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 Crystal Phend
Poor compliance with breastfeeding recommendations costs the nation at least $13 billion each year, with nearly all of the cost related to infant morbidity and mortality, according to a comprehensive economic analysis.
If 90% of new mothers followed guidelines for six months of exclusive breastfeeding for their children, an estimated 911 deaths would be prevented annually, said authors Melissa Bartick, MD, MSc, of Harvard Medical School, and Arnold Reinhold, …
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Breastfeeding rates cost the country billions
“On the Internet, nobody knows you’re a dog” was the caption of the famous cartoon by Peter Steiner in the July 5, 1993 issue of The New Yorker. The same is true of patient stories on health Web sites: nobody knows who really wrote them.
In the case of Lifestyle Lift, the company agreed to pay a $300,000 settlement last year to New York State because their patient stories were employee-generated.
Patient …
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Patient stories on the web may not be real
Debora T. had a blood pressure of 180/110 during her routine visit in my internal medicine clinic. She was already on every blood pressure medication I could think of, save one — amlodipine. I prescribed the medicine and asked her to follow up in a week. I feared her blood pressure was going to cause a stroke if it went up any higher.
At our next visit, her blood pressure was …
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Price transparency will improve patient care
by Crystal Phend
Only one person in 40 has an extraordinary ability to do safely what many take for granted in daily life — talk on a cell phone while driving.
These “supertaskers” excelled on a simulated driving exercise and a demanding, simultaneous test of memory and math skills conducted over the phone without any loss in performance on either, according to Jason M. Watson, PhD, and David L. Strayer, PhD, both …
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Cell phone use and driving requires attention that few have
A version of this op-ed was published on March 15th, 2010 in the USA Today.
If you recently saw a doctor, you might subsequently receive a survey in the mail asking whether your physician was friendly, spent enough time with you, or showed the appropriate level of concern for your medical issues.
Patient satisfaction surveys are being increasingly used in hospitals nationwide. Press Ganey, a leading organization measuring patient satisfaction, counts more …
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Op-ed: Patient satisfaction doesn’t mean the best medical care
Patient non-adherence is a big problem. Non-adherence among chronic disease patients is associated with higher rates of hospital re-admissions, higher costs and poorer outcomes.
Research has identified over 200 possible factors thought to influence patient adherence. According to the experts, these factors can be categorized into two groups:
1. unintentional non-adherence
2. intentional non-adherence.
Unintentional non-adherence is related to a patient’s ability and resources to take their medication (e.g., problems with manual …
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Patient beliefs and their role in non-adherence
When someone dies at home we call it ‘going to a better place.’ When someone dies in the hospital we call it a ‘code.’
Recently, working in the cardiac ICU, I have been thinking a lot about code status. Code status is the medical term that describes what a patient’s wishes are should his or her heart stop or lungs fail. While code status is not a topic that typically …
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Patient advance directives are critical in the ICU
by Nikolaos I. Kakavoulis, MD
Physicians are working harder than ever to generate even a small increase in their income. Despite seeing more patients, average physicians net income between 1995 and 2003 has declined about 7% after adjusting for inflation, according to a national study from the Center for Studying Health System Change.
Why is this happening?
Now more than ever, physicians face an avalanche of complex rules, regulations, and administrative processes needed …
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Physicians increase revenue with better appointment analysis
The health reform legislation was decidedly unpopular, with a variety of polls showing the majority disapproved of the bill.
What did the people want?
The ACP’s Bob Doherty linked to a post by Princeton’s Uwe Reinhardt, who observed 10 things that the public wants in health care reform:
1. Lets only patients and their own physicians determine how to respond clinically to a given medical condition, never an insurance clerk or, even …
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How health reform can be popular with the American public
Originally published in MedPage Today
by Kristina Fiore, MedPage Today Staff Writer
Thirty-somethings can expect to enjoy at least another 30 years of sex, researchers have found.
