September 15th, 2011 by Dinah Miller, M.D. in Opinion
Tags: Chief Complaint, Clinical Psychiatry, Delusional, Denial, Depression, Doctor-speak, Embarrassment, Harmful, Insulted, Medical Records, Mental Status, Misinterpretation, Notes, Paperwork, Psychiatry, Psychology, Report, Shrink, Therapy
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Please see my post on Clinical Psychiatry News and yesterday’s post What’s in a Note? along with the reader comments.
One reader asked why it’s weird to want to see your shrink’s notes and why shrinks refuse to show them on the grounds that they may distress the patients. Another reader asked why doctors write “patient denies” as though they don’t believe the patient. These are both great questions worthy of their own post.
Why don’t psychiatrists like to show patients their notes? Are they really going to “harm” the patient? There are a few reasons why a psychiatrist may not want to show a patient her notes. Here is my list of thoughts as bullet points. Please feel free to add to it. Read more »
*This blog post was originally published at Shrink Rap*
September 14th, 2011 by Jessie Gruman, Ph.D. in Opinion, True Stories
Tags: Cancer, Certainty, Final Days, health care, Health-related numbers, Illness, Jessie Gruman, Markers, Numbers, Quantifiable, Technology, Time, Time Remaining, Tools, Treatment
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“My doctor can titrate my chemotherapy to the milligram but can’t tell me when I am going to die,” a friend who was struggling with his treatment for cancer complained to me a couple years ago.
Had he lived, he might have been reassured by the announcement last week of a new scale that allows clinicians to estimate the time remaining to people with advanced cancer. He was spending his final days “living by the numbers” of his white blood cell count, the amount and size of his tumors and suspicious lesions, the dosage of various drugs and radiation treatments. And he was peeved about what he saw as a critical gap in those numbers. He believed (hoped?) that because his cancer was quantifiable and the treatment was quantifiable, that the time remaining should be similarly quantifiable. He needed that information to plan how to use the time that remained.
Many of us would make a different choice about knowing how long we will live when we are similarly ill. But most of us are attracted to the certainty we attach to the numbers that precisely represent aspects of our diseases.
It is not just when we are seriously ill that numbers dominate our experience with health care. Advances in technology have made it possible to quantify – and thus monitor – a seemingly infinite number of physiological and psychological health-related states. For instance: Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
September 13th, 2011 by RamonaBatesMD in Opinion, Research
Tags: Augmentation, Bariatric Surgery, Breast appearance, Breast Contour, Breast Reduction, Breast Surgery, Jeffrey A. Gusenoff, M.D., macromastia, Mammoplasty, Massive weight loss, Obesity, Research, Surgeon, Surgery
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Many women with large breast and weight issues seek breast reduction. I was taught to encourage them to lose weight first. Now there is a very small study that backs this up (full reference below).
The American Society of Plastic Surgeons issued a press release entitled “Breast Reduction and Bariatric Surgery—Which Should Be Done First?” and provided the answer “Final Results May Be Better When Weight Loss Comes First.” I agree, but find it odd that such a small study was published. There should have been more patients included.
Jeffrey A. Gusenoff, MD, and colleagues reviewed two groups of patients who sought consultation for body contouring surgery August of 2008 and February of 2010 after massive weight loss (defined as a weight loss of greater than 50 pounds).
Group I (n=15) included Read more »
*This blog post was originally published at Suture for a Living*
September 13th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
Tags: Bangor Daily News, Consumers, Crazy Sexy Cancer, Expenditures, Financial Incentives, GDP, growth, Healthcare System, Kris Carr, Overutilization, Stakeholders, Waste, Wasteful Procedures
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Patients are first. Patients are the reason for the existence of the healthcare system. Physicians are second. They are trained to understand the pathophysiology of illness and to treat patients for their disease. Everyone else is a secondary stakeholder (provider).
All the stakeholders create waste in the healthcare system. If an accurate analysis were performed, most of the waste and the resulting profits would be attributed to the secondary stakeholders. Patient and physicians drive this waste and profits into the hands of the secondary stakeholders. Neither patients nor physicians are aware of driving the waste and profit into these stakeholders’ coffers.
The patient-physician relationship should be a one on one transaction. Patients and physicians are frustrated and many have accepted the disappearance of this human-to-human interaction.
Healthcare insurance companies and hospital systems think they own the patients and the physicians. This will turnout to be a fatal misperception.
To many observers of the healthcare system Read more »
*This blog post was originally published at Repairing the Healthcare System*
September 12th, 2011 by Edwin Leap, M.D. in Health Policy, Opinion
Tags: Culture, Dotcor-Patient Interaction, Emergency Department Physician, Emergency Medicine, entitlement, Family, Government Regulations, House Call, Paperwork, Peaceful setting, Privelege, Relaxed, Right to Health care, Value
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Nostalgia for the house-call
Not too long ago, I made a house call. As a physician accustomed to working in the emergency department of a hospital, this was quite a change of pace. But it involved dear friends and their sick child, and it was a joy. We had spoken on the phone and I had some concerns about their infant, who was stricken with a high fever. When I went to their home I took only my stethoscope. That and my experience as a physician and parent of four.
When I walked through the door on Friday evening there were candles burning as dinner was prepared. There were no florescent lights. There was none of the chaos of a waiting room. No ambulances idled outside. No bloody, angry drunk screamed profanities. No one was stood by their exam room door, arms crossed in annoyance with waiting. It was a quiet place to be; and the child, on his worried mother’s hip, was quiet as well. He was in a place where he felt safe and was thus able to tolerate my poking and prodding.
I examined him and decided that he was not seriously ill. Because his mother had described him as lethargic when we spoke, I had been concerned that he might have meningitis. This was not actually the case. His parents and I were obviously relieved.
After he was dosed with ibuprofen and put to bed, I chatted a while with his mom and dad, then left for home. As I drove home I realized that Read more »
*This blog post was originally published at edwinleap.com*
Please see my post on Clinical Psychiatry News and yesterday’s post What’s in a Note? along with the reader comments.
