The emerging literature on chronic disease management suggests that successful programs rely on patient self management skills. Having been in the primary care role for 20 years, that initially seemed self evident and a bit “so what?” to me, thinking it meant that we just need to teach our patients a bit more in the primary care office.
However self-management skills refer to specific curricula of skills that can …
In the New York Times article “18 Stethoscopes, 1 Heart Murmur and Many Missed Connections,” Madeline Drexler tells her story of being a model patient. Not like a model citizen cooperative and pleasant but, a person with a medically interesting finding who is asked to help teach medical students. These “patients” are examined by small hoards of inexperienced medical students who have little knowledge, little skill and varying degrees …
If you’re a new intern you are hopefully a little afraid of the new found responsibility in your life. I say “hopefully” because there is nothing more frightening in healthcare than someone who is “unconsciously incompetent.” That is, someone that doesn’t even realizethey have no idea what they are doing.
Before starting medical school I was an emergency nurse. As an RN, I had the opportunity to see many medical …
A strange thing happens on your first day of med school. Yesterday, you may have joked with old friends about upping your Paxil dose, but starting today, you are expected to be professional. And professional is suddenly a word that prevents you from being open with your new friends, a word that hints admitting to any real struggle could be a career-ending mistake.
I want to tell you that it isn’t, but the truth is, I’m …
Is Dr. X a good doctor?
Being a doctor, I often hear this question being asked. More often than not, the response that I hear is a rather clear cut one, “oh yes, Dr. X is a great doctor,” or “oh no, Dr. X is not a good doctor,” making me wonder what such a definite response is based upon. Is it based on actual facts? Is it based on …
The non-compliant patient who sues his physician for an adverse clinical outcome is a storied malpractice bogeyman. After failing to follow a screening regimen, show for appointments, undergo recommended tests, make health-related lifestyle changes, or take their medications, these patients (now plaintiffs) have the audacity to blame the doctors and nurses for not being adequately clear or assertive.
Are they real?
Yes and no. Not every “difficult” patient is a potential …
We are living a new era where the progress for the civil rights of women is undeniable, yet Facebook COO Sheryl Sandberg points out in her compelling TED presentation:
“We still live in a world where some women don’t have [civil rights]. But all that aside, we still have … a real problem … women are not making it to the top of any profession …
According to Wikipedia, up to the beginning of the 19th century there had been only 3 occupations that were considered to be professions, Divinity, Medicine and Law.
A profession is considered a trade or occupation that transforms itself through “the development of formal qualifications based upon education, apprenticeship, and examinations, the emergence of regulatory bodies with powers to admit, discipline members, and enforce adherence to an ethical code of practice.”
Professionals are …
Everyone liked him. Though his later years (the only ones in which I knew him) took away his ability to do most things, and though he was in great pain every day, it was easy to see the mischief in his eyes. The subtle humor was still there, coming out of a man who was weak, in pain, dying.
She lived for him. She was always telling me of his pain, …
To do nothing is sometimes a good remedy.
-Hippocrates
Edna Frost is 88 years old, a slender, slow-talking woman with a dry sense of humor and a blood pressure that’s all over the place. At best, she runs ten points higher than any of her previous doctors wanted to put up with. At worst, she flirts with systolics over 200, but that doesn’t seem to be a common occurrence.
Edna has been my …
Walgreens is being sued by customers who are not happy that their prescription information – even though it has been de-identified – is being sold by Walgreens to data-mining companies.
The data privacy and security concerns surrounding the transfer of de-identified data are significant. To “de-identify” what is otherwise protected health information under HIPAA, some outfits will simply strip data of 18 types of identifiers listed in federal …
There’s been plenty of buzz about a recent New York Times story, “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy” by Gardiner Harris. The story is essentially a profile of Dr. Donald Levin, a 68 year old psychiatrist who has a private practice in Doylestown, Pa.
It is a poignant example of a common situation in psychiatry. Older psychiatrists were trained during a time when there …
Part of the reason I became a physician was because I got tired of watching those close to me as they suffered through illness and eventually died, while I stood helplessly by, unable to do a thing.
Throughout my training I watched as my mentors interacted with their patients, displaying a political correctness matched with just enough outward emotion so that there was no telling the difference between the good news and the bad.
“Don’t …
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by Grayson Wheatley, MD
It was supposed to be a routine office visit for my patient.
Unexpectedly, it turned into a real-world health economics lesson for me, the treating physician. The old adage “listen to your patients; they will always give you the answer” became exceedingly true in this case, even when it dealt with an issue beyond a medical diagnosis, such as lack of transparency …
As I finished my 24-hour call recently, I was reminded of a 2009 study revealing a decline in empathy as medical students transition from their mostly-didactic second year to third year, which is essentially an apprenticeship in the hospital with lecture as an afterthought. I began my third year with what most would argue is the most difficult rotation, surgery, and my experiences over …
As medicine adapts to the 21st century, new specialties arise.
General surgery is seeing two new fields emerge. One is “Acute Care Surgery,” which encompasses three facets of general surgery — emergency surgery, critical care and trauma care. The other is the concept of a surgical hospitalist. That is, a surgeon works only in a hospital and has no office or private practice. The idea is similar to the medical …
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It may not be rabbit season or duck season but it definitely seems to be doctor season.
Physicians are lined up squarely in the gun sights of the media, government agencies and legislators, our health care industry employers and coworkers, not to mention our own dissatisfied patients, all happily acquiring hunting licenses in order to trade off taking aim. It’s not enough any more to wear a bullet proof white coat. …
Many people think that tests (blood work, x-rays, scans, etc.) mean their doctor is doing something constructive and working hard to figure out what is wrong. But tests are a double-edged sword.
When I trained most diagnoses were derived from careful history and a physical exam. Perhaps because our province did not have funds to have enough CT scanners and we didn’t have an MRI, those tests were on a …
I was talking to a fellow physician and he inquired, “how many patients do you see in a day?” I said, “maybe around 20.”
He smirked and replied, “20 only! I can see around 40 in a day and still have time to hit some balls.” There is something fishy here at Smallville.
A few years ago I used to work for this company. I had no option but to see a …
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What is an EKG?
EKG stands for electrocardiogram. It should probably and sometimes is abreviated ECG, but EKG seems to have stuck as more popular.
Scientists have known for over 120 years that the heart gives off electrical currents when it beats, but it was the Dutch scientist Willem Einthoven in the early 20th century who discovered the nature of this phenomenon and who developed the electrocardiogram as a tool to …
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