Giving test results directly to patients: What’s missing is context

Physician
February 19, 2015

I do not think that word means what you think it means. 
– Inigo Montoya, The Princess Bride

Stick to Facts, sir! … In this life, we want nothing but Facts, sir: nothing but Facts!
– Charles Dickens, Hard Times

“Information without context isn’t transparency” flashed across my Twitter feed. So now I am thinking about context, and communicating context, in medical care.

This quote, from Heather Pierce, JD, MPH, Director of Science Policy and Regulatory …

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How to get your doctor to do what you want

Physician
February 18, 2015

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Sick of phone trees, endless refill requests, packed waiting rooms, out-of-control bills, and other medical misadventures?

Follow these seven simple steps to get your doctor to do what you want.

1. Get organized. Be clear about what you need from your appointment. Make a comprehensive list of all the issues you want to discuss — and your ideal outcomes for each. Patients who are …

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Doctor, why do you enjoy practicing gastroenterology?

Physician
February 16, 2015

Whenever I am asked this question, I can’t help but think of the punchline to a joke that was once supposed to be funny but would now be considered beyond the pale in all respects, so I won’t repeat it. The punch line is: “Just lucky, I guess.” That’s the short answer to why we gastroenterologists work in our field. Despite the distasteful aspect of human waste and the perverse …

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Solving the physician shortage requires these 3 things to happen

Policy
February 16, 2015

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The nationwide shortage of physicians is a very real crisis across all 50 states, causing a huge strain at all levels of health care. Hospitals and clinics are struggling to hire, current physicians are overworked, and ultimately patients have to wait longer.

There are a number of reasons why this has happened, but one thing’s for sure: With the aging population, the …

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Having surgery? Here’s how to manage your medications.

Conditions
February 16, 2015

american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

Before undergoing surgery, you should carefully discuss your medications with your surgeon and physician anesthesiologist. You may fare better during the operation and the early recovery phase if you continue required medications, but you might need to avoid some medications that could interfere with your anesthesia. Three …

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Taking care of patients who stop caring about themselves

Education
February 13, 2015

It’s been a long day, and you just want to decompress. My boyfriend tells me about his day. I get to hear about the insane amount of reading he has to do for graduate school, or about the occasional annoying customer he’s had to deal with at his part-time job as a bank teller. When it’s my turn to decompress, I usually gripe about a patient or two from the …

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The occupational hazards of being a doctor are frightening

Physician
February 13, 2015

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There isn’t any such thing as an ordinary life. 
– Lucy Maud Montgomery

Heroes are ordinary people who make themselves extraordinary.
– Gerard Way

My colleague, Dr. Jesse Ehrenfeld, is currently on leave from his academic anesthesia practice as well as from his post as speaker of the house of delegates for the Massachusetts Medical Society to serve as Lt. Commander Jesse Ehrenfeld, combat anesthesiologist in Kandahar, …

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The truth about Miralax in children

Meds
February 12, 2015

Parents are appropriately expressing concern about the safety of Miralax®, a commonly used stool softener in kids, after a recent New York Times article exposed a potential association with long-term use of the drug and undesired behavioral side effects. As the article explains, the FDA has awarded a research grant to a team at the Children’s Hospital of Philadelphia (CHOP) to directly address these concerns.

Miralax® has been used …

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If mechanics were paid like doctors

Physician
February 9, 2015

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My friend, Trent, is an auto mechanic. When he was growing up, he loved to work on old cars. He rebuilt his first one when he was fourteen — and drove it for 11 years. He loved finding problems and figuring out how to fix them. He never cared about getting rich; his goal was to make a decent living doing …

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The line between comfort care and murder

Physician
February 6, 2015

“So, I told the doctor at the nursing home that I loved my father more than anything. Dad was my friend and the most wonderful man I had ever known.  I wanted everything for him. But, I said, Dad was sick, weak, confused, and he never wanted to live like that. The next morning he was dead.  That was OK by me.”

I once participated in a panel discussion about hospice, …

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Survival pearls for surgical interns

Education
February 5, 2015

Living in the trenches of a surgical internship can be a gut wrenching, lonely experience for many.  The journey from medical student to resident to surgical attending is a notoriously steep trek, necessitating our long 6+ years of training. Surviving intern year remains as hard as ever despite the significantly greater resources and awareness that exists among residency programs today.

These burdens are felt by all specialties and have tragically led …

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Reflecting on an orthopedic surgery rotation

Education
February 5, 2015

“Katie, If you go into surgery, you’re going to miss patients.” It was three in the morning in the ED; the resident was feeling the strain of a 24-hour trauma call, and I was loving it. I had spent the past half hour with a lovely, older woman whose foot had gone through the floor of her vehicle in a crash. We chatted about where she had been traveling, and …

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How to build a great hospitalist team

Physician
February 1, 2015

Ever since we are children, our parents and society teach us how to play together with others. What we don’t realize is that this lays the groundwork for developing important teamwork skills — the same skills that enable success and positive outcomes in the workplace. My own experiences in hospital medicine practice throughout the last decade continue to increase my appreciation for these seemingly simple yet invaluable techniques.

Like many young …

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I’m a palliative care doctor. This is what I do.

Physician
February 1, 2015

Some people who know what I do don’t really know what I do.

They picture me floating through the hospital extinguishing lives, blowing them out one by one like candles down an endless corridor. They think I practice euthanasia, that my presence alone hastens death — that I consume hope and happiness like a black hole, compressing it all into nothingness. Some call me the Grim Reaper, others the Death Doctor. …

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Most doctors are financially illiterate

Physician
January 31, 2015

Many physicians I know are struggling to make ends meet while making several hundred thousand dollars per year. Despite growing incomes, their savings rates remain extremely low due to ever increasing expenses. What they do manage to save, they turn over to professional money managers.

How does this happen? Why are some of the smartest, hardest-working and most responsible members of our society unable to create real wealth? The answer is …

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We forget to ask patients what their goals are

Physician
January 29, 2015

Mr. Dwyer isn’t my patient, but today I’m covering for my partner in our family practice office, so he’s been slipped into my schedule.

Reading his chart, I have an ominous feeling that this visit won’t be simple.

A tall, lanky man with an air of quiet dignity, Mr. Dwyer is eighty-eight. His legs are swollen, and merely talking makes him short of breath.

He suffers from both congestive heart failure and renal …

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A tragic physician story the match doesn’t want you to hear about

Physician
January 28, 2015

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I will always remember my awkward medical school interviews. Filled with bioethical scenarios and questions to measure my ability to prevent an impaired physician from practicing, the interviewers seemed hardly interested in my prior career achievements or humble beginnings.

Such discussions carried on through the first two years of medical school. They never taught us how health care reimbursement works or why …

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How much testing should you do in chronic abdominal pain?

Conditions
January 26, 2015

I see patients with abdominal pain every day. Over my career, I’ve sat across the desk facing thousands of folks with every variety of stomach ache imaginable. I’ve listened to them, palpated them, scanned them, scoped them and at times referred them elsewhere for another opinion. With this level of experience, one would suspect that I have become a virtual sleuth at determining the obvious and stealth causes of abdominal …

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