Holiday update

I am heading to the beautiful, green and rainy Pacific Northwest for the holidays, so this blog will likely be pretty quiet for the next week or so. But I will be back in the new year, ready to continue the discussion on improving communication in health care.

Merry Christmas!

A gift for your doctor?

The New York Times Health blog has an interesting post about the ethics of doctors accepting gifts from their patients. http://well.blogs.nytimes.com/2007/12/21/when-your-doctor-is-on-the-gift-list/. It is, or course, the holiday season, and many patients may want to give their physician a gift to show their appreciation. Small. homemade or food gifts rarely raise ethical dilemmas, but what about more extravagant gifts? Might they raise expectations of entitlement with regards to treatment?

I was encouraged by the guidelines proposed by Psychiatric Times. Among other issues such as the monetary value, doctors are encouraged to consider the impact of accepting or rejecting the gift on the relationship with the patient. Patient-physician relationships are built on trust, and the rejection of a gift may be construed as a betrayal of trust and a great harm to the relationship.

Patients are encouraged to put themselves in the physicians shoes, and keep gifts modest and perhaps consider a gift that can be enjoyed by the entire clinic staff.

I would add, the most valuable gift may be your heartfelt, genuine appreciation. And maybe some cookies.

A patient advocate in an increasingly complex system

The New York Times calls Frederic Riccardi an attack dog disguised as an insurance counselor for the Medicare Rights Center. Riccardi helps elderly patients navigate the complex Medicare system. He endures bureaucratic phone trees at the state and federal level, to make sure patients get the medication and medical care they need. It's a difficult, but important job. And this story shows the difference an advocate, who works to communicate directly with patients and not above them, can make in the lives of patients.

See the story here: http://www.nytimes.com/2007/12/18/health/18tren.html?ex=1355634000&en=513a31769b8713f0&ei=5124&partner=permalink&exprod=permalink

Update on Ransom Ads

The Wall Street Journal Health blog reports that the NYU Child Study Center is pulling the controversial "Ransom Notes" public awareness campaign. The intention of the campaign was to raise awareness of the problem of untreated mental health illnesses in children. But many protested that the campaign went too far.

The NYU Child Study Center says they will continue the dialogue on mental illness in the coming year. See the link to the study center statement here: http://www.aboutourkids.org/about_us/public_awareness##

Miss Evers' Boys

The Tuskegee syphilis study is a horrific example of medical researchers abusing participants in the name of science. The abuse is almost hard to fathom in the abstract: researchers allowing African American men to die from syphilis despite known effective treatment. The abuse becomes all the more real when you hear the individual stories of the men affected by the 40 year study. The stories come alive in the movie Miss Evers' Boys. No one advocated on behalf of these men. No one spoke up to protect them. Those who tried to speak up went unheard. Nurse Evers tried her best to care for the men and nurse them in their time of need, but even she was lead to believe that letting these men die was the best she could do for the future of science.

Jumping through institutional review board hoops can be aggravating at times, and may even seem to inhibit research. But these regulations are in place to protect real people. And protecting the rights and safety of research subjects needs to be as important as the data being collected.

Desperately seeking a kidney

The New York Times Magazine had an engaging story about a woman seeking a kidney donor on Sunday. You can find the story here: http://www.nytimes.com/2007/12/16/magazine/16kidney-t.html?ex=1355374800&en=23384ef453ea4cdb&ei=5124&partner=permalink&exprod=permalink.

There is a huge shortage of transplantable organs. And many believe living donors may be an answer to that shortage. But the donor takes on a tremendous psychological burden. Many potential donors end up backing out when the full weight of what they are considering sets in. And the person receiving the transplant takes on a potential burden of a lifetime of guilt as well. These are difficult questions and the author doesn't pretend to have all the answers. But they are important questions to consider when it comes to the future of organ donation.

Does this campaign go too far?

A campaign by the New York University Child Study Center to raise awareness of the silent public health epidemic of child mental health illness is getting people's attention and raising eyebrows. The campaign uses billboards and advertisements depict ominous threats about depression, autism, obsessive-compulsive disorder, Asperger's syndrome and bulimia. For example, the autism ad reads: "We have your son. We will make sure he will no longer be able to care for himself or interact socially as long as he lives." The idea is to raise awareness of how mental health illness "kidnaps" millions of children. See an article in The New York Times here: http://www.nytimes.com/2007/12/14/business/media/14adco.html?ex=1355374800&en=8bf0e7a608ccac2b&ei=5124&partner=permalink&exprod=permalink

But some are concerned that these ads go too far. Some worry that these ads only further stigmatize these illnesses. Others are concerned the ads cast the young people who live with these illnesses in a negative light, that these young people are trapped, when families spend so much time trying to emphasize the things people with these illnesses can achieve.

But these ads are getting people's attention and they are getting people talking about mental illness. Isn't that the idea? Or is this the wrong way to get people talking?

