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My most recent posts stress the importance of understanding ‘the big picture’. For patients with a chronic, progressive disease, a critical component of this ‘big picture’  is an understanding of the natural history of that condition. but unknowingly, providers don’t always explicitly share that information.   One of the first patients I met during my palliativeRead more

The ‘systems’ approach is another strategy used to help organize treatment plans for patients with multiple ongoing medical issues.   The patient is divided into individual systems: cardiac, pulmonary, renal, etc…, and the ongoing treatments outlined. Like the ‘problem list’, the ‘systems’ approach is great for charting purposes; also like the ‘problem list’, it’s a poorRead more

The ‘problem list’ was initially proposed in the 1960’s as a means to organize patient medical information.  Since that time, it has become an integral part of provider notes because it succinctly outlines the patient’s health issues and treatment plans.  So all providers reading the record can quickly understand what the main issues are for thatRead more

definition “Failure or refusal to comply. In medicine, the term noncompliance is commonly used in regard to a patient who does not take a prescribed medication or follow a prescribed course of treatment. A person who demonstrates noncompliance is said to be noncompliant.” While the above definition sounds bland enough, in reality this label carriesRead more

a patient Mr C, 68 yrs old, is the patriarch of a very large extended family.  He was admitted to the hospital due to severe right sided chest pain and weakness.  No matter the time, day or night, family members were at his bedside. His initial work-up revealed a large right pleural effusion and aRead more

an example of how words matter. Typically, the conversation regarding ‘code status’ starts with the provider saying something along the lines of, “if your heart stops or you stop breathing, do you want us to resuscitate you?”. I didn’t understand that this question is so wrong on so many levels until my palliative medicine fellowship-Read more

She died dec 24, 2017 at the age of 89 It may sound a bit odd, but I’ve always been a reader of the newspaper obituary section.  It’s quite educational and the same time humbling to read about the lives of people from not only my local community, but the world at large.  I firstRead more

Because this is so important, it’s getting repeated… Start the conversation with something along the lines of “what is your understanding of your current condition?” so you know what your patient/family understands.  And this doesn’t just apply to the first interaction as illustrated by the following example. a Patient- one critically ill in the intensiveRead more

As my end of year post, here is the link to my story “She likes chocolate…” that was published in Pulse–voices from the heart of medicine, an online publication dedicated “to telling the personal story of health care…”   Happy Holidays to all,                        and here’sRead more

cardinal rule: let your patients talk first Even in my plastic surgery days, I would typically start my new patient encounter by inquiring as to why they were seeing me.  Typically they would clearly tell me what was going on with them, but sometimes I got quizzical looks, and sometimes their response was simply:  “myRead more