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.

10 good things that can happen from cancer

Conditions and Diseases
October 6, 2010

The following list is from a cancer survivor, Judy Engibous, posted on Hester Hill Schnipper’s blog Living with Breast Cancer.

We first published it back in March of 2009 but are “reloading” it in recognition of Showtimes’ The Big C starring Laura Linney. We were wondering if the story could be considered an example of “Participatory Medicine” with Linney’s character being an “e-patient.”

10. Being able to shamelessly make fun of smokers. …

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10 good things that can happen from cancer

Patients and physicians should screen for cancer, but cautiously

Conditions and Diseases
October 6, 2010

To screen or not to screen? That is not the question.

The question is not whether to screen, it is why, what, where, when, how, and how much, how often, and at what cost for what benefit.

Patients and physicians must and do screen. The issue is cautious appropriateness. Self-screening by patients is easy, free, and fundamentally harmless. Look at your skin for potential melanomas, be alert to warning symptoms of a …

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Patients and physicians should screen for cancer, but cautiously

We’re not ready for do it yourself genetic analysis

Conditions and Diseases
October 5, 2010

You may be wondering why Stanford Medical School’s new genetic interpretation class – the one that offers medical students the opportunity to study their own genes – has made the news. After all, what better genes are there to study than your own? And if you were a medical student, wouldn’t you want to have your medical school subsidize 80% of an $800 test as part of your curriculum – …

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We’re not ready for do it yourself genetic analysis

Cake with a terminal cancer patient

Conditions and Diseases
October 4, 2010

by Krupali Tejura, MD

A fellow physician called me with a consult this afternoon.

He described the case as a 60 year old who had stridor (difficulty breathing) for the past week and was admitted to the hospital recently. A CT scan showed lymph nodes in his neck which was compressing the trachea, and other scans didn’t show much better. A biopsy was done but the final results were …

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Cake with a terminal cancer patient

POLST and the next generation of the “Do Not Resuscitate” order

Patient
October 4, 2010

POLST stands for “Physician Orders for Life-Sustaining Treatment”. It is a next generation replacement for an Advanced Directive and DNR (“Do Not Resuscitate”) order. Advanced planning documents turn out to be less than useful, especially in urgent care settings, and many patients receive more aggressive care than they might want because universal, transferable physician orders are unavailable or, simply, not applicable because a patient is in a different care setting.

The …

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POLST and the next generation of the “Do Not Resuscitate” order

Heavy sleep debt extracts a price for patients

Patient
October 2, 2010

An excerpt from The Twenty-Four Hour Mind: The Role of Sleep and Dreaming in Our Emotional Lives.

by Rosalind D. Cartwright, PhD

We live in a culture that values speed; fast foods, fast cars, fast service, and fast decisions.

All of this takes a toll.  Fast food is blamed for the epidemic of obesity, fast cars for motor vehicle accidents, and the wish for fast service and decisions …

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Heavy sleep debt extracts a price for patients

The benefit of a drug cannot be measured by the law of averages

Medications
October 1, 2010

One of the topics that I have often thought about (especially in light of our seeming inability to develop zero-risk obesity drugs) is the problem of averages. Our entire medical philosophy of “evidence-based” medicine seems built on the “Gaussian” assumption that averages can reflect the true benefit (or risk) of a drug, when in real life (or medical practice) there is no such thing as the truly average patient.

Clearly, a …

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The benefit of a drug cannot be measured by the law of averages

Finding a doctor using ratings is a sound idea, but poorly executed

Physician
October 1, 2010

Let’s say you develop some heart problem and get sent to me for an evaluation. You show up to the office, check in, get ushered into an exam room, then you wait and wait and wait. When I finally come into the room I seem terse, impatient and rushed, and you end up visiting with me for less than 5 minutes. I provide you with a diagnosis, order a couple …

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Finding a doctor using ratings is a sound idea, but poorly executed

People live and die by their chronic illnesses by what they do at home

Physician
September 29, 2010

“You know, what Mr. HD really needs is for his mom or somebody to chain herself to him …” [the ICU team laughs] … “But seriously, he needs to be watched over, he needs to be talked to. He needs someone to give him his medications, someone to take him to his appointments, someone to take care of him. With that somebody he can live for years to come. Without …

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People live and die by their chronic illnesses by what they do at home

How house calls benefit patients and physicians

Physician
September 29, 2010

Physicians used to take care of patients at their homes.

