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'. Sat, 03 Sep 2011 02:05:30 +0100 http://www.medworm.com/index.php?rid=5181799&cid=t_202144_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=5181802&cid=t_202144_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_202144_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_202144_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_202144_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=5169553&cid=t_202144_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=5159258&cid=t_202144_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_202144_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=5118642&cid=t_202144_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpediatric-physician-joins-collaborative-network-and-sees-improvement-in-his-work%2F2011.08.11 I never thought I’d change the way I practice medicine.  But I recently enrolled as a provider in the Improved Care Now (ICN) collaborative network and I’m already working differently. ICN is an alliance of gastroenterologists and patients working in a new model of pediatric inflammatory bowel disease care based on the analysis of thousands of doctor–patient visits as well as the latest studies and treatments.  Doctors and patients apply this information, experiences are tracked in an open registry, the results are then shared and refined to improve care.  I can see what I’m doing well and where I’m falling short relative to other clinics and pediatric gastroenterologists. ICN is under the direction of Dr. Richard Colletti of the University of Vermont.  ICN is supported by t... Better Health blogs http://www.medworm.com/rss/comments.php?id=5118642 Thu, 11 Aug 2011 16:00:26 +0100 5118642 http://www.medworm.com/index.php?rid=5096205&cid=t_202144_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=5086171&cid=t_202144_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=5077684&cid=t_202144_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=5077685&cid=t_202144_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_202144_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=5057721&cid=t_202144_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_202144_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_202144_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_202144_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=5036235&cid=t_202144_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=5036236&cid=t_202144_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_202144_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_202144_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_202144_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_202144_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_202144_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_202144_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=4952844&cid=t_202144_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=4934586&cid=t_202144_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_202144_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_202144_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=4862545&cid=t_202144_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=4821007&cid=t_202144_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=4794860&cid=t_202144_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_202144_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=4744845&cid=t_202144_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_202144_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_202144_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_202144_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_202144_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_202144_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_202144_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_202144_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_202144_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_202144_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_202144_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=4527773&cid=t_202144_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F02%2F27%2Fj-raymond-depaulo-jr-on-getting-a-second-opinion%2F The following passage from J. Raymond DePaulo Jr.’s book, Understanding Depression, was helpful to me in knowing what to look for in a doctor, and when to go for a second (and third, and fourth, and fifth, and sixth, and seventh) opinion. My comments on his advice are in parantheses. The best patient care requires three components: A well-trained, dependable clinician who knows what to do and is accessible to the patient; A well-informed patient who actively participates in his or her care plan and follows it; and A trusting alliance between doctor, patient, and family. If you don’t understand or agree with a doctor’s diagnosis, you should ask for an explanation of how he or she came to the conclusion. What factors weight in favor of the diagnosis? What factors argue i... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4527773 Sun, 27 Feb 2011 12:08:06 +0100 4527773 