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.

7 ways inmates can receive quality medical care from doctors

Patient
March 12, 2010

Many non-correctional health care providers will also treat inmates from time to time. This may occur in the office or hospital. How can one best approach the challenges of working with the incarcerated in order to deliver the best possible care while simultaneously managing risk?

1. Treat the patient with respect. Not submissive respect, but mutual respect — the way we all want to be treated. I believe that this principle …

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7 ways inmates can receive quality medical care from doctors

Help doctors to best care for their patients

Patient
March 10, 2010

Part four of a series. See also parts one, two, and three.

When dealing with your doctor’s biases, you have on your side a fact I firmly believe to be true: most doctors want to do a good job and help their patients as best they can. So what exactly can you do to maximize your doctor’s ability to help you?

1. Position your symptoms and requests carefully. Don’t demand medications …

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Help doctors to best care for their patients

Evidence and the Eastern paradigm of medical treatment

Conditions and Diseases
March 7, 2010

Remember the trial a couple of years ago that showed that group support participation was associated with prolonged survival among women with metastatic breast cancer?

I’ve thought a lot about that over the years. Isn’t it interesting that something as simple as a supportive environment can make a difference in what researchers consider to be the hardest endpoint there is: survival? In our dualistic view of the human organism, we think …

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Evidence and the Eastern paradigm of medical treatment

Transgender patients face significant challenges in prison

Patient
March 2, 2010

Imagine that as a child you thought you had been born in the body of the wrong gender. If you were biologically male, in your mind you really thought of yourself as female. Likewise, if you were born in a girl’s body, you thought that you were actually a boy.

Yes, you were probably more interested in children’s role-playing games more often associated with the opposite gender as well, but the …

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Transgender patients face significant challenges in prison

A nurse practitioner is valuable in hospice and palliative care

Patient
February 28, 2010

by Patrice Villars

Recently, a physician colleague expressed her concern about signing routine hospice admission orders for her elderly patient with end stage heart failure. The routine ‘as needed’ (PRN) orders included phenobarbital, pentobarbital, haloperidol, lorazepam, and morphine. “The hospice nurses know more about this than I do, don’t they?” she said.

Yesterday, a longtime palliative care nurse told me she didn’t want to put her mother with end stage heart …

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A nurse practitioner is valuable in hospice and palliative care

A beautiful Valentine’s Day patient story

Patient
February 28, 2010

“I’ll be back in a little while, Hon’. Will you be okay without me?” the frail old woman asked of her husband. She was standing at the front door and breathing heavily.

“I’ll be fine,” her husband replied from his wheelchair. His voice sounded as weak as his body looked – emaciated, scaly, and full of cancer. “I’m sorry I can’t come with you.”

The woman opened the front door. A gust …

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A beautiful Valentine’s Day patient story

How patient comments will affect your physician practice

Physician
February 27, 2010

Originally published in HCPLive.com

by Owen Dahl and Altamash Rahman

“Her MA is very rude, uncompassionate. Dr. ABCD doesn’t return phone calls. They’re not helpful and not good with following up with the care plan for patients. We’re new seeing this doctor, but will never go back. I would not recommend this practice at all!!!!!!”

How would you handle a comment like this when …

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How patient comments will affect your physician practice

Condoms don’t work all the time, and here’s why

Patient
February 26, 2010

Originally published in MedPage Today

by Chris Emery, MedPage Today Contributing Writer

Condoms that don’t fit properly are more likely to break, slip off, and decrease the pleasure of both partners during sex, which may discourage their use and undermine their public health benefits, a survey found.

Ill-fitting condoms were reported by 44.7% of the men polled. They were more likely than …

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Condoms don’t work all the time, and here’s why

End-of-life decisions and making advance directive choices

Patient
February 22, 2010

Originally published in MedPage Today

by Crystal Phend

“I do not want my life to be prolonged if, to a reasonable degree of medical certainty, my situation is hopeless.”

“I want my life to be prolonged as long as possible within the limits of generally accepted medical standards, even if this means that I might be kept alive on machines for years.”

Check …

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End-of-life decisions and making advance directive choices

How to better notify patients of their abnormal test results

Patient
February 16, 2010

I just returned from vacation to find email messages from three patients inquiring about their recent test results.

