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.
How important is a doctor’s skill in the physical examination of a patient?
To the lay person, a doctor’s examination might seem really important. “Of course it is, Dr M … Come on.”
But is it so? Or, perhaps, is the examination a charade, a show, a necessity to complete the medical record.
It turns out that many in the profession think doctors may be losing the skill of palpating and listening. At …
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How important is a doctor’s skill in the physical exam of a patient?
This post was inspired by Dinah, a psychiatrist over at Shrink Rap.
She recently described how a psychiatrist friend of hers has been going through some phase-of-life changes. Recently he has regretted some of the advice that he previously had given to patients who were going through the same life changes he’s now going through himself. He realizes that he was not nearly so qualified to give the advice …
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When should psychiatrists give advice to patients?
Consumer Reports recently released a survey of both patients and primary care doctors, regarding their perceptions of each other.
Some interesting findings, as summarized by the WSJ’s Health Blog:
On the issue of respect and appreciation, 70% of doctors said they were getting less of it from patients than when they started practicing. For patients, meantime, the more they reported being treated respectfully and listened to, the more satisfied they were …
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How patients and doctors can improve the primary care office visit
People sort of want to try alternative care. They’re working up to it, but then they read more about it; they read about the theory and they say, “No I don’t believe that theory. That can’t possibly work. There’s nothing to it. I’m not going to do it.” But, the problem is that the theory of why something works or the explanation is not necessary related to the effect of …
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Why alternative care seems to work
Recently, I was reminded of the power of wellness. From the other side. And it came wrapped up in sound. Five words, to be precise.
I was instantly reminded how powerful a few words can be in the exam room.
We all want to feel wellness. The freeing kind, as in the way you feel when towered over by big objects. You know what I mean, the wide open wellness you feel …
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How powerful a few words can be in the exam room
One of my favorite conferences is The Conference on Practice Improvement hosted by the Society of Teachers of Family Medicine (STFM) and American Academy of Family Physicians (AAFP).
For all the upset and negativity there seems to be toward doctors, these family docs are in it — each and every one that I’ve met — for the good of their patients. And that is why I think every one of them …
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Every patient is an immigrant in the doctor’s office
by Karen Basen-Engquist, PhD
The next time you’re on your couch contemplating whether to watch your favorite sitcom or get up and exercise, remind yourself that being active for at least 30 minutes every day can help reduce your chances of getting certain types of cancer.
Physical activity fights cancer because it reduces body fat, and lowers hormone levels that raise breast and endometrial cancer risks. It also keeps the digestive system …
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Exercise to prevent cancer
As a marketer it’s important to be able to take a step back and look at the marketing environment from a patients perspective. Over the last couple of weeks, for example, consumers have read:
- That up to 40% of all published clinical trial studies may have omitted key information on drug effectiveness and side effects.
- That long term use of some medications may lead to new health problems.
- That in order to …
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Patients do not voluntarily search for health information online
I was enjoying lunch at a local café when I overheard one staffer say to another that she was facing her twenty fifth birthday soon. She went on to say, 25 is the last “real” birthday, after that “you’re just getting old”. I had to laugh, since I’m well past that age and holding up. Sure, there are some wrinkles and gray hair to contend with, that’s life.
I remember my …
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Aging is a blessing, a gift to be treasured
The OR was hushed on Friday.
Normally, it is a loud, busy place. The staff and surgeons are almost like a big family; we chat with each other and banter cheerfully with patients to help get their minds off the imminent ordeal of surgery. Chaplains pray with patients and families. Sometimes there are disagreements, as in any workplace. But everyone cares about everyone else.
Because of that caring, it was hushed. Instead …
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Tragedy of cancer in a small child
My old Canadian friend toxicologist Cliff Walberg was right when he famously said, “there is absolutely no limit to how revolting things can be.”
Remember that. It comes in handy, in addition to strong swear words, when stuff happens.
Case in point: I believe that every American deserves the right to choose to have a death with dignity and as pain-free as medical science and practice can provide.
To achieve that, patients and …
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Every American deserves the right to have a death with dignity
Dr. Erdoc happened to look up when the internist walked into the emergency department.
“Oh no,” he murmured under his breath. The consulting psychiatrist was sitting next to him, typing a note. She looked at him and raised an eyebrow.
“I hoped it wouldn’t be him. Unlike his colleagues, Dr. Internist seems to have a deep loathing for us emergency docs,” Dr. Erdoc explained as he stood up. Dr. Internist was frowning …
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ER and internal medicine docs, arguing over a patient admission
“We have a patient on a ventilator here who is stable enough to transfer to your ICU, if that’s OK with you.”
This call, coming from the transfer coordinator, is emblematic of an insurance generated “medical care” coverage issue. I am salaried under the patient’s insurance carrier so the insurer wants this patient back under its wing as soon as possible.
The community hospital has been keeping Stella Norris (not her real …
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The care was futile, and the patient’s wishes
Every illness is unique, and every person faces illness in his or her own way.
Anna Deveare Smith, in her one-woman Broadway show “Let Me Down Easy,” slips into the persona of twenty individuals who have faced an aspect of illness or death. In ninety minutes, Deveare Smith takes the audience on an existential scavenger hunt, allowing us to observe, and occasionally pluck, insights from this gathering of individuals.
These individuals do …
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Let Me Down Easy and facing illness and death
A bill given emergency status by Texas Governor Rick Perry is the largest invasion of the patient-physician relationship that I am aware of. Proposed by Senator Dan Patrick (R-Houston) and supported by Lt. Gov. David Dewhurst, the bill as originally written would require physicians to perform a ultrasound and explain the physical characteristics of the fetus to anyone contemplating an abortion.
Physicians would be required to inform women about alternatives to …
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Requiring an ultrasound and counselling before an abortion
As part of the routine scut of the overnight call team, I was sent up to the floor to preop an add-on for the next day’s OR schedule.
The Preoperative Anesthesia Assessment form has tidy little boxes for cardiac, pulmonary, renal, hematologic and an assortment of other complaints, and spaces for height, weight, allergies and personal or family history of untoward reactions to anesthesia. I put a single slash through the …
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Time with your patients in the hospital and time with your children
by John LaBine
What are the root causes of communication inefficiencies in hospitals? Hovering around any given patient/case are many players, each with a huge variety of demands for his/her time, attention and presence. And they know there are costs of certain outcomes (medical errors, stress, wasted nurse/physician time, etc.). Each caregiver has his own long list of things to do, places to be, people …
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Hospitals need healthcare flight crews
One of the central tenets of the patient safety movement is that modern medicine is a team sport. Unfortunately, its players – particularly physicians – were trained and socialized to be free-spirited individualists. We need the Celtics of the 80s; what we have is a collection of young John McEnroes.
While this theory has been generally accepted, there is less agreement regarding how to change things. When I speak about Read more…
Teamwork helps doctors with patient safety
Heads up folks in the Neonatal Intensive Care Unit (NICU), parents of premature babies want you to succeed more than you may realize. It is just hard for them to communicate this through the fog of stress and exhaustion that has consumed them for countless hours, days and even months.
So here is a little insight into the parent mind and what they want you to know about what it is …
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Top 5 NICU tips from a preemie parent
