MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'doctor patient communication'. Sat, 03 Sep 2011 02:32:25 +0100 http://www.medworm.com/index.php?rid=5181799&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fimproving-doctor-patient-communication-to-provide-patient-centered-care%2F2011.09.01 The first experience patients are likely to have with your hospital is not in an ER visit or inpatient stay.  A patient’s first experience will most likely be in one of your primary-care physician offices.  That because a person is 10 times more likely during a year to end up in the physician’s office for a routine visit than they are to require an overnight hospital stay. As a hospital marketer or patient experience officer this should raise an interesting question. How well do your physicians–particularly your primary-care physicians–represent your brand? Take “patient-centeredness.” Lots of hospitals these days are promoting themselves as providing patient-centered care.  You know … when the hospital and its staff try where possible to be sensitive to and honor the wish... Better Health blogs http://www.medworm.com/rss/comments.php?id=5181799 Thu, 01 Sep 2011 18:00:05 +0100 5181799 http://www.medworm.com/index.php?rid=5169553&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fgreat-clinical-care-and-excellent-bedside-manner-are-they-mutually-exclusive%2F2011.08.26 The New York Times recently published an article titled, Finding a Quality Doctor, Dr. Danielle Ofri an internist at NYU, laments how she was unable to perform as well as expected in the areas of patient care as it related to diabetes.  From the August 2010 New England Journal of Medicine article, Dr. Ofri notes that her report card showed the following – 33% of patients with diabetes have glycated hemoglobin levels at goal, 44% have cholesterol levels at goal, and a measly 26% have blood pressure at goal.  She correctly notes that these measurements alone aren’t what makes a doctor a good quality one, but rather the areas of interpersonal skills, compassion, and empathy, which most of us would agree constitute a doctor’s bedside manner, should count as well. Her articl... Better Health blogs http://www.medworm.com/rss/comments.php?id=5169553 Fri, 26 Aug 2011 14:00:00 +0100 5169553 http://www.medworm.com/index.php?rid=5096205&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwill-patients-accept-the-patient-portal-as-the-next-big-thing%2F2011.08.04 There seems to be an inverse relationship between the amount of spin one hears about “the next big thing”…and reality.    First it was EMRs and virtual e-visits, then social media, and now patient portals seem poised to be next big thing.  The drumbeat of vendors and pundits is unmistakable….physicians that don’t adapt will be toast.   It can all sound pretty convincing until you ask to see the evidence.  What do patients think? Take the physician patient portal.   If you read between the lines, patient portals are frequently being positioned as the new “front door” to physician practices.   By signing on to a secure website patients will have real time access to the electronic health record and will be able to communicate with their physicians by e-mail.   Addit... Better Health blogs http://www.medworm.com/rss/comments.php?id=5096205 Thu, 04 Aug 2011 16:00:59 +0100 5096205 http://www.medworm.com/index.php?rid=5077684&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpatient-empowerment-has-the-potential-to-be-problematic%2F2011.07.29 Let me say first that I am a practicing primary care doctor who is very much focused on patient centered care.  Though I cannot go back to being a patient who is unaware about what a doctor does, the terminology she uses, or what the importance of certain test results are, I can empathize with the overwhelming amounts of information, challenges, and stressors patients and families can have in navigating the healthcare system to get the right care.  This is the reason I wrote my book. However, over the past few months I’ve noticed a particularly disturbing trend.  Patients are not consulting doctors for advice, but rather demanding testing for diagnoses which are not even remote possibilities.  A little knowledge can be dangerous particularly in the context of little to no clinica... Better Health blogs http://www.medworm.com/rss/comments.php?id=5077684 Fri, 29 Jul 2011 21:00:00 +0100 5077684 http://www.medworm.com/index.php?rid=5057721&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fone-physician-learns-to-efficiently-manage-her-electronic-medical-records%2F2011.07.23 My practice has been using the EPIC electronic medical record for 5 years now, and it’s taken about that long for me to figure out how to tweak the system to make myself more efficient, and for the system to evolve to a place where I could tweak it myself. Case in point – Quick Actions. EPIC’s most recent upgrade includes little self-made macros called “quick actions” that turn repetitive tasks into a mouse click. I’m using quick actions to manage my results in basket in much the same way you may be using Rules in Outlook to manage your email. Some of my macros are actually little work-arounds for a system that is not yet entirely integrated and a patient population that has not yet embraced online results communication. About half of my patients sign up for online results – ... Better Health blogs http://www.medworm.com/rss/comments.php?id=5057721 Sat, 23 Jul 2011 19:00:03 +0100 5057721 http://www.medworm.com/index.php?rid=5057726&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fhealthecommunications.files.wordpress.com%2F2011%2F07%2Ftime-and-money.jpg “I don’t have the time…I don’t get reimbursed for that.”  This is an all too common refrain from primary care physicians and practice managers when ever the subject of improving physician-patient communications comes up. I get it.   Primary care physicians in particular are under tremendous pressure to produce.   Just imagine…physicians in small primary care practices spend about 3.5 hours/week just on dealing with insurance-related paperwork.  Then there’s keeping up with recommended treatment guidelines, journals, and IT issues and routine staffing issues…not to mention routine patient care, much of which they in fact do not get paid for.  Physicians do have it rough right now. But Doctors Can Sometimes Be Their Own Worst Enemies Currently, in just about every St... Better Health blogs http://www.medworm.com/rss/comments.php?id=5057726 Fri, 22 Jul 2011 18:00:52 +0100 5057726 http://www.medworm.com/index.php?rid=5036235&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fshould-you-find-a-new-doctor%2F2011.07.16 Come  on people… you know what I am talking about.  Sure you are comfortable with your current doctor… after all you are still alive and kicking.  Besides it has taken you years to figure out what you can safely tell your doctor and when it’s ok to speak up.  Yes the fact that your doctor is often late and never seems to listen to you bothers you just a little.  But you aren’t displeased enough to stop giving your doctor high satisfaction scores.  After all who wants to upset their doctor?   But admit it; you have wondered if there isn’t a doctor out there that would be a better fit with you.   I know I have. Doctors probably feel the same way about many of their patients.   It can’t be easy everyday trying to help patients that don’t seem to want to help themselv... Better Health blogs http://www.medworm.com/rss/comments.php?id=5036235 Sat, 16 Jul 2011 14:00:02 +0100 5036235 http://www.medworm.com/index.php?rid=4952844&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fhealthecommunications.files.wordpress.com%2F2011%2F06%2Fsatisifaction1.jpg While by no means a representative sample of how we think about physicians, there is a clear pattern to the comments.  A lot of people feel disrespected by their doctors…and they are pretty angry. Here’s what patients (including a lot of former patients) had to say.  I attempted to summarize the comments by category and included the top five categories of comments below. #1 – “Being on time is a two way street.” – patients are expected to be on time for their appointments – why aren’t physicians expected to be on time.   Doctors think and act as if their time is more valuable than the patient’s time. #2 – “Listen to what I have to say.” “Doctors should realize that many patients have more life experience and have done more research about a cond... Better Health blogs http://www.medworm.com/rss/comments.php?id=4952844 Tue, 21 Jun 2011 12:00:04 +0100 4952844 http://www.medworm.com/index.php?rid=4862545&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-physicians-have-to-say-no-does-patient-satisfaction-suffer%2F2011.05.25 The short answer: No. At least not in the context of a strong physician-patient relationship. Many physicians have legitimate concerns about the prospects of having their salary or level reimbursement linked to patient satisfaction. I would too given the way most health care providers go about measuring and interpreting patient satisfaction data. A major concern of physicians is the issue of patient requests – particularly the impact of unfulfilled (and unreasonable) requests upon patient satisfaction. According to researchers, explicit patient requests for medications, diagnostic tests and specialty referrals occur in between 25% to 40% of primary care visits. This figure is much higher when requests for information are factored in. (more…) *This blog post was originall... Better Health blogs http://www.medworm.com/rss/comments.php?id=4862545 Wed, 25 May 2011 14:00:01 +0100 4862545 http://www.medworm.com/index.php?rid=4794860&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-makes-a-great-oncologist%2F2011.05.06 I had a WOW experience yesterday when I accompanied my wife to interview a new doctor for her.   As some reader may know she is being seen by specialists at MD Anderson Medical Center in Houston for Stage IV lung cancer.   She has not had a local oncologist for the past 6 years…but she does now.   And we both love this guy! You need to understand that I have been very underwhelmed by the local oncologists I had met up till now.   I am sure they were clinically proficient…but as a group not a one could muster a smile….or any sense of interest or curiosity in my wife’s medical condition.  I held out little hope that this new doctor would be any different. After being ushered into the exam room, a Physician’s Assistant came into the room to get smart about my wife’s histo... Better Health blogs http://www.medworm.com/rss/comments.php?id=4794860 Fri, 06 May 2011 13:00:04 +0100 4794860 http://www.medworm.com/index.php?rid=4771024&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-medical-condition-is-the-most-costly-to-employers%2F2011.04.30 Ok…here’s a brain teaser.  What medical condition is the most costly to employers?  I’ll give you a hint.  It is also a medical condition that is likely to go unrecognized and undiagnosed by primary care physicians. If you guessed depression you are correct. If you mentioned obesity you get a gold star since that comes in right behind depression for both criteria…at least in terms of cost and the undiagnosed part. Four out of every ten people at work or sitting in the doctor’s waiting room suffer from moderate to severe depression.  Prevalence rates for depression are highest among women and older patients with chronic conditions.  