My story isn't Serena Williams' story, but some things sound the same

Tom Benzoni benzonit at GMAIL.COM
Tue Aug 21 14:32:41 UTC 2018


The EBR (I don't call it *Health *as it is not; it's *Billing*; CMS, not
FDA certifying agency) has occasioned such a fragmentation of care.
One of it's "advantages" is to "permit" visits with different practitioners.
Which is the definition of fragmentation.

I have no idea if this is true of the case under consideration, but I'll
bet there was not a plan:
Measure it today, return *to me* in 1 month, re-measure. Change = biopsy.
(Why we can't take the patient's word for a change in size is beyond me,
esp with cell phones and rulers which can be placed on the skin!)

tom

On Tue, Aug 21, 2018 at 9:27 AM Elias Peter <pheski69 at gmail.com> wrote:

> When I evolved a system of doing office notes collaboratively with the
> patient, on unplanned but valuable side effect was that it became natural
> to record (with the patient helping with the phrasing) both my impression
> and plan and the patient’s impression and requested plan when the two
> differed. Openly documenting in a non-judgemental way what the patient was
> worried about, questioned or requested clearly legitimized the patient’s
> perspective for both of us. Regardless of what we subsequently decided to
> do, it was a big step in the direction of listening.
>
> It is not the EHR that makes this aspect of care hard. It is the
> industrialization of medicine with its attendant time and productivity
> pressures.
>
> If Dr Cejas had been working early on with a clinician whose approach was
> to have her add her concerns and requests to the note, I think the outcome
> might have been different.
>
> Peter Elias, MD
>
>
> On 2018.08.20, at 6:13 PM, HM Epstein <hmepstein at GMAIL.COM> wrote:
>
> Excellent personal article from a doctor-turned-patient about implicit
> bias in medical decision-making. What can WE at SIDM suggest to doctors to
> change this common error?
>
> https://www.kevinmd.com/blog/2018/08/my-story-isnt-serena-williams-story-but-some-things-sound-the-same.html
>
> Best,
> Helene
>
> My story isn’t Serena Williams’ story, but some things sound the same
> Diana Cejas, MD <https://www.kevinmd.com/blog/post-author/diana-cejas>
> Conditions <https://www.kevinmd.com/blog/category/conditions> August 16,
> 2018
>
> I’m not much of a tennis fan, but I am a fan of Serena Williams. Who
> wouldn’t be after hearing her story? Her rise to the upper echelon of
> athletics was remarkable, and her longevity is incomparable. All the while,
> she has challenged the sporting world’s notions about who and what an elite
> tennis player is supposed to be. I watched her interviews after this year’s
> Wimbledon finals and was once again in awe.
>
> Less than a year prior to this championship, Ms. Williams delivered a baby
> girl and then suffered from a pulmonary embolism and other complications.
> What stuck with me most about her delivery story was the fact that her
> doctors didn’t seem to take her at her word. Ms. Williams has a history of
> a previous pulmonary embolism and knew the signs, symptoms, and management.
> When she became short of breath, she voiced her concerns about the
> possibility of a pulmonary embolism and asked to be worked up for it.
> However, members of her health care team thought that she was confused and
> tried to calm her down. They didn’t seem to believe her. They acquiesced
> after she kept insisting. What would have happened if she hadn’t kept
> insisting? Why didn’t they believe her the first time she said that
> something was wrong?
>
> I need my doctors to believe me. I am quite sensitive about that, and that
> is because I know what it feels like when they don’t. I found a mass on the
> right side of my neck during my first year of medical school. I remember
> pointing it out to my friends after anatomy lab and all of us agreeing that
> I should have it checked out. I dutifully went to student health where I
> was told that the mass was a lymph node and that I shouldn’t worry about it.
>
> Even then, I knew that didn’t seem right. I went back to student health
> and other doctors again and again as the mass slowly grew. Each time I was
> told it was some kind of lymphadenopathy or a random infection and
> something not worth troubling myself about. I asked for imaging and was
> denied over and over again. By the time I was a second-year resident, the
> walnut-sized mass was hard and fixed in place with three rubbery lymph
> nodes on top of it. I knew. I went to another doctor, and when she started
> to tell me not to worry about it, I had what amounted to a hissy fit. I
> knew myself and my body. I knew something wasn’t right and I wanted imaging.
>
> She ordered a CT to appease me, and I had it done that same day. Within
> two hours, I had my diagnosis: carotid body paraganglioma. It was resected,
> and those three lymph nodes were sent to pathology. That’s when it was
> confirmed to be malignant.
>
> Cancer and the stroke that followed it changed my whole life. It upended
> everything I thought I knew about the doctor-patient relationship. I
> realize that I had a relatively rare cancer and that my outcomes were
> unexpected. I could understand my physicians’ reassurance after our first
> meetings. I was young and otherwise healthy. Nothing was supposed to go
> wrong. What I couldn’t understand is that I kept coming back with the same
> complaint, a growing concern, and a growing mass, and despite that, my
> concerns were continually dismissed. I was a medical student and then a
> doctor myself and still felt like no one took me seriously. I started to
> wonder why.
>
> A growing number of studies are examining the way that physicians respond
> to their patient’s complaints. Too often, it seems that physicians downplay
> their patients’ pain, psychiatric symptoms, trauma and other concerning
> issues. Implicit biases and other psychosocial factors certainly influence
> our interactions with patients. Women, people with disabilities, minorities
> and other members of marginalized communities are particularly vulnerable
> to bias within the medical community.
>
> Unfortunately, these biases lead to poor patient outcomes. We, physicians,
> know that these disparities exist but we seem to be a bit unwilling to
> question ourselves about them. How often have we heard patients complain
> that doctors don’t listen to them? That we don’t take our patients
> seriously? How often are these patients labeled as “difficult,”
> “noncompliant” or “crazy?” How often are those patients women? Black?
> Latino? Gay? How often do those patients look different from us?
>
> My story isn’t Serena Williams’ story, but some things sound the same.
>
> We’re both young black women in positions of privilege who faced a
> catastrophic illness. Despite our respective privileges, we both had to
> fight to get the health care that we needed. Things could have been worse
> for us both, but they could have been a lot better too. I wonder if things
> would have been different if my first doctor had ordered a CT scan. I
> wonder if the tumor would have had the time to spread. I wonder if I would
> have had a stroke. Regardless of how things turned out, I’m glad for the
> lessons that I’ve learned. I know now that listening to my patients and
> making them feel heard is one of the most important things that I can do
> for them.
>
> Sometimes a patient’s complaints seem outlandish and their symptoms
> impossible. But sometimes they’re right. Sometimes just listening to a
> patient can save their life.
>
> *Diana Cejas is a pediatric neurologist.*
>
> *Image credit: Shutterstock.com
> <http://www.shutterstock.com/?cr=00&pl=edit-00>*
>
> <https://www.kevinmd.com/blog/2018/08/how-i-met-your-mentor-tips-to-finding-sponsorship-and-mentorship.html>
>
> <https://www.kevinmd.com/blog/2018/08/physicians-must-reclaim-the-medical-record.html>
>
>
>
> Website <http://hmepstein.com/> Twitter <https://twitter.com/hmepstein>
> LinkedIn <https://www.linkedin.com/in/helenekepstein/>
>> Facebook <https://www.facebook.com/HeleneEpsteinAuthor>
>
> ------------------------------
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
>
> ------------------------------
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


HTML Version:
URL: <../attachments/20180821/653f70a2/attachment.html>


More information about the Test mailing list