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When Great Healthcare Is Served With A Large Helping Of Unnecessary Mental Anguish

A wrist graft similar to what my friend's husband required.

I watched helplessly as a dear friend went through the emotional meat grinder of a new cancer diagnosis. Her  husband was found to have melanoma on a recent skin biopsy, and she knew that this was a dangerous disease. Because she is exceptionally intelligent and diligent, she set out to optimize his outcome with good information and the best care possible. Without much help from me, she located the finest specialists for her husband, and ultimately he received appropriate and state-of-the-art treatment. But along with his excellent care came substantial (and avoidable) emotional turmoil. The art of medicine was abandoned as the science marched on.

First came the pathology report, detailed and nuanced, but largely uninterpretable for the lay person. She received a copy of it at her request, but without any attempt at translation by her physician. In his view, she shouldn’t be looking at it at all, since it was up to him to decide next steps. She brought the report to me, wondering if I could make heads or tails out of it. Although I am not trained in pathology, I did know enough to be able to translate it, line-by-line, into normal speak. This was of great comfort to her as the ambiguity of prognosis (rather than certainty of metastasis and or mortality, etc.) was clearly outlined for the trained eye.

Then came the genetic testing and node biopsy. She was told that the tests could identify variants that would portend poorer outcomes, though it would take 6 weeks to find out if he had “the bad kind of melanoma.” Those 6 weeks were excruciating for her, as she planned out how they would manage financially if he needed treatment for metastatic disease, and if his life were shortened by various numbers of years. At week 6 they received no word from the physician, and so she called the office to inquire about how much longer it would take for the genetic testing to come back. She was rebuffed by office staff and was instructed to be patient because the lab was “processing an unusual number of samples” at this time.

Another week of anguish passed and she decided to contact the lab directly. As it turned out, they were eagerly awaiting the arrival of her husband’s sample, but it had been “lost” in hospital processing somehow. She called the hospital’s facility and someone found the tissue under a pile of other samples and tagged it appropriately and sent it on to the genetics lab. The hospital apologized for the delay via email – and she forwarded the note to her oncologist, so that he could sort out the potential processing bottleneck for other patients going forward.

The result was reported to the oncologist within a week’s time and in turn, the physician called (at 6:30am on a Monday morning) to discuss the result with my friend’s husband. He missed the call as he was in the shower getting ready for work, and wound up playing phone tag with the physician’s office for 3 more days. My friend had her heart in her mouth the entire time. She continued to imagine a world without her husband. If the disease stole him from her, how would she manage? What about the children? Could she make enough money alone to support her family?

“Why didn’t the physician leave any hint of the result in the phone message? If it was good news, surely he would have mentioned that.” She presumed. The physician required his patient to come into the office to discuss the results. And so they booked the next available time slot, another couple of days later. My friend was certain this was a bad sign.

As they arrived at the oncologist’s office, the staff forbade my friend to accompany her husband to the meeting. “Clinic policy” they stated. My friend’s mind was now spinning out of control – maybe my husband needs to be alone with the doctor because the results are so devastating that he must hear it by himself?

She insisted, nonetheless, to accompany him – and the staff felt obligated to clear it with the oncologist before they allowed her to enter the examining room with her husband. They whispered to him in another room before giving her the irritated nod that she could proceed. You could have cut the tension with a knife… she was certain that a death sentence was about to be handed down.

Once the oncologist entered the room, he spent the first 10 minutes making excuses for the delay in genetic tissue results. He argued that the hospital lab was actually not at fault for the delay and listed all the various reasons why nothing had been done incorrectly. His was so single-mindedly focused on the email he received weeks prior (simply describing the delay — as if it were some kind of assault on his own competency) that he almost left the room without telling them the results of the genetic test and biopsy sample.

As an afterthought at the end of the meeting, he announced: “Oh, and the tests suggest that you have a melanoma that is extremely unlikely to metastasize. The wide excisional biopsy is likely curative.”

And off he swished, white coat flowing behind him as he flung wide the door and moved on to the next patient.

The irony is that my friend’s husband got “great” medical care with a large helping of unnecessary suffering. His initial biopsy, wide excision and skin grafting, lymph node testing, and genetic lab studies were all appropriate and helpful in his diagnosis and treatment. But the way in which the information was presented (or not presented) was what made the entire process so painful. Unfortunately, we spend most of our time as physicians focused on the technicalities of what we do, rather than the emotional consequences they have on our patients and their families.

As we continue to “deliver healthcare” to our patients, let’s remember not to serve up any sides of unnecessary mental anguish. Clear and timely communication makes a world of difference in patient anxiety levels. And reducing those is part of the art of medicine that is so desperately needed, and disturbingly rare these days.

