“I dunno. But after I go to the mailbox and walk back up to the house, I’ve got to stop now where before I didn’t.”
Exertional dyspnea. It conjures up a large differential of potential cardiovascular or pulmonary causes. And as the above commonly-encountered doctor-patient conversation demonstrates, the problem is a dynamic one: at rest things are often fine, on exertion or with recumbency less so.
Now imagine that the doctor then sees elevated neck veins, hears rales in the lower lung fields, and sees swollen ankles on their patient. Heart failure, right? Read more »
*This blog post was originally published at Dr. Wes*
Check out this darkly humorous advertising campaign from the U.S. Department of Health and Human Services. How do you convince men to go to the doctor and get the preventive healthcare that’s known to save lives? You make it all about television. Men + HD TV = “Yes.” This video is funny on so many levels.
I saw the note on the patient’s chart before I opened the door: “Patient is upset that he had to come in.”
I opened the door and was greeted by a gentleman with his arms crossed tightly across his chest and a stern expression. I barely recognized him, having only seen him a handful of times over the past few years. Scrawled on the patient history sheet in the space for the reason for his visit were the words, “Because I was forced to come in.”
My stomach churned. I opened his chart and looked at his problem list, which included high blood pressure and high cholesterol –- both treated with medications. He was last in my office in November — of 2008. I blinked, looked up at his scowling face, and frowned back. ”You haven’t been in the office for over 18 months. It was really time for you to come in,” I said, trying to remain calm as I spoke.
He sat for a moment, then responded with very little emotion. “I’m doing fine. You could’ve just ordered my labs and called in my prescriptions. I don’t know why I had to be seen.” Read more »
In the practice of medicine, as in any human endeavor, we encounter a wide variety of human beings. While thinking about this recently, in light of the passage of the healthcare reform act, I realized something startling that supporters of the bill may not realize: There are some patients that nobody wants to see.
This uncomfortable truth exists irrespective of the presence or absence of insurance. Sometimes physicians are accused of dismissing or avoiding certain patients on the basis of their finances alone. While that problem exists (and I have seen it), a great many of the patients who can’t find (or keep) a doctor simply aren’t much fun to be around, much less to treat. Read more »
*This blog post was originally published at edwinleap.com*
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I saw the note on the patient’s chart before I opened the door: “Patient is upset that he had to come in.”
