Going to the doctor can be confusing. Doctors make recommendations based on what they know, and patients are conditioned to trust their doctors. While I think it’s wonderful that patients trust their doctors, there are times when patients want more input into their health care, and if this is the case, then let me make some suggestions as to what might be important questions to ask. There is nothing specific …
Ask your doctor smart health questions
There’s something compelling about the personal narrative that vast mountains of quantitative data cannot rival. Anecdotes are, quite simply, powerful. They tap into our shared humanity, making something seem somehow more real by putting a face on it. This is why, if you follow politics for very long, you will find numerous cases of policymakers championing issues that have touched their own lives in some way. For example, Senator X doesn’t care about issue Y, until they …
Should personal anecdotes play a role in health policy?
“I will never forget that day.”
She smiled broadly.
“It was about a week after my cancer surgery and I had finally worked up the courage to look in the mirror. I knew you had rearranged things a bit, okay. Moved stuff around. Taken things apart and jammed them all back together, right?”
I probably would not have said it quite like that, but she was correct that her surgery had involved removing part of her …
Imagining what goes through a patient’s mind after surgery
We are a new generation of physicians and physicians in training. The words “stem cell therapy,” “Robertsonian translocation,” and “artificial tracheal transplant” were part of our vocabulary from the first day of medical school. At the astounding speed at which scientific advancements are made, our ability to incorporate new material is in a constant state of change.
Slowly, the heavy textbooks became relics, as we migrated towards a mobile knowledge, a …
Ability to pay for medical expenses should be a vital sign
“I want you to get me a new doctor,” she told me, a bit of disgust coming out in the sharp tone in her voice.
“What happened?” I asked.
“He asked me if I was nauseated, and I told him no, I was just vomiting. Then he asked if I was feeling pain in my stomach, and again I told him no, it was just vomiting. He then told his nurse to …
Playing specialist roulette every time I send people to another doctor
Most of us want to know how to fix this healthcare mess these days. We’re scared about the future and how we’re going to afford costs that never, ever seem to stop skyrocketing. We’re scared about the world our kids are going to inherit and the phenomenal debt they’ll be haunted by throughout their lives. We’re scared about living in a country that’s cowering under the hefty weight of fear …
Health care change will have to come from the public
My mom always told me she gave me the “doctor name” (apparently my name looks good with an MD after it), so in some ways I knew from an early age that this was going to be my profession. Though I toyed with the idea of being a bank teller in kindergarten, I realized after a while that this was really not the job I thought it was (no offense …
Why I chose to become a rural primary care doctor
A better approach to primary care is imperative for improving the delivery of health services to our nation’s population. As a family medicine resident, I see the need first hand in the mountains of East Tennessee.
It’s 11:30pm on a Sunday night when the medical student and I receive the ER call.
“A thirty-two-year-old diabetic male with uncontrolled sugars and right arm cellulitis, I think he needs admission.”
When I reach the ER, …
Health is not Democratic or Republican, it resonates with both sides
Much has been written about educating patients. This can be in the form of educational materials provided during the office visit, providing access to accurate online medical data, or even educating patients about wellness- how to be well, stay well and live well. As physicians, I believe that part of our responsibility is to teach. As the familiar adage from residency goes: “see one, do one, teach one” – we …
Social media is crucial to the development of medicine today
Recently, I listened with interest to an interview on NPR that posed the question of who needs long-term-care (LTC) insurance. Only one percent of Americans own LTC insurance which defrays the cost of custodial care.
Because of recent experiences I’ve had with my mother, I’ve have been thinking about how I’d like to spend the rest of my life when or if (I admit to fits of denial) the time comes …
Think about the eventuality that comes to ourselves and our parents
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old woman is evaluated in the emergency department for the sudden onset of severe pain, which began 3 hours ago. The pain is in the middle of her chest and radiates to her back. Medical history includes hypertension treated with hydrochlorothiazide and lisinopril.
On physical examination, …
MKSAP: 68-year-old woman with the sudden onset of severe pain
Once upon a time people only went to the doctor when they felt sick. For most of human existence there was not much the doctor could actually do when you got there. Yet somehow the human race managed to get through to the second half of the twentieth century when things changed completely.
As technology advanced exponentially we developed a range of treatments so that conditions, which used to be fatal …
We are overdosing on medical tests
Supreme Court Justice Potter Stewart famously said he could not define hard-core pornography, but “I know it when I see it.”
We in health care seem to have the same reaction to the phrase, verbalizes understanding when it comes to patient education. Patient medical records, including electronic medical records now include free text notes or check boxes indicating the patient verbalized understanding without actually defining this phrase.
In a world where ambiguous …
Verbalizes understanding: What exactly does it mean?
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I don’t know how many of you readers are old enough to remember the frequent use of open chest cardiac massage, first successfully performed in 1901. It began as a way to resuscitate suddenly dead people, assuming that their hearts had arrested or fibrillated.
The surgeon would open the chest between ribs 5 and 6 and rhythmically squeeze the heart to move the blood and re-establish life. Sometimes it worked; usually …
CPR is less effective than we think
Some time ago, I endured a medical staff meeting, where attendance is taken and 50% attendance of all meetings is required. I learned that they are serious about this rule when, a few years ago, I was demoted from active staff when I failed to attend enough meetings. This demotion did not demoralize me, as I was only losing my right to vote, which I did not regard as a …
Contaminating medicine with mercenary incentives
Today would have been easier if I did not give a damn. Easier if patients were clients. Easier if medical advice was causal suggestion. Easier if I believed that patients were solely responsible for their health. Easier if suffering was not real. Much easier, if I did not care.
However, despite the popular movement from “the doctor knows best” towards shared decision-making, I feel responsible for my patients. What happens to …
When patients make the decisions to harm themselves
Google’s made big changes recently. Google Maps and Google Places are being replaced by Google+ Local.
While Google+ Local will likely advance the review system for many industries- doctor reviews, however, will grind to a halt. Unless Google recognizes the considerable onus of HIPAA on today’s healthcare professionals, and subsequently carves out a healthcare-friendly mechanism for doctor reviews, expect that far fewer patients will post; the posts will generally read like …
Google+ Local physician reviews: A barrier for patients
A recent post in the DailyDealMedia caught my attention. It was titled “Uprising in Mobile Health Care: Could Medical Apps Replace Doctors?”
The theme of technology versus humanistic aspects of medicine has been the subject of debate for many decades, obviously predating the advent of medical apps. I find it interesting that the introduction of the referenced PwC study highlights the fact that “Solutions, not technology, are the key to success.”
Another piece on this subject …
Could mobile apps replace doctors?
There’s no denying that the Internet has been an industry-changing phenomenon across a wide variety of fields. When it comes to healthcare, though, it’s suffered a rockier relationship.
The reason behind this strained relationship can be summed up handily in one word: skepticism. Skepticism from doctors, nurses and really anyone who spends time diagnosing patients. For the most part, this skepticism is understandable — after all, anyone with an Internet connection …
The physician Internet road does not need to be a rocky one
“Educate the young, regulate the old.”
That quote has literally followed me around the world. I can vividly remember when first making the statement. I was one of five “safety experts” on the closing panel at an international safety and quality meeting in Sydney, Australia a number of years ago. The thought was that the five of us would somehow be able to share “pearls” of wisdom regarding what was …
How to improve physician compliance
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