Doctors and quality of life

The Wall Street Journal reported a story today about how a new generation of doctors is seeking a greater work-life balance. Some physicians are rejecting jobs that require after-hours on-call, which has long been a staple of the physician's life. Hospitals and clinics are looking for new solutions, including shift work, to improve not only physicians quality-of-life by having a set hourly work week, but also patient safety.

You can find the article here: http://online.wsj.com/article/SB120942599600151137.html?mod=WSJBlog.

You can find blog opinions and comments, here: http://blogs.wsj.com/health/2008/04/29/call-of-medicine-gives-way-to-family-tug/?mod=WSJBlog and here: http://blogs.wsj.com/juggle/2008/04/29/not-on-call-young-doctors-want-workfamily-balance/?mod=WSJBlog.

Taking a hiatus

My best friend is getting married! So I'm off to primp and help with all the final details, and of course be by her side on her special day. So there won't be any updates from me for about a week or so. But I'll be back online sometime next week.

Emotion at the bedside

The New York Times published an essay today about physicians showing emotion at the bedside of their patients. Most patients want a physician who is empathetic and understanding, but physicians struggle with how and how much emotion they should show. The comments after the article are especially telling, as patients express a range of desires: from those who want an emotive physician and those who want a doctor who tells only the facts.

The article raises the importance of the individual relationship, that requires the physicians to fine-tune perceptions of patients and try to read the patient's desire for an emotive interactions.

You can find the article here: http://www.nytimes.com/2008/04/22/health/views/22essa.html?ex=1366603200&en=1078af22fd5fff5e&ei=5124&partner=permalink&exprod=permalink

Parish Nurses

My hometown newspaper The Milwaukee Journal Sentinel published an article today about the pivotal role of parish nurses. Parish nurses are usually registered nurses who are either hired by or volunteer at churches, to provide care for parishioners. But because they have a unique opportunity to build a sustained relationship with the individual patient and the community of patients, they can provide care in the context of the patient's spiritual and home life, and as such, are able to care for the whole person. In their trusted role, they can also help patients prepare for physicians visits, with pre-interviews to help patients prepare for doctor's appointments, and post-interviews to help patients put doctor's orders into practice.

These nurses play an important role in helping patients navigate the health care system, but also act as a warm and caring extension of the ministry of their respective churches.

You can find the article here: http://www.jsonline.com/story/index.aspx?id=741547

Keeping the door open between doctors and private industry

The Wall Street Journal Health blog brings attention to legislation in Massachusetts that would ban all gifts from pharmaceutical companies to physicians. But a group of physicians from Harvard is opposing the legislation, saying that the vague language of the legislation would effectively close communication between doctors and industry.

Drug reps who visit doctors can play an important education role and provide useful clinical information to doctors. There is cause for concern when the relationship between drug companies and physicians is not transparent, as demonstrated by the revealed use of ghostwriters to write journal articles about drugs. But as in most situations in life, the solution is not to further restrict communication. Greater transparency in the relationship can create an environment where both can learn from and benefit each other.

You can see the article here: http://blogs.wsj.com/health/2008/04/17/bring-on-the-drug-reps/?mod=WSJBlog.

Ghostwriters and clinical drug studies

The New York Times reports on an article published today in JAMA about ghostwriters, hired by Merck, to write up reports on Vioxx. Merck then found prestigious physician researchers to put their names on the reports as they appeared in medical journals.

Some of the physicians argued that they were actively involved in the research. The researchers in question may have been involved, but the troubling point is that the drug company was also involved in the drafting of their journal piece. The practice of the drug companies being actively involved in the drafting of reports raises questions about the objectivity of the research, especially if the company's involvement is not disclosed. The general public will have greater cause to trust the research published, if there is transparency about the research methods and personnel involved.

You can find the NYT article here, with a link to the JAMA article: http://www.nytimes.com/2008/04/16/business/16vioxx.html?ex=1366084800&en=ef29a5f6ea0a6e76&ei=5124&partner=permalink&exprod=permalink

patient perspectives

The New York Times has posted an interactive media health guide offering patients perspectives on recovering after a stroke. The interviews and photos are from a range of patients and ages. It is compelling reading and listening. You can find it here: http://www.nytimes.com/interactive/2008/04/14/health/healthguide/TE_STROKE_CLIPS.html##

Advertising for patients

The New York Times had an interesting article yesterday about the business of plastic surgeons marketing their services. Since plastic surgeons usually perform elective surgeries, they re not subject to insurance premiums and listing as a preferred provider. So they have to advertise to get themselves to stand out.

You can find the article here: http://www.nytimes.com/2008/04/10/fashion/10Skin.html?ex=1365566400&en=53ebad6de28d086a&ei=5124&partner=permalink&exprod=permalink.

What do you think?

More on the last lecture

The New York Times ran an article this week about Randy Pausch, the Carnegie Mellon professor whose "last lecture" containing all the advice he wanted to pass on to his children, has become a media sensation. Pausch, who is dying of pancreatic cancer, is taking his unexpected celebrity to promote funding for pancreatic cancer research. He has also written a book of all the advice he want to pass to his children.

You can find the article here: http://www.nytimes.com/2008/04/08/health/08well.html?ex=1365393600&en=dd3eec2a2c1d6a93&ei=5124&partner=permalink&exprod=permalink.

I missed the ABC special, but Pausch has certainly succeeded in getting people to talk about their dreams and fears. And he has created a lasting legacy for his children.

Asking the difficult questions

The New York Times Health blog posted an interesting article about a study on how some patients have questions asking their physicians difficult questions. Among the most difficult questions to ask on the survey were: "How many times have you done this surgery" and "have you washed your hands?"You can find the article here: http://well.blogs.nytimes.com/2008/04/03/doctor-did-you-wash-your-hands/.

This article reinforces the point that unless the patient feels comfortable asking questions of their physician, effective communication will be difficult, if not impossible. And lack of effective communication can carry real risks, such as compromising patient safety to prolonging diagnosis and treatment of chronic illnesses.

Should prescription ads carry the FDA's phone number?

The Wall Street Journal Health blog is reporting on an effort by Consumer Union to require direct-to-consumer prescription drug ads to carry the FDA's phone number to easier report serious side effects or problems. You can find the article here: http://blogs.wsj.com/health/2008/04/02/consumer-group-says-tv-drug-ads-should-carry-fdas-number/?mod=WSJBlog.

What do you think? Would posting the FDA's number empower patients and get information about adverse events to the public sooner? Or would it just create a logjam of phone calls about minor side effects?

A physician's perspective

The New York Times offered an intriguing first-person account of a doctor observing what could possibly be a serious medical problem in a stranger across the room. Does the doctor speak up, risking being seen as a busybody and potentially worrying or angering a stranger? Or can or should the doctor ignore his or her doctor observations when not acting in the role of a doctor?

You can find the article here: http://www.nytimes.com/2008/04/01/health/views/01case.html?ex=1364788800&en=75fcc34c2940e7d3&ei=5124&partner=permalink&exprod=permalink