One of the first things they teach in medical school is that if you haven’t pretty much figured out the diagnosis by the time the patient finishes sharing their history, your doctor hasn’t done his or her job well. Certainly, this is a bit of an exaggeration, as many diseases cause similar symptoms.
As you share your background, your doctor is creating a list of possibilities of the most likely conditions …
How you can help your doctor diagnose you
An article from the Wall Street Journal caught my attention, and for all the wrong reasons. It was a review of two recent studies showing that medical trainees have difficulty diagnosing patients with complicated histories or confounding psychosocial features. At least, that’s the way I would describe those studies.
The WSJ, however, used much more pejorative language, referring to them as “difficult patients,” “a nuisance,” and “an annoyance.” …
Patients are not a nuisance to their physicians
Patients with extended illness or chronic conditions often acquire a communicative competence with far more complex medical terminology than their doctors realize.
This is important, given that patients are too often seen as passive recipients of medical information, or worse, incapable of understanding their own health data. Recent studies show that one of the most effective prescriptions for increasing health outcomes and reducing medical malpractice rates is improving how doctors communicate …
Understanding the language of illness
I recently consulted a specialist at a major medical center in New York, and a few days later, here came a questionnaire in the mail. “How much time did I spend in the waiting area?” it asked. How long was I kept waiting in the examining room? How close to my appointment time did the doctor see me?
The one thing it didn’t ask was whether I cared.
There’s no mystery about …
Please, doctor, don’t rush on my account
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
As a lifelong resident of southeast Louisiana and a veteran of numerous weather and flood-related events that have required me to use my homeowners and flood insurance, I am very familiar with gaps in insurance coverage. Insurance policies are very detailed agreements that many …
When selecting health insurance policies, beware of surprise gaps in coverage
Obviously, chronic illness doesn’t affect everyone the same way. That said, I’ve heard from people all over the world with every imaginable chronic illness (which includes chronic pain), and our day-to-day lives are strikingly similar. And so, I thought I’d describe a typical “day in the life,” using my own experience from a few months ago as an example. My hope in writing this piece is for those of us …
A blow-by-blow account of daily life with chronic pain and illness
Dear doctors,
Are you looking through our charts and wondering what you’ve gotten yourself into? Are you maybe wishing we were someone else’s problem? Yeah, we know. It’s OK. We know we aren’t the type of patient most doctors like to take on. There are a lot of strings attached to us, and there’s a lot of paperwork waiting to join that already insurmountable mountain of paperwork on your desk.
We can’t …
Here’s what we want you to know about being our doctor
“You have no husband?” asked an oncologist at an Ivy League cancer center, his voice full of concern.
“No,” I replied.
“No sons?”
“No.”
“No daughters?”
“No.”
“No sisters or brothers?”
“No.”
“Your parents — are they living?”
“No.”
When I mentioned friends and extended family, he talked right over me. Without a nuclear family, he seemed to think, I had no one.
I’d been diagnosed with stage four gallbladder cancer, usually fatal within months. The surgeon who’d removed three-quarters of …
Patients without partners, and the doctors who stereotype us
Opioid painkillers, such as Vicodin (hydrocodone) and OxyContin (oxycodone), are crucial medical tools that are addictive and widely abused. Tranquilizers and sleeping pills of the benzodiazepine class, like Xanax (alprazolam), Ativan (lorazepam) and Klonopin (clonazepam), are safe and effective in limited, short-term use, but are often taken too freely, leading to drug tolerance and withdrawal risks. Stimulants such as Ritalin (methylphenidate) and Adderall (amphetamine) ease the burden of ADHD but …
The fuzzy line between medication use and abuse
Prior to her death, a courageous young woman named Jess Jacobs, who suffered from POTS (postural orthostatic tachycardia syndrome), wrote about the worst health care experience of her life. It is a somewhat horrifying account of hospitalization in Washington D.C. Her goal was to work toward meaningful health care changes in the system for the better.
When I came across the story of another young woman afflicted with this disease, it …
This patient’s story illustrates the barriers to health care
By the time I reached Dr. R, I was twelve months into an undiagnosed, severe, lower abdominal pain condition. Desperate for an accurate diagnosis and treatment plan after seeing ten doctors who had misdiagnosed me, I was exhausted and beyond frustrated with the care I’d received.
Seated across from Dr. R. in her office with copies of my medical records and symptom diary in tow, I waited quietly while she reviewed …
How empathy can help physician burnout
Dr. Kaveh Shojania, a prominent patient safety expert who scoffs at the numbers and laughs at the tragedy inflicted on countless victims of medical error, should step down as editor of a leading hospital safety journal.
About three years ago, a scientist named John James published a study proclaiming that — at minimum — 210,000 people die every year from hospital errors, making it the third leading cause of death in …
Death by hospital: Who’s right?
We are witnessing a strange migration of restless tribes, moving between doctors and clinics, traveling great distances in search of what no one wants to give them any more.
This eerie movement is steadily gaining momentum in our community, in our state, and across the country. We can hear it in telephone calls, we can read it in records of patients looking to switch their care, and we can see it …
How the integration of behavioral and primary care treats pain
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I never knew Jess Jacobs, and she never knew me. Everything I know about her I have learned from her Twitter feed, her website, and articles written about her. She was the same age as me when she died recently. She was educated. She knew the health care system inside and out, as an expert in insurance and policy and as a patient. But she was more than …
Jess Jacobs: Thank you for what you taught me
“Get well soon!”
That’s a common saying. All of us have heard it. But what if you have an illness that you won’t ever get better from? The most horrible part of having a chronic illness is that it’s forever, or for a very long time.
Unless your personal miracle comes, your illness will always be with you. There isn’t an end in sight. There’s just adjusting to the pain, the tiredness, …
This is my life with chronic illness. Tell me yours.
I knew it was bad when she couldn’t tell me her name. I watched her face fill with frustration as a word she had uttered countless times over eight decades somehow got lost between her brain and her lips.
It was 2 a.m. and I was on call as the surgical resident. I had been told that a patient with bladder cancer was being transferred from another hospital, and, as these …
Death is not the enemy. More physicians need to realize that.
After more than fifteen years of being mostly housebound by chronic illness (which includes chronic pain), here are a few of the dilemmas I’ve faced over and over. I’m confident that I’m not alone in my “should I/shouldn’t I?” world.
Do I accept an invitation from a friend to get together or do I refuse it?
If I refuse the invitation, depending on who issued it, it may be the last one …
The dilemmas faced by the chronically ill
Many of us now have high-deductible health insurance plans, which makes us “cash-pay” patients until we meet our deductibles. According to a Health Affairs health policy brief, high deductible plans are now much more prevalent in both individual and group markets.
The higher the deductible, the lower the monthly premium. If you have a high deductible plan and don’t consume much medical care, you are most likely a cash pay …
How cash-pay patients can beat high-deductible plans
One hot topic that has recently gained a relatively large amount of attention over almost all areas of medicine is quality improvement. Hospitals have created dedicated senior-level positions to oversee it, interdisciplinary councils have been formed to research and address it, and employees are reminded daily, if not more often, of their role in implementing it in the form of various quality benchmarks they are held accountable for (such as …
What does quality mean in the eyes of a patient?
I grew up thinking an “illness” was either a fever or croup. Illness was a stuffy nose — a sick day, an excuse to miss a day of school. At 18 years old, “illness” took on an entirely different meaning. Illness meant waking up from a coma, learning that my stomach exploded, I had no digestive system, and I was to be stabilized with IV nutrition until surgeons could figure …
PTSD was the illness I couldn’t see
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