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 relationship'. Sat, 03 Sep 2011 02:16:21 +0100 http://www.medworm.com/index.php?rid=5181802&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmisdiagnosis-happens-all-the-time-tips-to-avoid-it%2F2011.09.01 Billionaire Teddy Forstmann has apparently been diagnosed with a serious form of brain cancer.  There’s a tragic twist to the story: according to Fox Business News, Forstmann believes that for more than a year, he had been misdiagnosed with meningitis. ABC News wonders: How could such a misfortune befall a billionaire —- a man able to afford the best doctors, best technology and the most sophisticated diagnostic tests? They’re missing the point.  Misdiagnosis happens with shocking regularity – as much as (more…) *This blog post was originally published at BestDoctors.com: See First Blog* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5181802 Thu, 01 Sep 2011 12:00:03 +0100 5181802 http://www.medworm.com/index.php?rid=5181943&cid=t_247630_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F09%2Fwhere-are-indian-medical-entrepreneurs.html The Indian healthcare industry has become sick and disruptive innovations are needed to heal it ! This is a huge business opportunity . We need to remember that healthcare spending in India today accounts for less than 4.2% of the GDP, whereas in most developed countries it is 6-9% and in the USA it is as much as 16%. This means there is immense growth potential in India in this sector ! Since doctors deal with patients daily, and see the problems and pain points firsthand, one would expect them to be leaders in creating fixes to heal the system. However, they are very few medical entrepreneurs in India today . I feel there are many reasons for this. For one, doctors are part of the problem themselves ! They are so used to making patients wait, that they don’t even realize that this u... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5181943 Thu, 01 Sep 2011 05:58:00 +0100 5181943 http://www.medworm.com/index.php?rid=5174692&cid=t_247630_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F08%2Fputting-end-to-didnt-ask-didnt-tell.html This is a guest post from a clever medical student , Muthukar Ramanathan. If there are more like him, the future of medical practise holds a lot of promise ! ---------------- How many times have you felt that you forgot to mention something important after leaving your doctor’s clinic ? Unable to ask an embarrassing question or to did not remember to discuss your recent allergy? This familiar problem of "Didn't Ask Didn't Tell" among patients is due to multiple reasons - chiefly lack of recollection, stress or even laziness. But this inability to communicate well with physicians ultimately hurts patients due to incorrect diagnosis or treatment. As a medical student sitting as an observer in physician's office, I noticed that many times patients could not accurately provide much needed... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5174692 Mon, 29 Aug 2011 14:59:00 +0100 5174692 http://www.medworm.com/index.php?rid=5174614&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-beneficial-effect-of-laughter-on-your-health%2F2011.08.29 I stumbled upon the article ‘Laughter: gender-specific variations’ in Revista Clínica Española (‘Spanish Clinical Journal’) and I can’t help thinking about the need for taking this into account to improve doctor-patient relationships. The text can actually be read as a guide to understand how every person laughs and how to use it in clinical practice. Table 1. Laughter effect on health (more…) *This blog post was originally published at Diario Medico* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5174614 Mon, 29 Aug 2011 14:00:27 +0100 5174614 http://www.medworm.com/index.php?rid=5159258&cid=t_247630_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F08%2Fhow-can-we-get-patients-to-take-more.html It's extremely easy to criticize doctors for the sad state of health care today. Most patients are very articulate about the fact that their doctor spends very little time with them ; that he makes them wait unnecessarily for long hours ; and that he provides them with precious little information about their illness. This causes a lot of heartburn and frustration ; and many people believe that doctors are now behaving more like businessman rather than professionals. While there may be some truth in this criticism , it is also equally true that doctors are soft and easy targets. In fact , the press has played a major role in bashing doctors , and while it's true that stories about unethical doctors who indulge in corrupt acts help them to sell more newspapers , sadly all these stories also... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5159258 Tue, 23 Aug 2011 04:38:00 +0100 5159258 http://www.medworm.com/index.php?rid=5130747&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fshould-doctors-want-their-patients-to-use-the-web-to-stay-informed%2F2011.08.15 Recently, I’ve had an interview with a national newspaper and the woman who performed the interview told me she was surprised that I seemed to be the first doctor in her life who was happy about patients using the internet. Well, she surprised me with this statement as I’ve never thought about that before. But she must be right. There are many doctors who get upset when they find out the patient tried to find information online. They are frustrated as they don’t even know how to use these online tools and have no idea how to help the patients in this perspective. Myself, I’m pretty much happy about it. I love to hear patients (more…) *This blog post was originally published at ScienceRoll* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5130747 Mon, 15 Aug 2011 14:00:41 +0100 5130747 http://www.medworm.com/index.php?rid=5086171&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnew-program-at-usf-health-hopes-to-mold-more-empathetic-physicians%2F2011.08.01 Can we teach empathy to the next generation of physicians?  The University of South Florida Health thinks so and they’re putting it on the line this week with the launch of the SELECT program, a new curriculum intended to “put empathy, communication and creativity back into doctoring.” The SELECT (Scholarly Excellence. Leadership Experiences. Collaborative Training.) program will offer 19 select students unique training in leadership development as well as the scholarly tools needed to become physician leaders and catalysts for change. During their first week on campus, instead of the old-style medical school tradition of heading to the gross anatomy lab, SELECT students are immersed in leadership training centered in empathy and other core principles of patient-centered care. The h... Better Health blogs http://www.medworm.com/rss/comments.php?id=5086171 Mon, 01 Aug 2011 12:00:15 +0100 5086171 http://www.medworm.com/index.php?rid=5077685&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ftake-an-active-role-in-your-own-health-it-can-save-more-than-just-your-life%2F2011.07.29 Sometimes you need a published study to tell you what should be obvious in the first place. This time, researchers have discovered that: When physicians have more personalized discussions with their patients and encourage them to take a more active role in their health, both doctor and patient have more confidence that they reached a correct diagnosis and a good strategy to improve the patient’s health. Really? But wait, there’s more. (more…) *This blog post was originally published at See First Blog* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5077685 Fri, 29 Jul 2011 18:00:07 +0100 5077685 http://www.medworm.com/index.php?rid=5069480&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-stories-in-medicine-that-need-to-be-told%2F2011.07.26 I can’t help but think that as time passes we’ll forget about how much medicine has changed with the introduction of the Internet.  We’re witnessing a transition that hasn’t been seen in generations.  We live with the end result but the memory of how we got here is fading quickly.  