What is a difficult patient, and how doctors may be responsible

KevinMD
March 9, 2011

What, exactly, is a difficult patient?

Doctors can tell many tales of what they term as a difficult encounter.  Just as many patients can recall doctors whom they would say are difficult to work with as well.

According to a study from the Journal of General Internal Medicine, here’s a definition:

Patients deemed difficult included those with more than five symptoms, severe symptoms or an underlying mental disorder or were less functional. These …

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Asking a doctor for their opinion on another physician

Physician
March 8, 2011

If one of your patients asked your opinion of another doctor whom you know to be incompetent what would you tell your patient?

Incompetence in a physician is a scary thing! Doctors deal with problems of life and death and try to heal you with dangerous tools. A doc that isn’t competent can be seriously dangerous.

But how do you know who’s on their game and who’s falling down on the job? …

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Hospitals taking over private practices

Physician
March 8, 2011

A decade and a half ago, when I moved to Memphis, I proudly hung a sign outside an office I shared with another doctor. It had my name followed by an MD. I had started my own small business as a solo practitioner in medicine.

Over the years, the practice has grown. I now have several employees and my own office, with the names of several other doctors alongside mine on …

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Successfully appeal an insurance company reviewer decision

Physician
March 7, 2011

Coverage requests get rejected when the requested service does not fit within an insurance company’s initial guidelines for approval.

This happens for a number of reasons, but usually it comes down to poor documentation or inappropriate care, or in some cases care that is appropriate but can’t be supported in the literature.  When a denial occurs, the physician or patient has several opportunities to appeal this decision.  The first appeal is …

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Lifestyle changes to control the symptoms of prostate enlargement

Conditions
March 7, 2011

Prostate enlargement, or benign prostate hyperplasia (BPH), is a common, non-cancerous condition affecting nearly 14 million men over the age of 50.

The symptoms of prostate gland enlargement include a decrease in the force and caliber of the urinary stream, frequency of urination, urgency, a feeling of not emptying the bladder despite urination and nocturia, or the need to get up at night to urinate. Although lifestyle changes will not cure …

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Surgical error: The difference between mistake and complication

Physician
March 3, 2011

One of the benefits, or aberrations, depending on your point of view, of the fee-for-service model is that we surgeons are remunerated for correcting our mistakes and complications.

At first glance this seems wrong. But perspectives differ, and when a doctor has to deal with serious, undeserved complications and is self-employed he deserves to be compensated adequately.   So what really is the difference between the two?

A complication may be described as …

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Lack of sexual interest is the most common sexual complaint in women

Conditions
February 28, 2011

Lack of sexual interest is the most common sexual complaint in women.

The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), which defines psychiatric disorders, defines Hypoactive Sexual Desire Disorder (HSDD) as ‘‘persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity’’ that causes ‘‘marked distress or interpersonal difficulty.’’ Epidemiologic surveys have suggested that from 25 to 50 percent of women report prolonged periods …

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Can I be a doctor with bipolar disorder?

Physician
February 25, 2011

“I have bipolar disorder. Can I be a doctor?”

It’s one of those questions to which there is no real answer. Being a doctor takes a long time, it requires reliability, diligence, and a willingness to learn things you may not want to learn and do things you may not want to do. It requires endurance and passion. You need to be tolerant of many things: arrogant supervisors, irritable colleagues, sick …

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Gastric bypass is not a short cut to treat obesity

Conditions
February 24, 2011

Recently, a female patient saw me in the office for the first time to discuss her chronic digestive issues. Luckily for her, my recommendations did not include probing into her alimentary canal with the endoscopic serpents that we gastroenterologists rely upon.

As the visit concluded, she advised me that she intended to have a gastric bypass (GIB) procedure performed, and even used the medical term of bariatric surgery. I suppose that …

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Medical students should not be liable for malpractice

KevinMD
February 21, 2011

Should medical students receive immunity from malpractice liability?

That’s an interesting question that’s raised in a bill from Arizona.

