The See-Through Doctor: Sitting Naked in the Exam Room

The See-Through Doctor: Sitting Naked in the Exam Room Medscape Journal of Medicine, 2008; 10(8): 186
"There once was a time, only dimly remembered today, when doctors still hesitated to ask a patient to disrobe, struggling instead to drop the mouth of a stethoscope down a slightly unbuttoned shirtfront.
While this may sound like history from the horse-and-buggy era, it was commonplace in this country just 50 years ago.[1] Yet in that relatively short time, patient and physician roles have metaphorically begun to reverse. Today, it is the patients who are demanding that reluctant doctors stand naked in the exam room. “Your test results have just come back from Dr. Google,” they begin accusingly, “and I think we should discuss those patient satisfaction scores.”

Includes video.

Interesting changes in the Doctor-Patient Relationship...

Do Patients Trust Doctors Too Much?

Doctor and Patient: Do patients trust doctors too much?

By PAULINE W. CHEN, M.D., Published: December 18, 2008, NYT
When a doctor friend of recently heard a radio ad for a Web site where patients could rate their doctors, he almost drove off the road. “I can’t believe they’ve added doctors to the list,” he said of the site, Angie’s List, perhaps best known for its user-generated report cards on local contractors. “Why do patients want to assess my relationship with them in the same way they evaluate a roofing job?” he asked, shaking his head over what he interpreted to be more evidence of the disintegrating doctor-patient relationship...

M: Should patients spend more time researching their doctors?

Differing opinions about Telemedicine

Differing opinions about Telemedicine
Updated: Sep 2, 2008 07:23 PM EDT

Includes video...

"...Patients pay $99.95 to access MDWebLive. The fee includes a camera, headset, and the first online doctor's visit. After that, it's $40 up front per consultation. Some insurance companies reimburse for the service.

It is convenient, but it's also controversial.

Dr. Bernd Wollschlaeger, the president of the Dade County Medical Association, said patients must have a traditional face-to-face relationship with their doctors before using telemedicine.

"You see the physician first, establish patient-physician relationship, do a complete physical exam," Wollschlaeger said. "You can utilize the online consultation as an adjunct in your relationship, but not as a substitute for your relationship...."

At least the importance of a doctor-patient relationship is acknowledged!

Doctor and Patient, Now at Odds

Doctor and Patient, Now at Odds.
By TARA PARKER-POPE
Published: July 29, 2008
"A growing chorus of discontent suggests that the once-revered doctor-patient relationship is on the rocks.
The relationship is the cornerstone of the medical system — nobody can be helped if doctors and patients aren’t getting along. But increasingly, research and anecdotal reports suggest that many patients don’t trust doctors.

About one in four patients feel that their physicians sometimes expose them to unnecessary risk, according to data from a Johns Hopkins study published this year in the journal Medicine. And two recent studies show that whether patients trust a doctor strongly influences whether they take their medication."

Is the trust gone? Comments?

How to deal with the digitally empowered patient

How to deal with the digitally empowered patient

From the site:

ORTHOPEDICS TODAY 2008; 28:30
April 2008

In November I wrote an article for the Time magazine Web site about an encounter with a demanding and computer-search savvy patient named Susan that touched off a small firestorm in the blogosphere. At least 20 well-read blog sites ran pieces about it with vigorous reader-response on both sides, either pro-patient or pro-doctor. The New York Times blog site alone has more than 300 write-ins, many emotional. At the end of January, CNN still had an article concerning this on the front page of its Web site.

For this Orthopedics Today Round Table discussion, I have gathered together a panel of orthopedic surgeons to discuss how patient empowerment by the Internet as well as other factors such as new commercialization efforts, regulation and the liability threat in medicine is changing their current practice and what they see as their future.

Scott V. Haig, MD
Moderator

When the Disease Eludes a Diagnosis

By BARRON H. LERNER, M.D.
NYT Published: March 25, 2008
Why do doctors and patients often approach the diagnosis of disease so differently?

"...Part of the answer lies in the concept of triage — the notion, originated in wartime, of caring for the sickest and most salvageable patients first. Once they were saved, attention could be turned to less drastic cases.

A similar strategy has evolved in emergency rooms, where physicians are trained to “rule in” or “rule out” severe conditions. Thus, doctors immediately consider heart attacks or pulmonary embolisms for patients with chest pain, and intestinal rupture for those with abdominal pain.

