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 Kristina Fiore
More than a third of parents who have been tested for genetic breast cancer risk say they’d support similar testing for their children — despite scant evidence of any benefit for young people, researchers have found.
In interviews with 246 parents who were tested for the BRCA1/2 mutation, 37% supported testing minors, compared with 55% who opposed screening, according to Angela R. Bradbury, MD, of Fox Chase Cancer Center …
Read more…
Parents who want genetic testing for their children
You’ve seen it, somewhere.
Every city in America, and likely the world, has a local magazine. And once a year, that magazine publishes a “Best Docs” issue, usually listing 10 doctors from each specialty who they consider the best of the best.
Dr. Grumpy, for the record, is not biased against this. I’ve been named a “Best Doc” in my field several times.
And I know most of the other neurologists on the …
Read more…
Best Doc in a magazine, the inside story
As physicians, we all strive to practice good medicine. Good medicine means evidence based medicine in the patient’s best interests. In the ideal world this will make patients happy and satisfied. If you are getting the best treatment for your condition you should be happy, right?
In the real world, though, keeping patients or their families’ happy and practicing good medicine might not be possible at the same time. This is …
Read more…
Good medicine sometimes makes patients unhappy
by Brad Stuart, MD
The emergency department phoned my office right before lunch.
I was on call for our general IM group, so when I was done with my morning schedule I walked across the street to the hospital. Greg, my partner’s 38 year old patient, was a woodworker admitted with fever, chills, cough, a sharp pain in his right side, and a WBC of 18,000. On the chest x-ray, I …
Read more…
Talking with patients about their impending death
Are healthy people patients? Sometimes I wonder.
If you’re healthy, you rarely see a doctor. If you go for a “routine” checkup every five years, you just aren’t very affected by the system. You might not even know what the system is. Your health insurance premium is deducted from your paycheck, so you never really see that money — not the way you would if you had to write a check in that …
Read more…
Can patients demand changes in the healthcare system?
The decade ahead is one likely to be full of turbulence. How everything will shake out is anybody’s guess.
But we can be sure that technology advancements will slow for no one. The rate of medical technology advancement now is very fast and the speed will only accelerate. One big problem is that technology advances so fast that there is no time for a purchase – say new CT scanner or …
Read more…
America has a disease industry, not a health care system
Dana Jennings writes what is arguably the world’s most famous patient blog about his treatment for prostate cancer.
Just to be clear, I don’t have any statistics about how many readers he and other patient bloggers have. I believe his blog is the most widely read and best-know patient blog because of the number of comments he receives and its prominent location in the New York Times Health section, itself …
Read more…
Dana Jennings interview, the world’s most famous patient blogger
by Jeoffry B. Gordon, MD, MPH
As a family doc in practice for over 30 years I have been always tried to conceptualize disease states beyond the standard text book parameters.
Thus I was elated by the prospect of discovering a new beneficial treatment for muscular dystrophy when 5 years ago I gave some Viagra to a 57-year old patient of mine with limb girdle muscular dystrophy for the usual purpose. In …
Read more…
Viagra for muscular dystrophy and publicity for accidental insight
The topic of balance billing has arisen once again, this time in this post by Movin’ Meat about the new health care insurance bill and emergency medicine.
Without further explanation, “balance billing” is generally thought of as a bad thing; a way for rich doctors to squeeze even more ill-gotten gains from their poor beleaguered patients. And that’s without even realizing what it is. …
Read more…
Understanding balance billing, a primer for patients
I’ve only been studying healthcare for two years and I hesitate to be overly assertive.
But I have, finally, reached the point where I feel confident in citing cases where people are simply being unscientific: ignoring evidence. That’s always hazardous, and it becomes insidious when it’s caused by a blind, unquestioning belief in our institutions.
