Respect and patient-physician communication

The New York Times Health section had an interesting article today, written from a doctor's perspective, about the power of names. The question is: how should physicians and patients address each other? Should physicians insist on being called "Doctor"? Should patients insist on being called Mr. or Ms.? Is a title a show of respect or detachment? When a physician or patient calls the other by his or her first name, is it a way of demeaning the other? Are we over-thinking all of this? The article generate passionate response from both physicians and patients.

The fact that the issue of titles is a concern at all shows the inherent difficulty in effective physician-patient communication. Both parties wield a certain amount of power: one of expertise in a field, one of ultimate control of their body and where they take it. There is a need for respect in this communication relationship, but also a need for intimacy. How do you balance formality and respect with the intimate nature of physician-patient communication and clinical exams? And what do you call each other when you do it?

Intimate acts of care

Registered Nurse Theresa Brown, a regular contributor to the New York Times Well section, offers insight into the intimate acts nurses perform in the care of cancer patients. The essay demonstrates that communication between nurses and patients goes beyond words, to intimate moments of touch, comfort and care.

Giving as an act of healing

The New York Times Well blog reviewed a book that explores the health rewards of giving to others. Giving to others isn't a medical cure for anything, but is presented as a means of helping patients cope and gives them hope. The book and the article cite some of the science and questions behind the idea of giving as a means of healing. But in this case, the science isn't as compelling as the stories of patients who have gained from giving to others. And we will all do well in this season to remember that the joy of giving is a joy unto itself, regardless of the benefits.

The Cancer Lounge

The New York Times had a compelling article last week about the cancer recreation lounge at Memorial Sloan-Kettering Cancer Center in Manhattan. The lounge is a place for patient to both forget about their cancer and talk about their cancer freely with other patients who understand. It is a compellling read about the waiting involved in cancer treatment and the simple joy a card game can bring.

Tension at the Thanksgiving dinner table

The New York Times Well column this week reflects on the tension that sometimes joins the family at the holiday table. In particular, issues surrounding food, portions, control and preferences, can cause anxiety when families join together for a big meal. The article illustrates that health messages are not always healthy and that the messengers aren't always health professionals. We should all remember there is power in our words.

New breast cancer guidelines and possible confusion

New screening guidelines by the Preventative Services Task Force of the Department of Health and Human Services may start a lot of conversations in exam rooms across the country. The Preventative Services Task Force is recommending women be screened for breast cancer starting at age 50, with follow-up mammograms every other year. This is a change from previous guidelines and and is opposed by many cancer associations, which recommend annual mammograms starting at the age of 40.

The contrasting guidelines will likely be a source of confusion for some patients, faced with the decision to have a mammogram. It will be all the more important for physicians to provide effective counseling and ongoing dialogue with patients to help them make the decision that is right for them.

The importance of a name

The New York Times had an article today about the intangible importance of having a name for a disorder and how patients claim ownership of that name. The issue is being raised by a group of patients unhappy that the term Asperger's Syndrome will be removed from fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Asperger's Symdrome is a mild form of autism, in which children and adults often are socially awkward but many are verbal prodigies and highly skilled in specific expertise. But inconsistent diagnosis and a move to depict mental illnesses as falling on a spectrum rather than "they-have-it-or-they-don't" mentality have lead the editors of the D.S.M.-V to place what is known as Asperger's on the autism spectrum. But patient advocates are concerned that losing the well-known and well-accepted term will make others reluctant to seek treatment if they exhibit mild autism spectrum symptoms.

The American Psychiatric Association is expected to post a draft of the new terms and diagnostic criteria and solicit feedback from the community. There will likely be a lot of it, and the feedback will give the authors insight into how patients see themselves and their community.

The physical environment and communication

The New York Times blog on aging, "The New Old Age," had an article that illustrates how interpersonal communication isn't just about two people talking, but is also about the environment and circumstances surrounding the interaction and the relationship. The article takes a look at Continuing Care Retirement Communities or CCRC, where residents can enter into an independent living apartment and be moved within the same building to an assisted living floor when the time comes. Intuitively, these facilities seem like a great idea: residents can make friends while they are still independent and mobile and when they require more assistance they will still be able to remain in the same community. But studies and observations are finding that moving within the same facility doesn't mean relationships stay in tact. It seems physically moving, even if it is only to another floor of the same building, can disrupt interpersonal and community relationships.

What do you think? Is there a way these facilities can better accommodate communities as individuals' needs change?

Cancer and Halloween

I don't have much to add to this. Dana Jennings, a reporter for The New York Times, has chronicled his life with prostate cancer for the NYT Well blog. This week, he wrote about Halloween and the ghosts of cancer. You can find his eloquent post here.

Being a doctor and a patient

As part of their ongoing series on the 40 year war on cancer, The New York Times did a profile on the M.D. Anderson Cancer Center in Houston, Texas. Among the stories were the unique perspectives of both a nurse and a physician who faced a cancer diagnosis and treatment in the place where they have cared for so many patients.

The article touched on how being a patient might affect a physician's perspective:

“A common question people would ask is ‘Are you a better doctor since
you’ve been sick?’ ” Dr. [Martin] Raber said. “My first answer is that I
thought I was a good doctor before. I was worried about being a worse doctor.
Having lived through these biopsies and all these tests, would I be hesitant to
order all these things patients need because I had experienced them and knew
they were not pleasant?

“Then I realized I am not better, but I am a different doctor,” he said. “I
talk to patients differently. I understand more of what their situation might
be.

“My life was very different than it was before that day in the CT scanner,”
Dr. Raber said. “It’s not the life I thought I would have. But my life is still
really good."

Communication about cancer screening

Yesterday, the American Cancer Society announced a shift on their position on certain cancer screenings. The Cancer Society said that American medicine has over-promised on the benefits of screening and some screenings over-diagnosis disease while missing other deadly diagnoses.

While there is healthy debate about the Society's decision itself, from a health communication perspective it reinforces that medical professionals need to take time to engage in discussion with their patients about the real risks and benefits of screening exams. Many patients expect medicine to be certain, where in reality uncertainties abound and not every decision is as simple as "You should get this test when you reach this age." Clinicians need to understand how each individual patient understands and assess risk and other health information. There is a growing body of research examining both how individuals understand numbers (numeracy) and how they assess risks and benefits. But the research is meaningless unless physicians and patients engage in continued dialogue and education about the goals of care, treatment and screening. Continued conversations won't necessarily make the decisions about screening quicker or easier, but they have the potential to ensure that individual doctors and patients the decision that is right for them.

How do food companies define health food?

The Food and Drug Administration has sent a warning to food manufacturers about the criteria they are using to label foods "healthy." The FDA is concerned that too many healthy labels without clear criteria for defining what is healthy may confuse consumers. And some obviously unhealthy foods have been defined as a healthy using the manufacturers own standards.

The article about the warning made me chuckle, if only because I immediately thought of my least favorite commercial on television right now. I yelled at the television the first time I saw this commercial. Something to the effect of "You've got to be kidding me!" That's right, Kellogg's is trying to market Froot Loops as a healthy food. "They make your tummy happy." Sure, fiber is good, but I don't think health is Froot Loops best selling point.




