Do Difficult Patients Get Bad Medical Care?

By Dena Rifkin, MD

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

How Doctors Learn From Patients

By Dena Rifkin, MD
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.
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When You Really Need Your Doctor...and She's in Fiji

How to get great medical care from the doctor on call (from a doctor on call)
by Dena Rifkin, MD

A couple of my colleagues were out of town this week, so I’ve been taking care of some of their patients for them. This is known as covering, and we do it all the time: nights, weekends, holidays, vacations.

The days when doctors were on call 24 hours a day, seven days a week, are, by and large, gone with the horse-drawn ambulance and the once-ubiquitous black bag.

How does coverage work? Well, a lot depends on the system. Some practices cancel everything but urgent care while they are away. For others, the practice must continue—for instance, dialysis patients must come three times a week, every week. Some practices have electronic medical records that make it easy to look up old records if a patient calls in with a new problem.

The hospital where I work has an electronic-record system, and I can access it from home, which makes taking care of urgent calls much easier. But still, there are times when it’s pretty hard to figure out what’s going on when an unknown patient with a complicated history calls. Patients often call for reassurance about a new symptom—they don’t want to have to go to the ER (who would?). Sometimes we can provide that reassurance, and sometimes we can’t.
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Kidney disease may have heritable factor

United Press International

Tuesday, November 1, 2005


WINSTON-SALEM, N.C., Nov 1, 2005 (UPI via COMTEX) -- Wake Forest University scientists say nearly one-fourth of all kidney dialysis patients have a close relative on dialysis, suggesting a heritable factor.

The researchers at the university's Baptist Medical Center, and others, suggest screening such patients' relatives for undetected kidney disease.

The research was conducted by scientists from Wake Forest and Emory universities and the End-Stage Renal Disease Network 6, one of 18 such networks in the United States.

The largest study of its type ever performed, the research involved 25,883 newly treated dialysis patients from North Carolina, South Carolina and Georgia. Of those, 22.8 percent were found to have close family members also with end-stage kidney failure.

Dr. Barry Freedman, professor of internal medicine and head of the Baptist Medical Center's nephrology section, said, "Physicians caring for patients with chronic kidney disease should consider focusing screening efforts on high-risk family members in an attempt to slow the exponential growth rate of kidney failure."

The study was based on dialysis patients from North Carolina, South Carolina and Georgia and appears in the current online edition of the American Journal of Nephrology.

URL: www.upi.com

Copyright 2005 by United Press International

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