http://www.medworm.com/index.php?rid=4512448&cid=t_202144_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_202144_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_202144_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_202144_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=4455263&cid=t_202144_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_202144_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_202144_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_202144_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_202144_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_202144_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_202144_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_202144_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_202144_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_202144_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_202144_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_202144_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=4349514&cid=t_202144_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_202144_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_202144_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=4331012&cid=t_202144_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_202144_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_202144_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=4318331&cid=t_202144_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_202144_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=4298620&cid=t_202144_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_202144_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=4272291&cid=t_202144_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=4272293&cid=t_202144_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F11-healthcare-predictions-for-2011%2F2010.12.18 Here are 11 things that are absolutely going to happen* in 2011 (they’re in no particular order….or are they?): 1.  There will be no big compromise between President Obama and the Republicans on healthcare reform. Why? Because the law is such a massive collection of, well, stuff, that it is pretty much impossible to find pieces of it that you could cut a deal on, even if you wanted to. And no, the federal district court decision on the individual mandate doesn’t change my mind…and in fact may breathe new life into other parts of the law). State governments, insurance companies, and private businesses have made all kinds of important and hard to reverse choices based on the law as is. There’s not much of an appetite outside of people trying to score political points for m... Better Health blogs http://www.medworm.com/rss/comments.php?id=4272293 Sat, 18 Dec 2010 20:00:44 +0100 4272293 http://www.medworm.com/index.php?rid=4258868&cid=t_202144_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fblood-print-am-i-the-doctor-bleeding%2F2010.12.14 I’m diligently writing a detailed note in the patient’s chart as he speaks of his multiple concerns — severe depression, headaches, and dizziness. I’m not making good eye contact. Often this is effective because I can resist the allure of passively following his narrative to its own diagnostic suspicions. Instead I can record his intuitive guesses without persuasion, formulating my own independent ideas even as I value his. Except that as I write in his chart I notice streaks of red blood appearing among the black script. Am I hallucinating? Am I capable of making paper bleed? Am I, the doctor, bleeding? With closer inspection I notice three small cuts on my chapped knuckles and fingers, products of the incessant and obsessive handwashing compelled by modern medicine. We are ob... Better Health blogs http://www.medworm.com/rss/comments.php?id=4258868 Tue, 14 Dec 2010 13:00:50 +0100 4258868 http://www.medworm.com/index.php?rid=4251108&cid=t_202144_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_202144_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_202144_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_202144_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_202144_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_202144_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_202144_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_202144_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=4164524&cid=t_202144_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_202144_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_202144_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=4125009&cid=t_202144_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=4074065&cid=t_202144_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=4074066&cid=t_202144_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoctors-twice-as-likely-to-e-mail-another-provider-than-a-patient%2F2010.10.14 Only 6.7 percent of office-based physicians routinely e-mailed patients about clinical information in 2008, according to an issue brief from the Center for Studying Health System Change. Only 34.5 percent of office-based, ambulatory care physicians reported that information technology for communicating with patients about clinical issues via e-mail was available in their practice in 2008. Of that third, 19.5 percent routinely e-mailed patients, or 6.7 percent overall, while the rest were split between occasional use or non-use. The study sample was restricted to 4,258 office-based physicians and the response rate was 62 percent. In contrast, twice as many physicians spent at least some time each work day e-mailing physicians and other clinicians. (more…) *This blog post w... Better Health blogs http://www.medworm.com/rss/comments.php?id=4074066 Thu, 14 Oct 2010 20:00:00 +0100 4074066 http://www.medworm.com/index.php?rid=4018178&cid=t_202144_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_202144_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=4001688&cid=t_202144_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=3987055&cid=t_202144_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_202144_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_202144_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=3942789&cid=t_202144_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fabout-concierge-or-boutique-medicine%2F2010.09.07 A recent piece in The New York Times wondered if the few patients who can afford to pay for additional attention and access to their primary care doctors in a concierge medicine or boutique medicine practice might be ethical since the extra dollars are used to support the traditional primary care practice that the vast majority of patients currently receive.  