I recently came across two articles in the press concerning doctor-patient relationships and communication. I began to reflect on what makes communication between doctor and patient most successful and many questions surfaced. In the New York Times, a new study published in Annals of Internal Medicine was referenced. In this study, the way in which doctors communicate non-verbally was examined. Non-verbal communication was often discordant to the message being relayed, particularly ...

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Studies, medical societies and position papers are unanimous in their condemnation of inappropriate antibiotic prescriptions for an uncomplicated URI ... but not a single voice tells us how to do that. Let me give you a three part structure you can use in your patient conversations in the future - and some exact words to try out.  This structure is adapted from the Parenting literature, another role where boundaries and inappropriate ...

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I cradled my son's miniature body in my hands. Only moments old, he looked up with large glassy eyes. He was so alert, so perfect. I carried him over to the bedside. The obstetrician worked on the afterbirth as my wife waited patiently to hold her child. At the time, it hadn't sunken in yet how much our solitary lives were changing. The nurses swept the baby away for routine testing ...

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Unlike most other industries, safety in healthcare has a unique set of circumstances to overcome: 1) patients die from errors one-at-a-time, and 2) we rarely find out exactly why. The “sensationalism” from a front-page disaster is completely absent. And, due to a myriad of factors, the underlying hazards usually remain a secret. As we ride the crest of a current wave of interest in "patient safety," is the refreshing new focus blinding ...

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When I was a medical student and resident physician, those around me taught me how to distrust the pharmaceutical industry and how to distrust the insurance companies. The drug companies just wanted the public to buy their medications (to get rich) and the insurance companies just wanted to block services for my patients (to get rich). The more I learn as a physician, the more I realize how little I know. The ...

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Marge was aging and gradually "falling apart", as she would say. "First it was my back, then my knees, and now my heart is giving out". She confronted her doctor with this in a frustrated manner, "I'm no good for anything anymore. I can't really enjoy the things I used to. Most of my friends have died off, so maybe I'm next". The doctor in sizing up Marge's advanced age and ...

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Do you, or people you care about, have a chronic medical condition? There are all kinds of chronic diseases, but the ones that are most aggressively killing us—and the health care system—are heart disease, diabetes, and metabolic syndrome (a deadly combination of excess weight, high blood pressure, increased cholesterol and elevated blood sugar). These are all primarily lifestyle diseases and cancer should probably be on the list, too. I felt sad ...

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Being a child in 21st century Mexico utterly differs from any other era. The last decade has been a constant whirlpool for Mexico. Political, cultural and economical changes have shaken the country to its core. Primary care physicians, particularly pediatricians, have a burdensome challenge at hand. Problems like obesity have quickly emerged in all age groups. Obese children, childhood type 2 diabetes and sedentary lifestyles have invaded Mexican homes. Nutrition related customs ...

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When dealing with patients and families coping with life threatening illness, one of a physician’s greatest interventions may be that of empathy.  Defined simply, empathy is the responsiveness to the emotional state of another person—we try to understand another’s experience.  It is a process that requires effort and intention.  Sympathy is an awareness of another person’s situation and is an almost “autonomic” type response.  Sympathy is important and is part ...

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Primary care residency numbers didn't change much this year. Depending upon your vantage point, that's either a good or bad thing. For those who were hoping that the numbers would continue that 2-year steady climb out of the dumps, the 1% increase in FM positions seemed to be a disappointment. But for many of us who work day to day to revitalize the primary care pipeline, we breathed a sigh ...

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