Patients and caregivers writing on KevinMD about illness and the health care system from the other side of the exam table: navigating care, the doctor-patient relationship, being heard, cost, and what patients want physicians to understand. Physicians who have become patients write here too. For the record of what pain patients and physicians have said to each other about opioids since 2007, with patient authors cited at the same weight as physicians, see Opioids: what physicians and pain patients say, in their own words. For what patients pay and who is left out when physicians leave insurance, see Direct primary care: what physicians say, in their own words. For what patients, families, and physicians have said about dying, hospice, and the decisions families face, see End of life: what physicians say, in their own words. For what physicians and family caregivers have said about growing old, dementia, nursing homes, and caring for aging parents, see Aging and dementia: what physicians say, in their own words.
Atul Gawande, MD, is a technophile and a believer in the checklist, and he yokes these ideologies to an attractive metaphor in his newest essay for the New Yorker. The article is worth reading in its entirety, but it can be easily paraphrased.
The Cheescake Factory, like other successful restaurant chains, has “brought chain production to complicated sit-down meals.” They’ve done it by far-reaching standardization of the best possible …
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A patient is not a dish off the menu
How do you choose a doctor? Perhaps you start with a recommendation from a friend or a trusted physician, then you look at factors such as training, experience, board certification, access, online reviews and of course that vital issue, how well you like the doctor when you meet him or her. Tough thing, picking a person you barely know to whom you trust health and life. To this list, I …
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How well does your doctor play with others?
I believe the projected shortage of physicians caused by the Affordable Care Act will drive primary care into two opposite tracks. Each is a distinct and logical response to the patient overload and each points out gaping holes in our medical education that must be addressed.
The Association of American Medical Colleges estimates that there will be a shortage of 63,000 doctors by 2015 and 130,600 by 2025 in the wake …
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How the surplus of patients will impact primary care
I recently tweeted asking about favorite patients, physicians, and students on Twitter and was met with a plethora of shocked tweets at my inclusion of patients as potential Twitter interests.
Perhaps other medical friends interpreted this as being similar to meeting people in clinic and asking for their Twitter handle (which is not something I do) or maybe people really think it’s wrong to follow patients on Twitter, I don’t know. However, I do …
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I learn from patients who share their stories on Twitter
Physicians, hospitals and other providers are being misled by industry pundits claiming that more health information technology (as in EMRs, PHRs, smartphone apps, and web portals) is the key to greater patient engagement. It’s not.
If health information technology were all that was needed to “engage” patients then patient and member adoption rates of provider and payer web portals offering personal health records (PHRs) and electronic health records (EHRs) would not …
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There is no app for patient engagement
In my office, every new patient encounter starts the same way. I walk in and say, “Hello.” Then I put down my computer (which I take from room to room), wash my hands (which I purposely point out that I do before I touch anyone or anything else), and then I turn to the family and greet the child first. Depending on the age, I might be squatting and gently …
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Help your doctor better help you
He was just a kid.
Fifteen I think, something like that, too young to have experienced too much in life at that point, but old enough to die by his own hand.
His father, only a year and change older than me, had already dealt with some issues of his own. Diabetes, a member of his family on both sides for generations, had already taken its toll on him by the time …
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Death came in whatever he might be wearing at the time
Today’s healthcare consumer is constantly barraged with conflicting information. Does wine prevent or predispose to cancer? Should I eat certain foods or avoid them? Is this new medication going to hurt me or help me? Many issues are still controversial, but there are some things that have a large amount of evidence behind them.
1. Antibiotics will not help the common cold. Colds are caused by viruses, and antibiotics kill bacteria, which …
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5 things that I want my patients to know
I recently was on vacation in Rocky Mountain National Park. Suspended on an overlook of astonishing beauty at 11,000 feet above sea level, I stared out at the tundra and bits of August snow that still clung to the highest peaks. Suddenly my attention was snapped from the massive boulders and landscapes to the ringing of my cell phone. It was a referring doctor asking me about a mutual patient …
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Preserving the doctor-patient encounter in the face of technology
I have been practicing medicine for 35 years and the great secret is that it just keeps getting better. No day goes by without an important learning moment, a unique observation or just the satisfaction of making a difference. Today I had one of those moments of revelation that will slightly change all days which follow.
