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.
Doctors inevitably come into spotlight, being at the front end of health care delivery. Sometimes seen as guardian angels restoring health and life, other times, greedy minds sucking resources while they carelessly harm and kill patients to fill their wallets. After experiencing, observing, and hearing from others like me, I wonder if doctors are given more responsibility than they can handle, often attributed more aura than they deserve and frequently …
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Are doctors given more responsibility than they can handle?
“So the patient has been temporarily paralyzed by the drugs, and you’re the one keeping them alive by squeezing air into their lungs, but … no pressure”.
Gulp.
I was holding the mask as tightly against her face as I could, sealing the rubber to her cheeks in the effort to keep highly oxygenated air from leaking out. Looking down at her from the head of the bed I saw the patient from …
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The honor of patient responsibility
“When is it time to break up with your doctor? It can be a tough decision to make. After all, if you don’t like your experience at a store, you shop somewhere else next time. If you go for a haircut and hate it, you find someone else.
With your doctor, it’s a bit different. This is someone who might know some of your deepest, darkest secrets. There is a history …
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When is it time to break up with your doctor?
Health insurance is very complicated. At our practice, we deal with health insurance all the time and even for us, it gets to be very complicated sometimes. So it is natural that patients have a hard time understanding it as well.
Therefore, I decided to summarize a conversation I had with a patient in an effort to help other patients understand, at the very least, a portion of how medical health …
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What patients need to know about coding
It was an invitation that made no sense. I was asked to be a special guest of the South Korean Ministry of Tourism and KMI International, a company that markets medical tourism. Why me, I wondered? As I re-read the invitation, I remembered another strange offer I received in the 1970’s during a tense period in Israeli-Arab relations.
“Hello Dr. Goldberg,” an official from the Jordan Ministry of Education had said. …
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If you want to know how well the medicine works, ask the patient
In this day and age, with excellent rehabilitation care available for nearly every injury or illness—no matter how serious—it’s hard to believe that there are millions of people who leave the acute medical system far worse off than they entered it, and aren’t routinely offered rehab. I’m talking about cancer survivors– a group of individuals known for their tremendous advocacy abilities. It’s no surprise that these folks are really starting …
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Cancer rehab dramatically improves cancer care
Physicians are not trained to interpret paintings, and most patients do not have a lifetime of artwork to analyze. However, a rare opportunity for both to occur is at the Museum of Modern Art’s exhibition de Kooning: A Retrospective.
Wilem de Kooning, regarded as one of the most prolific American artists of the twentieth century, grounded himself in the Abstract Expression movement. The AbEx movement is widely associated and recognized with …
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The art of Alzheimer’s disease
My wife has two world-class oncologists who help her manage her stage 4 lung cancer. Both are excellent clinicians. Yet their skills differ in one very important way. Her radiation oncologist physically touches her a lot (in a good way of course!). There are the touches on her arm, a hand on the shoulder, hugs, and of course a thorough hands-on physician exam. Her medical oncologist not so much.
We all …
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The therapeutic value of touch in medicine
Sam is young man is applying for a summer program, a real resume builder. Among other things, the application asks if he has been treated for a psychiatric disorder. In fact, he’s seen a therapist and he’s felt anxious at times. His internist gave him some Lexapro samples and he feels better. The symptoms of his problems have been limited to his own subjective distress. His anxiety is not something …
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When applications ask about your psychiatric history
I am a third world doctor.
My patients have first world expectations.
Somewhere in the middle, I end up working too hard and then going home feeling cheated. For I too have expectations. I am in a tension between the reality and my aspirations.
In Jamaica, health care is free. Day after day, and night after night its freeness is confirmed, tested. But the system is inanimate. It doesn’t feel its own failure, …
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First world healthcare expectations in a third world country
1. Mobile health technology will increase patient engagement. Most patients do not take the responsibility they should for their own health. They are likely preoccupied with all the stresses of everyday life and might therefore take the ‘I feel good, so I must be’ approach. They possibly mutter these words after wiping their faces, hurriedly walking out of McDonald’s for lunch. Or is it because of mistrust of their physician …
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5 reasons why physicians will love mobile health
As a neuropsychologist, I have the chance to talk to patients throughout the week in detail about their medical histories, supplemented by a comprehensive medical records review. Part of this involves discussing which provider the patient has seen and if the provider was changed, why. Sometimes, a provider is changed for a benign reason, such as a move or an insurance …
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10 ways doctors can lose their patients
At the University Hospital in Madison Wisconsin in 1938, a patient was dying from a very painful bone cancer which had produced fractures. The young interns knew that more morphine injections were needed but they feared they might be blamed for giving a lethal dose. So a tacit agreement was reached. Every hour or so,one of them would come into the patient’s room and give a shot of morphine. This …
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We are seeing more terminal patients being referred to hospice
In the U.S., we’re getting ready to celebrate Thanksgiving. Soon, people around the world will turn their attention to the holiday season. Chronic health problems can take a toll on relationships any time of the year. Most people have to experience unrelenting pain or illness themselves before they understand how debilitating it is, physically and mentally. Loved-ones (by whom I mean family and close friends) may be in some form …
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Living with chronic illness during the holiday season
I’m a big fan of the teach-back. To my knowledge, it is the only way to confirm that my patient understands my message. I don’t believe avoiding jargon or creating written materials at a favorable readability level can ensure understanding. So, I’m always left with uncertainty until my patient teaches it back to me.
I’ve been teaching clinicians to do the teach-back for about a decade now. For the same amount …
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Teaching clinicians the teach-back for patient education
Science seeks certainty. The problem in medicine is, the body is complex and our knowledge is incomplete. People who want certainty – physicians or patients – are kidding themselves. And if we expect docs to be perfect, it’s a setup for dysfunction.
Sometimes I hear of patients who believe their physicians dissed a proposed or experimental treatment that’s not understood. (I’m not endorsing wacky treatments here – I’m only talking about uncertainty.) …
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Expecting doctors to be perfect is a setup for dysfunction
Have I told you how much I love Amazon? Its the awesome! Let’s say I need something – an external hard drive. So I go to Amazon and I type in “external hard drives.” Boom. I get a list of, not surprisingly, external hard drives. Which one do I chose? Fortunately, Amazon has some great data and filtering options. I want a desktop drive, not portable, so I filter those out. …
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Choosing a doctor should be like the Amazon shopping experience
Back to school. Kids get back into a routine, and mom gets her life back, right? Wrong. For most moms, back to school is anything but relaxing. However, for some of us, it’s even more tiring.
Is this the time of year when you struggle to drag yourself out of bed, despite hitting the sack as soon as you put the kids down for the night?
Is your focus during the day …
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Back to school fatigue can be caused by environmental allergies
To deal with the aftermath of medical errors, an increasing number of providers are encouraging injured patients to participate in “medical apology programs.” The idea, proponents say, is for patients to meet with facility representatives to learn what happened and why. It gives the patient a chance to ask questions and it gives providers a chance to apologize, and as appropriate, offer compensation. These programs are promoted as humanitarian, and, …
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Protecting patients from medical apology programs
Test your medicine knowledge with the MKSAP challenge, in partnership with the 
