adam Linker

A doctor at Sloan-Kettering Cancer Center recently advised that I submit to genetic testing without ever having met me. It turns out I may harbor a gene that increases my risk of developing prostate cancer.

This unsolicited advice was delivered via National Public Radio after a story on the JAMA study of preventive breast and ovarian surgery in women with BRCA1 or BRCA2 genes. Dr. …

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Talk to your own doctor when hearing advice on the radio

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A primary care physician who knows history and can relate to people

Patient
September 13, 2010

by Marianne Mattera

Recently, a press release from Mount Sinai School of Medicine in New York City landed in my e-mail inbox. “Students with Humanities Background Equally Successful in Medical School as Traditional Students”, the headline read.

The press release summarized the findings of a study published in the August issue of Academic Medicine. David Muller, MD, and Nathan Kase, MD, reviewed data on the Mount Sinai …

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A primary care physician who knows history and can relate to people

All patients will soon become e-patients

Patient
September 13, 2010

by Daphne Swancutt

I’m having a weird, visceral reaction to all of the recent brouhaha surrounding the term “e-patient.”

For some reason, semantically speaking, the term is slipping in to derogatorium. Up there with “cyberchondriac,” which definitely is derogatory. It’s kind of like research—one day, omigod, it’s Mecca; the next day, it’s the scab on a rotting wound.

Whatever.

I have a chronic condition—I’m not dying, it’s not …

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All patients will soon become e-patients

Bringing a friend or family member on doctor’s appointments

Patient
September 9, 2010

by Diana E. Lee

Most of the resources I’ve read about how to prepare for a doctor’s appointment recommend bringing a loved one with you so that person can help you remember what the doctor said and make sure you get your questions and concerns addressed.

But when I read Paula Kamen’s book All in My Head: An Epic Quest to Cure an Unrelenting, Totally Unreasonable and …

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Bringing a friend or family member on doctor’s appointments

Forgiveness shaped by the stories of people’s lives

Patient
September 8, 2010

If you had asked me what I thought forgiveness was when I was a young adult, I probably would have said that it is something you do for others—others who have wronged you in some way, to give them a break and let them know that you are no longer angry or upset with them.

As I’ve matured emotionally over the years, my view of forgiveness has evolved significantly. Some of …

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Forgiveness shaped by the stories of people’s lives

Anecdotal accounts of patient experiences with local physicians

Patient
September 8, 2010

by Liz O’Brien

A long time ago — when managed care-style employee healthcare benefits were a new thing — we worker bees learned we might have to throw our old family doc under the bus.

We were given a booklet of providers on the network panel, and if the faithful retainer who had served our family for years wasn’t on that list, it was sayonara — unless we …

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Anecdotal accounts of patient experiences with local physicians

Improve patient safety and cut costs with clinical pharmacists

Patient
September 8, 2010

by Emmanuel King, MD

What if you could improve patient safety, cut costs, broaden your medical knowledge and find 20% more time in your workday?  On October 1, 2010, that is just what we can expect when clinical pharmacists move from the back room to the bedside in ten general medical units at the Hospital of the University of Pennsylvania.

As we all know, medications play an intensely complex and ever-growing …

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Improve patient safety and cut costs with clinical pharmacists

Moments of internal struggle in the ER

Patient
September 5, 2010

I walked into Room 22 to find a very interesting patient who presented to our ER with complaints of abdominal pain and associated nausea and vomiting.

The patient sat on her cot with her pant legs rolled up above her knees, refusing, according to her nurse, Gwen, to put on a treatment gown. Her left leg hung in the air, her ankle crossed over the knee of her right leg. Her …

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Moments of internal struggle in the ER

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