Questions you might ask are: - What is a concierge medicine or boutique medicine practice? - Is it worth the money? - Is the care better quality? - Is it possible to get similar access and care by doctors not in a concierge or boutique medicine practice? When you think of a concierge, you think about a fancy hotel staff person who answers questions and speaks various languages, books reservations to restaurants, events, and tours (ev... Better Health blogs http://www.medworm.com/rss/comments.php?id=3942789 Tue, 07 Sep 2010 20:00:00 +0100 3942789 http://www.medworm.com/index.php?rid=3934480&cid=t_202144_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_202144_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_202144_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=3902901&cid=t_202144_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=3902902&cid=t_202144_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_202144_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=3885465&cid=t_202144_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=3880858&cid=t_202144_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_202144_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_202144_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=3872557&cid=t_202144_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoctor-patient-relationship-humanized-by-touch%2F2010.08.16 I’ve written previously that many doctors are finding the physical exam obsolete, and are favoring more technologically-advanced, and expensive, tests. In fact, I alluded to traditional physical exam advocates as “arguing for staying with a horse and buggy when cars are rapidly becoming available.” In a recent piece from the New York Times, internist Danielle Ofri says we need to look past the lack of evidence supporting the physical exam. The benefits of touching the patient, and listening to his heart and lungs, cannot be quantitatively measured: Does the physical exam serve any other purpose? The doctor-patient relationship is fundamentally different from, say, the accountant-client relationship. The laying on of hands sets medical practitioners apart from their counterparts in th... Better Health blogs http://www.medworm.com/rss/comments.php?id=3872557 Mon, 16 Aug 2010 12:00:41 +0100 3872557 http://www.medworm.com/index.php?rid=3865266&cid=t_202144_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=3858153&cid=t_202144_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ffixing-up-primary-care-is-anyone-home%2F2010.08.11 By John Henning Schumann, M.D. The Patient Protection and Affordable Care Act (aka “Health Care Reform”) signed by President Obama in March will revolutionize primary care in the United States. By 2014 tens of millions of uninsured people will “enter” the system by being granted insurance, either through expansion of the Medicaid program or through mandated purchasing of insurance via state pools or the private market. This alone will have a profound impact, straining the capacity of our already frayed system. Therefore, embedded in the law are funds to encourage growth and improvement in primary care: Incentives to encourage graduates to enter primary care fields (family medicine, internal medicine, and pediatrics) and practice in underserved areas (through scholar... Better Health blogs http://www.medworm.com/rss/comments.php?id=3858153 Thu, 12 Aug 2010 01:00:00 +0100 3858153 http://www.medworm.com/index.php?rid=3858155&cid=t_202144_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_202144_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=3822921&cid=t_202144_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-patients-are-wary-of-the-primary-care-medical-home%2F2010.08.04 Say the words, “Patient-centered medical home,” and you’re bound to get a variety of opinions. On this blog alone, there are a variety of guest pieces critical of the effort, saying it does not increase patient satisfaction, nor does it save money. And that’s not good news for its advocates, who are pinning primary care’s last hopes on the model. Medical homes hit the mainstream media recently, with Pauline Chen focusing one of her recent, weekly New York Times columns to the issue. She discussed the results of a demonstration project, showing some positive results. (more…) *This blog post was originally published at KevinMD.com* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3822921 Wed, 04 Aug 2010 14:00:17 +0100 3822921 http://www.medworm.com/index.php?rid=3812978&cid=t_202144_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-error-free-is-your-doctors-care%2F2010.08.02 According to the Annals of Internal Medicine, doctors make the wrong medical decisions surprisingly often. Using a “mystery patient” technique –- in which actors pretended to be patients –- researchers found that doctors made errors in complicated cases in 60 percent to 90 percent of cases. Sixty to ninety percent. In uncomplicated cases, they made errors in nearly 30 percent of cases. As one study participant put it, “I was shocked.” The study took place over three years, and included more than 100 doctors in six Chicago-area hospitals. The doctors had agreed to participate in a study on medical decision making, but had no idea that they might see a patient who was actually an actor. The actors recorded their conversations with the doctors. (more…) *This bl... Better Health blogs http://www.medworm.com/rss/comments.php?id=3812978 Mon, 02 Aug 2010 16:00:06 +0100 3812978 http://www.medworm.com/index.php?rid=3813054&cid=t_202144_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=3805820&cid=t_202144_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fgood-looks-in-medicine-does-it-matter%2F2010.07.30 I found this sign while driving past a mechanic’s shop the other day. Of course, now I get it. How do women pick their mechanic? This sign explains it all. Just look for the “Handsome Mechanic ‘Now On Duty’” sign. I wonder if it works for doctors, too. Be honest. If your doctor had exceptionally good-looking physical features by most people’s standards, would you be more likely or less likely to keep him or her as your doctor? Would you be more likely or less likely to think of them as highly intelligent? Would