Tuesday, March 25, 2008

When the Disease Eludes a Diagnosis

NYT Published: March 25, 2008
Why do doctors and patients often approach the diagnosis of disease so differently?

"...Part of the answer lies in the concept of triage — the notion, originated in wartime, of caring for the sickest and most salvageable patients first. Once they were saved, attention could be turned to less drastic cases.

A similar strategy has evolved in emergency rooms, where physicians are trained to “rule in” or “rule out” severe conditions. Thus, doctors immediately consider heart attacks or pulmonary embolisms for patients with chest pain, and intestinal rupture for those with abdominal pain.

But what happens when these conditions are ruled out? In such cases, doctors proceed to search for less dire (and, it must be said, more mundane) diagnoses. The trouble is that at this stage, some physicians, busy with other patients and duties, lose interest."

Saturday, March 22, 2008

Mansbridge with Richard Smith, former editor, BMJ

Former editor, British Medical Journal
One-on-one with Peter Mansbridge (video, 30 minutes)
Saturday, March 22, 2008
"...It seems every week there's a new medical study in the headlines, followed weeks later by other studies that seem to contradict the first findings.

What are we supposed to believe? And are journalists being vigilant enough in what they choose to report?

It's a delicate question but this week's guest has some tough answers to consider."

Practicing Patients

Practicing Patients
Published: March 23, 2008
PatientsLikeMe, an Internet start-up, creates information-rich communities for the chronically ill. Is it the next step forward in medical science — or just a MySpace for the afflicted?

"...There are a little more than 7,000 Todd Smalls at PatientsLikeMe, congregating around diseases like Parkinson’s, multiple sclerosis (M.S.) and AIDS, all of them contributing their experiences and tweaking their treatments. At first glance, the Web site looks like just any other online community, a kind of MySpace for the afflicted. Members have user names, post pictures of themselves and post updates and encouragements. As such, it’s related to the chat rooms and online communities that have inhabited the Internet for more than a decade.

But PatientsLikeMe seeks to go a mile deeper than health-information sites like WebMD or online support groups like Daily Strength. The members of PatientsLikeMe don’t just share their experiences anecdotally; they quantify them, breaking down their symptoms and treatments into hard data. They note what hurts, where and for how long. They list their drugs and dosages and score how well they alleviate their symptoms. All this gets compiled over time, aggregated and crunched into tidy bar graphs and progress curves by the software behind the site. And it’s all open for comparison and analysis. By telling so much, the members of PatientsLikeMe are creating a rich database of disease treatment and patient experience..."

Friday, March 21, 2008

The difficult doctor?

The difficult doctor? Characteristics of physicians who report frustration with patients: an analysis of survey data

BMC Health Services Research 2006, 6:128

Literature on difficult doctor-patient relationships has focused on the "difficult patient." Our objective was to determine physician and practice characteristics associated with greater physician-reported frustration with patients.

We conducted a secondary analysis of the Physicians Worklife Survey, which surveyed a random national sample of physicians. Participants were 1391 family medicine, general internal medicine, and medicine subspecialty physicians. The survey assessed physician and practice characteristics, including stress, depression and anxiety symptoms, practice setting, work hours, case-mix, and control over administrative and clinical practice. Physicians estimated the percentage of their patients who were "generally frustrating to deal with." We categorized physicians by quartile of reported frustrating patients and compared characteristics of physicians in the top quartile to those in the other three quartiles. We used logistic regression to model physician characteristics associated with greater frustration.

Tuesday, March 18, 2008

'Bothering’ Your Doctor

'Bothering’ Your Doctor
NYT March 17, 2008, 2:23 pm
By Tara Parker-Pope

Does the medical system try to prevent you from “bothering” your doctor?
That’s a question Sacramento physician Dr. Faith Fitzgerald mulled recently as she attempted to notify another physician about a health crisis involving one of his patients. She chronicles her futile effort to phone a fellow doctor in an essay that appeared in last months’ Annals of Internal Medicine.

Monday, March 17, 2008

Experts call for national pathology standards to protect patients

Experts call for national pathology standards to protect patients
March 17, 2008 5:15 pm
"...A looming judicial inquiry into how over 300 Newfoundland breast cancer patients received erroneous pathology results — and subsequent inappropriate medical treatment — is spawning calls for the development of national standards that would protect patients from such mistakes.
The medical errors made by Eastern Health authority were discovered in 2005 and led to the restesting of the results of thousands of patients.
Dr. Avri Ostry, a pathologist with Queen Elizabeth II Health Sciences Centre in Halifax, told CBC News Monday that pathologists are facing numerous challenges. These include a rapidly expanding workload along with ever-developing technology that requires constant retraining.
"I believe it is indicative of an issue that is certainly national — and that has to do with quality assurance and quality control across the spectrum in laboratory medicine," he said."
Is this terrifying or what?

