10 years later

The New York Times ran an article yesterday recalling the reaction of the public and the press to the introduction of the little blue pill, Viagra, 10 years ago. It is fascinating to read the initial reactions to this new drug, with the hindsight of knowing how much this drug would permeate the culture and change how many people view the utility of pharmaceuticals and pharmaceutical companies.

You can find the article here: http://www.nytimes.com/2008/03/30/weekinreview/30word.html?ex=1364616000&en=1f88540fc0d6b536&ei=5124&partner=permalink&exprod=permalink

How not to talk to your doctor

Pediatrician Dr. Barney Softness writes a guest blog today on The New York Times about how not to talk to your pediatrician. Included in the recommendations are to not make promises you cannot keep and not to trick your kids into a trip to the doctor. But the recommendation that generated the most discussion was "Don't tell me your diagnosis." His point was that a thorough description of the symptoms is of more value than a parent simply coming into rule out one diagnosis that they believe is the problem. There was a spirited discussion in the comments section about this assertion. Dr. Softness later clarified that any doctor certainly wants to know about any family history, social history and even what the parent thinks the problem may be. But parents should come in with an open mind and not just to rule out a diagnosis.

As some of the commenters suggested, it is in the approach. As we have discussed before on this forum, effective patient-physician communication requires openness and honesty from both parties. Patients need to be proactive in their care, be able to clearly and honestly articulate their symptoms, and should be open to listening to what the doctor suggests. Doctors need to really listen to their patients, educate them about what they are doing, and encourage them to be engaged in their care. Both parties need to be respectful of the expertise of the other: the doctor who is in expert in medicine and the patient who is an expert on their own body.

You can find the article here: http://well.blogs.nytimes.com/2008/03/27/what-not-to-say-to-the-pediatrician/.

So what about the question one of the commenters posed: Instead of a list of don'ts, how should a patient talk to their doctor?

Prayer. faith and doctors.

Dr. Robert Klitzman wrote a guest blog on the New York Times about the intersection of prayer, faith and doctors. This is a topic of particular interest to me, as my Master's thesis was on how personal beliefs impact how nurses communicate with patients. Dr. Klitzman says he does not think physicians need to be religious, but that they do need to realize how important religious beliefs may be to their patient. Physicians need to be aware of how personal beliefs can motivate and encourage patients and be able to pick up on it.

You can find the article here: http://well.blogs.nytimes.com/2008/03/24/prayer-faith-and-doctors/. A spirited discussion follows about the rationality of science, evidence-based medicine and religion. But I think the key thing to take away for patient-physician communication is that a doctor who realizes the importance of his or her patient's religious beliefs can be a great comfort to the patient.

Patients like me

The New York Times Magazine ran an article on Sunday about a new web site that can potentially change how research is shared among patients with chronic illnesses. "PatientsLikeMe" is a web site devoted to helping patients with chronic illnesses share information and in the process collects a vast amount of quantifiable data about how people live with these illnesses. Because the information is shared voluntarily, the web site has the ability to gather and share a large amount of information with little worry about privacy laws. Patients are able to use this information to make decisions about their own disease management and help facilitate conversations with their own physicians.

This web site has a great potential for getting information and new research to patients and helping them manage their own care. It also is a great resource for propelling research as researchers can watch cohorts of patients who report trying new therapies. But some are concerned about patients self-medicating for complex diseases based on information they glean, and potentially misinterpret, from non-medical sources.