you be more likely or less likely to sue them when something goes wrong? We know that babies respond to good-looking parents differently even as newborns. So why would we expect adults to respond to handsome mechanics and doctors any differen... Better Health blogs http://www.medworm.com/rss/comments.php?id=3805820 Fri, 30 Jul 2010 15:00:00 +0100 3805820 http://www.medworm.com/index.php?rid=3805895&cid=t_202144_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_202144_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_202144_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=3794772&cid=t_202144_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fminnesotans-get-more-lower-back-mris-why%2F2010.07.27 Kudos to Christopher Snowbeck and the St. Paul Pioneer Press for digging into new Medicare data to report that the state the newspaper serves is out of whack with the rest of the country in how many expensive MRI scans are done on Minnesotans’ bad backs. Snowbeck artfully captures the predictable rationalization and defensive responses coming from locals who don’t like what the data suggest. Because what they suggest is overuse leading to overtreatment. So here’s one attempt a provider makes to deflect the data: “The Medicare billing/claims data, which this report is generated from, would not capture conversations between a patient and provider that may have addressed alternative therapies for lower back pain,” said Robert Prevost, a spokesman for North Memor... Better Health blogs http://www.medworm.com/rss/comments.php?id=3794772 Tue, 27 Jul 2010 20:00:39 +0100 3794772 http://www.medworm.com/index.php?rid=3790705&cid=t_202144_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fteam-care-in-the-patient-centered-medical-home%2F2010.07.26 “Team care” has become a rallying cry for those who think the patient-centered medical home is bad for healthcare reform. Comments on a recent blog post in the New York Times provide a good example of this. When patients get sick, as the argument goes, they want to see their doctor — not some nurse or PA who they don’t know. I agree. There are a whole bunch of things wrong with all the current focus on team care in the patient-centered medical home. (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=3790705 Mon, 26 Jul 2010 14:00:24 +0100 3790705 http://www.medworm.com/index.php?rid=3726595&cid=t_202144_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-its-wrong-to-call-drug-seekers-a-micropopulation%2F2010.07.05 I don’t know what’s going on with American College of Emergency Physicians (ACEP) lately, but it’s disheartening. Their abdication of responsibility and engagement during the healthcare reform debate was depressing. Then there was a rigged poll designed to elicit a predetermined result. Now I see a bizarre op-ed piece in USA Today entitled “Opposing view on drug addiction: Don’t make us ‘pain police’” and authored by ACEP President Angela Gardener. An excerpt: The patient-physician relationship is sacrosanct, demanding candor and trust. In the emergency department, trust is built in nanoseconds because patients and doctors do not have prior relationships. Knowing that any pain prescription will be entered into a large, public database might p... Better Health blogs http://www.medworm.com/rss/comments.php?id=3726595 Mon, 05 Jul 2010 22:00:00 +0100 3726595 http://www.medworm.com/index.php?rid=3726598&cid=t_202144_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_202144_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_202144_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_202144_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_202144_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_202144_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=3662671&cid=t_202144_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fkeeping-patients-quiet%2F2010.06.14 Some things are just part of the problem in healthcare. The company Medical Justice is one such thing. I’ve written about them before. Medical Justice sees the medical malpractice crisis and devised a solution: Muzzle the patients. It’s as misguided as it is ridiculous. Medical Justice says doctors need to stop their patients from saying bad things about them. They charge doctors hundreds — even thousands — of dollars a year to help do this. Under one of their programs, they give doctors contracts to use with their patients. The doctor tells the patient that they must agree to the terms of the contract before the doctor agrees to see them.  Okay, so there are lots of forms that patients need to sign when they go to the doctor. What makes these so different? (more…) ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3662671 Mon, 14 Jun 2010 23:00:33 +0100 3662671 http://www.medworm.com/index.php?rid=3662672&cid=t_202144_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fless-is-more-in-medicine-why-patients-arent-buying-it%2F2010.06.14 In a recent article, the editors of the Archives of Internal Medicine make the case that too much unneeded care is being delivered in physician’s offices these days. According to the authors, “patient expectations” are a leading cause of this costly problem. Their solution? Get physicians to share with patients the “evidence” for why their requests are crazy, wrong, ill-informed or just plain stupid. But getting patients to buy into the “less is more” argument is a daunting task as most physicians already know. The problem is complicated by the fact that patients have a lot good reasons for not buying it. (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=3662672 Mon, 14 Jun 2010 20:00:18 +0100 3662672 http://www.medworm.com/index.php?rid=3603595&cid=t_202144_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_202144_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=3569804&cid=t_202144_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fis-minimally-disruptive-medicine-an-emerging-field%2F2010.05.17 I recently stumbled onto the “Minimally Disruptive Medicine” blog maintained by Dr. Victor Montori from the Mayo Clinic. I have to admit that the name caught my attention so I scoped it out. According to Dr. Montori, “minimally disruptive medicine refers to the practice of medicine that seeks to design effective treatment programs for patients while minimizing the burden of treatment.”  