Patient

How should doctors handle the difficult patient?

by Toni Brayer MD

I am willing to bet that patients do not know that the medical community talks formally about “The Difficult Patient”. Courses are taught on how to handle these patients and there is even an ethics study on Medscape about it. So what is the difficult patient?

Every practice encounters them and they come in many varieties. They are the patients who abuse the staff, miss appointments repeatedly, “lose” …

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How to reduce the risk of medical errors from patient hand-offs

One of the consequences of capping resident work-hours is increasing the frequency of patient hand-offs.

In a recent column in The New York Times, surgeon Pauline Chen cites a somewhat frightening statistic that during a course of a typical 5-day hospitalization, patients “are passed between doctors an average of 15 times.”

And residents sign over patients several hundred times during the first few weeks of training.

One interesting solution would be to …

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Should homebirth advocates continue support a doctor convicted of sexual exploitation?

Amy Tuteur calls sexual exploitation “the most egregious violation of professional conduct that any obstetrician-gynecologist can commit.”

And in that context, she details an interesting scenario brewing in California. Stuart Fischbein is an obstetrician that’s widely hailed in homebirth circles, writing a book and being a foremost advocate of homebirths.

Unfortunately for him, he also exercised some poor judgment, as detailed in this newspaper report:

He called her “sweet pea,” held …

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Is the obesity epidemic caused by too much exercise?

by Monte Ladner, MD

The August 17, 2009 issue of TIME magazine ran a cover story entitled “The Myth About Exercise” with a subtitle claiming it won’t make you lose weight. The author of the article cherry picked bits of data from several scientific studies to make the case that exercise won’t help with weight loss, and might even lead to weight gain by causing people to eat more.

The TIME …

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The Patients’ Bill of Responsibilities

by Susan H

1. I acknowledge and believe that I will die someday. Everyone I love will also die. That inevitable outcome will be factored into all my personal health care decisions.

2. I acknowledge that just because a paid professional might be found to assert that he would have performed differently under similar circumstances, doesn’t mean a doctor or nurse committed malpractice. Judges who are overturned on appeal ought to …

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How comfortable are compression stockings for post-surgical thromboprophylaxis?

by Crystal Phend, MedPage Today

“Every 10 years a doctor should be the patient,” said my doctor, squeezing me into pair of compression stockings that would make a sausage casing seem spacious by comparison.

medpage-today “Seems like a good idea,” I thought, as I lay there on the table feeling optimistic about the opportunity for first-hand experience.

It was my first minor …

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Does counseling kids to lose weight and increase exercise work?

by Todd Neale, Staff Writer, MedPage Today

Overweight and obese children who received counseling from a family doctor did not lose more weight or get more exercise than youngsters who did not receive counseling, Melissa Wake, MD, of Royal Children’s Hospital in Melbourne, and colleagues reported online in the British Medical Journal.

medpage-today Because the screening and counseling are so expensive, …

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The ultrasound that saved a baby girl’s life

by Linda Lee, MD

Bob Hebert, in his column in The New York Times, recently wrote that, “Life in the United States is mind-bogglingly violent. But we should take particular notice of the staggering amounts of violence brought down on the nation’s women and girls each and every day for no other reason than who they are. They are attacked because they are female.”

As a family physician I can …

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Should patients bear some responsibility when doctors miss a diagnosis?

Missing a diagnosis is, obviously, something both doctors and patients continually want to avoid.

But when it happens, is it completely the doctor’s fault? That’s a question Pauline Chen addresses in a recent column. When it pertains to primary care, it all comes down to followup. She cites a recent study looking at breast cancer diagnoses and found that, “roughly a quarter of patients had experienced process …

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How a wealth of information takes attention away from the patient

by Abraham Verghese, MD

This month I am the attending physician overseeing an internal medicine team, one of four such teams that admit patients to my teaching hospital. It’s a great time to be an attending physician. I have seasoned interns who in just a few weeks will be junior residents, and I have even more seasoned senior residents on their way to entering practice or entering subspecialty training. The team …

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Poll: How should doctors make patients responsible for their own health?

The current health reform proposals do not make enough of an effort to encourage patients to take care of themselves. After all, the frequency of two leading causes of death, diabetes and heart disease, can be markedly reduced with lifestyle changes.

What is the best way to encourage patients to take responsibility for their own health?

Rewards or penalties can indeed motivate change. Several years ago, West Virginia’s Medicaid program asked …

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Can stealing in childhood be normal, and when should parents worry?

Parents are often worried when they catch their children stealing, or worse, shoplifting.

When it occurs in toddlers, it’s often phrased as “a child who doesn’t want to share.” But, if the behavior continues, when should parents start to worry?

That’s the subject of a recent article by pediatrician Perri Klass. She talks with a variety of child experts, who all say that most children under the age of …

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Op-ed: Wikipedia isn’t really the patient’s friend

The following op-ed was published on July 15th, 2009 in the USA Today.

“I researched my condition on Wikipedia.” That’s what more doctors, myself included, are hearing from patients every day.

Wikipedia is the Web’s most popular online encyclopedia. Its more than 13 million articles cover almost every topic imaginable. It is among the most visited sites primarily because its articles routinely show up near the top of search engine results, like …

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Doctors take risks by treating celebrity patients

Treating a celebrity may not be all that it’s cracked up to be.

In the wake of Michael Jackson’s death, a recent piece from American Medical News summarizes some of the dangers physicians face by taking on celebrities.

The piece cites a study which concluded that “celebrities were an average 17% more narcissistic than the general public,” and perhaps because of this, some “are extremely manipulative, and there is a lot of …

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Should movies receive an R-rating for having smoking scenes?

Extreme?  Perhaps not.

Over at Better Health, Jonathan Foulds at first dismisses the somewhat radical suggestion that all movies that include smoking scenes should be slapped with an R-rating.

But after thinking about it, he realizes it’s not as extreme as it appears.

He cites the work of anti-smoking crusader Stan Glantz, who reasons that, “movies made to be viewed by kids do not need to include smoking, and therefore should be given …

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Do canes and walkers prevent falls in the elderly?

Not always.

Although when used correctly they can help maintain mobility, MedPage Today reports a study showing that they are associated with an increase in falls when used improperly.

According to the study, it’s “estimated that 47,312 fall injuries associated with walking aids are treated each year among older Americans.”

And worse, falls associated with canes and walkers resulted in more severe injuries, with a third of these cases requiring hospitalization. …

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When fat doctors talk to obese patients

How can doctors counsel obese patients why they themselves struggle with their own weight?

That’s the question pediatrician Perri Klass discusses in a recent New York Times column. On one hand, doctors who are obese may better connect with patients when they “understand their frailties.”

But on the other, patients also ignore advice from physicians who can’t follow it themselves. Indeed, that’s what pediatrician Julie C. Lumeng, an expert …

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