You can find the article here: http://www.nytimes.com/2008/03/23/magazine/23patients-t.html?ex=1363838400&en=71acf69334c63f68&ei=5124&partner=permalink&exprod=permalink

So what's the answer? How do you balance a great resource of data and health information, with standard practice and medical expertise? How does this potentially impact the patient-physician relationship?

risky trials

The New York Times ran an interesting article about parents choosing to enroll their child with an incurable cancer into a risky clinical trial. Clinical research professionals consider something called "therapeutic misconception" when informing potential participants in clinical trials. People sometimes go into clinical trials with unrealistic expectations of a clinical benefit and positive outcome, when really the purpose of a clinical trial is for research and there are no guarantees of benefit to participants. Though in this story, it had a good outcome, it is a reminder that as researchers we need to explain the risks of clinical trials and the reality that there are no guarantees. The parents in this story realize their daughter's story is only the beginning, and that their daughter is a part of a larger body of research in cancer tumors. And they realize the cancer could come back and say they are ready with knowledge if it does.

You can find the article here: http://www.nytimes.com/2008/03/18/health/18seco.html?ex=1363752000&en=6ee45f0ce2097996&ei=5124&partner=permalink&exprod=permalink

two interesting articles

Yesterday evening I was occupied at an Association of Clinical Research Professionals meeting so I didn't get a chance to post this interesting article from CNN about whether the Tuskegee syphilis trial still has repercussions for African Americans participation in clinical trials today. It is an interesting article that examines whether African Americans distrust clinical trials, or if they do not have equal access to opportunities to participate in clinical trials. You can find the article here: http://www.cnn.com/2008/HEALTH/03/17/clinical.trials.ap/index.html.

Today's New York Times ran an article today on trends in medical education, specifically the trend towards specialization in the highly competitive fields of dermatology and plastic surgery. While dermatology was once derided by other medical specialties, new research is drawing in more medical students and residents. Also enticing is the promise of high pay and stable hours as compared to other medical professions. But this has implications for medical care in that fewer doctors are specializing in primary and preventative care, which have longer hours and lower pay. The article explores these issues here: http://www.nytimes.com/2008/03/19/fashion/19beauty.html?ex=1363665600&en=6af29d977d525093&ei=5124&partner=permalink&exprod=permalink

Bothering your doctor

The New York Times Health blog highlighted an article in this month's Annals of Internal Medicine. Dr. Faith Fitzgerald recounted in an essay her struggles to get a hold of another doctor. The exercise in futility causes her to reflect on how difficult it must be for her patients, or any patients, to contact a doctor when they need one. The culture of medicine is such that the doctor is protected from being "bothered," even by the patients who need him or here. When a patient does get through, he or she may feel the need to apologize to the doctor for being a bother, when really, it is the doctor's job to listen to the patient. The blog is here, but the link to the article requires a subscription: http://well.blogs.nytimes.com/2008/03/17/bothering-your-doctor/.

With all the other time pressures and power differentials, even the culture surrounding the doctor makes it difficult for the patient to even approach the doctor with a question, let alone engage in a meaningful dialogue.

When a high profile person has a disability

Soon-t0-be New York governor David Paterson is legally blind. The New York Times Health blog ran an article about the various ways Gov. Paterson copes from day-to-day. You can see the article here: http://well.blogs.nytimes.com/2008/03/13/how-a-blind-man-will-lead-a-state/.

The comments that followed lead to an interesting dialogue. Some people thanked the newspaper for highlighting the story and putting an accomplished face on a disability sighted people could never imagine. Many people wished the governor well. But an interesting side discussion also emerged about how the disabled are treated differently once their disability becomes known. It is informative reading for anyone in the health care industry to get an idea of the problems disabled persons may encounter but may not disclose because they do not want to appear any less able than anyone else. Health care workers may not always know the right questions to ask to really understand the patient's perspective. But open dialogue gives a glimpse into real life.

when a donation causes protest

The New York Times ran an interesting article in the business section today about the protests regarding a donation by clothing company Abercrombie & Fitch to a Columbus, Ohio children's hospital. In gratitude for the gift, the hospital is naming the emergency department after the clothing company. Several advocacy groups are protesting linking a clothing company that uses highly sexually suggestive advertisements to market to teens and preteen and a place of healing. You can find the article here: http://www.nytimes.com/2008/03/12/business/media/12adco.html?ex=1363060800&en=21f3bf5041f6c111&ei=5124&partner=permalink&exprod=permalink.

