Respect and patient-physician communication

The New York Times Health section had an interesting article today, written from a doctor's perspective, about the power of names. The question is: how should physicians and patients address each other? Should physicians insist on being called "Doctor"? Should patients insist on being called Mr. or Ms.? Is a title a show of respect or detachment? When a physician or patient calls the other by his or her first name, is it a way of demeaning the other? Are we over-thinking all of this? The article generate passionate response from both physicians and patients.

The fact that the issue of titles is a concern at all shows the inherent difficulty in effective physician-patient communication. Both parties wield a certain amount of power: one of expertise in a field, one of ultimate control of their body and where they take it. There is a need for respect in this communication relationship, but also a need for intimacy. How do you balance formality and respect with the intimate nature of physician-patient communication and clinical exams? And what do you call each other when you do it?

Intimate acts of care

Registered Nurse Theresa Brown, a regular contributor to the New York Times Well section, offers insight into the intimate acts nurses perform in the care of cancer patients. The essay demonstrates that communication between nurses and patients goes beyond words, to intimate moments of touch, comfort and care.

Giving as an act of healing

The New York Times Well blog reviewed a book that explores the health rewards of giving to others. Giving to others isn't a medical cure for anything, but is presented as a means of helping patients cope and gives them hope. The book and the article cite some of the science and questions behind the idea of giving as a means of healing. But in this case, the science isn't as compelling as the stories of patients who have gained from giving to others. And we will all do well in this season to remember that the joy of giving is a joy unto itself, regardless of the benefits.

The Cancer Lounge

The New York Times had a compelling article last week about the cancer recreation lounge at Memorial Sloan-Kettering Cancer Center in Manhattan. The lounge is a place for patient to both forget about their cancer and talk about their cancer freely with other patients who understand. It is a compellling read about the waiting involved in cancer treatment and the simple joy a card game can bring.

Tension at the Thanksgiving dinner table

The New York Times Well column this week reflects on the tension that sometimes joins the family at the holiday table. In particular, issues surrounding food, portions, control and preferences, can cause anxiety when families join together for a big meal. The article illustrates that health messages are not always healthy and that the messengers aren't always health professionals. We should all remember there is power in our words.

New breast cancer guidelines and possible confusion

New screening guidelines by the Preventative Services Task Force of the Department of Health and Human Services may start a lot of conversations in exam rooms across the country. The Preventative Services Task Force is recommending women be screened for breast cancer starting at age 50, with follow-up mammograms every other year. This is a change from previous guidelines and and is opposed by many cancer associations, which recommend annual mammograms starting at the age of 40.

The contrasting guidelines will likely be a source of confusion for some patients, faced with the decision to have a mammogram. It will be all the more important for physicians to provide effective counseling and ongoing dialogue with patients to help them make the decision that is right for them.

The importance of a name

The New York Times had an article today about the intangible importance of having a name for a disorder and how patients claim ownership of that name. The issue is being raised by a group of patients unhappy that the term Asperger's Syndrome will be removed from fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Asperger's Symdrome is a mild form of autism, in which children and adults often are socially awkward but many are verbal prodigies and highly skilled in specific expertise. But inconsistent diagnosis and a move to depict mental illnesses as falling on a spectrum rather than "they-have-it-or-they-don't" mentality have lead the editors of the D.S.M.-V to place what is known as Asperger's on the autism spectrum. But patient advocates are concerned that losing the well-known and well-accepted term will make others reluctant to seek treatment if they exhibit mild autism spectrum symptoms.

The American Psychiatric Association is expected to post a draft of the new terms and diagnostic criteria and solicit feedback from the community. There will likely be a lot of it, and the feedback will give the authors insight into how patients see themselves and their community.