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 ...
Dr. Martin Young
Isn’t it time for a patient rating system for doctors?
Here's a devil’s advocate position.Historically doctors have held power over patients as compensation for the responsibility of that position, and the epatient and other patient advocacy movements seek to address that imbalance with good reason, arguing that the doctor-patient relationship should be equal. I don’t mind that. But let’s be truly equal partners then.The patient’s right to choose a doctor and be informed of the best ones via doctor rating ...
The day our hospital lost its heart
In about 1985, as I remember it, my training hospital underwent a pivotal change. In Cape Town, at the southern tip of Africa, Groote Schuur Hospital was world famous for being the place where in 1967 an arrogant, brash and brilliant surgeon by the name of Christiaan Barnard stunned the world by performing the world’s first heart transplant. Nearly twenty years later, Groote Schuur (Dutch for "Big Barn") still retained ...
In both my driving habits and my surgical practice, I look both ways
I noticed something different about my driving habits lately. At a traffic light I used to accept the green as an open invitation to drive through unconcerned, confident that other drivers would see the red and do what they are supposed to do: stop.I don’t do that anymore. I always look to see if the road is clear, and other drivers have indeed stopped. And then I go. I have ...
The rewards of medicine can be overwhelming
As I greeted my next patient of the morning, I knew from the early folder number that I had seen him six or seven years before. I no longer expect to remember everyone I have ever met professionally. The man before me was tall, fit and well built. There is usually some inkling of recognition, but nothing about him was familiar to me at all.We made small talk for some ...
Social media and the modern day House of God
In 1978, as I neared the end of high school and readied myself for medical training, a book called House of God was published by a doctor under the pseudonym Samuel Shem. By the time I read it as an intern eight years later it had become a cult classic among doctors. Everyone I knew in my hospital read it, passing around the single copy we had, writing our names in ...
The trouble with Dr. Google
Things have been a bit tough of late, the bad economy is starting to bite, and you’re feeling the pressure. To top it all, your body has been acting strangely in ways it never has before. Your muscles twitch in funny areas for hours at a time, you tire easily, and you have fleeting pins and needles in your limbs. Over the weeks these symptoms have become worse. The last ...
Implications when technology catches up with medical practice
In 2009 I posted a blog here on videotaping of surgeries and the issues and challenges this would present. I did not say I am in favor of this as a means of policing medical practice, but for documenting surgeries the technology can be very useful. I do video as many of my surgeries as I can, and I offer to show these recordings when appropriate to my patients. ...
How positive thinking affects patients with serious illnesses
I was sick the other day. A bout of gastroenteritis that had me vomiting with diarrhea for 24 hours and feeling weak for another 48. I felt rough for a while, but got over it pretty quickly. My family gave me just the right amount of care, and avoided me appropriately because I get grumpy when I am sick.Had they dared approach me with the suggestion that my state of ...
What big hospitals can learn from smaller ones
Every now and then a tonsillectomy patient bleeds after arriving back on the ward after surgery. On this occasion, there was nothing remarkable in the event itself. What was remarkable was the efficiency of the response.
I got the phone call from the ward sister at 11:05 am, and immediately drove the short distance back to our local hospital. I checked on my patient in the ward, confirmed the bleed, ...
A doctor’s letter to a patient with newly diagnosed cancer
Dear "Robin,"Nothing in my career in medicine has prepared me for being a friend to someone with such a terrible disease. As a doctor I dispense advice on a daily basis, but those interactions remain strangely impersonal. With you, cancer has invaded our inner circle, and we all share your shock and despair.No one can know exactly what it feels like ...
The three most useful words for a doctor
Here are the three most useful words for a doctor: "I don’t know."A close second would be "I’m not sure," another three that have got me out of trouble more times than I can remember. The older I get, and more experience I have, the more useful it becomes.Pattern recognition is essential in effective medical practice. So often patient complaints are vague and nondescript, and in the absence of physical ...
A tough disposition is required to endure physician training
The Theresa Brown furor has got me thinking. To be honest, I don’t think the doctor’s apparent offense was really that bad. I remember giving and taking worse.When I was at medical school and in specialist training, there were senior doctors and nurses of legendary temper and bad disposition. Tiptoeing around them, and working to their satisfaction, however unreasonable, was an accepted part of the job. But the ...
Be a boring patient, not an interesting patient
"She’s a really interesting patient!"The doctor visiting the lady in question at home is correct. Nothing about her illness either has been routine. The progression of her disease has confounded her regular doctors for months. Nothing about her condition is normal. Medications have not worked as expected. The original diagnosis -- Parkinson’s -- is in question. All my training and expertise is inadequate, for I am an ENT surgeon, not ...
When money gets involved, good medical ideas suffer
I read an interesting link via Reuters about how students have developed a smart phone application with a microscope attachment to diagnose malaria.The article shows a picture of a child at risk somewhere in Africa.This is a great idea, and one that can go a long way to help people who really need it. But the last word from the project’s software engineer in the article was the one that was ...
Can doctors learn surgical skills on YouTube and Facebook?
I am a self-taught bass guitarist in a church band, and, to be honest, it sometimes shows. I know I need to improve my skills, but time commitments make formal lessons difficult. So two days ago I opened up YouTube and entered "bass guitar lessons" into the search box.19,000 hits registered. I selected a few that looked good on ...
Surgical error: The difference between mistake and complication
One of the benefits, or aberrations, depending on your point of view, of the fee-for-service model is that we surgeons are remunerated for correcting our mistakes and complications.At first glance this seems wrong. But perspectives differ, and when a doctor has to deal with serious, undeserved complications and is self-employed he deserves to be compensated adequately. So what really is the difference between the two?A complication may be described as ...
Difference between proactive and reactive medicine
Looking back, some of my biggest medical mistakes have been times when I was reactive rather than proactive when faced with a clinical problem. A doctor may have to be one or the other depending on the circumstances, but knowing when and which approach to take is one of the harder skills of medicine, taking time and experience to master.What do I mean? Here are some examples from my field.Treating ...
Tinnitus highlights poor doctor patient communication
I’m both interested in and disturbed by what some doctors have said to patients at the first consultation for tinnitus, an annoying perception of sound that comes from somewhere within their heads. Not many of these patients are referred to me – most come of their own accord for a second opinion. What they tell me their doctor said is a lesson in how not to communicate with patients, and ...
What makes an e-Doctor?
The rise of the e-Patient movement has the potential to change the practice of medicine, in my opinion, for the better. e-Patients demand to be taken seriously, to be “equipped, enabled, empowered, engaged, equals, and emancipated.”My recent post on KevinMD.com suggested the need for e-Doctors as well, in response to the growth of the e-Patient movement.So how do you become an e-Doctor? I believe you, and I, need to be equally ...