What do you think? Does the FDA need to step in and set standards for what manufacturers call healthy food?

Fellow inmates provide hospice care in prisons

The New York Times had a compelling article about the growing geriatric prison population and how some prisons are starting hospice programs to provide care for the aging population. Some of the programs use prison volunteers, other prisoners to visit and provide comfort to the dying prisoners, who may not have family members who will visit in their dying days. The programs appear to have a dual benefit, both for the dying prisoners and for the prison volunteers. The dying receive some comfort at the end of life; the volunteers make a human connection with another person and learn to express empathy and emotions many have buried for a long time.

There are some challenges with programs like this, especially the risk that dying prisoners will pass pain medications the volunteers, who can sell them to the general prison population. But the prison volunteers can provide a compassionate ear in a way that a guard or nurse simply cannot.

What parents can learn from the books their children read

The New York Times Well column had an article today about what parents can learn about the lives and thoughts of their children from a popular book series. The article highlights the series Diary of a Wimpy Kid. The books talk about the regular struggles of a regular kid, a kid to whom readers can relate. The stories give insight into how a child struggles internally with issues of fairness and ethics and relates how a child works through these dilemmas, not how an adult thinks a child should work through them.

For many families, the books are serving as a catalyst of discussion between parents and children. What other books might help spur family communication?

Public health reading list

The Web site RNcentral.com has published a list of 50 excellent public health blogs. I am not familiar with all the blogs on the list, but I am looking forward to doing some reading.

Ongoing debate regarding physician's speaking fees at University of Wisconsin

The Milwaukee Journal-Sentinel had a story today about the ongoing debate at University of Wisconsin about the speaking fees UW physicians can receive from pharmaceutical and medical device companies. Earlier this year a new conflict of interest policy was proposed which would ban UW physicians from giving presentations paid for by pharmaceutical and medical device companies. But uproar from orthopedic physicians has meant an exemption for presentations about medical devices but maintains the ban for drug talks. The proposed policy has raised debates about ethics in medicine, conflicts of interest, and power and influence in medical schools. Some physicians are concerned about their own autonomy to conduct their medical practices and supplement their incomes as they see fit. Others are concerned about how one group of physicians was able to influence the policy in their favor.

Whatever the outcomes, it seems that these debates are only beginning, as medical schools and physicians continue to consider the interaction between pharmaceutical and medical device companies and medical practitioners.

Doctors in distress

Dr. Pauline Chen outlines the dangers of doctors under stress in her column this week. Personal, fundamental stress, beyond the normal stresses of the job, can cause as much harm and as many errors as a physicians who is sleep-deprived.

But I think what is most compelling about this column and Dr. Chen's other columns are the personal stories and anecdotes about physicians and the difficulties they face on the job. It is one thing to see your physician and think "Hey, he seems stressed." But it is another thing to hear firsthand from real physicians about their occupation and the stresses and insecurities that accompany it. Being able to empathize with the person on the other side of the exam table can be a valuable part of fostering trust and building a communication relationship between physicians and patients.

Interruptions to communication

The New York Times Cases section had an interesting discussion about interruptions during a clinical visit, both by the physician and the patient, and the chilling effect on communication and clinical care. The author outlines his typical response to disruptions. How do you think patients and physicians should handle disruptions? How can the interruptions be handled in a way that minimizes the potential harm they may cause?

Medical students behaving poorly

Several media outlets reported on a report this week from the Journal of the American Medical Association about medical students behaving poorly online. With the increased use of social media web sites, more schools are reporting incidents of poor behavior, including profane language, drunken behaviors, and sexually suggestive material. But few medical schools have policies of professionalism that extend to students' presence online. The report shows that medical schools have much work to do to address emerging technologies and work on ways to teach future doctors how to navigate the online social media world in a professional and appropriate manner.

A firsthand account of H1N1

Well if he was looking for an angle to tell the story, he now has it. CNN's well known medical correspondent Dr. Sanjay Gupta is now able to report on the H1N1 flu from the perspective of a patient. Dr. Gupta contracted the virus in Afghanistan and wrote about his experience as a physician/patient in his blog. Personal experiences color our communication with others. It will be interesting to see how the experiences of high-profile patients like Dr. Gupta will influence communication about H1n1.

Doctors working with spiritual healers

The New York Times had an article last weekend about a new program in a California hospital where Hmong Shaman are encouraged to visit patients and perform healing ceremonies in the hospital. The program is an example of how effective communication can foster understanding between patient and physicians, and also between cultures. Both the spiritual healers and the physicians have learned from about what the other does and why. Welcoming the Shamans has also helped to build a more trusting relationship between the Hmong community and Western medical practitioners. The Hmong patients, and the communities they come from, may be better able to trust and communicate with their physicians when their religious beliefs are upheld in the process.

10 countries, 10 approaches to an injury

The New York Times reviewed a book today "One Injury, 10 Countries: A Journey in Health Care" by Washington Post journalist T.R. Reid. The book reveals the different approaches and costs associated with the same frozen shoulder. I am intrigued by the premise. What do you think? What do these anecdotes add to our current health care policy debate?

Gauging public reaction to extreme caution

The New York Times City Critic conducted an amusing social experiment of sorts. Ariel Kaminer donned gloves, mask, goggles and a paper suit in a simulated effort to protect herself from the H1N1 flu and also gauge reactions to her protective measures. The result was an opportunity to examine the fine line between caution and excess. Interacting with others in society carries certain risks, including swine flu, but the potential rewards are worth the risk.

More on ghostwriting in medical journals

A study that was reported this week at a conference of journal editors sheds some new light on the use of ghostwriters in medical journal articles. Ghostwriters are paid writers who do not appear on the list of academic authors, who may be paid by pharmaceutical or medical device companies. The concern is that the unattributed authors introduce bias into a source where physicians turn for the latest in scientific developments.

It appears that some of the discrepancies in the study may be due to different journal policies having different authorship disclosure requirements. But this remains an important issue. Transparency in medical research and reporting is absolutely necessary in order to evaluate the evidence and make the best treatment decisions for the patients. Failing to disclose all the authors and their affiliations withholds an important key to sound medical-decision making. I hope that this study will encourage more journals to evaluate their current policies and work to make their author reporting requirements more transparent, so we can all learn from and evaluate the latest in medical research.

Medical students experience the ills of the health system firsthand

The New York Times had an article today about how medical students at the University of Washington spent their summer in underserved rural areas and clinics, where they learned firsthand about the ills of the American health care system. The students not only learned about how busy these clinics are, but also about the realities of reimbursements, matching prescriptions to Wal-Mart's $4 generic list, and ordering extra tests as protection against lawsuits.

The education the University of Washington medical students received working in those clinics cannot be found in any textbook or lecture. Seeing how the problems in the health care system affect real patients has the potential to open eyes and spur these young soon-to-be doctors to action, whether that action be advocacy for their individuals or advocacy on a policy level. And seeing how the health system affects patients will help prepare physicians to communicate and empathize with their patients as they navigate their way through the system and to good health.