Like any kind of cultural shift, once we’ve arrived it’s hard to remember what it was like along the way. How did patients think before the information revolution?  And how did it go down when patients began to search?  How specifically did information clash with the old model of doctor and patient and how did we deal with it?  There are stories here that need to be told.  I think the real stories are in the small details of what went down between doctors and patients. But as early adopters, ... Better Health blogs http://www.medworm.com/rss/comments.php?id=5069480 Tue, 26 Jul 2011 12:00:15 +0100 5069480 http://www.medworm.com/index.php?rid=5057726&cid=t_247630_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=5050775&cid=t_247630_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F07%2Fwhy-do-doctors-give-kickbacks-and-whats.html It's very easy for people to moralise and wax eloquent about the declining standards of ethics and morality amongst doctors in India today. However, rather than blame individuals or the medical profession, I think we need to focus on finding a solution.This is my viewpoint.Individually, most doctors are good people. They enter medicine because they want to be of service to others - and most are intelligent, conscientious, idealistic and hardworking when they enter medical college.However, as time goes by, they gradually become cynical and bitter. There are few positive role models they can look upto - and when they see their seniors indulge in unethical practises, they are quite resigned to toeing the party line. After all, how can you fight the "system" ? In India, isn't everyone corrupt,... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5050775 Fri, 22 Jul 2011 03:24:00 +0100 5050775 http://www.medworm.com/index.php?rid=5050776&cid=t_247630_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F07%2Fare-doctors-just-specialised-knowledge.html Lots of people believe that healthcare today is "mismanaged" - and that better management would allow more efficient and effective medical care to be provided ! After all, how can any argue against the statement that management is better than mismanagement - isn't this a no-brainer ?If you want to manage medical care, you need to manage doctors - and if doctors can be treated as "knowledge workers", then it's possible to use what we have learnt from the experience of managing engineers and computer programmers and then apply it to medicine. After all, aren't doctors just experts who deal with patients, just like computer programmers are experts who handle computers ? This seems to be entirely reasonable and logical - but it's precisely the seductiveness of the this argument which causes ma... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5050776 Thu, 21 Jul 2011 10:41:00 +0100 5050776 http://www.medworm.com/index.php?rid=5036236&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fshould-psychiatrists-disclose-their-personal-history-to-patients%2F2011.07.16 Dr. Maureen Goldman talks about self-disclosure for psychiatrists and brings the topic up in the context of Marsha Linehan’s recent announcement that she was treated for a psychiatric disorder as a teenager. In Clinical Psychiatry News, Dr. Goldman notes: Psychiatric care and psychotherapy are different from the Alcoholics Anonymous fellowship, where the mutual sharing of personal experience is an integral part of helping people maintain sobriety. I believe that there is middle ground between disclosing personal information and presenting myself as a blank slate. In my practice, I show myself to be a real person. I make mistakes and admit them. I joke about my poor bookkeeping skills and inferior technological skills. I look things up during sessions if necessary, and I tell patients... Better Health blogs http://www.medworm.com/rss/comments.php?id=5036236 Sat, 16 Jul 2011 12:00:00 +0100 5036236 http://www.medworm.com/index.php?rid=5028213&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-age-of-medical-disconnect%2F2011.07.14 It’s the age of medical disconnect. The disconnect describes the emotional and intellectual detachment that physicians feel from their patients and patients from their doctors.  This disconnect is the result of a confluence of factors, some from within the profession itself, others are more broadly social and economic. To understand the disconnect you need look no further than your neighbor or your parents.  Dissatisfaction is evolving as the norm.  Patients feel increasingly marginalized in their experiences with physicians.  Shrinking length of visits, indifferent attitudes, poorly coordinated evaluations, difficulty obtaining test results, an institutional feel to the patient experience, and the overall sense of not feeling at all important. The truth is that many of us are really... Better Health blogs http://www.medworm.com/rss/comments.php?id=5028213 Thu, 14 Jul 2011 21:00:13 +0100 5028213 http://www.medworm.com/index.php?rid=5028749&cid=t_247630_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Flife-may-be-weird-but-you-dont-have-to-be%2F Those of us who live with chronic pain each day have many choices to make. I know from first hand or should I say my “First Tushy” experience that we all feel helpless and robbed of choices more times than not, but that isn’t totally true. I realize “First Tushy” doesn’t have quite the elevation of First Lady but there you have it; my life. We are not mere victims. We remain the pilots of our planes as well as the captains of our own ships. I know we often have our doubts. We feel more enslavement than freedom; more the conquered than the victors and finally, hopelessly weird. I think that’s enough metaphors to choke a good sized horse but I’m certain you sense my direction. Today, after five years of chatting with all of you who also suffer, I would like to share three of ... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=5028749 Thu, 14 Jul 2011 20:24:47 +0100 5028749 http://www.medworm.com/index.php?rid=5028521&cid=t_247630_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F07%2Fshould-i-be-operating-or-talking-to.html One of my friends is a highly skilled cardiac surgeon. He spends most of his day in the OT, and while his technical skills are superb, his patients often complain that he is brusque and has poor bedside manner. When I was talking to him about the importance of good doctor-patient communication, he got visibly irritated .“ Really , what do people expect me to do ? I am a highly skilled surgeon and I should be spending most of my time in the operation theater , helping my patients to get better. I have spent over 12 years learning how to do surgery and am extremely good at my job ! Should I be operating in the theater or should I be sitting and talking to patients ? I operate all the way from 8 o’clock in the morning to 8 o clock in the evening. How could I possibly find time to sit and ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5028521 Mon, 11 Jul 2011 02:58:00 +0100 5028521 http://www.medworm.com/index.php?rid=5008350&cid=t_247630_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F07%2Fwhy-dont-doctors-stand-up-for.html The press has had a field day writing about doctors in Indore who allegedly perform surgery on helpless little girls to change them into boys. This started off with a badly researched article in the Hindustan Times; and has become a big issue with everyone from the Prime Minister's Office downwards jumping onto the bandwagon, clamoring for an inquiry . In their pursuit of their ten minutes of fame and a few columns of press publicity, activists are happy to talk at length about the stringent measure which need to be taken to book the guilty doctors and punish them, so these innocent girl children can be protected.What amazes me is how willing we are to assume that Indian doctors are crooked criminals who are happy to perform mutilating surgery just to earn a few bucks ! Is this really the ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5008350 Wed, 06 Jul 2011 03:27:00 +0100 5008350 http://www.medworm.com/index.php?rid=4992781&cid=t_247630_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F07%2Ftoday-is-doctors-day-so-what.html This is an article which I wrote for Times Wellness for Doctor's Day.