Patient

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.

Do not resuscitate or Allow natural death, does it make a difference?

Kevin

Patient

March 18, 2009

Do words matter, or is it just semantics?

A recent article in the USA Today highlights a study showing that nurses, student nurses and people with no health care backgrounds all “reported a greater likeliness to forgo resuscitation if ‘allow natural death’ was used.”

Palliative care physician Christian Sinclair sheds more light on the topic, noting the ambiguity of “Allow natural death.”

“What did it …

Poll: Should we loosen the restrictions on organ donation?

Kevin

Patient

March 16, 2009

Patients in need of a kidney often wait years for a suitable donor.

Instead of waiting, more patients are taking matters into their own hands by arranging private kidney transactions, through internet classifieds on Craigslist or social networking sites like Facebook or MySpace. Those who seek organs outside the traditional system can potentially save up to ten years of waiting.

But ninety percent of the transplant centers in …

Do computers interfere with the doctor-patient relationship?

Kevin

Patient

March 14, 2009

Lost in the zeal of those supporting electronic medical records is how computers can depersonalize the patient encounter.

In a nice op-ed in The New York Times, pediatrician Anne Armstrong-Coben talks about how doctors now have to make a concerted effort to look up from a computer screen simply to maintain eye contact with a patient. “I advise teenagers to limit computer time,” she writes, “as I …

Are patients who enter hospice care really abandoned by their primary care doctors?

Kevin

Patient

March 13, 2009

A recent study on hospice care has been making mainstream media headlines, and, of course, doctors are cast in a negative light.

The study, from the Archives of Internal Medicine, concluded that patients felt abandoned by their primary care doctors upon transfer to hospice care, and that the “feelings of abandonment resulted from lack of closure for patients and families.”

Palliative care physician Christian Sinclair gives …

Don’t have a GI bleed on the weekend, and why you’re more likely to die on Saturday and Sunday

Kevin

Patient

March 9, 2009

Patients don’t choose the days they get sick.

There are several studies, specifically dealing with heart attacks, showing that the mortality rate increases when a patient visits the hospital during the weekend.

It appears that the same goes for upper GI bleeding. MedPage Today discusses a recent study showing that “patients with nonvariceal upper gastrointestinal hemorrhage had a 22% increased mortality risk on weekends, and those …

Can a doctor sue a patient for a negative online review?

Kevin

Patient

March 7, 2009

That’s exactly what’s happening in this case in San Francisco.

Angered by a billing dispute with his chiropractor, a patient posted a negative review on the online review site, Yelp. Now he has to defend his review in court, which is, even if the case is thrown out, not a chance many patients are willing to take.

Indeed, if the medical profession really wants to shut down …

Doctors dealing with difficult patients, is it the fault of young physicians?

Kevin

Patient

March 6, 2009

A study released last week reported doctors found that one in six patients were “difficult.”

In addition, physicians who reported these difficult encounters tended to be young and female, leading to a 12-times increased risk of burnout.

Like any relationship, be it a marriage, job, or one between a physician and a patient, not all encounters are going to go smoothly. The editorial commenting on …

Using checklists in the ICU, a real world patient safety success story

Kevin

Patient

March 1, 2009

Initially skeptical of using seemingly commonsense checklists in the intensive care setting, an infectious disease specialist is now a convert supporting the practice.

In his regular Washington Post piece, Manoj Jain writes about his hospital’s initiative in conjunction with patient safety guru Donald Berwick. The program, instituted in 2002, required checklists to be followed prior to common ICU procedures, such as the insertion of central lines, endotracheal …

Should hotels be required to have AEDs?

Kevin

Patient

February 27, 2009

If your heart goes into ventricular fibrillation in a hotel, shouldn’t an automatic external defibrillator (AED) be on hand within minutes?

Surprisingly, that isn’t the case in the majority of hotels. A recent story in the WSJ points to the fact that no more than 20 percent of hotels have such devices.

The reason? Liability, and the questions surrounding Good Samaritan laws, which some lawyers …

Read more…

Should hotels be required to have AEDs?

Patient burns from a hospital visit, and fires in the operating room

Kevin

Patient

February 25, 2009

When undergoing a procedure in the hospital, the last thing most patients suspect would be sustaining burns from medical equipment or carelessness of the medical staff.

Thankfully, such instances are rare, but they do occur. As the WSJ reports, the oxygen-rich environment of an operating room can increase the risk of flames, from say, a stray spark of an electrocautery device.

Furthermore, medication patches, like nicotine …

Child mauled by a pit bull, but the ER sends the kid home

Kevin

Patient

February 23, 2009

Trying to find ways to decompress its crowded emergency department, the University of Chicago is “re-directing” non-urgent cases to community centers or clinics.

However, as emergency physician Shadowfax notes, you better be careful who you turn away, because as this case shows, doing it poorly results in a public relations nightmare.

Will those on Medicaid, or without insurance, be preferentially “re-directed” to safety net hospitals? In …

The privilege of being at a patient’s bedside

Kevin

Patient

February 22, 2009

The bedside exam has become increasingly irrelevant, as technology and tests have largely supplanted physical diagnosis skills.

Pauline Chen interviews Stanford’s Abraham Verghese, who also wrote last year’s excellent NEJM piece on the demise of the physical exam, and he provides some provocative insight.

Dr. Verghese calls the physical exam “an important ritual” that still matters to patients. “If as a doctor you shortchange the ritual, …

How to survive heart disease requiring quintuple bypass surgery, did continuity of care care help?

Kevin

Patient

February 22, 2009

Author Jay Neugeboren presented with shortness of breath after exertion, and eventually was diagnosed with coronary artery disease requiring an emergent quintuple-bypass.

How did two doctors, including a cardiologist, miss the urgency of his symptoms? It probably was because they didn’t know the author, whereas his lifelong friend, who turned out to also be a doctor, was able to “place [his] new symptoms in the context of [his] …

When should you keep your sick child away from school?

Kevin

Patient

February 17, 2009

It’s an age-old question that many parents still ask.

Pediatrician Perri Klass gives her take in a NY Times column. In general, you can’t prevent every child who’s shedding virus from going to school, as “that’s everybody all winter long.”

The only confirmed way to prevent the transmission of infection is hand-washing, a habit that should be regularly taught and enforced.

Dr. Klass’ bottom …

Should a doctor be banished from medicine after having sex with a patient?

Kevin

Patient

February 16, 2009

That’s a question this case in the UK is trying the answer.

As Dr. Crippen, the crusty blogger who notes the inanities of the UK medical system, notes, extra-martial affairs are commonplace.

But should a physician be censured, effectively ending his medical career, for having a dangerous liaison?

“If every man and women in Britain who had an extra-marital affair were to be prevented from working,” writes …

Is denial always bad for seriously ill patients?

Kevin Pho, MD

Patient

February 28, 2005

Much denial-blogging today. Alisha’s mother-in-law won’t accept physical limitations imposed by her cancer. Orac tries to help a patient who rejects her malignant biopsy results. What is denial, and how should we approach it? (Pause for a quick check – has the Cheerful Oncologist posted about this yet? No? I’d love to know what he thinks!) Here’s Dr. Simon Wein, MD, of Memorial Sloan-Kettering …

Patient

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