According to the Arizona Daily Sun,

State lawmakers are moving to keep patients injured by medical students from being able to sue them.

But proponents said that won’t leave victims without recourse.

SB1429, awaiting full Senate action, would spell out that students are not liable for malpractice if they are under the supervision of a …

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The biggest problem faced by pilots and obstetricians alike is nature

Physician
February 21, 2011

It’s a bit ironic that pilots, the people who spend the most time traveling above the magnificent landscape that is our planet earth, spend very little time appreciating the scenery.

That’s because they are trained to always be on guard for unexpected emergencies. While the passenger in a jumbo jet traversing the continent can admire the majesty of the Rocky Mountains, the desolation of the Great Salt Lake or the endless …

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Social medicine and its role in medical school curriculum

Education
February 19, 2011

This semester is coming to an end and we are almost halfway done with first year. I say semester, but technically we use the block system. What’s the block system? Here, it refers to dividing the academic school year into single subject blocks. Instead of taking concurrent, year-long courses, we spend several weeks on one course. For instance, we started off with 5 weeks of only biochemistry, then 8 weeks …

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How medical students should present patients to their attendings

Education
February 17, 2011

I just finished another inpatient service stretch at our community hospital with some great cases and lots of good medicine.  While attending rounds may have changed a lot in the last 40 years as highlighted in a recent Annals of Internal Medicine article, some things have not changed – the focus on medical student presentations during attending rounds.

Students spend hours through their call nights preparing for …

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Treatment guidelines pros and cons

Conditions
February 17, 2011

I was puzzled by a Health Affairs article showing the public finds arguments against treatment guidelines a lot more compelling than arguments in favor. But after reading the technical appendix, which contains the full text of the survey, I think the problem is that the researchers framed the question poorly. In particular, the researchers portrayed guidelines as unrealistically rigid.

In A National Survey Reveals Public Skepticism About Research-Based Treatment …

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What makes a good, competent psychiatrist?

Physician
February 16, 2011

A reader recently asked, how does someone find a good psychiatrist?

Stated another way, the questions are:

  1. What qualities make a good, competent psychiatrist?
  2. How do I find a good, competent psychiatrist?
  3. How do I get my concerns heard about the direction of my treatment?

I typed the question “How do I find a good psychiatrist?” in Google and got almost half a million results from around the world. I find it hard to believe …

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Difference between proactive and reactive medicine

Physician
February 16, 2011

Looking back, some of my biggest medical mistakes have been times when I was reactive rather than proactive when faced with a clinical problem.  A doctor may have to be one or the other depending on the circumstances, but knowing when and which approach to take is one of the harder skills of medicine, taking time and experience to master.

What do I mean?  Here are some examples from my field.

Treating …

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When in the ER with abdominal pain, adjust your expectations

KevinMD
February 14, 2011

Abdominal pain is the bane of many emergency physicians.

Recently, I wrote how CT scans are on the rise in the ER.  Much of those scans look for potential causes of abdominal pain.

In an essay from TIME, Zachary Meisel discusses why abdominal pain, in his words, is the doctor’s “booby prize.”  And when you consider that there are 7 million visits annually by people who report abdominal pain, that’s a …

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Why your doctor’s education is unique

Education
February 14, 2011

What makes your doctor’s education unique from that of other health care providers?

Recently, I was sitting in on a lecture by one of my favorite physician-teachers (certainly my favorite neurologist).  I’ll call him Dr. Deeds (for his resemblance to a character from the movie, Mr. Deeds).  He was giving a sort of broad, generalized lecture to prepare us for a series of lectures on neurodegenerative diseases …

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How to become a licensed, board certified doctor

Physician
February 12, 2011

I am licensed to practice medicine and surgery in Georgia. But that doesn’t mean I should, or that you ought to let me—at least not the surgery part. I’m actually pretty good at carving a turkey, but that’s pretty much the only kind of surgery that I’m qualified to do.

Don’t let the license fool ya, I’m no surgeon. So what, exactly, does a doctor have …

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