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.

Extended military deployments to combat areas increase stress, anxiety and depression among families

Kevin

Conditions and Diseases

January 26, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

The longer that U.S. Army soldiers spent in Iraq and Afghanistan, the greater the likelihood that their wives would seek psychiatric treatment, researchers said.

The risk that a woman would receive a new mental illness diagnosis during her husband’s deployment was significantly higher when he was overseas for a year …

Talking to a patient, without a translator, in mutual non-native languages

Danielle Ofri, MD, PhD

Patient

January 22, 2010

“Je m’a…,” I stuttered to Aristede Mezondes, the serious young man in a grey wool overcoat, standing before me with ramrod posture. “Je m’appelle Dr. Ofri.”

There. I’d gotten it out.

The language of Descartes, Voltaire, and Balzac had clearly vacated my cortex. Despite those years of French classes and one brief visit to Paris, “Je m’appelle” was the best I could come up with. And even that was a struggle. Pushed …

Primary care doctors should discuss organ donation with patients

Kevin

Conditions and Diseases

January 21, 2010

Originally published in MedPage Today

by Charles Bankhead, MedPage Today Staff Writer

Primary care physicians rarely discuss organ donation with patients, even though most of the doctors believe organ donation is within the scope of their practice, a survey of primary care physicians showed.

Fewer than 4% of physicians said they discussed organ donation with patients, compared with 30% who discussed end-of-life issues. …

How to prevent diabetes with diet and exercise

Erin Marcus, MD

Conditions and Diseases

January 20, 2010

By all accounts, Frances Vasquez ought to be a diabetic. Raised on a diet of fried steak, fried pork chops and lots of rice, her father, mother, and two sisters suffered from the disease. At age 47, Frances was overweight and already experiencing high blood sugar.

But over the past 11 years, Frances has been able to avoid diabetes, and her sugars are now normal. By participating in a ground-breaking, government-funded …

Did Martha Coakley kill health reform, and what Senator Scott Brown means for healthcare

Kevin

Health Policy

January 20, 2010

In case you haven’t heard, in a stunning result in yesterday’s special election in Massachusetts, Republican Scott Brown won the Senate seat previously occupied by the late Edward Kennedy.

Needless to say, pundits are going crazy analyzing the results, and its implications on health reform. I’ll leave the political commentary to them, but I’ll comment on what this means for health reform’s future.

In essence, what turned into a 95% likelihood …

Good doctors sometimes may make patients unhappy

Edwin Leap, MD

Physician

January 18, 2010

Most of us went into medicine because, in addition to being good students, we wanted to help people. How many oceans of ink and forests of paper have been used explaining that point to admissions committees we’ll never know. Suffice it to say, it felt very good when our professors wrote us glowing letters of recommendation. Of course, we were also saying, “I want to feel good about helping people. …

How a doctor’s office can affect patient trust

Kevin

Patient

January 17, 2010

Originally published in MedPage Today

by Marianne Mattera

Trust is an essential element in the doctor-patient relationship.

You’re well aware of how important it is that you can trust the history the patient gives you. You know the problems that can arise in planning and managing care if you’re working with only part of the story. And you probably even feel a twinge …

How psychiatrists may be giving their patients too many drugs

Kevin

Medications

January 16, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Psychiatrists who prescribe drugs for their patients today usually give more than one at a time, often with little scientific basis, researchers said.

About 60% of patients with psychiatrist office visits leading to a drug prescription received at least two medications in 2005-2006, according to government survey data analyzed by Ramin …

How bad patient outcomes affect physicians

Shantanu Nundy, MD

Physician

January 16, 2010

Ms. FR didn’t look so great even when I first met her. She had been admitted to the hospital three times in past 6 weeks for nausea/vomiting and generalized malaise. While the cause of her acute illness was not entirely clear, we suspected that her widely metastatic breast cancer had something to do with it.

By the time I met her she had already been in the hospital for 1 week. …

We are becoming a nation of people with multiple chronic diseases

Kevin

Patient

January 15, 2010

by Monte Ladner, MD

Many Americans are resolving that this will be the year they finally lose weight. Sadly, most of them will reach the end of 2010 heavier than when they started. We continue losing the weight loss game because our efforts are misplaced. The issue is lifestyle.

