“I swear to God, if you come any closer, I will kill you,” said the 30-something year old, arms as wide as bazookas, eyes as piercing as the very needles I was about to stick him with. He was hooked up to IVs on every limb, had tubes coming out of his nose and going down his throat, but other than that, he was about as physically fit as anyone I’d …
Learning about patients as a phlebotomist
Recently, I decided to take up surfing again. As a 20-year old kid, I was pretty good at most things that required athleticism (even surfing).
However, as a 42-year old, things come a little harder. My daughter began taking surfing lessons about 9 months ago from a young professional surfer. She quickly was able to get up on the board and was soon riding waves (upright) to shore. I decided that …
What surfing can teach doctors about patient recovery
If you want to identify me,
ask me not where I live,
or what I like to eat,
or how I comb my hair,
but ask me what I am living for,
in detail,
ask me what I think is keeping me
from living fully
for the thing I want to live for.
– Thomas Merton
As a patient waiting to see my health care provider, I would adapt Merton’s template …
Patients want to tell us their story
The patient had a large abscess surrounding his spleen. On a large screen in the middle of the operating room, I watched a surgeon drain the fluid collection and remove the organ with small metal tools.
I remember the surgeon navigating the complex anatomy with alacrity, handling the laparoscopic equipment with expert finesse, and quickly and confidently answering the battery of questions from the assisting medical student. To a young and …
How much does surgery cost? About $147 a minute
One magical thing I see while working in health care is the love story. Each and every child who encounters a diagnosis or illness spawns a collection of love stories around them. The stories come spontaneously from parents, siblings, friends, nurses, doctors, community, and peers. It all happens organically and sometimes it happens without notice. Babies cling to their parents when they ache; parents cling to their children when they …
Behind every illness, there is a love story
An excerpt from Behind the Mask.
Why do you do it?
Do what? Get up in the middle of the night? Rush in to the hospital to patch mangled bodies, sew holes closed, stick my finger in a dike spewing blood and, hopefully, repair what’s broken and allow some unfortunate soul to live and love another day? A good question. I could have been a pediatrician, almost became one as a matter of …
Supreme Court Justice Potter Stewart famously said he could not define hard-core pornography, but “I know it when I see it.”
We in health care seem to have the same reaction to the phrase, verbalizes understanding when it comes to patient education. Patient medical records, including electronic medical records now include free text notes or check boxes indicating the patient verbalized understanding without actually defining this phrase.
In a world where ambiguous …
Verbalizes understanding: What exactly does it mean?
There’s no denying that the Internet has been an industry-changing phenomenon across a wide variety of fields. When it comes to healthcare, though, it’s suffered a rockier relationship.
The reason behind this strained relationship can be summed up handily in one word: skepticism. Skepticism from doctors, nurses and really anyone who spends time diagnosing patients. For the most part, this skepticism is understandable — after all, anyone with an Internet connection …
The physician Internet road does not need to be a rocky one
A year ago, KevinMD.com was kind enough to post my piece, 10 Tips from 10 Years Sick. Well, a year has gone by and I’m still sick. So, I’ve re-visited that post, changing several of the tips and adding to others. And, of course, there are now 11 tips, not 10! At the end of the piece, I hope you’ll share your own experiences.
1. The onset of chronic illness …
11 tips I’ve learned from 11 years sick
Professor James Reason is the intellectual father of the patient safety field. I remember reading his book Managing the Risks of Organizational Accidents in 1999 and having the same feeling that I had when I first donned eyeglasses: I saw my world anew, in sharper focus.
Reason’s “Swiss cheese” model, in particular – which holds that most errors in complex organizations are caused not so much by …
James Reason and the foundation of patient safety
Mirrors reflect, and give us pause for reflection. Not always eagerly sought after or welcome, this reflection does not always reinforce the image one has of oneself. For a physician, publicly-posted patient ratings that contradict the doctor’s perception of his or her standard of care can be jarring.
Through “How Does Your Doctor Compare?”, the physician practice rating collaboration between Massachusetts Health Quality Partners (MHQP) and Consumer Reports, patients can access …
Physician ratings can help identify missed opportunities
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 relishes the role. 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 being an empowered patient …
Both patients and physicians need to communicate in the exam room
What do you think is the physician-view of an “ideal patient”?
Well, as physicians, though we would like to think of caring for an ideal patient, we have to face the reality that this would rarely happen. You see, the ideal patient would be one who, first of all, bears many of the views and goals of the physician. As physicians, we really can’t believe that we will be so lucky. …
Should doctors really want ideal patients?
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“I just love working here!” my nurse told me. “We have great supervision, I have wonderful colleagues – we all help each other in an emergency. The doctors are really responsive and I feel like I am doing important work. I thought I would only stay for a year because oncology is so hard, but I’ve been here ten and I still love it.”
This is what we want to hear …
Physician disrespect impedes patient safety
While reading the New York Times I stumbled upon an article by Pauline Chen addressing issues with doctor patient communication.
In the article, Dr. Chen describes a highly educated, articulate patient who was unwilling to speak up and discuss care related issues with her doctor. The reasons given for not wanting to speak up included not wanting to anger the physician and not giving the perception of questioning judgement.
I immediately began …
Patients must speak up at the doctor’s office
There’s a push-pull happening right now in the evolution of health care and it’s all about you. The question under debate is simple: can you handle being the first to know your own test results?
Are you smart enough to read the results? And are you emotionally capable of handling the situation?
Do you need someone next to you when an over-the-counter test tells you whether or not you have a disease? Can …
Can you handle being the first to know your own test results?
As I like to remind my women’s heart health presentation audiences, I am not a physician. I’m not a nurse. I am merely a dull-witted heart attack survivor. I also warn them that a lot of what I’m about to say to them is already available out there, likely printed on some wrinkled-up Heart and Stroke Foundation brochure stuffed into the magazine rack at their doctor’s office.
So when the organizer …
The power of engaging peer-to-peer health care
In the United States many people feel it is their God given right to sue anyone, anytime for anything. Whether you are successful or not may be another story. So what are the cost implications for healthcare in the United States? Few other developed countries rely upon this method for resolving malpractice issues. What is the cost-benefit equation? To protect themselves, American physicians practice what is called defensive medicine designed …
Protecting patients by solving the problem of defensive medicine
Patients often don’t get the respect they deserve. Take the subject of patient engagement. Just about everywhere you turn in the health care literature these days we are told how physicians and other providers need to do a better job getting patients involved in their own health.
But is that really their role?
Patient engagement is not the job of health care providers
Why? Because by the time a person (aka patient) …
What is the role of providers when it comes to patient engagement?
There’s nothing better than sitting down with a patient, going though an entire visit, and collaborating on a well thought out plan that meets everyone’s expectations.
Shared decision making is a wonderful and necessary concept in modern patient care. Paternalistic attitudes are fading away in the medical community as the next generations of doctors continue to get educated on how to manage patients who are very knowledgeable and yearn to be …
Shared decision making is a necessary concept in modern patient care
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