October 28th, 2010 by DrRob in Better Health Network, Opinion, True Stories
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Her eyes were bloodshot. She responded to my casual greeting of “How are you?” with a sigh. “How am I? I’m alive, I can tell you that much for sure.” She went on to describe a situation with her adult son who’s in a bad marriage and has struggled with addiction. She sighed again: “I feel weak. I don’t know if I can deal with this one. I’ve had so many hard things in my life already. When will it stop?”
“Many hard things” — yes, I agree with that assessment. She’s been my patient for more than a decade, and I’ve had a front row seat to her life. Her husband died a few years ago (while in his 40′s) of a longstanding chronic disease. Her daughter also has this disease, and has been slowly declining over time. I’ve watched her bear that burden, and have actually shared some in that load, being the doctor for the whole family.
I’ve also taken care of her parents, who had their own psychological problems. They were difficult patients for me to manage, and they had died long enough ago that I had forgotten that difficult chapter of her life. I’ve helped her with her emotional struggle from all of this. It was hard, but she hung on as best as she could. I know. I was there when it was happening.
To me, this is the biggest benefit of primary care. Yes, it’s nice to have a doctor who knows what’s going on with all of your other doctors. It’s good to have a doctor you are comfortable talking with about anything. It’s good to have someone without a financial stake in doing surgery, performing procedures, or ordering tests. But the unique benefit a long-term relationship with a primary care physician (PCP) is the amazing big picture view they have. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
October 23rd, 2010 by Lucy Hornstein, M.D. in Better Health Network, Health Policy, Humor, Opinion, True Stories
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Regular readers have heard me rant about the fragmentation of medical care in this country. Each body part not only has its own medical specialist, but in some cases its own allied health profession. Such is the case with the feet.
Doctors of podiatric medicine have to complete a four-year course of study after college, followed by a three-year podiatry residency. At the end of all that, I grant, they are expert in the care and management of complex disorders and conditions of the foot, ankle, and lower leg. I refer to them regularly, especially for stubborn ingrown toenails. (I did indeed learn how to remove offending portions of nail bed, but over the years I’ve gotten away from it.) They fail, though, when they try to extend their reach beyond their grasp, which is the case of the podiatrist above the knees. Read more »
*This blog post was originally published at Musings of a Dinosaur*
October 22nd, 2010 by KevinMD in Better Health Network, Health Policy, Opinion, Quackery Exposed, Research
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Dr. Robert Sears’ The Vaccine Book, is, as Dr. Rahul Parikh puts it, “a nightmare for pediatricians like me.”
In a piece from Salon, Dr. Parikh brings his issues to the author. The controversy of the book is the so-called “alternative vaccine schedule,” which, as vaccine developer Paul Offit puts it:
…is “misrepresentation of vaccine science” that “misinforms parents trying to make the right decision for their children” in the Journal of Pediatrics. And yet, as a pediatrician myself, I have seen an increasing number of caring, reasonable parents hold it up like a bible in my practice (and that of my colleagues).
This post, however, isn’t about the vaccine controversy — I’ll leave you to read Dr. Parikh’s excellent piece for yourself.
What I found interesting was a passage discussing the public health fears stemming from an increasing number of unvaccinated children. Read more »
*This blog post was originally published at KevinMD.com*
October 20th, 2010 by Shantanu Nundy, M.D. in Better Health Network, Health Policy, Opinion
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It’s a scene that plays out thousands of times every day in doctors’ offices across the country — the moment the doctor shifts from addressing the concerns that brought the patient into clinic to when he or she attempts to make sure everything else is going okay.
Often this happens at the end of a sick visit, after working up an upper respiratory infection or back pain. Sometimes it happens after following up a chronic medical problem such as high blood pressure or arthritis, and occasionally it happens under ideal circumstances, during an annual physical or routine wellness visit. It doesn’t necessarily happen at the end of the visit. Often it sneaks it’s way into various points in the encounter — as when the doctor places his or her stethoscope over a patient’s chest while evaluating for knee pain.
What I’m referring to is so indistinct that it doesn’t even have an universal name, but rather goes by many titles — “preventive health,” “preventative health,” “preventive medicine,” “preventive care,” “healthcare maintenance,” “routine healthcare,” “routine checkup,” “annual physical,” and “health and wellness” — to name a few.
But whatever you call it nearly everyone agrees how important it is. The healthcare reform debate was ripe with calls for more “health”-care not just “sick”-care, and one of the most welcome measures in the new healthcare legislation across both sides of the aisle are provisions to support it. Outside of Capitol Hill, from cereal boxes to magazine racks and celebrity doctors, messages about staying healthy are everywhere, as is the general belief that “an ounce of prevention is worth a pound of cure.” Read more »
*This blog post was originally published at BeyondApples.Org*
October 20th, 2010 by Davis Liu, M.D. in Better Health Network, Health Policy, News, Opinion
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The first-year medical students I precept were too young to see Tom Cruise’s alter ego Lieutenant Pete “Maverick” Mitchell grace the big screen in the 1986 blockbuster film “Top Gun.” Yet, the story has a relevant analogy to medicine.
According to the film, during the Vietnam war American pilots were relying too much on technology to bring enemy fighters down. They weren’t as skilled in taking out the opposition. They fired their technologically advanced missiles to try and get the job done. They didn’t think. It didn’t work. They forgot the art of dogfighting.
The military discovered that technology alone wasn’t going to get the job done. The best fighter pilots needed the skills, insight, and wisdom on when to use technology and when not to. As a result, the Navy Fighter Weapons School, known simply as Top Gun, was created to retrain the military pilots on this vital lost skill. The goal of the program was specifically to make the best of the best even better.
Like the military, the country is discovering that the healthcare system enabled with dazzling technology isn’t getting the job done either. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
