I’m the only person in my immediate family who works in the medical profession. And when I visited with my extended family last weekend, I was reminded of how much they dislike even thinking about medicine. My older relatives have reached their 70s with relatively few health problems and only see doctors when absolutely necessary. To them, doctors take up valuable time, poke and prod them in uncomfortable ways, and (worst of all) have the potential to deliver bad news. My relatives don’t understand why I would want to do those sorts of things all day long. Read More
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Most Patients Don’t Want to See Me
By Dena Rifkin, MD
August 15, 2008
When Doctors Don’t Have All the Answers
By Dena Rifkin, MD
August 12, 2008
I recently ran into a colleague who was returning from an internal medicine review course. These expensive and elaborate affairs consist of a week or so of lectures, tips, and new techniques, usually taught by well-known academics. Many doctors take these courses before taking the medical board exam in their specialty, and some doctors repeat the course every few years, to keep up with new developments or prepare for recertification exams. To be “board-certified” in a specialty, doctors must take exams every 10 years, so I’ll be attending a course next week to review kidney diseases.
A key part of the course is problem-solving. Just like when the audience votes in “Who Wants to Be a Millionaire,” the 400 doctors in the room press buttons to answer multiple-choice questions. The number of people who give each answer is displayed on a big screen. Read More
Sickness on the Street: How I Almost Walked Past My Own Patient
By Dena Rifkin, MD
August 1, 2008
On my way home from work a few days ago, I saw someone staggering toward me as I headed to the subway station. It was a typical city scene—lots of pedestrians steering clear of someone who was probably drunk, potentially homeless, and possibly dangerous. No one was offering to help him as he stopped and crouched in a doorway. And I did what any urban-dwelling young woman with a sense of self-preservation would do: I started to walk quickly past him.
Then I did a double take. He was one of my patients. Read More
We Need a Better System to Avoid Medical Mistakes
By Dena Rifkin, MD
July 25, 2008
I saw a patient in the hospital awhile ago with a disease you probably haven’t heard of—iatrogenesis imperfecta. ‘Iatrogenesis,’ in plain English, means that the illness was caused by medical intervention. Sometimes such complications of care are inevitable or idiosyncratic, like unexpected allergic reactions to medications. Sometimes they are preventable, or caused by human error. That is the ‘imperfecta’ part—no one is perfect, and we can make some very high-stake errors when we try to make people better.
In my patient’s case, he received a medication that was contraindicated given the multiple diseases he had. The situation was very complex—as it almost always is in the hospital these days—and no one anticipated the problems that might occur. The end result was a patient with organ failure who became one of the many people for whom modern medical care is fraught with error and complication. Read More
A Doctor on Vacation: Diagnosing Disease Wherever She Goes
By Dena Rifkin, MD
July 18, 2008
As I prepared for a vacation recently, I realized that it’s getting harder and harder to really “check out” of any kind of job these days. The ubiquitousness of BlackBerries, Wi-Fi, cell phones, and other devices designed to keep us forever in touch with each other make it impossible to really escape. As a doctor, I face an added difficulty in taking a break from my work—the inescapable urge to diagnose disease in random passersby. Read More
Do Difficult Patients Get Bad Medical Care?
By Dena Rifkin, MD
June 27, 2008
A question that has received a lot of attention in the doctor community is whether patient attitude affects the quality of care they receive. In an effort to tackle it, let’s take a look at two of my past patients.
Case Study #1: No matter how late I was to see him, or how bad the news was when I did see him, Mr. X was unflaggingly polite. He had a quiet, gentle voice, and his “Yes, doctor” and “Thank you, doctor” responses were kind and reassuring. He is the only patient who ever thanked me for offering him dialysis. He chose home dialysis, learning the mechanics of the system quickly and managing the multiple medications we prescribed without any problems. Read More
What We Can Learn From the Death of Tim Russert
By Dena Rifkin, MD
June 20, 2008
Like most people, I read about the sudden death of Tim Russert with sadness. Out-of-hospital sudden cardiac death is, unfortunately, still a common event among people with undiagnosed or diagnosed heart disease. In fact, it is very common indeed: 310,000 people a year die this way in the U.S. What’s more, it’s a tough problem to study or treat. How do you treat something that happens out of the blue, far from a hospital, away from medical care? And what’s the point of even worrying about something that is seemingly random and unstoppable? Read More
Saying Good-Bye to Patients
By Dena Rifkin, MD
June 12, 2008
Next month I’ll be finishing the final year of my fellowship in kidney disease and transitioning into my new role as attending physician, with mainly in-hospital rather than outpatient responsibilities. So I’m saying good-bye to some patients I’ve been seeing in clinic for the past two years.
These patients won’t be left scrambling to find a new doctor. The attending physician who followed them for years before I showed up, and who supervised me, will see them from here on, albeit with another fellow. This pattern repeats itself every two or three years in our clinic. Read More
What a Teaching Hospital Is All About
By Dena Rifkin, MD
June 6, 2008
My last post about how doctors learn from patients inspired a lively (sometimes heated) discussion, and I read the response to it with great interest. I think some good points were made. Notably, one reader took issue with my statement that a patient who helped me learn by letting me practice drawing blood from him “understood what a teaching hospital is all about.”
How Doctors Learn From Patients
By Dena Rifkin, MD
May 22, 2008
I need to learn a new technique for inserting a large intravenous line. As a resident I learned how to place these lines (used for medications and dialysis) in the groin or neck by locating the arterial pulse with my fingers, looking at the anatomical landmarks nearby, and then calculating in my mind where the vein ought to be. After a while I could reliably get a needle into the vein by “feel.”
Since then, a bedside ultrasound device has become part of the procedure, allowing you to actually “see” the vein you are aiming for—a pretty amazing difference from the way I learned. I’m told it’s awkward the first few times you try it, since you have to juggle the ultrasound and the needle while keeping everything sterile. So I asked my colleagues to teach me.
Previous Doctor's POV Stories
Go Ahead, Email Your Doctor…As Long As It’s Not Serious
05/02/2008 - Doctor's POVA Doctor Wants a Better Way to Break Bad News
04/25/2008 - Doctor's POVHow Can I Tell My Patient His Drugs Cost $800?
04/18/2008 - Doctor's POVIn Medicine, Simple Questions Often Have Complex Answers
04/10/2008 - Doctor's POVWhen You Really Need Your Doctor…and She’s in Fiji
04/04/2008 - Doctor's POVThe Hidden Costs of Your Doctor Visit
03/28/2008 - Doctor's POVWeighing Pros and Cons for My Patients
03/07/2008 - Doctor's POV
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