An excerpt from Talking to Your Doctor: A Patient’s Guide to Communication in the Exam Room and Beyond (Rowman & Littlefield, 2013. All rights reserved.)
There are plenty of books out there to teach us how to boldly and proudly advocate for ourselves in the doctor’s office. Doctors have held the reins too long, goes the …
Doctors should give patients their damn data
Movie buffs and science fiction fans certainly remember HAL, the computer in 1968’s hit movie “2001: A Space Odyssey”. Considered one of the greatest villains in film history, HAL was capable of reasoning and language processing to assist the astronauts on their space mission. Ultimately, however, HAL decided that its best course of action was to kill all the astronauts. “I am …
Sedasys for anesthesia: Can a machine guide sedation?
A study published in the British Medical Journal highlights the importance of carefully choosing which children should receive diagnostic CT scans. As a diagnostic test, CT scans utilize ionizing radiation that can cause cellular DNA damage, increasing the risk of cancer. Children who received a CT scan were 25% more likely to develop a cancer in 10 years after radiation exposure, according to a study of 11 …
Radiation exposure is related to the rise of a lawsuit culture
A JAMA Pediatrics article found that the use of pediatric CT scans rose in the late 1990′s and early 2000′s. Further, research shows that these CT scans can increase risk for future cancer diagnoses. Authors calculated the risk: they estimate that for every 4 million pediatric CT scans preformed annually, some 4800 children will go on to develop cancer as a result. Like many studies published this decade, the …
Judiciously order CT scans to protect our children
Who is responsible for mistakes in health care? Who should take credit for success or blame for failure? Most families, patients and obviously the courts, hold the doctor responsible. It seems to me this is reasonable; it is the obligation physicians assume and which society returns with empowerment and respect. However, is this changing because of the Internet and big data?
In 2013, most patients have spent hours on the Internet …
Are physicians still responsible for mistakes in health care?
A fascinating op-ed piece by Brigham and Women’s physician and Harvard Medical School professor Jerry Avorn appeared on June 11th in the New York Times. It’s called “Healing the Overwhelmed Physician.” What the ‘overwhelmed physician” about whom Dr. Avorn writes is overwhelmed by may surprise you.
It surprised me.
Looking at the title of the piece, I thought it might be about the emotional toll of practicing medicine, which may contribute …
One source of information that never feels overwhelming
Patients do need the power to complain about bad doctors and, trust me, there are some bad doctors out there. That being said, the other way for patients to get some retribution is to stop seeing that doctor. Word of mouth will spread, like any other business, and that doctor’s business goes under.
Right now, state boards allow patients to complain about anything and they have to investigate that complaint. …
Allowing patients to define a medical adverse event
On June 10, 2013 a 32-year-old pregnant woman was reported to have died after having an ovary removed instead of her inflamed appendix. As the infected appendix festered, she became septic and succumbed to multiple organ failure. This tragedy occurred in the UK in late 2011, but has just come to light.
How could this have happened?
Let me count the ways.
The surgery was performed by two trainee surgeons. Their …
An ovary removed instead of an inflamed appendix: What happened?
I’ve learned a few things about children over the years. While most have come from raising children, the rest have come from caring for them as patients. Knowing children, knowing their hearts and their ways, gives me great joy. I like to think that as I know them better, I become more like them, and while my time on earth may not be any longer for it, it may be …
What medicine has taught me about children
Your front office staff are the face of your practice — an expression of your practice’s philosophy, attitude, and values. So it should be a top priority to hire and retain top-quality people to fill such roles as receptionists, phone operators, medical secretaries, and transcriptionists.
But it can be a challenge to keep these people and keep their morale high because these positions often include high levels of stress for low …
Finding and keeping great front office staff
Everyone has opinions. You probably know what they say about that. But leaving aside the olfactory qualities of all the opinions to which we are entitled, we at least tend to know when our opinions are just opinions. But not with nutrition, where not only does everyone have an opinion, but everyone seems to think theirs is an expert opinion. And our culture seems to be okay with that. I’m …
Not everyone who has an opinion on nutrition is an expert
Historians are left forever chasing shadows, painfully aware of their inability to ever reconstruct a dead world in its completeness.
-Simon Schama
“Tell me about your prior cancer treatment,” I say. “When did you have the surgery and radiation?”
“It wasn’t a surgery,” He tells me emphatically. “It was a biopsy.”
“But the doctor SAID it was a surgery!” chimes in his wife.
“Yes, Dad. You have a long scar on your neck,” adds his …
I need to take my role as historian very seriously
A post I wrote nearly three years ago has recently gone viral, bringing tens of thousands of readers and a huge number of comments. It’s a letter I wrote to my patients who do something that all but guarantees a bad relationship with many (if not most) physicians: they don’t get better.
There are basically two responses I get to this post: either readers are grateful to have a doctor admit …
How can we fix the doctor-patient relationship?
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Jeff Goldsmith recently opined on why practice redesign isn’t going to solve the primary care shortage. In the post, Goldsmith explains why a proposed model of high-volume primary care practice — having docs see even more patients per day, and grouping them in pods — is unlikely to be accepted by either tomorrow’s doctors or tomorrow’s boomer patients. He points out that we are replacing a generation of workaholic boomer …
Primary care doctors need 35 hour work weeks
Last month marked the first anniversary of two very important milestones in my career in medicine: I began training as a physician and started writing about medicine. Although perhaps not equally as demanding, both of these new activities in my life required overcoming steep learning curves and involved constant self-reflection and personal change.
Writing medical humanities pieces for different media outlets has been and continues to be a source of personal …
Medical writing: Tips to avoid burnout when starting out
“Well then, if you won’t prescribe the Xanax for me, I guess I’ll just have to get it off the street.”
“If you send me home, I promise you’ll be reading about me in the obituaries tomorrow.”
“I’m in terrible pain. You have to treat me. You have to give me narcotics. If you don’t, I’ll call the state medical board and report you.”
I hate to be manipulated.
Hate. It.
There is a certain …
True pain and suffering: There is no place for manipulation
A dichotomy has emerged as we consider the best way for women physicians to realize both their potential and their dreams in the service of patients and society. One position states that women have to internalize behaviors that are known to result in success and are based on a long history of professionalism, albeit developed for and by men physicians over the last 100 years. This is more along the …
How should the workplace accommodate women physicians?
In the Department of Public Health (DPH) clinics in San Francisco, CA, demand for doctor’s appointments far outweighs supply. This has been especially dramatic in clinics that have switched to “open access” scheduling, an innovation that allows patients to schedule same-day or next-day appointments. Open access is meant to eliminate long waits for appointments, but the reality is that often dozens of patients call for a limited number of appointments. …
How teamwork can help improve primary care access
My shift is over, and I’m ready to head out the emergency department door. When I walked in 12 hours ago, the department had 20 waiting patients. I look up at the monitor and after 12 hours of trying to wrestle the department under control, not only is it not under control, now we’re 25 patients deep in the weeds. My partner Dr. Jim looks at me and says, “Get …
A ruptured eardrum turns out to be something much more
Here’s a thought experiment presented a recent conference on healthcare consumer advocacy. Let’s say that you’re told you need surgery of your knee. It’s an elective surgery to repair a torn knee ligament, the ACL. Your insurance covers part, but not all, of the cost. How do you choose which hospital to go to?
At the moment, there is very little information for you to make such a decision. Many people will choose …
Choosing a hospital: What is most important to you?
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