By now, you’ve probably heard the story of the Long Island surgeon who is suing his estranged wife for the kidney he donated to her. If it can’t be returned, he wants the $1.5 million dollars he believes it is worth.
For most of us, this is just tabloid fodder, but in her latest Doctor and Patient column, Dr. Pauline Chen says the case is representative of the “extent to which money has become enmeshed with medicine.” She writes, “Many of us reading, listening to and even writing about the story, myself included — accepted the premise long enough to wonder how (they) came up with that high a figure or if it was even physiologically possible for him to take back the kidney.”
Dr. Chen goes on to describe her first kidney transplant operation with a living donor, and how difficult it is to place a value on the transaction.
The experience was nothing short of extraordinary. And like the very act of donating an organ, the kidney itself was hardly glamorous, demanding nothing in return for its miraculous work. It was a sturdy organ – pink, firm as a small rubber ball, and shaped much like the kidney beans you’d find at a restaurant salad bar…. It was, I remember thinking that morning, a gift of life. But it’s a gift, according to some, that can be assessed for as much as $1.5 million or as little as $20,000 or less.
Health writers often suggest Web sites and strategies for finding the best doctor. But what do doctors think about all this advice?
In today’s “Doctor and Patient” column, Dr. Pauline W. Chen talks to other doctors about the best way to find a doctor you trust, and the best places to research health information.
Many of the doctors I spoke to or exchanged e-mail with made commonsense suggestions that were not unexpected. They urged patients to find out which doctors their closest friends really like, to ask a prospective doctor questions like how much experience he or she has with a specific condition or operation, and to make sure that as a patient you feel part of a shared decision-making process and comfortable saying how you feel, or that you don’t understand or that you respectfully disagree.
But many of the physicians also shared links to valuable Web sites, several of which I was unfamiliar with. All the sites are free to the public and accessible to anyone with an Internet connection. When I looked at these sites while writing this column, I became really excited as a patient about the amount of information available.
Do patients place too much trust in their doctors? (Andersen Ross/Getty Images)
Patients are more likely to spend time researching a job change or a new car than they devote to learning about their doctor.
In her latest “Doctor and Patient” column, Dr. Pauline W. Chen looks at a Web site where consumers rate their doctors, along with roofers, dog walkers and a number of other trades. The reviewers appeared to hold non-medical professionals and service providers to a high standard — sharing reviews and photos of past work, for instance. But she noticed that the doctors often were judged on issues such as attentiveness and demeanor, rather than training and experience.
“A healthy doctor-patient relationship does not simply entail good bedside manners and responsible office management on the part of the doctor,” Dr. Chen writes. “It also requires that patients come to the relationship educated about their doctors, their illnesses and their treatment.”
To read more about how blind trust in your doctor may ultimately undermine your care, read “Do Patients Trust Doctors Too Much?,” and then join in the discussion below.
In today’s Doctor and Patient column, Dr. Pauline Chen explores a looming public health crisis: the doctor shortage.
Already experts are predicting a shortage of primary care doctors of 35,000 to 44,000 by the year 2025. Given population estimates that means “either primary care doctors will be seeing many more patients than they do now, or several million people will be without a primary care doctor, no matter how accessible health care might be for the rest,” she writes.
So while president-elect Obama is struggling for ways to give everybody access to health care, a more pressing problem may be getting ignored.
“We may find ways to give patients access to the waiting room,” writes Dr. Chen. “But what if there’s no doctor on the other side of the door? ”
While the focus was adding sleep time to 30-hour shifts as a way to curb doctor fatigue, one key point may have been missed. Many residents don’t want to nap or leave the hospital. They want to put in whatever hours are necessary to care for patients.
In her latest “Doctor and Patient” column, Dr. Pauline W. Chen talks about her own 100-plus hour workweeks during residency and the education she received in the process. She writes:
I can’t help but wonder if we may also risk losing something by trying, prematurely perhaps, to fit the unpredictability of the illness experience and the individuality of human relationships into a scheduling grid that has little proven efficacy.
Is it better for a doctor to keep mum about personal information? (Amanda Rohde/iStock)
A doctor visit is supposed to be about the patient. But what happens when it becomes about the doctor?
In her latest “Doctor and Patient” column, Dr. Pauline W. Chen explores what happens when doctors share too much. Everyone likes a friendly, warm physician, but are doctors who tell you about their families, friends and problems paying enough attention to their patients?
