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.
In March 2010 President Barack Obama and the Democratic-led Congress passed the single largest change in the American health care industry since the introduction of Medicare and Medicaid in 1965. The Patient Protection and Affordable Care Act (PPACA) aims to drastically change the way that health care is delivered and financed. It partially draws upon the idea of personal responsibility and its role in promoting individual health. Some states, notably …
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Personal responsibility in promoting individual health
It is well known that men see doctors much less frequently than women. The reasons are multifactorial and not all that well studied. It’s certainly not because men are healthier than women as they die on the average seven years before women. Clearly women are accustomed to seeing doctors at an earlier age than men for reasons relating to childbirth and birth control. Most accept the recommendations to get an …
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Embarrassment is one reason why men don’t see the doctor
The following op-ed was published on September 18, 2011 in USA Today.
A fellow physician recently shared a frustrating clinic visit with me, in which a patient had left by saying, “You doctors need to wake up and realize that patients (who are) in pain are in a no-win situation.”
The patient was absolutely right. This summer, the Institute of Medicine released …
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Doctors and patients cannot win when it comes to chronic pain
Several years ago, during an annual mammogram, my wife, who is in her 40s, was told a mass had been found in one of her breasts. Anxious and uncertain, she had a biopsy, and we braced for the worst.
My father-in-law, when in his 50s, went through a similarly harrowing experience when a prostate specific antigen (PSA) test given during a routine physical exam came out positive, and he underwent a …
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The fallacies of screening tests extend beyond false positives
I don’t know when I lost my sentimentality.
Whaaap.
With a thud the fish stops flopping up and down. It lays still on the floor of the boat. My camp counselor, a tanned college student, carefully places the paddle on the seat and cuts the fishing line. The hook remains dangling from the lifeless mouth.
He grabs the fish with his bare hand and throws it back into the water. He talks slightly …
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When sentimentality is lost
It’s a sad commentary when human beings have to be reminded how to act like human beings, especially when they’re in the helping profession.
Loni Hildebrandt was a 29-year old certified nursing assistant who was pregnant with her first baby. Make that two babies because she was pregnant with twins. Hildebrandt considered her pregnancy miraculous because she had infertility and was a diabetic since the age of one. Together, she and …
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When doctors have to be reminded how to act like human beings
The public gets much of its health-related news from lay-oriented synopses of scientific papers published in refereed medical journals or presentations at major medical conventions. Longer, more detailed commentary is published in the print media, but the majority are short pieces posted on many websites or blogs. I try to familiarize myself with information pertaining to cardiovascular disease as well as predisposing conditions such as diabetes and hyperlipidemia with the …
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The ability to quantify empathy
One recent morning, my grandma awoke with abdominal pain. She was taken to a good, local community hospital and diagnosed with acute ischemic bowel. There are various causes of ischemic bowel, but regardless of cause, getting the right care quickly determines whether such patients live or die.
After speaking with her physicians, I called some friends. A quick discussion with colleagues in radiology, surgery, and gastroenterology helped me know that the …
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Would patients benefit from experts who never meet them?
You heard me correctly. Do not go to your next doctor’s appointment. I repeat, do not go. Do not pass go or collect money.
Now that I have your attention, you may be thinking what is this crazy doctor saying? If I had a dollar every time a patient came in and asked for my advice but didn’t follow it, I would have been retired long ago.
Why is this?
Change takes time. …
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Why you should cancel your doctor’s appointment
Not many years ago it was assumed that most cancers were not caused by viruses. Today it is clear that many are and the list is growing. Head and neck cancers are either caused by the environment (especially tobacco) or by the human papilloma virus, the same virus that causes cervical cancer and some genital warts.
The incidence of HPV-related head and neck cancer has been rising rapidly in the past …
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Quality of life issues in caring for cancer patients
My 64-year-old patient with terminal cancer and less than six months to live wanted to go to Oregon. He was contemplating assisted suicide, which is legal there. “My life has been long and good,” he said. “I believe it is my right. I want the ability to say it’s too much, I can’t do it anymore. A person should have a dignified quality of life.”
Another one of my patients, an …
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Doctors are reluctant to have end of life conversations
I took my daughter to the orthodontist last week to get braces.
There’s a lot about the process that seems better than when I was a kid. Mostly, it’s that instead of having to slide brackets around each of your teeth (yishk!) the orthodontist just paints a special glue on the enamel and places the brace on the front of each tooth. Kids get to pick the color of their braces …
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What doctors can learn from the orthodontist’s office
The digital age has had a deep and likely permanent effect on the patient-physician relationship. I can’t tell you how many times I’ve had physicians beg me to provide them with a way to stop their patients from Googling their symptoms and diagnosing themselves before their first office visit and much to their chagrin, my answer is always the same, “You can’t stop them. Get over it.”
The Internet acts …
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Patients and physicians in the digital age
Few things smell worse to me than the stank of a cigarette while trying to trying to load up on cholesterol via awesome blossom. Perhaps one such thing is the beguiling tale of what perverse fate has befallen the gobs of cash money rewarded to state governments from Big Tobacco.
This seemingly righteous pursuit was fought by brave attorneys general of 46 various states to regain money we dished out to pay …
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How state governments are addicted to tobacco revenue
Last year I was assigned to complete a history and physical on a patient in the hospital. Stifling my excitement to be doing this on a weekend night, I walked to the operator’s desk and paged the on-call intern, who — I’d been assured — knew I was coming. “You’re who now for what?” she stared blankly back at me after I’d explained my task.
My patient (we’ll call her Betty) …
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A nurse offers a medical student sage advice
“Better” is another one of the difficult words I have to deal with on a daily basis.
“Doc, I’m better” can mean a lot of things and can lead to both misdiagnosis and poor treatment. Does “I’m better” mean you are well? If not, are you really better or is it just wishful thinking? How much better are you?
On a busy, stressful day, even the most skilled physician can fall for, …
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Doctor, I’m better: What does that really mean?
Physicians, nurse practitioners, nurses, psychologists, physical therapists, and a whole host of other health care professionals entered their respective professions to help people. One part of being an effective health care provider is to advocate for your patient when they need it. For example, if your patient (who is a mechanic) broke his arm and needs a note for the employer for a few weeks off, you provide it. If …
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When patient advocacy leads to patient enabling
For years, it has been widely known throughout the medical profession that basic education in nutrition for training physicians has simply been ineffective. And whether this failure was due to a lack of time or simply a failure of emphasis, the point remains that the medical profession in general is woefully inadequate when it comes to a sound knowledge base related to nutrition and its effects on optimal health. …
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Does your doctor really know what you should be eating?
Test your medicine knowledge with the MKSAP challenge, in partnership with the 