Yet despite its high prevalence and costly nature, depression is significantly under-diagnosed (<50%) and under-treated by physicians. For em... Better Health blogs http://www.medworm.com/rss/comments.php?id=4771024 Sat, 30 Apr 2011 19:00:08 +0100 4771024 http://www.medworm.com/index.php?rid=4600535&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fenough-about-physician-empathy%2F2011.03.16 Is anyone else tired of hearing about how important empathy is in the doctor-patient relationship? Every other day it seems a new study is talking about the therapeutic value of empathy. Enough already! It’s not that I don’t believe that empathy is important — I do. I also believe the data that links physician empathy with improved patient outcomes, increased satisfaction, and better patient experiences. A recent study released in Academic Medicine reported that “patients of physicians with high empathy scores were significantly more likely to have good control over their blood sugar as well as cholesterol, while the inverse was true for patients of physicians with low scores.” Findings from this study by Hojat, et al. are consistent with a 2009 study by Rakel, et al. which f... Better Health blogs http://www.medworm.com/rss/comments.php?id=4600535 Wed, 16 Mar 2011 19:00:36 +0100 4600535 http://www.medworm.com/index.php?rid=4489678&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedical-aspects-of-the-king%25e2%2580%2599s-speech%2F2011.02.16 Over the weekend I went to see “The King’s Speech.” So far the film, featuring Colin Firth as a soon-to-be-king-of-England with a speech impediment, and Geoffrey Rush as his ill-credentialed but trusted speech therapist, has earned top critics’ awards and 12 Oscar nominations. This is a movie that’s hard not to like for one reason or another, at least most of the way through. It uplifts, it draws on history, it depends on solid acting. What I liked best, though, is the work’s rare depiction of a complex relationship between two imperfect, brave, and dedicated men. At some level, this is a movie about guys who communicate without fixating on cars, football (either kind), or women’s physical features. Great! (Dear Hollywood moguls: Can we have more like this, please?) T... Better Health blogs http://www.medworm.com/rss/comments.php?id=4489678 Wed, 16 Feb 2011 17:00:11 +0100 4489678 http://www.medworm.com/index.php?rid=4472950&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fconsumer-health-information-the-new-third-party-in-the-exam-room%2F2011.02.13 It was sometime in the mid-nineties that parents started showing up in my office with reams of paper. Inkjet printouts of independently unearthed information pulled from AltaVista and Excite. Google didn’t exist. In the earliest days of the Web, information was occasionally leveraged by families as a type of newfound control. A young father and his inkjet printer One case sticks clearly in my mind. It was that of a toddler with medically unresponsive acid reflux and chronic lung disease. After following the child for some time, the discussion with the family finally moved to the option of a fundoplication (anti-reflux surgery). On a follow-up visit the father had done his diligence and appeared in the office with a banker box brimming with printed information. He had done his homewo... Better Health blogs http://www.medworm.com/rss/comments.php?id=4472950 Sun, 13 Feb 2011 16:00:39 +0100 4472950 http://www.medworm.com/index.php?rid=4455263&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fartificial-sweeteners-and-telling-pregnant-women-in-moderation%2F2011.02.09 I can already tell that this pregnancy is different from my first. When I was pregnant with Little Isis, I drank no caffeine and took no over-the-counter medication. I remember having a few headaches and Mr. Isis fighting with me to take a headache pill. I would then proclaim dramatically, “But I can’t! What if it hurts the baby?!” This morning, now pregnant with my second, I washed down a Zyrtec and two Tylenol with a cup of coffee. The little bugger is going to have to grow up with Little Isis. He might as well start building up his tolerance to exogenous substances at some point. I figure, now that its got a closed neural tube and a beating heart, we might as well begin. Still, you can’t blame a pregnant woman for being a bit neurotic. The feeling that one is solely res... Better Health blogs http://www.medworm.com/rss/comments.php?id=4455263 Wed, 09 Feb 2011 20:00:01 +0100 4455263 http://www.medworm.com/index.php?rid=4450294&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdifficult-patients%2F2011.02.08 Physicians see nearly one in five patients as “difficult,” report researchers. Not surprisingly, these patients don’t fare as well as others after visiting their doctor. Researchers took into account both patient and clinician factors associated with being considered “difficult,” as well as assessing the impact on patient health outcomes. They reported results in the Journal of General Internal Medicine. Researchers assessed 750 adults prior to their visit to a primary care walk-in clinic for symptoms, expectations, and general health; for how they functioned physically, socially and emotionally; and whether they had mental disorders. Immediately after their visit, participants were asked about their satisfaction with the encounter, any unmet expectations, and... Better Health blogs http://www.medworm.com/rss/comments.php?id=4450294 Tue, 08 Feb 2011 16:00:00 +0100 4450294 http://www.medworm.com/index.php?rid=4419139&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpossible-5-million-fine-or-prison-for-doctors-who-ask-about-guns-in-the-home%2F2011.01.31 No photo for this post. You can imagine why. I’m a little stunned by the news that a politician in Florida is trying to stifle pediatricians from asking questions about guns in the home. My reaction is utterly predictable. Should I YELL IT or write it down or leave it up to your genius (and imagination)? (silence) The skinny on the Florida proposal: Florida Rep. Jason Brodeur said “he has heard about a number of cases in which doctors asked about guns. He thinks the topic should be off-limits.” Brodeur says he’s concerned about doctors asking patients about guns in the home. He’s concerned that information could get into the hands of the government or insurance companies. Under the proposed legislation, a doctor could face a fine of up to $5 million or be sent to prison for up t... Better Health blogs http://www.medworm.com/rss/comments.php?id=4419139 Mon, 31 Jan 2011 16:00:08 +0100 4419139 http://www.medworm.com/index.php?rid=4386272&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmystery-providers-healthcare-professionals-and-identification-badges%2F2011.01.22 So I’m in the exam room recently with a new patient. After some initial dialog with the child and family, I launched into the business of problem solving. Ten minutes into my history the mother politely asks: “I’m sorry, and you are?…” I hadn’t introduced myself. I had left my ID badge at my workstation, and by order of some innocent distraction with the child or family, I hadn’t identified myself immediately on entering the room. This is rare. Sometimes I assume people will know who I am. But I don’t wear a white coat and my stethoscope is concealed. I wear clothes only good enough to sustain the barrage of regurgitation, urine, full-frontal coughs, and sloppy hugs that mark a successful clinic day. A colleague once told me I dress like an algebra teacher. I haven’... Better Health blogs http://www.medworm.com/rss/comments.php?id=4386272 Sat, 22 Jan 2011 20:00:56 +0100 4386272 http://www.medworm.com/index.php?rid=4382766&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-doctors-feel-about-patients-who-google-their-symptoms%2F2011.01.21 Many doctors roll their eyes whenever patients bring in a stack of research they printed out, stemming from a Google search of their symptoms. A piece by Dr. Zachary Meisel on TIME.com describes a familiar scenario: The medical intern started her presentation with an eye roll. “The patient in Room 3 had some blood in the toilet bowl this morning and is here with a pile of Internet printouts listing all the crazy things she thinks she might have.” The intern continued, “I think she has a hemorrhoid.” “Another case of cyberchondria,” added the nurse behind me. It’s time to stop debating whether patients should research their own symptoms. It’s happening already, and the medical profession would be better served to handle this new reality. According to the Pew Internet and ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4382766 Fri, 21 Jan 2011 14:00:37 +0100 4382766 http://www.medworm.com/index.php?rid=4372044&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-good-is-your-doctor-at-diagnosing-you%2F2011.01.19 We’ve all been there. It often starts with some kind of recurring pain or dull ache. We don’t know what’s causing the pain or ache. During the light of day we tell ourselves that it’s nothing. But at 3:00am when the pain wakes you, worry sets in: “Maybe I have cancer or heart disease or some other life-ending ailment.” The next day you make an appointment to see your doctor. So now you’re sitting in the exam room explaining this scenario to your doctor. Based on your previous experience, what’s the first thing your doctor would do? A. Order a battery of tests and schedule a follow-up appointment. B. Put you in a patient gown and conduct a thorough physical examination, including asking you detailed questions about your complaint before ordering any test... Better Health blogs http://www.medworm.com/rss/comments.php?id=4372044 Wed, 19 Jan 2011 22:00:07 +0100 4372044 http://www.medworm.com/index.php?rid=4361085&cid=t_295132_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F01%2Fpatient-education-in-india-times-of.html (Source: The Patient's Doctor) The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4361085 Mon, 17 Jan 2011 13:33:00 +0100 4361085 http://www.medworm.com/index.php?rid=4355716&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdo-patients-have-clinical-judgment%2F2011.01.16 I used to think they didn’t, but they do. Clinical judgment is the application of individual experience to the variables of a patient’s medical presentation. It’s the hard-worn skill of knowing what to do and how far to go in a particular situation. It’s having the confidence to do nothing. Clinical judgment is learned from seeing lots of sick people. Good clinical judgment is when the gifted capacity of reasoning intersects with experience. Some doctors have better judgment than others. Aristotle called this phronesis – or practical judgment. Patients have practical judgment. We often can tell when something’s amiss with our own body. Things feel different or look different. Taking action on these observations is how we exercise judgment as patients. Parents of chi... Better Health blogs http://www.medworm.com/rss/comments.php?id=4355716 Sun, 16 Jan 2011 23:00:49 +0100 4355716 http://www.medworm.com/index.php?rid=4337934&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-doctors-and-patients-speak-different-languages%2F2011.01.12 I can’t say that I enjoy the patient encounter as much when it involves a translator. There’s just something about communicating through a third party that changes the experience. But there are some things you can do as a provider to bridge the language gap: Look. Even thought the translator is doing the talking, look at the patient just as if you are asking the question yourself. There’s a