Health care crisis close to home

The New York Times had an article featuring a clinic in my hometown of Milwaukee, Wisconsin. The clinic is the only urgent care facility in the northern part of the city, and while it serves a great need in a part of the city with few primary care doctors, it still faces financial collapse and it may not even be helped by provisions in both the Federal stimulus package and the proposed health care reform legislation. The eye-opening feature discusses the real problems patients in lower incomes neighborhoods have accessing care, even when they qualify for state-subsidized insurance. The case of Milwaukee Immediate Care shows that improving access to health insurance is only part of what is needed for real health care reform.

The pressures when the patient is a VIP

The New York Times Well blog had a guest column today exploring the potential problems and pressures when a patient is a VIP. A VIP patient may cause a physician to second guess their course of treatment or a VIP may insist on a treatment that the physician knows may cause harm. But if a physician fears losing the prestige or the monetary benefit of having a VIP patient, that fear may cloud the physician's sound medical judgement.

From a communication perspective, it demonstrates how extreme power imbalance in a relationship impairs effective and honest communication. When physicians hold all the power, patients have trouble finding this voice. When patients have the power in the relationship, physicians have the some trouble.

The lasting trauma of having a child in the NICU

I wanted to be sure and highlight The New York Times article today discussing the long-term potential trauma associated with having a child in the neonatal intensive care unit. These are the kind of underlying issues that physicians and nurses need to be aware of when speaking with patients and parents about treatment and health care decisions. Communication is not just about the current conversation, but all the previous conversations and experiences that color our perspective. And having a child in the NICU can make a lifelong impression.

Experiencing a patient's perspective firsthand

The New York Times featured an article today about an innovative geriatric education program, in which medical students have the opportunity to experience life in a nursing home. Medical students at the University of New England are given a diagnosis that an elderly patient might have and spend two weeks living as a patient with that diagnosis, including medical exams, being assisted in and out of bed, and passing the time with other nursing home residents. The goal of the program is that the two week experience better equips future geriatric doctors to interact with and understand their elderly patients. When clinicians can empathize with their patient's situation and actions, they will be better able to communicate with their patients about their medical and quality of life needs.

Talking about end-of-life care

A provision in the proposed health care reform legislation to reimburse physicians for discussions with patients about their wishes at the end of life has been misunderstood and even misinterpreted as government intervention to ration care to elderly patients near the end of life. The provision is gone now, but the provision has started conversations about end-of-life care in homes and doctors offices across the country. Conversations about what the kind of care patients want at the end of life should be ongoing, both with the patient's physician and the patient's family. But when a patient is near the end, often the person to have the difficult end-of-life conversation with the patient is a palliative care specialist. The New York Times had a compelling article today about palliative care doctors and how they approach their difficult job. I think the most important part of this article is the conversations that it is capable of generating, both online and in hospitals and physicians offices and homes across the country. The only way to assure that you or a loved one will reach the kind of end-of-life care you want at the end is to have ongoing, respectful and honest conversations.

Talking to your doctor about conflicts of interest

The Wall Street Journal Health blog pointed to an interesting article this morning in the Washington Post about potential physician conflict of interests and the difficulty patients have in asking their physicians about them. Patients don't want to ask questions that might alienate their physicians, but many express interest in knowing just how much influence pharmaceutical companies may have on their physician. There are some mechanisms for finding out this information on your own, such as physician and practice profiles online, especially if your physicians works for an academic medical center. And there is now proposed legislation to create greater transparency by disclosing all pharmaceutical company payments of more than $100. This transparency will equip patients to ask their physician more about their prescribing habits.

Of course, being able to find this information yourself is good, but it doesn't replace the real need for conversation between physicians and patients. Patients need to be able to express their concerns about potential physician conflicts of interest. Physicians need to know that their patients have concerns and perhaps help the patients gain insight into the physician's prescribing thought process. But the question is how to start these conversations between physicians and patients. Ideas?

Another great source for information on the health care debate

The Association of Healthcare Journalists offers a great resource page for finding facts of the health care policy debate. It's a great source for journalists and all citizens looking to get beyond the shouting.

Making sense of the health care reform debate

The New York Times has taken an extra step to help inform readers about the health care reform debate. The online edition has added a new blog in the Health section called "Prescriptions" devoted to the dissecting the health care debate. The writers are off to a fast start, filling the page with articles about the key players in the health care debate, criticisms of policy proposals, and even analysis of advertisements and public service announcements.

This kind of analysis is long overdue. There has been so much shouting and arguing over the possibility of health care reform that there has been little time devoted to what the actual proposals are and what changes may or may not occur. I especially like the informative graphic showing how the different proposals would affect Americans in different economic and marital situations. The availability of this kind of information probably won't stop the shouting and arguing, but it does give the rest of us a chance to consider the future of health care in this country.

How can physicians and patients find reliable information?

The New York Times had two articles in two different sections that together highlighted the problems both physicians and patients can encounter in accessing reliable health information. In the first article, the "Room for Debate" feature in the Opinion section, several contributors debated whether direct-to-consumer prescription drug advertising should be banned. The second article in the Health section examined the use of ghostwriters in medical journals, and the lack of disclosure when pharmaceutical companies sponsor journal articles.

Both articles, and the accompanying comments, demonstrate the desire and need for both physicians and patients to find reliable health information. But that task is often difficult. The argument often presented in favor of direct-to-consumer prescription drug ads is that they make information available and accessible to the patient. But that information is obviously one-sided, and some fear that the ads interfere with another important source of information: the patient's physician. Physicians on the other hand, turn to medical journals to find the latest in medical research. But when articles are influenced by pharmaceutical companies, with or without disclosure of that influence, it makes it all the harder for physicians to discern which new practices are best. Both articles demonstrate the need for transparent communication, whether it is transparency in advertising or transparency in research. But that transparency is easier said than achieved.

Doctors from Cuba starting over in the U.S.

The New York Times had a compelling article today about Cuban doctors who have defected to America and the struggles some go through to establish themselves in the medical field in their new country. Foreign trained doctors have to complete four rigorous exams and several years in residency training before being licensed to practice in the U.S. For many Cuban doctors, lack of proficiency in English and residency programs that favor younger physicians, means that the compelling dream of coming to America will require them to make the choice to take other jobs in the medical field, such as nursing or medical technicians.

It is difficult to think about what it must be like to make that decision - to devote years to retraining to pursue that profession you have already trained for in a new home or even to give up a profession you feel called to in order to pursue new opportunities and new freedoms. The compulsion to pursue medicine, to help others in their time of need, is strong. Even for those who cannot pursue medicine in the U.S., deep down still feel like the physicians they are called and trained to be.

Campaigning for health care reform

In 1992 and 1993 opponents to health care reform ran a series of ads featuring a fictional middle class couple, Harry and Louise, who were worried that health care reform would limit their access to care. Now health care reform is before Congress again and Harry and Louise are reprising their roles. But this time, the grayer Harry and Louise are in favor of health care reform. The New York Times article has links to videos from 1992 and 2009.

