I didn’t even examine him: Physician-patient communication

One doctor – call him Dr. M – says he has always been circumspect when he talked to patients. But one patient who came for a visit five years ago for a physical exam was skilled at furniture building, Dr. M's hobby. The patient spent 40 minutes with the doctor. When he left, Dr. M looked at his notes. "I realized I didn’t even examine him," Dr. M admitted.

The patient was gracious when Dr. M called to apologize, saying, "We’ll just wait for next time."

A recent study in the Archives of Internal Medicine concluded this happens often, though maybe not for such a long time. Researchers studied 113 surreptitious audio recordings of office visits of test patients. The researchers discovered that doctors talked about themselves in a third of the visits and that there was no evidence that any of the doctors’ disclosures about themselves helped patients or established rapport. Patients were not comforted, and conversations got off track, the authors of the study found, wasting patients' time. "What’s shocking about this article is how often they moved from the patient’s concerns to their own,”"commented one physician chairperson of family medicine at an academic medical center.

Advice: If this is a problem with your doctor, leave a copy of this blog post in the doctor’s office as a gentle reminder.


Read Gina Kolata’s article in the June 26 New York Times.

She told the EMTs to take her an hour away: Stroke and tPA

Dr. Diana Fite, a 52-year-old emergency medicine doctor in Houston, knew her blood pressure had been dangerously high for five years. But she convinced herself her actual blood pressure was lower and healthier. And she thought she was too young to take medicine; she would worry about high blood pressure when she got older.

Then, one morning while driving, her whole right side felt weak. She "had no strength whatever in the hand that was holding the wheel. And my right foot was dead. I could not get it off the gas pedal," she recalled. She grabbed the steering wheel with her left hand, and steered into a parking lot. Then she used her left foot to pry her right foot off the gas pedal. She called 911, and spoke with great difficulty. She told the ambulance crew to take her to a hospital an hour away, to a stroke center whose doctors had experience with diagnosing stroke and giving the medicine tPA within the essential three-hour window for it to be effective.

The tPA started to immediately dissolve the blood clot that had caused her stroke. "I had weird spasms as nerves started to work again. An arm would draw up real quick, a leg would tighten up. It hurt so bad I was crying because of the pain. But it was movement, and I knew something was going on," she said.

Now she has completely recovered. She looks back with dismay on her cavalier attitude toward high blood pressure. Now she takes three blood pressure pills, a drug to prevent blood clots and a cholesterol-lowering drug, and plans do so daily for the rest of her life.

"Boy, when you go through this, you never want to go through it again. I have been given that precious second chance. I was so blessed."

She was also blessed in being among the 3 – 4% of stroke victims who receive tPA when they should. Many victims wait too long to report their symptoms, and many hospital Emergency Room doctors don’t always diagnose stroke accurately.

Advice: Send this to your friends with high blood pressure.

Read another of our healthy heart stories, or read Gina Kolata’s source story in yesterday’s New York Times.

He had a secret plan: A patient compliance story

Keith Orr thought he would surprise his doctor when he came in for a checkup. His doctor had told him to have a weight loss operation to reduce the amount of food his stomach could hold, worried because Keith weighed 278 pounds, had a very high blood sugar level, putting him at high risk of diabetes, and a strong family history of early death from heart attacks. Indeed, he himself had had a heart attack nine years ago, at age 35.

But Keith had a secret plan. He had been dieting and exercising for four months and lost 45 pounds. He imagined proudly telling the doctor what he had done, sure that his tests would show huge drops in his blood sugar and cholesterol levels. He planned to admit that he had also stopped taking all of his prescription drugs for heart disease since, he thought, he no longer needed them. He had never taken them regularly, so stopping completely wouldn’t matter much, he thought, in light of his improved diet and exercise.

But the surprise was not at all what he expected. A week before his scheduled doctor’s appointment, while at the gym in Boston on February 6, he felt a tightness in his chest—the start of a massive heart attack, with the blockage in an artery that doctors call "the Widow-Maker."

He survived, miraculously, with little or no damage to his heart.

Advice to people on aggressive diets and exercise plans: Discuss them with your doctor first.

Read another of our heart disease stories, or Gina Kolata’s source story in the April 8 issue of The New York Times, "Lessons of Heart Disease, Learned and Ignored."