But what happens when these conditions are ruled out? In such cases, doctors proceed to search for less dire (and, it must be said, more mundane) diagnoses. The trouble is that at this stage, some physicians, busy with other patients and duties, lose interest."

The difficult doctor?

The difficult doctor? Characteristics of physicians who report frustration with patients: an analysis of survey data

BMC Health Services Research 2006, 6:128

Background
Literature on difficult doctor-patient relationships has focused on the "difficult patient." Our objective was to determine physician and practice characteristics associated with greater physician-reported frustration with patients.

Methods
We conducted a secondary analysis of the Physicians Worklife Survey, which surveyed a random national sample of physicians. Participants were 1391 family medicine, general internal medicine, and medicine subspecialty physicians. The survey assessed physician and practice characteristics, including stress, depression and anxiety symptoms, practice setting, work hours, case-mix, and control over administrative and clinical practice. Physicians estimated the percentage of their patients who were "generally frustrating to deal with." We categorized physicians by quartile of reported frustrating patients and compared characteristics of physicians in the top quartile to those in the other three quartiles. We used logistic regression to model physician characteristics associated with greater frustration.

'Bothering’ Your Doctor

'Bothering’ Your Doctor
NYT March 17, 2008, 2:23 pm
By Tara Parker-Pope

Does the medical system try to prevent you from “bothering” your doctor?
That’s a question Sacramento physician Dr. Faith Fitzgerald mulled recently as she attempted to notify another physician about a health crisis involving one of his patients. She chronicles her futile effort to phone a fellow doctor in an essay that appeared in last months’ Annals of Internal Medicine.

Is cybermedicine turning us into a nation of expert patients?

Is cybermedicine turning us into a nation of expert patients? University of Glasgow
Issued: Tue, 11 Mar 2008 11:01:00 GMT
"Researchers from Manchester Business School and The University of Glasgow are undertaking an in-depth study into the impact of cybermedicine, such as virtual health communities and self-help sites, on face-to-face healthcare.
Funded by the NHS National Institute of Health Research Service Delivery and Organisation Programme, the research responds to the rise of the “expert patient” – who uses cybermedicine to self-diagnose – and the decline in the deference traditionally linked to professional judgement."

Is There Hardening of the Heart During Medical School?

Is There Hardening of the Heart During Medical School?

Physician-Patient Relationship

Academic Medicine. 83(3):244-249, March 2008.
Newton, Bruce W. PhD; Barber, Laurie MD; Clardy, James MD; Cleveland, Elton MD; O'Sullivan, Patricia EdD

Abstract:
Purpose: To determine whether vicarious empathy (i.e., to have a visceral empathic response, versus role-playing empathy) decreases, and whether students choosing specialties with greater patient contact maintain vicarious empathy better than do students choosing specialties with less patient contact.

Patient Fired by Doctor

Patient fired by her doctor

CARLY WEEKS

From Friday's Globe and Mail,
February 29, 2008 at 8:56 AM EST

"Ms. Matthews' case illustrates the difficulty many people with mental illness have functioning in society. But it also highlights the grey area in doctor-patient relationships that can emerge when a patient is seen to refuse treatment, be unco-operative or display other behaviour that causes friction.

The Canadian Medical Association has guidelines governing the relationship between doctors and patients and says that patients should have the chance to find a new family doctor before a physician terminates treatment.

However, doctors in Canada have the right to stop seeing patients at their discretion, particularly if a patient is difficult or won't accept treatment, said Jeff Blackmer, executive director in the CMA's office of ethics."

Miracle Workers? Why we expect doctors to do the impossible

"Even today, in our high-tech, accountability-obsessed and, supposedly at least, patient-empowered times, the oldest of all relations between patient and physician — that of supplicant to shaman — continues to exert its authority. This may not seem sensible if the only valid criterion for judging the doctor-patient relationship is the use that is made of scientific data and clinical findings. But good doctors want to treat their patients, not just their patients’ diseases, and certainly most patients want to be treated as human beings, not cases. Viewed from that perspective, the elevated expectations patients bring to the consulting room may be for the best."
From the New York Times Magazine, 17.2.2008

Includes elements of the doctor-patient relationship