Researching and trusting your doctor

Dr. Pauline Chen wrote her column yesterday about Angie's List, an online community where participants can rank and review service providers, and now allows patients to rank their physicians. Dr. Chen observed how when reviewing service providers such as roofers, participants detailed the quality and competence of work, often giving details such as supplies used, quality of technique and even photos of finished products. But when ranking doctors, patients consistently ranked physicians higher for things such as attentiveness, and gave failing grades to physicians who were brusque and rushed. But the reviews of physicians said little about physician's actual medical skills. Dr. Chen then goes on to discuss the difficulties patients have in assessing and researching physician skill and competence, and why patients need to take an active part of their health care by researching and knowing about their physicians.

You can find the column here: http://www.nytimes.com/2008/12/19/health/18chen.html?partner=permalink&exprod=permalink

And the blog and comments here: http://well.blogs.nytimes.com/2008/12/18/in-doctors-we-trust/

What do you think? How should patients take a more active role in their health care? How can patients do this without putting physicians on the defensive?

More on the experience of prostate cancer

I wanted to include two more links with regards to the blog I posted yesterday about New York Times editor Dana Jennings and his articles about his experiences with prostate cancer.

You can find yesterday's Well Blog and comments here: http://well.blogs.nytimes.com/2008/12/15/prostate-cancer-in-the-flesh/

And all of Dana Jennings' articles about his experience with cancer are here: http://well.blogs.nytimes.com/tag/jennings/

Being treated for cancer

Dana Jennings, an editor at The New York Times has been undergoing treatment for prostate cancer. He has been writing occasional blogs for the Well blog and today offers his perspective in the Cases section. Today he write about how he feels that as a patient, he is reduced to an abstraction. But every once in a while, his case becomes real to someone.

It's compelling reading. You can find the article here: http://www.nytimes.com/2008/12/16/health/views/16case.html?partner=permalink&exprod=permalink.

physician disclosure rules

The Boston Herald has an interesting article today about proposed new disclosure requirement for Massachusetts physicians banning expensive meals and trips paid for by pharmaceutical companies and requiring disclosure of payments to physicians to promote certain drugs. The proposed laws are believed to be the toughest in the nation, but one group is still critical of the rule because of what it leaves out: physicians will not be required to disclose payments from pharmaceutical companies for clinical research. The proposal's creators said the exception was made to keep clinical trials in the state, but some activists want the state to do more to encourage physicians to disclose all possible financial interests.

You can find the article here: http://www.bostonherald.com/business/general/view/2008_12_11_Doctor-gift_regulations_loophole_hit:_Pay_for_research_stays_secret/srvc=business&position=recent_bullet

What do you think? Should doctors have to disclose payments from drug companies for medical research? What are the possible pitfalls?

Communication with under-age patients

There was an article in The New York Times today about the unique relationship and communication between pediatricians and pediatric patients. Confidentiality and trust are important in a physician-patient relationship, but what about when the patient is a minor, who asks the doctor not to tell Mom what he or she just said. Of course, it is a different matter when the child's safety is at risk, and there is more consideration given to confidentiality with an older teen. But what about a middle schooler? They are still young, but old enough to want autonomy, and old enough to know when their confidence has been betrayed. It is an interesting set of communication challenges.

You can find the article here: http://www.nytimes.com/2008/12/09/health/09klas.html?partner=permalink&exprod=permalink

What do you think? How can pediatricians approach these young patients?

doctors and sleep

The Institute of Medicine released recommendations last week regarding the amount of sleep doctors, specifically residents, should be required to get. The recommendations are in part, to protect patient safety, as sleep-deprived physicians may be more prone to errors.

But Dr. Pauline Chen raises some interesting questions about whether the recommendations may have unintended consequences by depriving young doctors with the ability to put in as many hours as it takes to learn medicine and also preventing doctors from establishing relationships with hospitalized patients because they have to fit so much into the limited number of hours they can be at the hospital that they sacrifice time at the patient bedside. There are also concerns about problems with hand-offs between doctors at the end and beginning of shifts.

So what do you think? How can we balance physician's education time with patient safety? How can we encourage hands-on learning, but guard against abusing residents with inordinate hours in the hospital? What are the benefits and drawbacks of regulating physician activities like the number of hours they can work?

You can find the article here: http://www.nytimes.com/2008/12/05/health/05chen.html?partner=permalink&exprod=permalink

And Dr. Chen's blog here: http://well.blogs.nytimes.com/2008/12/04/what-if-your-doctor-doesnt-want-to-nap/

Media bias in clinical trials reporting

The ACRP Wire published an article about a couple of journal articles discussing shortcomings in how mass media report on clinical trials. Among the shortcomings, the articles found that media articles failed to report investigators' financial conflicts of interest, information about dose and sample size and methods for randomized trials.

You can find the article here: http://newsmanager.commpartners.com/acrpwire/issues/2008-12-04/3.html

The mass media has the potential to be a great educator about the complex and fascinating world of clinical trials research. How do you think media could report on clinical trials in a better way?

Too much talk?

The New York Times published an article in today's paper about the "Six Habits of Highly Respectful Physicians" in addition to an article from yesterday which shot up to the top of the most e-mailed list: "Arrogant, Abusive and Disruptive -- and a Doctor." These articles about physician-patient relationships generate a lot of discussion. But sometimes the articles put physicians on the defensive. Doctors have a very difficult job, compounded by a difficult fiscal environment, and all the while patients and patient advocates criticize everything from their communication skills to how often they wash their hands. So does all this talk about physician-patient communication, and the brokenness of the health care system and how physicians can and should improve really help anyone? Or is it just complicating the relationship further by putting physicians on the defensiveness?

How can we make these conversations more constructive?