---------------------------There used to be a time when the doctor was a highly regarded member of society. Doctors were treated as trusted professionals who could be counted upon to provide wise counsel in times of sickness.Sadly, times have changed. Doctors are now looked upon as mercenaries who run a business and are out to make a quick buck, often at the expense of the patient. The doctor has been knocked off his pedestal and part of the reason for this is because patients have unrealistic expectations from medical technology. They assume that there is a pill for every ill – and they jump to the conclusion that if the patient does not improve, this means the doctor was negligent.Doctors are also to blame for this sa... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4992781 Fri, 01 Jul 2011 06:18:00 +0100 4992781 http://www.medworm.com/index.php?rid=4975866&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdo-physicians-prefer-ventilated-and-sedated-patients%2F2011.06.28 You ever wonder what doctors really think but are afraid to say out loud?  Here’s one example: “I wish all my patients were on a ventilator” There’s a reason vented and sedated patients are considered desirable.  In addition to the obvious economic benefits of ROS unobtainable Billing critical care CPT 99291, 99292 There are the less talked about, but equally pleasant side effects most hospitalists, ER doctors, cardiologists, gastroenterologists, pulmonologists,  surgeons, infectious disease doctors, endocrinologists, psychiatrists, rheumatologists, dermatologists, nurses, respiratory therapists and physical therapists wouldn’t admit, but would agree, without hesitation.  As a general rule: Patients on ventilators are just faster, easier and more pleas... Better Health blogs http://www.medworm.com/rss/comments.php?id=4975866 Tue, 28 Jun 2011 15:00:00 +0100 4975866 http://www.medworm.com/index.php?rid=4934586&cid=t_247630_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fsues-patient-rights-responsibilities-and-opportunities%2F You have the right to life as long as you realize it might not be quite as you planned. You have the opportunity to change what you can and accept that which you cannot change. Just remember the word impossible is a relative term. You have the responsibility to seek options, be they health care, marital status or parenthood. All three require early action rather than late. You have the responsibility to judge each situation you face with candor, good judgment, and valor. If you choose not to do the above, you have the right to screw things up. It is your life, after all. You have the responsibility to maintain your body even though it appears to not give a fig about you. Disloyal lot these physical shells. You have the responsibility to remember your brain and your heart are in charg... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4934586 Thu, 16 Jun 2011 22:46:43 +0100 4934586 http://www.medworm.com/index.php?rid=4934161&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-boundaries-between-doctor-and-patient%2F2011.06.16 This post from Kelly Young on Howard Luks’ blog asks when patients cross the line with respect to their own advocacy.  It’s worth a peek. The question of boundaries between doctor and patient is interesting.  All of my patients are empowered in some way.  The extent and level of that empowerment is personal.  On our own there are few lines and little with respect to boundaries.  We have effectively unlimited access to information and resources.  And how far we go to look after ourselves and our kids has few limits. But when we enter into a relationship with a provider, we’re no longer alone.  It’s unreasonable for a provider to tell a patient (more…) *This blog post was originally published at 33 Charts* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4934161 Thu, 16 Jun 2011 12:00:58 +0100 4934161 http://www.medworm.com/index.php?rid=4893456&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoes-your-doctor-have-time-to-think-about-you%2F2011.06.02 At the New York Times’ City Room Blog, Joel Cohen writes: my wife and I are convinced that all medical students should have to pass Overbooking 101 before they can become doctors.Again and again, we arrive at a doctor’s aptly named waiting room on or before the scheduled time, only to learn that three or four others sitting there have been given the same appointment. He says doctors need to understand the impact of this on their patients.  I agree, but not just because it’s annoying. A typical doctor sees thirty patients a day.  Some see even more. Reflect on that math.  If your doctor sees 30 patients a day, that’s 150 a week, 600 a month, maybe 7,000 a year. It means that if it’s been even two months since you last saw your doctor, he has probably seen more than a thousand p... Better Health blogs http://www.medworm.com/rss/comments.php?id=4893456 Thu, 02 Jun 2011 15:00:57 +0100 4893456 http://www.medworm.com/index.php?rid=4821007&cid=t_247630_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fchoices-for-good-or-choices-for-evil-its-up-to-you%2F Each day, as mere mortals, we have decisions to make. Choices surround us 24 hours a day. We are assaulted by choices even when we’re asleep. For instance, during the night, are we cold, are we hot, do we get up to urinate or is it worth the effort? Do we feel enough pain to check the clock and see if it’s time for a pain pill or perhaps, a muscle relaxant? Does that mean we have to get up or did we plan ahead and put some water or juice at the bedside, trying to avoid that long, long hobbling walk to the bathroom in the middle of the night? When we try to get back to sleep we wonder about life, decide we need a new mattress, or in my case, think of ways to get my spouse to stop snoring. I hate to bother the poor, tired man so I try not to wake him but I have found he will stop snoring... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4821007 Thu, 12 May 2011 19:23:27 +0100 4821007 http://www.medworm.com/index.php?rid=4744845&cid=t_247630_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F04%2Fdoctors-as-online-trusted-patient.html " Guiding patients to better online sources of medical information should be a new physician responsibility for the digital age. Not only should doctors expect and be receptive to questions patients raise from Web research, they need to proactively engage patients online in order to dispel falsehoods and guide them to legitimate sites."This is why I feel every doctor should have their own website ! It forces them to search for reliable health websites ( to which they can link) so they can guide their patients intelligently, rather than getting upset when patients come with many sheets of internet printouts ! Even better, it will encourage thoughtful doctors who are not happy with the quality of the information they find on other sites , to publish better customised content on their own... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4744845 Sun, 24 Apr 2011 05:41:00 +0100 4744845 http://www.medworm.com/index.php?rid=4742544&cid=t_247630_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fsues-official-rules-for-whining%2F When you’ve had chronic pain for many years whining becomes an art form, a sacred ritual while also becoming a bit repetitive. That’s why you have to jazz it a bit by coming up with new ways to whine. Sure, it sounds easy. If you’re new to all this you might think all you have to do is be the victim, I mean patient, then spot another victim, also known as the listener and you’re all set to go. It’s much more complex than that. Let me see if I can sum it up for you. You know I love a list so let’s try, shall we? Never whine when you’re with someone sicker than you are. They don’t give a rat’s ass and you will find it very unfulfilling. Whining is not a contest but if it were, you’d have to find someone without any problems of their own. Good luck with that. You might a... