Submitted by PeterElias on Sun, 03/08/2015 - 06:00
A professional colleague and I were discussing (bemoaning) how hard it is to do quality primary care. She asked why I bothered to keep pushing for change in the face of so much institutional resistance and evidence that it was pointless. I told her, what we put up with is what we end up with.
In return, I asked her why she didn't push back and demand change if she is so unhappy about the way things are?
Her response: "Well, I watch you, and I can see that it is pointless."
Submitted by PeterElias on Sat, 03/15/2014 - 06:00
In medicine, unlike much of the world, it is the questions one doesn’t ask that lead to trouble. When taking a medical history, the biggest enemies are time and fear. Time, because there is never enough to ask all the questions, listen carefully to all the answers, and pursue all the possible clues. Fear, because the natural reluctance to ask certain questions is a trap.
Submitted by PeterElias on Sat, 03/08/2014 - 06:00
I was taught that being an asymptomatic carrier of strep in the throat was not associated with either illness or risk of complications. That’s not always true. The schedule said ‘strep throat x 5 weeks and diarrhea.’ Handing me the encounter form, my nurse warned me: ‘Mom’s not a happy camper.’
Submitted by PeterElias on Tue, 10/29/2013 - 06:00
Throughout our medical training we are told again and again that the most important task is an accurate diagnosis. And we hear it at CME lectures and read it in journals. An accurate diagnosis is certainly essential if one wants to offer successful and safe treatment. But it is not enough to ask and answer: “What is the diagnosis?”
There are several other questions that every experienced clinician asks - and answers - with every visit. Or should ask. We skip these questions at considerable risk to our patients.
Submitted by PeterElias on Sun, 09/01/2013 - 06:00
A recent commentary in the New York Times eloquently addressed the phenomenon of psychiatric diagnoses biasing clinicians and resulting in poor care. One concern that arose in the comments was that this might increase the likelihood that patients would withhold crucial diagnostic and therapeutic information, to their detriment.
Submitted by PeterElias on Thu, 08/08/2013 - 06:00
Trust but verify (Doveryai no Proveryai) is a Russian proverb that underlies an important principle in medicine. We need to trust our patients, our tests and our knowledge - but must also always remember to check and verify.