Case in point:
Julie Thoren is an active practitioner of Participatory Medicine who’s seen first-hand the tremendous value …
Read more…
Participatory medicine and evidence from medical journals
Although a majority of Americans probably couldn’t give you an accurate description of the differences between fascism, socialism, and communism, they have no trouble applying–and often interchanging–those labels to any effort by government to reform health care.
And, based on their efforts, one might conclude that the defining characteristic of any government involvement in health care is rationing. As if we don’t already ration, but will as soon as the government …
Read more…
Health care needs public acceptance of evidence based medicine
by Kristina Fiore
Websites that encourage teens to continue in their eating disorders tend to do so via “thinspiration” — a combination of images and prose that drive the viewer toward continued weight loss, researchers say.
About 85% of these sites provide thinspirational photos (or “thinspo”) of ultrathin women and oaths to “Ana” or “Mia” — nicknames for anorexia and bulimia — according to Dina L.G. Borzekowski, EdD, of Johns Hopkins, and …
Read more…
Thinspiration and pro-ana sites perpetuate eating disorders
If you have to ask what jazz is, you will never know.
– Louis Armstrong
The stillness in the meeting room was electric.
First, one panelist addressed the audience members who have never experienced a malignancy. She described the unique and powerful bond that exists between cancer survivors. She described how the brush with mortality forces each survivor to renegotiate terms with Life itself. She reminded everyone that the cancer care system too often lets …
Read more…
Cancer patients need compassion and balanced information
My friend and colleague Katherine Chretien has a provocative op-ed in USA Today entitled, “A doctor’s request: Please don’t ‘friend’ me,” which asks the question whether doctors and patients should interact in social networking sites such as Facebook.
Social networking has huge potential in health care regarding the sharing of information and ideas, and could possibly even enhance communication between doctors and patients. However, as Dr. Chretien points out, many …
Read more…
Facebook friend issues between doctor and patient
by Shelly Towns
Many people have the mistaken idea that “socialized healthcare” means that medicine and care will now be free for everyone, but in all actuality, nothing could be further from the truth.
The new healthcare bill represents one of the largest, most sweeping domestic policy changes in a generation, and aims to provide an estimated $940 billion in healthcare to over 32 million uninsured Americans (and that’s only for the …
Read more…
Healthcare reform: Who’s getting stuck with the bill?
Over the past few weeks I’ve had ample opportunity to be on the other side. Not like some parents with chronically ill children or those with children who have suffered tragic illness. No, not like that; I am fortunate that hospitals aren’t a part of my family’s everyday (except for work). My children have had amazing fortune and I remain in awe of good health. Lately though, we’ve had some …
Read more…
When the doctor is the patient, humanism and competency matter
by Melissa Velez-Avrach
About eight years ago, I was in an accident that left me with chronic lower back pain and muscle spasms.
Then, about a year and half ago, I was in a car accident. Bad combo for the pain. I’ve been to chiropractors, orthopedic spine specialists, had MRIs, the works and am following my doctor’s recommendations, doing yoga, deep breathing and physical therapy when needed. It has all helped me …
Read more…
Not all pain patients in the ER are drug seekers
Paro the robot baby harp seal was the final straw.
I had vowed to myself not to think about or write about “the internet makes you smarter, the internet makes you dumber” argument. Even when some of my favorite authors (Steven B. Johnson, Clay Shirky, Nicholas Carr, and Jonah Lehrer) weighed in, I thought it best not to participate.
And then I read about Paro, either “a disturbing turn in our treatment …
Read more…
Why technology and the Internet may not be good for patients
“I’m worried about my daughter’s posture. What can I do about it other than constantly nagging her to stand up straight?”
You’re probably talking about “kyphosis,” which is the rounded-shoulders, hunched forward kind of posture common in children and many adults. It’s often called “postural kyphosis” because it can be corrected if the child tries to stand straight up. Rarely, there’s a genuine spinal deformity, called Scheuermann’s Kyphosis or Scheuermann’s Disease, …
Read more…
How to treat slouching in children
