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?