Creative Glucose Meter Case Reminds Kids That Diabetes Shouldn’t Stop Them From Having Fun

A few years ago, I connected with Kyrra Richards, creator of Myabetic, to highlight the completely adorable “Lovebug” meter case.  She and I have talked a few times since, and I had the opportunity to reconnect with her at the Diabetes Sisters conference in San Diego back in October.

It was at that conference that I was able to check out her new project, Champ, in person.  And it’s totally cool, in that “hey, let’s make my glucose meter case something that doesn’t suck” sort of way.  I love it.

I asked Kyrra what the inspiration for Champ was, and she had this to say: Read more »

*This blog post was originally published at Six Until Me.*

Video Outlines Testing For Reflux Or Abnormal Esophageal Muscle Activity

Our office has created a new video describing what a patient goes through when they undergo esophageal manometry as well as 24 hour multi-channel pH and impedance testing.

This test is often ordered when a patient is suspected to be suffering from reflux, whether acid or non-acid, or is possibly suffering from abnormal muscle activity of the esophagus.

Symptoms that a patient may experience that may lead to such testing include: Read more »

*This blog post was originally published at Fauquier ENT Blog*

Dengue Fever: Mosquito Born Illness Now Found In Texas, Florida, And Hawaii

Asian tiger mosquito, Aedes albopictsDengue fever is a viral (flavivrus) disease transmitted by Aedes albopictus and female A. aegypti mosquitoes. It is estimated that 50 to 100 million people in more than 100 countries are infected each year with dengue viruses.

There are four different types of dengue virus, and there is no cross-immunity, so a person may be stricken with dengue fever four times in his life. The most active feeding times for dengue vector mosquitoes is for a few hours after daybreak and in the afternoon for a few hours just after dark (dusk).

As opposed to the night-feeding mosquitoes that transmit malaria, these species tend to be “urban,” may also feed during daylight hours (also indoors, in the shade, and during overcast weather), and are known to bite below the waist. Dengue fever is seen chiefly in the Caribbean and South America, as well as other tropical and semitropical areas, such as Southeast Asia, Africa, and Mexico. In the United States, cases have been noted in Texas, Hawaii and Florida. The larvae flourish in artificial water containers (e.g., vases, tires), often in a domestic environment.

The incubation period following a mosquito bite is two to eight days. The disease is self-limited (five to seven days) and characterized in older children and adults by a sudden onset of symptoms, including: Read more »

This post, Dengue Fever: Mosquito Born Illness Now Found In Texas, Florida, And Hawaii, was originally published on Healthine.com by Paul Auerbach, M.D..

Strange Requests In The Emergency Department: Virginity Testing And More

As the country wrestles with the cost of health-care, and as various media outlets address the role of emergency departments, I thought this little guide-might be helpful!  I pulled it out of my archives from several years ago.  Enjoy!

All too often, I discharge a patient and think to myself, What instructions can I give for this? Sometimes there are problems and questions that don’t have obvious solutions or answers. And in these situations, coming up with something useful for the patient to read at home is, to say the least, difficult. I’ve come up with a few based on some of the enigmas I see at Oconee Memorial Hospital.

Virginity evaluation: The emergency physician has not determined the status of your daughter’s virginity. In fact, the emergency physician does not wish to know the status of your daughter’s virginity. Furthermore, this doesn’t constitute an emergency. Unfortunately, no one has so far developed any simple home kits for making this determination. If you do, please notify the emergency department so that we can refer other families to your product. If you wish to know more about your daughter’s sexuality, try talking to her. If you found her naked in bed with a boy, you don’t need us.

Drug use evaluation: The emergency physician has not performed a random drug test on your teenage son. He has no complaints, is not suicidal, and has no apparent medical problem. This is not a family counseling center. If you want to know if he is using drugs, talk to him. Admittedly, he is a surly, unpleasant, disheveled, and foul-mouthed young man, whose multiple piercings make him look like a Stone Age erector set. But finding out if he is using drugs simply doesn’t constitute what we like to call an emergency. If he isn’t using drugs, be certain that repeated trips to the emergency department accompanied by screaming parents will certainly give him good reason to start.

Whole body numbness: It simply isn’t possible to be awake, walking, talking, and functioning and be entirely numb from head to toe. Admittedly, your ability to overcome the sensation of sharp needles and other painful stimuli is impressive, and may herald a future career with the CIA. For now, however, our physician has determined that the one thing likely to be numb on your person is your skull. Read more »

*This blog post was originally published at edwinleap.com*

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