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.
Everybody has a shadow. Although as a small child you may have tried, you cannot separate yourself from your shadow no matter what you do. Electronic medical records may be the first tiny step on the road to attaching yet another indivisible part to your persona, a “panoramic, high-definition, relatively comprehensive view of a patient that doctors can use to assess and manage disease”, and this, in the words of …
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Striking the balance between the public good and patient privacy
Many elderly patients get admitted to the hospital with profound weakness due to their acute and chronic medical conditions. Many of them will leave the hospital with profound weakness from their acute and chronic medical conditions (and unfortunately without a palliative care consult). In many situations, these patients will be too weak to take care of themselves. They will need extra help with their activities of daily living either from …
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Any doctor can make the decision for mental capacity
Many doctors are now getting into movie production and making videos that are loaded onto YouTube. These videos are effective in attracting new patients and educating your existing patients. There are a few guidelines that you can use to create an effective script for each of your videos. These scripts can be loaded onto your computer in a PowerPoint format and will serve as poor man’s teleprompter to assist in …
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How to create YouTube videos for patient education
Planning a lengthy hospital stay is like planning any extended vacation or business trip, with the difference that transitioning to hospital life means transitioning to no longer being in control, where choice is limited, and where one is dependent on others.
Given my lengthy hospital stays as part of my stem cell transplants – some planned, some as a result of complications – the following may be helpful should you find …
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How to plan for a long hospital stay
“The question” comes in several forms: “Doc, what stage is my cancer?” “What is my prognosis?” “Can it be cured?” “Am I going to die?” “Have long have I got?” These tough honest words require courage. “The question” superficially asks for a simple answer. Time to live. However, in the real world of life and death, these questions and therefore the answers are far more complex and subtle.
Years ago we …
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How long do I have? The question of prognosis has no simple answer
For thousands of first-year medical students, including myself, last week marked the beginning of classes and our official entrance into the medical profession. We sat through lectures on the normal functions of the body, and many of us even set foot in the gross anatomy lab for the first time.
At my school, we didn’t just delve back into the basic sciences—on day two, we also began a class that will …
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Patient centered care starts in medical school
Years ago, I attended college near the home of a favorite great aunt. Aunt Lucy lived alone in a tidy apartment with a tiny courtyard balcony, overlooking a busy Pasadena street. Sometimes, I would make the short, chaotic drive through the tangle of LA freeways in order to spend a few days visiting my aunt in her neatly arranged home.
I visited Aunt Lucy when I was in need of a …
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The healing art of listening: Life lessons learned from my great aunt
It’s easy for those with health problems to complain about what we don’t want to hear others say to us, but I thought it might be helpful to let others know what we wish they would say to us.
“You look so good, but how are you really feeling?”
It’s hard for us to respond to comments like, “You look so good” (or …
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Helpful things to say to someone who’s sick
My mother is my role model and my inspiration for what I do every day. She was diagnosed with breast cancer when she was in her forties, and fought it courageously for seven years until she passed away in 2010.
There are so many stories I can tell about my mother and her battle with cancer. Let me start with just one. Whenever she’d go to her oncologist, she would go …
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My mother couldn’t advocate for herself when she needed it the most
I talk with lot of physicians about the need to improve the quality of communications between physicians and patients. Regular followers of my work will know that I am an advocate for the adoption of patient-centered communication skills by the physician and provider community.
Physicians with whom I talk seldom disagree as to the need for better physician-patient communications. They know that physician communication skills top the list of patient complaints …
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Put patients to work during their wait time
Our septic tank backed up recently. When I say backed up, I mean, into the basement. And when I say into the basement, I mean, out of the bathroom and onto the carpet. And under the walls. The stars were aligned, and I had to go to work. My wife borrowed a Shop-Vac and rented a steam cleaner. I was assigned to call the septic-tank guy. The kids helped clean …
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Why must medical care be provided for free?
“Here is a prescription for pain medication. Don’t drive if you take it. Call your surgeon if you have a temperature or are worried about anything. Go see your doctor in two weeks. Do you want a flu shot? I can give you one before you leave. If you need a wheel chair to take you to the door, I’ll call for one. If not, you can go home. Take care of yourself. You are going to …
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Hospital discharge planning: Involve the patients
Do you feel connected with your doctor or other health care providers? Do you partner with your providers? How important is patient engagement to you? What words do you use to define patient engagement? Do you consider yourself an empowered patient or health care consumer?
What is patient engagement?
Here is how I define patient engagement.
Patient engagement is a connection between patient, caregiver and health care provider. An empathetic and trusted relationship …
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How I define patient engagement
Does your doctor use a computer in the exam room? Some people think that computers are a great way to keep track of patient information. Others see some advantage, but problems in the implementation. There are also a few Luddites who oppose this change simply on principle. I’ve had good experiences, and bad experiences, and believe we have a long way to go before computers are as helpful as they could be.
There …
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Computers in the exam room: Good and bad setups
Risks are not certainties. They are the possibility that an activity will end badly. Risk is a handmaiden to almost everything we do.
Life itself is risky. Every decision is associated with the possibility of harm. Risk can’t be avoided, but it can be managed. Let’s talk today about the chances we take while living our everyday lives.
Risks are subject to a variety of misconceptions. What’s risky and what’s not is …
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Making poor choices by misjudging the level of risk
Turns out that while most of us (90%) would like be able to make a doctor’s appointment and check lab results online. 85% of us also still want the option of be able to talk to our physician face-to-face. These are the finding from a recent 2012 study conducted by Accenture.
These finding will no doubt come as a surprise to many of those high tech newcomers to health care looking …
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Health care is fundamentally about social interactions
A few days ago, I received a question that stopped me in my tracks. I was giving a talk to a local church group on the importance of patient advocacy, and most everyone was nodding. Yes, doctors don’t always listen — let’s do something about it! Yes, we need to control of our health.
Then someone raised her name. Her name is Susan, and she is the owner of a mom-and-pop grocery in …
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Improving medical care needs to involve the doctor
I am a patient. Yes, and a physician; a brother, father, husband, grandfather, uncle, friend, neighbor, taxpayer and concerned citizen. What healthcare reform means to you means the same to me, or more. Maybe because as a physician I focus on it a little more than the average person, I have an additional responsibility to share my perspectives? Maybe a little knowledge is a dangerous thing, as the saying goes.
I …
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Integrated care cannot change how we behave
