June 16th, 2011 by Bryan Vartabedian, M.D. in Opinion
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This post from Kelly Young on Howard Luks’ blog asks when patients cross the line with respect to their own advocacy. It’s worth a peek.
The question of boundaries between doctor and patient is interesting. All of my patients are empowered in some way. The extent and level of that empowerment is personal. On our own there are few lines and little with respect to boundaries. We have effectively unlimited access to information and resources. And how far we go to look after ourselves and our kids has few limits.
But when we enter into a relationship with a provider, we’re no longer alone. It’s unreasonable for a provider to tell a patient Read more »
*This blog post was originally published at 33 Charts*
June 2nd, 2011 by EvanFalchukJD in Opinion
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At the New York Times’ City Room Blog, Joel Cohen writes:
my wife and I are convinced that all medical students should have to pass Overbooking 101 before they can become doctors.Again and again, we arrive at a doctor’s aptly named waiting room on or before the scheduled time, only to learn that three or four others sitting there have been given the same appointment.
He says doctors need to understand the impact of this on their patients. I agree, but not just because it’s annoying.
A typical doctor sees thirty patients a day. Some see even more.
Reflect on that math. If your doctor sees 30 patients a day, that’s 150 a week, 600 a month, maybe 7,000 a year.
It means that if it’s been even two months since you last saw your doctor, he has probably seen more than a thousand people since your last visit. It’s why there’s often that Read more »
*This blog post was originally published at See First Blog*
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*
April 19th, 2011 by Nicholas Genes, M.D., Ph.D. in Opinion
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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*
March 19th, 2011 by Bryan Vartabedian, M.D. in True Stories
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This week I lost one of my patients, Cooper. He was a feisty 4-year-old with mitochondrial depletion syndrome. I began looking after him as an infant when he wouldn’t stop screaming. I saw him through surgeries, diagnostic rabbit trails, and ultimately helped with the painful decision to undergo small bowel transplantation. Inexplicable symptoms and strange complications defined his short life. While he spent his final days in considerable pain, his lucid moments were spent throwing marshmallows at his siblings. It sort of encapsulates who he was. Great spirit.
Independent of the circumstances, a child’s death is always brutally difficult to process. It’s counterintuitive. And facing Cooper’s parents for the first time after his passing was strangely difficult for me. When he was alive I always had a plan. Every sign, symptom, and problem had a systematic approach. But when faced with the most inconceivable process, I found myself awkwardly at odds with how to handle the dialog. In a hospital my calculated clinical role has a way of sheltering me from a parent’s reality. At a funeral it’s different. Read more »
*This blog post was originally published at 33 Charts*