In some ways, the change reflects the changing landscape of the costs of health care. The change also reflects the different groups that are coming together for health care reform that did not come together in 1992. But in addition to all of those factors, after watching the clips, I think you'll agree that reviving the Harry and Louise ads is just smart advertising.

When the doctor has a hard time saying no

CNN had an interesting article exploring the reasons why physicians can have a hard time saying no to patient requests, even when those requests could be harmful to the patient. One of the factors is time: it may simply be easier to give a patient what they ask for rather than have a conversation about why it is inappropriate. But sometimes, the requests are difficult to turn down because of the nature of the physician-patient relationship. The physician wants to help their patients by providing them the care they want. And physicians don't want to lose patients by denying requests.

Patients are expected to take an active role in their own health care and are increasingly treated like health care consumers. With increasingly informed patients, physicians need to have real discussions with their patients, even when the topic is uncomfortable. This means taking the time to discuss the real risks and benefits of treatments. And patients need to be willing to listen their physicians, even when the physician declines their request.

Physician lawmakers see the health care debate up close

The 16 physicians who serve in the U.S. Senate and U.S. House of Representatives have all seem the problems with the current health care system - patients who cannot afford prescriptions, patients who cannot get insurance, and working with the limits of managed care. But they don't agree on how the U.S. should address health care reform. An article this week in the New York Times shows the perspective that these physician lawmakers bring to the health care reform debate. They can agree of a few key points - the importance of insurance portability and eliminating pre-existing conditions. But the physicians, like Congress at large, do not agree about whether a public option should be part of the solution or what that would look like.

Though they do not always agree, the physician lawmakers offer a unique voice in the conversation about the future of health care. These physicians have a unique platform to speak up for their patients and to speak up for all the health care workers who would help them. If they make use of that platform, we will all benefit.

Answering the question "Where did I come from?"

The New York Times had an article last weekend about the additional complexities of answering a child's question "Where did I come from?" when a surrogate is involved. No matter what technology was used to conceive a child, parents are encouraged to communicate to children that no matter how they came about, they are with the parents they are supposed to be with. And with more and more surrogate pregnancies, more families are going to consider just how they will communicate their unique story with their children.

Convent offers model for end-of-life care

The New York Times had a compelling article this week about a convent in New York providing comfort, care and support to elderly sisters at the end-of-life. The sisters in the convent communicate with their social network and their physicians about the care they wish to receive, and ultimately the death they want to have. Most of the sisters die at home in the convent, surrounded and comforted by their loved ones, and without aggressive medical treatment if they so choose. The convent offers a model of care for elderly patients, in which they are able to express their desires, and to be comfortable and at home in their last days. At the core of the model are open communication between patients, physicians and the social network and respect and tender care for patients at the end.

How does what we believe affect how we communicate?

How does what we believe affect how we communicate? How does religious belief intersect with professional life, especially when the profession is health care? These questions piqued my interest in 2005 and I had the opportunity to explore them as I pursued my Master of Arts degree in communication at Marquette University. I defended my thesis and graduated in 2006. But I still had more to learn and to share, so I took my thesis research on the road. I presented my findings at the International Conference for Communication in Healthcare in 2007, and then began the process of submission, rejection, revision and resubmission to get my thesis research published. The result was a more refined look at the question that first caught my attention: How does what we believe affect how we communicate? In the survey, I found that a nurse's religious beliefs can enhance the clinical experience without the nurse trying to impose his or her beliefs on the patient, as the nurse works to make sure the patient's religious beliefs are upheld.

The article has been accepted for publication in Patient Education and Counseling. You can find the article here. If you do not have access to an academic library and would like to check out the article, please let me know.

The danger of nurse stereotypes

Theresa Brown, an oncology nurse and regular contributor to The New York Times Well column, wrote this week about a new book, "Saving Lives: Why the Media’s Portrayal of Nurses Puts Us All at Risk.” The book and Brown's column explore the stereotypes surrounding nurses and the problems that those stereotypes can create. The stereotypes come from everything from media depictions of nurses to lack of understanding about the range and depth of nurse education. Such stereotypes can impede effective communication between patients, nurses and other medical staff, and as such can impede clinical care.

Many patients never learn the complex and diverse roles that nurses play until they find themselves in a hospital bed. Better educating the public about the many different roles in medicine will create a better clinical environment for everyone and will take some of the mystery, and fear, out of the medical experience.

The comfort of routines

New York Times editor Dana Jennings has been documenting his struggles with cancer and cancer treatment in the NYT Health section. Today he discusses perhaps one of the toughest questions after treatment ends: What's next? Rigorous treatment builds a routine for cancer patients, make them feel as if they are doing something to face the cancer. Cancer treatment also introduces the patient to a community of other patients also receiving treatment. But after active treatment ends, the patient may not be done with cancer, but loses the comfort of a routine and knowing what to do about it.

It is a compelling reminder that facing cancer does not end in the treatment room.

Communication and medical myths

The New York Times Well blog had an article today about a new book that explores common medical myths, that both physicians and patients believe to be true. The article made me think about the role these myths may play in how patients and physicians communicate with each other. After all, if a patient can write off a symptom to a commonly held belief, will he bother his physician with the detail? Or will a physician dismiss a patient's complaint if it seems to fall under common medical belief?

What both physicians and patients believe to be true about health can be taken for granted when trying to communicate. How should physicians and patients work together to create an environment where both can communicate about and explore even the seeming simplest medical symptom?

Cancer researchers playing it safe

The New York Times published the first article in a series today about the the struggle to make progress in cancer research. This article focuses on the dilemma of grant funding. Because groups like the National Institutes of Health (NIH) have a limited amount of money and many applicants, the NIH tends to focus on grants with guaranteed results. But these studies yield little in the way of new knowledge. And this approach to funding means that innovative, high-risk, potentially high payoff studies don't get funded at all. An accompanying article explores what should be done.

What would you suggest grant reviewers should focus on, when considering innovation, risks and payoffs in cancer research?

Where can the doctor go for help?

The New York Times Mind section offered an interesting insight into how psychiatrists learn from each other and the close relationships they form in the process. But the close relationships these psychiatrists form make it all the more difficult to reach out to seek psychiatric help if they need it, if only because they often know all the colleagues in the area. But the psychiatrists know it is worse to not seek help at all, so they seek other solutions.

No news is not always good news

The New York Times reported on a new study by researchers at Weill Cornell Medical College that shows that more than 7 percent of clinically significant test results are never reported to the patient. The tests included significant results from blood tests, x-rays and other imaging studies that would potentially affect the patient's ongoing treatment. The results show gaps in communication between physicians' offices, specialists and labs, that can result in important results, and possibly the next steps in treatment, falling through the cracks. It also shows the importance of patient communication. If a patient doesn't hear the results with a week or two, the patient should nudge the lines of communication by calling the physician's office and inquiring.

Will tweeting improve physician communication?

That was the question posed by AACH on Twitter (@aachonline). An article in Health Leaders Media examines the trend of hospitals using Twitter to reach out to patients, families and potential new patients. The trend isn't necessarily going to bring in new patients, but many hospitals see it as a means of becoming more transparent with increasingly involved patients and their families.

