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.
Each issue of the Journal of the American Medical Association includes an excerpt from an issue of exactly 100 years ago (JAMA has been published continuously since 1883).
The May 7, 1910 issue of JAMA included remarks on how much physicians were paid and, by implication, how they were regarded in 2250 B.C.
Ability to pay and malpractice
According to the famous Babylonian Code of Hammurabi (“an eye for an eye”), a physician’s …
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What medicine was like in ancient Babylonian society
It’s hard to look at the mug-shot of the 60-year-old woman charged with tampering with forensic drug evidence (basically, stealing police-confiscated cocaine) without wondering how things got to this point. I mean, surely they weed out the felons, and the known addicts, and do a background check, and then make you pee in a cup before they even hire you for a job like this. Right?
So just exactly how can …
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Cocaine and drug addiction from work exposures
The trauma for Artyom continues. After having been given up to an orphanage by his alcoholic mother who lost her parental rights, being adopted by a US family, sent back to Russia alone when his adoptive mother allegedly was unable to cope with his psychological problems, he has now become the object of a tug-of war between Russia and the US over his citizenship. His future seems to hold unimaginable …
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Adoption lessons after Artyom Savelyev
Pharmaceutical companies and their shareholders are always looking for the next “blockbuster” drug, the label given to a drug that generates more than $1 billion of revenue per year.
Blockbuster drugs don’t necessarily have to save many (or any) lives – slick marketing more than compensates for marginal improvements in treatment efficacy — but they do need to target conditions that are common enough that millions of patients will buy them. …
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How health reform will help breastfeeding mothers
Obsession with medical technologies and machines characterizes American’s cultural expectations. We tend to think of our bodies as perpetual motion machines, to be preserved in perpetuity.
If the face of our machines sag, we lift it up. If our pipes clog, we roto-rooter or stent them. If impurities gum up our machinery, we filter them out. If our joints give out or lock up, we replace them. If we want to …
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Machine and technology fixation is why health costs are high
by James Baker, MD
Using the diagnosis “bipolar disorder” for children with problems in mood has been controversial ever since a surge in its use in the mid-1990’s.
A recent article in the Los Angeles Times gives the pros and cons on the use of “bipolar disorder” in children through the opinions of two psychiatrists on opposite sides of the controversy.
The problem with using “bipolar” is that it requires a too-loose interpretation …
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Can children really have bipolar disorder?
They say an ounce of prevention is worth a pound of cure, but is that still true in today’s money? Recently I had an illuminating conversation with a patient that got me thinking about how I may try to answer this question. This is the first in a short series on the price of preventive health care.
Mr. GR, as I will call him, had recently turned 60 years young. Though he …
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Shingles vaccine and the price of preventive care
I’m a doctor. We get all the glory. And credit. And guess what? We only deserve part of it.
I started out in medicine in the mid-80’s, volunteering at an ER. And the biggest shock to me was learning how much of what happens in a hospital is nurse territory. Doctors will see you anywhere from 5 to 30 minutes a day, …
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Listening to nurses is key to being a good doctor
Though I’ve never lost a friend or family member to suicide, I have lost a patient.
I have known a number of people left behind by the suicide of people close to them, however. Given how much losing my patient affected me, I’ve only been able to guess at the devastation these people have experienced. Pain mixed with guilt, anger, and regret …
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6 reasons why people commit suicide
by Brad Stuart, MD
Rob Pardi’s comments in Pallimed affected me deeply. His honesty, integrity, and willingness to share were so impressive that I feel reluctant to take issue with anything he had to say. Yet today I find myself somewhat in conflict with his message.
Rob’s wife, a palliative care doctor, died of cancer recently and her story, published in the New York Times made it sound as if …
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Patients who are dying and their awareness of death
An excerpt from Top 5 Questions to Ask Your Doctor
by Sagar Nigwekar, MD and James Sutton, RPA-C
Tips for Talking to Your Doctor
Entering a doctor’s office can be like entering a different world. There are often “rules” and “protocols” that the doctor, nurses, and staff follow that you may not be familiar with. This book offers some very helpful questions for you to have an intelligent conversation with …
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Questions patients should be asking their doctors
The new definition of participatory medicine at the Society’s website notes that patients “shift from being mere passengers to responsible drivers of their health, and … providers encourage and value them as full partners.” As with any collaboration, this must include a hefty dose of listening by both parties.
I recently returned from an extraordinary week in Minnesota, with visits to several thought-provoking care facilities. The week was all about …
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Medical compliance from a patient perspective
by Marianne Mattera
“I Hate [Insert Health Insurer Here]”
Not long ago I sent an e-mail with those headline words as the subject line — I have withheld the name of the insurer to protect . . . , well, myself.
A combination of circumstances has led to massive hassles costing me what is easily 100 hours of checking, rechecking, e-mailing, and phone calling over the last 3 months. …
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Paperwork results in wasted work for doctors, insurers and patients
by Ray Carlson
With so many health insurance consumers familiar with standard “PPO” or Preferred Provider Organization health plans that feature lower annual deductibles, the HSA-compatible health plan might be getting overlooked.
These same consumers who – because of the downturn in the economy and subsequent job loss – are now shopping for, or considering shopping for, a new individual or family health plan might gravitate towards a PPO that features the …
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HSA-compatible high deductible health plan advantages
In April 2010 the American Society of Anesthesiologists (ASA) published updated guidelines for the management of chronic pain. The guidelines were based on a review of recent scientific evidence as well as a survey of expert opinion. As I read through the guidelines, summarizing the efficacy of various therapies for chronic pain ranging from epidural injection to medication management, some of my most challenging clinical cases involving pain management …
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How primary care should manage chronic pain patients
A middle aged patient whom I have seen in the past for benign palpitations called today because of atypical chest pain. Although I have criticized the overuse of nuclear imaging studies, and probably order the fewest of any cardiologist in the city, there are times when they are appropriate –this was one of those occasions. Symptoms did not rise to the level of an invasive angiogram, but could not be …
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Healthcare needs to be simpler and more like real economics
by Joyce Frieden
Two new studies of electronic medical records (EMRs) have come to different conclusions: one found that they don’t save money or staffing time, but the other suggested that at least one part of EMR — electronic prescribing — does save lives.
In the electronic prescribing study, at a single California hospital, the mean monthly adjusted mortality rate decreased by 20% …
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EMR use may not save money but can save lives
by Sandeep Grewal, MD
We as doctors and patients as well as medicine as a whole have evolved over time. What used to be a simple conversation of between a doctor and a patient has turned into a melee of medical issues, legal issues, insurance and financial issues and not to mention the complicated ICD 9 and CPT code system.
Conversation between a doctor and patient in 1960s:
Patient: Sir, I am …
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Patient relationships with their doctors over time
Correctional psychiatrists inevitably treat patients who have been convicted of a broad array of crimes. There is a correlation between the security level of the institutions in which one works and the severity of the crimes of the inmates being housed there.
Since I’ve treated inmates of minimum, medium, and maximum custody levels, I’ve had the opportunity to work with people who have been convicted of everything from drug possession to …
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Treating patients in prison for murder
Waterbirth has become a central component of “natural” childbirth dogma, despite the fact that for primates giving birth underwater is entirely unnatural. You don’t need a medical degree to appreciate the idiocy of birth in water. The most critical task for the newborn is to take its first breath.
Inhaling a mouthful of fecally contaminated water instead of air is profoundly dangerous. Not surprisingly, as the popularity of waterbirth has grown, …
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Waterbirth dangers to newly born babies
