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.
Hypertension was the trigger that forced medical cost awareness to the forefront. My doctor decided that with my rise in blood pressure it would be prudent to prescribe a blood pressure medication and order a nuclear stress test. With only a catastrophic insurance policy and a $5000 deductible it was imperative for my financial health to know the cost of both the drugs and the procedure up front.
The prescription was …
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Question the price of drugs and medical procedures
Here is a toast to the miracle of love. Not to the romantic, chocolate, dance club nightlife type of love. Not warm sandy beach vacation, new bigger home and grand Thanksgiving dinner love. Not even baby’s first words love. I mean power passion that gets us through the hard times, type of love.
Edna and Ken are 90, married and both have active cancer. They have been partners for 62 years. …
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In love there is a life giving force
One of the things I have come to really enjoy and appreciate is the opportunity to interview the subjects of my articles and multimedia pieces. In a way, being a reporter reminds me a lot of being a physician-in-training – both roles require me to go into a room, learn an individual’s story inside out, and present the learned information for a further goal.
In my Public Issues Reporting class, the …
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Reporters and doctors are more similar than you think
No one wants to die. Even people who want to go to heaven don’t want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because death is very likely the single best invention of life. It is life’s change agent. It clears out the old to make way for the new.
-Steve Jobs, …
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How to get ready for death
One morning this May, I woke up with a stiff neck. I applied hot and cold therapy all day and took an Advil before bed. By the end of that week, I was unable to comfortably move my head and I was feeling numbness down my left arm to my fingertips. I saw my doctor within 24 hours of calling his office. After a brief exam, he was sure of …
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The long term cost of a pain in the neck
A recent article in the Wall Street Journal reviewed the emerging role of email in healthcare, arguing that doctors should more aggressively offer their patients the option to communicate with each other through email. Unlike other professionals in the United States, doctors have generally resisted the adoption of email into their practices. But according to the WSJ article, email can result in many benefits to both the doctor and patient. …
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The pitfalls of email communication with patients
Visiting someone who is dying or critically ill is an experience many of us will have in the course of our lives. Whether your visit is to be in the person’s home, a hospice or a hospital, there are a few rules of thumb to guide your time together so that it can be mutually satisfying.
This post introduces some of the basics.
1. Call ahead. Find out what prime visiting times …
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Preparing for your visit with someone in hospice care
Everyone in our industry — policymakers, clinicians, healthcare facility administrators, public and private payers, technicians, pharmacists — shares concerns about the state of healthcare in the U.S., each of us from a slightly different viewpoint.
The thread that joins us all is that one day each of us will be a patient.
As its title suggests, patients are central to almost every provision of the Patient Protection and Affordable Care Act (Act), …
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Patient preferences may not be rational, but they are not irrelevant
I found a recent Associated Press article on an aspect of the new health care law that many of us may have overlooked. It requires consumer-friendly summaries of what insurance plans cover, a provision that now seems to be at risk. The insurance industry is up in arms about implementation costs and added regulatory burdens. (There’s a good story at NPR, which includes a link to an example of what …
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Why we need to go from e-patient to i-patient
I come back into the exam room, keeping my best poker face, sit down and turn to face her. She’s on the edge of her seat, nervous and barely able to contain herself, maybe not even sure which answer she wants.
“Congratulations,” I say. She lets out her breath and smiles, huge.
“Thanks!”
Once the adrenaline settles down and she can hear me again, …
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Be aware of your food choices, especially when pregnant
A great deal of effort in the current health care environment is being put into improving communication – between patients and families and members of the health care team, among family members, and among members of the team. The case can be made that good communication is at the heart of patient safety, cultural sensitivity, and the pillar of palliative care — aligning patient’s wishes and goals with treatment plans.
So …
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Good communication in health care is about listening
I love listening to life stories. As a hospice chaplain, I loved sitting with our patients and their loved ones engaging in what many hospice teams call “life review.” When did you meet your spouse? When was Reggie born? What is your favorite holiday? When did you learn you were ill? A few simple questions and the stories come pouring forth.
Of late, I’ve been listening to the life stories of …
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How will the Baby Boomers age and die?
For health care professionals, patient engagement is the holy grail of health care. It is the key to patient adherence – a prerequisite to achieving better outcomes, fewer ER visits and hospitalizations and more satisfied patients. It is easy to recognize an engaged patient – they do what their health care providers recommends …what their health care team knows what is right for them.
But doesn’t engagement depend upon your perspective?
In …
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Patient engagement is the holy grail of health care
As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to. At those times, in particular, we evaluate their health in the context of relationship, family, and workplace. Having practiced family medicine for so many years, and now in counseling medicine, I have had the responsibility of advocating for my patients with their health insurance companies, within their families, …
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Physicians have a natural role as advocates
As a physician, technology cannot replace you, but it can make you more efficient and effective.
This was the message from Richard Satava, MD, who spoke on the future of surgical technology at the recent Seattle Surgical Society Annual Meeting. Dr. Satava’s speech was fascinating as he laid out the future for robotics, remote surgery, internal locomotion actuators, molecular imaging biosurgery, etc. I looked over my shoulder a couple of times …
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The Internet is where patients go for pre-visit consultations
So, Megen at Not Nurse Ratched wrote post recently about therapeutic presence. The following passage really caught my attention: “Question is: are there more things in nursing, Horatio, than science can explain? Can we touch patients and zap them with calmness or take away their pain? Can we, by our mindset during our provision of care, substantially affect our patients’ outcomes? Can any of this be taught? Can we do …
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How touch can calm patients
While payers and providers are usually in the spotlight when it comes to accountable care, the most successful models will be the ones that place a strong focus on patient accountability. More and more frequently patients are selecting doctors with the best outcomes, asking proactive questions, and taking an active role in their lifestyle and behaviors. Empowering patients with the support and tools to be responsible for and more involved …
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Implementing strategies to encourage patient accountability
When Dr. Timothy Malia of Fairport, New York, runs behind schedule, he passes out five-dollar bills to everyone in the waiting room. And when Dr. Cyrus Peikari of Dallas, Texas canceled his appointments for a family emergency, he gave each patient 50 bucks for the inconvenience.
Most doctors apologize. Few offer cash. Others get creative: Dr. Gwen Hanson of Bellevue, Washington gives out Starbucks cards; Dr. Sharon McCoy George of Irvine, …
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Doctors who give cash to patients for running late
To just what age do you expect to live? You haven’t thought about it? I bet you have. Would you like to live as long as Methuselah?
Television’s “Today Show” antes up centenarians to celebrate from time to time. There are about 70,000 American outliers past the age of 100. But that’s out of a population of some 311,000,000 people.
The most sensible place I know to read about this conundrum of …
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How long do you expect to live?