Dr. Dana King of the Medical University of South Carolina recently published two papers on the erosion of American lifestyle …

What will the next big medical advance be?

Kevin

Medications

January 14, 2010

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

It’s tough to make predictions, especially about the future.

That famous observation from baseball great Yogi Berra applies in spades to medicine.

What technological advance or new insight will shape the next few years? As Yogi noted, it’s tough to predict:

It could be — as Leif Ellisen, MD, PhD, thinks — tumor genotyping.

Why doctors in the United States order so many CT scans and MRI tests

Kevin

Conditions and Diseases

January 13, 2010

It’s commonly thought that health care in the United States is heavily dependent on diagnostic testing.

But how do we compare with the rest of the world? Perhaps these graphs, courtesy of the New York Times can provide a stark illustration.

Here’s the data regarding CT scans, showing the number of tests per 1,000 people. Guess which country’s on top:

Why I had to fire my primary care doctor

Susan Giurleo, PhD

Physician

January 12, 2010

I like my PCP. She is knowledgeable, kind, efficient, and trusts that I know my body best. All great qualities in a doctor.

But I need to fire her and find someone new. Why? Her support staff and their administrative systems don’t work for me. They make it difficult for me to access timely care and I dislike that very much.

Some background: I rarely visit the doctor. Overall, I’m healthy and …

Protecting the security of electronic patient data

David Harlow

Health Technology

January 12, 2010

Originally published on HCPLive.com

If your patient records aren’t already stored digitally, they are likely to be digitized soon. There is a tremendous push by the federal government—as well as by some private payors and self-insured employers—to get all healthcare providers wired in the near future, in order to better coordinate patient care, improve outcomes, and “bend the cost curve” all at the same time. There are some financial incentives in …

How sleeping late can lead to depression in teenagers

Kevin

Conditions and Diseases

January 12, 2010

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Later parent-set bedtimes and correspondingly shorter sleep durations appear to be related to the development of depression in adolescents, a cross-sectional analysis showed.

In addition to depression, adolescents with later bedtimes also had a greater risk of having suicidal thoughts, James Gangwisch, PhD, of Columbia University in New York City, and …

National Influenza Vaccination Week: Time to take stock of our influenza vaccination efforts

Kevin

Conditions and Diseases

January 11, 2010

The following is part of a series of original guest columns by the American Medical Association.

by Nancy H. Nielsen, MD

Back in September, I wrote in this space about ways physicians can prepare their practices to handle this challenging flu season and mentioned the importance of vaccination for all health care professionals. Today as National Influenza Vaccination Week begins, this is an excellent opportunity to remind ourselves, …

How a psychiatrist can write 100,000 prescriptions a year, and what that means for primary care

Matthew Mintz, MD

Physician

January 8, 2010

The Miami Herald is reporting an investigation of a psychiatrist who wrote almost 100,000 prescriptions a year. Sen. Grassley and the feds have halted payment to this Miami psychiatrist who stated that “he prescribes only what is medically necessary” and “works long hours, seeing patients for 10 minutes at a time and many of his patients need four or five medications.”

I have no personal knowledge, interaction, acquaintance with psychiatrist Dr. …

How similar is pandemic H1N1 influenza to the seasonal flu?

Kevin

Conditions and Diseases

January 8, 2010

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Pandemic H1N1 influenza behaved much like seasonal and previous pandemic flu viruses in an early, isolated outbreak at a New York City high school, researchers found.

Natural history and transmissibility characteristics were similar in an April outbreak that sickened about 800 students and staff members, according to Justin Lessler, PhD, …

Linking the USPSTF mammogram guidelines to their virtual colonoscopy recommendations

Kevin

Conditions and Diseases

January 7, 2010

by Mark E. Klein, MD

“I think anytime you use science to kind of fundamentally change what people are used to, I think it’s a difficult thing to grapple with.” So spoke Ned Calonge, chair of the United States Preventive Services Task Force (USPSTF) in explaining the reaction to that group’s recommendation to radically alter their previous guidelines for breast cancer screening. Regrettably the incorrect application of science, as in …

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