Confusion over prescription names

The Wall Street Journal Health blog posted a story Tuesday about a report from U.S. Pharmacopia about the confusion and potential problems caused by multiple drugs with names that sound alike. You can find the story here: http://blogs.wsj.com/health/2008/01/29/confusion-over-sound-alike-drug-names-can-harm-patients/.

What strikes me the most is not the story itself, but the comments by other readers. At least two of the commenters placed a large burden of responsibility on patients. They suggest patients should ask questions of their pharmacist and make sure they are receiving the correct drug for the correct treatment and not shift the blame to thepharmaceutical companies. This is an interesting question for the patient-physicians-pharmacist communication dynamic. Where does the burden lie for making sure the patient gets the correct medication? Or should the burden be shared by all three?

Patient advocates

CNN ran a moving story about a cancer patient who took her diagnosis and used it to propel herself to start a foundation to advocate for other patients. You can see the story here: http://www.cnn.com/2008/HEALTH/01/30/bg.paf.founder/index.html.

The Patient Advocate Foundation helps patients navigate the complex worlds of doctors and treatments. And the people who work for the Foundation help patients find their voice.

transparency in medical practice

The Milwaukee Journal Sentinel has been running a series of articles on medical malpractice in Wisconsin. You can find part 1 here: http://www.jsonline.com/story/index.aspx?id=711582 and part 2 here: http://www.jsonline.com/story/index.aspx?id=711730.

Reading these articles makes me wonder if some of the problems between doctors and patients and lawyers would be resolved by greater transparency in the medical profession. I'm not just talking about disclosing errors, but teaching the public about the medical profession, about what it takes to be licensed and what we can expect of physicians and other medical professionals. What is an error, what is negligence, what is a mistake. What are the acceptable outcomes for a given treatment? Greater transparency and greater understanding would be a foundation for greater trust between patients and physicians and between physicians and the public. And it would be easier than the defensiveness generated by malpractice lawsuits.

MCW in the news again

Last year, the Physicians Committee for Responsible Medicine and the Wisconsin Humane Society protested the Medical College of Wisconsin's use of dogs in its physiology lab. The dogs were anesthetized, cut open so the students could observe the living system, and eventually given lethal doses of anesthesia. Well, this year, the physiology lab is using pigs. The Physicians Committee for Responsible Medicine has responded by calling on the Medical College to stop using pigs. You can see a story in the Milwaukee Journal-Sentinel here: http://www.jsonline.com/story/index.aspx?id=711751. It is not clear if the Humane Society has taken a position yet.

Physiology is the study of living systems, and the animal labs give medical students the opportunity to do just that. But the Physicians group and others have advocated the use of human simulators. But is the experience the same? What do you think?

And now...

And now, the Vytorin ads are gone. http://blogs.wsj.com/health/2008/01/23/merck-schering-plough-silence-vytorin-tv-ads/.

Is anyone surprised?

It seems market forces and legislative pressure took care of things, at least in this case. Is this an argument that there doesn't need to be additional regulation on direct-to-consumer prescription advertising?

Fighting back online

The New York Times featured an article today about the growing trend of blogs advocating body acceptance and fighting against anti-obesity efforts. You can find the article here: http://www.nytimes.com/2008/01/22/health/22fblogs.html?ex=1358744400&en=85e51683f19075d6&ei=5124&partner=permalink&exprod=permalink.

There is a concern among the featured bloggers that health concerns are being used to justify discrimination against obese people that would not be tolerated against other groups. And they point out research that suggests that the relationship between weight and health is more complex than usually presented.

Physicians have a complex job when talking with patients about weight to balance not entirely blaming the individual for their obesity, but also to help the patient realize that weight is largely related to lifestyle. It can be tempting for physicians to ignore or gloss over the complex relationship between weight and health and just tell patients they need to lose weight. But it is clear that many people are not tolerating that paternalistic answer and are fighting back online.

Doctors using viral communication

The New York Times Health blog ran a story about a group of doctors who are responding to a viral e-mail with a viral e-mail of their own. The original e-mail is written by an ovarian cancer survivor advocating the use of a cancer test to catch cancer sooner. Doctors are concerned about the test because its predictive value is not that good and fear that many people are falsely reassured or even undergo unneccessary treatments because of the test. And as a result of fielding a lot of questions about this test, these doctors decided to put their own opinions about the test out into the wild winds of the internet.

You can find the blog here: http://well.blogs.nytimes.com/2008/01/18/doctors-take-on-a-notorious-e-mail/.

