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.
First aid is defined as the immediate care given to an acutely injured or ill person. It can literally be life-saving so it behooves all of us to know some basic principles.
What follows are some rules that cover common conditions and general practices:
- Don’t panic. Panic clouds thinking and causes mistakes. When I was an intern and learning what to do when confronted with an unresponsive patient, a wise resident advised …
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First aid rules that everyone needs to know
Side effects. Every medication has them. Some are mild, some are annoying, and some are downright dangerous.
When doctors write a prescription, they mention that some people experience side effects, and if certain bizarre things happen, the patient should phone the doctor.
How do we keep track?
If you get one antibiotic to take for two weeks, it isn’t so hard. First, because it’s for a short time period, and also because it’s …
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Side effects of medication sometimes confuse patients
How can patients get a straight answer from a doctor?
The answer is really very simple: Don’t accept a non-answer answer from a doctor on a question that really matters to you!
If you get a dodgy, vague, or useless answer don’t take it lying down. Politely insist that the doctor elaborate and clarify until you get a reply that you understand.
We doctors are totally scary, but if you have to have …
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Get a straight answer from your doctor
The New England Journal of Medicine analyzed Medicare statistics from the beloved Dartmouth Atlas of Health Care study revealing a wide disparity in the number of coronary bypass procedures in Golden Colorado compared to other areas.
The report reveals a 60% reduction in the number of procedures as compared to Miami, Florida. The Dartmouth Atlas Study has been used to justify changes in payment systems by Medicare. The study has …
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Why patients in Grand Junction, Colorado have better health outcomes
Diana Cole told me, “The internet saved my life,” and recounted a story about using the internet to identify a bat bite and learn about rabies in bats, leading to an emergency room trip.
She later introduced me to her sister, Carolyn Kingston, who attributed her successful outcome from hip replacement surgery to her use of the internet. I asked Carolyn about her general use of the internet for health, her …
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Using the internet for health information before surgery
by James Merlino, MD
The patient experience is the right thing to do, and a business necessity. But improving it is not necessarily easy.
The fact is, large medical centers are at a real disadvantage when it comes to performing well on HCAHPS. The Centers for Medicare & Medicaid Services (CMS) do not discriminate or differentiate the scores of small community hospitals from those of large academic tertiary care …
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The patient experience needs to be improved: here’s how
This item has nothing to do with OpenNotes itself – it’s what I’m seeing now that I’ve started accessing my doctor’s notes. In short, I see the clinical impact of not viewing my record as a shared working document.
Here’s the story.
In OpenNotes, patient participants can see the visit notes their primary physicians entered. Note – primary, not specialists. I imagine they needed to keep the study design simple.
So, …
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Patients seeing the visit notes their primary physicians entered
She was like … Superwoman. A strapping medical visionary probably in her forties. Gray long coat falling below the knees. She strode confidently down the hallway towards the elevator, a father hurrying beside her with his young lanky daughter cradled in his arms. The girl’s head nuzzled into her father’s shoulder. She was old enough to walk by herself…but clearly she was sick. Unable.
Undoubtedly they were headed from the medical …
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Why patients are leaving our practices
For myself I am an optimist — it does not seem to be much use being anything else.
-Winston Churchill
Even before I met him, I could tell that his cancer was extensive. His problems had started several months before with a cough, a voice change, and some trouble swallowing. His primary doctor had not spotted anything but had kept an eye on him. Antibiotics and cough medicine had not helped. After …
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Coping with frightening circumstances after a cancer diagnosis
by Dennis Fortier
More so than with any other major disease, our near-term progress in the battle against Alzheimer’s will be determined largely by our ability to improve awareness about several aspects of this encroaching threat.
Summarized here are five reasons why greater awareness about Alzheimer’s disease, and a deeper public understanding of risks and prevention strategies, will play a key role in the nation’s ability to triumph against the prospect of …
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Alzheimer’s disease: 5 reasons why awareness matters
My colleagues at the Advisory Committee on Immunization Practices (ACIP) are examining a proposed policy for hepatitis B vaccination for diabetic patients. If accepted, this would be the next in a series of baby steps expanding hepatitis B vaccine recommendations for adults. While we are taking these baby steps, HBV incidence rates among U.S. adults remain pretty flat, and they haven’t changed much since 2006.
We know the vaccine works. We …
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Expanding hepatitis B vaccine recommendations for adults
Folks across the country are paying hard cash for total body scans, abdominal aortic aneurysm testing, CAT coronary artery scans and carotid artery evaluations to prevent disease or find important lesions early. It’s a seductive argument, and it’s a scam.
Ordinary patients don’t understand about pre-test probability and positive and negative predictive values. Indeed, all physicians were taught to consider Bayesian theory when ordering diagnostic tests. This is very tough concept for …
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Why total body scans are a scam
When we think of infidelity as “mere cheating” we are often overlooking the many fears that go along with this. Infidelity may be due to fears and fears themselves may lead to infidelity. Why is this, and what can you do about this?
1. Fear of being trapped. One of the greatest fears of commitment is the fear of being trapped. When people feel trapped, their primitive brains start to rebel. …
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How fear may lead to infidelity
These days, it seems that for every consumer advocate out there who promotes the personal health record (PHR) as The Patient Empowerment Ubertool, there’s at least 10 physicians worried sick that the technology will further complicate their frazzled work lives.
The fear and loathing derives from an increasingly common and distinctly distasteful experience in which a patient presents the physician with a thumb-drive, computer disk or Web-link to a site containing …
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Physicians should establish rules with their patients before using a PHR
Patients’ gender preferences for medical care are a factor that we all know exists yet most physicians prefer to ignore it in daily practice hoping that modern medicine is gender neutral. Forty plus years ago when I started in medicine this wasn’t a consideration. Nearly all physicians were men and nurses were women. Patients simply had no choice. Male physicians felt entitled to see all comers and present day women …
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Patient gender preferences for medical care
The psychiatrist knocks on the door of the patient’s hospital room.
Patient: “Come in.”
Psychiatrist: “Good afternoon, Mrs. Jones. I’m Dr. Moodbetter, one of the psychiatrists here. Your doctor asked me to see you. Did he say anything about this?”
Patient: “No, he didn’t! You know, I’m not nuts. I didn’t think he believed me. Great. Now he just thinks it’s all in my head.”
Psychiatrist: “Well, I don’t think he meant to imply …
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Involving a psychiatrist in a patient’s care for the first time
Doctors and nurses are leaders in health care. Being a great leader means having a clear vision, mission or goal. It means being committed, and knowing how to listen and communicate, but it involves much more. It’s about having heart, empathy, and an uplifting spirit.
I value and respect a well written post by Thomas Goetz, author of The Decision Tree: Taking Control of Your Health in the New Era of …
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Deeply connect and engage your patients with empathy
I’m both interested in and disturbed by what some doctors have said to patients at the first consultation for tinnitus, an annoying perception of sound that comes from somewhere within their heads. Not many of these patients are referred to me – most come of their own accord for a second opinion. What they tell me their doctor said is a lesson in how not to communicate with patients, and …
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Tinnitus highlights poor doctor patient communication
