Wednesday, June 26, 2013


I give a lot of advice in the course of the day. One might say it’s how I make a living. Some of my advice is pretty general (try get some exercise every day) and some rather specific (you have a weight goal of 153 pounds). But no matter what I say, I choose my words very carefully and use precise language.

I find that the best way to convey information is face to face. That way, I can tell if a person is following me. I encourage follow up questions and I may ask the patient to teach it back to me. I also like to give the patient some written information, often in a follow-up note. Many doctors are using discharge instructions for office visits, but I find that prewritten templates are too generic and sometimes make no sense. A non-smoker doesn’t like being told to stop smoking.

Telling a patient, “call if you are not better” is not nearly as helpful as, “Call if you have a fever greater than 101 or if you are short of breath.” Doctors tell patients to “push fluids” – but what does that mean? Far better are the instructions, “you should be urinating light yellow urine every two hours while awake.”

I also need my patients to choose their words carefully. It’s always best to use natural language rather than medical jargon. When a patient says she is worried about “osteo,” I have to wonder if it could be osteoporosis, osteopenia, osteomyelitis or a number of other “osteos.” What does IBS mean? Even worse is the made-up jargon used to push pharmaceuticals.

It might be hard to take advice, but my goal is that least the patient will understand it.

Monday, June 10, 2013

Electronic or Paper?

Electronic medical records can be terrific – until they are not.

Paper records are very low tech: paper and a black ballpoint pen. There’s actually a law about the pen but no requirement about the type of paper. Other paper rules: every page in the chart must have two identifiers (such as name and date of birth, or name and patient number) and each entry must be dated and signed. No need for power or an internet connection. We all have heard the negatives: difficult to read, often misplaced and impossible to share. The written information can be scanty and may appear to be written in code. Medication directions are still in Latin.

Electronic records need computers. No power, no chart. Computerized records are easy to read – at least the letters on the page are always legible. The notes are very complete since all background information is dragged in, no matter the relevance to the current problem. (Yup, parents are both still deceased). There are still lots of abbreviations, both standard and not. You won’t see the diagnosis “pneumonia” but rather CAD, PNA or 486.  There is so much information in the note that it can hard to discern the plan. Entries still need to be signed (a multi-step process). In theory, information can be shared.

Electronic records can vanish in an instant. I have seen it happen. Paper records endure. Paper can be salvaged if wet and fire is less likely than a computer glitch. It’s not difficult to locate a misplaced paper chart but can be impossible to recover lost computer data. And how much do we want shared, anyway?

Wednesday, June 5, 2013

Please Take Your Medicine

Nearly three in four Americans don't take their prescription medicine as directed. Even among those with serious chronic health conditions such as diabetes, about one in three don't.

Patients not taking medicine as prescribed cost the U.S. healthcare system roughly $290 billion a year in extra treatment and related costs, research shows. One study estimated those patients pay about $2,000 a year in extra out-of-pocket medical costs.

There can be serious consequence of note taking medication as prescribed. Patients who don't always take medicines for high blood pressure and cholesterol problems can suffer a heart attack or stroke, causing disability or death. Doctors may believe a drug they prescribed for the patient didn't work and switch to another one that has worse side effects or costs more.

There are a variety of reasons that people don’t take their medication as prescribed. The most common reasons are:

financial problems/lack of health insurance, complicated or confusing medication schedule, forgetfulness, and problems with or fears of side effects. A more basic problem is the belief the medicine isn't really needed. This is common with symptomless conditions such as high blood pressure.

Doctors are not clairvoyant. Let us know if you have concerns or problems There are many ways to treat medical problems: diet, exercise, a change in prescription medications or the use of non-prescription products.

If you are having trouble paying for your medications:

Please be careful when entering personal information on any website. This list is from the AARP website.