Through the 1960s, patients would make a phone call and the doctor would arrive at the doorstep, black bag in hand, eager to serve. This changed in the mid to late-1960s as doctors developed group practices and as medical care expanded to include technology-based studies and specialty referrals, and thus became more hospital-centered. Prior to World War II, 40 percent of …

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How house calls benefit patients and physicians

Bad lifestyle isn’t a medical issue, it’s a social one

Physician
September 29, 2010

Almost every Sunday night, I walk to this one restaurant in my neighborhood for some comfort food (we’re creatures of habit aren’t we?).

I pass a church on my way where an Alcoholics Anonymous meeting is held almost every night. As I walk through the crowd of smokers, I look at them and they look at me. They don’t know that I know they’re recovering addicts. And they put a smile …

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Bad lifestyle isn’t a medical issue, it’s a social one

Nurses expect to be called by their first names, should doctors follow?

Patient
September 29, 2010

I’ve worked in hospitals since I was 16 years old — 42 years ago now. I was first an orderly, then a nurse’s aid, then a practical nurse, and a finally a surgical technician before I became a physician.

When I started, female nurses wore caps, the details of which identified which nursing school they had graduated from, as well as a pin that gave the same information. They wore starched, …

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Nurses expect to be called by their first names, should doctors follow?

Keeping the terminal patient comfortable is the purpose of comfort care

Patient
September 28, 2010

Dealing with an incurable illness or terminal condition is an inevitable reality of the practice of medicine. Not uncommonly, especially in the intensive care unit, we care for the patient with no chance for recovery and survival. Keeping that patient comfortable and allowing him or her to die with dignity becomes the priority of care.

Occasionally, I hear requests from the family members of the dying patient – “Can you give …

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Keeping the terminal patient comfortable is the purpose of comfort care

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Using denial to control a patient’s anxiety

Patient
September 28, 2010

A few years ago, a patient of mine was diagnosed with lung cancer.  A metastatic work up revealed a small mass in his liver that had the radiographic appearance of a benign liver cyst.  But in the setting of a newly diagnosed lung cancer, we couldn’t be sure it wasn’t a metastatic lesion, so we decided to biopsy it.  Due to scheduling issues, we couldn’t get it done for seven …

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Using denial to control a patient’s anxiety

Confronting the fear of death takes preparation

Patient
September 28, 2010

by Brad Stuart, MD

Atul Gawande’s brilliant essay in the New Yorker sums up the dilemma we face, whether we’re patients, families, and/or clinicians, as we near the end of life. His point is that we have to face it together:

“People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say …

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Confronting the fear of death takes preparation

Are e-Patients expert in their own diseases?

Patient
September 28, 2010

As an e-Doctor, one with some IT literacy, I welcome the e-Patient movement.

I think patients should be equipped, enabled, empowered, engaged, equals, and emancipated, as Wikipedia explains.  The link also adds “and experts” and here I have a problem, not because I don’t think patients should have access to knowledge or know a lot about their own disease, but because knowing one pattern of pathology, i.e. your own, does not make you an expert.

No more …

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Are e-Patients expert in their own diseases?

Can a pharmacy profit from gouging patients without insurance?

Medications
September 27, 2010

It just shouldn’t be hard to get a refill on the medicines I’m taking:

  • phone the pharmacy to refill prescriptions
  • show up the next day to pick up refills
  • pay

Simple, right?

Note that this is about my old pharmacy, not the new one.  For quite a while the pharmacy had been having difficulties, which is why I never trust the pharmacy.  Between the distance and the frustrations I had dealing with them, …

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Can a pharmacy profit from gouging patients without insurance?

The story of vitamin D and its association with other diseases

Conditions and Diseases
September 27, 2010

Vitamin D is a fascinating molecule with a fascinating story.

Historically, “vitamins” were defined as chemicals that humans required from their environment that were “vital” to human health.  These chemicals were needed only in very small amounts to prevent disease; an absence of a particular vitamin in the diet led to a specific deficiency disease: vitamin C, scurvy; thiamine, beri beri.  Other vitamin deficiencies were found …

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The story of vitamin D and its association with other diseases

Health and well-being hypocrisy in the health care industry

Patient
September 27, 2010

by Edward Stevenson

One of the things that drew me towards medicine was the fact that I personally value health and the sense of well being.

I would expect that if I inquired of my colleagues that a similar statements of values would echo this fact. Yet despite this near universal affirmation of value for health and well-being, a considerable amount of hypocrisy exists in the …

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Health and well-being hypocrisy in the health care industry

Why good doctors give useless answers

Physician
September 27, 2010

Before he tells you how to get a straight answers from physicians, Doctor D is going to stall for time by explaining why doctors give vague answers.

Why would a good doctor give useless answers?

1. There is an answer, but your doctor doesn’t know it. Don’t be hard on doc for this one. There is no MD in the world that knows the entire breadth of medical knowledge. Some docs pretend …

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Why good doctors give useless answers

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