tendency to let the translator act as a surrogate with respect to eye contact and visual feedback. Smile. A smile doesn’t need translation. It conveys very clearly that have a sincere interest in making a connection. Touch. I never leave the exam room without some type of sincere physical contact. A firm handshake or a hand on the shoulder go a long way in closing the language barrier. Sa... Better Health blogs http://www.medworm.com/rss/comments.php?id=4337934 Wed, 12 Jan 2011 22:00:29 +0100 4337934 http://www.medworm.com/index.php?rid=4337935&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-if-all-patients-were-this-engaged-in-their-health%2F2011.01.12 This video is an excellent testimony of what a truly engaged and knowledgable patient with diabetes looks and sounds like. Kudos to the Mayo Clinic for sharing this wonderful piece about shared decision making. Pay particular attention to the fact that the patient in the video was treated for diabetes by her primary care physician for eight years before being referred to a clearly “patient-centered” endocrinologist. Also note her belief that a patient-centered approach to chronic disease management probably results in shorter, more productive visits in the long run. *This blog post was originally published at Mind The Gap* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4337935 Wed, 12 Jan 2011 20:00:14 +0100 4337935 http://www.medworm.com/index.php?rid=4318331&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcomparative-effectiveness-research-more-can-be-less%2F2011.01.06 Discussion About Comparative Effectiveness Research When the public turns its attention to medical effectiveness research, a discussion often follows about how this research might restrict access to new medical innovations. But this focus obscures the vital role that effectiveness research will play in evaluating current medical and surgical care. I am now slogging through chemotherapy for stomach cancer, probably the result of high doses of radiation for Hodgkin lymphoma in the early 1970s, which was the standard treatment until long-term side effects (heart problems, additional cancers) emerged in the late 80s. So I am especially attuned to the need for research that tracks the short and long-term effectiveness — and dangers — of treatments.  Choosing a surgeon this Septembe... Better Health blogs http://www.medworm.com/rss/comments.php?id=4318331 Thu, 06 Jan 2011 22:00:53 +0100 4318331 http://www.medworm.com/index.php?rid=4302122&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F10-new-years-resolutions-for-doctors-and-patients%2F2010.12.31 #1 Doctor: Resolve to let patients speak without interruption and describe their symptoms. Patient: Resolve to focus on the problem I am seeing the doctor about and not come with a list of 10 complaints for a 15-minute office visit. #2 Doctor: Resolve to keep a pleasant tone of voice when answering night and weekend phone calls from the answering service, patients, or nurses. Patient: Resolve to get my prescriptions filled during office hours, not forget my medications while traveling, and to use night and weekend phone calls for emergencies only. #3 Doctor: Resolve to exercise a minimum of four times a week for better health. Patient: Ditto. #4 Doctor: Resolve to train my staff and model excellent customer service for patients. Patient: Resolve to understand that getting an instant refer... Better Health blogs http://www.medworm.com/rss/comments.php?id=4302122 Fri, 31 Dec 2010 22:00:00 +0100 4302122 http://www.medworm.com/index.php?rid=4272291&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fis-it-bad-patient-behavior-or-poor-doctor-patient-communication%2F2010.12.19 It seem like everyone these days is focused on changing some aspect of patient health behavior. You know — getting patients to get a mammogram or PSA test, exercise more, take medications as prescribed, or simply becoming more engaged in their healthcare. If only we could change unhealthy patient health behaviors, the world would be a better place.   I agree with the sentiment, but I think that patients and their health behavior often get a “bad rap” from healthcare professionals. I would even go so far as to say that much (not all) of what we attribute to poor patient behavior is more correctly attributable to ineffective doctor communications with patients. In my last post I talked about the link between strong physician advocacy, e.g., I recommend, and desirable health outcom... Better Health blogs http://www.medworm.com/rss/comments.php?id=4272291 Sun, 19 Dec 2010 14:00:18 +0100 4272291 http://www.medworm.com/index.php?rid=4251108&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fvideo-the-too-informed-patient%2F2010.12.11 This video, “The Too-Informed Patient,” came my way lately. It’s featured on NPR’s Mar­ket­place website: The Too Informed Patient from Marketplace on Vimeo. —– The pup­peteer skit fea­tures the inter­ac­tion between a young man with a rash and his older physi­cian. The patient is an informed kind of guy: He’s checked his own med­ical record on the doctor’s web­site, read up on rashes in the Boston Globe, checked pix on WebMD, seen an episode of “Gray’s Anatomy” about a rash and, most inven­tively, checked iDiagnose, a hypo­thet­i­cal app (I hope) that led him to the con­clu­sion that he might have epi­der­mal necro­sis. “Not to worry,” the patient informs Dr. Matthews, who mean­while has been try­ing to ex... Better Health blogs http://www.medworm.com/rss/comments.php?id=4251108 Sat, 11 Dec 2010 19:00:28 +0100 4251108 http://www.medworm.com/index.php?rid=4237897&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-best-social-tool-for-doctors-and-patients%2F2010.12.07 We all want technology to improve communication between doctors and patients. We fantasize that social tools will open doors and bridge the expanding divide between doctors and patients. I’m wondering if it’s a case of unicorns and rainbows: Fancy new tools to do the old thing in a less-effective way. I’m guessing that if Facebook was the old platform for doctor-patient dialog and the telephone was invented this year, everyone would be clamoring to use the phone (“Dude, this is amazing…you can hear them talk.”) I like the telephone. Written copy misses intonation, timing, pitch, and all the other rich elements of human speech. Subtle changes in a parent’s voice tell me if I’ve made my point and exactly how I need to proceed [with caring for their child]. Unspoken wo... Better Health blogs http://www.medworm.com/rss/comments.php?id=4237897 Tue, 07 Dec 2010 13:00:50 +0100 4237897 http://www.medworm.com/index.php?rid=4230160&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F5-reasons-why-patients-dont-mention-symptoms-to-their-doctors%2F2010.12.04 To com­plain or “be good” is an appar­ent dilemma for some patients with seri­ous illness. Yes­ter­day I received an email from a close friend with advanced breast can­cer. She’s got a lot of symp­toms: Her fatigue is so over­whelm­ing she can’t do more than one activ­ity each day. Yes­ter­day, for exam­ple, she stayed home all day and did noth­ing because she was sup­posed to watch a hockey game in the evening with her teenage son and other fam­ily mem­bers. Her voice is weak, so much it’s hard to talk on the phone. She has dif­fi­culty writ­ing, in the man­ual sense — mean­ing she can’t quite use her right arm and hand properly. “It’s some­thing I would never men­tion to the doc­tor because it is very sub­tle,” she wrote. “But it has no... Better Health blogs http://www.medworm.com/rss/comments.php?id=4230160 Sat, 04 Dec 2010 21:00:07 +0100 4230160 http://www.medworm.com/index.php?rid=4225250&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fhealthecommunications.files.wordpress.com%2F2010%2F12%2Fphysician-recommendation-styles.jpg “I recommend.” These are two word which, when spoken by a physician to a patient have tremendous power to change behavior. That assumes of course a trusting relationship between patient and physician (but that’s a topic for another day.)   Take the colonoscopy. The U.S. Preventive Services Task Force (USPSTF) recommends that adults aged ≥50 years get a colonoscopy every 10 years. In 2005, 50 percent of adults aged ≥50 years in the U.S. had been screened according to these recommendations. Not surprisingly, the rate of colonoscopy screening is much lower than that of other recommended adult preventive services. I was curious: Why?   Here are two interesting facts: 1. Studies show that patients cite “physician recommendation” as the most important motivator of colorectal sc... Better Health blogs http://www.medworm.com/rss/comments.php?id=4225250 Fri, 03 Dec 2010 15:00:35 +0100 4225250 http://www.medworm.com/index.php?rid=4214108&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Funderstanding-treatment-the-communication-disconnect-between-doctors-and-patients%2F2010.11.30 Over the long week­end I caught up on some read­ing. One arti­cle* stands out. It’s on informed con­sent, and the stun­ning dis­con­nect between physi­cians’ and patients’ under­stand­ing of a procedure’s value. The study, pub­lished in the Sept 7th Annals of Inter­nal Med­i­cine, used sur­vey meth­ods to eval­u­ate 153 car­di­ol­ogy patients’ under­stand­ing of the poten­tial ben­e­fit of per­cu­ta­neous coro­nary inter­ven­tion (PCI or angio­plasty). The inves­ti­ga­tors, at Baystate Med­ical Cen­ter in Mass­a­chu­setts, com­pared patients’ responses to those of car­di­ol­o­gists who obtained con­sent and who per­formed the pro­ce­dure. As out­lined in the article’s intro­duc­tion, PCI reduces heart attacks in patients wi... Better Health blogs http://www.medworm.com/rss/comments.php?id=4214108 Tue, 30 Nov 2010 17:00:42 +0100 4214108 http://www.medworm.com/index.php?rid=4190153&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-amas-policy-on-professionalism-in-the-use-of-social-media%2F2010.11.22 A new policy on professionalism in the use of social media was [recently] adopted by the American Medical Association (AMA). The AMA Office of Media Relations was kind enough to share a copy of the policy: The Internet has created the ability for medical students and physicians to communicate and share information quickly and to reach millions of people easily. Participating in social networking and other similar Internet opportunities can support physicians’ personal expression, enable individual physicians to have a professional presence online, foster collegiality and camaraderie within the profession, provide opportunity to widely disseminate public health messages and other health communication. Social networks, blogs, and other forms of communication online also create new challe... Better Health blogs http://www.medworm.com/rss/comments.php?id=4190153 Mon, 22 Nov 2010 15:00:18 +0100 4190153 http://www.medworm.com/index.php?rid=4164524&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ftalk-to-patients-before-running-tests%2F2010.11.14 The Associated Press ran a provocatively-titled piece recently, “Family health history: ‘best kept secret’ in care”, which noted how a geneticist at the Cleveland Clinic discovered that asking about family members and their history of breast, colon, or prostate cancer was better than simply doing genetic blood testing. Surprising? Hardly. This is what all medical students are taught. Talk to the patient. Get a detailed history and physical. Lab work and imaging studies are merely tools that can help support or refute a diagnosis. They provide a piece of the puzzle, but always must be considered in the full context of a patient. They alone do not provide the truth. (more…) *This blog post was originally published at Saving Money and Surviving the H... Better Health blogs http://www.medworm.com/rss/comments.php?id=4164524 Sun, 14 Nov 2010 15:00:00 +0100 4164524 http://www.medworm.com/index.php?rid=4164525&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F5-tips-on-how-to-be-a-healthcare-survivalist%2F2010.11.13 There are plenty of “survivalists” out there who stock their basements with canned goods, getting ready for some unexpected (and unlikely) apocalypse. Meanwhile there are things that are much more likely to happen to you — like getting sick — which many of us don’t prepare for at all. So to help you get started, here are five important tips on how you can become a healthcare survivalist: 1.  