One of the first things they teach in medical school is that if you haven’t pretty much figured out the diagnosis by the time the patient finishes sharing their history, your doctor hasn’t done his or her job well.  Certainly, this is a bit of an exaggeration, as many diseases cause similar symptoms. As you share your background, your doctor is creating a list of possibilities of the most likely conditions ...

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An article from the Wall Street Journal caught my attention, and for all the wrong reasons. It was a review of two recent studies showing that medical trainees have difficulty diagnosing patients with complicated histories or confounding psychosocial features. At least, that’s the way I would describe those studies. The WSJ, however, used much more pejorative language, referring to them as “difficult patients,” “a nuisance,” and “an annoyance.” The ...

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Patients with extended illness or chronic conditions often acquire a communicative competence with far more complex medical terminology than their doctors realize. This is important, given that patients are too often seen as passive recipients of medical information, or worse, incapable of understanding their own health data. Recent studies show that one of the most effective prescriptions for increasing health outcomes and reducing medical malpractice rates is improving how doctors communicate ...

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I recently consulted a specialist at a major medical center in New York, and a few days later, here came a questionnaire in the mail. "How much time did I spend in the waiting area?" it asked. How long was I kept waiting in the examining room? How close to my appointment time did the doctor see me? The one thing it didn't ask was whether I cared. There's no mystery about ...

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american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. As a lifelong resident of southeast Louisiana and a veteran of numerous weather and flood-related events that have required me to use my homeowners and flood insurance, I am very familiar with gaps in insurance coverage.  Insurance policies are very detailed agreements that many ...

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Obviously, chronic illness doesn’t affect everyone the same way. That said, I’ve heard from people all over the world with every imaginable chronic illness (which includes chronic pain), and our day-to-day lives are strikingly similar. And so, I thought I’d describe a typical “day in the life,” using my own experience from a few months ago as an example. My hope in writing this piece is for those of us ...

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Dear doctors, Are you looking through our charts and wondering what you’ve gotten yourself into? Are you maybe wishing we were someone else’s problem? Yeah, we know. It’s OK. We know we aren’t the type of patient most doctors like to take on. There are a lot of strings attached to us, and there’s a lot of paperwork waiting to join that already insurmountable mountain of paperwork on your desk. We can’t ...

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"You have no husband?"  asked an oncologist at an Ivy League cancer center, his voice full of concern. "No," I replied. "No sons?" "No." "No daughters?" "No." "No sisters or brothers?" "No." "Your parents -- are they living?" "No." When I mentioned friends and extended family, he talked right over me.  Without a nuclear family, he seemed to think, I had no one. I'd been diagnosed with stage four gallbladder cancer, usually fatal within months.  The surgeon who'd removed three-quarters of ...

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Opioid painkillers, such as Vicodin (hydrocodone) and OxyContin (oxycodone), are crucial medical tools that are addictive and widely abused. Tranquilizers and sleeping pills of the benzodiazepine class, like Xanax (alprazolam), Ativan (lorazepam) and Klonopin (clonazepam), are safe and effective in limited, short-term use, but are often taken too freely, leading to drug tolerance and withdrawal risks. Stimulants such as Ritalin (methylphenidate) and Adderall (amphetamine) ease the burden of ADHD but ...

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Prior to her death, a courageous young woman named Jess Jacobs, who suffered from POTS (postural orthostatic tachycardia syndrome), wrote about the worst health care experience of her life.  It is a somewhat horrifying account of hospitalization in Washington D.C.  Her goal was to work toward meaningful health care changes in the system for the better. When I came across the story of another young woman afflicted with this ...

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