Giving is good for you

The New York Times ran an article and blog today about the psychological benefits of giving to others http://www.nytimes.com/2007/12/11/health/11well.html?ex=1355115600&en=8759bebe20b79539&ei=5124&partner=permalink&exprod=permalink and http://well.blogs.nytimes.com/2007/12/11/are-you-a-grinch-or-a-giver/.

It's easy to rail against the materialism of the holiday season. The materialism does after all take the focus away from the true purpose of the season, that is the celebration of the birth of the Messiah. And I have my own cache of holiday nightmare stories this season. But I do love the joy and apparent psychological high of giving a great gift to someone I care about and love. I especially love giving special handmade gifts. So when the craziness of the season threatens to steal your joy, the answer may be to find the nearest Salvation Army bell ringer and get a little high from giving.

a little bit of looney fun

The Wall Street Journal Health blog had a little fun this morning http://blogs.wsj.com/health/2007/12/07/hospital-casting-call-st-looney-tunes/. The blog points readers to another health blog Aggravated DocSurg who has a little fun casting the usual characters found in a hospital as Looney Tunes characters. http://docsurg.blogspot.com/. Sometimes the best thing you can do is have a sense of humor.

For the record, I am not a doctor, but I feel like Sylvester at the Looney Tune hospital.

research safety and efficiency

Research safety and efficiency? Does that seem like an odd combination? Might someone even say impossible? Well I don't know about that, but I do know some of the mechanisms in place to keep research safe and to protect the rights of participants can seemingly bog down the research experience, not to mention increase the cost. The Wall Street Journal Health blog reports on an effort by Duke University and the FDA to improve the nation's clinical trial process http://blogs.wsj.com/health/2007/11/20/duke-fda-put-clinical-trials-on-the-examining-table/.

No matter the changes to the clinical trial process, patient safety must remain paramount. Every regulation has a face behind it. The regulations are in place because there has been terrible abuse among research participants. But efficiency is also a worthwhile goal. And an efficient clinical trials process may mean that drugs get approved sooner, at less cost, but are still properly examined for safety and efficacy.

Reforming the clinical trials process will be an arduous task. But it is a process that will only succeed if the parties involved keep their eye on the goal of safe and efficient clinical trials and not exclusively on the fiscal bottom line.

doctors and professionalism

The New York Times Health blog posted an article about a recent Annals of Internal Medicine survey about doctors and professionalism http://well.blogs.nytimes.com/2007/12/03/how-professional-is-your-doctor/.

Especially concerning is the number of physicians who are aware of and do not report medical errors. But there is a larger, systematic issue at play here. We cannot expect physicians to report medical errors when the system is stacked against them. There is a huge professional liability to reporting errors, whether your own or a colleague's. And while we can hope that a physician's ethical beliefs would cause him or her to rise above this, we cannot depend on it. I'm not saying that there are no situations in which the doctor should be held liable. But health systems have to work on a way that encourages doctors to report risks and errors without a constant fear of legal implications.

a public face on a misunderstood disease

OK, I'll admit it. I've occasionally watched America's Next Top Model (not regularly, just when I need background noise when working on a craft project). Well this exceedingly shallow show proved to be a launching pad for one young woman, and I'm not talking about launching her modeling career. Heather Kuzmich, one of the contestants, has the neurological disorder known as Asperger’s syndrome. Asperger's is considered a form of autism and can manifest itself in social awkwardness and trouble making eye contact. And now this young woman has found herself as a spokeswoman of sorts for the cause. Audiences have seen the awkward manifestations of the disease in Heather's behavior on the show. And this has given her a platform for raising awareness. http://www.nytimes.com/2007/12/04/health/04well.html?ex=1354510800&en=43391992a37eb3ac&ei=5124&partner=permalink&exprod=permalink.

Other public figures have put a face on poorly understood or socially stigmatizing diseases by their disclosure of living with the disease: Betty Ford and breast cancer, Magic Johnson and AIDS. If anything, these public persons open the door to creating dialogue about these diseases. And whether or not they sought the spotlight or were thrust into it, these people may in some ways find it empowering to tell their story. And they might just help others find their voice along the way.

Health care and the movies

'Tis the season for serious award-seeking movies. And it seems the health care industry is playing a starring role in several movies this season. And these aren't just your usual doctor as a character in a love story or even your run-of-the-mill good old hospital drama. These movies are taking on issues such as living with paralysis and the terror of waking in the middle of a medical procedure. You can see the blog on this topic on the Wall Street Journal Health blog and links to reviews of the movies here: http://blogs.wsj.com/health/2007/11/30/health-care-now-playing-at-a-theater-near-you/.

Personally, I'm not entirely surprised that health care is playing such a role at the movies. These are stories of life and death, stories of how we live and how our lives affect the lives of the people around us. That's compelling human drama.