If doctors need to listen to patients to figure out what’s going on, patients need to tell doctors what’s going on.  Why is that so hard sometimes?  It’s hard to speak up when you feel rushed, but have doctors ever done other things that made it harder for me to talk to them? Sometimes doctors blame the patient Years ago I got a terrible abdominal pain.  I could only explain that it felt like ...

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The opening anecdote of the e-patient white paper tells of a patient who impersonated a doctor in 1994, to get his hands on an article about an operation he was about to have. He got busted. Two years later episode 139 of Seinfeld had something similar – Kramer impersonates a doctor to try to get Elaine’s medical record. It aired October 17, 1996. It was a turning point in American healthcare: ...

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I’ve been hearing and reading a lot lately about how the doctor-patient relationship is under siege. There are many reasons for this, ranging from care decisions increasingly being made by insurers to the shortage of primary care physicians, to patient empowerment.  I didn’t quite understand how patient empowerment could be a threat, until I started thinking about the recent perceptual shift from patients to health-care consumers. I agree with the consumer ...

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Great doctors listen to their patients. They start out by asking open-ended questions, and unless patients get too far off-track, they don’t typically interrupt them. Despite having limited time for appointments, they have an unhurried manner. They make eye contact with their patients and do not bury their heads in charts and computer screens. Their patients leave their appointments feeling respected and heard. Of course no doctor is likely to be able ...

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Since the subtext of the natural childbirth and attachment parenting movements is the notion of the good mother, it's worth asking what makes a good mother. My whole approach to writing about childbirth and mothering choices is based my rejection of currently popular beliefs about good mothering. Simply put, I believe that good mothering is about choosing mothering and not about mothering choices. What does choosing mothering mean? It means actively embracing ...

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Raising children in a world full of accessible opinion is a funny thing. Everyone seems to have an idea about how to do this right. Stay home, work full time, work part time, return to work, cry to sleep, not cry to sleep, pacifier, no pacifier … the recipe for each of us is different, of course. Often we’re all right in what we’re doing from picking out baby food to ...

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I often find, when I talk with patients and families about hospice care, there is a palpable sense of relief; relief that there is another option when facing a terminal diagnosis or end stage disease process. Families who have participated in caring for their loved one at the end of life are grateful for the guidance provided in hospice care. Patients in turn are grateful to spend their last days at ...

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I've written previously that many doctors are finding the physical exam obsolete, and are favoring more technologically advanced, and expensive, tests. In fact, I alluded to traditional physical exam advocates as "arguing for staying with a horse and buggy when cars are rapidly becoming available." In a recent piece from the New York Times, internist Danielle Ofri says we need to look past the lack of evidence supporting ...

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"Avoiding those twin traps of overtreatment and therapeutic nihilism" Recognize this phrase? It's from our Hippocratic Oath, the one I took, standing beside my newly assigned cadaver, in my second year of medical school. "What Broke My Father's Heart", recently in the New York Times Magazine, is an exquisitely painful story of medicine and our Oath gone awry in the United States. I urge you to read it. End-of-life care is a ...

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An except from The Empowered Patient. by Elizabeth Cohen, MPH Did you ever see the Seinfeld episode where Elaine gets into trouble at the doctor’s office? While she’s waiting in the examining room, she sneaks a peek at her chart and notices that it says she’s “difficult.” When the doctor comes in, he whips the chart out of her hands. DOCTOR: You shouldn’t be reading that. ELAINE: ...

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