July 7th, 2010 by AlanDappenMD in Better Health Network, Health Policy, Health Tips, Opinion, Primary Care Wednesdays, True Stories
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One of my patients is an elderly woman who is completely bedbound due to osteoarthritis. Since she’s considered “too old,” she isn’t considered a surgical candidate for a knee replacement. Her son, George, is her caregiver.
George had been referred to our practice through word-of-mouth from a geriatric care consultant. When he called me for an initial visit, his mother had a spot on her left forearm that was growing rapidly. The nodule was red and tender. Both of them wanted a doctor to look at and remove it, and at the house if possible. Read more »
June 23rd, 2010 by AlanDappenMD in Better Health Network, Opinion, Primary Care Wednesdays, True Stories
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A few weeks back, I had introduced a patient who was willing to let her religious beliefs stand in the way of receiving the proper medical treatment she needed to stay alive. I want to revisit with you this dying patient, who hadn’t known me or any doctor for over 30 years.
As the rest of the family, who were not as committed to a religious path, stood by her expectantly, I said to her: “I had a brother who was a true believer in the power of God and that faith could heal all things or be called God’s will. Like you, he was a competent adult in charge of his decisions. He wouldn’t listen to anyone else — not his wife, father, mother, children, brother — not even me, the doctor. He died two years ago, leaving behind 10 children and a wife who depended on him. We all believe he died unnecessarily.
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June 2nd, 2010 by AlanDappenMD in Better Health Network, Opinion, Primary Care Wednesdays, True Stories
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Today my brother Arthur helped someone stay alive a little bit longer. He wouldn’t be happy with how I used his story, but he’s dead enough to not hear it.
Art had an enormous IQ which helped him dance through school, standardized testing, and academic awards like a hot knife through butter. But life requires many skill sets, genius being just one. My brother’s biography in many ways mirrors that of the Unabomber’s — move for move — until one decisive moment when Jesus walked into Art’s life.
Forever and irrevocably from that moment forward, Art became God’s logic pugilist. Heretofore, all of his training in science and math was used to prove that the truth in the Bible could be found only in literal interpretation. Read more »
May 26th, 2010 by SteveSimmonsMD in Primary Care Wednesdays
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Most experienced physicians expect uncertainty in caring for real people with average everyday problems. Yet those inexperienced or uninitiated in medicine tend to see the practice of medicine as exact or even absolute.
I remember waiting in vain as a medical student and resident for my instructors to illuminate a path towards certitude. Instead, I was given something far more real and lasting: An acceptance of the indeterminate mixed with the drive to be compulsive on behalf of my patients.
During my internal medicine internship, I remember a more-senior resident during our daily morning report bemoaning her uncertainty by saying, “But I just don’t know what’s wrong with my patient.” Although she was visibly upset, our program director’s reaction to her comment bordered on amusement, culminating with, for me, an unforgettable response: “Well, you certainly have chosen the wrong profession.”
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May 19th, 2010 by AlanDappenMD in Primary Care Wednesdays
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Last week we examined how, in a typical practitioner’s day, he or she often needs to make adjustments in patients’ care to keep them on the path to getting –- or staying — healthy.
Usually a face-to-face physical exam isn’t necessary to make accurate changes to a patient’s care regiment. Instead, all discussions can be done via a form of telemedicine, such as a phone call, email, or video-conferencing. Unfortunately, it’s become standard that face-to-face time is required between patient and doctor, creating more hassle for the patient while not impacting the quality of the outcome.
I’d like to visit the case of a particular patient, Mrs. EE, and discuss how telemedicine allowed me to make small, ongoing adjustments to her medical regiment quickly and easily, and with very positive outcomes.
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