How to be a good patient

How to be a good patient
From Dr. Rob

"...This handout was posted in our exam rooms.

We want you to get the best care possible in this office and hope to care for you for many years to come. If there is anything we can do to give you better care, please let us know. Yet there are some expectations we have for our patients. We ask that you read the list below and do your best to abide by these suggestions..."

Friday, March 14, 2008

Is cybermedicine turning us into a nation of expert patients?

Is cybermedicine turning us into a nation of expert patients? University of Glasgow
Issued: Tue, 11 Mar 2008 11:01:00 GMT
"Researchers from Manchester Business School and The University of Glasgow are undertaking an in-depth study into the impact of cybermedicine, such as virtual health communities and self-help sites, on face-to-face healthcare.
Funded by the NHS National Institute of Health Research Service Delivery and Organisation Programme, the research responds to the rise of the “expert patient” – who uses cybermedicine to self-diagnose – and the decline in the deference traditionally linked to professional judgement."

Friday, March 7, 2008

Wednesday, March 5, 2008

How to Handle a Medical Crisis

How to Handle a Medical Crisis

Time, Wednesday, Jul. 11, 2007 By Alice Park

One medical crisis is certainly enough to turn your world upside down. But imagine living through four of them. That's what Jessie Gruman did, with admirable resilience and laughter.

The 53-year-old social psychologist has turned her history into a practical and accessible guidebook, AfterShock, for people who are going through the same things she did — confusion, fear, and emotional seesaws — every time a doctor gave her devastating news about her health. Founder and director of the Center for the Advancement of Health, a non-partisan institute that helps patients get reliable information about their medical care, Gruman talks to TIME about her experiences and provides advice about how to weather medical storms...

Gruman's Common Sense Help for Getting Through the First 48 Hours

1. This is a crisis. Treat it as one.
Don't try to go on as though nothing is happening to you. Don't go to work for at least 48 hours, and cancel you social engagements until you get your feet back under you.

2. Protect Yourself
Talk if you want to talk, cry if you feel like it. There is no particular benefit or harm in either. Stop searching for information online if it is confusing or frightening. You will have time to learn more later.

3. Don't rush to resolve your treatment plan
The only task you must accomplish during the first 48 hours is to make sure you have set up the next doctor's appointment.

4. Eat
Even if you aren't hungry: you don't need a hunger headache. Drink, too. Water, for sure. Coffee or tea? Whatever you are used to. A little Scotch? Sure (but not the whole bottle).

5. Rest
Emotional stress is exhausting. If you can nap, do it. If you are agitated, get up and walk around the block. If nothing else, it'll remind you that the world is carrying on in spite of your news.

6. Breathe

7. Move around

8. Remember: You will not always feel like this.

From AfterShock, by Jessie Gruman, PhD, Walker & Co., 2007.

Saturday, March 1, 2008

Is There Hardening of the Heart During Medical School?

Is There Hardening of the Heart During Medical School?

Physician-Patient Relationship

Academic Medicine. 83(3):244-249, March 2008.
Newton, Bruce W. PhD; Barber, Laurie MD; Clardy, James MD; Cleveland, Elton MD; O'Sullivan, Patricia EdD

Purpose: To determine whether vicarious empathy (i.e., to have a visceral empathic response, versus role-playing empathy) decreases, and whether students choosing specialties with greater patient contact maintain vicarious empathy better than do students choosing specialties with less patient contact.

Patient Fired by Doctor

"Ms. Matthews' case illustrates the difficulty many people with mental illness have functioning in society. But it also highlights the grey area in doctor-patient relationships that can emerge when a patient is seen to refuse treatment, be unco-operative or display other behaviour that causes friction.

The Canadian Medical Association has guidelines governing the relationship between doctors and patients and says that patients should have the chance to find a new family doctor before a physician terminates treatment.

However, doctors in Canada have the right to stop seeing patients at their discretion, particularly if a patient is difficult or won't accept treatment, said Jeff Blackmer, executive director in the CMA's office of ethics."

Books on Doctors as Patients and a few on the Doctor-Patient Relationship