Patients

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.

MKSAP: 67-year-old man with an abdominal aortic aneurysm

mksap

Conditions and Diseases

May 7, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 67-year-old businessman is evaluated during a routine health examination. He has a 30 pack-year history of smoking, but quit 5 years ago. He consumes two or more alcoholic beverages on most days. He is asymptomatic, but performs no regular physical exercise. He takes no medications.

On …

Fewer choices for patients with health care consolidation

John Mandrola, MD

Health Policy

May 6, 2011

As a specialist, one of the saddest truisms about practicing medicine in the private world has always been how little one’s clinical skills determines referrals. Unfortunately, as our present healthcare climate pushes “providers” to consolidate along the lines of major hospital networks this injustice will only worsen.

A decade-or-so ago when I started private practice it was obvious that referrals came to me because of my association with an established …

National Quality Strategy and Partnership for Patients to improve care

David B. Nash, MD, MBA

Health Policy

May 6, 2011

One year after passage of the Affordable Care Act, the Department of Health and Human Services (HHS) has unveiled two programs that will most certainly be transformative for U.S. healthcare, affecting both quality and safety.

With the announcement of the first-ever National Quality Strategy in March, HHS signaled a strong commitment to improving the quality of healthcare.

In essence, …

3 ways to deal with serious illness and engage the health care system

Peter J. Weiss, MD

Patient

May 6, 2011

I am deeply conflicted about how we as a society have come to use physicians, medical science and advanced technology in our lives.

Everything has its place in life, but we have given modern medicine with its focus on the chemistry and physics of illness too prominent of a place. We’ve forgotten that we are not treating diseases; we are helping people with diseases.

Many readers, especially those with lifestyle diseases, can …

Be a boring patient, not an interesting patient

Dr. Martin Young

Patient

May 6, 2011

“She’s a really interesting patient!”

The doctor visiting the lady in question at home is correct. Nothing about her illness either has been routine. The progression of her disease has confounded her regular doctors for months. Nothing about her condition is normal. Medications have not worked as expected. The original diagnosis — Parkinson’s — is in question. All my training and expertise is inadequate, for I am an ENT surgeon, not …

Recovery may be predicted with a perception of the inner pulse

Kevin

Physician

May 6, 2011

An excerpt from The Inner Pulse: Unlocking the Secret Code of Sickness and Health.

by Marc Siegel, MD

The Pulse of Recovery

People are like stained-glass windows. They sparkle and shine when the sun is out, but when the darkness sets in their true beauty is revealed only if there is light from within.
–Elisabeth Kübler-Ross

The inner pulse can keep beating—loudly—long after doctors, researchers, and their monitors …

Improving atrial fibrillation communication between doctors and patients

Kevin

Patient

May 6, 2011

by Mellanie True Hills

I have heard from thousands of atrial fibrillation patients who have shared their afib experiences with me. For so many of us, the diagnosis and treatment of afib is confusing and scary.

To improve communication between patients and their health-care providers, and ultimately, provide better care, I recently shared with doctors at the Western Atrial Fibrillation …

The government reversal on end of life planning

Naomi Freundlich

Health Policy

May 5, 2011

After all the ridiculous fear-mongering about “death panels,” Congress dropped a proposal to encourage end-of-life planning from the health reform legislation passed last March.

But the administration had in fact quietly included reimbursing doctors for end-of-life counseling along with a host of new Medicare regulations. The provision, which authorizes payment for “voluntary advance care planning,” went into …

How genomics can help doctors target drug therapy

Stephen C. Schimpff, MD

Medications

May 5, 2011

Little more than a decade ago, most people had never heard of the word genomics; today it is used frequently. It is indeed a revolutionary science that is and will transform medical research and medical care. To better understand how this new science will markedly change medicine, it is convenient to consider it through a few categories:

Pharmacogenomics
Nutragenomics
Disease classification
Disease …
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How genomics can help doctors target drug therapy

Best hospital lists influence consumer decision making

Tobin Arthur

Patient

May 5, 2011

We all like lists. US News & World Report has told us for years which colleges are considered the top in the nation. Castle Connolly tells us which are the “Top Doctors” in our community and Car & Driver gives us a ranking of cars by type.

In The Order of Things, Malcolm Gladwell pokes serious holes in some of our most revered rankings and lists.

