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.
Why do my patients with cancer get better care than my patients in primary care? As the senior resident on my hospital’s inpatient leukemia service recently, this question troubled and intrigued me daily.
Despite the sheer complexity of treating leukemia (administration of chemotherapy, bone marrow biopsies, stem cell transplantation), the resources required (transplantation routinely costs $1 million), and the severity of the illness …
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Cancer patients get better care than patients in primary care
Kevin Pho, at KevinMD.com, posted a commentary about encounters with “difficult patients.” He correctly notes that physicians themselves contribute to these interactions. To reduce the likelihood of these encounters, he suggests that physicians would benefit from more training in “psychosocial skills.”
Kudos to Kevin for adjusting his own language by the second sentence of his post: He makes the distinction between difficult patient and difficult encounter.
A vital step in decreasing …
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Label the interaction as difficult, not the patient
It is hard to imagine that someone can emerge from intern year – 12 months of chaos, little sleep, and hours upon hours spent responding to pages and putting orders in a computer – and know something, anything, about medicine. I did not believe in this training system until now, after my first night as a supervising resident. The knowledge I have absorbed over the …
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Gratitude from patients and their families
Just the other day I was called to see a patient coming up to the Intensive Care Unit with a diagnosis of pneumonia. Upon my arrival the patient is “hanging in there” with the blood pressure in the 60’ and 70’s systolic.
This is a no-brainer situation – the patient is in sepsis and septic shock.
Early intravenous antibiotics and aggressive resuscitation is what this gentleman needs right now. Per the ER …
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Do Not Resuscitate and the need for a central line
I recently finished another 5-week clinical rotation. This one was primary care (outpatient internal medicine +/- family medicine).
First a few words about primary care as a field: I found it to be both awesome and boring.
It was awesome because I was the “doctor.” I had essentially full responsibility for my each patient. From calling him in from the …
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Why this medical student found primary care awesome, and boring
“Do you know a good doctor?” is a question tossed around in conversation sometimes. If the person is reasonably nice/intelligent, I’m happy to hand out my doctor’s name and phone number.
Recently, I referred more friends to my all-time favorite doctor. Instead of just taking his name and phone number, the couple wanted to know why I like him. That’s a fair enough …
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Why this patient recommends her family physician
Americans spend an astounding 34 billion dollars on alternative medicine annually. Given that so many of us put our faith in alternative care, I wanted to clear up some common misconceptions about it to help people make wiser choices when and if they turn to it.
What is alternative medicine?
In general, alternative medicine is used to describe practices outside the bounds of conventional medicine. …
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Alternative medicine problems patients need to know about
I do not wish simply to use the buzz word of the hour. Nor do I wish to assert that I have all the answers.
I genuinely desire to bring to light an interesting conflict that has plagued the nursing profession for decades.
Bullying.
Why in a profession centered around the concepts of compassion, caring, and healing has a mindset of bullying permeated the culture. Even more confusing is that most often, this …
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Bullying among nurses needs to stop
As in anyone’s life, the hardest thing to achieve in life is a balance. Whether it’s work, school, home, or play, it’s just plain tough. For those of us with challenges such as cerebral palsy, it brings a new set of challenges. Here’s why.
Task execution takes longer. Where it might take my sister thirty minutes to get herself ready and out the door in the mornings, it will take me …
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Achieving balance in life with cerebral palsy
Governor Brewer’s decision to withhold liver transplants for Medicaid recipients in Arizona should serve as a loud warning to the electorate regarding governmental intrusions into health care financing and health care operations.
The decision was ill advised on the basis of multiple factors. The survival rates differ from one facility to another.
What is the liver transplant survival rate and what information needs to be considered when looking at such numbers?
For example, …
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Withholding liver transplants for Medicaid recipients in Arizona
Despite the advances in evidence-based medicine, not every patient benefits.
In a recent column from the New York Times, Pauline Chen looks at a study showing exploring the issue:
For many patients, evidence-based medicine isn’t working. Two-thirds of patients with diabetes, a disease with some of the strongest evidence-based guidelines available, continue to have trouble controlling their blood sugar levels; and only half of all …
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Why team based primary care won’t help evidence based medicine soon
What, exactly, is a difficult patient?
Doctors can tell many tales of what they term as a difficult encounter. Just as many patients can recall doctors whom they would say are difficult to work with as well.
According to a study from the Journal of General Internal Medicine, here’s a definition:
Patients deemed difficult included those with more than five symptoms, severe symptoms or an underlying mental disorder or were less functional. These …
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What is a difficult patient, and how doctors may be responsible
If one of your patients asked your opinion of another doctor whom you know to be incompetent what would you tell your patient?
Incompetence in a physician is a scary thing! Doctors deal with problems of life and death and try to heal you with dangerous tools. A doc that isn’t competent can be seriously dangerous.
But how do you know who’s on their game and who’s falling down on the job? …
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Asking a doctor for their opinion on another physician
Medicare was touted as the social entitlement program that would forever change health care access for our seniors.
But is it becoming the biggest challenge to seeing the doctor of your choice?
For the first time in the almost 50 years of the program more and more Medicare recipients are facing the challenge of finding a doctor who will take their government sponsored insurance.
Sure, there have recently been …
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Is Medicare the biggest challenge to seeing the doctor of your choice?
by Sujatha Prabhakaran, MD
Suicide is arguably the most preventable cause of death. It is also a tough thing to talk about. But talk we should, because suicide costs Americans a lot. In 2000, self directed violence cost $1 billion in medical costs and $32 billion in lost productivity. Self-directed violence affects men and women of all racial/ethnic groups. However, as highlighted in the 2011 …
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Mental illness in men, and how physicians can prevent suicide in males
My oncologist’s office implemented a new EMR system when I was in the middle of chemo. Once the nurses learned the system, I saw no difference in the care I got from them.
Not quite so with the doctor. My experience with him changed dramatically.
Before EMR I would enter the exam room and sit on a chair, play Angry Birds on my iPhone and wait. My doctor would walk in, make …
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EMR, a patient’s perspective