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4742544 Thu, 21 Apr 2011 21:36:19 +0100 4742544 http://www.medworm.com/index.php?rid=4664361&cid=t_247630_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fsharp-retorts-for-dull-people-in-a-life-of-chronic-pain%2F Each of us who lives a life of compromised health doesn’t do it on an island. Neither do we live in a gilded cage, whatever the heck that is. No, we live in a larger cage without any adornments as we struggle to make it through each day — each of us in different circumstances and conditions. Some of us are seriously disabled while others live with different degrees of equally serious pain. There is definitely one aspect of life we experience as we live in flocks, groups or herds. Yes, herds. Have you been to a large city lately? The only thing missing is the mooing. There is a certain insensitivity that has crept into our society as we bump up against others, going through life in our limited capacity or attempting full speed ahead. Most people do not understand what a life of chr... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4664361 Fri, 01 Apr 2011 14:53:31 +0100 4664361 http://www.medworm.com/index.php?rid=4600535&cid=t_247630_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=4570544&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fquestioning-the-annual-pelvic-exam%2F2011.03.10 A new article in the Journal of Women’s Health by Westhoff, Jones, and Guiahi asks “Do New Guidelines and Technology Make the Routine Pelvic Examination Obsolete?” The pelvic exam consists of two main components: The insertion of a speculum to visualize the cervix and the bimanual exam where the practitioner inserts two fingers into the vagina and puts the other hand on the abdomen to palpate the uterus and ovaries. The rationales for a pelvic exam in asymptomatic women boil down to these: Screening for chlamydia and gonorrhea Evaluation before prescribing hormonal contraceptives Screening for cervical cancer Early detection of ovarian cancer None of these are supported by the evidence. Eliminating bimanual exams and limiting speculum exams in asymptomatic patients would reduce cos... Better Health blogs http://www.medworm.com/rss/comments.php?id=4570544 Thu, 10 Mar 2011 22:00:48 +0100 4570544 http://www.medworm.com/index.php?rid=4565903&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmanaging-patient-uncertainty%2F2011.03.09 How comfortable are we with uncertainty? I struggle with this question every day. I treat children with abdominal pain. Some of these children suffer with crohns disease, eosinophilic esophagitis, and other serious problems. Some children struggle with abdominal pain from anxiety or social concerns. I see all kinds. But kids are tricky, and sometimes I can’t pinpoint the problem. Trudging forward with more testing is often the simplest option since it involves little thinking. And some parents perceive endless testing as “thorough.” The question ultimately becomes: When do we stop? Once we’ve taken a sensible first approach to a child’s problem and judged that the likelihood of serious pathology is slim, when and how do we suggest that we wait before going any furt... Better Health blogs http://www.medworm.com/rss/comments.php?id=4565903 Wed, 09 Mar 2011 20:30:46 +0100 4565903 http://www.medworm.com/index.php?rid=4549751&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdefining-online-physician-conduct%2F2011.03.04 This week a reporter cornered me on the issue of professional behavior in the social space. How is it defined? I didn’t have an answer. But it’s something that I think about. Perhaps there isn’t much to think about. As a “representative” of my hospital and a physician to the children in my community, how I behave in public isn’t any different than a decade ago. Social media is just another public space. Sometimes it’s easy to forget that we’re in public. When I’m wrapped up in a Twitter thread it’s easy to forget that the world is watching. But the solution is simple: Always remember that the world is watching. On Twitter I think and behave as I do in public: Very much myself but considerate of those around me. I always think about how I might be perceived.... Better Health blogs http://www.medworm.com/rss/comments.php?id=4549751 Fri, 04 Mar 2011 20:00:27 +0100 4549751 http://www.medworm.com/index.php?rid=4540564&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fit%25e2%2580%2599s-time-to-tango-impatient-with-progress-on-patient-physician-partnership%2F2011.03.02 The other day I came across this photo of a couple clasping each other in a dramatic tango on the cover of an old medical journal – a special issue from 1999 that was focused entirely on doctor-patient partnership. The tone and subjects of the articles, letters and editorials were identical to those written today on the topic: “It’s time for the paternalism of the relationship between doctors and patients to be transformed into a partnership;” “There are benefits to this change and dangers to maintaining the status quo;” “Some doctors and patients resist the change and some embrace it: Why?” Two questions struck me as I impatiently scanned the articles from 12 years ago: First, why are these articles about doctor-patient partnership still so relevant? And second, why ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4540564 Wed, 02 Mar 2011 22:00:43 +0100 4540564 http://www.medworm.com/index.php?rid=4532207&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fyou-are-the-biggest-wasted-resource-in-health-care%2F2011.03.01 ABCNews.com has posted a great new piece by Dr. Roni Zeiger entitled, “The Biggest Wasted Resource in Health Care? You.” Subtitle: “How Your Internet Research Can Help Your Relationship With Your Doctor.” It’s well reasoned and clearly written, and continues the trend we cited a month ago, when Time posted Dr. Zack Meisel’s article saying that patients who Google can help doctors. Related notes: – Dr. Zeiger’s article title parallels what Dr. Charles Safran told the House Ways & Means Subcommittee on Health in 2004: Patients are “the most under-utilitized resource.” He was talking about health IT, quoting his colleague Dr. Warner Slack, who had said it many years earlier. I often quote it in my speeches for the Society for Participatory Medicine, assert... Better Health blogs http://www.medworm.com/rss/comments.php?id=4532207 Tue, 01 Mar 2011 16:00:16 +0100 4532207 http://www.medworm.com/index.php?rid=4532209&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-third-place-in-healthcare-what-we-can-learn-from-starbucks%2F2011.02.28 Media reports on misdiagnosis continue to mount. A recent study on patients with Alzheimer’s found that half had been misdiagnosed. Half. Another headline blared “4 out of 10 patients being misdiagnosed.” The article encouraged patients to “see another doctor” if they are worried about their diagnosis. You know what it makes me think about? Starbucks. Why? Because the way Starbucks revolutionized coffee drinking shows a way forward for healthcare. Starbucks realized that since our lives focus on two places — home and work — most of us don’t have a “third place” to go. A place where we can be free of everyday distractions and take care of ourselves. Starbucks set out to create that “third place” by making its shops comfortable, inviting places. It works... Better Health blogs http://www.medworm.com/rss/comments.php?id=4532209 Mon, 28 Feb 2011 23:00:22 +0100 4532209 http://www.medworm.com/index.php?rid=4532211&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdr-watson-and-the-7-human-qualities-of-an-ideal-physician%2F2011.02.28 After the computer known as Watson easily dispatched of the best two human Jeopardy! contestants in history, IBM announced that one of the first applications of their artificial intelligence technology would be in the medical field. We should soon expect virtual physician assistants in the exam room. At least one of my friends even speculated that the days