This post from Kelly Young on Howard Luks' blog asks when patients cross the line with respect to their own advocacy. It's worth a peek. The question of boundaries between doctor and patient is interesting. All of my patients are empowered in some way. The extent and level of that empowerment is personal. On our own there are few lines and little with respect ... Continue Reading about Doctors, Patients and Boundaries
And a Child Will Lead Them
This week I lost one of my patients, Cooper. He was a feisty 4-year-old with mitochondrial depletion syndrome. I began looking after him as an infant when he wouldn’t stop screaming. I saw him through surgeries, diagnostic rabbit trails, and ultimately helped with the painful decision to undergo small bowel transplantation. Inexplicable symptoms and strange ... Continue Reading about And a Child Will Lead Them
How I Structure a Patient Visit
If you visit my clinic, I follow a structured process during the the encounter. It’s fairly traditional but has some hidden twists that I think are worth thinking about. Here’s how I structure a patient visit: Introduction (provider directed). During the first few minutes I try to connect and find some type of common ground with the child and parents. Basic, ... Continue Reading about How I Structure a Patient Visit
A Young Father and His Information
It was sometime in the mid-nineties that parents started showing up in my office with reams of paper. Inkjet printouts of independently unearthed information pulled from AltaVista and Excite. Google didn’t exist. In the earliest days of the web, information was occasionally leveraged by families as a type of newfound control. A young father and his inkjet ... Continue Reading about A Young Father and His Information
Bug Spray and the Doctor-Patient Disconnect
Before every upper endoscopy I spray a local anesthetic in the mouth to minimize a child’s gag. It’s pretty nasty tasting stuff. So I have this little charade I pull before every scope: I apply the spray, look at the bottle, then announce in shock that the nurses have mistakenly given me bug spray. As quickly as I deliver the punch line I make it clear that ... Continue Reading about Bug Spray and the Doctor-Patient Disconnect
Phronesis: Do Patients Have Clinical Judgment?
I used to think they didn’t but they do. Clinical judgment is the application of individual experience to the variables of a patient’s medical presentation. It’s the hard worn skill of knowing what to do and how far to go in a particular situation. It’s having the confidence to do nothing. Clinical judgment is learned from seeing lots of sick people. Good ... Continue Reading about Phronesis: Do Patients Have Clinical Judgment?