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.

MKSAP: 68-year-old woman with difficulty seeing out of her left eye

mksap

Conditions and Diseases

July 7, 2010

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 68-year-old woman is evaluated in the emergency department for difficulty seeing out of her left eye.

The symptoms were first present upon awakening 45 minutes earlier. She describes her vision as “looking through a dark veil.” Her right eye is unaffected. There is …

Treatment decisions under migraine headache influence

Diana E. Lee

Patient

July 7, 2010

by Diana E. Lee

At an appointment with my local neurologist I showed up feeling bone tired and mentally drained.

Next thing I knew I was going back on a medication I had deliberately chosen to stop taking just because a doctor told me I should be taking something.

When the doctor finally came into my exam room he looked over the list of medications I was taking and declared that Lyrica alone …

Patients can ask for discounts if the doctor is running late

Kevin Pho, MD

Patient

July 7, 2010

Should doctors face consequences if they run late?

From the New York Times’ health blog, Well, comes a story where a medical group promises, “same-day appointments and longer, more personalized visits that start on time.”

Sounds good, right?

But it comes with a caveat, namely, a $199 annual membership fee. A tremendous amount of primary care can be bought with that amount of money, and if patients were willing to pay that, …

Op-ed: Empowered e-patients are failed by our health system

Kevin Pho, MD

Physician

July 6, 2010

The following op-ed was published on June 7th, 2010 in CNN.com.

“I read all about my condition on the Internet,” a recent patient proudly told me. Like other doctors, I’m seeing more patients research their symptoms thoroughly before setting foot in the exam room.

Patients are using the Web in unprecedented ways for their own health empowerment. According to the Pew Internet & American Life Project, 61 percent of American adults …

Physical features of autism spectrum disorder (ASD)

William R. Yates, MD

Conditions and Diseases

July 6, 2010

Social and language issues dominate most of the discussion about the features of autism spectrum disorder (ASD).

A neglected area of study are the physical feature characteristics that have been known to be associated with ASD. Unlike some of the diagnostic physical changes in disorders such as Down Syndrome, physical features found in ASD are often subtle and missed by most clinicians.

Ozgen and colleagues from the Netherlands, UCLA and the UK …

Oil spill got you down? Here’s what to do about it

Jeffrey Knuppel, MD

Conditions and Diseases

July 6, 2010

As I’ve watched all of the media reports and videos of the oil uncontrollably gushing into the sea, the decaying marshlands, and the suffering or dead wildlife, the profound sense of sadness, anger, helplessness, and disappointment that I felt after 9/11 returned.

I don’t feel it all the time—it’s not clinical depression. It’s just strong negative emotion associated with the fact that both 9/11 and the oil spill were man-made disasters …

PTSD frequency in National Guard soldiers

Kristina Fiore

Conditions and Diseases

July 5, 2010

by Kristina Fiore

After combat duty in Iraq, members of the National Guard appear to have higher rates of mental health problems than soldiers in the Active Component, researchers have found.

Rates of post-traumatic stress disorder (PTSD) with serious functional impairment increased from about 7% to more than 12% over a nine-month period, compared with only about a 1% increase among those in the Active Component, according to Jeffrey L. Thomas, PhD, …

Abuse is linked to obesity in children

MedPage Today

Physician

July 4, 2010

by Todd Neale

Children whose mothers reported chronic abuse at the hands of an intimate partner were more likely to be obese at age 5 than those from violence-free families, researchers found.

After controlling for several potential confounders, including maternal obesity and depression, children whose mothers reported chronic violence had 1.8 times the odds of being obese, according to Renée Boynton-Jarrett, MD, ScD, of Boston University, and colleagues.

The association appeared to be …

Read more…

Abuse is linked to obesity in children

How to treat patients who want everything

Lyle Fettig, MD

Patient

July 3, 2010

The Annals of Internal Medicine had a perspective article by palliative medicine communication gurus Drs. Tim Quill, Bob Arnold, and Tony Back which details an approach to discussing treatment preferences with patients who want “everything.”

When I think of a patient requesting “everything,” I typically think of it as a response to a physician who offers the patient the choice of “doing nothing” if the patient’s heart should stop or …

Post-traumatic stress disorder (PTSD) may increase dementia risk

MedPage Today

Conditions and Diseases

July 3, 2010

by Todd Neale

Older U.S. veterans with post-traumatic stress disorder (PTSD) appear to have an increased risk of developing dementia, a retrospective study showed.

Compared with those without PTSD, predominantly male veterans with the disorder had a 1.77-fold (95% CI 1.70 to 1.85) greater risk of developing dementia, according to Kristine Yaffe, MD, of the San Francisco Veterans Affairs Medical Center and the University of California San Francisco, and colleagues.

