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.
Residency is hard. The hours are long, the work is grueling, and, simply put, hospital food is not good. Many days, we, as residents, walk the wards in a lifeless haze – coasting on the wings of our white coats, our fuel tanks pointing way past empty.
During these times, we find ourselves sitting in wheelchairs that are stored in dark remote corners, questioning whether or not all of this is worth it. For years, …
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A reminder of why doctors do what they do
I remember joking with Dad about how he’d outlive us all. He had gone vegetarian 10 years before I was born, never smoked, took vitamins, and asked for a designated driver after his annual Heineken at the neighbor’s Christmas shin-dig. He flossed, wore a seat belt, and looked forward to annual physicals. If I tried leaving our Michigan house in the winter with more than 3 inches of skin exposed, …
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Asking patients about their health care financial concerns
When I use the term “telemedicine,” what does it mean to you?
In current parlance, it usually refers to radiologists looking at digital images of x-rays and other scans from locations remote from the site of acquisition. Think “outsourcing” where the radiologist could even be as far away as India.
But according to a recent conference I attended, telemedicine could mean so much more. It can range from synchronous video chat …
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Telemedicine to augment the patient encounter
As a graduate student in the health field I often get phone calls from various family members and friends asking what I happen to know about different drugs, procedures, and devices. I was having one such conversation with my younger sister last spring. She had just completed her undergraduate education, started a new job, and was very proudly financially self-sufficient for the first time.
We were talking about birth control. Her …
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An incorrectly coded $1,000 billing error
Parents often wonder when is the appropriate time to introduce solid foods to their infant’s diet. It seems like a simple question. So simple that the American Academy of Pediatrics (AAP) cannot agree on the answer. The AAP Committee on Breastfeeding recommends starting complementary foods (rice cereal and baby foods) after six months of age and the Committee on Nutrition recommends the introduction of complementary foods between four to six …
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When is the right time to introduce solid foods to an infant’s diet?
If the media and Internet are to be believed (and these days, really, what is the difference?), the act of parenting has become a full-scale cultural war. How to raise your kids. On what to raise your kids. How your kids sleep, eat, play, and practice “Little White Donkey” on the piano–nowadays, these are all grist for the mill.
But if modern parenting feels like a war, its bloodiest battlefield surely …
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When people decide not to vaccinate their children, I take it personally
Between the cracks is a frightening place to be.
During the course of trying to improve our family’s financial stability, my husband and I were blind-sided by one hidden detail: We’d face $10,000 in costs to continue my husband’s serious medical treatment because we found ourselves unexpectedly without coverage for 30 days.
This was money we simply did not have. We had been prepared to foot the full bill for good health …
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Slipping through the cracks in our health care system
Golfer Phil Mickelson has had a rough year and a half. First, his wife and mother are diagnosed with breast cancer, and then he has a health scare of his own. Last year, after the US Open, Mickelson began to experience some troublesome symptoms.
In an interview with Extra’s AJ Calloway, Mickelson opened up about what was going on: “After the U.S. Open last year, I wasn’t able to …
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Phil Mickelson’s psoriatic arthritis explained
Most of us who write about health believe that knowledge can make a difference. But is the primary health issue facing us today a lack of knowledge? Or is it, instead, something I’d call the tenth-patient-of-the-day challenge?
Here’s what I mean: You pick up a chart and head to Exam Room B, reading as you speed-walk. Your patient’s blood sugar is running high again, she didn’t show at the smoking cessation …
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10 ways to make a difference in the lives of your patients
The inspector general of HHS recently reported that nearly half of the anti-psychotic drugs fed to the demented elderly in nursing homes are inappropriately prescribed. That’s about one in fourteen nursing home residents.
Forget about cost, which is over a quarter billion dollars a year. “Government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek solutions,” wrote Daniel R. Levinson, the HHS I.G. wrote …
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Should the elderly with dementia be given anti-psychotic drugs?
I’m really miserable and need that 5 day antibiotic to get better faster.
Ninety eight percent of the time it is a viral infection and will resolve without antibiotics.
But I can’t breathe and I can’t sleep.
You can use salt water rinses and decongestant nose spray.
But my face feels like there is a blown up balloon inside.
Try applying a warm towel to your face.
And I’m feverish and having sweats at night.
Your temp …
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A real doctor will first do no harm
All day I badger and cajole my patients to take better care of their bodies:
“We really need to get some of this weight off, Mr. Jones.”
“This blood sugar level means diabetes is right around the corner – it’s time to get serious about changing your diet, Ms. Smith.”
“This blood pressure reading tells me that you’re not getting enough exercise, Bill.”
I’ve got pills for everything, it seems. I just wish I …
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How diet and exercise beat high blood pressure
Most women in their 40′s believe they should have annual mammograms, regardless of what screening regimen their doctor might recommend.
So say researchers in Massachusetts who surveyed women (primarily white, highly educated) ages 39-49 presenting for annual checkups. They gave the women a fact sheet about the new USPSTF guidelines on mammogram screening in their age group, and asked them to read one of two articles either supporting or Read more…
An informed screening choice for breast cancer
“Doc, it’s only $10. I can’t believe you’re throwing me out of the practice for a measly $10. You, docs, are all the same. It’s all about the money!”
Unfortunately, the money is important. It costs money to keep a practice running. It costs money just to collect the money owed to the practice.
So, let’s look at some simple facts. Your physician’s office is one of the few places where you …
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Money keeps a physician practice running
Diabetes tries to steal moments from me every second of every day. I choose to steal these moments back. Thus, the chosen name for my attitude toward diabetes, Outlaw Diabetic.
Unlike the majority of the 360 million diabetics worldwide, I did not become a diabetic in my adult life. I became a type I diabetic at 14 months old. As a result, I have never had to change my way …
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Control and be responsible for your diabetes
Recently, Kevin Pho wrote about a physician, Alexandra Thran, who was disciplined by both her hospital and the state medical board for writing about a trauma patient she had seen. Although Dr. Thran hadn’t divulged the patient’s name, enough information was conveyed that allowed others in the community to identify the patient in question.
That story really freaked me out. Because, as you know, I sometimes write about my …
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How doctors can write about clinical cases online
I read an article in my local newspaper the other day that gave me reason to pause. The State of Florida intends to hand over 3 million Medicaid patients to managed care companies who will reduce payments to physicians and hospitals. In exchange for accepting these low payments for professional services, doctors are guaranteed through pending legislation that no matter what egregious errors they make, the patient will only receive …
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How managed care is bad news for pregnant women
Whether your office has wireless access or not, there will be patients texting, surfing the Internet, Facebooking, and otherwise engaging with the outside world on their smartphones while in your office.
These smartphones have another function: the ability to record audio or video. It is understandably tempting for patients to record consent discussions, medication and follow-up instructions, and other physician or staff interactions.
Recording a medical discussion via video or audio is …
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Should patients be allowed to record their office visit?
Much as war begets both high-profile losses and the unsung wounded, two ranks of casualties lay fallen, rent financially by medical treatment.
First are those of headlines, injured mortally, or nearly so, by insurmountable debt. Such wretched tragedy serves notice to all that a singular turn of fate may lead one swiftly to financial ruin.
Less-celebrated are members of the second order, surviving but spending more than requisite for their care. In contrast to the …
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A physician responsibility for the financial health of patients