Twitter is a potentially powerful communication tool, but it is only as powerful as the people using it. Physicians, nurses and hospitals using Twitter have to approach it the same way they approach all communication with patients. That is, it is best to be transparent, honest and to speak in a language the patients can understand. Physicians should listen to their patients as to how much and what kind of information they want and need. Twitter can a great tool for listening to patients in addition to talking at them.

Social support during illness and social media

CNN had an interesting story this week about the importance of social support when facing an illness and the role social media can play in creating a place for that support. Web sites and social networking sites can give patients and families a chance to share their stories and hear about the stories of others. Dr. Charles Raison, an assistant professor of psychiatry and behavioral sciences at Emory University School of Medicine and CNNhealth.com's mental health expert said in the story "The jury is still out a little bit on whether social support helps you survive -- but it definitely helps you live better."

One of the best New York Times headlines ever

The headline?

"Lights, Camera, Contraction!"

In all seriousness, the article in the New York Times Style section examined the trends of childbirth videos on Youtube.com and the value of these videos to expectant moms and families. Many years ago, before childbirth was moved to the hospital, women and girls would have seen many childbirths, as their mothers and sisters gave birth at home. But now many women may not see a childbirth until they experience their own and as such may not know what to really expect. The youtube videos offer a raw and very real account of childbirth, unlike sanitized and heavily edited versions show in a birthing class, or unrealistic fictionalized births on television. The mothers get to share their story and their joy and the moms-to-be can get a glimpse of what to really expect.

The struggle to be a nurse

Oncology nurse Theresa Brown, a regular contributor to the Cases section of The New York Times writes today about the emotions and fears she felt when she transitioned from her career as an English professor to her career as a nurse. It is a detailed account of a patient struggling to breathe and a new nurse working to find her footing in a career where nothing is predictable and lives hang in the balance. It is a candid and compelling read about the emotions clinicians rarely disclose but nonetheless influence how clinicians communicate and build relationships with their patients.

The importance of rapport in taking the expanding medical history

The American Academy of Communication in Healthcare (@AACHonline) tweeted an American Medical News story about the challenges of taking a medical history and importance of rapport in collecting those histories. Physicians are being asked to collect more social and health information from patients in shorter interviews, all while updating new electronic records, often with a computer in the room. The article explore the importance of developing trust between physician and patient and cultivating educational elements into the history-taking process.It is a difficult but important task, as the history-taking is an important element in diagnosis and in educating and working with the patient to develop treatment plans. The article discusses specific strategies such as question-asking and repeating back what the patient says to better understand the patient's concerns.

Letting patients have their say

Dr. Pauline Chen's column this week focuses on a conversation with health quality expert Dr. Donald M. Berwick. Dr. Berwick advocates a radical change in how health care is delivered in this country to a system that is truly patient-centered. As it stands now, the system is physician-centered; everything from how the hospital gowns to the set up of medical records is set for the convenience of the physician. But such physician-centered care creates passivity in patients, when numerous studies and experience show that active and engaged patients have better health outcomes.

But advocating a radical shift to patient-centered care and decision-making raises questions about the burden on the patients. Physicians train for years to learn evidence-based medicine and best practices. Is it fair or responsible to ask a patient with no medical training to weigh and make major decisions about their care, especially when they are sick?

It seems that the ultimate goal of patient-centered care is that the patient would have an active voice in the planning of their care. That is not to say that the patient does the physician's job, but that the patient and physician are able to openly communicate about the reasons for and against a course of treatment and both are able to come to and understand a decision for treatment. Effective and on-going communication and trust are fundamental to this process. If a patient doesn't understand the reason for a treatment or doesn't trust the physician's skills and intentions, then neither the patient nor the physician is going to get anywhere near quality of care and outcomes.

The power of being able to talk at the end-of-life

The New York Times had a compelling case yesterday written by a psychoanalyst who examine the importance of being able to talk at the end-of-life. The author captures the dignity that patients experience when they can talk about their fears and hopes surrounding life and death. It is an important reminder of why all health care workers should strive to make sure patients have a voice, both in their care and to tell their story at the end of their story.

celebrity weight loss and our own health

The New York Times had an article about celebrities' public weight battles and how their reactions to their bodies affect with readers and their own struggle with, or acceptance of, their own weight. Some of the efforts to lose weight set unrealistic, and even unsafe, weight loss. Beyond that, celebrity reactions to their bodies and their weight gain foster unhealthy body image.

Not all health messages are healthy. Public health workers and health communicators need to take into consideration the other messages and other stories being told when creating health campaigns.

The importance of compassionate communication at end-of-life

There’s nothing like a networking event to get you reenergized about the work you do. Last night I attended a Marquette alumni networking event and I got into a conversation with an alumna who is a hospice nurse and also has a background in communication. In the course of our conversation, she asked me about some of the trends in communication research in health care. After telling her a little bit about the study I am working on at the Medical College of Wisconsin, I said that there is a tremendous amount of compelling research on situations she would be familiar with: communication about breaking bad news and communication about the end-of-life.

Sure enough, Dr. Pauline Chen’s column this week was about communication at the end-of-life and the difficulties it raises. These are difficult but very important conversations. These conversations are especially difficult because they are layered with family members who may not be ready to accept such a diagnosis, the uncertainty the physician has at the length of time a patient may have left, and religious and cultural beliefs about death. Physicians also worry about taking away hope from their patients. But studies have found that patients who are made aware of their condition have a better quality of life in their final days.

I was also excited to tell my fellow alumna about my own research on nurse-patient communication regarding end-of-life care, and was especially pleased to be able to tell her that after three years of revising and editing, my article was accepted for publication in Patient Education and Counseling.

These are important conversation for physicians, nurses, patients and families to have. And as Dr. Chen points out, they should not be one-time conversation, but should be ongoing.

The history of discrimination in medicine

The New York Times had a compelling article today from Dr. Barron H. Lerner about the little known history of Jewish physicians facing quotas and discrimination in hospitals in the U.S. in the early 20th century. The practices weren't explicit, so they were hard to track and document, but many medical schools and hospitals discriminated against Eastern European Jewish physicians and medical students. Lewis P. Rowland discusses the history of discrimination in "The Legacy of Tracy J. Putnam and H. Houston Merritt." The book documents one physician's strategy for working around the quotas to hire many top physicians who were fleeing from Europe in the years leading up to World War II. Dr. Putman was later fired from his job as the head of Columbia's Neurological Institute, because he refused to fire all "non-Aryan physicians."

Dr. Lerner notes at the end of the article that the quota policies largely disappeared after the end of World War II, but that the contribution of Dr. Putnam should not be forgotten.

hospitals and social media

The New York Times had an article yesterday about the growing trend of hospitals using various types of social media to reach potential patients. In the past, hospitals have been quite conservative about marketing and advertising, but now you can find hospitals posting videos of surgeries on youtube, surgeons twittering during surgery, and patients blogging about their care at a hospital.

