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.
Recently, two executions by lethal injections were carried out in America. One ended the life of Troy Davis in Georgia, the other with too much hate Lawrence Russell Brewer in Texas. Death and dying offer complexity and complications in the profession medicine bound by policies, mandates and laws driven by internal (e.g. professional associations, medical boards) and external (e.g. federal, state, medical center) forces.
Lethal injections involve delivering a fatal dose …
Read more…
Lethal injections are not good medicine
“Doc, my back is killing me! I think I need an MRI.”
I don’t know if you’ve ever uttered those words, but I can tell you I’ve sure heard them … more times than I can count. And believe me, I get it. When you’re in pain, all you care about is finding out what’s causing it as soon as possible so you can get rid of it as soon as possible. It’s quite tempting to …
Read more…
An MRI for back pain may only confuse the diagnosis
I’m getting married in November and am not “registered” anywhere. Doing so hadn’t even occurred to me until people started asking, “where are you registered?”
At first, I simply laughed. Dan and I have enough for two households. Now I’m re-thinking the bridal registry thing.
Here comes the under-insured, chronically-ill bride going on two years without primary medical care … and I want to register at the Mayo Clinic.
My bridal registry wish list …
Read more…
A bride who wants to register at the Mayo Clinic
Yesterday, someone asked me, “Can I be perfectly honest with you?” I wanted to reply, “No, just be dishonest, I like it better that way!” “Can I be” implies that, in past conversations, my patient has been dishonest. Dishonesty is a relationship breaker. Dishonesty leads to distrust and if I cannot trust what a patient is telling me, I cannot be effective; the doctor-patient relationship is terminated.
Am I being too …
Read more…
Honesty between doctors and patients goes both ways
The edges of Cameron’s lips rise undeniably toward the clear blue sky. His legs move methodically. One motionless on the scooter and the other periodically kicking to propel himself forward. He weaves in and out dodging my shadow as I jog beside him.
I struggle to keep pace. My breathing unsteady and labored. My joints aching. And my brain foggy from lack of sleep and replaying the events of the day.
***
The …
Read more…
Father and son, doctor and grieving family member
I would like to share a story about my son’s recent surgery that, while only one simple case, reveals the foundational problem with the U.S. health care system.
I write this story as a father of a 12 year old boy who has cerebral palsy. Jack is fortunate to be healthy and active with minor medical needs. As he has grown he experienced some issues with contractures in his right lower …
Read more…
It is not easy being a patient-consumer, but it can be done
Sir William of Ockham has achieved a degree of mortality via the wide promulgation of an aphorism, now generally known at Occam’s Razor (I’ll use the more economical spelling). There are many iterations of the razor, but my favorite is this: “simpler explanations are, other things being equal, generally better than more complex ones.” That trips off the tongue more easily than, say, “plurality should not be posited without necessity.”
In …
Read more…
If you need to say you’re all about the patient, you aren’t
In med school budding doctors are told: “When you hear hoof beats, think horse.” The problem is that sometimes when you hear hoof beats, it’s a zebra, and when that “zebra” is a disease, your patient leaves your office misdiagnosed. I’m that patient.
In 1998 I had my first abdominal attack. I vomited for days and walked hunched over like a frail octogenarian. (For reference, I was extremely fit and twenty-seven …
Read more…
Learning the hard way that there is an art to medicine
In the course of our work as doctors we will undoubtedly witness events that change lives, but coming into medical school I never realized how directly some of these events would change my life.
Often in medicine we see people at the worst possible time. Patients are sick or grieving and rarely happy to be in our presence, no matter how great we might think we are. Usually, they are experiencing …
Read more…
How social media helped this medical student
What’s the most effective way to predict which patients will be hospitalized in the coming year? The Heritage Provider Network, a managed care group in California, hopes to answer this question through its sponsorship of the Heritage Health Prize, a $3 million X Prize-like competition for health care. The contest invites participants to develop a prediction algorithm to identify patients who will spend time in the hospital in …
Read more…
How to predict which patients will be hospitalized
Not long ago, when my father was about to undergo a heart procedure, I hinted to the cardiologist, a colleague, that I wanted to be there, too, not just to offer comfort but also to be present for the play-by-play that would lead to a critical decision: whether to open his blocked arteries with a stent or to perform bypass surgery. Draped in an X-ray-shielding body suit over his blue …
Read more…
Patient transparency cannot be mandated by a federal agency
No one knows for certain what the future holds for American medicine. With cutbacks again on the horizon, we do know that reimbursements are going to decrease in the near future resulting in a decrease in income. An effective way to maintain our incomes is to increase the volume of patients seen but also to increase the income per patient that is seen in our offices. One of the best …
Read more…
See more patients with same day appointments
In 1978, as I neared the end of high school and readied myself for medical training, a book called House of God was published by a doctor under the pseudonym Samuel Shem. By the time I read it as an intern eight years later it had become a cult classic among doctors. Everyone I knew in my hospital read it, passing around the single copy we had, writing our names in …
Read more…
Social media and the modern day House of God
If death was the end zone, George had been on the one yard line twice in the last five years. And I, as part of his team of doctors, watched as he stubbornly maintained his goal line stand. Miracles rarely happen in medicine. They certainly don’t happen to the same person more then once.
Yesterday as George glided into my office you would have never known that eternity’s grip had been …
Read more…
My good intentions had helped start a reaction
I was tempted to avoid venturing into this topic, only because I strive to keep my website and blog away from politics and religion. In that light, I am going to stay away from the politics and religion of this topic and just stick with the main theme of the story and respond based on my own experiences, which includes assessing patients who are known to have or are suspected …
Read more…
Divorce after the diagnosis of Alzheimer’s disease
It was 1976 and I had just started my solo practice. I employed only a receptionist and a nurse. My nurse was absent because of an illness and I asked my middle-aged mother to come and serve as my chaperone for the afternoon.
The first patient was a young lady and I asked her to give a urine specimen and place it in the turnstile in the restroom. My mother, wearing …
Read more…
The day my mother became a saint
Always covered by an employer health plan, I had never given a thought to prescription costs – my medications had been covered by moderate copays. This changed when I retired and enrolled in Medicare (and a Medicare Part D plan).
Just prior to retirement, my eyes suddenly began tear and swell so much that it impacted my vision. The eye doctor diagnosed an allergic reaction and prescribed prednisone drops to …
Read more…
The impact of hiding medication costs from patients
People living along the Gulf of Mexico are still feeling the effect of the BP oil spill disaster, the largest oil catastrophe in history. To learn more about the spill’s health effects, I spoke with Dr. Gina Solomon, an Associate Clinical Professor of Medicine at the University of California, San Francisco, and Senior Scientist at the Natural Resources Defense Council. Dr. Solomon was on the Louisiana coast during …
Read more…
Health effects of the BP Gulf Coast oil spill
A white paper from The Beryl Institute reveals a 10% increase in general patient satisfaction and over 40% improvement in satisfaction with educational materials at hospitals when interactive technology is provided.
The publication examines six different hospital systems using the industry-standard Hospital Consumer Assessment of Healthcare Providers and Systems survey for evaluation. According to a press release on the study, the technology gave patients faster access to hospital staff and services by submitting …
Read more…
Mobile technology will be omnipresent in health care
