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.
Although filled to the brim with patients, hospitals were created to support doctors, not us patients. Historically, their organizational structure focused on doctors’ needs and doctors’ requirements. The concept of centering hospital care on patient needs and requirements is a relatively recent development.
How can a hospital switch from being provider-centered to patient-centered? Shifting such a complicated and cumbersome behemoth a full 180 degrees is a huge undertaking.
For many academics and researchers, the debate is over: The use of mental health screening questionnaires in a routine fashion in primary care offices greatly increases the detection of mental disorders among children and adolescents. With such information, the American Academy of Pediatrics, Bright Futures, the US Preventive Services Task Force and others have weighed in. Screening is the order of the day, at least for adolescent depression. The remaining …
In early February, my new patient was a middle-aged woman from here in Silicon Valley with a self-discovered 2 cm right breast mass. Her internist was all over this. She quickly had a core needle biopsy, was evaluated by one of our breast surgeons, and was referred to me for an opinion regarding pre-operative (neo-adjuvant) chemotherapy. I saw her …
It happened on a bus on my way to work. I got on and sat in the only available seat, which I quickly realized was next to a disheveled looking man who smelled faintly of urine and had a dry hacking cough that could be heard throughout the entire bus. He was leaning against the window and did not seem to notice me. I was less than pleased with my …
Spent a sweaty week operating in a hilltop Hospital Nacional in Guatemala a while back.
A patient gave me a hat in thanks for her surgery. It’s a full-brimmed canvas safari number – I’m sure Hemingway shot a rhino in one. I’m just mature enough now to value sun protection and always grateful, sometimes to the point of pain, for gifts from those who have almost nothing. I was also …
Simply put, habits are hard to break and bad habits like smoking, drinking, sedentary lifestyle and overeating are making our population sick. Who in the healthcare system can tackle these issues before they manifest into chronic disease?
Doctors are trained to diagnose and treat, but they aren’t trained to help people change their behavior, nor should they be since most physicians, particularly general practitioners, are already severely overloaded. Nurses provide …
You have insurance and, supposedly, it covers your medicines. However, you still get stuck with a portion of the bill that the insurance company calls a “copay.” In some cases these copays can run more than $150/ month per medication (e.g. Enbrel). If you are on more than one of these expensive, branded medications the copays can really add up. What are your options?
1. Generic alternative. Always ask your doc if there …
Jackson’s blood pressure was low, and this had the emergency room physician scrambling, barking orders. A nurse was busy at each arm, attempting to place large-bore IV’s so that fluids could be given rapidly and thus improve the low blood pressure. Other nurses were preparing strong antibiotics for immediate administration. An automated blood pressure cuff was attached to the left arm, inflating every 3-4 minutes with a characteristic grinding …
Erik’s wife had warned him many times, “Stay off ladders dear, leave it to someone younger.” Erik though was a pretty spry 72 years old and had been cleaning the gutters for many years. He had a sturdy 25 foot extension ladder, had years of experience as an athlete, and wasn’t about to slow down for no good reason.
It was an unusually bright crisp November day in Seattle, when Erik …
When working with a patient population with chronic and terminal illnesses, very often, stressful and difficult conversations take place frequently. Often the news is not good or not what the person wants to hear. Having the assessment skills and knowledge about how to read body language and react accordingly to manage the interaction in a positive way are important skills to have.
Here are 5 tips that can help you navigate difficult …
I was present recently at a meeting between representatives of a hospital and the relatives of a recently deceased patient. The death had been the subject of an inquiry and in preparation for the inquest, the family had been given copies of the medical notes. A significant part of the meeting was spent, explaining the meaning and significance of various entries in the notes. Embarrassingly, some handwritten entries in …
The emerging literature on chronic disease management suggests that successful programs rely on patient self management skills. Having been in the primary care role for 20 years, that initially seemed self evident and a bit “so what?” to me, thinking it meant that we just need to teach our patients a bit more in the primary care office.
However self-management skills refer to specific curricula of skills that can …
Any primary care clinic has a schedule that lists the appointments of the day in incremental time slots. There is a column for the name of the patient, the patient’s age, and always there is a place for the reason for the visit–the “chief complaint” according to medical parlance.
A quick review of the “chief complaints” for the day gives the physician a sense of how clinic will flow. There are the seemingly “quick” concerns, …
The nature of an average child’s free time has changed. For the past 25 years kids have been spending decreasing amounts of time outdoors. The time that our kids do spend outdoors is frequently a part of an organized sports activity. Other activities taking up our children’s time include indoor lessons and organized events such as music, art and dance lessons. Another big indoor activity, taking up to 7.5 …
Being a doctor, I often hear this question being asked. More often than not, the response that I hear is a rather clear cut one, “oh yes, Dr. X is a great doctor,” or “oh no, Dr. X is not a good doctor,” making me wonder what such a definite response is based upon. Is it based on actual facts? Is it based on …
In 2009 I posted a blog here on videotaping of surgeries and the issues and challenges this would present. I did not say I am in favor of this as a means of policing medical practice, but for documenting surgeries the technology can be very useful. I do video as many of my surgeries as I can, and I offer to show these recordings when appropriate to my patients. …
I was getting ready for the day, my 2 1/2 year old was watching Sesame Street. In the show, the segments change every few minutes or so and seem to weave old-school 1970′s content (familiar to me) with newly created vignettes that have a modern feel and construction. I like it nearly as much as the boys. One of the stories this morning was about tooth fairies. An animated group …
Taking a trip to the grocery store can be more dangerous than you’d think.
Waiting for you in each and every aisle are marketing ploys aimed at suppressing your better reasoning, the ultimate result being you making poor dietary or financial decisions – whether you know it or not (enter the 100 calorie pack, my arch nemesis, right behind diet soda). But it doesn’t have to be that way – …
It’s time that we rethink the doctor’s office encounter. It’s inefficient for doctor and patient, and doesn’t optimize care for those that need it most. Everyone is treated the same, even though not every illness or medical need has the same urgency.
To get to see a doctor I have to make an appointment days or even weeks in advance. I have to drive over to the complex, find parking or …
Sure you are comfortable with your current doctor, after all you are still alive and kicking. Besides it has taken you years to figure out what you can safely tell your doctor and when it’s ok to speak up.
Yes, the fact that your doctor is often late and never seems to listen to you bothers you just a little. You aren’t displeased enough to stop giving your doctor high Read more…