Take care of your chronic conditions. Whether it’s high blood pressure, diabetes, high cholesterol, depression, asthma or any other kind of ailment, do what it takes to manage your own care. Take your medications and follow your doctors’ instructions. Why? Because if you don’t, your condition can get worse and lead to even more serious problems. As much of a pain as it may (... Better Health blogs http://www.medworm.com/rss/comments.php?id=4164525 Sat, 13 Nov 2010 22:00:47 +0100 4164525 http://www.medworm.com/index.php?rid=4151789&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpatient-engagement-how-empathy-can-empower-your-patients%2F2010.11.10 In my recent post on KevinMD, “Deeply Connect and Engage Your Patients With Empathy,” I write about how empathy is essential to help empower our patients: “It is with empathy that we can engage and empower our patients.” Doctors and nurses are leaders in health care. Being a great leader means having a clear vision, mission or goal. It means being committed, and knowing how to listen and communicate, but it involves much more. It’s about having heart, empathy, and an uplifting spirit. I value and respect a well written post by Thomas Goetz, author of The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine recently published on KevinMD, “How can doctors successfully engage their patients?” Goetz writes about “Five things they should seek to... Better Health blogs http://www.medworm.com/rss/comments.php?id=4151789 Wed, 10 Nov 2010 14:00:50 +0100 4151789 http://www.medworm.com/index.php?rid=4074065&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-to-help-your-doctor-make-a-good-diagnosis%2F2010.10.14 When patients and doctors communicate effectively, the patient has the best result. Not every doctor asks the critical question that can cinch a diagnosis. Yet good communication, coupled with good diagnostic skill can be worth more than $10,000 in tests and referrals to consultants. You can help your doctor figure out what is going on by thinking and communicating like a physician. Whether you have a new problem or something that has been bothering you for a long time, here are some things that the doctor will want to know: 1. What are the symptoms? Be specific. Don’t just say “Sometimes I have a pain in my stomach.” Since more than 80 percent of health problems can be diagnosed based on information that you provide, make sure you can verbalize what you are feelin... Better Health blogs http://www.medworm.com/rss/comments.php?id=4074065 Fri, 15 Oct 2010 01:00:00 +0100 4074065 http://www.medworm.com/index.php?rid=4018178&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-governments-involvement-in-new-primary-care-models%2F2010.09.30 Government healthcare reform efforts are picking up the pace to roll out new reimbursement and practice models for primary care. Medicare is giving out $10 billion for pilot projects encouraging new models of primary care, including the patient-centered medical home. New Jersey just passed legislation to explore the patient-centered medical home. Now, Massachusetts, the early adopter of mandatory health insurance, is now ambitiously planning how to take on the fee-for-service reimbursement system and moving toward accountable care organizations. Under discussion are the scope of power for state regulators, what rules will apply to accountable care organizations, and how to get rid of the existing fee-for-service system. Blogger and pediatrician Jay Parkinson, MD, MPH, comments about the &#... Better Health blogs http://www.medworm.com/rss/comments.php?id=4018178 Thu, 30 Sep 2010 12:00:00 +0100 4018178 http://www.medworm.com/index.php?rid=4002884&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealth-care-not-health-performance%2F2010.09.26 The “empowered patient” movement (which I think is a good thing) strives to take the doctor out of the center of care and put the patient at its focus. The role of doctor is not to be the star of the show, the quarterback, the superhero, but the advocate and helper for the patient to accomplish their goal: Health. Many rightly attack doctor prima donnas who want the exam/operating room to be about them instead of the patient. This is health care, not health performance. They want doctors who care more about the people they treat than they do about money, praise, or status. I get it. I get the message that doctors have to adjust to this new age of patient empowerment and patient-centeredness. I get the fact that making patients wait is a bad thing, and that communication is as essentia... Better Health blogs http://www.medworm.com/rss/comments.php?id=4002884 Sun, 26 Sep 2010 15:00:36 +0100 4002884 http://www.medworm.com/index.php?rid=3987055&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fto-change-patient-behavior-change-how-you-talk-to-them%2F2010.09.20 According to Marshall Becker, PhD, MPH, a one-time professor of mine and prime mover behind the Health Belief Model (HBM), four things must be in place for health behavior change to occur. I am paraphrasing here:  A person has to know that they have a particular health condition. A person has to believe that having said health condition is bad. A person must perceive the benefits of behavior change to outweigh the difficulties of behavior change. There must be a “call to action” to spark the change. Absent any one of these steps and the likelihood that behavior change will occur is diminished. (more…) *This blog post was originally published at Mind The Gap* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3987055 Tue, 21 Sep 2010 02:19:26 +0100 3987055 http://www.medworm.com/index.php?rid=3980829&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedical-errors-discuss-them-or-switch-doctors%2F2010.09.17 Patients won’t confront doctors if they think there’s been a mistake. They’ll just find a new doctor, even if there’d been no medical error. Researchers looked at adult visits to seven primary care practices in North Carolina during 2008. They asked patients about their perceptions of medical mistakes and how did it influence the choice to switch doctors. Of 1,697 patients, 265 (15.6 percent) reported a mistake had been made, 227 (13.4 percent) reported a wrong diagnosis, 212 (12.5 percent) reported a wrong treatment, and 239 (14.1 percent) reported changing doctors as a result. Results appeared in the Archives of Internal Medicine. But anecdotes cited by patients as mistakes were often normal diagnostic or therapeutic challenges. A typical scenario might be the pa... Better Health blogs http://www.medworm.com/rss/comments.php?id=3980829 Sat, 18 Sep 2010 04:32:24 +0100 3980829 http://www.medworm.com/index.php?rid=3942788&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F5-reasons-why-people-dont-ask-their-doctor-questions%2F2010.09.07 A neighbor of mine was diagnosed with breast cancer about the same time my wife was being treated for lung cancer. I saw my neighbor the other day for the first time in several years. I asked her how she was doing. She said great. In turn I asked her how her PET/CT exam looked. PET/CT scans are often done to make sure that one’s cancer hasn’t spread. My wife gets one every year. My neighbor told me her doctor never told her she needed one, that mammograms would suffice. She went on to say a friend had also recently asked her if she had a PET/CT as well. “Maybe I should ask my doctor,” she told me. That was the same response she gave me the last time I raised the subject two years earlier: “I should ask my doctor.”   So Why Don’t People Ask More Questions?   My nei... Better Health blogs http://www.medworm.com/rss/comments.php?id=3942788 Wed, 08 Sep 2010 00:14:14 +0100 3942788 http://www.medworm.com/index.php?rid=3934480&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoctor-patient-relationship-how-patients-can-help-enhance-communication%2F2010.09.04 From Kevin Pho’s medical blog, KevinMD, a post archived from 2004, Pho talks about the struggles of communication between doctor and patient during the 15-minute office visit. Pho sites a New York Times article that explains that more than two decades ago, research shows that patients were interrupted 18 seconds into explaining their problem (on average) and less than 2 percent got to finish their explanations. Pho sites that he sometimes falls into the “interruption trap,” saying: “I think this is a natural progression to our managed care environment. Physicians are compensated by quantity of patients seen, and are kept to a strict schedule -– in most cases every 15-minutes.” (more…) *This blog post was originally published at Health in 30* (Source: Better Healt... Better Health blogs http://www.medworm.com/rss/comments.php?id=3934480 Sat, 04 Sep 2010 12:00:37 +0100 3934480 http://www.medworm.com/index.php?rid=3924902&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoctor-patient-communication-much-room-for-improvement%2F2010.09.01 In a surprising report from the Archives of Internal Medicine, we learn that most hospitalized patients (82 percent) could not accurately name the physician responsible for their care and almost half of the patients did not even know their diagnosis or why they were admitted. If that isn’t enough, when the researchers queried the physicians, 67 percent thought the patients knew their name and 77 percent of doctors thought the patients “understood their diagnoses at least somewhat well.” I would call that a pretty significant communication gap. Ninety percent of the patients said they received a new medication and didn’t know the side effects. Although 98 percent of physicians thought they discussed their patients’ fears and anxieties with them, only 54 perc... Better Health blogs http://www.medworm.com/rss/comments.php?id=3924902 Thu, 02 Sep 2010 01:00:00 +0100 3924902 http://www.medworm.com/index.php?rid=3911699&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fanother-law-to-ensure-doctors-do-right-by-their-patients%2F2010.08.27 Recently the [state of] New York signed a law requiring hospitals and doctors to discuss breast reconstruction options with the patient prior to her undergoing cancer surgery. It troubled me that this law was needed. Is it not the duty of the physicians and surgeons to educate the patient on the options available?  