of human doctors are numbered. Is it possible that machines will replace humans in the doctor-patient relationship? I doubt it. According to a study done by the Mayo Clinic in 2006, the most important characteristics patients feel a good doctor must possess are entirely human. According to the study, the ideal physician is confident, empathetic, humane, personal, forthright, respectful, and thorough. Watson may have proved his cognitive ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4532211 Mon, 28 Feb 2011 18:00:27 +0100 4532211 http://www.medworm.com/index.php?rid=4512448&cid=t_247630_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F02%2Fmake-patients-do-more-of-work.html There is a shortage of doctors. This is true all over the world because of many reasons. Medical training is expensive and arduous, and not many people are capable of surviving the grind. Also, doctor are unevenly distributed, which means that there are too many in large cities, but not enough in the villages. Finally, a lot of the doctor’s time , energy and expertise is wasted in handling problems which do not really need their expert attention. These are problems which can easily be handled by the patient and his family himself.The standard solution to the chronic shortage of doctors has always been the standard knee-jerk response - train more doctors ! This solution comes in many different flavours - open more colleges; or create a new cadre of barefoot village doctors. However, these... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4512448 Wed, 23 Feb 2011 04:02:00 +0100 4512448 http://www.medworm.com/index.php?rid=4489678&cid=t_247630_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_247630_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=4459957&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoctors-and-patients-wish-their-relationship-was-better%2F2011.02.10 Physicians said in a survey that noncompliance with advice or treatment recommendations was their foremost complaint about their patients. Most said it affected their ability to provide optimal care and more 37 percent said it did so “a lot.” Three-quarters of patients said they were highly satisfied with their doctors. But they still had complaints ranging from long wait times to ineffective treatments. Those are just some of the findings from two surveys, the first a poll of 660 primary care physicians conducted by the Consumer Reports National Research Center in September 2010 and the second a poll of 49,000 Consumer Reports subscribers in 2009. The magazine reported its results online. In the doctors’ poll, physicians named these top challenges: – 76 percent o... Better Health blogs http://www.medworm.com/rss/comments.php?id=4459957 Fri, 11 Feb 2011 00:00:00 +0100 4459957 http://www.medworm.com/index.php?rid=4450294&cid=t_247630_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=4445803&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-doctors-brain-the-most-important-piece-of-healthcare-technology%2F2011.02.07 Some people may tell you that healthcare IT will solve many of the quality and cost problems in healthcare. I don’t believe them. I know a 70-year old man named Carlos (not his real name) who was hospitalized following a bout of hydrocephalus. Hydrocephalus is a build-up of fluid in the skull, which affects the brain. Among other things, people with hydrocephalus can be confused, irritable, and nauseous. Carlos had all of these symptoms. Carlos’ problem was fixable by inserting a special kind of drain in his head called a “shunt.” This kind of shunt is, essentially, a series of catheters that runs from the brain into the abdomen, and which drain the excess fluid. You can’t see it from the outside, so it’s meant to stay inside of you for a very long time. For a week after Ca... Better Health blogs http://www.medworm.com/rss/comments.php?id=4445803 Mon, 07 Feb 2011 17:00:08 +0100 4445803 http://www.medworm.com/index.php?rid=4419139&cid=t_247630_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=4399524&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-second-opinion-is-good-but-a-third-or-fourth%2F2011.01.26 A few years ago I started writing a book on what it was like to be a cancer patient and an oncologist. This morning I came upon this section on second opinions: Is It OK To Get A Second Opinion? Definitely. And there’s no need to be secretive about it, or to worry about hurting the doctor’s feelings. Second opinions are routine in fields like oncology, and are often covered by insurance. Be up-front: Any decent oncologist can understand a cancer patient’s need to find a doctor who’s right for them, with whom they’re comfortable making important decisions. And in difficult cases, some specialists appreciate the chance to discuss the situation with another expert. So a second opinion can be beneficial to patients and physicians alike. When things can get out of hand, though, is whe... Better Health blogs http://www.medworm.com/rss/comments.php?id=4399524 Wed, 26 Jan 2011 14:00:50 +0100 4399524 http://www.medworm.com/index.php?rid=4394545&cid=t_247630_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F01%2Fwhy-i-love-talking-to-my-patients.html I had just finished seeing a patient who came to me from Bangalore for IVF treatment , and before leaving the room, he turned around and said - " Thank you so much for taking the time to listen to us so patiently ! "I was flummoxed ! After all, isn't listening to a patient a part of the doctor's job description ? Why was he thanking me for doing something which is so routine and mundane ?When I asked my next patient why I was being thanked, he said - That's because you are so different from most other doctors, doc ! Most doctors just rush like automatons through a long line of patients. It's like they are just processing an assembly line of people - and they have 7 minutes in which to listen to you . They are always rushed and harassed - and it's very hard to have a decent convesration wit... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4394545 Tue, 25 Jan 2011 07:11:00 +0100 4394545 http://www.medworm.com/index.php?rid=4394444&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-the-end-of-internal-medicine-as-we-know-it-might-be-a-good-thing%2F2011.01.24 A recent post on the Health Affairs blog proclaimed “The End of Internal Medicine As We Know It.” What the post is really asking about is the future of primary care in the world of healthcare reform and the creation of accountable care organizations (ACOs). While doctors should be naturally concerned about change, I don’t completely agree with this article. ACOs are organizations that are integrated and accountable for the health and well-being of a patient and also have joint responsibilities on how to thoughtfully use a patient’s or employer’s health insurance premium, something that is sorely lacking in the current health care structure. These were recently created and defined in the healthcare reform bill. Yet the author seems to suggest that this is a s... Better Health blogs http://www.medworm.com/rss/comments.php?id=4394444 Mon, 24 Jan 2011 20:00:00 +0100 4394444 http://www.medworm.com/index.php?rid=4386272&cid=t_247630_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=4349514&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-the-term-patient-is-so-important-in-healthcare%2F2011.01.14 An online friend, col­league, and out­spoken patient advocate, Trisha Torrey, has an ongoing e-vote about whether people prefer to be called a “patient,” a “con­sumer,” a “cus­tomer,” or some other noun to describe a person who receives healthcare. My vote is: PATIENT. Here’s why: Providing medical care is or should be unlike other com­mercial trans­ac­tions. The doctor, or other person who gives medical treatment, has a special pro­fes­sional and moral oblig­ation to help the person who’s receiving his or her treatment. This respon­si­bility — to heal, hon­estly and to the best of one’s ability — over­rides any other com­mit­ments, or con­flicts, between the two. The term “patient” con­stantly