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About Patient Autonomy

Recently, I was involved in a discussion on an email list serve and decided to takes some of my comments on patient autonomy and blog about them. This arose following a debate about whether the term “patient” engendered a sense of passivity and, therefore, whether the term should be dropped in favor of something else, like “client” or something similar.

Having participated in the preparation and dissemination of the white paper on e-patients, I don’t see the need for “factions” or disagreements in the service of advancing Participatory Medicine. As Alan Greene aptly stated: “This is a big tent, with room for all.”

I want all of my patients to be as autonomous as possible. In my view, their autonomy is independent of the doctor-patient relationship that I have with them. They make the choice to enter into, or to activate or deactivate, the relationship with me. They may ignore my input, seek a second opinion, or fire me and seek the care of another physician at any time. They truly are in control in that sense. The only thing I have control over and am responsible for is trying to provide the best advice or consultation I can. Read more »

*This blog post was originally published at eDocAmerica*

Getting Good Sleep

Our busy lifestyles often aren’t conducive to getting the recommended amount of sleep at night. According to the National Sleep Foundation, adults need between seven and nine hours of sleep every night.

Dr. Kenneth Berg of the Mayo Clinic states that people who get less than seven hours of sleep per night have a higher mortality than those who have adequate sleeping habits.

Inadequate sleep has been linked to increased risk of motor vehicle accidents, an increase in body mass index and a greater likelihood of obesity due to an increased appetite caused by sleep deprivation, increased risk of diabetes and heart problems, increased risk for psychiatric conditions including depression and substance abuse, and decreased ability to pay attention, react to signals or remember new information. Read more »

*This blog post was originally published at eDocAmerica*

Reflections On The State Of Online Healthcare

As 2009 draws to a close, the US health care system is ailing and quasi-reform proposals are frantically being debated and voted on. Although some type of reform is likely in 2010, we will have only scratched the surface of what still needs to be changed.

One particular aspect relates to the ease with which patients can use the internet to improve their health care. At eDocAmerica, we’ve been using the internet to improve the health of our users for over a decade. Ten years ago, I predicted that patients would routinely use internet messaging to interact with the health care industry by now, but I was wrong. Although, increasingly, web 2.0 approaches are providing innovative communication and health management tools for patients, the growth of interaction between patients and doctors has been much slower than I predicted it would be. And the future still remains cloudy. The issues are nothing new and include: Read more »

*This blog post was originally published at eDocAmerica*

Medical Discovery Made By Dying Cancer Patient

By Charles Smith, MD

This post is adapted from one I wrote last week on Blog.

Matthew Herper’s post about thalidomide treatment of Myeloma is a good example of how patients will contribute to medical knowledge in the future, and may form a cautionary tale for patients who get involved to this degree in formulating new treatment approaches.

Read more »

*This blog post was originally published at eDocAmerica*

Participatory Medicine: The New Face Of Personal Responsibility

Participatory Medicine is a cooperative model of health care that encourages and expects active involvement by all connected parties (health care professionals, patients, caregivers, etc.)

When patients are aware of such things as their weight, BMI, blood pressure, recent key laboratory results, and so on, and when they come to the office motivated and prepared, outcomes are likely to be much better. The patient who passively waits for advice and direction from the physician is more likely to forget instructions, make excuses for failures, lack the discipline to lose the needed weight or stay on the required diet, and so forth.

Patients themselves, not their doctors, must be the ones to make the essential decisions about their health. They must be able to obtain the necessary information to make key decisions, then act on them.

How does this process happen? A patient may agree with this statement and want to begin to operate in this mode, but not know how to do it. Here is a short list of the essential steps necessary to begin the practice of participatory medicine:

1. If possible, find a physician who understands, and supports, this concept, including one who is willing to communicate with you by e mail and directly answer your phone calls.

2. Consider the option of using a service like edocamerica, that is dedicated to providing you with the information necessary to make decisions about your own health care. They can supplement your physician and are available to you 24/7 and always welcome your questions. Moreover, they are dedicated the concept of PM and are oriented towards health and wellness, not just managing your diseases.

3. Start following blog and twitter posts by persons who are now actively discussing how Participatory Medicine is going to change the way health care is practiced.

4. Keep a current list of your medications, including the Brand name, generic name, dose and frequency of each one.

5. Look up the most common side effects of each of your medications.

6. Check your medications for any drug-drug interactions. You can use a web site such as for this.

7. Keep a list of all of your current medical conditions and review the basic information about each of them. A site such as Mayo Clinic or Medicine Net are good, trustworthy sources for this review.

8. Start making a list of questions that you want your doctor to answer for you. If he doesn’t have time to answer all of them at the next visit, ask him if you can e mail them to him. If not, ask one or two at each visit until you get them all answered. If you can’t get him to address all of your questions in a satisfactory and timely fashion, consider getting another doctor who will.

Participatory medicine, working on an equal footing with your provider, in a partnership for your optimal health, is the only way you can get the most out of the health care system. So, get on the train before it leaves the station!

Your comments and dissenting opinions are always welcome.

*This blog post was originally published at eDocAmerica*

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