We need to make sure the patient and their family know of the treatment options which may vary depending on the diagnosis and stage: Radiation, chemotherapy, surgery (lumpectomy, mastectomy, axillary dissection) – a combination of treatments. Even if the patient and her physicians don’t chose to do immediate reconstruction, isn’t the discussion and information part of the discussion? At least inform the patient of the option. Do we physicians and surgeons need an... Better Health blogs http://www.medworm.com/rss/comments.php?id=3911699 Fri, 27 Aug 2010 20:00:00 +0100 3911699 http://www.medworm.com/index.php?rid=3902902&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fluddism-and-internet-based-medicine%2F2010.08.25 My recent post on the subject of email from patients raised more eyebrows than I expected. It also put me in a position I’m unfamiliar with: Looking like a luddite. Perhaps I’m not forward-thinking enough in my reluctance to embrace this advance. Perhaps I’ve gotten conservative as I’ve grown grey. Electronic communication is a great idea (I’m doing it right now), so why not apply it to my medical practice? Has Ned Lud gotten into my circle of influence? This is, of course, extremely ironic. I lived so much on the cutting edge that my butt developed calluses. The calluses, however, were not just put there by the edge, they also came from occasional kicking. The problem is I have an addiction: I’m addicted to change. I’m constantly looking for new a... Better Health blogs http://www.medworm.com/rss/comments.php?id=3902902 Wed, 25 Aug 2010 12:00:25 +0100 3902902 http://www.medworm.com/index.php?rid=3895888&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Faccountable-care-and-doctor-patient-communication-go-hand-in-hand%2F2010.08.23 Accountable Care Organizations (ACOs) figure prominently in the new Patient Protection and Affordable Care Act (PPACA). The concept behind ACOs is that by tying both physician and hospital compensation to outcomes via a bundled fee (say for pneumonia) we can expect to see an improvement in quality and value. In principal, accountable care makes a lot of sense. Practicality speaking, however, doctors and hospitals must address a huge challenge before they can expect benefit financially. Before doctors can be held accountable for the care they deliver, they must first be held accountable for the quality of their communication with patients. Take hospital readmissions, which are a big healthcare cost driver today. According to a recent study in the New England Journal of Medicine, 20 perce... Better Health blogs http://www.medworm.com/rss/comments.php?id=3895888 Mon, 23 Aug 2010 18:00:39 +0100 3895888 http://www.medworm.com/index.php?rid=3880858&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Femergency-palliative-care-we-cant-save-you%2F2010.08.18 An alert reader alerted me to this related piece in Slate: “We Can’t Save You: How To Tell Emergency Room Patients That They’re Dying.” An excerpt: The ER is not an easy place to come to these realizations or assess their consequences. A handful of physicians are trying to change that. Doctors like Tammie Quest, board-certified in both palliative and emergency medicine, hope to bring the deliberative goal-setting, symptom-controlling ethos of palliative care into the adrenaline-charged, “tube ‘em and move ‘em” ER. Palliative/emergency medicine collaboration remains rare, but it’s growing as both fields seek to create a more “patient-centered” approach to emergency care for the seriously ill or the dying, to improve symptom m... Better Health blogs http://www.medworm.com/rss/comments.php?id=3880858 Thu, 19 Aug 2010 00:00:00 +0100 3880858 http://www.medworm.com/index.php?rid=3880861&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcommunication-gap-widens-between-doctors-and-patients%2F2010.08.18 In a surprising report from the Archives of Internal Medicine, we learn that most hospitalized patients (82 percent) could not accurately name the physician responsible for their care and almost half of the patients did not even know their diagnosis or why they were admitted. If that isn’t enough, when the researchers queried the physicians, 67 percent thought the patients knew their name and 77 percent of doctors thought the patients “understood their diagnoses at least somewhat well.” I would call that a pretty significant communication gap. Ninety percent of the patients said they received a new medication and didn’t know the side effects. Although 98 percent of physicians thought they discussed their patient’s fears and anxieties with them, only 54 per... Better Health blogs http://www.medworm.com/rss/comments.php?id=3880861 Wed, 18 Aug 2010 16:00:00 +0100 3880861 http://www.medworm.com/index.php?rid=3880862&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcan-novel-approaches-fill-primary-care-needs%2F2010.08.18 New primary care arrangements show how primary care is evolving — or splitting apart, depending upon one’s perspective. Retainer fees let one practice handle more patients by phone or email. But, points out Richard Baron, FACP, affluent communities can take advantage of such arrangements, and not every community is. And Sam Fink, FACP, of southern California says tele-visits are no substitute for hands-on care. In another model, nurse-led facilities service the poor in north Philadelphia, and more states are expanding the power of the pen to cover shortages.  Another trend is the shared medical appointment. Led by physicians and conducted by “behaviorists,” the sessions cover a half-dozen or more patients at a time for both primary and specialty care. Even pharmaci... Better Health blogs http://www.medworm.com/rss/comments.php?id=3880862 Wed, 18 Aug 2010 14:00:00 +0100 3880862 http://www.medworm.com/index.php?rid=3865266&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-story-of-online-care-without-opennotes%2F2010.08.13 Next in our series on my experience with OpenNotes, a project sponsored by the Robert Wood Johnson Foundation’s Pioneer Portfolio. This item has nothing to do with OpenNotes itself –- it’s what I’m seeing now that I’ve started accessing my doctor’s notes. In short, I see the clinical impact of not viewing my record as a shared working document. Here’s the story.  ______ In OpenNotes, patient participants can see the visit notes their primary physicians entered. Note “primary,” not specialists. I imagine they needed to keep the study design simple. So here I am in the study, going through life. Five weeks ago I wrote my first realization: After the visit I’d forgotten something, so I logged in. (more…) *This blog post was originally published at e-... Better Health blogs http://www.medworm.com/rss/comments.php?id=3865266 Fri, 13 Aug 2010 16:00:13 +0100 3865266 http://www.medworm.com/index.php?rid=3858155&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-to-talk-to-your-doctor-3-simple-steps%2F2010.08.11 As a practicing primary care doctor, I continue to work incredibly hard on making my bedside manner even better so that patients feel heard. The other reason is because as most doctors learned in medical school 90 percent of getting the right diagnosis comes from taking a good history from a patient. Unfortunately with shorter doctor office visits and doctors interrupting patients within 23 seconds of starting, you need to know how to get your concerns across. While I don’t believe this is the responsibility of patients, the reality is not everyone has access to doctors with great bedside manner. How to talk to your doctor is quite easy if you follow three simple steps. (more…) *This blog post was originally published at Saving Money and Surviving the Healthcare Cris... Better Health blogs http://www.medworm.com/rss/comments.php?id=3858155 Wed, 11 Aug 2010 20:00:00 +0100 3858155 http://www.medworm.com/index.php?rid=3848871&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-do-doctors-know-about-their-unemployed-patients%2F2010.08.09 Anyone who’s ever been downsized or otherwise lost a job knows the feelings: Personal loss (social, financial and routine), self doubt, and in some cases fear of what the future will bring. Unemployment and its cousin, underemployment, are not subjects that a lot of people are comfortable brining up in polite conversation — even with their doctor. Given today’s tough economic environment, chances are that 15 to 20 percent of the people sitting in most doctors’ waiting rooms are out of work. Do you know who they are? You should. (more…) *This blog post was originally published at Mind The Gap* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3848871 Mon, 09 Aug 2010 16:00:36 +0100 3848871 http://www.medworm.com/index.php?rid=3813054&cid=t_295132_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F08%2Fhow-to-treat-your-patients-well-simple.html While many doctors handle their VIP Patients with kid gloves, the way they deal with most of their " run of the mill " patients leaves a lot to be desired. This is not because all doctors are arrogant, but because they simply do not have the luxury of time to be able to "sit down and chat" with their patients. Unfortunately, these hurried 5 min consultations create a lot of unhappiness and angst - both for doctors and patients. Patients feel neglected and unheard - and can become very resentful and angry when things go wrong. Doctors also suffer. Because they do not get a chance to establish a bond with their patients, they lose out on a very powerful source of gratification and happiness . Thanks from patients can provide powerful emotional fuel to help the doctor lead a meaningful and pr... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3813054 Mon, 02 Aug 2010 10:38:00 +0100 3813054 http://www.medworm.com/index.php?rid=3805895&cid=t_295132_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F07%2Fbest-way-to-get-second-opinion.html This article is contributed by Susan White, who regularly writes on the subject of surgical technician schools. She invites your questions, comments at her email address: susan.white33@gmail.com. (Source: The Patient's Doctor) The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3805895 Fri, 30 Jul 2010 14:04:00 +0100 3805895 http://www.medworm.com/index.php?rid=3798559&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fshould-doctors-be-paid-to-communicate-with-patients%2F2010.07.28 I often hear from physicians that they would do a better job communicating with patients if they were adequately reimbursed for the time it took to do so. Given that certain types of physician-patient communications (patient education, care planning, etc.) can have quantifiable, therapeutic benefits for patients, I can see their point. I have no problem with physicians asking to be adequately reimbursed for services they provide, as long as they are high quality and add value. For example, teaching chronic disease patients how to care for themselves at home takes time and is critical to effective patient self care. In this role, physicians are called upon to be a provider of necessary information as well as a coach to encourage and support patients. But as evidence suggests, many physic... Better Health blogs http://www.medworm.com/rss/comments.php?id=3798559 Wed, 28 Jul 2010 22:00:34 +0100 3798559 http://www.medworm.com/index.php?rid=3798561&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ffailure-for-a-doctor%2F2010.07.28 I went to a patient’s funeral this past weekend. I generally don’t do that for people whose relationship I’ve built in the exam room. It’s a complex set of emotions, but invariably some family member will start telling others what a nice doctor I am and how much the person had liked me as a doctor. It’s awkward getting a eulogy (literally good words) spoken about me at someone else’s funeral. This patient I had known prior to them becoming my patient, and his wife had been very nice to us when we first