The results were …

Euthanasia in dogs and the moral lessons for doctors

Edward Pullen, MD

Physician

July 2, 2010

We had our dog put down yesterday.

Simon joined our family when our son was 10 years old as a two year old that we adopted from the Purdy Prison Pet Parole Program and was with us until he developed status epilepticus forcing our decision to have Simon euthanized.

Simon had been getting old, lame, nearly blind, and uncomfortable most of the time, but we felt he still had some enjoyment in …

Drinking and smoking associated with migraine headaches

Kristina Fiore

Conditions and Diseases

July 2, 2010

by Kristina Fiore

Drinking coffee and alcohol, smoking, and lack of physical activity all appear to be associated with migraine and tension-type headaches in teenagers, researchers found.

High consumption of cocktails appeared to put students at the greatest risk for these headaches, increasing the odds almost three-and-a-half-fold, Astrid Milde-Busch, PhD, of Ludwig Maximilians University Munich in Germany, and colleagues reported online in the journal Headache.

“Rather unexpectedly, recommendations to increase fluid intake as …

A medical home does not guarantee increased patient satisfaction

Steve Wilkins, MPH

Physician

July 2, 2010

One of the more notable findings from the special report on the TransforMED National Medical Home Demonstration project was that “patient satisfaction doesn’t automatically go up.”

Terry McGeeney, CEO of TransforMED, attributed the lack of increased patient satisfaction experienced by the 18 participating physician practices to a variety of factors, chief of which “was the turmoil of change experienced by patients as practices implemented after-hours access, quick access to laboratory results …

Customer service needs to be a priority in health care

John Schumann, MD

Patient

July 1, 2010

What do Enterprise Rent-a-Car, KeyBank, and the Cleveland Clinic have in common?

They all make customer (patient) satisfaction a top priority.

They accomplish this in industry-specific ways, but together their emphasis on service as a passion shares common themes:

1. Buy-in for a service culture comes straight from the top, and permeates the entire organization.
2. Copious resources are delegated to building a service culture, starting with hiring.
3. Employees are “hired for fit.” If …

Children of lesbian mothers have healthy psychological growth

Kristina Fiore

Conditions and Diseases

July 1, 2010

by Kristina Fiore

Children born to lesbian mothers appear to have healthy, if not better, psychological development when compared with average American children, researchers have found.

In the first prospective cohort study of its kind, these children were found to have better social, academic, and overall competence and significantly fewer social problems than typical American children, according to Nanette Gartrell, MD, of the University of California, San Francisco, and Henry Bos, PhD, …

Why patients don’t value primary care doctors

Chris Rangel, MD

Physician

June 30, 2010

“Hey doc, all I need is this referral.”

I’ve been encountering more of this lately. A patient who has not been seen in the office for months to years (well beyond when they were supposed to come back for a follow up visit) walks in and requests a “referral” for a specialist visit but they can’t be bothered with actually being seen and evaluated in the office or to be compliant …

Vitamin D myths and advice for patients

Jan Gurley, MD

Conditions and Diseases

June 29, 2010

As the mountain of vitamin D research showing its importance grows to Everest heights, you may be wondering about some statements that are thrown around as “truth.”

Here are some fun vitamin D myths to pass along to friends, family and loved ones, because, when it comes to vitamin D, you want to get your dose (even of information) just right.

1. Just go out in the sun, already. That will fix …

Read more…

Vitamin D myths and advice for patients

How EMR and EHR systems can kill patients

Margalit Gur-Arie

Health Technology

June 29, 2010

Back in the times when EHRs were just EMRs, they had a very simple and humble mission.

The software was supposed to help providers of health care services better manage their business. EMRs were supposed to help physicians adhere to CMS documentation rules, automate patient flow management and get rid of all the mountains of paper floating around a typical medical office or hospital. It was assumed that EMR software will …

When patients don’t take their prescription drugs

Kenneth Lin, MD

Medications

June 28, 2010

One of my favorite patients in residency was a lady in her seventies who had longstanding high blood pressure, high cholesterol, and diabetes.

Each time she visited the office, I would recommend that we start multiple medications to control these conditions, and every time she would politely decline. Her previous physicians had left frustrated notes in her chart littered with terms such as “non-compliant,” “against medical advice” and expressing wonderment why …

American cigarettes contain more carcinogens

MedPage Today

Medications

June 27, 2010

by Todd Neale

Levels of tobacco-related nitrosamines — known carcinogens produced when curing tobacco — are higher in popular brands of American cigarettes compared with those from other countries, potentially leading to more cases of lung cancer, researchers found.

The study of 126 smokers in four countries found that exposure to one carcinogen — 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) — was highest among those from the U.S. compared with smokers from England, Canada, and Australia, …

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