Stan is a 57-year-old man with curable colon cancer who requires surgery. Unfortunately, that surgery …
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When patients decide the best is not for them
Today’s healthcare consumers are increasingly asked to take a more participatory role in their care. For many this is a daunting task – even if the patient desires being in the driver’s seat. There are a myriad of issues undermining patient-physician communication – such as time constraints, lack of comfort with the subject matter, lack of shared language, or even fear – that can make the task of …
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Patients need to overcome the fear of asking questions
As I contemplate retirement from clinical practice as a general surgeon, something I’ve been doing for over 41 years including residency, I’ve been having some unsettling thoughts.
Like many physicians, I’ve tried to stay somewhat emotionally detached from my patients. You must maintain some distance in order to be able to make tough decisions and to keep on doing surgery for so long.
I have written in a previous blog about the …
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As I reach the end of my career, I empathize more with my patients
We’re a disgruntled bunch these days. We think there must be a better way to experience health care.
Doctors say they’re pressed for time, don’t make enough money, have to hassle with insurance companies and typically feel generally burned out about medicine.
Patients feel they wait too long in the waiting room, don’t get much time in the examining room to ask questions or share concerns, want to be more involved in …
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How can we improve the patient experience?
Janus is the Roman god of doors and gateways but also the god of beginnings. Interestingly, good beginnings and required for good endings. The Temple of Janus had doors facing east and west, which allowed illumination of the temple at the beginning and the end of the day. Most statues of Janus show him with two faces facing opposite directions.
The Janus principle in your medical practice is the idea of …
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Use the Janus principle in your medical practice
Dr. Anthony Youn, a plastic surgeon practicing in Detroit places most of the blame for long office waiting times at the feet of the patients themselves. He comes up with three general categories; patients who arrive late for their appointments, emergencies that require the physician to leave the office, and “oh by-the-way” scenarios:
“Here is a typical scenario: It’s the end of a 10-minute office visit, scheduled as …
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Don’t blame the patients for long wait times
It turns out that the practice of medicine is just common sense. If someone has fallen and their hip hurts, it is probably related. If someone does not have an infection, do not give an antibiotic. Exercise and good food are, well, good for you. If it is not broken, do not fix it.
Usually, patients understand this basic idea. The best chance of becoming and staying healthy is the simplest …
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When patients stray from the common sense approach to health care
One of the hardest things after a cancer diagnosis is telling others: family, friends and colleagues. I preferred to a more open approach for a number of reasons.
Keeping everything inside was harder, talking and writing was a form of release. People close to you need to know to help them support you. Letting people know avoids awkward questions, providing an invitation for support. Previous experience with others who did not share …
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How to tell your friends and family that you have cancer
Have you ever sat on your bed after being discharged from a hospital stay and suddenly felt – along with the relief of being home – overwhelmed by what you have just been told that you and your loved ones must now do? Similarly, have you ever walked out of an appointment with your clinician and said, “HUH? Exactly what did we agree I am going to do about this …
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An OpenTable approach to hospital discharge planning
A few weeks ago I was brought in to speak to the staff of a local university. I gave a two hour workshop, which is even more fun for me than giving a keynote as I get to interact personally with the audience and draw their stories out. One of the sections of the workshop was about listening to your body. Every person’s body “speaks” to them in a different …
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Learn to understand and interpret your body’s language
I recently experienced my first Facebook-era death. It had been several years – long before the ubiquity of social media – that I had last lost a relative, and I quickly discovered that experiencing loss and grieving online comes with a unique set of pros and cons.
I learned of my uncle’s stroke the old-fashioned way: via phone. My parents and I kept in steady contact that way over the next 36 hours, but it was Facebook that filled me in …
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Experiencing my first Facebook era death
