We have the best talks

When it comes to patient outcomes it’s not a question of the most advanced technology that provides the best care; It boils down to communication.  At its most fundamental level the physician/patient relationship is about the interaction and what is expressed and what is understood.  

Oftentimes I will see medical practices marketing body scans and advanced blood work. While it is exciting to think of a Star Trek type of practice where one is simply scanned and all health concerns are known we simply aren’t there yet.  These body scans and extra blood work have never been proven to increase health in any way. Having an open dialogue with patients and allowing patients the time to tell their story is the best way to improve patient outcomes.  There is an old adage in medical training:  “90% of the diagnosis is the story.”  If a provider doesn’t listen to the story then getting it right is that much harder.

It is estimated that up to 40% of hospital admissions could be avoided by better communication between the physician, the care team and the patient.  It is distressing to think of all the suffering and needless waste of money that could be avoided by simply listening.  By understanding patient concerns and getting feedback on medications and symptoms providers are better able to preempt healthcare deteriorations that land patients in hospitals.

Every provider has a different style, but I typically start out appointments by asking patients about what brings them into the doctor. I know the sorts of things that I want to address to keep them healthy: preventative measures, immunizations, blood work, etc.  These are the issues that I want to address, but oftentimes you cannot get there until you address that nagging shoulder pain or other complaint that the patient has. From a patient standpoint, if you can’t take the time to deal with an ache or pain why bother dealing with an abstract issue such as cholesterol or hypertension.

At the end of every visit I review the plan and ask patients if there any questions. Sometimes I think we are communicating and in reality we just aren’t. I try as often as possible to make sure that I’m on the same page as my patients.  On top of the willingness to communicate from staff and clinicians, there needs to be a general openness. If patients feel that they are being judged or that they are being pressured for time they’re less likely to tell a physician important information.  

Sometimes questions come up after the visit has ended. Every patient has access to me via email and every email is responded to within a 24 hour period.  By keeping  messages in the patient’s own words it reduces the likelihood that information is lost in translation from staff to the physician.

Sometimes practices change over time and with the pressure to comply with government regulations and insurance demands the one-on-one that providers enjoy with their patients falls to the wayside.  We have engineered our processes so that this doesn’t happen, even as we continue to grow.  Communication is a core belief in our practice, and with such a small price and such a great reward it will always be front and center.

That’s snot what that means

Oftentimes patients will make the declaration “My snot is green, I need antibiotics!” I’m uncertain where this popular belief that green mucous means that antibiotics are required originated from, but it just isn’t true. I wish it were – my days would be easier and the decision-making process of using antibiotics would be about as complicated as a traffic light.

The reality is that the green color in mucous comes from an enzyme called myeloperoxidase found within our immune cells. This enzyme is used to fight off viruses and bacteria, and has iron at its center. It is this iron that give mucous its green color when fighting an infection.

While your mucous may be green from fighting a bacterial infection it is more likely to be green from fighting off a virus. The amount of viral infections patients fight off is significantly more than bacterial infections that must be dealt with.

When deciding whether or not to use antibiotics there are more important factors such as age, overall health, duration of symptoms, vital signs and physical exam. The reality is that most colds will have their peak at 3-5 days with resolution at 7-10. For most patients watchful waiting with symptomatic care is all that is needed.

In this age of antibiotic resistance it is important to use antibiotics only when needed. For more information on antibiotic stewardship check out the CDC site here.

The yearly doctor’s visit may have just gotten a little less uncomfortable

The United States preventative task force, the agency which makes recommendations for screening and disease prevention, recently published that they could not recommend performing the pelvic exam as part of the yearly well-woman physical.


After reviewing the evidence for the benefits and risks of the yearly exam, the USPTF decided that there was no clear benefit.  Now, this only applies to non-pregnant women without gynecological complaints.  Also, it doesn’t mean that you can skip your Pap smear or other screenings.  But it does mean that in select patients having this exam done isn’t a foregone conclusion.


When we built our offices one of the design points that was important to us was the sliding barn door concealing the exam room and table.  The reasoning for this was that without the exam table looming over the patient/provider conversation there would be less stress.  Better communication, and thus better medical care, comes out of low stress environments.


Given the anxiety that these sorts of exams can produce it is certainly worth a discussion with your doctor about whether or not yours is merited.