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.
It was January 12, 2007 during rush hour traffic in the metro station in Washington, DC. A nondescript man wearing a baseball cap and khakis began to play the violin. He played six Bach pieces for about 45 minutes. During that time, since it was rush hour, it was calculated that at least a thousand people went through the station, most of them on their way to work. Nearly everyone …
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Each patient has something special that they can share with us
Last night was clear with full moonshine and the owls were busy hunting on our farm, calling back and forth to each other, comparing notes on where to find prey.
Thankfully they were not calling my name. At least I don’t think so, nevertheless their hoots haunted me.
A coastal tribal legend has it that if you hear an owl call your name, your death is imminent. I’ve had no recent brushes …
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Considering the preciousness of life and preservation of health
While I, as a physician, would not perform an abortion unless there was an extreme, medical rational, abortion is a choice. It is a woman’s determination of how best to live and manage her life. Also, while the issue of viability is an important medical topic, and while I believe that any life, from the moment of conception, is of supreme value, some women do not. If they are the …
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Granting rights to a fetus at the cost of the mother
Based on a survey conducted by the largest cosmetic surgery provider in the U.K., 76% of British women feel “depressed” about their appearance in January, related to an average weight gain of 11 pounds during December. Inquiries about cosmetic procedures peak on the third Monday in January, dubbed “Fat Day” in the U.K.
Most people will, of course, try various diet and exercise programs before resorting to cosmetic or Read more…
Which celebrity diet will you recommend to patients?
Estelle’s lipstick was apple-red and generous. She did not limit its application to lips, but wore it in the general area of her mouth. Together with pink rouge, color stood out brightly on her pale face. She wore a threadbare dinner dress, years faded. Estelle had dressed carefully for the visit and I showed respect.
I met Estelle in the winter of her life. 92 years old, she lived by herself …
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Saying a very special goodbye
Shortly after 3:00 I was listening to Chloe’s precise clinical description: her daughter, Mysti, had been fine and “in her usual state of rambunctious health” despite a runny nose and a low grade temperature of 99.8 to 100.6 that mom had not felt warranted treatment because she was eating and drinking and playing normally, and sleeping despite a very mild cough when she lay down.
That morning she had noticed a …
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Mistaken identity at the family physician office
“Do you remember my name?”
Like a broken record, I repeat this question again and again as I make rounds in the hospital. My patients’ universal answer, given with furled eyebrows and an apologetic look is “uh, no, I don’t remember”.
My response: “Don’t worry. It’s Dr. Tony Breu, but call me Tony.” Theirs’ (again with furled brow, but also a smile): “Oh, okay.”
In a busy teaching hospital, it is not uncommon …
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How patients can remember their doctor’s name
I recently left medical practice in order to pursue a career in mobile health technologies, for which I have had a passion for many years. I had wanted to become a physician since I was very young. The intellectual challenge and curiosities of the natural science and the human body stirred my intellect like nothing else.
What I will surely miss most are the priceless personal interactions I experienced on a …
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Why I miss practicing medicine
Editor’s note: Please read Dr. Yang’s entire Red Herring series for background prior to reading this post.
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The patient really is fine.
She returned to the gastroenterology clinic several times for treatments to widen her esophagus. (It’s a neat procedure: The GI doctors insert a small balloon into the esophagus. They gently inflate the balloon to stretch the stricture a few millimeters. With repeated stretching, the esophagus will remain open.) The patient ate more. …
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Physicians must advocate for their patients
Distance medicine technologies can be disruptive in the way physicians and other care givers interact with patients and with each other and can fundamentally change how patients are able to interact with the entire health care system. This is of increasing relevance as medicine gravitates toward chronic illnesses where diagnosis and treatment are complex and require multi-specialist teams. It also has potential to alleviate some of the effects of the …
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Distance medicine will transform medical practice
More and more providers see the value of providing patient portals. In an attempt to be responsive, EMR vendors are providing patient portals that have some limited capabilities (get lab results, email your doctor and possibly fill out a form requesting an appointment). However, just as the ability to design an airplane cockpit is radically different from a car dashboard, so to is designing an EMR geared towards medical professionals …
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Designing a friendly patient portal for consumers
I am a big fan of DIY (do-it-yourself) healthcare, at least for the bulk relatively minor issues that plague people. I think the days when doctors were needed to control, interpret and dole out health data and information are waning. There are simply too many ways, primarily via the internet, to get good, reliable, easy-to-understand information about our own health.
The Quantified Self (QS) people who use sensors, mobile apps, …
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Risks and benefits of direct access to lab results
I wish my patients could see what I see. I see through a lens sharpened over 30 years of experience. I see the present and often the future. Yes, I’m a fortune teller! Many times, the picture of the future I see is bleak.
It’s my job to predict the future and then try to change it. A friend once told me that he believed life was a movie playing on …
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I wish my patients could see what I see
Imagine this scenario. You are a male health care provider and you complete an evaluation of a woman close to your age. You establish good rapport as you always do, she laughs at some of the same jokes you make with all patients, and she expresses delight that you are listening to her problems (unlike those other providers she says she has seen), feels you are helping her, and is …
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Should healthcare providers hug their patients?
Recently, the Philadelphia Flyers announced that all star defensive stalwart Chris Pronger has been shut down for the rest of the NHL season with what the team has described as “post-concussive syndrome”. Pronger joins Pittsburgh Penguin superstar Sidney Crosby, teammate and NHL leading scorer Claude Giroux, and Ottawa Senator forward and NHL second leading scorer Milan Michalek out of action due to concussion. To list every star player currently on the …
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The phenomenon of concussions in professional sport
An excerpt from What Is It and How Did I Get It? Early Stage Chronic Kidney Disease.
The symptoms of kidney disease don’t show up until you’ve lost most of your kidney function. That’s when you’ll experience the fatigue that’s not always a result of anemia, the muscle cramps that usually – but not always – present themselves in your calves, nausea, vomiting, appetite loss, easy bruising, itching and the shortness of …
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Chronic kidney disease from a patient perspective
When tragedy strikes, one looks for comfort in many places. When traditional resources–relatives, physicians, clergy members–do not completely satisfy, one may reach out for comfort from unexpected places. Increasingly, people turn to online health and wellness support communities.
My family’s tragedy occurred when my father suffered a Sudden Cardiac Arrest, or SCA, in 2010. As I watched him lay lifelessly on life-support in that hospital bed, the man who was undoubtedly …
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Overcoming tragedy requires a team
As doctors, we have pills to treat infections and high cholesterol. We have scalpels to replace hips and open clogged arteries. But beyond pills and scalpels, what tools do we have? Walking out of the doctor’s office without a prescription is a rare occurrence these days. And the famous surgeon tagline has always been “a chance to cut is a chance to cure.” We see people when they’re sick and …
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Being a good doctor is more than writing prescriptions
One will find many examples of precaution and their corresponding examples of risk in how medical care is provided by physicians and accepted by patients. In fact, not only do these two elements correspond but at times the price, itself, of precaution becomes the risk.
Risk is everywhere in medical practice. Risk is present when a patient is selecting a physician. The risk is becoming the patient of a doctor whose …
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Balancing precaution and the apparent risk in medicine
Dear United States House of Representatives and Senate:
I really hope that you enjoy your Christmas break going back home to your families. While you’re home, I really hope that you will hear from those constituents who will be affected by the 27.4 percent Medicare physician pay reduction that is schedule to take effect January 1st. I really hope that the American Academy of Family Physicians, the American Medical Association, …
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The patient reality of a Medicare payment cut
