I love listening to life stories. As a hospice chaplain, I loved sitting with our patients and their loved ones engaging in what many hospice teams call “life review.” When did you meet your spouse? When was Reggie born? What is your favorite holiday? When did you learn you were ill? A few simple questions and the stories come pouring forth.Of late, I’ve been listening to the life stories of ...
How many times as a doctor do you ask the same questions over and over again as part of the routine process of taking a history from your patient? And how often as a patient do you have to answer those same questions each time you see a new doctor? How long does this take, given that doctors and patients both complain that there is too little time for the ...
It was 1976 and I was a junior resident in urology at Baylor College of Medicine in Houston, Texas. I was assigned to a rotation in pathology where my job was to process specimens taken at surgery, dictate a gross description of the specimen and then place the specimens into the cassettes that would be used to make the permanent sections. I was transferring a prostate biopsy, approximately 0.5mm x ...
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 58-year-old woman is hospitalized for acute left-sided flank pain. She has had fever and night sweats for 1 month and a 9.1-kg (20-lb) weight loss over 6 months.On physical examination, temperature is 37.7 °C (99.8 °F), blood pressure is 135/88 mm Hg, pulse is ...
Diagnosis is the foundation on which all care and treatments rest. If the diagnosis is wrong, most probably so is the treatment. Diagnosing an illness is an art. A diagnostician needs to be one part scholar, one part detective, and four parts artist. He has to be a good listener, open minded, and capable of assimilating a large amount of sometimes confusing data into an accurate picture of a disease ...
There is a time for sitting in classrooms. When such heady topics as congestive heart failure are abstract and intangible. Discussion veers from myocytes to cardiac output and stroke volume.The world, through the student's eyes, is inflamed with passion and opportunity. The reality of doctoring is a distant dream. Hope peals back layers of fear and loss of confidence. Reward is imagined as a handshake, a return to health, and ...
For health care professionals, patient engagement is the holy grail of health care. It is the key to patient adherence – a prerequisite to achieving better outcomes, fewer ER visits and hospitalizations and more satisfied patients. It is easy to recognize an engaged patient – they do what their health care providers recommends …what their health care team knows what is right for them.But doesn’t engagement depend upon your perspective?In ...
As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to. At those times, in particular, we evaluate their health in the context of relationship, family, and workplace. Having practiced family medicine for so many years, and now in counseling medicine, I have had the responsibility of advocating for my patients with their health insurance companies, within their families, ...
This series is brought to you by MedPage Today.1. Prostate Surgery Plans Often Change After MRI. Preoperative magnetic resonance imaging of the prostate changed the surgical plan in more than one in four patients undergoing robotic-assisted laparoscopic prostatectomy (RALP).2. Men More Likely Develop Mild Cognitive Problems. Men are more likely than women to develop mild cognitive impairment (MCI), with and without memory problems.3. ...
As a physician, technology cannot replace you, but it can make you more efficient and effective.This was the message from Richard Satava, MD, who spoke on the future of surgical technology at the recent Seattle Surgical Society Annual Meeting. Dr. Satava's speech was fascinating as he laid out the future for robotics, remote surgery, internal locomotion actuators, molecular imaging biosurgery, etc. I looked over my shoulder a couple of times ...
Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for "feeling good", but he did hope that it would help him avoid illness. It was worrisome when he started with some belly cramping and noticed some blood streaks in his stools. It took about a month until he could be scheduled for a colonoscopy. The news was shocking. "There's a cancer ...
When I finished my book on famous patients, the most common question I received was “Are the stories of sick celebrities really relevant to other patients?” My answer was that yes, with some caveats, these experiences are well-worth knowing.The same can be said for the story of Patrick Swayze’s terminal pancreatic cancer, which has now been told by his widow, actress Lisa Niemi Swayze, in a new book, “Worth Fighting ...
“I laughed so hard, tears ran down my leg.”That was a quote from a sign I saw on vacation last summer. While we read it and laugh, we all know what it means. “How’s your bladder working?” is a common question that I ask patients in the office. The responses I get include, “fine, except when I ____”, or, I’m fine as long as I know where the bathrooms are. ...
This series is brought to you by MedPage Today.1. Iodine in Contrast Material Poses Thyroid Threat. The use of contrast media that contains iodine -- on the rise with increased cardiac catheterization and CT scanning -- is associated with an increased risk of thyroid dysfunction.2. Dyslexic Kids Show Brain Changes at an Early Age. Young children at risk for developing dyslexia showed abnormalities ...