So what do you think about doctors putting out information this way? Is it an appropriate way to fight misinformation online? Or does refuting information require a more personal touch in a face-to-face encounter between doctor and patient?

How doctors see themselves

We started enrolling physicians into our study of quality communication last month. So I now spend a lot of time on the phone talking to physicians on the phone, trying to get them to rehearse with me how they will talk to their patients about a screening result. We will later analyze the taped rehearsals for quality of communication.

Physicians are busy, so we knew going in that recruitment would be difficult. But I can't help but speculate about who decides to practice and who does not. I know some people who decline to practice are simply too busy. But I can't help but think that some of those physicians who decline to practice don't think they need to practice. They think they are effective communicators already. And let's face it, most of them likely are not as good as they think they are.

And I wonder about those who decide to practice. Are they acknowledging that maybe they need to improve their communication skills? Or are they just being polite to the very polite screening lab follow-up worker who just happened to catch them on the phone?

It makes me wonder: How do these physicians see themselves and does it affect whether physicians will try to improve their skills?

Congress investigating Vytorin ads

Well, when you can't turn on the television or flip open a magazine without seeing an advertisement for a particular drug, it might get some people's attention. And people will really start paying attention when research emerges that the drug is not as effective as first thought. The Wall Street Journal Health blog is reporting that Congress is investigating advertisements for Vytorin. You can see the blog here: http://blogs.wsj.com/health/2008/01/16/congress-investigates-vytorin-ads/.

This just adds to the continuing debate about the value of direct-to-consumer prescription drug advertising, especially when it comes to drugs that are still being studied. There are indications that drug ads may help some patients ask their doctor more questions and be more involved in their health care. But that value may be limited if patients do not realize the limitations of these ads and the fact that just because a drug is on television does not mean it is more effective than a drug without a big advertising budget.

Coffee!!

Let me begin by confessing, I am a coffee snob. I had an espresso machine in my apartment before I had a bed. I take the time to make my own lattes, just the way I like them at home. Even better, are the ones my Dad makes.

Still, I do find myself at a Starbucks every now and again. That's why the article from The New York Times Health blog caught my attention this morning. Starbucks is trying to shorten the lingo when it comes to ordering drinks. Customers can now ask for a skinny drink and it will come with nonfat milk, sugar-free syrup and no whip, rather than asking for each of these things individually http://well.blogs.nytimes.com/2008/01/15/the-skinny-at-starbucks/.

It raises some interesting rhetorical connotations when you call a drink skinny. Can you really call a nonfat latte a healthy drink? And does the word "skinny" insensitive to those with weight insecurities?

Besides that, it doesn't really help me. I like to order half the sweetener, even the sugar-free, because they over-sweeten their drinks and an extra shot because their drinks are too weak. Or I just go to a independent coffee shop or my dad's kitchen.

First person - the first week of surgery

The New York Times Health blog points to a blog by a third year medical student about his initial experiences in the operating room. You can find the New York Times blog here: http://well.blogs.nytimes.com/2008/01/14/the-mysteries-of-surgeons-revealed/ and the original blog here: http://scienceblogs.com/denialism/2008/01/a_week_of_surgery_some_impress.php.

While commenters may be quick to point out the student's naivete, it is fascinating to read a student's first impressions. So much of the education of a doctor takes place beyond textbooks and lectures. A large amount of medical education takes place as the student soaks in the culture of the practice of medicine and the attitudes of more experienced practitioners. The question is: How do these first impressions impact how that doctor practices medicine years down the road?

Medical Googlers part II

Dr. Rahul K. Parikh has written a response in Salon.com to Dr. Scott Haig's Time article "When the Patient is a Googler." Dr. Parikh suggests that physicians should not disdain the
Internet, but embrace it. Having informed patients ultimately helps the doctor do a better job, as patients who understand their treatment are more likely to comply. And the doctor can be a source for pointing patients to reliable web sites so they can learn reliable, understandable information. You can see the article here: http://www.salon.com/mwt/feature/2008/01/10/web_doctor/index.html.

As I have said before, effective patient-physician communication is the responsibility of both patient and physicians. Physicians have a responsibility to effectively inform patients in a language the patient can understand so the patient can make a truly informed decision. Patients have a responsibility to be honest with their doctor and to take an active interest in their own health. The Internet can be an effective tool to keep both patients and physicians informed. But both have a responsibility to use and study such information to supplement the practice of medicine and the patient-physician relationship, not replace it.

