Katie had always come to clinic in an anxious and frazzled state. Hair blond hair disheveled, large handbag open, items at the verge of spilling out. Yet she came, dutifully, to meet her counselor, to attend group therapy, to get vitals checked by her nurse, then to drop off a urine sample. But not today. Nor did she return to clinic over the next three weeks. Katie was found by …
The tragedy of opioid addiction in the young and homeless
A strong wind would have knocked Geraldine to the ground. At 78 pounds, she was underweight, chronically ill, and in need of acute medical or psychosocial care every time she came to the clinic. A survivor of domestic violence with severe mental illness, she had a history of substance abuse and was infected with both HIV and Hepatitis C. In chronic pain but too high a risk to prescribe opioids, …
Why we are #ProudtobeGIM: A general internal medicine top 10 list
It occurred to me towards the end of our conversation that there was a large gaping hole. We had talked about physician burnout, career choices, and his current plans. He had drawn a map of his future. It originally shot like a straight arrow towards clinical medicine, but now veered precipitously. I took a moment to first clear my thoughts, and then my throat.
Medicine, I explained, is still as …
Medicine can still be noble. If we fight for it.
Studies show over and over again that empathy is the key to physician-patient communication and is directly related to patient satisfaction, adherence to medical treatment, lawsuits, and clinical outcomes. Yet despite its importance, many doctors still struggle with showing empathy.
The reality is that while most medical students start school with high levels of empathy, it doesn’t take long before that empathy is beaten out of us. Studies show …
Can you fake empathy until it becomes real?
On July 3, 2015, at approximately 2:00 a.m., I was awakened by my mobile phone ringing. I looked at the number the call was originating from and was fearful this was the call I was dreading to receive. My mother’s long-term care facility was calling, and the news was not good. My mother was found without a pulse and was rushed to a local hospital.
I called the emergency department of …
3 ways to improve your delivery of bad news to patients
Compassion. Once upon a time, I had a lot of it. I guess I still do, or I wouldn’t be at this desk.
I think most medical students start out that way. We want to help the sick, heal the wounded, decrease suffering. All that stuff we once wrote in the “personal statement” section of the universal med school application. And believed.
A friend …
Medicine can suck the compassion out of you. But I still give it my best shot.
I’ve been thinking about this over the last ten and a half years since my soul mate had a cardiac arrest and died. He was 38 and as fit as a fiddle. I am a rural general practitioner in South Australia (family practitioner in American parlance). He left behind four kids (from his previous relationship), and me with a broken heart. We had been together a little over two years.
Western …
6 reasons why doctors grieve differently
While studying for a certification exam, I came across a question that stayed with me well after taking the practice test. The case discussed a patient who was prescribed antibiotics by his physician for a presumed bacterial illness and then returned the following week with an antibiotic-associated diarrheal infection. The test question then asked what could be concluded from this case. The answer: informed consent (i.e., patient permission for a …
Discussing the side effects of medications: How can doctors do better?
A trip to the doctor’s office usually isn’t something we look forward to. Many people have shared their frustrations with me regarding their experiences with doctors, and it occurred to me that there are many things that go on behind the scenes that people may not realize. Here are five things to know to help you avoid having a disappointing experience.
1. Doctors want to be able to spend more time with you. Frustrated on having to wait …
Before visiting the doctor, consider these 5 things you may not know
Ask physicians across the country what problems they want solved, and they won’t hesitate to tell you. They worry about the growing health risks they observe in patients based on lifestyle choices, obesity and a variety of social factors that they feel powerless to change. Ask what they would modify if they had a magic wand, and they’ll point to the illogical, problematic and increasingly complex reimbursement schemes still favored …
4 ways to improve the lives of doctors and their patients
Being your doctor is exhilarating.
Every day I wake up to a schedule brimmed with purpose. The door of my office is a portal into the richness of the human experience. I become a thread in the tapestry of other’s lives. I bear witness to the joy and pain, laughter and heartache, and mundane daily routine.
I spend my days bouncing between art and science. Paid to be the wily detective, my …
Being your doctor is exhilarating. Being your doctor is excruciating.
Sixty years ago, before he became a controversial figure in the field of psychiatry, Dr. Thomas S. Szasz co-authored an article for the Archives of Internal Medicine (now JAMA Internal Medicine) on “The Basic Models of the Doctor-Patient Relationship,” which is well worth reading today, particularly for those who believe that patient empowerment/engagement is a novel and disruptive innovation of our digital times.
The paper is describing …
How can we measure the doctor-patient relationship?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
An 84-year-old man is evaluated for a 5-day history of rhinitis, nasal congestion, sneezing, and nonproductive cough. The symptoms began with a sore throat, which resolved after 24 hours. He has mild ear pain when blowing his nose or coughing. He has a history of coronary artery disease and hypertension. Medications are …
Test your medicine knowledge: 84-year-old man with cough and nasal congestion
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What is the difference between a health care system and a Burger King? In a health care system, you can’t always have it your way.
At some point in our training, most physicians are introduced to the Institute of Medicine’s landmark report on Crossing the Quality Chasm. The report outlines 6 key elements that are necessary for providing high-quality care: safety, timeliness, effectiveness, efficiency, equitability and patient centeredness. Although I recognize …
Is patient-centered care part of the problem?
Let me be the first to admit that my mind’s internal and unspoken dialogue produces scathing critiques of the people whose behavior or ideologies are divergent from my own. This isn’t to say that I intentionally treat anyone differently because of personal differences that I observe.
On the contrary, I make a conscious effort to make my actions and spoken words consistent among everyone with whom I interact, particularly when I’m …
Judging without judging is the physician’s paradox
I have a long history with family medicine as my father was an early pioneer – heading up the family medicine program at Chicago’s Cook County Hospital in the 1970s. Even back then my dad was using physician assistants (PAs) — many of them former military medics in the Vietnam War era — who were part of what was at that time a brand new profession.
Family medicine as a whole …
Why physician assistants are critical as health systems evolve
Dr. Google has been the brunt of numerous jokes and various denigrations from the medical community for some time. The most recent such offering to come to my attention was from Tanya Feke who seems to want Dr. Google sued for malpractice. As one who was instrumental in the construction of the Internet, which allowed the creation of Dr. Google, I read these attacks with mixed emotions. I …
Dr. Google is in the house. All hail Dr. Google!
The job of being a doctor can sometimes be like that of your favorite sidewalk juggler. It used to be that a good family doctor would have to show up in the clinic for a couple of hours, make a few house calls, and be available if anyone needed him while he played a round of golf in the afternoon. (Really, this is quite an exaggeration but it sets the …
This story will show you how doctors are like sidewalk jugglers
1. Be nice to others, even if there are a lot of butt sniffers out there.
2. Waiting to be seen is really hard. Try to keep a schedule and routine.
3. Get out for that walk. It will fill you with joy, well-being and makes the rest of the day calmer. Take other dogs on that walk to improve their well-being too.
4. “Good …
25 things my dog taught me about medicine
A guest column by the American College of Physicians, exclusive to KevinMD.com.
I love pre-visit planning.
OK, “love” may be too strong a word — I like pre-visit planning. Pre-visit planning isn’t new. Many of you have done it for years, even before it had a name, for example when pre-ordering labs before a visit.
I did not begin …
How pre-visit planning saves time and helps the bottom line
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