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.

Patient safety lapses in the hospital

David B. Nash, MD, MBA

Physician

January 31, 2011

Earlier this month, at the third annual American Medical Student Association Patient Safety and Quality Leadership Institute, I listened with sympathy — and, frankly, a certain amount of discomfort — to a fourth-year medical student’s account of his grandmother’s recent hospitalization at a well regarded inpatient facility in New York City.

Admitted with an initial diagnosis of pneumonia, Cole Zanetti’s grandmother languished in the hospital for almost four weeks.

As the medically …

Read more…

Patient safety lapses in the hospital

Help your doctor formulate an accurate differential diagnosis

Stewart Segal, MD

Conditions and Diseases

January 31, 2011

Last night, I turned on “House,” a TV show about a physician who is in charge of a team of highly specialized diagnosticians. Every week the team solves a difficult to diagnose medical case by working through an exhaustive differential (DD) diagnosis list. While the show is absurd to the extreme (as the team of physicians almost kills the patient each week), eventually the correct …

Patient advocacy is essential in health insurance appeals

Steven Reznick, MD

Patient

January 30, 2011

An active 61 year female, who has been in my practice for 30 years, developed strange aches and pains and abdominal symptoms. My evaluation turned up nothing.

I then asked for help at the University of Miami rheumatology and gastroenterology divisions. With the help of a brilliant local gastroenterologist and rheumatologist, and after a trip to Johns Hopkins Medical Center and the Mayo Clinic, collagenous …

Integrity, discipline, respect: Using kung fu to control your eating

Melanie Lane, MD

Conditions and Diseases

January 28, 2011

About seven months ago, I began training kung fu with my family. Our classes are intense and require the students to really pull out our personal best. Periodically our instructor will remind us by shouting out, “Train like a black belt!” when she catches us being sloppy or less than enthusiastic. Her exclamation inspires me to squat a little lower in my horse stance, amps up my intensity, and focuses …

Haggling with your doctor about the costs of care

Jessie Gruman, PhD

Patient

January 28, 2011

“How to Haggle With Your Doctor” was the title of a recent Business section column in the New York Times. This is one of many similar directives to the public in magazines, TV and Websites urging us to lower the high price of our health care by going mano a mano with our physicians about the price of tests they recommend and the drugs they prescribe. Such articles provide simple, …

What’s next for doctors if pay for performance fails?

Kevin Pho, MD

KevinMD

January 28, 2011

I recently pointed to a BMJ study concluding that pay for performance doesn’t seem to motivate doctors. It has been picking up steam in major media with TIME, for instance, saying, “Money isn’t everything, even to doctors.”

So much is riding on the concept of pay for performance, that it’s hard to fathom what other options there are should it fail. And there’s mounting evidence that it will.

Aaron Carroll, a …

Electronic medical records and pay for performance don’t improve care

Kevin Pho, MD

KevinMD

January 27, 2011

Electronic medical records and pay for performance are among the ways health reformers are going to improve patient care.

It’s a fundamental shift in how doctors practice, with more practices adopting expensive EMRs. And with the advent of Accountable Care Organizations, doctors will soon be compensated in part by quality measures.

But will they work? Well, the jury’s still out.

Two articles caught my eye recently.

The first, from the WSJ’s Health Blog, reports …

Solving the puzzle of patient compliance

Dennis Grace

Patient

January 27, 2011

by Dennis Grace

I recently received a message from the Center for Connected Health. I must admit the opening of the letter really put me off. It asked:

How do you solve the puzzle of patient compliance?

I responded to the gentleman who sent the invitation with:

Well, you might start by calling it something less offensive. Patient compliance? The phrase assumes “patient” as direct object rather than subject of participatory medicine. We …

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Solving the puzzle of patient compliance

A lesson about true friends for those facing serious illnesses

Kevin

Patient

January 27, 2011

by Danielle Leach, MPA

“A true friend walks in when everyone else walks out.”

I read that on a magnet on my friend’s refrigerator recently and the simple power of that saying brought me to tears. I have learned that lesson of true friends since my son’s diagnosis of cancer in 2007.

Anyone who has faced a serious illness as a patient or a caregiver knows that you quickly learn who your …

Palliative care can lead to higher quality of live and longer survival

John Schumann, MD

Patient

January 25, 2011

Every once in awhile amidst the weekly deluge of medical articles comes a show-stopper that has the potential to change the way we practice.

Rarer yet is the article that not only changes how we practice, but calls into question why we do what we do.

This recent article from the New England Journal of Medicine is just such an article. Before you bolt, let me simplify it for you.