This article leads to many interesting questions. Departments at hospitals and universities have been named after people for years. Why is a hospital department different? What about the naming of sports stadiums after corporations: how is this different? Would it be different if the company was an alcohol company or a tobacco company? Would it be better if the hospital just put up a large plaque in the department, thanking the company for the donation, rather than naming the department after the company? Hospitals always need money. Do hospitals need to think about the message they are sending by associating with certain companies, or should they just take the money and keep quiet?

The culture of titles

The Wall Street Journal Health blog posted a blog about how a handful of scientists in Germany, who earned PhDs at such places as Cal Tech, as facing criminal charges for using the title "Doctor." Apparently, you cannot use the title in Germany unless your degree was earned in the European Union. You can find the blog here: http://blogs.wsj.com/health/2008/03/07/who-are-you-calling-doctor/.

So what do you think? Is this just a matter of cultural difference? Is it legitimate for a government to want to control who can use a specific title? Or is this all a little much?

When a celebrity gets cancer

The New York Times Health blog ran a series of two interesting blog posts in relation to the actor Patrick Swayze's announcement that he is receiving treatment for pancreatic cancer. The first blog is about the attention a celebrity brings to a disease: http://well.blogs.nytimes.com/2008/03/05/an-actors-diagnosis-may-bring-attention-to-a-neglected-cancer/. The second is about how limited cancer research funds are, and how they should be, divided: http://well.blogs.nytimes.com/2008/03/06/cancer-funding-does-it-add-up/.

Several studies in the past have studied the effect a celebrity face brings to disease awareness and disease screening. It's probably impossible to predict what effect, if any, this latest discussion about pancreatic cancer will bring. But such a high profile cancer diagnosis has the potential to perhaps start a conversation about a difficult diagnosis.

My Sister's Keeper

Last weekend, I read Jodi Picolet's My Sister's Keeper. This was an incredible story about two sisters: the older with leukemia and the younger who was conceived as a genetic donor to save her sister's life. The story is told from the perspectives of the multiple family members and friends affected by this struggle for life. This story shows that ethical questions about genetics and drastic measures to prolong life are more than mere philosophical discussions. These stories affect the lives of people, the people they love, and their own desires for autonomy and justice.

All of this and it was simply a beautifully told story that pulled me into its grip and didn't let me go until I read it from start to finish in one day. In exploring stories like these, medical researchers learn to think about more than just the facts and consider the lives and loves that hang in the balance.

the ethics of the story

The New York Times ran an article today about a Starbucks barista in Tacoma, Washington who is donating a kidney to a regular customer. The story is here: http://www.nytimes.com/2008/03/04/us/04barista.html?ex=1362373200&en=c0a732568c89729f&ei=5124&partner=permalink&exprod=permalink.

The thing that got my attention was not the article itself, but one of the reader comments. This reader thought it was irresponsible to print the story because the donor might feel pressured to give the kidney, even if she has second thoughts, because the story has been so publicized.

So what do you think about this story? Does it create unacceptable pressure on the donor to publicize the story in this manner? Would it have been different if the story was published after the donation took place?

People will talk

Today I had the opportunity to sit in on a Medicine and Humanities class at MCW. The topic of the class was the Carey Grant movie People Will Talk http://www.imdb.com/title/tt0043915/ and the image of the ideal doctor. Fourth year medical students discussed how an ideal doctor behaves and how and when a doctor may decide to cross ordinary boundaries for the sake of caring for the patient. It was interesting to watch the student cringe with some of Dr. Praetorious' actions, but at the same time admire the heart behind those actions.

Every doctor who seeks to practice with compassion and empathy may have to risk crossing boundaries, and even maybe making some people squirm, to provide the best care possible. And doctors can learn a little bit here and there from watching the example of others.