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.
This evening I went to a meeting of many of the independent physicians in our community who came together to discuss ways we can help each other to remain viable as relatively small independent practices of medicine. Two things about the meeting really hit home for me.
First is how seldom I get to meet socially with my fellow physicians in the community. Now that many of us use hospitalists to take care …
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We need a better way to share information to care for patients
I am a medical doctor. I am also called an allopath, someone who practices “Western medicine.”
We allopaths like data, proof, science, randomized, double-blind, placebo-controlled trials. We want to know the “mechanism of action.” We want someone to prove that yoga or medication or some procedure actually helps your depression or blood pressure or back pain and that these treatments are safe before we prescribe them. We feel more confident about …
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Most doctors don’t like prescribing pills
After seeing Mrs. WhiteCoat argue on the phone with Medco representatives for 20 minutes about why one of her 80+ year old patients hadn’t received her medicine despite three lost faxes to Medco, I had to write this post to let the public know what is going on with some mail order pharmacies.
If you’re like most Americans, you want to try to save some money. One of the ways that …
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Mail order pharmacies have cheap prices, but also problems
Thinking is hard work. This is why so few people bother. At least voluntarily. So whenever it seems like the threat of brainwork looms in modern American medicine, we can thank our lucky stars for the geniuses behind healthcare reform and guidelines of care.
This comes up as a result of a conversation that I had with a patient the other day. A pleasant, obese gentleman. He had been struggling with …
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Preparing for gastric bypass surgery by eating more
by Dennis Grace
So, you have to go to the hospital. You’ve had an accident and the doctor wants to keep an eye on you for a few days. Maybe you need major surgery. Whatever the reason for the stay, a lot a people think you should have an advocate with you.
Why? In my life, I’ve had lots of hospital stays. Why is this suddenly a big …
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An advocate for patients might save your life in the hospital
As a whooping cough epidemic hits California, you may be asking yourself, “hey, weren’t we all vaccinated for that?” Even as the headlines imply a Victorian-level outbreak of hacking and coughing, perhaps you’re looking around and wondering where, exactly, this epidemic is located. And what you should know about whooping cough to protect you and yours.
Here are some fun, weird, and sometimes worrying tidbits to know about whooping cough. Pass …
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Whooping cough and pertussis tips you need to know
A single mom juggling two jobs and four kids may be right in thinking her life is complicated – but it is certainly not complex – at least not in the scientific sense of the word.
In medicine we also differentiate between procedures that are complicated (difficult, requiring skill) and complex (no clear solutions, unknown and incalculable risks, unpredictable outcome).
The best description of complexity was the “simplified” one I found in …
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Obesity is a complex problem that may not have simple solutions
Assumptions are ubiquitous. Neither patients nor physicians are exempt. Sometimes they are justified, other times entirely misguided.
Webster’s defines “assume” as “to take as granted or true.” The cliché’s have probably always existed: Doctors are greedy and paid too much, and are uncaring. Some patients believe doctors do care and that their doctor actually likes them. That’s an assumption too. Some assumptions are newer. Patients assume doctors will substitute their prescription …
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Assumptions in medicine can inhibit care
The following op-ed was published on July 18th, 2010 in USA Today.
A new patient recently said he was referred to me after his last doctor had left medicine. His old doctor always looked unhappy and burned out, he noted.
Burnout affects more than half of doctors, according to researchers at the University of Rochester School of Medicine. Beyond mere job dissatisfaction, these doctors are emotionally exhausted to the …
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Burnout in doctors and stressed physicians hurt patients
by Robert Graham, MD
As the nation works to reinvigorate primary care, a lot is riding on the medical home.
Some see it as an answer to a fragmented health care system that is not responsive to patients’ needs for coordinated, comprehensive care. Others have invested in it as a vehicle to improve both the quality of care and control costs. While we work to address …
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Implementing patient centered medical home pilot projects
Every time you subject the patient to an invasive procedure you take the risk of causing complication. I have done hundreds if not thousands of procedures which makes me even more aware of the risk I take every time I stick a needle or cut into the patient. We can do everything possible to enhance the safety, yet we cannot completely eradicate the risk of adverse events.
With the recent progress …
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Applying the minimally invasive concept to patient management
Eating right, exercising, avoiding the sun or using sunscreen, moderating alcohol consumption, abstaining from tobacco use, getting mammograms, Pap smears, colonoscopies—almost every measure we’re asked to take to safeguard our future health is difficult. It’s a strange paradox that we have to work in some way, to expend energy, and experience discomfort of some kind in order to gain benefit in life.
Wouldn’t it be nice if the most pleasurable things …
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Positive reinforcement can motivate preventive behaviors
Have you ever read what your physicians and nurses have written in your medical chart? If not, would you want to?
The OpenNotes project is a recently launched observational research study that involves 100 primary care doctors and about 25,000 patients. Lead author Dr. Tom Delbacoa, a primary care physician at the Beth Israel Deaconess Medical Center, poses the research question succinctly: “After a year, will the patients and doctors still want to continue sharing notes?”
In the study, …
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Why OpenNotes and access to the medical chart is important
I heard a prominent speaker talk about studies at the National Institute of Aging. The speaker described several new large and well funded trials aimed at preventing illnesses associated with aging, such as dementia and disability. These studies are terrific, and worthy of funding.
I was disappointed, however, that little was said about funding for studies of older adults already living with dementia and disability. Research in prevention will not help these patients. I asked: where is the …
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Adults living with dementia and disability need research funding
If doctors need to listen to patients to figure out what’s going on, patients need to tell doctors what’s going on. Why is that so hard sometimes? It’s hard to speak up when you feel rushed, but have doctors ever done other things that made it harder for me to talk to them?
Sometimes doctors blame the patient
Years ago I got a terrible abdominal pain. I could only explain that it felt like …
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How patients can stop doctors from blaming them for their health
The New England Journal of Medicine recently published a troubling article on acupuncture, which was ably deconstructed by Dr. Mark Crislip. This incident has reignited a discussion of what, exactly, “placebo” is.
A common argument is that placebo is like any other intervention, something that can be intentionally harnessed for the benefit of patients. This is both true and overly simplistic.
First, we must review what “placebo” …
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Is placebo a therapy, like surgery or medication?
Stories can enhance health websites because they resonate with health information seekers, who find support and encouragement from the experiences of others like them. Two excellent examples are Weight Watchers’ Success Stories and Livestrong.org’s Survivorship Stories. Both sites include extensive libraries of well-written stories about people’s experiences losing weight and surviving cancer, respectively.
Because of the effectiveness of stories in health websites like these, I challenge my Online Consumer Health students …
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How patient stories can enhance health websites
The opening anecdote of the e-patient white paper tells of a patient who impersonated a doctor in 1994, to get his hands on an article about an operation he was about to have. He got busted. Two years later episode 139 of Seinfeld had something similar – Kramer impersonates a doctor to try to get Elaine’s medical record.
It aired October 17, 1996. It was a turning point in American healthcare: …
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OpenNotes and whether patients should see their medical notes
Everyone understands the need for a robust primary care workforce in making healthcare more affordable and accessible while keeping those in our care healthy. With the aging of America and healthcare reform, even more Americans will need primary care doctors at precisely the same time doctors are leaving the specialty in droves and medical students shun the career choice. So as a practicing primary care doctor, I’ve watched with …
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Americans will need doctors but physicians are leaving primary care
