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.
The following column was published on November 10, 2011 in Medical Economics.
I recently saw two patients in my primary care clinic, each with new-onset hypertension.
The first, a middle-aged executive, brought printouts from the Internet and already had researched the various treatment options for high blood pressure. During the visit, we discussed this information, and I gave my thoughts on what …
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How much guidance do patients want with their medical decisions?
People who regularly take medicine should know what we’re taking. To me, this seems obvious, but there are always those who need everything stated explicitly. People taking prescriptions, vitamins, herbs, and any other treatments should know what’s being taken and why.
It’s pretty easy to make yourself a list and stick it in your wallet so that it’s always available. If you need medical assistance (for instance, if you’re in a …
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Abbreviate your med list with caution
Here’s a devil’s advocate position.
Historically doctors have held power over patients as compensation for the responsibility of that position, and the epatient and other patient advocacy movements seek to address that imbalance with good reason, arguing that the doctor-patient relationship should be equal. I don’t mind that. But let’s be truly equal partners then.
The patient’s right to choose a doctor and be informed of the best ones via doctor rating …
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Isn’t it time for a patient rating system for doctors?
“51-year old female presents today with …”
Funny, the vast majority of my clinical notes last week began with that phrase, give or take a year or two. Women in their fifties who saw me in the clinic, who I spoke to via television in my telepsychiatry practice, or who I interacted with in some other way. It struck me as odd that so many women of similar age came to …
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The fifties woman has many reasons to get better
“Medical training rarely deals with helping the dying patient find peace and comfort. In fact, most physicians are uncomfortable with the entire subject. I believe it is one of the most neglected aspects of medical care. I have spent my career as a pulmonary and critical care physician, and I have cared for thousands of dying patients. In many cases, both the patients and I knew that they were dying. …
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Advance planning should be a public health issue
The recently instituted 30-hour-shift work restrictions placed on medical residents have created a need for “dayfloat” services to safeguard potentially unsafe handoffs in patient care and help residents adhere to duty hour limits. The past two weeks I’ve been the dayfloat resident for the cardiology inpatient service. My job is to round with the post-call team, help them get out of the hospital on time, and then take care of their …
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Making tailored health education standard of care
Our children (and grandchildren) are the future and we are responsible for their growth and development. As responsible parties, we are clearly failing.
That is my interpretation of the report issued a few days ago by the Centers for Disease Control (CDC) on seven criteria known to the associate with ideal cardiovascular health as part of the National Health and Nutrition Examinination Survey. They are defined, briefly, as 1) a diet …
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How many parents are failing their children
I remember like it was yesterday. My patient was a young blond female with two beautiful Samoan dogs. Her name was Margaret. I was only two years younger than she was. The diagnosis was poor. She was friendly when I introduced myself. And she proceeded to tell me about her health issues, how she was diagnosed and what treatment she was receiving. Marge as she wanted to be called was …
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The powerful connection of emotions in healthcare
Almost four years ago now, I left my practice as an emergency medicine physician to enter the business world. However, the medical world isn’t easy to escape. I just couldn’t seem to forget some of the problems I used to face in the emergency department. So, when I had the chance to fix one of them, I took it.
The most intractable problem for me was fraud, especially as it related …
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Patient identity fraud in the emergency department
Political correctness and sensitivity training are interfering with medicine and healthcare. In a recent article published in the journal, Pediatrics, a group of researchers published their findings regarding parental perceptions of the terminology that doctors use to describe childhood obesity (ages 2 to 18). The researchers found that it was undesirable to use the term “fat,” “obese,” or “morbidly obese” because they were stigmatizing, blaming, and the least motivating to …
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How political correctness interferes with healthcare
Sonia struggled to express herself through broken English. Her lively facial expressions and exuberance betrayed by her inability to string the words together fluently. One hand gesticulated widely while the other rested gently on the elderly woman’s hair.
She somehow managed to coo quietly in her companions ear, calming her, as she continued the conversation with me. Sonia’s eyes opened and closed in an exaggerated blinking manner as she questioned me …
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Health quality requires looking at our caregivers
“I’m sorry, Doctor, but we can’t have you give that talk; you have a conflict of interest since you’ve been paid to do research on that medicine.”
“Well, Senator, it’s a conflict of interest for a doctor to sell those crutches in his office.”
“It is the opinion of this newspaper that physicians should declare to each patient any ownership interest they might have in a surgery center so that the …
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Stop trivializing conflict of interest
The notion that dying is a right seems nonsensical to argue: death is given to all of us equally without the need of anyone’s sanction. The right to die well, on the other hand—well, that’s another matter entirely. A good death is, in many cases, something our fellow human beings have great power to grant or deny, and is therefore, sadly, a right for which we must indeed fight.
The …
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A good death is a right we must fight for
I have not always been excited to hear patient complaints. As a younger manager I absolutely dreaded when a patient wanted to speak to me. I felt that I had little to offer a patient who expressed anger or frustration with something that had happened and I was very impatient to get past the complaint and get back to my “job.”
Now, I can’t wait to hear patients’ complaints. Complaints …
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Why patient complaints are an opportunity
Whether you call it Health 2.0, Medicine 2.0, or e-Health 2.0, the Internet is changing medicine in ways that challenge the status quo. This article explores how a group of amateurs who call themselves “health hackers” and “citizen scientists” are trying to use the Internet to connect with other patients, run experiments, and conduct clinical trials on their own diseases.
Dr. Gunther Eysenbach states “Medicine 2.0 applications, services and tools are …
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The rise of citizen scientists and patient initiated research
There is a fire burning in America over an issue that at times seems hotter to me than the anger against Wall Street: obesity. Time after time when I talk about taking responsibility for our individual health by eating well, maintaining a healthy weight, and exercising more, someone responds in anger.
Many would consider me to be a wellness evangelist. They would be right. For nearly a decade I was sick …
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The skinny on obesity
It’s that time of year. The media is filled with stories about people traveling to be with loved-ones. Holiday decorations and yummy recipes abound. But for many people, the holidays are a difficult time of year. This piece is for those of you who face isolation during the holidays, either because you’re unable to be with others at all due to health or financial limitations (which often go hand in …
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How to ease the pain of isolation during the holidays
As we get older, having a good doctor in our corner becomes incredibly important.
And you don’t want just any doctor for your parent. Smarts, signs of basic compassion and a few other things are essential for the relationship to work.
Good doctor quality #1: Listening skills
Picture it: Your Mom’s doctor’s office. 10am Tuesday. She reaches into her pocket for her list of three concerning symptoms she plans to mention, if she can …
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Good doctor qualities for your aging parent
Well-meaning but clueless person: “Let me know if you need anything.”
Snarky me: “Really? Thanks! Empty your purse and let’s see what you have in there. Wait, is that purse Prada? I need that; I have medical bills to pay and want to look good paying them. Oh, that’s a pretty wedding ring, lots of diamonds, can I have that too?”
What you should say is absolutely nothing. This is a time …
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What do you say to a person who has cancer?
“Superior doctors prevent the disease.
Mediocre doctors treat the disease before evident.
Inferior doctors treat the full-blown disease.”
-Huang Dee Nai-Chan 2600 BC; 1st Chinese Medical Text.
Not only does my work in integrative medicine have me on the front lines of big pharma-created “syndromes”, like chronic fatigue, fibromyalgia and irritable bowel (these are real for patients, but are not formal syndromes), but I get to see the worst of our sickcare system. I …
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Find a physician, not a general
