There's so much of this going around: Co-production of a diagnosis

Mrs. R: I'm here because I just feel rotten.

Provider: What kind of symptoms are you having?

Mrs. R: Really high fevers. Last night it was 102. I just ache all over. And I've got this cough...It started the day before yesterday, all of a sudden in the afternoon, something just hit me like a ton of bricks.

Provider: It sounds like you have influenza. There's already a lot of this going around.

Mrs. R: I don't see how this could just be the flu. I've never had anything like this, and I can't ever remember feeling so sick.

Provider: What you have is more than just the run of the mill flu....Have you been under a lot of stress lately?

Mrs. R: Things have been tougher at home lately....My husband and I aren't getting along so well...we fight about money and he parties too much.

Provider: Let's get back to the medical reasons for the visit, but if you ever want to talk about the personal issues, I'm available.

Mrs. R: I'm just worried that this virus or whatever will keep hanging on.

Provider: There's so much of this going around. Everybody's got it this week.



In Provider-Patient Partnerships, Helen Meldrum and her co-author, Dr. Mary Hardy, discuss the case study summarized here in a section entitled, "What is it you're not telling me?" in their chapter about sensitive issues. In this case, the provider didn't learn about Mrs. R's husband's IV drug use, and so couldn't detect her possible exposure to HIV from her husband. Mrs. R had spoken quite indirectly, as many patients do, and the provider didn't understand what she hadn't told him.

Using many rich scenarios like this one, Helen Meldrum's book discusses how providers can improve their communication with patients. The book respects the messy complexity of patients' medical issues, and the frequently indirect communication by patients about their problems. The book is a practical and insightful guide for providers. Its specific prescriptions for seeing the truth among patients' murky comments are much needed.

Ken's advice for patients with sensitive issues to discuss: Rehearse what you'll say to the doctor ahead of time to clarify your concerns.

For more ways to improve communication of providers and patients, read the chapter on "Interacting with Your Doctor" in my book, Getting Your Best Health Care: Real-World Stories for Patient Empowerment.

Lucio Satar: A flu vaccine story

Lucio Satar, a healthy eight-year-old boy in Minnesota, began feeling sick with the flu on Jan. 24. He died Wednesday of pneumonia, a complication from the flu.

Across the U.S., about 100 children die every year from flu complications, according to Patsy Stinchfield, a pediatric nurse practitioner who leads the Minnesota Immunization Practices Advisory Committee.

Advice to parents: Please have your families vaccinated against the flu.

Read the story in the Lacrosse Tribune.

“Just a little sunbeam, very sweet”: Flu vaccine

Nichole Lang-Veru, a fourth-grader at Dale Mabry Elementary School in Tampa, Florida, died Dec. 27 after she became ill. An autopsy confirmed her death was flu-related, the Medical Examiner said. Doctors said Lang-Veru's death should serve as a warning to parents because the girl seemed to be healthy. "She was somewhat shy, very quiet, very respectful," said an adult classroom volunteer. "Just a little sunbeam, very sweet."

This isn’t a story about medical error, but since I have a daughter, it strikes close to home.

Advice to parents: Get your family vaccinated to protect them from the flu—it’s not too late.

Read another story of how parents can prevent tragedies, or read the newspaper story about Nichole by Abbie VanSickle or the story in Florida Today.