The first email was from a young man who had fainted and underwent Holter monitoring, a test that checks for abnormal heart rhythms. The second was from a woman I recently started on cholesterol-modifying therapy who wanted to know whether her recent blood work showed a satisfactory improvement in her cholesterol. The third …

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How to better notify patients of their abnormal test results

Why The Biggest Loser uses CT scans to help contestants lose weight

Conditions and Diseases
February 15, 2010

Originally published in MedPage Today

by Cole Petrochko

The train wreck has become an integral part of reality TV programming, and that’s terrible. As much as I’ve learned on the internet about the “Snooki Punch” fiasco from MTV’s Jersey Shore, there’s little to watching a household of adults thrown together under a wacky premise turn into overgrown, throat-seeking children under lights and a camera, except on the one-season CBS show Kid …

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Why The Biggest Loser uses CT scans to help contestants lose weight

Thoughts from a doctor attending a patient funeral

Patient
February 12, 2010

On the way to the funeral you wonder how you’ll be received by the grieving. Although you are confident that your care for the deceased was sincere, professional, and adept, you still question if others will so assume. There is silence in the car. This is a trip you make alone.

You manage a bitter smile as you recall stories the patient shared in unguarded moments, behind the door of a …

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Thoughts from a doctor attending a patient funeral

Neuroscience explains why changing addictive behavior is so difficult

Conditions and Diseases
February 12, 2010

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

By the end of January, many New Year’s resolutions have been tossed out with the leftover holiday cookies. That’s because change is hard — and neuroscientists are learning why.

Advances in neuroimaging have enabled researchers to peer inside the brains of addicts and patients with addictive behaviors. They can see in …

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Neuroscience explains why changing addictive behavior is so difficult

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When doctors can’t figure out what’s wrong with a patient

Conditions and Diseases
February 10, 2010

Part one of a series.

The first patient I ever saw as a first year resident came in with a litany of complaints, not one of which I remember today except for one—he had headaches. The reason I remember he had headaches isn’t because I spent so much time discussing them but rather the opposite: at the time I knew next to nothing about headaches and somehow managed to end the …

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When doctors can’t figure out what’s wrong with a patient

Not enough patients receive vaccines and what doctors can do about it

Medications
February 9, 2010

Imagine a world where consumers all knew about the latest developments in preventive health.

Earlier this month the Advisory Committee on Immunization Practices (ACIP) released the 2010 immunization schedules. Revised annually, the immunization schedules are what doctors in the U.S. use to decide who should be immunized against what diseases. Far from esoteric, the schedules pertain to every single person living in the United States. If the H1N1 pandemic and subsequent …

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Not enough patients receive vaccines and what doctors can do about it

The power of a doctor’s choice of words in explaining CPR

Conditions and Diseases
February 8, 2010

Words have power. Language has power.

The words we use may comfort or shock, allay or provoke, sooth or batter. Words often imply layers of meaning that are not explicitly articulated, yet rest beneath the surface:

“I worry that time is short for you” (You are dying) (I care about you)

“I wish we could have done more” (Nothing would have changed her death) (I am on your side)

“I hope with you that …

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The power of a doctor’s choice of words in explaining CPR

A comprehensive plan to fight obesity begins at an early age

Conditions and Diseases
February 2, 2010

Originally published in HCPLive.com

by Jeffrey Gene Kaplan, MD, MS

In a given year in the U.S., 1/4th of US men and 2/5ths of US women attempt to lose weight, unfortunately, they often fail to keep the weight off.

Sobering statistics that we see all around us, particularly poignant in my office as a pediatrician. Clearly a multifaceted approach is required, but the most …

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A comprehensive plan to fight obesity begins at an early age

How the stress of caregiving can lead to stroke

Conditions and Diseases
January 31, 2010

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

The strain of caring for a disabled spouse is associated with an increased risk of stroke, researchers found.

The risk is increased for men, and especially African-American men, according to William Haley, PhD, of the University of South Florida, in Tampa, and colleagues.

On the other hand, there was no significant …

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How the stress of caregiving can lead to stroke

Will New York’s ban on salt really make patients healthier?

Conditions and Diseases
January 29, 2010

Originally posted in MedPage Today

by Mike Himowitz

I have a libertarian streak that compels me to shout “Nanny State!” when local governments put up speed-trap cameras to extort money from otherwise law-abiding citizens who drive a few miles over artificially low limits. Same for legislators who want to make me a criminal for calling my wife on my cell phone to ask her if I should pick up anything at …

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Will New York’s ban on salt really make patients healthier?

How should patients decide which hospitals are best for them?

Physician
January 26, 2010

Johns Hopkins Hospital is consistently named one of the best in the country. I can’t disagree with that; after all, I just started working there as an internist in September. Coincidentally, in the midst of the raging debate around health care reform, the past few months have seen increasing discussion of a small but crucial question: why do some of the best hospitals spend more money than others? If other …

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How should patients decide which hospitals are best for them?

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