In my interactions with patients, I always ask them to tell me when their weight problems began and what they believe contributed to their weight gain.
Broadly speaking, there are two categories: people, who were big (or were considered big by others) as long as they can remember and those, who can often clearly pinpoint when their weight …
Themes explaining why people are obese
by Mike Cadogan, MB ChB
Crossing multiple time zones can produce a constellation of symptoms known as jet lag.
Jet lag is most noticeable in the first 24-48 hours following travel and can last for up to 5 days before individuals return to normal functioning. Symptoms are closely affected by both the length and direction of travel. Symptoms include: reduced alertness, night-time insomnia, loss of appetite, depressed mood, poor …
The science and treatment of jet lag
I find that it takes more effort for me to talk patients out of doing tests than it takes to get them to submit. It doesn’t seem like it should be that way:
I need you to undergo a test where you fast for 12 hours, show up to the hospital 3 hours before the sun comes up, strip down and slide into a breezy hospital …
Talking patients out of doing tests takes effort and time
8,000 patients will no longer be able to receive care from UNC Hospitals and their affiliated physician practices because of a dispute between UNC and the insurance company Aetna.
The bottom line is that Aetna does not want to pay as much for care provided by UNC as UNC wants to be paid for providing this care. No surprise there, as the interests of the two parties (health care provider and …
How a dispute with an insurance company can affect patients
Part two of the three-part series, Let’s Pay Popular People More!
Take a moment to ask yourself whether any of these categories describe you or someone you love:
If any of these terms describes you or a loved one, then you are statistically more likely to give a doctor a lower Read more…
How paying doctors for patient satisfaction is racist
Do you spend 8 hours in front of a screen at work? Do you then spend your free time watching TV or poking around the internet when you get home? How much time are you spending cooking healthy meals to eat with friends and family? How much time are you doing physical activities that make you happy?
A recent study in the Journal of the American College of Cardiology entitled, Screen-Based …
Work should be about optimizing your productivity and health
When I was called to see the patient after a motorcycle accident I expected the worst. The patient sustained a thoracic spine injury with cord transection at T5 level as well as significant chest wall injury on the right side.
Multiple ribs were broken; some with a significant displacement. Managing patients with a significant chest wall trauma could be a nightmare. Pain control is only one of the challenges.
Read more…
Pain control in a patient with rib fractures and a spinal cord transection
by Alison McKnight
I have been in and out of the doctor’s office ever since I was little, and I have had my share of good and bad experiences during this time.
These experiences can shape the expectations of both the physician and the patient, in both negative and positive ways. While the perfect relationship between …
When communication is broken, the quality of care is diminished
Dr. Kevin Kikta was one of two emergency physicians on duty at St. John’s Regional Medical Center in Joplin, MO on Sunday, May 22, 2011, when an EF-5 tornado struck the hospital.
You never know that it will be the most important day of your life until the day is over. The day started like any other day for me: …
What happened inside the hospital during the Joplin, MO tornado
I went off to medical school thirty-seven years ago.
For the era, I went to what folks regarded as a very progressive place. It had a curriculum that was quite revolutionary for the time. Among other things, we started having interactions with actual patients during our first year, rather than the third year, as was traditional then.
These days many, probably most, medical schools …
Why medical students should be closely observed with patients
“The most important thing I learned was that different doctors know different things: I need to ask my internist different questions than I do my oncologist.”
This was not some sweet ingénue recounting the early lessons she learned from a recent encounter with health care. Nope. It was a 62-year-old woman whose husband has been struggling with multiple myeloma for …
Guiding patients through fragmented health care
The psychosocial needs of patients can feel overwhelming for a doctor.
Our rite of passage as medical students, after all, is anatomy, not sociology. Even now, after a family medicine residency specializing in the biopsychosocial approach to medicine, I still brace myself for surprises before asking routine mental health screening questions of the patients in …
Helping with the psychosocial needs of patients
I was sitting next to a resident in the preceptor room yesterday. He was calling a patient to discuss lab results, and introduced himself on the phone by his first name and last name … but not with “Doctor.” (e.g., “Hi, this is John Smith from the Family Health Center.”)
I occasionally see the residents’ patients for urgent visits. When I ask them who their regular PCP is at the office, …
Should doctors be addressed by their first name?
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Compliance. I really hate that word! The general impression given throughout the blogosphere is that patients:
A few typical quotes:
It drives me crazy to read accusations such …
Compliance happens when it’s the patient’s treatment plan
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old man is evaluated during a routine examination. He has a 5 pack-year cigarette smoking history but stopped 12 years ago. He has no history of hypertension, diabetes mellitus, stroke, or transient ischemic attack. He has no claudication. He is being treated for hyperlipidemia. There …
MKSAP: Healthy 68-year-old man with a cigarette smoking history
My wife had just finished meeting with her medical oncologist for her bi-annual check-up at MD Anderson’s Thoracic Clinic.
We were sitting in an area called “the Park” rehashing what her doctor had said when a mother and her daughter sat down at our table. There were lots of empty seats in area but for some reason they decided to sit with us. Call it serendipity. …
Benefits of chance meetings with other cancer patients
by Greg Smith, MD
As a psychiatrist, part of my job is to listen as you tell me about symptoms that bother you every day.
If I can help you put these symptoms into a framework such as a syndrome or a disease, then we can work together on trying to figure out how to treat them. Often times in Read more…
Why cookbook medicine detracts from compassionate care
If you have been at your nursing job for a while, you’ve probably almost forgotten.
Forgotten what it was like to come in to the healthcare system you now work for and realize there are hundreds of new protocols for you to learn and adhere by as a nurse. After years of routine, you now go about your day as if you actually have some choice in the way you give …
How protocols are taking the decisions away from nurses
Sixty five years ago my maternal grandmother, having experiencing months of fatigue, abdominal discomfort and weight loss, underwent exploratory abdominal surgery, the only truly diagnostic tool available at the time.
One brief look by the surgeon told him everything he needed to know: her liver and omentum were riddled with tumor, clearly advanced, with the primary source unknown and ultimately unimportant. He quickly closed her up and went to speak with …
The patient is a partner in their illness management and health maintenance
I love to pick up my two year old from daycare. Her language is becoming increasingly complex with small sentences, lots of gesturing and expression. When I ask how school was, she says, “Miss you. I crying.” Or, “I running fast with friends.” Or sometimes a confident, “good,” with a head nod.
Yesterday, she said, “friend, bite me.”
Her very kind teacher confirmed the event, and asked my daughter to show me …
Biting in children is a sign of normal social experimentation
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