At my office we provide care for a fair number of patients without medical insurance. Sometimes we are faced situations with no good options.
At a patient visit, often times the diagnosis is not clear without doing some diagnostic tests other than the history and physical exam. Many of these tests are ordered from sources outside the office, where I have little or no control over the cost of the test …
Patient costs when making medical decisions
When I make rounds with my students and interns, I always try to sneak in a poem at the end. I think poetry is important because it helps convey the parts of the medical experience that don’t make it into textbooks. It’s important because it teaches creative thinking—something of immense value to doctors.
It’s important because interpreting metaphors is a critical clinical skill in diagnosis; patients’ symptoms often present in metaphorical …
Poetry that your patient can appreciate
Many non-correctional health care providers will also treat inmates from time to time. This may occur in the office or hospital. How can one best approach the challenges of working with the incarcerated in order to deliver the best possible care while simultaneously managing risk?
1. Treat the patient with respect. Not submissive respect, but mutual respect — the way we all want to be treated. I believe that this principle …
7 ways inmates can receive quality medical care from doctors
Part four of a series. See also parts one, two, and three.
When dealing with your doctor’s biases, you have on your side a fact I firmly believe to be true: most doctors want to do a good job and help their patients as best they can. So what exactly can you do to maximize your doctor’s ability to help you?
1. Position your symptoms and requests carefully. Don’t demand medications …
Help doctors to best care for their patients
In the Tony award winning play God of Carnage two couples meet in an elegant living room for an ostensibly civilized conversation about the aggressive act of one couple’s child against the other’s. The meeting soon degenerates to reveal the underbelly of conflict in the two marriages. Husband and wife hurl insults, precious items and even themselves with escalating rage. We see, as they attempt in vain to focus on …
Aggressive behavior in children and the family dynamic
The Framingham Heart Study is perhaps the most famous long-term medical study. As every medical student learns, starting in 1948, the lifestyle habits of thousands of residents of Framingham, Massachusetts were followed to determine important risk factors for cardiovascular disease.
It is because of this study that your physician can, with a few keystrokes, predict with great accuracy your risk of having a heart attack within the next 10 years and …
Obesity treatment in family members should be contagious
Ideally, the medical decisions doctors make for their patients should be free of any outside influence.
But for regular readers of this blog, we know that’s not always the case.
A 2010 HealthLeaders Media Industry Survey identifies some factors that may influence a physician’s medical decision. Here are some of the results.
Pressure from patients was a significant influence, with only 17.9% of doctors saying it wasn’t a factor. Doctors often …
Medical decision making is influenced by patients, lawsuits, and money
Imagine that as a child you thought you had been born in the body of the wrong gender. If you were biologically male, in your mind you really thought of yourself as female. Likewise, if you were born in a girl’s body, you thought that you were actually a boy.
Yes, you were probably more interested in children’s role-playing games more often associated with the opposite gender as well, but the …
Transgender patients face significant challenges in prison
by Patrice Villars
Recently, a physician colleague expressed her concern about signing routine hospice admission orders for her elderly patient with end stage heart failure. The routine ‘as needed’ (PRN) orders included phenobarbital, pentobarbital, haloperidol, lorazepam, and morphine. “The hospice nurses know more about this than I do, don’t they?” she said.
Yesterday, a longtime palliative care nurse told me she didn’t want to put her mother with end stage heart …
A nurse practitioner is valuable in hospice and palliative care
“I’ll be back in a little while, Hon’. Will you be okay without me?” the frail old woman asked of her husband. She was standing at the front door and breathing heavily.
“I’ll be fine,” her husband replied from his wheelchair. His voice sounded as weak as his body looked – emaciated, scaly, and full of cancer. “I’m sorry I can’t come with you.”
The woman opened the front door. A gust …
A beautiful Valentine’s Day patient story
Originally published in MedPage Today
by Chris Emery, MedPage Today Contributing Writer
Condoms that don’t fit properly are more likely to break, slip off, and decrease the pleasure of both partners during sex, which may discourage their use and undermine their public health benefits, a survey found.
Ill-fitting condoms were reported by 44.7% of the men polled. They were more likely than …
Condoms don’t work all the time, and here’s why
by Lockup Doc
Physicians learn a lot about many different topics, both in medical training and in practice. However, there are some life lessons that we never learn as well as when we become patients ourselves.
When I was 13 or 14 years old, I regularly interacted with 2 different physicians with disparate interpersonal styles. Little did I know then that these seemingly meaningless encounters would indelibly shape my own beliefs about …
How doctors can improve patient interactions
Originally published in MedPage Today
by Liz O’Brien
Exactly whom are we honoring on Presidents (or is it President’s) Day?
A. George Washington
B. George Washington and Abraham Lincoln
C. All presidents
The answer is more complicated than you’d ever expect. Probably A is most correct, but if it were up to me, I’d pick C.
Certainly every one of these 43 men has earned the …
Why being President of the United States is a health hazard
Not literally, of course.
In an interesting marketing concept, some would call it a gimmick, a Texas hospital is utilizing speed dating concepts to match patients with obstetricians.
I like it.
As chronicled by the American Medical News, here’s what happens:
It involves setting aside a room for two 30-minute sessions over the lunch hour. About five or six physicians sit at tables while a dozen or so potential patients rotate through. Every five …
How speed dating can help the doctor patient relationship
Originally published in MedPage Today
by Crystal Phend
“I do not want my life to be prolonged if, to a reasonable degree of medical certainty, my situation is hopeless.”
“I want my life to be prolonged as long as possible within the limits of generally accepted medical standards, even if this means that I might be kept alive on machines for years.”
Check …
End-of-life decisions and making advance directive choices
I just returned from vacation to find email messages from three patients inquiring about their recent test results.
The first email was from a young man who had fainted and underwent Holter monitoring, a test that checks for abnormal heart rhythms. The second was from a woman I recently started on cholesterol-modifying therapy who wanted to know whether her recent blood work showed a satisfactory improvement in her cholesterol. The third …
How to better notify patients of their abnormal test results
On the way to the funeral you wonder how you’ll be received by the grieving. Although you are confident that your care for the deceased was sincere, professional, and adept, you still question if others will so assume. There is silence in the car. This is a trip you make alone.
You manage a bitter smile as you recall stories the patient shared in unguarded moments, behind the door of a …
Thoughts from a doctor attending a patient funeral
A patient learns about a treatment for his condition. So he goes to his physician to suggest the treatment as an option. Is there anything wrong with that?
It depends on how his “suggestion” is presented.
In today’s age of patient advocacy and direct-to-patient marketing of pharmaceuticals, a new phenomenon is flourishing in doctors’ offices: patients asking for specific diagnostic tests or therapies.
I think it’s terrific if you bring information and ideas …
How patients can bring information and new ideas to their doctors
It’s no secret that primary care doctors are getting burnt out.
Last July, I pointed to a study observing that “large numbers of physicians claimed a lack of control of their work, a chaotic work pace and time constraints during patient visits,” and, “more than a quarter complained of burnout. More than 30 percent indicated they would leave the field within five years.”
Now there’s data showing that unhappy physicians provide …
How physician burnout worsens patient care
A recent study suggests that doctors may put off holding end of life care discussions that involve subjects like advance directives, hospice or site of death.
Recommendations suggest that physicians hold these conversations when patients have about a year to live, but the data shows those guidelines aren’t being followed.
Why?
According to the study’s authors, they suggest that doctors “may not be comfortable discussing it,” and, “these conversations are time-consuming and …
Why are doctors so reluctant to discuss end of life care?
Get free updates delivered free to your inbox.
