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?
Medicine is at risk from a technology takeover.
Consider hospital rounds, for instance. Records are electronic, and doctors have to sort through data from an increasing number of diagnostic tests, like laboratory values and imaging results. Even before stepping into a patient’s room.
Stanford’s Abraham Verghese continually reminds doctors about what’s most important: the patient before us. In fact, his essay published a few years back in the New …
The balancing act between science and art is what makes medicine so challenging
“Je m’a…,” I stuttered to Aristede Mezondes, the serious young man in a grey wool overcoat, standing before me with ramrod posture. “Je m’appelle Dr. Ofri.”
There. I’d gotten it out.
The language of Descartes, Voltaire, and Balzac had clearly vacated my cortex. Despite those years of French classes and one brief visit to Paris, “Je m’appelle” was the best I could come up with. And even that was a struggle. Pushed …
Talking to a patient, without a translator, in mutual non-native languages
Most people automatically filter out spam e-mails, or delete them without ever opening them up.
But a surprising number of people actually take the time to read them, which is probably why annoying spam will continue unabated. From the New York Times’ Well, Tara Parker-Pope writes points an interesting study looking at who actually read health-related spam e-mails.
Looking at college students who were overweight, a study showed that an …
Obese college students are reading health related spam e-mails
Originally published in MedPage Today
by Marianne Mattera
Trust is an essential element in the doctor-patient relationship.
You’re well aware of how important it is that you can trust the history the patient gives you. You know the problems that can arise in planning and managing care if you’re working with only part of the story. And you probably even feel a twinge …
How a doctor’s office can affect patient trust
by Monte Ladner, MD
Many Americans are resolving that this will be the year they finally lose weight. Sadly, most of them will reach the end of 2010 heavier than when they started. We continue losing the weight loss game because our efforts are misplaced. The issue is lifestyle.
Dr. Dana King of the Medical University of South Carolina recently published two papers on the erosion of American lifestyle …
We are becoming a nation of people with multiple chronic diseases
According to a recent study from the BMJ, more than half of patients preferred that doctors call them by their first name.
But what about doctors? Do they mind if patients didn’t address them with a proper title?
In a piece from the New York Times, physician Anne Marie Valinoti notes some discomfort when patients addressed her as “Anne Marie”:
How does one address one’s physician? It is almost always an …
When should patients call doctors by their first name?
More celebrities are giving medical advice these days.
Rahul Parikh explores the phenomenon in a recent piece from Slate, citing Lance Armstrong, Suzanne Somers, and Jenny McCarthy, among others.
But does their celebrity make them an authority in a given medical issue? Unfortunately, too many people think so, as following celebrity medical advice can be dangerous
Their messages have led some doctors and patients to make inappropriate health decisions, at times increasing …
Why patients should be careful of celebrity medical advice
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by Tim Noonan
When a team misses out on an opportunity to go to the Super Bowl, World Series, Final Four, or something similarly trivial, these words may be appropriate. When the person, who has been the center of your life dies, what is more insensitive than, We’re sorry for your loss?
What kind of language is that to use when providing some of the worst news we could imagine? True, we …
How to tell a family that their loved one has died
It’s beginning to look like health care consumers are going to have to take lowering health care into their own hands since no answers are coming down from above.
Here are ten tips for lowering your costs.
One, encourage your employer to offer a health savings account with a high deductible. Encourage the employer to pay half the deductible. Your premiums will be much lower, and your employer will save up to …
10 ways patients can save on health care costs
“Angelina Gomez,” the medical assistant hollers out to the crowded waiting room. As always, I cringe when I hear this. It sounds so harsh, so cattle-like. I know that the assistant is actually a gentle and caring person, and I understand that he uses a loud voice so that he can be heard over the general din of a large waiting room.
Nevertheless it feels horrible to me, so demeaning, like …
How doctors can show respect to patients
The advent of the internet, combined with social media, has made everyone experts and has increased the disdain for authority.
No where is that more apparent than the firestorm that surrounds vaccines and its detractors.
The Los Angeles Times’ James Rainey writes a column on the phenomenon, observing the backlash against a well-written, nuanced piece debunking the link between vaccines and autism.
But as we know, those who already believe there is a …
Patients using internet health information without physician guidance
Originally published in MedPage Today
by Todd Neale, MedPage Today Staff Writer
With the amount of research being published in medical journals and presented at meetings, it should not be surprising when a new finding slips by a busy physician.
Nor should it be surprising, then, that some decisions about patient care might be made without benefit of the most recent evidence.
Although experts …
How doctors can stay up to date with current medical information
It’s estimated that up to 30 percent of the 50 billion dollars Medicare spends on end of life care has no meaningful impact on patients.
Is there a rational way to control costs when it comes to terminal care?
Most patients want to spend their last days at home, but 75 percent die in either a hospital or nursing home. Almost 20 percent of terminal patients end up in intensive care settings.
Worse, …
Poll: How to control costs in end of life, or terminal, care
by Nancy Rappaport, MD
In order to be truly effective in our work, we physicians need to conduct our own personal exploration, take time for introspection, and replenish our personal reserves. Part of our job is to balance the demands of our work (be they finding a cure for cancer, caring for terminally ill patients, solving the problems of healthcare or delivering twins—whatever our calling may be) with caring for ourselves. …
Doctors need to take care of themselves, for their patients’ sake
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