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.
by Lorelei Armstrong
Doctors debate whether patients Googling symptoms is a good thing or a bad thing. I bet you haven’t thought about something that might be worse: your teenage patients are answering one another’s medical questions on Yahoo! Answers.
They’re not always clear on anatomy and terminology: “How can I tell if I’m circumcised?” and “What’s the best way to shave my vagina?” and “Where is the female prostate located?”
They are …
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Teenage patients are answering medical questions on Yahoo! Answers
Six months down. Six to go. I am officially halfway through what people have told me will be one of the most challenging years of my life. I’ve rotated through Cardiology, Primary Care, Gastroenterology, General Medicine, Psychiatry, Palliative Medicine, the Medical Intensive Care Unit (MICU), and Rheumatology. Finally I have reached every resident’s favorite rotation – vacation.
Intern year has been hard work, but I’ve enjoyed it and am extremely pleased …
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Combat compassion fatigue in caregivers to improve patient care
I saw two patients recently that really made me scratch my head.
The first was a 15-year-old girl who was smoking a pack of cigarettes daily and had been for 3 years; the other was a 26-year-old man who smoked 1.5 packs daily for 10 years and had recurrent oral ulcers and bleeding gums. In sitting and talking with these two patients, it became blatantly obvious that the risks of tobacco …
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Discussing smoking habits with patients
I didn’t always recognize its importance. I mean when I was younger, I thought that being attractive, slim, athletic, articulate were sure-fire antidotes to one’s suffering a life of mediocrity. I just never recognized the value of something I took for granted, my sense of humor. And then life happened.
When I was 36, my husband (who was older by 12 years) was diagnosed with lung cancer. Inoperable, incurable, his type …
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Kernels of humor in a tragic cancer story
The role of stressful life events in suicide attempts and completed suicides has been a key area of study in the epidemiology of mental disorders. Although suicidal behavior often occurs in the context of acute and chronic stressor, this does not prove a causal link. We all could probably report serious life stressors throughout out lives and these could be interpreted as a reason for suicidal behavior. So these associations …
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Stressful life events in suicide attempts and completed suicides
In the spring of 2005, the sinus infection returned. I awoke severely congested with a pounding forehead and pain around my eyes that grew worse when I bent to tie my shoes. The feeling was familiar. Two years earlier, I had similar symptoms, but was uninsured and endured a miserable week with nothing but over-the-counter medication. Now they were back.
Fortunately, when I started graduate school, my father insisted that I …
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Finding out the cost of lab tests is a real challenge for patients
by Peter J. Pitts
As the saying goes, the plural of anecdote isn’t data. That is unless the anecdote supports your theory. Here’s a personal anecdote — a story of how the system works.
Being adopted, I have no family history, so when I suffered through some late night chest pains I figured I’d better act on the warning signals. I called my GP and got a same-day consultation, resulting in a next-day referral …
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A stent anecdote from a former FDA Associate Commissioner
by Zakari Tata, MD
Biomedical ethics and bedside communication is currently taught to medical students in a classroom mainly in the first two years. In residency it is not usually given a lot of attention. This is leading to a situation where a very basic part of daily patient interaction is not addressed. This leads to many complex problems in the hospital that lead to moral dilemmas and conflicts.
The idea needs …
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Bioethics and bedside communication in daily patient interaction
You’ve probably experienced that age-old ritual of cooling your heels in an ER waiting room hoping that it won’t be too many hours before a nurse lets you inside the sliding doors.
Simon Bradley tweeted this to my Twitter Account @WCBADoctorBrian: “My buddy had a deep laceration between the thumb and the index finger – a full layer of skin. Took 10 hours at (name of hospital withheld), fastest in town.”
A …
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Can posting ER wait times be dangerous to patients?
Nutrition fascinates me – I’ve been studying it for over twenty years and have a university degree in Dietetics. These days I’m particularly interested in the secrets of high-performance eating; the busier and bigger my life gets, the more I need to be on the ball. Food is an essential part of my success strategy. Put another way: if I didn’t know how to eat right for my brain, I’d …
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Food is an essential part of a doctor’s success strategy
by John Mooney
A recent study conducted by Dove Press Patient Intelligence Journal asked this question of patients: “Have you ever asked your physician to prescribe something different than the original recommendation?” Thirty-four percent of the respondents indicated that in fact they had. Perhaps even more interesting: of that 34 percent, 69 percent of the doctors agreed to prescribe the alternative drug when asked. Why is this important? The health …
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Why the time is right for collaborative care
Doctors have no trouble or compunction giving these good pieces of advice:
- stop smoking
- lose weight
- eat less saturated fat
- wash your hands
- vaccinate
- schedule your mammogram
- get a colonoscopy
These all likely can augment both life quality and expectancy.
Do doctors, then, (in appropriate situations obviously) go the extra mile and tell a patient to get married? There are reasonable reports church-going adds to longevity, but with sensitivity to broaching religious beliefs, doctors may be reluctant to suggest …
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Should doctors give marriage advice?
Gentle nudges is a concept termed recently to describe a micro-choice movement that is beginning to carve out a sizable niche in the healthcare start-up space, and is gaining a lot of well deserved national attention. The secret ingredient relates to the power of a gentle nudge; verbal, text or otherwise to accomplish a change in the behavior of the person who receives the nudge. We are just starting to …
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Change health behavior with a gentle nudge
I recently read a post from Jan Gurley, MD on here on KevinMD.com.
Her opinion is that medical malpractice lawsuits are a “crap-shoot”; she notes that “malpractice lawsuits fail when it comes to medical errors-in both directions. People who’ve suffered from errors both don’t sue, and lose suits, in the same percentages that people who sued have no suffered from errors.”
Assuming that information is correct for purposes of this …
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Patient-physician relationships in medical malpractice
I usually work two or three shifts a month at a small, rural hospital about two hours from where I live. Why? Mainly, the small hospital is less than ten miles from my childhood home, where my widowed father still resides, and thus provides me an opportunity to catch up with Dad as well as four of my siblings and their families, all who live within five miles of Dad.
I …
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Treating a patient in a small town versus a big city
Chronic cough is a common condition that’s seen by many doctors, and in most cases, after a thorough history and exam, an answer can usually be found. However, just because a physician followed all the accepted guidelines and evidence based medicine principles to successfully address and treat a condition, it doesn’t mean that it was the right thing to do. Let me explain.
A 49 year old healthy woman presented to …
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Laryngopharyngeal reflux disease and a complex case or chronic cough
Doctors vs. nurses (or doctors vs. nurse practitioners, or doctors vs. physician assistants, or what have you). The debate is old, tired, unimaginative, divisive, and wrong-headed–for reasons that are too obvious even to list. Does it get perpetuated because it garners comments (175 of them, to be exact)? Snarkniess is not appreciated by this reader, at least.
The New York Times recently ran a column by one of its editors, “Read more…
Praise nurses without comparing them to physicians
by Drew Rosielle, MD
The Annals of Internal Medicine recently had a timely discussion of advance care planning, trying to focus the discussion away from helping patients specify what they’d want, and more towards laying the groundwork for appropriate decision making by loved ones whenever that time comes. Good one for the teaching file.
That is, instead of thinking of ACP as patients pre-specifying “if X …
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Focus advance care planning on outcomes