moved here from up north. But that’s not why I am writing this. As I was sitting in the service, the thought occurred to me that a patient’s funeral would be considered by many to be a failure for a doctor. Certainly there are times when that is the case — when the... Better Health blogs http://www.medworm.com/rss/comments.php?id=3798561 Wed, 28 Jul 2010 18:00:12 +0100 3798561 http://www.medworm.com/index.php?rid=3726598&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fevidence-based-medicine-do-patients-understand-it%2F2010.07.05 Doctors trying to help patients understand a course of treatment must teach them new terms such as “medical evidence,” “quality guidelines” and “quality standards.” Patients might not be willing to accept that language lesson. A study in Health Affairs concluded that 41 percent of patients didn’t ask questions or tell doctors about problems. The main barriers were that patients didn’t know how to talk to doctors, or their physicians seemed rushed. Only 34 percent of patients recalled physicians discussing medical research in relation to care management. But, physicians say, that’s only half the problem. Sometimes, patients demand to see specialists when they don’t really need to. Or, they don’t accept it when evidence show... Better Health blogs http://www.medworm.com/rss/comments.php?id=3726598 Mon, 05 Jul 2010 14:00:00 +0100 3726598 http://www.medworm.com/index.php?rid=3706677&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fis-doctor-patient-communication-better-in-medical-homes%2F2010.06.28 Probably not yet. I think everyone would agree that Group Health of Seattle probably has a pretty good “take” on issues dealing with primary care redesign and the patient-centered medical home (PCMH). That’s why I surprised by a recent comment on a Group Health blog from by Matt Handley, M.D., in response to an earlier post here about patient question-asking. Dr. Handley is an Associate Medical Director for Quality and Informatics at Group Health. Dr. Handley writes: “While doctors often take pride in how open they are to patient questions, our self assessment doesn’t match up very well with empirical evidence. A recent post on Mind the Gap summarizes a small study that is relatively terrifying to me –- the take home is that doctors spend very little time explaining their reco... Better Health blogs http://www.medworm.com/rss/comments.php?id=3706677 Mon, 28 Jun 2010 14:00:45 +0100 3706677 http://www.medworm.com/index.php?rid=3701676&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoctor-to-patient-do-you-text-and-drive%2F2010.06.26 It’s time to ask patients whether they text and drive. An important perspective piece from the New England Journal of Medicine urges doctors to include that question during preventive health exams. The data surrounding texting and driving is grim: Although there are many possible distractions for drivers, more than 275 million Americans own cell phones, and 81% of them talk on those phones while driving. The adverse consequences have reached epidemic proportions. Current data suggest that each year, at least 1.6 million traffic accidents (28% of all crashes) in the United States are caused by drivers talking on cell phones or texting. Talking on the phone causes many more accidents than texting, simply because millions more drivers talk than text; moreover, using a hands-free device does... Better Health blogs http://www.medworm.com/rss/comments.php?id=3701676 Sat, 26 Jun 2010 14:00:05 +0100 3701676 http://www.medworm.com/index.php?rid=3690839&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fkeeping-the-primary-in-care%2F2010.06.23 He came in for his regular blood pressure and cholesterol check. On the review of systems sheet he circled “depression.” “I see you circled depression,” I said after dealing with his routine problems. “What’s up?” “I don’t think I am actually clinically depressed, but I’ve just been finding it harder to get going recently,” he responded. “I can force myself to do things, but I’ve never have had to force myself.” “I noticed that you retired recently. Do you think that has something to do with your depression?” I asked. “I’m not really sure. I don’t feel like it makes me depressed. I was definitely happy to stop going to work.” I have taken care of him for many years, and k... Better Health blogs http://www.medworm.com/rss/comments.php?id=3690839 Wed, 23 Jun 2010 16:00:00 +0100 3690839 http://www.medworm.com/index.php?rid=3687102&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpay-patients-to-take-their-medicine%2F2010.06.22 The New York Times reported recently on efforts by providers and payers to increase patient medication adherence through the use financial incentives paid to patients. The article cited the use of small financial payments (<$100), awarded via lotteries, to patients that take Warfarin –- an anti-blood clotting medication. There is certainly nothing wrong with financial incentives. Incentives have been proven successful in changing selected provider (quality and safety improvement) and patient behavior (stop smoking, weight loss and taking health risk surveys). But paying patients to take their medication is different. Actually, the evidence suggests that it is a just plain stupid idea for a whole lot of reasons. (more…) *This blog post was originally published at Mind The... Better Health blogs http://www.medworm.com/rss/comments.php?id=3687102 Tue, 22 Jun 2010 14:00:17 +0100 3687102 http://www.medworm.com/index.php?rid=3671700&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F8-things-you-shouldnt-keep-from-your-doctor%2F2010.06.16 It’s important to have an open relationship with your primary care physician because the more he or she knows about your health and lifestyle, the better able he or she is to diagnose illnesses as they come up. You wouldn’t take your car to a mechanic and not tell him that the brake is sticking, and a human organism is thousands of times more complicated than a car. But patients are shy. They’re embarrassed. They don’t want you to think badly about them, so they often leave out important information that’s critical for the physician to know. (more…) *This blog post was originally published at EverythingHealth* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3671700 Wed, 16 Jun 2010 16:00:00 +0100 3671700 http://www.medworm.com/index.php?rid=3603595&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-an-empowered-patient-finds-a-new-doctor%2F2010.05.26 What if the average patient (person) knew what healthcare insiders, providers and expert patients know? Take the process of looking for a new personal physician. Conventional wisdom tells people that when looking for a new physician they need to consider things like specialty, board certification, years in practice, and geographic proximity. Online services like Health Grades allow you to see and compare the satisfaction scores for prospective physician candidates. But industry insiders know different. Consider those patient satisfaction scores for physicians. In reality, “one can assume that the quality of care is actually worse than surveys of patient satisfaction would seem to show,” according to a 1991 lecture by Avedis Donabedian, M.D.: “Often patients are, in fact, overly pati... Better Health blogs http://www.medworm.com/rss/comments.php?id=3603595 Wed, 26 May 2010 16:00:23 +0100 3603595 http://www.medworm.com/index.php?rid=3592209&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpatient-tests-ehrs-and-medical-homes-the-price-isnt-right%2F2010.05.24 Healthcare reform is forcing medical students to learn about the financial costs of the tests they order, as well as their clinical importance. Once a taboo topic, it’s being openly taught to students to prepare them for practice. At Harvard, one physician in training duplicated television’s “The Price is Right” to keep his peers guessing at the costs of tests on a patient’s bill. Molly Cooke, FACP, a Regent of the College, encourages doctors to consider the value of the tests they order as they deliver care. (Kaiser Health News, New England Journal of Medicine) The price isn’t right for electronic medical records. Even $44,000 in stimulus money isn’t enough to make doctors jump into using computers. (more…) *This blog post was origin... Better Health blogs http://www.medworm.com/rss/comments.php?id=3592209 Mon, 24 May 2010 14:00:00 +0100 3592209 http://www.medworm.com/index.php?rid=3569805&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fim-your-doctor-and-im-worth-it%2F2010.05.16 I saw the note on the patient’s chart before I opened the door: “Patient is upset that he had to come in.” I opened the door and was greeted by a gentleman with his arms crossed tightly across his chest and a stern expression. I barely recognized him, having only seen him a handful of times over the past few years. Scrawled on the patient history sheet in the space for the reason for his visit were the words, “Because I was forced to come in.” My stomach churned. I opened his chart and looked at his problem list, which included high blood pressure and high cholesterol –- both treated with medications. He was last in my office in November — of 2008. I blinked, looked up at his scowling face, and frowned back. ”You haven’t been in the office for over 18 months. It was r... Better Health blogs http://www.medworm.com/rss/comments.php?id=3569805 Sun, 16 May 2010 22:00:46 +0100 3569805 http://www.medworm.com/index.php?rid=3563964&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-value-of-social-media-for-patients-doctors-and-nurses%2F2010.05.13 A patient apologized to me for asking so many questions. “There’s no need to apologize,” I said to the patient, “It’s wonderful that you have so many questions concerning your healthcare.” I mentioned to her that she is an “empowered and engaged patient,” and that’s a good thing. It’s no secret that health consumers are turning to the Internet for health information. In a recent article from MediaPost News, Gavin O’Malley writes that, according to new a study by Epsilon Strategic & Analytic Consulting Group, “40% of online consumers use social media for health information — reading or posting content — while the frequency of engagement varies widely. According to the study, individuals who use healthcare social media fall into two br... Better Health blogs http://www.medworm.com/rss/comments.php?id=3563964 Thu, 13 May 2010 16:00:53 +0100 3563964 http://www.medworm.com/index.php?rid=3556093&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-primary-care-doctors-are-so-busy%2F2010.05.12 There’s been a lot of commentary on a recent article from the New England Journal of Medicine, detailing the undocumented tasks that a typical primary care physician performs. For those who haven’t read the piece, entitled, What’s Keeping Us So Busy in Primary Care? A Snapshot from One Practice, it’s available free at the NEJM website. I highly recommend it. To summarize, primary care doctors are responsible for much more than seeing patients in the exam room. In the cited practice, which has a fairly typical makeup, physicians were responsible for an average of over 23 telephone calls and 16 e-mails per day. Many practices don’t engage their patients over e-mail, so it’s conceivable that the number of telephone calls is lower than average here. (more…) *This blog... Better Health blogs http://www.medworm.com/rss/comments.php?id=3556093 Wed, 12 May 2010 14:00:26 +0100 3556093 