reminds the doctor of the spe­cialness of... Better Health blogs http://www.medworm.com/rss/comments.php?id=4349514 Fri, 14 Jan 2011 21:00:02 +0100 4349514 http://www.medworm.com/index.php?rid=4337934&cid=t_247630_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=4331012&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoctors-patients-and-remote-third-parties%2F2011.01.10 From the ominously-titled book “New Rules” by Donald Berwick, M.D., and Troyen Brennan M.D.: “Today, this isolated relationship [between doctor and patient] is no longer tenable or possible. . . Traditional medical ethics, based on the doctor-patient dyad, must be reformulated to fit the new mold of the delivery of health care. . . The primary function of regulation in health care…is to constrain decentralized individualized decision making.” Unfortunately, Dr. Berwick’s straightforward formulation of the appropriate role of the individual physician in our reformed healthcare system is not isolated to thinkers of the Progressive persuasion. The notion that most clinical decisions can be usefully made by a centralized authority is attractive even to some conservatives. For examp... Better Health blogs http://www.medworm.com/rss/comments.php?id=4331012 Mon, 10 Jan 2011 22:00:27 +0100 4331012 http://www.medworm.com/index.php?rid=4322507&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpain-contracts-do-they-threaten-the-doctor-patient-relationship%2F2011.01.07 Doctors today are wary about treating chronic pain. One of the main worries is precipitating fatal opioid overdoses. Indeed, according to the CDC, and reported by American Medical News, “fatal opioid overdoses tripled to nearly 14,000 from 1999 to 2006 … [and] emergency department visits involving opioids more than doubled to nearly 306,000 between 2004 and 2008.” Requiring chronic pain patients to sign pain contracts is a way to mitigate this risk. But how does that affect the doctor-patient relationship? Indeed, a contract is an adversarial tool. Essentially, it states that a patient must comply with a strict set of rules in order to receive medications, including where and how often they obtain controlled substances, and may involve random drug testing. Break the contract and the ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4322507 Fri, 07 Jan 2011 20:00:11 +0100 4322507 http://www.medworm.com/index.php?rid=4322508&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysician-visibility-in-public-i-see-patients-and-they-see-me%2F2011.01.07 In the movie “The Sixth Sense,” there was that kid who saw dead people. I’m like that. But I see patients and their parents instead. They’re all around me. They’re watching at the grocery store when my kids act up. We meet during anniversary dinners, at Christmas Eve service, and on the treadmill at the Y. I bump into parents when buying personal effects and even during the early morning coffee run in my oldest sweats. I see patients. The follow-up dialog between the parents might go something like this: Dad: “Marge, don’t you think Billy’s colitis might be better managed by a doctor capable of pulling himself together?” Mom: “Don’t be ridiculous, Frank. DrV’s bedhead has nothing to do with his ability to care for Billy. And besides, I’ve heard tha... Better Health blogs http://www.medworm.com/rss/comments.php?id=4322508 Fri, 07 Jan 2011 18:00:43 +0100 4322508 http://www.medworm.com/index.php?rid=4298620&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fabout-patient-autonomy%2F2010.12.29 Recently, I was involved in a discussion on an email list serve and decided to takes some of my comments on patient autonomy and blog about them. This arose following a debate about whether the term “patient” engendered a sense of passivity and, therefore, whether the term should be dropped in favor of something else, like “client” or something similar. Having participated in the preparation and dissemination of the white paper on e-patients, I don’t see the need for “factions” or disagreements in the service of advancing Participatory Medicine. As Alan Greene aptly stated: “This is a big tent, with room for all.” I want all of my patients to be as autonomous as possible. In my view, their autonomy is independent of the doctor-patient r... Better Health blogs http://www.medworm.com/rss/comments.php?id=4298620 Wed, 29 Dec 2010 22:00:00 +0100 4298620 http://www.medworm.com/index.php?rid=4277860&cid=t_247630_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F12%2Fdoctors-gods-knights-knaves-or-pawns.html Like all professionals, doctors have a certain image about themselves . Similarly, patients have expectations of their doctors and expect them to conform to their mental model of how a doctor should behave.Life was much easier in the past when both patients and doctors expected doctors to behave as demi-Gods. The doctor was a shaman who was considered to be a healer who had been inspired by divine powers which he could use to help the sick to get better.In modern society, however, things have changed considerably; and few patients will treat their doctors as God-like figures ( and I feel most doctors would also be very uncomfortable in this role !)What roles do doctors adopt today ? These are primarily three, as articulated so well by the British economist, Julian Le Grand. We perceive doc... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4277860 Wed, 22 Dec 2010 05:13:00 +0100 4277860 http://www.medworm.com/index.php?rid=4190153&cid=t_247630_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=4186906&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Finfection-control-and-the-doctor-patient-relationship%2F2010.11.20 Hospitals have recently been stepping up their infection control procedures, in the wake of news about iatrogenic infections afflicting patients when they are admitted. Doctors are increasingly wearing a variety of protective garb — gowns, gloves, and masks — while seeing patients. In an interesting New York Times column, Pauline Chen wonders how this affects the doctor-patient relationship. She cites a study from the Annals of Family Medicine, which concluded that, fear of contagion among physicians, studies have shown, can compromise the quality of care delivered. When compared with patients not in isolation, those individuals on contact precautions have fewer interactions with clinicians, more delays in care, decreased satisfaction and greater incidences of depression and anxiety. T... Better Health blogs http://www.medworm.com/rss/comments.php?id=4186906 Sat, 20 Nov 2010 15:00:09 +0100 4186906 http://www.medworm.com/index.php?rid=4172057&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-a-patient-contacts-a-doctor-on-twitter%2F2010.11.16 When perusing my Twitter feed [one] morning, I stumbled onto this post directed to me: Patients reaching me in public social spaces is becoming a regular thing. I’ve discussed this in the past, but I think it bears repeating. So here’s what I did: I understood the mom’s needs. Patients resort to “nontraditional” means of communication when the traditional channels fail to meet their needs. Recognize that these patients (or parents in my case) are simply advocating for themselves. My specialty struggles with a shortage of physicians, so we’re dependent upon phone triage to sort out the really sick from the less-than-sick. It’s an imperfect system and consequently parents find themselves having to speak up when the gravity of their child’s condition hasn’t be... Better Health blogs http://www.medworm.com/rss/comments.php?id=4172057 Tue, 16 Nov 2010 23:00:23 +0100 4172057 http://www.medworm.com/index.php?rid=4125009&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-future-of-american-healthcare%2F2010.11.01 You want to see a doctor? You’re going to have to wait. And I don’t mean like an hour in the office. I mean like 53 days. It’s not some doomsday story from the future. It’s happening today here in Massachusetts. Massachusetts — the state whose 2006 law was the model for the federal healthcare reform law. Massachusetts — home to some of the world’s best medical centers and doctors. And, as the Boston Globe’s “White Coat Notes” blog reports, Massachusetts — home to doctor shortages and long waits to see a doctor: When primary care patients do secure an appointment for a non-urgent matter, they have to wait to get in the door, the survey found. The average delay is 29 days to see a family medicine doctor, down from 44 days last year, and 53 days ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4125009 Mon, 01 Nov 2010 14:00:44 +0100 4125009 http://www.medworm.com/index.php?rid=4001688&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdiabetes-criminals-and-diabetes-police%2F2010.09.25 At TCOYD [Taking Control Of Your Diabetes], one of the sessions I attended was about Diabetes Police (Healthcare Providers) and Diabetes Criminals (People With Diabetes). And I was a little taken aback by the title of the session, but we used it to our advantage when we walked into the session a few minutes after it had already started. “Okay, we see a few late stragglers in here. It’s not like they had to be on time or anything,” Dr. Edelman quipped from the front of the room, giving us a smirk.   “I’m sorry we’re late. But what do you expect? We’re the criminals, man!” I shot back at him. And the crew of us “criminals” took up the last few rows, our smartphones at the ready to Tweet out the best of the session. (We were... Better Health blogs http://www.medworm.com/rss/comments.php?id=4001688 Sat, 25 Sep 2010 14:00:18 +0100 4001688 http://www.medworm.com/index.php?rid=3902901&cid=t_247630_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprimary-care-doctors-rewarded-for-time-with-patients%2F2010.08.25 Abraham Verghese is a professor of medicine at Stanford University and one of the most articulate physician-writers today. He recently wrote an op-ed highlighting primary care’s plight, and focuses on the scarcity of time: The science of medicine has never been more potent – incredible advances and great benefits realized in the treatment of individual diseases – yet the public perception of us physicians is often one of a harried individual more interested in the virtual construct of the patient in the computer than in the living, breathing patient seated on the exam table.Time is the scarcest commodity of all. Patients, particularly when it comes to their routine, day-to-day care, want a physician who has time to understand them as people first, and then as patients. It’s bee... Better Health blogs http://www.medworm.com/rss/comments.php?id=3902901 Wed, 25 Aug 2010 14:00:27 +0100 3902901 http://www.medworm.com/index.php?rid=3885465&cid=t_247630_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fgoing-to-a-new-doctor-in-a-life-with-chronic-pain%2F Most of us who have lived with chronic pain for many years know how important it is to find a doctor/partner who listens, treats, and cares. We all have kissed a lot of frogs along the way to finding our prince or princess of a doctor. I know each of us have varying opinions about what we are looking for in a doctor. My mom used to want compassion above all attributes in a doctor and if that doctor reached over and held her hand or patted it, he could have been Dr. Mengele or the most ignorant one in history and she wouldn’t have cared. If one was rude to her, she wouldn’t go back to see him or her ever again and would dismiss them by saying, “Well, they are just ‘practicing’ you know.” Other patients have ideas and concepts about the nationality, the ag... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=3885465 Thu, 19 Aug 2010 15:12:09 +0100 3885465 http://www.medworm.com/index.php?rid=3327235&cid=t_247630_134_f&fid=34841&url=http%3A%2F%2Fwww.diabetesmine.com%2F2010%2F03%2Fthe-%25e2%2580%259cpatient-centered-medical-home-too-good-to-be-true.html Those of you who follow me on twitter may know that I traveled to Washington DC late last week to take part in a “roundtable event” discussing paths to better diabetes care. Now, I’m no policy-maker, and certainly no expert on the crazy mixed-up reimbursement system in this country.  I was there, again, to talk [...] (Source: Diabetes Mine) Diabetes Mine blogs http://www.medworm.com/rss/comments.php?id=3327235 Wed, 03 Mar 2010 13:00:38 +0100 3327235 http://www.medworm.com/index.php?rid=3327051&cid=t_247630_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F03%2Fhow-internet-can-promote-ethical.html Many good doctors are wary of putting up their own website. They feel that this will be seen to be advertising their practise - something which is unethical and demeaning to their dignity. Doctors are professionals and advertising to solicit patients is unethical and frowned upon . It is also true that many quacks have put up websites which are full of garbage and tall claims , as a result of which many responsible doctors have shunned the internet so far.However, it is my argument that it is unethical in this day and age for a doctor not to have a website !The word doctor is derived from the word, "docere", which means to teach. An integral part of a doctor's responsibility, both to his patients and to society, is to teach patients about their medical problems and help them to remain heal... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3327051 Wed, 03 Mar 2010 05:28:00 +0100 3327051 http://www.medworm.com/index.php?rid=3251265&cid=t_247630_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F02%2Fhow-email-improves-doctor-patient.html Many doctors are worried that email will ruin doctor-patient communication, because they feel that face to face interaction is vital to preserving the doctor patient relationship.Actually, for established patients, email is a far better way of communicating with the doctor, as compared to a phone call.I find that patients are quite reluctant to phone a doctor with their "minor doubts" because they do not want to disturb the doctor. This means that a lot of worries remain unresolved. With email, on the other hand, they are much more willing to ask for clarifications, because email is much less intrusive, and they know I can answer at my convenience ! Email allows me to provide reassurance and comfort much more easily to my patients.My replies can be thoughtful and reasoned - and because I a... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3251265 Sun, 07 Feb 2010 18:38:00 +0100 3251265 http://www.medworm.com/index.php?rid=3084739&cid=t_247630_86_f&fid=38272&url=http%3A%2F%2Flaikaspoetnik.wordpress.com%2F2009%2F12%2F13%2Fempathy%2F The next Grand Rounds will be hosted by Barbara Olson of Florence dot com. The theme will be Simplify, identical to the theme of the annual conference of the Institute for Healthcare Improvement in Orlando. We are invited to share what’s on our mind about any healthcare-related topic indicating with one word why it is [...] (Source: Laika's MedLibLog) Laika's MedLibLog blogs http://www.medworm.com/rss/comments.php?id=3084739 Sun, 13 Dec 2009 21:17:06 +0100 3084739 http://www.medworm.com/index.php?rid=3052111&cid=t_247630_87_f&fid=35052&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FWomensBioethicsBlog%2F%7E3%2FYr-8KbdyHI4%2Fwbp-mentioned-on-cnn-health.html Kathryn Hinsch, founder of the Women's Bioethics Project, was quoted on CNN Health, regarding ethical issues in cosmetic surgery and patient-doctor relationships: "Part of the fundamental trust between a patient and doctor is the idea that the doctor has the patient's best interest at heart, and that there is no financial incentive for the doctor to perform any procedure," Hinsch says. "When doctors start adding cosmetic procedures, which they're adding because they're big moneymakers, there's a corruption of that basic trust."The article goes on to explore how physicians sidestep this ethical quagmire by never directly hawking their fat-blasting, wrinkle-smoothing, and hair-removal services, but that even a stack of brochures in the waiting room, Hinsch insists, sends the message to patie... Women's Bioethics Blog blogs http://www.medworm.com/rss/comments.php?id=3052111 Wed, 02 Dec 2009 22:55:32 +0100 3052111 http://www.medworm.com/index.php?rid=2473716&cid=t_247630_123_f&fid=34778&url=http%3A%2F%2Fwww.33charts.com%2Fparenting_solved%2F2009%2F06%2Fpreemptive-online-health-literacy.html I recently discussed endoscopic biopsy results with a patient’s mother.  