June 23rd, 2010 by DrRob in Better Health Network, Health Policy, Opinion, True Stories
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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 know him to be a solid guy. “I have seen this in a lot in men who retire. They think it’s going to be good to rest, and it is for the first few months. But after a while, the novelty wears off and they feel directionless. They don’t want to spend the rest of their lives entertaining themselves or completing the ‘honey do’ list, but they don’t want to go back to work either.”
He looked up and me, “Yeah, I guess that sounds like me.” Read more »
*This blog post was originally published at ACP Internist*
June 15th, 2010 by DrRob in Better Health Network, Health Policy, Opinion
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Quiz: What does the term “meaningful use” mean?
A. Using something in a way that gives life purpose and leads to carefree days of glee.
B. It depends on your definition of the word “term.”
C. It’s not mean. It’s really nice.
D. A large number of rules created by the government to assess a practice’s use of electronic medical records (EMRs) so that they can spur adoption, give criteria for incentive rewards, and have physicians in a place where care can be measured.
E. Job security for those making money off of health IT.
The answer, of course, is D and E. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
May 26th, 2010 by DrRob in Better Health Network, Health Policy, Opinion, True Stories
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The recent discussion of the appropriateness of bringing patients back to the office has really gotten me thinking about my overall philosophy of practice. What are the rules that govern my time in the office with patients? What determines when I see people, what I order, and what I prescribe? What constitutes “good care” in my practice?
So I decided to make some rules that guide what I think a doctor should be doing in the exam room with the patient. They are as much for my patients as they are for me, but I believe that thinking this out will give clarity in the process.
Rule 1: It’s the Patient’s Visit
The visit is for the patient’s health, not the doctor’s income or ego. This means three things:
- All medical decisions should be made for what is in their interest, including: when they should come in, what medications they are given, what tests are ordered, and what consults are made.
- Patients who request things that are harmful to themselves should be denied. People who ask for addictive drugs or unnecessary tests should not get them. Patients who are doing harmful things to themselves should be warned, but only in a way that is helpful, not judgmental.
- All tests done on the patient should be reported to them in a way that they can understand.
Rule 2: Minimize
Many doctors and patients have a “more is better” mentality. This not only costs more money to the system, but it can cause harm to the patient. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
May 16th, 2010 by DrRob in Better Health Network, Health Policy, Opinion, True Stories
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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 really time for you to come in,” I said, trying to remain calm as I spoke.
He sat for a moment, then responded with very little emotion. “I’m doing fine. You could’ve just ordered my labs and called in my prescriptions. I don’t know why I had to be seen.” Read more »
*This blog post was originally published at Musings of a Distractible Mind*
May 13th, 2010 by DrRob in Better Health Network, Health Tips, Humor, Medical Art, Opinion, True Stories
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Back to the subject at hand.
To those who are relatively new to this blog, one of the most popular…uh…tolerated series of posts has been my series on the physical exam. If you haven’t done so already, you may want to go back and read the posts to get in the proper mindset (or destroy enough brain cells).
Astute readers will note that doctors are not the only professionals to examine the hand.
Long before we knew anything about carpal tunnel syndrome or the thenar eminence, we had Madam Linda and her cohorts looking at the hand for signs of what the future will bring for the individual that happens to be connected to the hand in question. Just as stars and planets can have a peculiar interest as to whether a person will run into money, the lines on a person’s hand can foreshadow a person’s future. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
