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.