Over the last four years, there have been several studies on the effects of physician self-disclosure on patient satisfaction. It turns out that patients don’t always want to know about their doctors’ personal experiences. And doctors don’t always do a great job when they do choose to share their personal information….
When I consider my experiences as a patient, I find that my favorite doctors rarely offer their own information in the exam room. Nonetheless, I do feel a deep personal connection with them and can even reel off a few facts about their lives. But I have learned about my gynecologist and my children’s pediatrician because I have asked them specific questions during our office
visits on terms that I, the patient, have set.
Do racial barriers impede care between doctors and patients? (Getty Images)
The presidential election has triggered a national discussion on race in America. In her latest “Doctor and Patient” column, Dr. Pauline W. Chen starts a conversation about the racial barriers that remain in the health care setting.
Dr. Chen recalls the words of a fellow surgical resident named Eric, who is African-American.
“You know, Pauline,” he said, “there are a lot of times when I go to a patient’s room for the first time and they ask me, ‘Are you transport? Are you here to wheel me to radiology?’ I can remember Eric shaking his head as he spoke. “They never assume I’m one of the doctors.”
Animal trainers have long known that positive reinforcement is more effective than negative methods. But that message hasn’t reached the people who train our doctors.
As Dr. Pauline W. Chen notes in today’s “Doctor and Patient” column, new doctors receive much of their medical training in a culture of fear and negative feedback. She recalls that during her own early training, praise was rare.
Negative reinforcement during those early years taught me to be a cautious and conscientious doctor. Our teachers rarely praised us for good work and never allowed us to forget our errors. But sometimes the lessons had little to do with learning how to care for patients.
One night during my internship, for example, a powerful senior attending called to chew me out for putting his V.I.P. patient in a double room. His voice was so loud I can still remember holding the phone away from my ear. “Do you know I can get you fired for this?” he roared.
“Yes, sir,” I responded meekly. I was too scared to tell him the truth, which was that the head nurse, not the intern, assigned patient rooms.
Those early lessons were so effective that even today whenever I hear anyone say the words, “I need to talk to you,” my first response is: Did I do something wrong?
Every doctor starts as a student. And the experiences students have in medical school help shape the kind of doctors they become.
But the reality is, many medical students are painfully unhappy. That’s the issue explored by Dr. Pauline W. Chen in her latest “Doctor and Patient” column.
Medical school was not easy for me. I knew that I wanted to become a doctor to help people, but I had given little thought to the process. I was poorly prepared for many things: the pressure to excel in ways that seemed so far from caring for people; rapidly mounting debts I signed off on every semester; a roller coaster existence from chronic lack of sleep; hazing from the more experienced students and residents; and the realities of patient suffering despite my best efforts.
Essays and poems are part of Dr. Richard Panush’s rounds at Saint Barnabas Medical Center. (Aaron Houston for The New York Times)
As a health and medical writer, I have been fascinated to learn about the role writing, and reading, can play in medicine and better patient care.
That’s the issue explored by Dr. Pauline Chen in this week’s “Doctor and Patient” column, where she writes about how literary training can be an essential part of medical training.
Dr. Chen writes: “There is now emerging evidence that exposure to literature and writing during residency training can influence how young doctors approach their clinical work.
“‘We’re teaching the humanities to our residents, and it’s making them better doctors,’ said Dr. Richard Panush, a rheumatologist and chairman of the department of medicine at Saint Barnabas Medical Center.
“The idea of combining literature and medicine — or narrative medicine as it is sometimes called — has been part of medical education for over 40 years. Studies have repeatedly shown that such literary training can strengthen and support the compassionate instincts of doctors.”
Anna Deavere Smith portrays multiple characters in “Let Me Down Easy.” (Michael Lutch)
Medical dramas like “House” and “Grey’s Anatomy” are some of the most popular shows on television, but can we learn anything from a dramatic interpretation of medicine?
In this week’s “Doctor and Patient” column, Dr. Pauline W. Chen explores actress and playwright Anna Deavere Smith’s latest show, “Let Me Down Easy,” which most recently appeared at the American Repertory Theatre in Cambridge, Mass. A portion of her new work is devoted to health care and to the stories of patients and doctors. The show is “filled with the kind of stories that make your heart swell, many of them about how friends, family members, politicians, teachers and even doctors dealt with illness or human frailty,” she writes.