Heart Health and Diet Coke

The National Institutes of Health's National Heart, Lung and Blood Institute is partnering with Coca Cola to bring awareness to women's heart health. Diet Coke is sponsoring NHLBI's Red Dress Fashion Show during Fashion Week in February, as well as sponsoring NHLBI's heart truth ad campaign. But the authors and comments at The Wall Street Journal Health blog are wondering about the connection between a sweet soda and heart health. http://blogs.wsj.com/health/2008/01/08/hearth-health-goes-better-with-diet-coke/.

So what are the ramifications of having a not-so-healthy beverage sponsoring a health campaign? Advertisers align themselves with certain programming to try and project a certain image. Is the advertiser trying to buy a healthy label by sponsoring a health campaign?

Empathy in cancer care

The New York Times highlighted an article recently published in the Journal of Clinical Oncology. A little bit of empathy can go a long way in helping patients understand and stick with their treatment.

You can find the article here: http://www.nytimes.com/2008/01/08/health/08seco.html?ex=1357448400&en=8203887449e399dc&ei=5124&partner=permalink&exprod=permalink.

And the abstract is here: http://jco.ascopubs.org/cgi/content/abstract/25/36/5748.

This article got my attention because it parallels the research we are doing at MCW about quality communication. Empathy is an important aspect of clinical care. It shows the humanity of the doctor and potentially offers the patient hope. But when patients open up about emotions, doctors rarely engage in the discussion and too often, divert the conversation back to science and medicine. But the good news is that younger doctors and those who identify themselves as socioemotional responded better to emotional cues. Emphasis and training on addressing the emotions of health care will help doctors be better equipped to respond to their patients' emotional, as well as physical needs.

Status careers

This article doesn't really have to do with doctors and communication, but it still caught my eye. The New York Times ran an article about how the traditional status careers - doctors and lawyers - are no longer considered the highest status careers. There has been a cultural shift in defining career success, one that focuses more on creativity and flexibility. Doctors and lawyers are important, staid careers, but they lack creativity, and are certainly not flexible as both careers demand long hours.

You can find the article here: http://www.nytimes.com/2008/01/06/fashion/06professions.html?ex=1357275600&en=e6188de13887a970&ei=5124&partner=permalink&exprod=permalink.

Medicine and law both have high burnout rates and growing levels of professional dissatisfaction. Though there are plenty of reasons for both, I propose that if you are going to go into these careers for the right reason. If you are going to these careers for status, you will not be satisfied. But if you go into these careers because they are what you love, that passion can sustain you through the most demanding days.

therapeutic misconception

The Association for Clinical Research Professionals December Wire reported on a study that many research participants do not understand the difference between research and standard treatment and may be under the misconception that enrolling a clinical trial means they will receive better treatment. You can find the article here: http://newsmanager.commpartners.com/acrpwire/issues/2007-12-31/1.html.

The idea of therapeutic misconception highlights the importance of clear and honest communication between the research coordinator and the research participant. The research staff has an absolute imperative to make sure the patient understands the implications of participating in clinical research, including treatment alternatives. That's what informed consent is all about.

Sharing the benefits of government-funded research

The Wall Street Journal Health blog commented that the spending bill President Bush signed last week included a provision that researchers have long been fighting for: NIH-funded research results need to be posted online, for free, one year after the results are published in an academic journal http://blogs.wsj.com/health/2007/12/27/congress-gives-fda-a-raise-sets-information-free/.

This is an exciting development for researchers. Academic institutions have financial limitations to how many journals and databases to which they can subscribe. Having access to emerging research data from NIH-funded research in a searchable, accessible database will facilitate medical research and encourage collaboration.

Explain and apologize

I am still coming down from the holiday busyness and post-holiday catch-up, but I wanted to share this story from The New York Times. Sandeep Jauhar write a firsthand account of how both admitting medical errors and apologizing for them can enhance the physician-patient relationship and even possibly reduce the risk of litigation. http://www.nytimes.com/2008/01/01/health/views/01case.html?ex=1356843600&en=62133043c42c5595&ei=5124&partner=permalink&exprod=permalink

In the past, legal departments discouraged doctors from admitting mistakes. But many states have created litigation to encourage physicians to disclose mistakes by offering some protection from litigation.

It is important to build trust in the physician-patient relationship and one of the most important elements of trust is honesty. And admitting and apologizing for mistakes is one big step in building an honest communication relationship.