If …

Cooperation between patient and doctor is essential today in health care

Paul Dorio, MD

Physician

May 4, 2011

There are many aspects to being a doctor. Just as important are the many aspects that go into being a patient. Of course, the difference is that one has been perceived as being a position of power and the other one has not. I don’t believe this distinction is useful or true in today’s world.

Patients and doctors work …

Why patient satisfaction scores won’t decrease health care costs

Edwin Leap, MD

Physician

May 4, 2011

So now, in addition to the many other bits of medical meddling we have from CMS (Centers for Medicare and Medicaid Services), there’s this.

Reimbursements to hospitals, from Medicare, will be partly tied to patient satisfaction scores. We’ve seen payments already being tied to ‘quality indicators,’ as dictated by the federal government; rewards for doing a better job on care for heart attacks, pneumonia, etc. At least that’s quantifiable, whether scientifically …

The mission of the hospice and palliative care is to ease patient suffering

Kathy Kastner

Patient

May 4, 2011

Until recently, I had but the vaguest idea of what hospice and palliative care and medicine (hpm) entailed.

Until tuning into the #hpm Twitter group – hospice and palliative medicine – both words conjured a gloomy atmosphere of despair, grief, anger, pain en route to dying. I wondered at those working in the field: they must be a bit weird.

I now know differently, …

Explaining why belief in pseudoscience is often evidence resistant

Amy Tuteur, MD

Conditions and Diseases

May 4, 2011

What links belief in tarot cards, UFOs and vaccine rejectionism? Yes, they are all forms of superstitious or magical thinking, but are there characteristics that predict who will believe in such nonsense? That’s one of the questions that psychologists Marjaana Lindeman and Kia Aarnio seek to answer in their paper, Superstitious, magical, and paranormal beliefs: An integrative model.

Lindeman and Aarnio postulate that believers in superstition, paranormal phenomena and pseudoscience make …

End of life care is being influenced by politics

Kevin Pho, MD

KevinMD

May 3, 2011

A version of this op-ed was published on April 12, 2011 in USA Today.

“Would you like to discuss your end-of-life plans today?”

It’s a question that I ask my patients, although not as often as I would like. Talking about death may be uncomfortable, but it’s a conversation that needs to happen more often.

We can never know …

Medicine’s paradigm shift is a microcosm of a trend occurring in society

Paul Fischer, MD

Health Policy

May 3, 2011

In 1994 Jeff Bezos revolutionized how consumers shop. He founded Amazon.com.

Shortly after, Ebay followed suit—solidifying a paradigm shift that has redefined shopping from an in-person to online experience. In 2004, Facebook capitalized on another trend: individuals were becoming more comfortable sharing personal information online. Interestingly, people did not wake up one morning and decide it would be convenient to shop from home, or that sharing pictures with their friends online …

People feel anger and fear over our health care situation

Aldebra Schroll, MD

Health Policy

May 3, 2011

During the election season, the biggest loser appears to be civility. Anger, attack ads and name calling ruled the day. We are faced with enormous and complex challenges, issues not easily addressed in sound bites. Yet that is what we usually get from our representatives. I find myself asking are we not willing or able to do the hard work of examining the issues before us?

During the ongoing discussions over …

Dealing with a negative online review on a physician rating site

Kevin Pho, MD

KevinMD

May 3, 2011

Whenever I speak about social media to doctors across the country, I often get asked, “How do I deal with a negative online review?”

Here’s one way not to handle it: sue the patient writing the review.

There’s a well publicized case in Minnesota, where a resident posted a screenshot of …

Physician responsibility and leadership is critical for ACO implementation

Kevin

Health Policy

May 3, 2011

by Jeffrey L. Cohen

The current fixation on Accountable Care Organizations (ACOs) is causing an enormous amount of two things: 1) talking, and 2) inactivity.

Yes, the concept of delivering care in a manner that reduces or at least controls costs is important and interesting. Yet, the marketplace is replete with people and businesses that have adopted …

Patient satisfaction should not influence how doctors are paid

Kevin Pho, MD

KevinMD

May 2, 2011

Medicare is thinking of using patient satisfaction scores in part to determine bonuses to hospitals.

According to Kaiser Health News,

… patient gripes soon will affect how much hospitals get paid by Medicare.

The Centers for Medicare & Medicaid Services is finalizing details for the new reimbursement method, required by last year’s health care law. Consumer advocates say tying patient …

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Patient satisfaction should not influence how doctors are paid