To read about the show, and how it left Dr. Chen mulling her own dramatic encounters in medicine, read her latest column, “What Does Grace Mean to You?” And then, join a discussion with Dr. Chen below.
The good and bad decisions doctors make about health care are often discussed on this blog and elsewhere. But what about the decisions patients make?
In today’s “Doctor and Patient” column, Dr. Pauline W. Chen explores choices made by patients that can sometimes be at odds with medical advice. Dr. Chen interviews long-term heart transplant survivor Amy Silverstein, author of the memoir “Sick Girl” (Grove Press, 2007), and writes of her own patient, “Donna,” who stopped taking anti-rejection medications years after a successful liver transplant.
“There are certain choices patients make that I have never understood,” Dr. Chen begins. “But I am not in their shoes. And as much as I’d like to believe I have tried, I have not even begun to understand my role in their choices.”
The reality is, heroic efforts by doctors may keep a patient alive, but it’s not always a life the patient wants to live. Read Dr. Chen’s full column here, “The Choices Patients Make.” And post your comments below.
During the last weeks of my mother’s life, I was with her on a routine doctor visit when she began experiencing excruciating pain. She was rushed to the emergency room, where she was quickly given some sort of scan. Minutes later, a nurse administering pain medicine didn’t talk or look at me or my father. Her effort to avoid eye contact told me all I needed to know. My mother’s cancer had returned with a vengeance.
Memories of that nurse’s discomfort came rushing back to me this week as I read Dr. Pauline W. Chen’s latest “Doctor and Patient” column. This week she writes about the “dance of avoidance” that occurs when doctors have bad news to deliver.
In trying to protect patients, doctors may be misjudging them and the consequences of not sharing our suspicions. We may be assuming that patients and families are more fragile than they really are and that keeping our hunches to ourselves will protect them, when in fact we may be making the situation worse.
A new study this week found that doctors often miss opportunities to express empathy to their patients. Does this mean doctors don’t care? Or could it be they just don’t have the time?
In her latest “Doctor and Patient” column, surgeon Dr. Pauline W. Chen writes about the new research and her own experiences talking — and empathizing — with patients.
Read the full column here, “Taking Time for Empathy,” and please share your thoughts with Dr. Chen below.
For more from Dr. Chen, listen to the Best of Well podcast below to hear our conversation about the new “Doctor and Patient” column and her reaction to the hundreds of reader comments she has received so far.
Often patients visit the doctor with a litany of symptoms and the hope that the doctor can give them a diagnosis.
But as Dr. Pauline W. Chen notes in her “Doctor and Patient” column today, a diagnosis doesn’t always lead to better care. The problem, she notes, is that once doctors settle on a diagnosis, they start treating that specific disease, rather than always listening to the specific problems of the patient in front of them. The illness may have a name, but the patient has become anonymous. Dr. Chen writes:
Over the last century and a half, however, medicine has increasingly decoupled disease from the individual. This decoupling has given rise to the concept of precise, objective and quantifiable diagnoses, diagnoses so separate from patients that they seem in many ways to take on a life of their own…. When we know what is wrong, we sometimes stop paying such close
attention to those patient experiences that seem to have little relevance to the diagnosis at hand. We focus less on the individual and more on the diagnosis.
To read more, check out today’s fascinating “Doctor and Patient” column: “The Tyranny of Diagnosis.”
Have you been frustrated by the medical community’s inability to diagnose your ailment? Did your care improve once doctors were able to put a label on your problems? Please join Dr. Chen in the discussion by sharing your thoughts and experiences below.
Healthy living doesn't happen at the doctor's office. The road to better health is paved with the small decisions we make every day. It's about the choices we make when we buy groceries, drive our cars and hang out with our kids. Join columnist Tara Parker-Pope as she sifts through medical research and expert opinions for practical advice to help readers take control of their health and live well every day. You can reach Ms. Parker-Pope at well@nytimes.com.
Healthy living doesn't happen at the doctor's office. The road to better health is paved with the small decisions we make every day. It's about the choices we make when we buy groceries, drive our cars and hang out with our kids. Join columnist Tara Parker-Pope as she sifts through medical research and expert opinions for practical advice to help readers take control of their health and live well every day. You can reach Ms. Parker-Pope at 
