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?