They made a regal couple, the elderly man and woman sitting in Room 19. She was the patient, he the supportive husband. She sat in the treatment cot while he sat in a chair pulled near her bedside. Together, they greeted me with their warm smiles as I walked into their room.
They both had full heads of healthy, silvery hair that shimmered from the overhead fluorescent bulbs. Their eyes were …
Metastatic cancer and the matching walkers
OncRN is a wonderful blog written by an anonymous author sharing stories and insights in her line of work that many times speak to palliative themes. S/he says it best in her blog description,
my life gets intermittantly (sic) rocked by the wonders/horrors of being an oncology nurse. i just need to talk it all through sometimes.
A recent post is about how to say good-bye to our patients, particularly …
How to say goodbye to patients
A while back I did in a post where I asked the question, What can patients really expect from their physicians today? In that post, I wondered at the fact that many patients still have a high degree of trust in their physician in spite of the quality and safety problems attributed to physicians in the press.
For example:
Is patient adherence responsible for health quality and safety?
by Michael Smith
Clinicians treating dying patients did well in managing pain but fell short on communicating with patients and their loved ones, researchers said.
The findings, from a single-institution study, suggest that those who care for terminal patients also often failed to assess shortness of breath in a dying patient whose mechanical ventilation was withdrawn, according to Anne Walling, MD, of the University of California Los Angeles, and colleagues.
But overall those …
Caring for dying patients needs better physician communication
An excerpt from Stroke Diaries.
by Olajide Williams, MD
The man who did not take his medicine
Pedro was lying on the bathroom floor next to the toilet bowl. Water was still running from rusty faucet, overflowing the sink, and pooling around his body as he lay limp on wet porcelain tiles. Lucy was standing over him and whining. The young black Labrador retriever had not left …
What does a TIA feel like? A Stroke Diaries excerpt
Most people enter the healing arts with a genuine desire to serve others.
The long educational journey and the realities of both the workaday world and the various business models of health care often strain our abilities to act in an empathic manner.
We have to pay the bills, after all.
“No money, no mission,” is a refrain I’ve often heard in the non-profit corners of the health care world, justifying business decisions …
Empathy is needed for better relationships with patients
by Scott Cowsill
A third or more of scans may be unnecessary or repetitive, studies show, and in scans that are medically appropriate, radiation doses could be dramatically reduced without hurting the quality of images.
As pointed out by Robert Centor, MD, “one cannot easily develop rules for testing because the presentations that we see vary so greatly.” That being said, guidelines for diagnostic …
Decision support can help doctors order scans
The news that Dr. Marcus Conant has quit practicing medicine is a blow to healthcare here in the Bay Area.
And a sad symbol of all that is wrong with healthcare – and in particularly, the way we treat primary care practitioners – in America today. It would be hard to find a doctor more symbolic of the best of medicine than Marcus Conant – a man willing to devote …
What to do if your doctor quits and leaves medicine
by Crystal Phend
iPod users beware. Listening to an MP3 player for even an hour can induce short-term hearing loss, researchers affirmed.
Compared with controls, hearing deterioration among MP3 users was 3.97 to 4.40 times more likely when listening to pop/rock music through earbud headphones at different output levels, found Hannah Keppler, MS, of Ghent University in Ghent, Belgium, and colleagues.
Listening to an iPod with over-the-ear headphones also boosted the odds of …
Hearing loss from iPods and other MP3 players
by Brad Stuart, MD
The emergency department phoned my office right before lunch.
I was on call for our general IM group, so when I was done with my morning schedule I walked across the street to the hospital. Greg, my partner’s 38 year old patient, was a woodworker admitted with fever, chills, cough, a sharp pain in his right side, and a WBC of 18,000. On the chest x-ray, I …
Talking with patients about their impending death
Dana Jennings writes what is arguably the world’s most famous patient blog about his treatment for prostate cancer.
Just to be clear, I don’t have any statistics about how many readers he and other patient bloggers have. I believe his blog is the most widely read and best-know patient blog because of the number of comments he receives and its prominent location in the New York Times Health section, itself …
Dana Jennings interview, the world’s most famous patient blogger
I’ve only been studying healthcare for two years and I hesitate to be overly assertive.
But I have, finally, reached the point where I feel confident in citing cases where people are simply being unscientific: ignoring evidence. That’s always hazardous, and it becomes insidious when it’s caused by a blind, unquestioning belief in our institutions.
Case in point:
Julie Thoren is an active practitioner of Participatory Medicine who’s seen first-hand the tremendous value …
Participatory medicine and evidence from medical journals
If you have to ask what jazz is, you will never know.
– Louis Armstrong
The stillness in the meeting room was electric.
First, one panelist addressed the audience members who have never experienced a malignancy. She described the unique and powerful bond that exists between cancer survivors. She described how the brush with mortality forces each survivor to renegotiate terms with Life itself. She reminded everyone that the cancer care system too often lets …
Cancer patients need compassion and balanced information
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A recent blog post and series of responses on KevinMD.com aroused my interest.
Dr. Kevin Pho posed the question: Why are doctors so reluctant to discuss end-of-life care? Responders, including patients, doctors, nurses, and even a veterinarian highlighted the stress inherent in this discussion for patients and for medical professionals alike.
To me, the real issue is not whether the discussion should occur, because clearly it should, but when and how? …
How doctors can discuss advance directives with patients
Over the past few weeks I’ve had ample opportunity to be on the other side. Not like some parents with chronically ill children or those with children who have suffered tragic illness. No, not like that; I am fortunate that hospitals aren’t a part of my family’s everyday (except for work). My children have had amazing fortune and I remain in awe of good health. Lately though, we’ve had some …
When the doctor is the patient, humanism and competency matter
I used to get frustrated when patients, typically at the very end of a long visit for some other serious problem, would utter one-liners like “What can I take for headaches?” “How do I know if I have cancer?” or “Why can’t I lose weight?”
Now I have a one-liner, of sorts, myself in response to those types of questions. I usually lean back slightly, widen my eyes, nod and say:
“Now, …
Answers to patient questions may not always be simple
by Diana E. Lee
At an appointment with my local neurologist I showed up feeling bone tired and mentally drained.
Next thing I knew I was going back on a medication I had deliberately chosen to stop taking just because a doctor told me I should be taking something.
When the doctor finally came into my exam room he looked over the list of medications I was taking and declared that Lyrica alone …
Treatment decisions under migraine headache influence
Should doctors face consequences if they run late?
From the New York Times’ health blog, Well, comes a story where a medical group promises, “same-day appointments and longer, more personalized visits that start on time.”
Sounds good, right?
But it comes with a caveat, namely, a $199 annual membership fee. A tremendous amount of primary care can be bought with that amount of money, and if patients were willing to pay that, …
Patients can ask for discounts if the doctor is running late
The Annals of Internal Medicine had a perspective article by palliative medicine communication gurus Drs. Tim Quill, Bob Arnold, and Tony Back which details an approach to discussing treatment preferences with patients who want “everything.”
When I think of a patient requesting “everything,” I typically think of it as a response to a physician who offers the patient the choice of “doing nothing” if the patient’s heart should stop or …
How to treat patients who want everything
What do Enterprise Rent-a-Car, KeyBank, and the Cleveland Clinic have in common?
They all make customer (patient) satisfaction a top priority.
They accomplish this in industry-specific ways, but together their emphasis on service as a passion shares common themes:
1. Buy-in for a service culture comes straight from the top, and permeates the entire organization.
2. Copious resources are delegated to building a service culture, starting with hiring.
3. Employees are “hired for fit.” If …
Customer service needs to be a priority in health care
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