Hospitals see social media outlets as a cheap way to reach out to potential patients, who are increasingly doing more research and comparing hospitals for treatment, rather than simply going where the doctors sends them. But ethicists quoted in the NYT article raise some important questions, not just about patient privacy concerns, but also about the responsibilities hospitals have regarding how they represent themselves. Do these videos and other outreaches paint too rosy a picture of medical care at a given facility? Do hospitals have an obligation to disclose on the video what can go wrong during a procedure? There are also serious questions about using social networking sites to recruit volunteers for clinical trials. After reading the article, I would add questions about whether patients might be coerced into allowing a physician to broadcast a procedure or to give a positive review for a web video.

The article raises important questions. What do you think? What ethical questions should hospital consider when thinking about social marketing strategies?

occupational risk

Dr. Pauline Chen wrote an article today about the occupational risk facing physicians. Physicians have the honor and obligation to treat patients, but with that, run risk for infection and disease. But the actual risk is largely an estimate, since there is no registry to document the number of occupational deaths of health workers, unlike similar registries for fire fighters and police officers.

How do you think this information would shape perceptions of health workers? You can see some comments on the article here.

Not just disclosing payments, but making them public

The New York Times reported today that the Vermont legislature has passed a bill that requires pharmaceutical companies to make public how much money is paid to doctors and to whom. This legislation goes beyond other state measures restricting what pharmaceutical companies can pay to physicians to require complete disclose of all payments made to individual physicians. The law also bans nearly all gifts, including free meals, to physicians, nurses and health systems. The idea is that making the information public will give patients information about a physician's potential financial interests.

What do you think of this kind of information? Is it useful to patients?

Fighting for unapproved drugs

The New York Times had a compelling article yesterday about one family's fight to access a new drug to treat ALS that has not been approved by the FDA. The story is gut-wrenching. It's hard not to feel for the patients, who are fighting for any shred of hope of treatment. But at the same time, it's hard not to see the side of the FDA, who doesn't want to release harmful drugs or promote false hope.

There is no easy or final answer to this dilemma. It will likely continue as long as there are new drugs in development and patients and their families are looking for any hope for treatment.

The potential trouble with novels and eating disorders

The New York Times Well blog had an intriguing post about the influence novels may play in giving young people ideas about anorexia. Girls with anorexia, or teetering on the edge of anorexia, may look at books that portray the horrifying consequences of anorexia as inspirational rather than precautionary. The literary detail may even function as a how-to guide.

No one thinks that someone would pick up a book like the reviewed Wintergirls and decide that anorexia is glamorous and decide to try it. There are likely a host of other psychological issues at play in those with eating disorders. But if someone with those psychological issues picks up that same book, could it be a trigger? Can these stories be told any other way?

You can find the review of the new book Wintergirls here and a discussion on Well here.

A patient tells her story

Connie Culp, the first U.S. face transplant patient, is now telling her story. Though her story is not yet complete, in coming forward, she is hoping to help foster acceptance of others who have suffered from burns and other disfigurements.

How we see ourselves and see others

The New York Times had an interesting article earlier this week about how we perceive ourselves and how we perceive others regarding moral decisions. People tend to over-estimate their own moral goodness and use the over-estimation when judging the behaviors, or moral shortcomings, of others. The author explores how this over-confidence can benefit in some circumstances and hurt in others.

Nurses and physicians learning from each other

I enjoyed the article yesterday from Registered Nurse Theresa Brown in The New York Times Well column. She examines the relationship between nurses and physicians, and how both learn from each other. Nurses learn from doctors and younger doctors often learn from the experience and guidance of nurses. I thought the final quote was particularly pointed: "There’s always more to learn, and no matter how hard any of us try, there’s rarely enough time for one person to learn it all."

More on pharmaceutical companies and physicians

The New York Times had an article today about an Institute of Medicine report that advises stopping the flow of gifts from pharmaceutical companies to physicians. While pharmaceutical companies have voluntarily stopped giving small gifts, such as pens and notepads, earlier this year, but the IOM report goes even further, recommending the end of industry-sponsored medical education courses. The recommendation to end industry-sponsored education courses is the most controversial, because many physicians and the companies argue that the courses provide a valuable and necessary service, to educate physicians about rapidly changing medical advances. But others warn about the dangers of bias and influence that pharmaceutical companies wield.

bad advice

Dr. Peter Ubel offers a physician's perspective on giving patient's the information they need to make a decision, even if it means giving bad advice. The article examines the complications of the physician-patient relationship when it is not simply a directive relationship, but one in which a physicians acts as a patient's guide.

You can find the article here.

Review board steps aside approving a fake study

The Wall Street Journal Health blog had an article today about Coast IRB, a for-profit Institutional Review Board that approved a fake study posed by the Government Accountability Office. The GAO conducted the sting operation to see if for-profit IRBs adequately review and supervise medical trials and the interest of research subjects. The approved study had a fake company, falsified records and an unapproved product. The company failed to ensure that risks to subjects were minimized and whether the research would be conducted under acceptable legal and professional guidelines. As such, the company has agreed to stop reviewing new FDA-regulated studies and halt enrollment to previously approved studies. The company itself will undergo complete restructuring, with a new board, new standards of practice and frequent internal audits.

The case shows the importance of institutional review of clinical research studies and the importance of knowing that the reviewers are capable of doing their jobs.

lessons from pharmaceutical sales

The New York Times had an article today about how the New York City health department is taking a lesson from pharmaceutical sales forces. The health department sends health educators to clinics in under served areas to detail city health resources and educate physicians about health interventions. The educators come armed with posters, condoms, and yes, even pens, to reinforce their message. They also work to build on-going relationships with the physicians and clinics they serve.

What do you think? What other strategies can public health workers learn from other industries to make their message stick?

The science behind health policy

John Tierney wrote an article in today's New York Times science section about the science behind political health policy decisions, citing New York mayor Michael Bloomberg's initiative to cut the nation's salt consumption in half. Tierney expressed concern about the lack of randomized control trials as evidence that cutting salt so drastically will have a health benefit. He also expressed concern about what happens to science when a health policy seems to declare a matter closed. See what others have to say here.

What do you think?

health literacy and the responsabilities of health and communication

Dr. Pauline Chen's column in the New York Times last week examined patients with limited health literacy and the effect that has on their health. Doctors talk and patients don't always listen and doctors get blamed for talking over patients heads. But as some of the commenters on Dr. Chen's column pointed out, communication is always a two-way street. If patients don't understand, shouldn't they ask more questions? Shouldn't patients be proactive participants in their own care? But how can the patients ask questions if they don't have a relationship with their doctor, don't trust their doctor, are intimidated by their doctor?

There are no easy answers in human communication.

How far should a smoking ad go?

The Today Show aired an interesting story this morning about an anti-smoking ad running in New York. The ad shows a very upset little boy, lost in a train station, and asks the audience to imagine if he was this upset to lose you for a minute, how upset would he be to lose you for a lifetime?

Some are concerned about the little boy in the ad, asking if those tears are a little too real to be acting. But it also raises the question of how far is too far to go in a health ad.

Visit msnbc.com for Breaking News, World News, and News about the Economy

What do you think? Does it go to far? Or is it effective?

Two perspectives on patients and those who comfort them

The New York Time Health section had two stories that at first may not seem to have a connection. But on closer examination, both offer the perspective of the those who comfort a patient in their time of need and what the comforter gains from being with a patient.