Her child had inflammation in the upper intestinal tract with cells called eosinophils.  As I began to explain the basics of tummy irritation and the significance of the eosinophils in her daughter’s duodenum she cut me off, “Actually doctor, you don’t need to go into too much detail, just spell ‘eosinophil’ for me if you would.” As it turns out mom was more interested in getting to Google than listening to how I think her daughter’s biopsy results related to her problem. I wasn’t put off or irritated.  There was once a time when I would have been.  I did feel compelled, however, to help her understand what she would find online when searching for eosinophils and how that in... Parenting Solved blogs http://www.medworm.com/rss/comments.php?id=2473716 Sat, 13 Jun 2009 21:54:43 +0100 2473716 http://www.medworm.com/index.php?rid=2405738&cid=t_247630_123_f&fid=34778&url=http%3A%2F%2Fwww.33charts.com%2Fparenting_solved%2F2009%2F05%2Fis-paternalism-ever-okay-for-doctors.html So I’m reading comments on my Doctor Delicious post and I see a comment from a reader named Yoyo.  Interesting really.  Yoyo doesn’t understand why anyone would want a Delicious page for patient information and resources.  She just wants to be cared for without knowing every detail. It got me thinking: Is there a role for paternalism in the provider-patient relationship?  Is there ever a time when someone should just be cared for without having to double and triple check his doctor? Perhaps.  I remember when my wife and I went through fertility treatment.  We did our homework up front, triple checked our network of contacts, chose a doctor, made an initial appointment (‘interview’) and then decided that this was our doc.  At this point we... Parenting Solved blogs http://www.medworm.com/rss/comments.php?id=2405738 Thu, 14 May 2009 01:36:31 +0100 2405738 http://www.medworm.com/index.php?rid=2390109&cid=t_247630_123_f&fid=34778&url=http%3A%2F%2Fwww.33charts.com%2Fparenting_solved%2F2009%2F05%2Fparticipatory-pediatrics-1.html Pediatrics is changing.  There was once a time when parents learned all they needed to know from their doctors.  Web 1.0 then created seemingly unlimited access for patients seeking information.  We’re now approaching the point where information seeks parents via social networks.What does this mean for pediatricians?  The doctor-parent relationship is changing.  Empowered parents are doing their homework and talking among themselves.  And more than that they’re getting involved in evaluating treatment options.  This increasing role that parents play in their child’s care may be referred to as participatory pediatrics.  It is an inevitable derivative of expanding access to information, evolving social networks, and the shrinking capacity... Parenting Solved blogs http://www.medworm.com/rss/comments.php?id=2390109 Thu, 07 May 2009 04:52:09 +0100 2390109 http://www.medworm.com/index.php?rid=2349090&cid=t_247630_123_f&fid=34778&url=http%3A%2F%2Fwww.33charts.com%2Fparenting_solved%2F2009%2F04%2Fdefining-the-doctorfollower-relationship.html Recently I received a friend request from a woman in the community where I practice.  I didn’t recognize her so politely sent a message apologizing for not remembering where we had met.  She promptly responded and informed me that we had never met but she had read my book.  Her baby it seemed was miserable and the wait for an appointment in my clinic was too long for her to bear.  Politely pleading for her baby to be seen, I arranged a phone call and subsequently saw the baby in my office. Now I’ve always helped out those I’m connected to.  As a doc I offer friendly advice to friends and neighbors when they need help with medical stuff.  Frequently I speak on the phone to the relatives of close friends needing direction with their child.  So... Parenting Solved blogs http://www.medworm.com/rss/comments.php?id=2349090 Sun, 19 Apr 2009 03:42:13 +0100 2349090 http://www.medworm.com/index.php?rid=1914708&cid=t_247630_87_f&fid=35052&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FWomensBioethicsBlog%2F%7E5%2F433648989%2FFlyer_Medical_Ethics_and_Human_Rights.pdf Event AnnouncementThe Appignani Bioethics Center and NGO Health Committee are co-sponsoring a panel discussion on human rights and their impact on doctor-patient relationship. Date & Place: Wednesday, October.29, 2008, 1:00 PM-3:00 PM, 777 UN PLAZA, 10th Floor, 10th floor - Conference Room, NY 10017 A 15 minutes documentary film will be presented entitled "Children of the Decree" by Romanian filmmaker Florin Lepan. In 2004 the film was selected for screening in NYC by the Margaret Mead Film & Video Festival. This documentary analyzes Romania's quest during Ceausescu's dictatorship to increase their population by over fifty percent in a single decade through imposing a ban on abortion from 1966 till 1989. It was a unique experiment in human reproduction infringing upon women's rig... Women's Bioethics Blog blogs http://www.medworm.com/rss/comments.php?id=1914708 Mon, 27 Oct 2008 16:08:14 +0100 1914708 http://www.medworm.com/index.php?rid=1464629&cid=t_247630_93_f&fid=36982&url=http%3A%2F%2Fprep4md.blogspot.com%2F2008%2F05%2Fcore-character-traits-for-family.html From the Association of Family Medicine Residency DirectorsAnnals of Family Medicine 6:278- (2008)"Character is the trump card. It doesn’t matter what your USMLE scores are if you lack the character to be a family physician." What are the character traits that make a good family physician? The AFMRD Board came up with the following: "Excellent interpersonal skills, compassionate, good work ethic, enthusiasm to learn, maturity, honesty, and a sense of humor." "Character traits for a good FP: trustworthy, loyal, helpful, friendly, courteous, kind, obedient, cheerful, thrifty, brave, clean, reverent; actually that’s what I memorized to be a good Boy Scout, but most of it applies to family medicine as well." "There are 2 bottom-line principles of character that relate to work ethic: commi... My M.D. Journey! blogs http://www.medworm.com/rss/comments.php?id=1464629 Thu, 22 May 2008 19:24:00 +0100 1464629 http://www.medworm.com/index.php?rid=1455461&cid=t_247630_93_f&fid=36982&url=http%3A%2F%2Fprep4md.blogspot.com%2F2008%2F04%2Fselected-threads-from-sdn-for-medical.html Good Websites for Allopathic Medical StudentsWhat do medical students do in their summers?Should PhDs be teaching us?No medical students go to class?"When I tell non-med school friends that I don't go to class & watch lectures online, they make this comment. I wonder if it decreases their confidence in physicians? Eh... the stuff we really need to be taught (i.e. can't really learn it on your own) is during the clinical years. We're just memorizing b.s. in the first two years, and you just figure out the best / most time efficient / least painful way to get through the b.s. (basic sciences / bull shizer / whichever!) ""At most schools anywhere from 40-60% of the class will attend regularly. It's all about how you learn best. If you have the discipline to sit down and truly study the ma... My M.D. Journey! blogs http://www.medworm.com/rss/comments.php?id=1455461 Wed, 09 Apr 2008 13:18:00 +0100 1455461 http://www.medworm.com/index.php?rid=1255111&cid=t_247630_87_f&fid=35052&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FWomensBioethicsBlog%2F%7E3%2F240940200%2Fpatient-responsibility-for-medical_25.html Universal health care in the U.S. would be a step in the right direction toward solving some of our many problems in the area of costs and delivery. One of the numerous pressures on costs are... [[ This is a content summary only. Visit my website for full links, other content, and more! ]] (Source: Women's Bioethics Blog) Women's Bioethics Blog blogs http://www.medworm.com/rss/comments.php?id=1255111 Mon, 25 Feb 2008 15:36:05 +0100 1255111