He describes this as an emerging field. I have to admit that I was simultaneously puzzled and intrigued. After all, how is this different from the way good medicine is practiced? I, for one, like to think that I create individually-tailored programs that meet my patients’ needs while minimizing their treatment burden. (more…) *This blog post was originally published at 3... Better Health blogs http://www.medworm.com/rss/comments.php?id=3569804 Mon, 17 May 2010 12:00:42 +0100 3569804 http://www.medworm.com/index.php?rid=3569805&cid=t_202144_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_202144_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_202144_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_202144_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=3542602&cid=t_202144_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealth-and-medicine-scientific-or-miraculous%2F2010.05.06 I was recently listening to an audiobook about diet, written and read by a “famous” doctor who gets people healthy through dietary changes. Since my podcast pushes me a little into the mainstream (more than this blog does), I thought it would be good to hear what the “average” person is reading about health. Plus, I am not exactly the most compliant patient when it comes to diet, so I thought I could possibly get something out of it personally. I did my best to listen with an open mind, ignoring what I thought were gimmicks and trying to glean the valuable information from what this doctor was saying. I had to stop, however, before finishing the book. It wasn’t the content so much that gave me cause to feel the desire to smash my iPod, it was the hype. The author was constantly u... Better Health blogs http://www.medworm.com/rss/comments.php?id=3542602 Fri, 07 May 2010 01:00:29 +0100 3542602 http://www.medworm.com/index.php?rid=3538093&cid=t_202144_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=3538094&cid=t_202144_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Frelational-medicine-the-joy-of-primary-care%2F2010.05.05 I was happy when I looked at [the day's] schedule. Two husband-and-wife pairs were on my schedule, both of whom have been seeing me for over 10 years. Their visits are comfortable for me — we talk about life and they are genuinely interested in how my family is doing. They remember that I have a son in college, and want to know how my blog and podcast are doing. I can tell that they not only like me as a doctor — they see me, to some degree, as a friend. Another patient on the schedule is a woman from South America. She has also been seeing me for over 10 years. I helped her through her husband’s sudden death in an accident. She brings me gifts whenever she goes on her trips, and also brings very tasteful gifts for my wife. Today she brought me a Panama hat. I know these pe... Better Health blogs http://www.medworm.com/rss/comments.php?id=3538094 Wed, 05 May 2010 20:00:58 +0100 3538094 http://www.medworm.com/index.php?rid=3538095&cid=t_202144_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F9-tips-to-improve-patient-satisfaction%2F2010.05.05 Some interesting points were raised at a recent Society of Hospital Medicine (SHM) session by Winthrop Whitcomb and Nancy Mihevc on patient satisfaction. To improve satisfaction scores: 1. Review the patient’s chart before you go in the room. It makes a big difference if the patient perceives you know what’s going on without having to bury your face in a chart. 2. Patients are often confused about who they are supposed to see after discharge. This, of course, is a safety issue as well as one that affects patient satisfaction. 3. Sit down when you are visiting a patient. Patients are happiest when they perceive you’ve spent enough time with them, and they are more likely to perceive this if you are sitting than standing with your hand on the doorknob. (more…) ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3538095 Wed, 05 May 2010 18:00:00 +0100 3538095 http://www.medworm.com/index.php?rid=3538096&cid=t_202144_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fconnecting-with-patients-a-forgotten-piece-of-medicine%2F2010.05.05 I [recently] visited a small town in west Texas to address a local medical society on the emerging role of social media in healthcare. My presentation involves social media and the evolving relationship that patients share with doctors. I discuss challenges and opportunities -– especially as it relates to transparency, personal boundaries, and even the ethical obligation to participate in the online conversation. I target the disconnected physician and offer education as well as a compelling argument for involvement. When I arrived at the venue I found that the meeting was attended predominantly by physicians much older than myself.  While waiting to speak, I was concerned that my message of connection and changing relationships would elicit pushback. After all, isn’t it this era o... Better Health blogs http://www.medworm.com/rss/comments.php?id=3538096 Wed, 05 May 2010 16:00:16 +0100 3538096 http://www.medworm.com/index.php?rid=3529788&cid=t_202144_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_202144_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=3327235&cid=t_202144_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_202144_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=3276056&cid=t_202144_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=3251265&cid=t_202144_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=3153600&cid=t_202144_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_202144_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=3084739&cid=t_202144_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