The first is from Dana Jennings, an editors for The New York Times who has been chronicling his course with prostate cancer for the Well blog. His blog today is on the comfort provided by his dog.

The other story is from a medical student Nell Burger Kirst, who recounts how he watched the boyfriend of an ailing patient reach out to comfort others.

Both stories show the power of living connections. Healing doesn't just come from medicine, but also from caring and a warm touch.

who should be a doctor?

The New York Times reported on a case from Sweden that raises the question of who should be a doctor, or who shouldn't be a doctor. The questions arise from several cases in Sweden of people with criminal backgrounds getting into top medical schools. Because medical schools in Sweden are not allowed to conduct background checks, it raises questions or where and when they can limit who practices medicine.

You can find the article here.

What do you think? How should Sweden approach it?

a nurse's perspective

Registered Nurse Theresa Brown offers a beautiful perspective of a nurse's distress over a dying patient. She also writes about the hard time families and physicians and doctors have when a patient is near death. Everyone wants to do the right thing, but it can be hard to know what the right thing is.

You can find the article here.

financial disclosures, medical research and journal readers

The Wall Street Journal Health blog had a story late last week about JAMA's editor's reaction to a reader who criticized the journal for printing a story without disclosing the author's financial ties to the pharmaceutical industry. You can find the article here.

Obviously, we don't know all the details about what happened since some of the parties involved aren't talking to the media. But what struck me was the tension in academic research to be competitive, publish interesting findings, be relevant, but all the while keep an arm's length from the pharmaceutical companies. So even the appearance of impropriety makes the editors of a well-known journal saying the first things the pops into their head to discredit the reader who raises a question about an article.

What do you think?

Patients feeling abandoned by their doctors

Dr. Pauline Chen reports on a study published in the Archives of Internal Medicine which examines the emotions of physicians, caregivers and patients near the end-of-life. Many patients and caregivers reported feeling abandoned by their physicians. Physicians were aware that patients might feel abandoned, and even believed they were taking steps to prevent it, but patients still reported feeling abandoned in their last hours. Dr. Anthony Back, lead author of the study, attributed the misunderstanding to physicians who may not realize the importance of closure to patients. And patients may not be able, or think they need to, speak up.

You can find the article here and the comments here.

What do you think?

Do physicians really want patients to ask more questions?

Patient advocacy groups encourage patients to speak up and ask their physicians questions, even asking if the doctor has washed his or her hands. But as Laura Landro of The Wall Street Journal writes, despite the encouragement, many patients are still reluctant to ask questions, and some who do ask might get a response that discourages such questions in the future.

You can find the article here.

What do you think? What else can advocacy groups, clinicians and others do to encourage patients to speak up?

How one case changed medical education

It can be easy to forget the many of the rules and regulations in place in medical education and medical research were put in place because of specific cases. Real people are behind the push for greater regulation, oversight and safety. And sometimes it can be one case that is the catalyst for a major change. Such is a case of Libby Zion, who died 25 years ago this week. Her death at New York Hospital while under the supervision of harried residents with little or no sleep lead to reforms in work hours and supervision rules for medical residents all over the country. Dr. Barron Lerner offers a compelling account of the case and the rules put in place since then here.

Dr. Pauline Chen examines some of the implications and ethical dilemmas raised by the hour restrictions. Among the consequences are errors and problems with patient hand-offs, when one shift of physicians briefs an oncoming shift and the ethical dilemmas when residents are faced with the prospect of leaving a patient they are compelled to stay with and being in violation of, or even lying about, their hours in the hospital. You can find the article here.

pharmaceutical companies and medical education

The New York Times Business section published an interesting article today about a group of medical students and faculty at Harvard Medical School pushing for greater disclosure of the relationship between pharmaceutical companies and faculty teachers. The article and the comments on the NYT web site raise an interesting discussion. Those who advocate full disclosure and even the removal of pharmaceutical money and interest in medical schools content that medical education must be objective and cannot be so if faculty members are paid by pharmaceutical companies. Others contend that pharmaceutical money, used responsibly, is absolutely necessary to support important medical research and innovation that is being conducted on medical school campuses across the country.

What do you think? How can pharmaceutical money be used by medical schools responsibly? Is it time to get pharmaceutical companies out of medical schools? Is that even possible?

pay for performance and the physician-patient relationship

In her column in The New York Times Dr. Pauline Chen explores the implications of pay-for-performance systems, in which physicians are paid based on quality indicators rather than volume. An emphasis on quality outcomes rather than volume may make it easier for physicians to spend more time with patients. But one of the concerns is that physicians will cherry-pick healthy patients who will have positive health outcomes, rather than difficult patients who do not comply with prescribed regimens.

You can find the article here and the comments here.

What do you think? Is there a balance to find between pay-for-service and pay-for-performance?

using social networks to self-medicate

The New York Times had an article today about how many young adults in New York go without medical insurance and the lengths they go to seek alternatives to aid in self-diagnose and sometimes self-medicate. Of particular interest is how some of the people interviewed used health web sites to find health information and social networks to find medications to share.

You can find the article here.

the camaraderie of healing

The New York Times offered an interesting patient perspective today about the camaraderie of physical therapy. Physical therapy patients work with therapists for weeks or months, in a facility with other patients of varying ages and walks of life. Caitlin Kelly examines the relationships that evolve. You can find the article here.

Rating your physician

The group that made restaurant, hotel and spa ratings by the public, available to the public, are now working with one health insurance group to rate physicians. The New York Times had an article today about WellPoint working with Zagat to allow patients to rate their physicians and read ratings of other physicians. Physicians are rated on such qualities as trust and communication. Some physicians and ethics groups are concerned that the ratings don't give patients useful information, and may ultimately cause harm to patients making decisions based on personality factors that have no correlations to patient outcomes. You can find the article here.

What do you think? Is this kind of rating system harmful? Is it possible for some kind of rating system to provide useful, accessible information?

Ads that promise too much

The New York Times published an article this week about Bayer, which is running a series of corrective advertisements about its birth control pill, Yaz. The FDA asked Bayer to run the corrective ads in response to previous advertisements for Yaz that claimed to also help with such sumptoms as pimples and premenstrual syndrome. The requirement from the FDA to run a corrective campaign is part of a new crackdown on deceptive consumer drug advertising. Given that the financial stakes are so high for drug companies, it likely won't be the last time the FDA has to ask a pharmaceutical company is asked to run a corrective advertising campaign.

You can see the article here.

What do you think?

Should you warn about bad news?

What is the best way to break bad news? Some communication research suggests that clinicians should give a"warning shot" prior to giving the patient bad news. Something like "The news I have to share may be upsetting." The idea is that preparing the patient for the prospect of bad news allows the patient to better prepare for and process the information. If bad news is just sprung, the patient may not hear anything else after the upsetting news and may be too upset to talk about important issues such as next steps. But is it possible that classifying news as upsetting may be more upsetting than just breaking news to a patient without prior qualification? Rather than qualifying information beforehand, maybe clinicians should instead give patients time to process the information before moving on to the next topic.

