April 19th, 2011 by Nicholas Genes, M.D., Ph.D. in Opinion
Tags: Communication, Disconnect, Doctor Patient Relationship, Emergency Medicine, My Doctor Did Nothing, My Doctor Told Me Nothing
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Reading the ER Stories blog is often a guilty pleasure for me. Today’s post, however, struck a nerve:
Very often I ask patients about their recent visits to other doctors. While I am taking a history, it’s important for me to know if you’ve recently been seen by another provider for the same or similar complaints and what they did, what they diagnosed you with, what they prescribed, etc.
I often get a kind of irritated response such as “Oh, he didn’t do anything” or “he said it was nothing” or “he didn’t say anything to me”. Although I know my share of layzee doctors, I bet the vast majority of times, the doctor DID do something and DID say something.
Just not what the patient either wanted to hear or that their perception or comprehension was wrong. …
… Now, maybe he is not a good communicator. Maybe he doesn’t have the time to sit there and explain the pathophysiology of viruses or something like benign peripheral vertigo – and thus you feel short changed. After all he “just asked me a few questions, listened to my lungs and told me to go home and rest”.
Early on in my training I was fortunate to be taught that proper communication is the responsibility of both doctor and patient. So when a patient shows up in my ED and says their last doctor “did nothing” — when I can see with a few clicks that they got labs, a CT, and two prescriptions — well, there’s a failure to communicate. And the other doctor carries at least some of the blame for this. Read more »
*This blog post was originally published at Blogborygmi*
April 19th, 2011 by Jessie Gruman, Ph.D. in Opinion
Tags: health care, Making Lemonade Out Of Lemons, Meaning In Illness, Narrative Medicine, Psychiatry, Psychology, Wisdom
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“Life gives you lemons and you make lemonade…your response to all those cancer diagnoses is so positive, such a contribution!” “Your work demonstrates that illness is a great teacher.” ”Your illness has been a blessing in disguise.”
Well-meaning, thoughtful people have said things like this to me since I started writing about the experience of being seriously ill and describing what I had to do to make my health care work for me. I generally hear in such comments polite appreciation of my efforts, which is nice because I know that people often struggle to know just what to say when confronted by others’ hardships.
But beneath that appreciation I detect a common belief about the nature of suffering from illness in particular, that in its inaccuracy can inadvertently hurt sick people and those who love them.
The belief is that sickness ennobles us; that there is good to be found in the experience of illness; while diseases are bad, they teach life lessons that are good. Read more »
*This blog post was originally published at CFAH PPF Blog*
April 19th, 2011 by Harriet Hall, M.D. in Opinion
Tags: Aging, Evidence Based Medicine, Experience, Role Of Experience, Science Based Medicine, Trust Me I'm A Doctor, Wisdom
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Before we had EBM (evidence-based medicine) we had another kind of EBM: experience-based medicine. Mark Crislip has said that the three most dangerous words in medicine are “In my experience.” I agree wholeheartedly. On the other hand, it would be a mistake to discount experience entirely. Dynamite is dangerous too, but when handled with proper safety precautions it can be very useful in mining, road-building, and other endeavors.
When I was in med school, the professor would say “In my experience, drug A works better than drug B.” and we would take careful notes, follow his lead, and prescribe drug A unquestioningly. That is no longer acceptable. Today we ask for controlled studies that objectively compare drug A to drug B. That doesn’t mean the professor’s observations were entirely useless: experience, like anecdotes, can draw attention to things that are worth evaluating with the scientific method.
We don’t always have the pertinent scientific studies needed to make a clinical decision. When there is no hard evidence, a clinician’s experience may be all we have to go on. Knowing that a patient with disease X got better following treatment Y is a step above having no knowledge at all about X or Y. A small step, but arguably better than no step at all.
Experience is valuable in other ways. First, there’s the “been there, done that” phenomenon. Older doctors have seen more: they may recognize a diagnosis that less experienced doctors simply have never encountered. My dermatology professor in med school told us about a patient who had stumped him: she had an unusual dermatitis of her hands that was worst on her thumb and index finger. His father, also a doctor, asked her if she had geraniums at home. She did. She had been plucking off the dead leaves and was reacting to a chemical in the leaves. The older doctor had seen it before; his son hadn’t. Read more »
*This blog post was originally published at Science-Based Medicine*
April 18th, 2011 by Dinah Miller, M.D. in Opinion
Tags: Diagnosis, Diagnosis Codes, Insurance Reimbursement, Mental Health, Psychiatry, Stigma
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From time to time, our readers comment that they are distressed with a diagnosis a psychiatrist has given. They’ve met with a doctor, talked for a while (half an hour, an hour, maybe two hours) and based on whatever information the psychiatrist has, a diagnosis is made. Maybe it’s right, maybe it’s not, and maybe the diagnosis will change over time. Some readers have commented that they object to the idea that psychiatrists must assign a diagnosis to be paid, when in fact there is no diagnosis, and they think that’s wrong. The psychiatrist should work for free?
Since I don’t accept insurance, I’m not obligated to make a diagnosis, but if I don’t put one on the statement, the patients won’t get reimbursed. Some tell me that they aren’t submitting psychiatric claims to an insurance company, others don’t have insurance, and many do submit claims. I’m left to wonder why someone with no psychiatric diagnosis would consult a psychiatrist to begin with, especially since some diagnoses (Adjustment Disorder, for example, or Anxiety Not Otherwise Specified) are not particularly stigmatizing. Read more »
*This blog post was originally published at Shrink Rap*
April 17th, 2011 by Elaine Schattner, M.D. in Opinion
Tags: Academic Medicine, Books, Communication, Conflicts of Interest, Health IT, Ideas, Medical Ethics, Medical Information, Pharmaceutical Companies, Texts
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Recently Ed Silverman of Pharmalot considers the case of a ghost-written medical text’s mysterious disappearance. The 1999 book, “Recognition and Treatment of Psychiatric Disorders: A Psychopharmacology Handbook for Primary Care,” (reviewed in a psychiatry journal here) came under scrutiny last fall when it became evident that the physician “authors” didn’t just receive money from a relevant drug maker, SmithKline Beecham; they received an outline and text for the book from pharmaceutical company-hired writers.
poster for the X-Files
Now the book’s listing is gone from the website of STI (Scientific Therapeutic Information), the company that provided the authorship “help.” I tried to get a copy of the handbook on Amazon.com, where it’s currently out-of-stock. The book is listed in the Library of Congress on-line catalog: #99015420.
I’m reminded of clinical handbooks I used all the time when I was practicing hematology and oncology. At the hospital, I’d get freebie, small-sized chemo regimen primers that conveniently fit into my white coat pocket. In retrospect, perhaps I didn’t adequately check the authors’ credentials on those mini-book sources. It was too easy to take that information and keep it at hand, literally, especially in the times before we had constant Web access. Read more »
*This blog post was originally published at Medical Lessons*
