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.
Patients and friends tell me it’s sometimes difficult to decide exactly what symptoms merit a doctor’s appointment. I find that it helps to think of three basic categories of visits. One category is the all-important annual checkup, which assesses and promotes overall health and can detect signs of early disease. Another category is the follow-up appointment to track chronic conditions or recovery from a major illness.
But the third category …
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When to see a doctor if you have a new symptom
I’ve been reading A Game Plan for Life: The Power of Mentoring written by famed UCLA basketball coach John Wooden. Wooden spends half of his book thanking the people who had a powerful influence on his life, coaching, philosophy, and outlook on life. Important people included his father, coaches, President Abraham Lincoln, and Mother Theresa.
Yes, President Abraham Lincoln and Mother Theresa.
Though …
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How Steve Jobs mentored a physician and changed health care
According to a recent study, depression causes an 23% drop in productivity at work. The drop is almost 45% for treatment resistant depression, defined in that study as depression that has not responded to 2 adequate trials (i.e. adequate dosage for adequate duration) of antidepressants.
My gut, based on clinical experience, tells me that even when depressed, people devote lot more of their emotional resources to trying to not let …
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Depression causes a drop in productivity at work
Language matters. The words we choose can have far-reaching impact on those we interact with. This is arguably more true in medicine than in any field.
Ryan Madanick wrote a recent blog post on the use of descriptor terms used by physicians in patient’s charts. He felt that the use of phrases like “is a very pleasant 52 y/o woman” or “is an unfortunate 16 y/o boy” is inappropriate. I …
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The words we choose can have impact on those we interact with
I was reading the other day in a magazine the personal account of a woman who had a “perfect example of a mitral valve click” (a type of heart murmur) that was so textbook in sound that she was asked to be a listening post for a class of medical students. She was pleased to help, but was disappointed in how of the 15 examiners no one treated her like …
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Patients and families must be tireless in expressing any frustrations
Recently, a friend sent me a text message with a rather conservative back-of-the-envelope calculation putting the number of lecture slides we’ve seen since October 2009 at roughly 41,000. That got me thinking: how many questions have I answered in that same time period?
Here’s the conservative estimate, not including quizzes, workshops, and miscellaneous other goodies: with roughly 100 questions per exam, an average of an exam every 3 weeks, and accounting for a few weeks …
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Disease treatment progress will continue to be slow and painful
What if you passed a regulation, and nobody cared? Obesity is quickly emerging as a major policy issue, with related health costs consuming 10 cents on every health dollar – and rising. Policymakers, then, are eager for ideas. Top of the list: regulations to force chain restaurants to post calorie counts on their menus. This past Friday, the FDA released proposed regulations to force restaurants to do exactly that.
New York …
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Obese Americans don’t actually realize they are obese
Several questions have come my way recently about what kinds of job opportunities might exist for patient advocates. I refer people to an article I’ve written elsewhere, but the real answer is – to be a true advocate, you must analyze who is paying for your services, and what your responsibility will be to them.
Finding an employer
In 2011, most of the job possibilities for patient advocates are found either …
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Considering patient advocacy as a career
I know of few students who aspire to serve in end of life care. I sure didn’t. If anyone had told me that I would spend the first decade of my professional life serving the dying and their families as well as thinking, writing and talking about death and I dying, I would have thought that person to be morbid, strange, and sad. Most of society does not think …
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A day in the life of a hospice professional
I was just thinking the other day how much I need my mom friends. The ones I’m fortunate enough to have in real life and the ones (you) who come here, read, offer support, share your stories, and commiserate at times.
All of you moms are incredibly important to me. It doesn’t matter to me whether you’ve breastfed or bottle fed, whether you are a champion of sleep training or prefer co-sleeping, …
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Forget the mommy wars, offer support instead
Medicine has changed so much over the past years, I look back even to when I finished my program and in the mere 20 years since I finished, medicine has changed dramatically. I can remember when I was a student, seeing a patient with rheumatoid arthritis and advising her that the best treatment we could give her was a DMARD. Now we have multiple monoclonal antibodies that not only …
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Patients have a part to play in their own medical care
Patients want to be cared for by doctors who show an interest in them as individuals. It has been a well-known statistic that the average doctor interrupts a patient within 16 seconds after the doctor-patient interview begins. You know full well that few patients can learn to develop an emotional attachment in 16 seconds. This article will discuss 7 steps to develop rapport that will make patients like you, will make them …
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7 ways to make patients like you
I’m worried about the future. Everyone I know is stressed. Patients fail to follow up as directed. They fail to take their medications as directed. They have too much to do. Their priority lists are in shambles.
With all the responsibilities that today’s multitasking society thrust on my patients, they don’t even have the time to pick up the phone and call each other; instead, they text, IM, SMS, and email. …
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Sometimes cyber-medicine is fraught with danger
As a patient care provider and someone who is occasionally a patient myself, I am going provide some suggestions on ways to know when it is time to consider seeking a second opinion or time to seek a new health care provider. This top 10 list is taken from personal experience.
- The number one reason to seek a new healthcare provider is when the treatment you are receiving is not working. …
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10 reasons why you need to change doctors
A friend of mine recently took an exotic trip. While shopping in a market, she picked up an appealing item and asked the seller what it cost. She was given a price that seemed high, and paused to consider whether the impulse seemed justified. The shopkeeper grew confused in the silence. Finally he asked my friend, “Don’t you want to know if I can do better?”
Clearly this person was outside …
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Health care consumers require a crash course on bargaining
Patients may soon be universally able to view their lab results thanks to a new rule proposed by the Department of Health and Human Services. This means patients may access without permission or release by their providers. This is a victory toward patient empowerment and a step in the right direction.
Classically patients do not see their lab results. The busy primary doctors are often left with nothing more than …
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The empowered patient is a relief for physician practice
Physicians recommend different treatments for patients than they would choose for themselves. The preceding statement is true according to a similarly titled article recently published in the Archives of Internal Medicine, and has, I will argue, important implications for how we view the doctor-patient relationship.
In the study, one group of physicians was asked to choose between two hypothetical treatment alternatives for either avian flu or colon cancer as …
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Doctors should not treat every patient like their mother
I once asked a man in his 30’s why he was on disability. He had fallen attempting to ford a swift stream while fishing. He replied: “Well, the judge said I have a bad attitude, I don’t like people and I can’t hold a job.” Shocking as it sounds, it wasn’t very different from other reasons I’ve heard. “I don’t remember, my Dad put me on it.” “I have anxiety.” …
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America’s broken disability system
Test your medicine knowledge with the MKSAP challenge, in partnership with the 
