The blossoming truth of “No Apparent Distress†is that a segment of American society has been casually cast aside, left to scavenge on the meager scraps of volunteer health services, and failing that, left to die. Some politicians might call this “choice.†A more medically accurate term would be abandonment. More
The doctor-patient relationship is a one-on-one interaction, and so conflicts of interest are concrete and directly personal. Medical decisions can be swayed by money, even unconsciously, regardless of whether it’s from insurance companies or from industry. But the most basic conflict of interest is that health care access is tied to health insurance. Presence or absence or extent of health insurance is the most powerful influence on how doctors care for patients. More
Advocating for patients is as much a part of medical care as the medical care itself. Should that advocacy, however, extend beyond the doctor’s office, when politics has palpable effects on patients’ health? Most doctors see an intrinsic distinction between calling an insurance company and calling a senator. But in terms of our patients’ health, there is a moral argument that they are equivalent More
On the campaign trail, Donald Trump promised better health care at a lower cost that would include everyone. Although he almost certainly did not realize it, he was promoting an idea of universal health care that could only be achieved by a single-payer plan. More
“For all the sophisticated diagnostic tools of modern medicine, the conversation between doctor and patient remains the primary diagnostic tool.†This idea lies at the heart of Danielle Ofri’s new book What Patients Say, What Doctors Hear, in which she acknowledges, dissects, experiments with, and analyses the complexities and miscues of the patient–doctor exchange. More
He made his way into my exam room supported by two metal crutches that braced at the elbow, lurching his withered legs forward, step by excruciating step. He was a wisp of a man, barely clocking in at 100 lbs—wasted away, it looked like, from untreated polio and a lifetime of subsistence living. Yet somehow here he was in bustling Manhattan, having managed to navigate our bureaucratic hospital system just a few months after arriving from East Africa. More
Gun violence has been characterized as an epidemic. But can a disease model of contagion help predict future victims and potentially protect them? Is gun violence really like chicken pox? More
When patients get “lost to follow-upâ€â€”for whatever reason—their health status plummets. Often times the damage wrought by gaps in care and inconsistent access is permanent. When was the last time that a president of the United States deliberately put so many Americans in harm’s way? More
Some will always see the doctor-patient exchange as a fluffy appendage to ‘real medicine’. But if Ofri’s book succeeds in easing the passage from ‘presenting complaint’ into open conversation, informative for and complementary to further technical interventions, that would be very good news for both the doctor and the patient. More
“What Patients Say, What Doctors Hear†is not so much a how-to guide, but a convincing argument for why good communication is at the heart of good medical care. More
Doctor-patient communication is a two-way highway of information, with each person endeavoring to convey information to the other. But there can be numerous roadblocks and detours, as anyone who has been party to our medical system can attest. More
“We have two ears and one mouth so we can listen twice as much as we speak,†said Epictetus. It’s clear that the Greek philosopher wasn’t a physician in 21st century America. How long, I’ve sometimes wondered, would my patients actually talk if I didn’t say anything at all? More
Modifying our external behavior and how we communicate is clearly important, but I believe we in the medical profession have a duty to work to change our inner landscapes as well. It’s a tall order, I realize, but if we wish to claim the high mantle of professionalism, we need to at least be actively attempting to challenge our gut feelings. More
Ofri argues in her new book “What Patients Say, What Doctors Hear” that the conversations doctors have with their patients are the most important part of a medical visit, far surpassing blood tests, X-rays or various scans. And she believes it’s time both doctors and patients give these conversations their due. More
“If you’ve switched physicians in search of someone more caring, or left an exam feeling unseen and unheard, you will find much to appreciate in Danielle Ofri’s perceptive book. ” More