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How Physicians are Coping with Self-Diagnosis in the Information Age

Bryan Vartabedian, M.D., a pediatric gastroenterologist practicing in the Woodlands, Texas, has a bone to pick with eosinophils. A type of white blood cell that can be elevated in patients with inflammatory bowel conditions like milk allergies or Crohn’s, Vartabedian has found himself repeatedly explaining to anxious parents who have Googled test results that their […]

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How Technology Helps, and Hurts, Healthcare

Robert was the picture of health. He had run eight marathons and finished countless 5K and 10K races. He tracked everything from sleep to food intake, logging his exercise parameters religiously. A seven minute mile was a routine workout for Robert. But over the course of a few days, he noticed that he felt more winded during his run. One morning, when he awoke and checked his heart rate variability (HRV), it revealed a unusual drop. His VO2 max had also fallen considerably. So Robert sent an email to his physician, sharing his data and concerns. His doctor was also a runner, and loved when his patients armed him with data that enabled him to treat them. Read more...

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Why Are Appointments Booked Online Canceled Less?

Back in medical school, I always heard how hard it was for patients to get in to see a doctor in dermatology, my chosen field. It was a refrain I often found a little difficult to believe, considering how many newly minted dermatologists graduate each year, not to mention how this specialty usually can see more patients in a day than a family physician. Living in Houston, I had only to look on Zocdoc to see appointment availabilities to fit almost every sub-speciality, time requirement, and insurance plan. Yet talking to patients, the problem seemed very real, and especially so when I left Houston to work in a rural setting. But what I also began to notice, having now joined the workforce, was how many appointments were cancelled – and how many last-minute openings even my busiest colleagues seemed to have. Could it be that the lack of doctor availability isn’t just due to a physician shortage, but to the way patients schedule and attend their appointments? Read more...

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Mindfulness at Work: Bringing Joy to the Practice of Medicine

Recent news stories have catapulted the value of providing “mindfulness” and the health community is paying attention. Clinically introduced by Dr. John Kabat-Zinn in 1979, Mindfulness Based Stress Reduction (MBSR) brings together mindfulness meditation, body scanning and simple yoga postures over an eight-week training program. Participants are taught that they can decrease their response to stress through “moment-to-moment, non-judgmental awareness.” Compelling research studies published in 2015 show MBSR is effective for veterans with PTSD, relief of depression and anxiety among patients with cancer, a better quality of life for individuals living with inflammatory bowel disease, treatment of insomnia, alleviation of depression in the elderly living in nursing homes, and decreasing chronic low back pain. Read more...

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Why Medicine Needs Its Stories

I was at a dinner meeting for our hospital last week, and before everyone went in to sit at their tables and hear the evening’s speeches, there was some time for the usual networking over wine in the reception room. I got chatting with an established local primary care physician. A respected member of the…

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Patient Honesty in the Exam Room: Doctors React to New Survey

To any physician, the fact that patients aren’t always entirely honest about their health concerns will come as no surprise. Health issues are tremendously personal, and we all know how challenging they can be to discuss. Yet the more detailed and accurate the doctor-patient relationship becomes, the better equipped both parties are for success. Read more...

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Changing Patient Feedback Forms Could Transform Healthcare

We’ve all seen them: those once paper but increasingly digital forms that enthusiastically request our feedback.Tell us how we’re doing, they cheerfully announce, or Help us improve! Some of us even send them out as part of our practices or health systems or educational programs. We also fill them out, both as regular citizens and as clinicians. Or we mean to. I certainly try to, with some exceptions. Recently, I deleted a survey from a hotel I stayed at for one night in a country I am unlikely to return to in this lifetime. I just didn’t care enough to bother. Read more...

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Doctors, Patients, and Email: Taking the Office Visit Online

The subject heading of a recent email correspondence read “beware, graphic picture ahead!!!” Obviously this piqued my curiosity, so, with one eye closed, I scrolled down on my iPhone to a picture of my patient’s tongue, which, truth be told, had a certain “you haven’t seen anything yet quality.” The tongue in question? Maybe some white spots, certainly nothing gruesome, and most assuredly nothing I hadn’t seen before in my 12+ years in clinical practice. My advice to the patient, after confirming through a few back and forth emails that this was not an immediate threat to her, was that she see her dentist and/or primary care doctor for evaluation. If she wasn’t able to book either of them, then, yes, I would be happy to take a look myself. What was remarkable about this exchange was not that a patient was asking for guidance, or for that matter, a diagnosis, about a symptom that drew her concern. Rather, it was that this correspondence did not involve an actual doctor-patient conversation, in the traditional sense of the word. Currently, a little under one third of physicians say they communicate with patients by email, according to Manhattan Research. That said, the practice is far from routine. On the patient side, data from the National Health Interview Survey found that just over five percent of Americans say they email with their doctor. Read more...