What do you think? What is the role of the warning shot?

Can nurses care too much?

The New York Times Well blog featured a guest blogger earlier this week that touched on an issue of particular interest to me: nurses and empathy. Theresa Brown, an oncology nurse, shares her stories about caring for patients and wonders if it is possible to care too much. You can find the story here.

What do you think? How can nurses balance empathy and the emotional strength to get through what can be a very draining profession?

New Research Opportunities

So the pace of the blogging has slowed down for me in the beginning of 2009. The reason is because I am in the process of pursuing new research opportunities in the Pacific Northwest. I am looking to apply my communication research and clinical research skills to a new research coordinator or clinical research monitoring position. It is a challenging time, but I am looking forward to new research possibilities and the prospect of applying my communication and research skills in a new setting.

Health care marketing - using all the tools available

The Centers for Disease Control published their annual report about their health marketing for 2008. The report shows all the activities the CDC has undertaken to empower patients and encourage the public to take an active part of their own health care. You can find the marketing blog here and the report here.

We have seen in the articles and discussion on this blog that it only helps both physicians and patients when everyone has access to good information to make health care decisions. And the CDC is showing that in order for messages to be effective you have to reach the intended audience. And that means going beyond a brochure and engaging in the types of media that draw people in.

What types of new media strategies health groups should cultivate and use in the upcoming year?

Can empathy be taught?

Dr. Pauline Chen's column this week in the New York Times examined a new study about empathy skills training published in Academic Medicine. Dr. Chen reflects on her own experiences and the prevailing attitude that bedside manner is either something you have or something you don't have. But the results of the study in Academic Medicine indicate training can have some effect on physicians of all experience levels. And young physicians can certainly learn from the examples of their attending physicians, for better or for worse.

But what does it mean? Can empathy be taught? Or is it something you either have or don't have? You can find the article here and comments here.

inside perspectives on being a patient

The New York Times reviewed a new book about an inside perspective on what it's like to be a patient in public and private mental hospitals in this country. While the review is interesting, what's even more illuminating was the historical perspective that the reviewer mentioned in her review: the adventures of intrepid reporter Nellie Bly. Nellie Bly went undercover and had herself committed to a mental institution in 1887 for the purpose of doing an investigative piece on what really went on in such institutions. Her reporting on the horrors of mental hospitals of that time scandalized people and ultimately was responsible for many reforms in hospital treatment and conditions. You can read Nellie's account at the Penn Digital library here.

changes in medicine

The New York Times published an interview with Dr. Robert Martensen, an emergency room and intensive care physician who has worked in emergency rooms and academic medical centers, and as such has witnessed the changes in medicine, for better and for worse. He has a new book called A Life Worth Living: A Doctor’s Reflections on Illness in a High-Tech Era.

The conversation is an interesting perspective on the changes in the medical field, from a physician who has seen it firsthand. He also makes interesting comments about why physicians should study literature in addition to science. You can find the article here: http://www.nytimes.com/2009/01/20/health/policy/20conv.html?partner=permalink&exprod=permalink

Medical advice on television

The New York Times published an article on Sunday about the syndicated television show The Doctors. The Doctors is a show where a panel of physicians offer medical advice, often about topics that patients might find embarrassing to bring up to their own physician face-to-face. The show has quickly gained popularity, matching the audience of other, more established talk shows.

The article points out that the success of the show points to the public appetite for health information, especially in financially difficult times and for those without health insurance. The producers and hosts of the show, as well as health advocates, remind audiences that the information in the show is not intended to replace a visit your own doctor, but rather, supplement it.

So what do you think of the popularity of this show? What cautions do you think the show should take? What would make this tool even better for patients? How can this show facilitate patient-physician face-to-face communication?

Who would you rather have as a doctor?

I've started following the health blog KevinMD on Twitter. The blog is written by Dr. Kevin Pho, an internist in New Hampshire looking to pull back the curtain on medicine.

One of the entries that caught my attention was an entry from yesterday about a survey reported in Medical Economics last month that found that the most popular television doctor is the snarky Dr. Gregory House from Fox's show House. In the same survey, the majority of people also said the most important characteristic in a doctor is bedside manner/communication skills, something Dr. House is lacking.

So what do you think? Is this just a weird quirk - that we like fictional doctors who say smart alecky things and cure medical mysteries all within 60 minutes, but we expect our own doctors to be excellent and empathic communicators? Do we say we value communication skills, when what we really want is the best technically skilled doctor? Or is it just entertainment?

Should patients be told where they can get better care?

PLoS (Public Library of Science) Medicine published an article this week debating whether informed consent procedures for cancer treatment should include discussions about hospital outcome disparities. Hospitals that perform procedures more often have better treatment outcomes. Should a physician offer that information, even if it means sending a patient to another facility and another physician? Does expecting doctors to offer this information create a conflict of interest?

You can find the PLoS article here.

And a New York Times article about the debate here.

Who should be the next surgeon general?

The news that neurosurgeon and CNN correspondent Dr. Sanjay Gupta is being considered for the post of Surgeon General has raised a lot of opinions. Some people want to dismiss Dr. Gupta as a television personality who lacks the policy experience for the post. But others welcome the thought of another high profile Surgeon General, someone the public would know and trust, and who might be able to encourage and enable the public to become active in personal health issues.

The opinions and questions mirror some of the questions that emerge in discussions of interpersonal communication and relationships between physicians and patients. Technical skill is important, but where do the trustworthiness and personality fall? Are patients better off with a highly technically skilled, but gruff physician, or a moderately skilled physician with excellent interpersonal skills? Which doctor will get the better outcomes: the one with technical competence or the one personable enough enable the patient to take better care of their own health? And why do we often find ourselves assuming that physicians cannot be both technically skilled and skilled communicators? There are doctors who are both technical and personable, Dr. Gupta arguably being one of them.

What do you think?

Forbidden foods

So this doesn't really have much to do with patient-physician communication, but I found this article about one man's relationship with the foods that were forbidden in his childhood entertaining. You can find the article here: http://www.nytimes.com/2009/01/04/magazine/04lives-t.html?partner=permalink&exprod=permalink

Can anyone else relate?

No more pens and mugs

Happy New Year! Starting today, Pharmaceutical Research and Manufacturers of America has issued a voluntary ban on branded pens, mugs and other promotional items to physicians and physicians' offices. So no more pens, clipboards, stethoscope tags, clocks and more advertising the latest, newest, or most marked drugs. Some advocates have criticized the ban, saying it doesn't go far enough. They say the pens and mugs are not the problem, but rather the entangled relationship between big pharma and physicians that blurs the line between education and advocating for expensive, profitable drugs. Others say the ban is a positive start and will remove a potential improper influence in prescribing, and from the patient perspective, remove the appearance that physicians are unduly biased or even sponsored by pharmaceutical companies.

You can find the article here.

And here you can find one physician's blog documenting all the fun products he has received from pharmaceutical reps. Starting today, he won't have more to add to his collection.

So what do you think? What does the ban accomplish? What else do you think could or should be done to more clearly delineate the relationship between pharmaceutical companies and physicians?