Many clinical decisions in older persons are dependent on life expectancy. For example, as life expectancy declines, cancer screening is likely to do more harm than good. Also, persons who have limited life expectancy may want to plan, discuss their values, and consider palliative care approaches of care in addition to care focused on living as long as possible.But can one actually predict life expectancy accurately in an individual patient? ...
This is a response to Deb Discenza's article requesting a one page informational sheet informing a patient about hospice or palliative care.This would allow the patient and their family to make decisions regarding end of life care before it becomes a necessity. I am a crisis care hospice nurse. I am the one who comes to your home, whether it is a million dollar beachfront mansion, or a single wide mobile ...
William Osler famously said (among other things): “Listen to the patient. He is telling you the diagnosis.”I was doing my obstetrical rotation as a first year family practice resident. I had done nearly 100 deliveries and was feeling more confident in my skills and knowledge than was justified. Although this rotation did not involve actual care for the recently delivered newborns, I loved pediatrics and frequently stopped by the nursery ...
Mark Twain, the American author and humorist once said, “It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.” In my experience as a geriatrician, I’ve encountered many misunderstandings about this degenerative neurologic disease that devastates both patients and their families. Countering these can help patients, families, professionals, and all those who have someone in their lives with Alzheimer’s disease.1. ...
This series is brought to you by MedPage Today.1. Enzymes Show Early Heart Damage in Diabetes. A highly sensitive troponin test revealed evidence of subclinical heart damage in patients with hyperglycemia but no known coronary artery disease or heart failure, with particularly high enzyme levels in those with diabetes.2. Time in ER Sends Infection Back to Nursing Home. An emergency department visit may ...
The little boy, who looked to be about two, darted away in a fit of giggles. His young mother, who seemed thoroughly worn out and exasperated, ran after him, grabbed him by the arm and said in a harsh whisper, "You must stand here!"We were on line waiting to board a Southwest Airlines flight. For those of you not familiar with the Southwest system, there are no assigned seats. Rather, ...
According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever...
One of the reasons there is such a movement against vaccines is the democratization of information, perpetuated by search engines like Google....
In a widely circulated CNN article, many radiologists have been found to cheat on their board exams: "Doctors around the country taking an...
Are doctors really going broke? According to this piece from CNN Money, some are: "Doctors list shrinking insurance reimbursements, changing regulations, rising...
It was 1976 and I was a junior resident in urology at Baylor College of Medicine in Houston, Texas. I was assigned...
Diagnosis is the foundation on which all care and treatments rest. If the diagnosis is wrong, most probably so is the treatment. ...
As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to....
Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for "feeling good", but...
I love listening to life stories. As a hospice chaplain, I loved sitting with our patients and their loved ones engaging in...
For health care professionals, patient engagement is the holy grail of health care. It is the key to patient adherence – a...
This is a response to Deb Discenza's article requesting a one page informational sheet informing a patient about hospice or palliative care. This would...
So, Megen at Not Nurse Ratched wrote post recently about therapeutic presence. The following passage really caught my attention: "Question is: are...
A social media movement is happening before our eyes with action starting to take shape. The #occupyhealthcare movement has begun within to...
The triple aim of health care, as defined by the Center for Medicare and Medicaid Services (CMS) is: improving the experience of care, bettering...
The storyline is familiar. An organization is challenged to achieve better results without spending more money. An executive is committed to obtaining...
Why are cancer organizations waiting until it starts to rain before they suggest buying an umbrella? “Join my Medicare Advantage plan and...
How many times as a doctor do you ask the same questions over and over again as part of the routine process...
Many clinical decisions in older persons are dependent on life expectancy. For example, as life expectancy declines, cancer screening is likely to...
“To Err Is Human” is the title of the now famous book from the Institute of Medicine on patient safety published about...
Professor Gunter Dueck, is a calm and eloquent german mathematician who’s also the CTO of IBM Germany. He studied mathematics and philosophy...
As a physician, technology cannot replace you, but it can make you more efficient and effective. This was the message from Richard...
Looking ahead to the next several months, I’ve found myself frequently wondering how many physicians will make this their year to take...
The physician’s decision to first dive into social media can be stress-inducing. Issues of time management, maintaining professionalism, and determining a return...
The impact of social media on medicine could arguably be compared to the impact of the industrial revolution on the human condition....
