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.

Op-ed: Not all screening tests lead to early, better treatment

Kevin

Conditions and Diseases

April 23, 2009

The following op-ed was published on April 23rd, 2009 in the USA Today.

As a primary care doctor, it’s heartening to hear President Obama call for “the largest investment ever in preventive care.” That means more people, for one, will be undergoing tests to screen for various forms of cancer. But this might be one of those cases where what sounds like common sense is actually more …

6 top medical comments, April 19th 2009

Kevin

Uncategorized

April 19, 2009

Here are some of the more interesting comments readers have left recently.

1. Manalive on quality measures:
It is almost always a leap of faith to apply evidence-based guidelines to the frail elderly, to patients with many medical problems, to alcoholics, to the poorly insured — in short, to a large percentage of my practice. Accordingly, I have been on the wrong end of too many …

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6 top medical comments, April 19th 2009

5 top medical comments, April 12th 2009

Kevin

Uncategorized

April 12, 2009

Here are some of the more interesting comments readers have left recently.

1. Dr. Gwenn on limited health literacy:
For us to do a better job with patients and teach them to be better advocates for themselves, we need more time – plain and simple. At the same time, patients need more community supports to understand the complex health world and build the skills they need …

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5 top medical comments, April 12th 2009

Most hospitalists are good, but some, like these ones, aren’t

Kevin

Physician

April 1, 2009

It’s a well known phenomenon that hospitalists are taking over inpatient medicine.

And no wonder, the payment system strongly discourages newly minted doctors to practice outpatient medicine, and the demand that hospitals have for inpatient physicians is surging at an unprecedented rate.

It’s a good time to be a hospitalist, but, as this reader writes to me, that may lead to an increasingly variability in the quality …

Op-ed: Unbiased research for doctors is good medicine

Kevin

Health Policy

March 26, 2009

The following op-ed was published on March 26th, 2009 in the USA Today.

As a primary care doctor, I am frequently faced with decisions where the choice is not always clear. Do the latest, more expensive drugs work better than the less costly, older medications? Will ordering an MRI help me treat a patient’s lower back pain? Often, the answer to these questions is, “I’m not sure.”

Because …

Is Natasha Richardson brain dead? Was an epidural bleed, or “talk and die” syndrome, to blame after her ski accident?

Kevin

Physician

March 18, 2009

Tragic news this morning regarding actress Natasha Richardson, who reportedly, suffered a head injury during a ski lesson in Canada.

According to reports, she fell on a beginner’s ski hill, and did not hit anyone or anything during the fall. There was no obvious sign of injury, and in fact, she was “was walking around and feeling fine for an hour after her accident.”

Things then …

Will reforming the malpractice system be a deal breaker for health reform?

Kevin

Physician

March 17, 2009

In a surprise, President Obama has signaled a willingness to discuss medical liability as part of the health reform process.

Good for him for standing up to the trial lawyers, a core constituency of the left.

That’s a good sign, as the costs of defensive medicine brought on by the broken malpractice system, should be addressed if there is any hope of reducing health care spending.
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Will reforming the malpractice system be a deal breaker for health reform?

Will patients or doctors be the biggest obstacle impeding health care reform?

Kevin

Health Policy

March 10, 2009

If both patients and doctors don’t accept the changes required of their behavior, no amount of comparative effectiveness studies will cut health care spending.

Two prominent medical journalists write as much in their respective blogs.

First, the NY Times’ Tara Parker-Pope notes that patients have to realize that, yes, they should demand the best care possible. However, that means, “we will have to accept that ‘best’ …

Relative value units, and how the RVU payment system doesn’t allow doctors to practice good medicine

Kevin

Health Policy

March 5, 2009

For those who don’t know, every piece of work that a doctor performs is quantified and measured.

The base unit of physician work is known as the relative value unit (RVU). Most physician salaries are determined by the amount of RVUs a doctor produces in a given year, and in most cases, can range between$35 and $45 per RVU in primary care, depending on geographic location and …

Op-ed: Pads, pens, prescriptions

Kevin

Medications

February 26, 2009

The following op-ed was published on February 26, 2009 in the USA Today.

Have you ever noticed the pens, coffee mugs and prescription pads at your doctor’s office? Chances are, they were prominently adorned with the brand name of the prescription drug its company is touting.

The pharmaceutical industry has been giving these types of small gifts to doctors for years, in hopes of raising physician awareness of …

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Op-ed: Pads, pens, prescriptions

Op-ed: More coverage requires more doctors

Kevin

Health Policy

February 25, 2009

The following op-ed was published on February 25th, 2009 in The New York Times’ Room for Debate blog.

With the number of the uninsured having risen to 48 million Americans, clearly the need for reform is dire. But President Obama made no mention of who exactly will take care of these patients, even if they get insurance under a successful health reform initiative.

As a primary care physician in southern New …

Ways you can die from having sex

Kevin

Potpourri

February 17, 2009

Cosmo Magazine, that bastion of reliable medical advice, declares, “An orgasm almost killed her.”

Intrigued, gynecologist Amy Tuteur reads further, and finds its about case where a woman developed stroke-like symptoms after intercourse, and was diagnosed with an embolic stroke.

The patient was taking the birth control pill, which can raise the risk of blood clots. In this case, it was also combined with the presence of …

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Ways you can die from having sex

Her hands and feet amputated, a Brazilian model dies from Pseudomonas aeruginosa sepsis. What happened?

Kevin

Uncategorized

January 25, 2009

Mariana Bridi da Costa, a 20-year old Brazilian model, tragically died early Saturday morning from Pseudomonas aeruginosa urosepsis.

How can this happen?

Miss Bridi da Costa initially presented on December 30th, and was diagnosed with kidney stones. An ultrasound, plain film, or CT scan likely would have been done to confirm the diagnosis. I assume that a urinalysis was also performed, and if …

Op-ed: Medicare’s mistake

Kevin

Health Policy

January 14, 2009

The following op-ed was published on January 14th, 2009 in the USA Today.

Every patient’s worst nightmare is going to the hospital for a procedure only to have a surgical instrument left in his body, the wrong limb or organ operated on or, worse, dying from a medical mistake. These types of mistakes should never happen.

So when Medicare recently instituted a plan to deny hospital payments for …

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Op-ed: Medicare’s mistake

Doctors are not gods: a surgeon on empathy with patients

Sid Schwab, MD

Physician

June 15, 2008

There’s an old joke about a guy waiting in line at the Pearly Gates, slowly working his way forward to sign in with St. Peter. Wearing a white coat, carrying a black bag and with a stethoscope slung around his neck, a man walks past those in line and is waved right into Heaven. “Hey, what’s up with that?” asks the guy in line. “How come that person gets to …

Humor in medicine: why laughter helps patients open up

Rob Lamberts, MD

Physician

April 25, 2008

The following is a reader take by Dr. Rob.

I don’t remember why he came to see me on that day. He was anxious on most of his office visits, so I had to spend most of my time dealing with his surplus of symptoms. As I walked in to see him on this day, he started rapidly hitting two fingers of against the top …

What “take 2 tablets twice daily” really means on a label

Kevin Pho, MD

Medications

July 31, 2007

What does that mean to you? More patients than you think are confused by drug labels:

Did that mean a total of two, or a total of four? A third of patients who were deemed literate got confused. A more clear instruction would be: “Take two tablets in the morning and two tablets at night.”

The fix is not complicated. When I write a prescription, I spell out how …