At age 30, men will be sexually active for another 35 years, while women will be active for another 30, Stacy Tessler Lindau, MD, and Natalia Gavrilova, PhD, of the University of Chicago, reported online …
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Sex habits of older women and men
I am often asked how we get the prices for the radiology imaging tests, such as MRI’s and mammograms, or ultrasounds. Most people assume that my day job as a doc gives me some sort of special access to this info. But that’s just not the case. Anyone can find out testing prices.
However, over the last year, those of us working at LesliesList.org have gotten more experienced and better at …
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Radiology tests, and how to find their price
Ask your doctor. I think most of us would agree that is good advice, at least up to the point that we find ourselves sitting half naked on an exam table in our doctor’s office. Then the doctor walks in and for some reason many of us just “clam up.”
Patient question-asking during the primary care office visit was and continues to be an “index” of patient health information …
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Patient questions during doctor visits are uncommon
by Robin Tang
Sunday, March 22, 2010, marked the passage of the Health Care and Education Affordability Reconciliation Act (H.R. 4872) by the House by a narrow 219-212 margin, with no Republicans voting in favor. Whether you think the bill is good, bad, sustainable, or even constitutional, we can agree this was a historic day.
Putting politics aside, I want to highlight two parts of the bill that aren’t getting enough …
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Tax credits and new patient care models in health reform
by Patrice Villars
The best learning experiences for me have been times when I come away questioning core assumptions about the work I/we do. As palliative care folks, we try to help people understand where they are in relation to their disease and what their hopes and goals are for care. We offer treatments and resources to match those needs through, in part, supportive communication.
What if, in our kind, well-meaning …
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Palliative care shows the importance of language
Thanks all who responded to my recent USA Today piece, Patient-satisfaction surveys have drawbacks.
But in a letter published in the paper yesterday, a reader from Oklahoma City was quite unhappy with my take.
Mark R. Heaton writes, somewhat angrily:
Dr. Kevin Pho’s recent opinion piece was not only arrogant but also grossly naive.
His basic premise was twofold:
• Doctors know best and should therefore ignore patient feedback regarding possible tests and treatments.
• …
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Patient input in their treatment should be valued by doctors
As correctional health care professionals, there may be times when we are tempted to conduct ourselves in a less than professional manner simply because we can.
We may be able to get away with speaking to our patients rudely, using profanity profusely, or wearing inappropriate clothing. After all, we work in jails and prisons. This culture is far from prim and proper. And, our patients are inmates. Many may tolerate misbehavior …
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Professionalism matters in correctional health care
Originally published in MedPage Today
by Kristina Fiore, MedPage Today Staff Writer
Taxing junk food may help reduce obesity and improve health, researchers have found.
Patients got significantly less of their energy (calories) from soda or pizza when there was a 10% increase in the price of either (P<0.001), Penny Gordon-Larsen, PhD, of the University of North Carolina at Chapel Hill, and colleagues …
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Taxing junk food may improve your health
At my office we provide care for a fair number of patients without medical insurance. Sometimes we are faced situations with no good options.
At a patient visit, often times the diagnosis is not clear without doing some diagnostic tests other than the history and physical exam. Many of these tests are ordered from sources outside the office, where I have little or no control over the cost of the test …
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Patient costs when making medical decisions
A number of respected physicians have called for a renewed emphasis on the physical exam. Perhaps most prominently, Abraham Verghese has joined with colleagues at Stanford University to publicize the Stanford 25, a list of physical-exam maneuvers that they hold should be required of internal medicine residents.
These calls reflect in part the fear that checklist medicine will lead to doctors’ obsession with what Jerome Groopman calls the “iPatient” (the …
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Physical exam evidence and whether it’s still useful
When I make rounds with my students and interns, I always try to sneak in a poem at the end. I think poetry is important because it helps convey the parts of the medical experience that don’t make it into textbooks. It’s important because it teaches creative thinking—something of immense value to doctors.
It’s important because interpreting metaphors is a critical clinical skill in diagnosis; patients’ symptoms often present in metaphorical …
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Poetry that your patient can appreciate
