Primary Care

Depersonalization of the patient and the loss of compassion

Physician
January 25, 2011

A common complaint about modern medicine is the depersonalization of the patient and the loss of compassion.

So let’s take a look at compassion.

Compassion is derived from the Latin “cum” (together with) and “patior” (suffer). From the perspective of clinicians, compassion is defined by two concurrent emotions: (1) a feeling of deep sympathy and sorrow for another who is stricken by medical misfortune accompanied by (2) a strong desire to relieve that …

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Your blood test and the need for better designed results

Conditions
January 18, 2011

Either as a patient or as a physician there’s a very high chance that you’ve ever got your hands on a simple blood test.

These range from very basic ones to complex ones with multiple pages and are substantial to any cinlical evaluation. Blood tests are probably one of the most performed tests in a clinical environment with direct patient contact. Also, if you’ve ever seen a typical blood test from …

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Alternative medicine and osteopathic medical education

Education
January 14, 2011

by Tayson DeLengocky, DO

There has been a growing public interest in complementary and alternative medicine (CAM) in recent years. Osteopathic manipulative therapy, a form of physical manipulation of the body for improvement of health and body function, has been designated as complementary and alternative medicine (CAM) by the National Institutes of Health (NIH).

According to data reported in 2007 by the National Institutes of Health’s National Center for Complementary and Alternative …

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Your attention deficit disorder may be an anxiety disorder

Conditions
December 29, 2010

Are you one of those people who simply cannot concentrate for long enough? Do you find that no sooner than you start doing something, that your attention is scattered all over the place? Do you find that you log onto your computer and within minutes are surfing every possible tangential site that you find?

Your problem may not be a problem with your attention. In fact, it may be that the …

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Reduce phone calls in your medical practice

Physician
December 28, 2010

A physician approached me at the end of a talk on optimizing practice efficiency and improving service to patients and said, “I dream of an office with no phones.”

Do you have days where the phones are ringing off the hook? Or the phone message forms in your in-box seem to be reproducing? Maybe it’s been one of those days when you can never get your nurse’s help because she’s been …

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Patient complaints do not fit the primary care office visit

KevinMD
December 28, 2010

Primary care physicians often have to see patients with a litany of issues.  Often within a span of a 15-minute office visit.

This places the doctor in the middle of a tension — spend more time with the patient to address all of the concerns, but risk the wrath of patients scheduled afterwards, who are then forced to wait.

And, in some cases, it’s simply impossible to adequately address every patient question …

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A physician story of addiction and recovery

Physician
December 16, 2010

by an anonymous physician

I am a physician now in recovery.

I don’t like that term. The correct thing to say is, I am sober.  I am going on a year sober without any problems. Recovery suggests some disease state and I don’t think it is that simple.  It also suggests an ongoing daily struggle or effort to remain sober, and I don’t find that the case, either.  I know this …

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William Osler’s humor, and finding fun in medicine

Physician
December 7, 2010

In 1905 William Osler gave his farewell address as he prepared to leave Johns Hopkins for Oxford and England. After speaking to the assembled medical students about the tragic side of medicine he said:

The comedy, too, of life will be spread before you, and nobody laughs more often than the doctor at the pranks Puck plays upon the Titanias and the Bottoms among his patients. The humorous side is really …

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Lifestyle matters for specialties that want to survive

KevinMD
December 2, 2010

Medical students today consider lifestyle an essential criteria when choosing a specialty.

It’s become a cliche that most are looking towards the ROAD (radiology, ophthalmology, anesthesiology and dermatology) to happiness.

There’s been some recent media attention at how women are lured to specialties that offer a greater balance between their family lifestyle and professional demands.

Claudia Golden, a Harvard economics professor, recently noted that,

high-paying careers that offer more help in balancing work …

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Taking a multivitamin, vitamin D and fish oil every day

Conditions
November 17, 2010

There is very little doubt that if we eat the diet we were designed to eat and spend adequate time in the sun that we will get most if not all the nutrients we need.

That’s the ideal, but not the reality for a lot of us.  I was recently advised by a group of physicians who are experts in the area that it is reasonable, and probably preferable, for adults …

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Why patients are leaving our practices

Physician
November 9, 2010

She was like … Superwoman. A strapping medical visionary probably in her forties. Gray long coat falling below the knees. She strode confidently down the hallway towards the elevator, a father hurrying beside her with his young lanky daughter cradled in his arms. The girl’s head nuzzled into her father’s shoulder. She was old enough to walk by herself…but clearly she was sick. Unable.

Undoubtedly they were headed from the medical …

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Why total body scans are a scam

Conditions
November 7, 2010

Folks across the country are paying hard cash for total body scans, abdominal aortic aneurysm testing, CAT coronary artery scans and carotid artery evaluations to prevent disease or find important lesions early. It’s a seductive argument, and it’s a scam.

Ordinary patients don’t understand about pre-test probability and positive and negative predictive values. Indeed, all physicians were taught to consider Bayesian theory when ordering diagnostic tests. This is very tough concept for …

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A physician seeing the husband and wife together

Physician
October 27, 2010

As a medical provider, while seeing a husband and wife, or a couple, regardless of gender, one comes across several situations that  may be considered difficult to handle and that require a good deal of tact and confidentiality.

This is the case with seeing a husband and wife or (couple), together, for an examination. Ultimately, it depends on the rapport that the couple shares. If they …

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When parents should be concerned about a lump on their child

Conditions
October 8, 2010

I was recently scanning an online forum about pediatric health concerns. (What can I say? I sometimes need inspiration.) One thread within the forum was significantly longer than any other. Parent after parent posted about how they had noticed a knot on their infant or toddler. This concern parallels what I see in practice. An unexplained knot on the head is a common reason parents bring their child to be …

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Why doctors have poor customer service

Physician
October 7, 2010

One of my docs was telling us about a patient’s experience at another practice. Apparently, the parent was at her wits end with her crying baby. She called the  on call doctor to ask for advice and the doctor told the patient, “your baby has colic’s; turn on the vacuum and stop calling.”

It turned out the baby had some gastric condition (not colic) and needed treatment. The patient ended up …

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Doctors should work weekends, and how reformers alienate physicians

Policy
October 5, 2010

Peter Orszag wants doctors to work weekends.

The former director of the White House Office of Management and Budget wrote as much in this past weekend’s New York Times:

Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or …

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How much staff should a doctor have?

Physician
October 1, 2010

“How many staffers should we have per doctor?” That’s a question I’m asked at almost every seminar I present. Of course, like many good consultants, I almost invariably respond “it depends.”

One of the factors that needs to be considered is what jobs we’re talking about — clinical or front office. It’s staffing in the clinical area that will do most to enhance a physician’s productivity, so that’s what we’ll focus …

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Why good doctors give useless answers

Physician
September 27, 2010

Before he tells you how to get a straight answers from physicians, Doctor D is going to stall for time by explaining why doctors give vague answers.

Why would a good doctor give useless answers?

1. There is an answer, but your doctor doesn’t know it. Don’t be hard on doc for this one. There is no MD in the world that knows the entire breadth of medical knowledge. Some docs pretend …

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What’s the difference between family practice and med-peds?

Physician
September 26, 2010

I like Dr. Rob, the one with the distractible mind. And although I thoroughly agree with the stance he takes in his recent post against cholesterol screening in kids, I must take issue with his opening statement:

I have a unique vantage point when it comes to the issue universal cholesterol screening in children, when compared to most pediatricians.  My unique view stems from the fact that …

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