Grand Rounds At The Prepared Patient Forum

Grand Rounds, a collection of the best blog posts surrounding medicine from the last week is at The Prepared Patient Forum. Check it out!

Some day soon I’ll have an entry to Grand Rounds and maybe I’ll host it in the future as well. If you’re a blogger with any focus on medicine, consider submitting a post to Grand Rounds.

Dr Atul Gawande- Physician, Writer, Role Model

Last year I attended a lecture by Dr Atul Gawande, a physician with several best selling books (Complications, Better and most recently The Checklist Manifesto) who came into prominence due to an article he wrote in June 2009 for the New Yorker called The Cost Conundrum. It is well worth your time to read it.

The article became popular after President Obama read it and brought it into a meeting with several senators regarding health care reform. Since then Dr Gawande has increasingly been seen as an innovative voice in regards to improving health care quality while controlling costs.

Based on the speech I heard, that distinction is well deserved. He is an impressive speaker. He explains complex issues clearly and is a talented story teller. Most of all, he is inspiring. He sincerely believes that we can improve health care and he’s so passionate about it that you can’t help but want to come along for the ride.

One of his main points was that when examining outcomes and making comparisons in medicine the most useful comparison is not looking at good vs. bad, but rather good vs. great. Most physicians and hospitals in the USA fall somewhere along the good spectrum. Dr Gawande argued that the best way to to improve care is to observe who is standing out and doing the best, then examine why that is the case and how that can be emulated in other places.

At the end of the lecture they allowed a question and answer period. The questions were written on note cards by audience members during the lecture. My question was picked! I asked,

‘What can medical students be doing while in school to make sure that they become great?”

His answer was brief and basically touched on two points.

1. Medicine is become more and more collaborative, so the better you work in a team environment the better a physician you will be. Practice working with other people.

2. Take the initiative to learn things on your own.

Medical school starts next month. I’ll do my best to become a great physician, with Dr Gawande as a role model. Maybe someday I’ll write some bestsellers too!

Have you read any of Dr Gawande’s books? What did you think?

Words I Want to Avoid as a Physician: Asymptomatic

I’m starting a new series of posts called “Words I Want to Avoid as a Physician.” 3593239363_a69f948bfe_o

A huge chunk of my day as an ER Scribe is spent observing patient-doctor interactions. Too often I’ve seen physicians use a medical word or phrase that 90% of the time the general population would not know. Unfortunately, some doctors completely miss the fact that their patients are utterly confused.  They feel they have adequately described what was necessary and leave the patient’s room even as the patient’s face clearly is asking, “WTF did he/she just say?”

In especially obvious cases I’m tempted to stay and offer a short explanation, but I’m basically tethered to the physician I’m working with so I risk being left behind and missing something important. Thus, I leave too.

This example of poor communication furthers the disconnect between patients and physicians. Patients nearly always are initially at a position lower than their physician, as they are coming in saying, “I don’t know what is going on, you’re the expert, please figure it out.”

Clearly there are times when certain terminology may communicate most accurately what a physician is trying to explain. But is it the most effective way to communicate? If you describe something accurately but the other party has no idea what you’re talking about, what is accomplished?

With this in mind, I’m keeping track of words and phrases that most often appear to trip up patients and their families. This is mostly for my benefit, so I can go back and read this list when I’m actually practicing medicine and see if I’m actually meeting my own ideals. My goal is to be able to use simple, clear language without coming across as patronizing. Some doctors I work with are great at it, and it’s their example I hope to follow.

My first word/phrase? Asymptomatic. It means without symptoms. Example that I hear often that throws people off: “How long have you been asymptomatic?”

This question is usually answered with a blank stare.

Alternative question: How long have you not had (such and such symptom, cough, fever etc)?

I hope you enjoy the series! I’m cooking up a post about a crazy story in the ER from the other day, stay tuned…

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