Can Anyone Be a Patient Advocate?
Can a good doctor, or a nurse, or a physical therapist, or any other person employed by the health care system, serve as a patient advocate?
How Much Do You Want Your Doctors To Say About Risks of Treatment?
This kind of paternalism, when a doctor assesses the risks and benefits, and spares the patient’s “knowing” seems anachronistic. But it may, still, be what many people are looking for when and if they get a serious illness. Not everyone wants a “tell me everything” kind of physician.
Remembering a Warm-Hearted Patient
When I was a resident I worked in a general medicine clinic. One afternoon each week, I’d get more dressed than usual and split off from my inpatient team around noon to go see patients in another building, outside of the hospital. Today, I’m reminded of a man I saw there and treated for two […]
Thoughts, on Getting My Photo Taken at a Medical Appointment
A funny thing happened at my doctor’s appointment on Friday. I checked in, and after confirming that my address and insurance hadn’t changed since last year, waited for approximately 10 minutes. A worker of some sort, likely a med-tech, called me to “take my vitals.” She took my blood pressure with a cuff that made […]
The Immeasurable Value of Continuity of Care
Today I visited my internist for a checkup and flu shot. We talked about how I’m doing, and she examined me, and we discussed what procedures I ought have done and not done. She’s been my doctor since the summer of 1987, when I was an intern at the hospital. We reviewed so much that […]
A Video About a Robot and a Patient
Since Watson won on Jeopardy, there’s been lots of talk of robots assuming doctors’ roles. Ten years into our future, machines with programmed empathy and nuanced diagnostic skills will solve diagnostic dilemmas, deduce optimal treatment and make us well. Yesterday I found a new Xtranormal video, this one crafted by Dr. Charles of his excellent […]
May I Call You ‘Doctor’?
Last week I considered the relationship between the Prince Albert and his speech therapist in The King’s Speech. One aspect I wanted to explore further is why the future king initially insisted on calling the practitioner “doctor.” In real life, now, patient-doctor relationships can be topsy-turvy. This change comes partly a function of a greater […]
The King’s Speech is Not Just About Stuttering
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 […]
Why It’s a Good Idea to Get a Second Opinion, and Maybe a Third, But Rarely a Fourth
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 […]
Why the Term ‘Patient’ Is So Important in Health Care
roviding health 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 care. This responsibility – to heal, honestly and to the best of one’s ability – overrides any other commitments, or conflicts
I Feel Your Pain (not)
A tweet hit me on Sunday evening, from a stranger: @Mibberz I’m saddened by how many ADULTS can’t get their #rheum 2 understand the level of severity of their pain.What hope is there for my daughter? I half-watched an on-line exchange about the issue, and then went about my family’s dinner preparations. The message came […]
A Video About a Patient Who Might Have Too Much Information
A link to a video, the Too Informed Patient came my way several times lately. You can find the curious clip on NPR’s Marketplace site: The Too Informed Patient from Marketplace on Vimeo. — The skit depicts the interaction between a young man with a rash and his older physician. The patient is an informed […]
Health Care Costs, Communication and Informed Choices
For those of you who’ve been asleep for the past year: the health care costs conundrum remains unsolved. Our annual medical bills run in the neighborhood of $2.4 trillion and that number’s heading up. Reform, even in its watered-down, reddened form, has stalled.
Despite so much unending review of medical expenses – attributed variously to an unfit, aging population, expensive new cancer drugs, innovative procedures, insurance companies and big Pharma – there’s been surprisingly little consideration for patients’ preferences. What’s missing is a solid discussion of the type and extent of treatments people would want if they were sufficiently informed of their medical options and circumstances.
Maybe, if doctors would ask their adult patients how much care they really want, the price of health care would go down. That’s because many patients would choose less, at least in the way of technology, than their doctors prescribe. And more care.
What I’m talking about is the opposite of rationing. It’s about choosing.
Are Doctors Necessary?
Ten years ago, my colleagues and I squirmed in our swivel chairs when a few tech-savvy patients filed in bearing reams of articles they’d discovered, downloaded and printed for our perusal.
Some of us accepted these informational “gifts” warily, half-curious about what was out there and half-loathing the prospect of more reading. Quite a few complained about the changing informational dynamic between patients and their physicians, threatened by a perceived and perhaps real loss of control.
How a decade can make a difference. In 2008 over 140 million Americans…
How to Avoid Death in the ICU
It was sometime in April, 1988. I was putting a line in an old man with end-stage kidney disease, cancer (maybe), heart failure, bacteria in his blood and no consciousness. Prince was on the radio, loud, by his bedside. If you could call it that – the uncomfortable, curtained compartment didn’t seem like a good place for resting.
Why Medical Lessons?
One of the things I liked best about practicing medicine is that I was constantly learning.
Making rounds at seven in the morning on an oncology floor would be a chore if you didn’t get to examine and think and figure out what’s happening to a man with leukemia whose platelets are dangerously low, or whose lymphoma is responding to treatment but can’t take anymore medicine because of an intense, burn-like rash. You’d have to look stuff up, sort among clues