http://www.medworm.com/index.php?rid=3552243&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpatient-follow-up-what-doctors-can-learn-from-dentists%2F2010.05.11 I have to give my dentist credit. He and his staff know when I am due for a cleaning and call me to schedule an appointment without fail. They also call to remind me the day before an appointment. Many dentists, I understand, do similar kinds of things for their patients. As a patient, I like being reminded — it’s a great service. I also like the fact that someone’s looking out for me. From a business perspective it makes a lot of sense as well. Fewer “no shows,” more cleanings, more billings, and so on. It’s too bad that more physicians don’t routinely follow up with their patients, particularly when it really counts. (more…) *This blog post was originally published at Mind The Gap* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3552243 Tue, 11 May 2010 14:33:07 +0100 3552243 http://www.medworm.com/index.php?rid=3538093&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-patient-complaints-affect-defensive-medicine%2F2010.05.05 Doctors often have a communication disconnect with their patients. A recent piece from the New York Times encapsulates the issue, citing a recent New England Journal of Medicine perspective. According to oncologist Ethan Basch, “Direct reports from patients are rarely used during drug approval or in clinical trials. If patients’ comments are sought at all, they are usually filtered through doctors and nurses, who write their own impressions of what the patients are feeling.” There are a variety of reasons for this. Some doctors feel they have a better sense of the patient’s symptoms than the patient himself. Biases can affect how doctors and nurses perceive symptoms. (more…) *This blog post was originally published at KevinMD.com* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3538093 Wed, 05 May 2010 22:00:22 +0100 3538093 http://www.medworm.com/index.php?rid=3529788&cid=t_295132_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-not-so-unforseen-complication-of-electronic-health-records%2F2010.05.03 [Here's a] good article [from] the New York Times written by a doctor [Pauline Chen, M.D.] about intrusive aspects of electronic health records (EHRs) on doctor-patient communication. An excerpt: “…just because EMR improves information sharing and retrieval, it doesn’t necessarily follow that our communication with patients and colleagues will also be better.” Read the rest of the article here. *This blog post was originally published at a few thoughts from a tumor surgeon* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3529788 Mon, 03 May 2010 18:00:03 +0100 3529788 http://www.medworm.com/index.php?rid=3335314&cid=t_295132_99_f&fid=35344&url=http%3A%2F%2Fzackarysholemberger.blogspot.com%2F2010%2F03%2Fhow-can-patients-and-doctors-talk-about.html Check out this presentation (based on other people's research) that I'm giving tomorrow at the meeting of the Mid-Atlantic branch of the Society of General Internal Medicine. The Power Point version, prettier in its Microsoft way, is here. (Source: Zackary Sholem Berger) Zackary Sholem Berger blogs http://www.medworm.com/rss/comments.php?id=3335314 Thu, 04 Mar 2010 19:34:00 +0100 3335314 http://www.medworm.com/index.php?rid=3276056&cid=t_295132_136_f&fid=39025&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Feverythingchangesbook%2F%7E3%2FRxt4EFQxr3s%2Fgood-doctors-nurses Patients excel at slamming our doctors online.  Sometimes our words are thoughtful, constructive criticism, and other times we are just spewing.  While it is necessary to vent sometimes, we run the risk of losing credibility if that is all we do.  I hope my blog contributes to constructive patient conversation. Still, I don’t think I take enough time to acknowledge who has done right by me. So that’s what I want to do today. Someone who’s done right by me: My anesthesiologist. My first surgery had scary recovery room complications due to anesthesia.  I was totally freaked out and didn’t want a repeat performance with my second surgery. I asked to speak with my anesthesiologist before going under the knife. He visited me an hour before hand and sat in a chair, eye level with... Everything Changes blogs http://www.medworm.com/rss/comments.php?id=3276056 Tue, 16 Feb 2010 16:00:27 +0100 3276056 http://www.medworm.com/index.php?rid=3153600&cid=t_295132_136_f&fid=39025&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Feverythingchangesbook%2F%7E3%2Fr6bpqInPPUk%2Fcommunication-cancer-friends It’s great to vent online with like minded patients about how we’d like to tell off the friend, family member, co-worker, or doctor who made the stupidest comment to us about our illness. But venting only goes so far.  I’m more interested in the realistic responses we can use that might make us feel better.  Fasten your seat belts, this post is gonna sound a bit therapisty, but screw it – it’s an important topic, so here I go! It’s so frustrating and soul corroding to have someone shower you with stupidity.  And it’s even worse to think of the perfect comeback three hours later when you are laying in bed.  So I’ve started to turn these situations around. Here’s an example: A friend recently said: “You gotta think positively and it will make your test results com... Everything Changes blogs http://www.medworm.com/rss/comments.php?id=3153600 Fri, 08 Jan 2010 12:59:17 +0100 3153600 http://www.medworm.com/index.php?rid=3089523&cid=t_295132_136_f&fid=39025&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Feverythingchangesbook%2F%7E3%2FnkoO8zmTks4%2Fsurvival-rates One of the most heart wrenching days of my life came after my first surgery when I learned I had a rare disease variant of my cancer.  It tanked my survival rate an extra 20%.   I felt like someone was yanking my heart through my nostrils.  Years later, a subsequent pathology report showed no evidence of the rare disease variant.  Poof, I was jacked back up to the normal papillary thyroid cancer statistics – which are damn high.  I don’t know what made the variant disappear but I’m extremely grateful. I love this quote from Rick Gribenas in my book Everything Changes: “Ambiguity is more real than a prescribed prognosis, which is complete crap.  If there’s an 80% chance of this, or a 20% chance of that, it’s still a chance.  Who knows which percentage I’ll fall into?�... Everything Changes blogs http://www.medworm.com/rss/comments.php?id=3089523 Tue, 15 Dec 2009 06:40:21 +0100 3089523 http://www.medworm.com/index.php?rid=3052156&cid=t_295132_99_f&fid=35344&url=http%3A%2F%2Fzackarysholemberger.blogspot.com%2F2009%2F12%2Fwhat-bridges-gap-between-evidence-based.html Under the withering barrage of recent guideline changes, doctors and patients alike have raised their hands in surrender. It seems like guideline group after group have changed their recommendations to say (more or less) the same thing: "[name of screening test here] should be discussed with the patient according to their risk profile."We used to think that population studies ("big-E epidemiology") would provide us with the tools to fix health care. The drill of empirical science would become the Swiss Army knife of evidence-based medicine.But something got in the way: inconveniently enough, that something is the patient.A patient is not a population, but a unique individual with a one-of-a-kind combination of characteristics. So how to apply the population findings (or even the evidence-b... Zackary Sholem Berger blogs http://www.medworm.com/rss/comments.php?id=3052156 Thu, 03 Dec 2009 04:55:00 +0100 3052156 http://www.medworm.com/index.php?rid=3019091&cid=t_295132_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2009%2F11%2Fteaching-doctors-how-to-write.html Most doctors are very inhibited about writing. Since they are science students, writing is often not their forte. Unfortunately, this means they cannot share their expertise with the rest of the world and many will take their lifetime’s clinical wisdom with them to the grave.What can we do to prevent this ?In the past, doctors did not have much opportunity to publish or write about their clinical experience. Most doctors would write only for medical journals, which had a very rigid format and limited space, which means most never ever managed to get a single article in print. This was a big problem especially for Indian doctors , because most medical journals were published in the West.The good news is that thanks to the web, anyone who wants to write can do so . I feel doctors have an o... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3019091 Mon, 23 Nov 2009 06:47:00 +0100 3019091 http://www.medworm.com/index.php?rid=2974182&cid=t_295132_136_f&fid=39025&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Feverythingchangesbook%2F%7E3%2FEd4jXvDH8-U%2Fcancer-patient-compliance When it comes to following prescription drug dosing and directions, I’m like a teacher’s pet.  I’m terrified of potential drug side effects – almost to a neurotic and paranoid level.  And I do exactly what my doctor says.  But many patients don’t or can’t.  Especially with the economy in the crapper, I know a lot of people who are splitting pills or skipping out of medications all together. There have been times, however, when I’ve made educated decisions to go against my doctors’ orders for procedures.  I don’t have a medical degree, but I do have a ton of common sense and research the hell out of my disease.   And sometimes it makes more sense to me to disobey what my doctor is recommending. Here’s an example: The last time my doc ordered a biopsy of nodes that... Everything Changes blogs http://www.medworm.com/rss/comments.php?id=2974182 Mon, 09 Nov 2009 08:45:27 +0100 2974182 http://www.medworm.com/index.php?rid=2971951&cid=t_295132_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2009%2F11%2Fhow-to-talk-to-your-doctor-on-telephone.html (Source: The Patient's Doctor) The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=2971951 Sun, 08 Nov 2009 15:06:00 +0100 2971951 http://www.medworm.com/index.php?rid=2971952&cid=t_295132_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2009%2F11%2Fmaking-friends-with-your-doctors-clinic.html (Source: The Patient's Doctor) The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=2971952 Sun, 08 Nov 2009 03:05:00 +0100 2971952 http://www.medworm.com/index.php?rid=2963182&cid=t_295132_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2009%2F11%2Fwhy-dont-patients-ask-for-their-medical.html We all know that our medical records contain important information about our health . Just like you own your body, you own these records as well, because they are about your body !This is why I feel patients should routinely ask for doctors for a copy of their medical records. After all, bad things can happen to your records. Clinics can close down; doctors can die; you can move town; you may need your medical records in an emergency when the doctor is on a holiday ; and files can get lost. No one will take better care of your medical records than you will, which is why you must have a copy !Keeping a copy will ensure that your records are safe; and that they are available when you need them. Equally importantly, going through them will help you get better medical care, because you are lik... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=2963182 Mon, 02 Nov 2009 10:44:00 +0100 2963182 http://www.medworm.com/index.php?rid=2920459&cid=t_295132_136_f&fid=39025&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Feverythingchangesbook%2F%7E3%2FZ_tVJLa6atI%2Fdoctor-patient-disclosur I injured my knee while napping on Wednesday.  (Who gets injured napping?)  Still super painful on Thursday, Shannon pushed me into my doctor’s office in a wheelchair.  The cause of the pain is still a mystery.  We joked with my doc that it’s H1N1 in my knee, or a very new and original manifestation of PMS.  He told me to ice, rest, pop Advil and check in with him on Monday when he gets back from vacation. My doc’s going on vacation.  Well that’s what he said at first.  Then at the end of the appointment he said, “I’ll be back on Monday, it’s a simple procedure so I should be on my feet in no time.”  What?  He slipped up but obviously wanted me to think he was off to Tahiti not the OR. The same day, I read on the New York Times Well Blog a post called &#821... Everything Changes blogs http://www.medworm.com/rss/comments.php?id=2920459 Fri, 23 Oct 2009 14:25:33 +0100 2920459 http://www.medworm.com/index.php?rid=2916197&cid=t_295132_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2009%2F10%2Fgetting-doctors-to-act-as-professionals.html Many Indians will agree that the Indian healthcare system needs an overhaul and quite a few young entrepreneurs are trying out clever new ideas to help patients get better medical care. A good example is the use of PHRs to help patients become empowered consumers. The major stumbling block they face is getting acceptance from doctors.We all know that patients will do anything their doctors will tell them to do. However, if you suggest they try something using their own initiative , which their doctor has not explicitly recommended , most become passive observers and flatly refuse. They feel that medical science is best left upto their doctor . They don't know enough to try to do anything about it. My doctor knows best is a very comforting mantra ( even though it may be false !)Doctors play... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=2916197 Thu, 22 Oct 2009 12:36:00 +0100 2916197 http://www.medworm.com/index.php?rid=2899027&cid=t_295132_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2009%2F10%2Fwhy-doctors-dont-talk-to-patients.html One of the excuses many doctors give for not talking to their patients is their concern that the patient will not understand all the technical minutiae. Their approach is - It took me 10 years to master medicine. How can a poor patient possibly understand all the subtleties and complexities in 10 minutes ! I am a good doctor and will decide what's best for the patient, based on my vast experience and great expertise. What's the point in confusing the patient and burdening her with knowledge will may go above her head ? Isn't it better than I take control of her medical course - after all, that's what she is paying me for ! This way, she can focus her energies on getting better, while I work on her medical treatment.While this paternalistic approach is still surprisingly common in India eve... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=2899027 Fri, 16 Oct 2009 15:21:00 +0100 2899027 http://www.medworm.com/index.php?rid=2886529&cid=t_295132_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2009%2F10%2Fhow-being-good-patient-helps-you-to-get.html Most articles on improving doctor-patient communication tell doctors that they must learn to be empathetic, and see things from the patient's point of view. While this is great advise, the sad truth is that most doctors so busy, that they find it very hard to be able to implement this. I feel it is equally important that patients learn to see things from the doctor’s point of view. Just like there are good doctors and bad doctors , it is equally true that there are good patients and bad patients; If you are a good patient, the chances of your getting high quality medical care are much better.It’s actually quite easy to do this ; and all your need to do is to put yourself in your doctor’s shoes. The doctor wants to help you get better - but he does operate under certain constraints; a... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=2886529 Tue, 13 Oct 2009 04:07:00 +0100 2886529 http://www.medworm.com/index.php?rid=2871669&cid=t_295132_99_f&fid=35344&url=http%3A%2F%2Fzackarysholemberger.blogspot.com%2F2009%2F10%2Fdoes-stress-cause-hypertension-view.html If you ask a doctor, they'll say that stress doesn't cause hypertension ~ or, at least, they will analyze "stress" in biomedical terms (catecholamines and what not). But every clinician has had the experience of patients who are sure that they know when they have high blood pressure: it's when they get stressed. In a thought-provoking talk at the International Conference of Communication in Healthcare (which I return from tonight), Barbara Bokhour (from Boston) et al. helped reframe my experience with their analyses of interviews done with patients with uncontrolled hypertension. Patients have their own models for hypertension (psychological stress playing an important role in these) and they take action to self-treat, by trying to reduce their stress. Among the researchers' interesting ... Zackary Sholem Berger blogs http://www.medworm.com/rss/comments.php?id=2871669 Tue, 06 Oct 2009 22:23:00 +0100 2871669 http://www.medworm.com/index.php?rid=2842546&cid=t_295132_99_f&fid=35344&url=http%3A%2F%2Fzackarysholemberger.blogspot.com%2F2009%2F09%2Fi-dont-know-why-im-in-hospital.html Continuing to tweak my thoughts about doctor-patient diagnostic discordance (i.e. doctor says: she's in the hospital for X; patient says: my doctor told me I'm in the hospital for Y), this time for the International Conference on Communication in Healthcare to be held Oct 4-7 in Miami Beach. I will be heading to the sukkah, not to the surf (I'm arriving 10/5 if anyone wants to look me up), but I am looking forward to it nonetheless. I'm also working on an application for an AHRQ grant on the same topic so I can reproduce my Bellevue pilot study at the Johns Hopkins Hospital. (Source: Zackary Sholem Berger) Zackary Sholem Berger blogs http://www.medworm.com/rss/comments.php?id=2842546 Tue, 29 Sep 2009 15:41:00 +0100 2842546 http://www.medworm.com/index.php?rid=2859068&cid=t_295132_136_f&fid=39025&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Feverythingchangesbook%2F%7E3%2FMXxpwuPVbCg%2Fhave-you-ever-fired-a-doctor I was interviewed in the Chicago Tribune this past Sunday about when you know it is time to ditch your doctor. For me the answer hinges on what kind of doctor it is: primary care physicians (PCP) versus a specialist. I’m actually much more stringent about my PCP, and much more lenient on my specialists. Here is why: My PCP is the gatekeeper of my health. If they don’t ask the right questions, don’t investigate a symptom, don’t remember who I am or if my body has changed over the years it’s a big problem. In the myriad interviews in my book Everything Changes, it was most often the PCP who neglected the signs and symptoms of young adult cancer. Dana’s PCP suggested her back pain was caused by the sexual positions she was using. Mary Ann’s PCP told her she was anorexic and a hy... Everything Changes blogs http://www.medworm.com/rss/comments.php?id=2859068 Thu, 03 Sep 2009 19:19:00 +0100 2859068 http://www.medworm.com/index.php?rid=2626043&cid=t_295132_99_f&fid=35344&url=http%3A%2F%2Fzackarysholemberger.blogspot.com%2F2009%2F07%2Fthis-is-dr-berger-he-is-visiting.html I spent the day enjoyably. I gave a talk this morning to the folks at VMA General Practice Training, one of a number of provider training centers throughout Australia. (Recently - within the past decade or so - the Australian government has decentralized the training of general practitioners, formerly under the College of General Practitioners, in order to promote competition.) I had a feeling of being at home among people like those at the primary care program I just graduated from. Now, primary care doctors in the US are (with the addition of philosophical self-consciousness and their own advocacy organization) just like internists, while their equivalent in Australia is the GP. Australia is civilized because about half their practitioners are GPs. What struck me was how little differenc... Zackary Sholem Berger blogs http://www.medworm.com/rss/comments.php?id=2626043 Wed, 22 Jul 2009 09:45:00 +0100 2626043 http://www.medworm.com/index.php?rid=2376055&cid=t_295132_99_f&fid=35344&url=http%3A%2F%2Fzackarysholemberger.blogspot.com%2F2009%2F04%2Fshe-doesnt-know-why-shes-in-hospital.html I'm still thinking about an all-too-common hospital situation: doctor and patient don't agree on the reason why the doctors put the patient in the hospital. I'm giving a revised talk about it on Wednesday to my primary care colleagues. Comments welcome! (Source: Zackary Sholem Berger) Zackary Sholem Berger blogs http://www.medworm.com/rss/comments.php?id=2376055 Tue, 28 Apr 2009 01:17:00 +0100 2376055 http://www.medworm.com/index.php?rid=2285186&cid=t_295132_99_f&fid=35344&url=http%3A%2F%2Fzackarysholemberger.blogspot.com%2F2009%2F03%2Fhow-could-someone-not-know-why-theyre.html As it happens, I gave a talk on that topic today. It involves some ongoing research of mine. Have a look! (Source: Zackary Sholem Berger) Zackary Sholem Berger blogs http://www.medworm.com/rss/comments.php?id=2285186 Tue, 24 Mar 2009 03:27:00 +0100 2285186 http://www.medworm.com/index.php?rid=1526797&cid=t_295132_154_f&fid=35946&url=http%3A%2F%2Fcanadianmedicine.blogspot.com%2F2008%2F06%2Fweb-buoys-doctor-patient-communication.html There's a high chance the next patient who walks into your office has been researching their diagnosis on the internet and fretting over what they've found.Roughly 62.5% of your patients Google their symptoms before stopping by the clinic, according to research published mid-April in the journal Arthritis and Rheumatism.SHY GUYSBut of those patients only 20% will discuss their concerns with you. The others, the study discovered, say they'd rather not come off as challenging your authority.However, the research also found that when patients do bring up their concerns, both they and their doctors feel more satisfied with the visit.M Cameron Hay-Rollins, the study's lead author and an assistant professor of anthropology at Miami University, suggests taking a couple minutes to ask patients wha... Canadian Medicine blogs http://www.medworm.com/rss/comments.php?id=1526797 Tue, 17 Jun 2008 19:44:00 +0100 1526797 http://www.medworm.com/index.php?rid=537456&cid=t_295132_99_f&fid=35344&url=http%3A%2F%2Fzackarysholemberger.blogspot.com%2F2007%2F04%2Fthinking-about-thinking-about-medicine.html Thinking about thinking about medicineRx: Think better.I recently had the opportunity to interview Jerome Groopman for the Forward on the occasion of his new book, How Doctors Think. I hope the Q&A will appear soon. Meanwhile, enjoy this discussion in Slate which is rather less polite and chummy than ours was. Perhaps I should have said to Dr. Groopman what I was thinking, which is: Research on the patient-doctor interview has been accumulating for the past twenty-five years; why are mainstream MDs discovering it only now? (It's also interesting that the Slate discussion does not touch on doctor-patient communication at all. Groopman: doctors need to be trained better! Sanghavi: systems need to be more effective! But, guys, getting the patient to tell the doctor what the problem is? This i... Zackary Sholem Berger blogs http://www.medworm.com/rss/comments.php?id=537456 Wed, 11 Apr 2007 20:47:00 +0100 537456