December 29th, 2010 by KevinMD in Better Health Network, Opinion, True Stories
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Primary care physicians often have to see patients with a litany of issues — often within a span of a 15-minute office visit.
This places the doctor in the middle of a tension: Spend more time with the patient to address all of the concerns, but risk the wrath of patients scheduled afterwards, who are then forced to wait. And in some cases, it’s simply impossible to adequately address every patient question during a given visit.
It’s a situation that internist Danielle Ofri wrote recently about in the New York Times. In her essay, she describes a patient, who she initially classified as the “worried well” type:
… a thin, 50-year-old educated woman with a long litany of nonspecific, unrelated complaints and tight worry lines carved into her face. She unfolded a sheet of paper on that Thursday morning in my office with a brisk snap, and my heart sank as I saw 30 lines of hand-printed concerns.
Ms. W. told me that she had recently started smoking again, after her elderly mother became ill, and she was up to a pack a day now. She had headaches, eye pain, pounding in her ears, shortness of breath and dizziness. Her throat felt dry when she swallowed, and she had needling sensations in her chest and tightness in her gut. She couldn’t fall asleep at night. And she really, really wanted a cigarette, she told me, nervously eying the door.
This is the kind of patient who makes me feel as though I’m drowning.
Dr. Ofri did as many doctors do: She listened appropriately, went over the patient’s history and physical, reviewed prior tests, and concluded that many of her symptoms were due to anxiety. Except, in this case, they weren’t. The patient eventually had a pulmonary embolus, and hospitalized. Read more »
*This blog post was originally published at KevinMD.com*
December 24th, 2010 by DrRob in Better Health Network, Opinion
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Every day I go to work and spend time with suffering people. They come to me for help and for comfort. They open up to me with problems that they would not tell anyone else. They put trust in me — even if I am not able to fix their problems. I serve as a source of healing, but I also am a source of hope.
Christmas is a moving season for many of the same reasons. No, I am not talking about the giving of gifts or the time spent with family. I am not talking about traditions, church services, or singing carols. I am not even talking about what many see as thereal meaning of Christmas: Mary, Joseph, shepherds, wise men, and baby Jesus. The Christmas story most of us see in pictures or read about in story books is a far cry from the Biblical account. The story we see and hear is sanctified, clean, and safe.
Before I go on, I want to assure my readers that I am in no way trying to persuade them to become Christians. I am a Christian, but whether or not you believe the actual truth of the story, there is much to be learned from it. I find it terribly hard to see the real Christmas story here in a country where the season is filled with so much else — much of it very good. It is far easier to just be happy with family, friends, giving gifts, singing songs, and maybe even going to church, than it is to contemplate the Christmas story. I think the Christians in our culture have gotten way off base on this — much to our shame.
Christmas is not about prosperity and comfort. It is about help to the hopeless. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
December 22nd, 2010 by Lucy Hornstein, M.D. in Better Health Network, Health Tips, Opinion, True Stories
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The most moving speaker at the American Academy of Family Physicians (AAFP) convention I went to in Denver a few months ago was a doctor with Stage 4 cancer who had survived well past all expectations for his disease. While talking about achieving happiness through balance in life, he pulled out of his wallet a card made for him by his daughter, a preschool teacher.
“This is the C card,” he told us. “It says: ‘I have cancer. I can do whatever I want.’”
What a great idea, I thought. As much as it resonated with me, though, I couldn’t help but feel there was more to it than that.
Recently I was comforting a dear friend who had lost her mother. Remembering this handout from the AAFP, I held her close and said: “You’re a mourner now. You can do whatever you want.” I might as well said: “You have the M card.”
There’s this crotchety old guy in his eighties whom I’ve known for years. He does whatever he wants. I don’t think he actually carries a card in his wallet that says: “This is the O card. I am old. I can do whatever I want,” but he might as well. He is indeed old, and so he is entitled. Read more »
*This blog post was originally published at Musings of a Dinosaur*
December 22nd, 2010 by DrRob in Better Health Network, Opinion, True Stories
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“I need you to do me a favor,” my nurse asked me at the end of our day on Friday.
“Sure,” I answered. “What do you want?”
“Please have a better week next week,” she said with a pained expression. “I don’t think I can handle another one like this week.”
It was a bad week. There was cancer, there was anxiety, there were family fights, there were very sick children. It’s not that it’s unusual to see tough things (I am a doctor), but the grouping of them had all of us trudging home drained of energy. Spent.
I think this is one of the toughest thing about being a doctor (and nurse, by my nurse’s question): The spending of emotional reserves. I’m not physically active at work, yet I come home tired. I don’t have to be busy to feel drained. It’s not the patients’ fault that I feel tired. They are coming to me to get the service I offer to them, and I think I do that job well. The real problem is in me. The real problem is that I care. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
December 19th, 2010 by StevenWilkinsMPH in Better Health Network, Health Tips, Opinion, Research, True Stories
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It seem like everyone these days is focused on changing some aspect of patient health behavior. You know — getting patients to get a mammogram or PSA test, exercise more, take medications as prescribed, or simply becoming more engaged in their healthcare. If only we could change unhealthy patient health behaviors, the world would be a better place.
I agree with the sentiment, but I think that patients and their health behavior often get a “bad rap” from healthcare professionals. I would even go so far as to say that much (not all) of what we attribute to poor patient behavior is more correctly attributable to ineffective doctor communications with patients.
In my last post I talked about the link between strong physician advocacy, e.g., I recommend, and desirable health outcomes, i.e., patients getting more preventive screening.
Here’s what I mean. Mammography studies have consistently shown that screening mammograms rates would be much high if more physicians “strongly recommended” that women get screened, e.g., “I recommend” you get a mammogram. In studies where physicians advocated for screening, mammography screening rates were always higher compared to physicians that did not advocate for them. The same phenomenon can be found in studies dealing with exercise, weight loss, colorectal cancer screening, HVP immunization, and patient participation in clinical trials. Read more »
*This blog post was originally published at Mind The Gap*
