June 11th, 2011 by StevenWilkinsMPH in Opinion
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When you or I visit an accountant, a lawyer or car mechanic, we know what our role is and have a pretty clear understanding of what the ” expert” is supposed to do. But when it comes to a trip to the doctor these days the roles and responsibilities of patients and physicians have become blurred and unpredictable…and the patient seems to generally be on the losing end.
Take my Mom’s case. My Mom who was 89 years old and evidently had severe osteoarthritis. She never knew that even though she was been seen every couple of months by her Internist for years and years. It’s too bad…because my Mom died last week from complications due to a compression fracture of her spine. Turns out her spine was very fragile according to her consulting Neurosurgeon but no one ever told her.
The first question that entered my mind when I heard of her condition was why didn’t her primary care physician “pick up” on the severity of her condition before she fell and fractured her spine? Read more »
*This blog post was originally published at Mind The Gap*
May 31st, 2011 by Jessie Gruman, Ph.D. in Health Tips
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“The most important thing I learned was that different doctors know different things: I need to ask my internist different questions than I do my oncologist.”
This was not some sweet ingénue recounting the early lessons she learned from a recent encounter with health care. Nope. It was a 62-year-old woman whose husband has been struggling with multiple myeloma for the last eight years and who herself has chronic back pain, high blood pressure and high cholesterol and was at the time well into treatment for breast cancer.
Part of me says “Ahem. Have you been paying attention here?” and another part says “Well of course! How were you supposed to know this? Have any of your physicians ever described their scope of expertise or practice to you?”
I can see clinicians rolling their eyes at the very thought of having such a discussion with every patient. And I can imagine some of us on the receiving end thinking that when raised by a clinician, these topics are disclaimers, an avoidance of accountability and liability.
But all of us – particularly those receive care from more than one doctor – need to have a rudimentary idea of what each clinician we consult knows and does. Why is this clinician referring me to someone else? How will she communicate with that clinician going forward? How and about what does she hope I will communicate with her in the future?
Why does our clinician need to address these questions? Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
May 25th, 2011 by StevenWilkinsMPH in Health Policy, Opinion
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The short answer: No.
At least not in the context of a strong physician-patient relationship.
Many physicians have legitimate concerns about the prospects of having their salary or level reimbursement linked to patient satisfaction. I would too given the way most health care providers go about measuring and interpreting patient satisfaction data.
A major concern of physicians is the issue of patient requests – particularly the impact of unfulfilled (and unreasonable) requests upon patient satisfaction. According to researchers, explicit patient requests for medications, diagnostic tests and specialty referrals occur in between 25% to 40% of primary care visits. This figure is much higher when requests for information are factored in. Read more »
*This blog post was originally published at Mind The Gap*
May 14th, 2011 by StevenWilkinsMPH in Health Tips, Opinion
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Lots of smart people over the years have been trying to figure out why people stop taking their medications within the first 12 months. Within the first 12-months of starting a new prescription, patient compliance rates drop to less than 50%. This rate is even lower for people with multiple chronic conditions taking one or more prescription medications.
If these medications are so important to patients, why do they just stop taking them? It defies common sense. Sure issues like medication cost, forgetfulness, lack of symptoms, and psychosocial issues like depression play a role in patient non-compliance. But there also something else going on…or in this case not going on.
The problem is that doctors and patients simply don’t talk much about new medications once prescribed. Here’s what I mean. Let’s say that at a routine check-up a physician tells a patient that he/she wants to put them on a medication to help them control their cholesterol. The doctor spends about 50 seconds telling the patient about the medication. The patient nods their head takes the prescription and boom…the visit is over. Read more »
*This blog post was originally published at Mind The Gap*
May 6th, 2011 by StevenWilkinsMPH in True Stories
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I had a WOW experience yesterday when I accompanied my wife to interview a new doctor for her. As some reader may know she is being seen by specialists at MD Anderson Medical Center in Houston for Stage IV lung cancer. She has not had a local oncologist for the past 6 years…but she does now. And we both love this guy!
You need to understand that I have been very underwhelmed by the local oncologists I had met up till now. I am sure they were clinically proficient…but as a group not a one could muster a smile….or any sense of interest or curiosity in my wife’s medical condition. I held out little hope that this new doctor would be any different.
After being ushered into the exam room, a Physician’s Assistant came into the room to get smart about my wife’s history and records (which she brought). Three things surprised me about the PA. 1) She was incredibly thorough actually reading the radiology reports and reflecting with my wife on what she learned, 2) her empathy – as she read the reports she actually used terms like “bummer” when she read how my wife developed pneumonia during her treatment, and 3) she faithfully summarized the results of her review to the doctor before he came in. In other words – the PA listened and heard what my wife shared with her!
Now enters the doctor. He has a warm smile on his face while he extends a hand to my wife and me. He says just enough for us to know that he has talked to the PA. He asks my wife to sit on the exam table and does a physical exam (also a rare event these days). Read more »
*This blog post was originally published at Mind The Gap*
