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Do Patients Have Clinical Judgment?

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 children with central venous lines, for example, can often identify the early signs of infection before fever has ever appeared. They know the subtleties of their child’s behavior. The same goes for children with epilepsy. People with diabetes increasingly have the latitude to apply judgment to the management of their disease. This tends to be quite defined, however, with fixed variables and limited options for intervention. Read more »

*This blog post was originally published at 33 Charts*

Why The Term “Patient” Is So Important In Healthcare

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 the rela­tionship. If a person with illness or medical need became a con­sumer like any other, the rela­tionship — and the doctor’s oblig­ation — would be lessened.

Some might argue that the term “patient” somehow demeans the healthcare receiver. But I don’t agree: From the prac­ticing physician’s per­spective, it’s a priv­ilege to have someone trust you with their health, espe­cially if they’re seri­ously ill. In this context, the term “patient” can reflect a physician’s respect for the person’s integrity, humanity and needs.

*This blog post was originally published at Medical Lessons*

Patient Engagement: How Empathy Can Empower Your Patients

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 give every patient, strategies to tap the most underutilized resource in medicine, their patient,” however I feel the most critical ingredient is missing, empathy.


It is with empathy that we can engage and empower our patients. With empathy and heart we can help our patients feel good, valued and respected. Empathy allows us to engage and empower our patients to take charge of their health and well-being. Read more »

*This blog post was originally published at Health in 30*

How Patients Can Enhance Communication With Their Doctors

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.” Read more »

*This blog post was originally published at Health in 30*

Why It’s Wrong To Call Drug Seekers A “Micropopulation”

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 prevent patients from being truthful, or in the worst case, from seeking needed care. … As an emergency physician, I can assure you that the drug abusers who use the emergency room simply to get a prescription drug fix represent a micropopulation of the 120 million patients who seek emergency care every year in the USA. … Put bluntly, if legislators have money to spend, they should spend it where it will do the most good for our patients, and that is not on drug databases.

I really don’t know what to say, other than to wonder whether Dr. Gardner and I practice in the same United States in which abuse of prescription drugs is growing exponentially and in which “drug-seeking” patients are a part of each and every shift worked in the ER, where deaths due to overdoses of prescription medications are on the rise, and where diversion of narcotics is a serious and growing problem. Read more »

*This blog post was originally published at Movin' Meat*

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…

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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…

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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…

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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…

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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…

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