Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

10 New Year’s Resolutions For Doctors And Patients

#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 referral, prescription, note for jury duty, or letter to my insurance company from my doctor is not my God-given right and I will stop [complaining] if it doesn’t happen the day I request it. Read more »

*This blog post was originally published at EverythingHealth*

11 Healthcare Predictions For 2011

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 making big changes.

2. No major employer will drop their health benefits. No major employer is going to outsource their healthcare benefits to the government any time soon. Employers — particularly the big self-insured employers that pay for healthcare costs as a bottom-line expense — see their benefits as an integral part of their business and competitive strategies. As Congress looks at this issue more closely, they will learn this.

3. Time that doctors spend with patients will be less in 2011 than earlier years. It’s a long-term trend, and the factors that create this problem aren’t getting better. The latest government data show that the average doctor visit features face to face time with the patient of 15 minutes or less. With an aging population, increasing numbers of people getting health insurance, and no influx of new doctors, this problem will keep getting worse. Read more »

*This blog post was originally published at See First Blog*

Blood Print: “Am I, The Doctor, Bleeding?”

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 obliged to wash our hands before and after each patient contact, which leads to about 60 hand washings per day. In the dry winter air this can become punishing to the integrity of the skin barrier.

I apologize to the patient for marring his chart, yet it almost seems symbolic — physician blood spilled upon a script of human affliction. I know I should tear the page out of his chart and write a clean new one, yet the scrawls of black ink and stripes of red blood look like art. It is a poem, punctuated with living iron and crimson flourish. Despite having made poor eye contact in an attempt to distance and strengthen my consideration of his symptoms, ironically I see the commonality of our bleeding.

*This blog post was originally published at The Examining Room of Dr. Charles*

Video: “The Too-Informed Patient”

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 exam­ine him (“Say aaahhh” and more): He’s eli­gi­ble for an exper­i­men­tal pro­to­col. After some back-and-forth in which the doc­tor — who’s been quite cour­te­ous until this point, call­ing the patient “Mr. Horcher,” for exam­ple, and not admon­ish­ing the patient who’s got so many ideas of his own — the doc­tor says that the patient may be exac­er­bat­ing the con­di­tion by scratch­ing it, and ques­tions the wis­dom of tak­ing an exper­i­men­tal treat­ment for a rash. Read more »

*This blog post was originally published at Medical Lessons*

The Best Social Tool For Doctors And Patients

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 words on a screen are so one-dimensional.

Of course, email has a tightly-defined place in patient communication. And real-time social interaction between patient and clinic will evolve to have a clear role in patient care. But for now, the phone remains one of the most effective tools for helping doctor and patient really understand one another.

[Image credit: Cemagraphics]

*This blog post was originally published at 33 Charts*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »