Dr. Bruce Campbell, a physician at the Medical College of Wisconsin, wrote a feature article in JAMA, which was featured in The New York Times Health blog. I was excited to see this because I have been to a humanities interest group at MCW where Dr. Campbell talked about his writing and he is a clearly a doctor who sees the value of contemplating the effects of medicine on the hearts and souls of patients, doctors and students.
Dr. Campbell's article is about his personal experiences treating a patient whose religious beliefs prevented him from using blood products during the surgery. It is a compelling read about the the inner turmoil when a physician's values conflict with a patient's values, and life and health is in the balance.
The NY Times blog is here: http://well.blogs.nytimes.com/2008/02/27/faith-in-the-operating-room/ and Dr. Campbell's blog is here: http://www.froedtert.com/HealthResources/ReadingRoom/HealthBlogs/Reflections/ListeningtoLeviticus.htm
Thursday, February 28, 2008
Tuesday, February 26, 2008
Writing for your health
The New York Times Health blog points to an article in the journal Oncologist that confirms what many people have already experienced: that journaling can help cancer patients improve their quality of life. The article is here: http://well.blogs.nytimes.com/2008/02/26/the-power-of-words-for-cancer-patients/.
It isn't so much just repeating facts in writing. That actually has little benefit. What is beneficial is writing about the feelings and experience of cancer, as a way of acknowledging your fears and the changes that cancer brings. It is about giving yourself a voice, even if it is only on paper.
It isn't so much just repeating facts in writing. That actually has little benefit. What is beneficial is writing about the feelings and experience of cancer, as a way of acknowledging your fears and the changes that cancer brings. It is about giving yourself a voice, even if it is only on paper.
Monday, February 25, 2008
medical dilemmas
The New York Times had an article today about how some people are hesitant to get DNA tests for diseases for which they are at risk because of the possible implications. It's not just learning you are at greater risk for a disease, but the risk that employers and insurers may also learn of your risk. The article is here: http://www.nytimes.com/2008/02/24/health/24dna.html?ex=1361682000&en=75993f1a1501661c&ei=5124&partner=permalink&exprod=permalink.
It is a difficult dilemma. While there are laws in place to protect patients from discrimination, the fears the patients have about getting medical coverage are real. This reality adds one more complicating layer to the relationship between doctors and patients. When patients fear they will lose their medical coverage, this may give them a reason not to be honest with their doctor and not let their doctor know their entire medical history, even if it could save their life.
It is a difficult dilemma. While there are laws in place to protect patients from discrimination, the fears the patients have about getting medical coverage are real. This reality adds one more complicating layer to the relationship between doctors and patients. When patients fear they will lose their medical coverage, this may give them a reason not to be honest with their doctor and not let their doctor know their entire medical history, even if it could save their life.
Thursday, February 21, 2008
Who needs to know I'm ill
The New York Times Fashion and Style section had an interesting story today exploring the complexities of employees disclosing chronic illnesses to their employers and co-workers. You can find the article here: http://www.nytimes.com/2008/02/21/fashion/21WORK.html?ex=1361336400&en=00e18701a23ca5e9&ei=5124&partner=permalink&exprod=permalink.
It is an interesting dilemma. There are laws in place to prevent discrimination, but this is hard to enforce in practice. As a culture, Americans tend to value health and vitality and hard work, and chronic illness may be seen simply as weakness. This is yet another worry for those already dealing with the complexities of chronic illness. A caring doctor or patient advocate can be a sounding board for a person making this difficult decision.
It is an interesting dilemma. There are laws in place to prevent discrimination, but this is hard to enforce in practice. As a culture, Americans tend to value health and vitality and hard work, and chronic illness may be seen simply as weakness. This is yet another worry for those already dealing with the complexities of chronic illness. A caring doctor or patient advocate can be a sounding board for a person making this difficult decision.
Wednesday, February 20, 2008
knowing the vulnerability of being a patient
Dr. Richard Friedman, professor of psychiatry at Weill Cornell Medical College wrote an interesting piece in The New York Times today about psychiatrists knowing themselves as they explore the minds of their patients http://www.nytimes.com/2008/02/19/health/19mind.html?ex=1361250000&en=94fd6ed3fad82e9c&ei=5124&partner=permalink&exprod=permalink.
Psychiatry is unlike any other medical specialty, and in no other specialty is the relationship between doctor and patient as important. As Dr. Friedman says "If your cardiologist does not have the best bedside manner but effectively treats your hypertension, you might not be happy, but at least you are heading in the right medical direction. In contrast, if you do not have a rapport with your therapist, then the treatment is useless."
The psychiatry field is changing and the role of therapy in training psychiatrists is diminishing. Dr. Friedman says it was once common for psychiatry residents to undergo psychotherapy themselves, but the practice is becoming less common. But the psychiatrists who have undergone therapy can better understand the anxiety, frustration and vulnerability that comes with being a psychiatry patient. These psychiatrists would better understand all that their patients are experiencing.
Dr. Friedman does make an interesting point that therapists bring their own history to the therapeutic relationship. It seems a therapist who has explored his or her own feelings would be better equipped to explore his or her patient's feelings.
Psychiatry is unlike any other medical specialty, and in no other specialty is the relationship between doctor and patient as important. As Dr. Friedman says "If your cardiologist does not have the best bedside manner but effectively treats your hypertension, you might not be happy, but at least you are heading in the right medical direction. In contrast, if you do not have a rapport with your therapist, then the treatment is useless."
The psychiatry field is changing and the role of therapy in training psychiatrists is diminishing. Dr. Friedman says it was once common for psychiatry residents to undergo psychotherapy themselves, but the practice is becoming less common. But the psychiatrists who have undergone therapy can better understand the anxiety, frustration and vulnerability that comes with being a psychiatry patient. These psychiatrists would better understand all that their patients are experiencing.
Dr. Friedman does make an interesting point that therapists bring their own history to the therapeutic relationship. It seems a therapist who has explored his or her own feelings would be better equipped to explore his or her patient's feelings.
Monday, February 18, 2008
The doctor is online
The New York Times Health blog posted an article today about an article in The Archives of Surgery which reported on the use of e-mail between patients and surgeons. Simply providing the surgeon's e-mail address nearly triples the likelihood the patient will contact the surgeon about the surgery http://well.blogs.nytimes.com/2008/02/18/the-doctor-is-online/.
E-mail is a potentially powerful tool to facilitate conversations between patients and physicians. It gives a method for a patient to ask potentially embarrassing questions, and also gives patients a chance to take their time and compose questions, rather than getting flustered during a short appointment. But some physicians believe good medicine can only be conducted in person, and others fear how e-mail could be used in the event of a malpractice law suit. There are also real concerns about e-mail's lack of security, which makes e-mail communications non-HIPAA compliant.
What do you see as the possibilites for e-mail or some other sort of secure messaging service between physicians and patients? Could this be an important tool for facilitating communication between patients and physicians? Or should physicians and patients both be concentrating on improving face-to-face communication?
E-mail is a potentially powerful tool to facilitate conversations between patients and physicians. It gives a method for a patient to ask potentially embarrassing questions, and also gives patients a chance to take their time and compose questions, rather than getting flustered during a short appointment. But some physicians believe good medicine can only be conducted in person, and others fear how e-mail could be used in the event of a malpractice law suit. There are also real concerns about e-mail's lack of security, which makes e-mail communications non-HIPAA compliant.
What do you see as the possibilites for e-mail or some other sort of secure messaging service between physicians and patients? Could this be an important tool for facilitating communication between patients and physicians? Or should physicians and patients both be concentrating on improving face-to-face communication?
Thursday, February 14, 2008
the trouble with creating campaigns
The New York Times published an interesting article today about Britain's struggles to create a nationwide anti-obesity campaign. The article is here: http://www.nytimes.com/2008/02/11/business/media/11adco.html?ex=1360472400&en=f9a7f5ae40a339a3&ei=5124&partner=permalink&exprod=permalink.
Everyone agrees on the the problem, but few agree on the solution. Especially contentious is whether food marketers would be able to use the symbol on their products. Others are concerned than any advertising campaign would be a drop in the bucket compared to how much food advertisers will spend to counter the advertising and market their own products.
The British case shows all the considerations that have to go into the decision to create health awareness campaigns. What other factors need to be considered?
Everyone agrees on the the problem, but few agree on the solution. Especially contentious is whether food marketers would be able to use the symbol on their products. Others are concerned than any advertising campaign would be a drop in the bucket compared to how much food advertisers will spend to counter the advertising and market their own products.
The British case shows all the considerations that have to go into the decision to create health awareness campaigns. What other factors need to be considered?
Tuesday, February 12, 2008
Seeking a second opinion
Dr. Robert Klitzman, a psychiatrist at Columbia University, wrote an opinion piece about the difficulties of seeking a second opinion in today's New York Times http://www.nytimes.com/2008/02/12/health/views/12essa.html?ex=1360472400&en=930ce81b5bfc8d73&ei=5124&partner=permalink&exprod=permalink.
Second opinions are an invaluable tool in preventing medical errors. But seeking a second opinion can potentially create an awkward strain on the relationship between patients and physicians. Seeking another opinion may create ambiguities over just who is the patient's doctor. And second opinion are not always covered by insurers.
Dr. Klitzman has been interviewing physicians who found themselves as patients and he found that the answer is not black-and-white. Some physicians thought second opinions were acceptable, but third opinions are not. Some considered the acceptability of second opinions to be based on the complexity and risks of the proposed treatment. There is a taboo on questioning your colleagues, but also a responsibility to do what is best for the patient.
Asking for a second opinion will never be easy, even with a doctor you respect and trust. But honest communication on the part of both the patient and physician can make the process easier.
Second opinions are an invaluable tool in preventing medical errors. But seeking a second opinion can potentially create an awkward strain on the relationship between patients and physicians. Seeking another opinion may create ambiguities over just who is the patient's doctor. And second opinion are not always covered by insurers.
Dr. Klitzman has been interviewing physicians who found themselves as patients and he found that the answer is not black-and-white. Some physicians thought second opinions were acceptable, but third opinions are not. Some considered the acceptability of second opinions to be based on the complexity and risks of the proposed treatment. There is a taboo on questioning your colleagues, but also a responsibility to do what is best for the patient.
Asking for a second opinion will never be easy, even with a doctor you respect and trust. But honest communication on the part of both the patient and physician can make the process easier.
Monday, February 11, 2008
Reliable cancer information on the web
The Journal Cancer has an article in its March 15 issue that says that aout 95% of the information about breast cancer on the Internet is accurate. You can see a Washington Post article about the journal article here: http://www.washingtonpost.com/wp-dyn/content/article/2008/02/11/AR2008021100809.html.
Patients should always be cautious about any information they get from the Internet, and always consider the source and recency of the information. But the good news is there is a lot of good information available to patients. This kind of information can help patients ask questions and have meaningful conversations with their physicians.
Patients should always be cautious about any information they get from the Internet, and always consider the source and recency of the information. But the good news is there is a lot of good information available to patients. This kind of information can help patients ask questions and have meaningful conversations with their physicians.
Wednesday, February 6, 2008
thinking about prescription drug advertising
The Wall Street Journal Health blog wrote a piece yesterday about Consumers International, and the spoof they have produed of a prescription drug advertisement. The blog is here: http://blogs.wsj.com/health/2008/02/05/striving-for-an-antidote-to-drug-marketing/.
And the video is here:
Consumers International and their web site http://www.marketingoverdose.org/ raise some important questions about prescription drug advertising. The group raises some important points about the relationship between drug companies and patient organizations and the lack of transparency in these relationships.
I hesitate to rule these drug advertisements out altogether. I still continue to believe that these advertisements can be a valuable tool to help patients articulate questions and initiate conversations with their doctors. And more involved patients ultimately have better outcomes because they understand their treatment and care. But these ads can be potentially problematic when consumers do not understand the limitations of the advertisements and do not understand that these drugs have risks. These problems require better education and awareness about the pharmaceutical industry and meaningful conversations between patients and health providers.
There is clearly a desire from health consumers for information about drugs, devices and treatments that can improve their health. But the information pharaceutical companies is slanted to paint the drug in a positive light. Is biased information potentially useful for health consumers, even if it only helps consumers ask more questions? Or is it time to start thinking about turning back the clock and returning to a time without direct-to-consumer prescription drug advertising?
And the video is here:
Consumers International and their web site http://www.marketingoverdose.org/ raise some important questions about prescription drug advertising. The group raises some important points about the relationship between drug companies and patient organizations and the lack of transparency in these relationships.
I hesitate to rule these drug advertisements out altogether. I still continue to believe that these advertisements can be a valuable tool to help patients articulate questions and initiate conversations with their doctors. And more involved patients ultimately have better outcomes because they understand their treatment and care. But these ads can be potentially problematic when consumers do not understand the limitations of the advertisements and do not understand that these drugs have risks. These problems require better education and awareness about the pharmaceutical industry and meaningful conversations between patients and health providers.
There is clearly a desire from health consumers for information about drugs, devices and treatments that can improve their health. But the information pharaceutical companies is slanted to paint the drug in a positive light. Is biased information potentially useful for health consumers, even if it only helps consumers ask more questions? Or is it time to start thinking about turning back the clock and returning to a time without direct-to-consumer prescription drug advertising?
Tuesday, February 5, 2008
A couple of books
Here are a couple of books for your winter reading pleasure. How Doctors Think by Jerome Groopman offers insight into how doctors diagnose patients and what that means for patient care. Groopman says physicians should be careful not to match a patient's symptoms against their mental templates or clinical prototypes too quickly. Physicians need to take the time to really listen to their patients. Sometimes when you hear hooves, it is a zebra. The book is an interesting read for patients to understand that the clinical diagnosis process is not always straightforward, certain or even rational.
Today, I started reading The Soul of a Doctor - Harvard Medical Students Face Life and Death, edited by Susan Poires, Sachin H. Jain and Gordon Harper. It is a compelling first-hand account of medical students' first experiences in medicine. There is a great amount of reflection and many students admit a certain amount of naivete, but these students are able to eloquently articulate much of what is wrong with medicine and the patient-physician relationship. I just finished the series of essays on Communication and I look forward to continuing with the essays on Empathy, Easing Suffering and Loss, and Finding a Better Way.
Today, I started reading The Soul of a Doctor - Harvard Medical Students Face Life and Death, edited by Susan Poires, Sachin H. Jain and Gordon Harper. It is a compelling first-hand account of medical students' first experiences in medicine. There is a great amount of reflection and many students admit a certain amount of naivete, but these students are able to eloquently articulate much of what is wrong with medicine and the patient-physician relationship. I just finished the series of essays on Communication and I look forward to continuing with the essays on Empathy, Easing Suffering and Loss, and Finding a Better Way.
Monday, February 4, 2008
A child's view of ADHD
The New York Times Health blog ran an article on an interesting study published in the Journal of Pediatric Nursing. Drs. Shattell, Bartlett and Rowe conducted in-depth interviews with college students diagnosed with ADHD as children. The study yielded rich, personal accounts of what it is like to learn and live with the disorder, as well as the coping strategies the students developed and the reaction from parents, friends and teachers.
You can find a link to the article here: http://well.blogs.nytimes.com/2008/02/01/a-childs-view-of-attention-deficit/ and Dr. Shattell included a link to a PDF of the full journal article here: http://www.monashattell.com/uploads/FINAL_I_have_always_felt_different_--_exp_of_ADHD_in_childhood.pdf.
The authors said that nurses will be able to use this knowledge to improve the long-term care and outcomes of children with ADHD. Improved knowledge of what its like to actually have a condition can help providers empathize and better communicate with patients. And better communication can improve patient satisfaction and outcomes in the long-term.
You can find a link to the article here: http://well.blogs.nytimes.com/2008/02/01/a-childs-view-of-attention-deficit/ and Dr. Shattell included a link to a PDF of the full journal article here: http://www.monashattell.com/uploads/FINAL_I_have_always_felt_different_--_exp_of_ADHD_in_childhood.pdf.
The authors said that nurses will be able to use this knowledge to improve the long-term care and outcomes of children with ADHD. Improved knowledge of what its like to actually have a condition can help providers empathize and better communicate with patients. And better communication can improve patient satisfaction and outcomes in the long-term.
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