Here’s …

Formula and the placebo effect on your baby

Michael Gonzalez, MD

Patient

January 25, 2011

You are a new parent. Your infant is gassy, fussy, spitty, and does not sleep much. In other words your infant is a normal baby. You are stressed, and like any good parent, you want to fix what “ails” your infant. As you stroll down the baby aisle at the grocery store, you see labels that tout words like gentle, comfort, and restful. Formula manufacturers are brilliant. They know their …

Depersonalization of the patient and the loss of compassion

Wendy S. Harpham, MD

Physician

January 25, 2011

A common complaint about modern medicine is the depersonalization of the patient and the loss of compassion.

So let’s take a look at compassion.

Compassion is derived from the Latin “cum” (together with) and “patior” (suffer). From the perspective of clinicians, compassion is defined by two concurrent emotions: (1) a feeling of deep sympathy and sorrow for another who is stricken by medical misfortune accompanied by (2) a strong desire to relieve that …

What your medical office can learn from Norman Rockwell

Brandon Betancourt

Physician

January 24, 2011

This past summer I got a chance to visit Washington DC. While I was there, I saw a Norman Rockwell exhibition at the Smithsonian American Art Museum. As it turned out, the exhibition was the private collection of George Lucas and Steven Spielberg. The exhibition highlighted Rockwell’s masterful storytelling.

I didn’t know much about Norman Rockwell before that day. I knew he was a famous American painter and I had seen …

Adherence to HIV treatment in Africa

Paul Sax, MD

Patient

January 24, 2011

There has been an irresistible urge for people — doctors, public health officers, politicians, journalists, the usual pundits — to compare adherence to HIV treatment in resource-rich vs. resource-limited setting.

I suspect this is because the whole issue got off to a famously bad start in 2001, when then-head of the U.S. Agency for International Development (USAID) Andrew Natsios said in an interview with the Boston Globe that Africans,

don’t know what Western time …

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Adherence to HIV treatment in Africa

Should obesity be classified as a brain disease?

Michele R. Berman, MD

Conditions and Diseases

January 23, 2011

Many of our most popular stories are about diets and weight management.

Did you know that some psychologists and psychiatrists would like to classify obesity as a brain disease? The reason for this is that there is mounting evidence that food, or certain types of food, can trigger the same addictive effects in the brain as drugs like heroin and cocaine. There is also substantial evidence that some people lose control over …

Problems with the connection between thimerosal and autism

Kevin

Medications

January 22, 2011

An excerpt from Tabloid Medicine: How the Internet is Being Used to Hijack Medical Science for Fear and Profit.

by Robert Goldberg, PhD

From the beginning, there were two problems with the connection between thimerosal and autism. The first problem with was that thimerosal, while about half mercury, contains ethyl mercury, for which there were no exposure guidelines. So the scientists used the ones for methyl mercury. However, the ethyl mercury …

Payment systems must take into account the art of medicine

Marya Zilberberg, MD, MPH

Health Policy

January 22, 2011

You know that joke about the farmer whose cows are not producing enough milk? A university panel gathers under the leadership of a theoretical physicist. They analyze each aspect of the problem thoroughly and carefully, and after much deliberation produce a report, the first line of which is “First, assume a spherical cow in a vacuum.”

This joke has become short-hand for some of the reductionist thinking in theoretical physics, but …

Are parents to blame for childhood obesity?

Dr. Joe Kosterich

Patient

January 21, 2011

Childhood obesity is a problem. It is a function of the foods children eat both at home and at school. The people responsible for feeding children are parents not advertisers. Running the line that it is all to do with advertising allows adults to run a “Johnny told me to” line, which would not be accepted as an excuse from a child.

It is not about blaming parents. It is about …

Menopause and cancer: What women should know

Therese B. Bevers, MD

Conditions and Diseases

January 21, 2011

Menopause often brings more than physical changes. It also may bring uncertainty about cancer risks and cancer prevention.

Below, I’ve compiled some of the questions I frequently hear from patients about menopause and cancer. I hope these answers will help other women start informed conversations with their doctors about menopause-related concerns.

How does menopause affect a woman’s cancer risk?

Menopause does not cause cancer. But your risk of developing cancer increases …

Mental illness in the college student

Emily Gibson, MD

Conditions and Diseases

January 21, 2011

Along with millions of Americans, I’ve tried to comprehend the tragic shootings in Tucson, reaching deep within myself to find compassion for a young man who has forever changed the world for himself and so many others through his actions.

For those of us who assess, diagnose and treat college students struggling with mental illness while trying to succeed in their academic pursuits, the events leading up to his impulsive killings …

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Mental illness in the college student

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