A third party in the relationship

The New York Times Well blog raises an interesting question about the relationship between a physician and a patient: Do physicians need a chaperon when performing invasive procedures?

The presence of a chaperon during invasive procedures is intended to protect both the physician and the patient. But It raises a question of how this could potentially impact the relationship. If either or both the physician and patient feel a chaperon is necessary, does that imply something about the level of trust in the relationship? Or does the presence of a chaperon simply indicate caution and not a lack of trust?

How do you think this would affect physician-patient communication? Will the communication somehow be different if both the doctor and the patient know that a third party has to come in and watch the procedure? How should physicians and patients discuss the issue of chaperons?

A new face of AIDS activism

On the eve of World AIDS day, The New York Times has an article about the changing face of AIDS activism. Where advocacy was once dominated by those affected by the disease, specifically the gay community, now a growing voice of activism is found public health students. The student protesters are armed with knowledge and research about disease rates and what could and should be done to fight AIDS. And many of these students are using political protests to be heard, even protesting against a president they worked to get elected.

What do you think of this shift in activism? What role should political protest play in bringing attention to public health issues?

Communicating about religion in the hospital

An article in The New York Times Health section featured an article today about an article in the Journal of Medical Ethics, considering Muslim religious beliefs and how those beliefs may impact the delivery of health care. Muslims differ in adherence, but maintaining modesty is an overriding ethic, and may even cause some to delay care if they cannot get in to see a physician of the same gender.

While it may not always be possible to accommodate all religious requests, respect and communication can go a long way to facilitate trust between the physician and patient. It starts by the physician simply asking, either in person or in an intake form, what their religious concerns are and what can be done to make them more comfortable. Those conversations can be a good starting point for discussing what can be accommodated and what is necessary. A conversation, rather than a directive, will help the patient feel heard and cared for.

Is candy evil or misunderstood?

The New York Times Health section featured the Candy Professor, Samira Kawash, a writer and professor who researches the history of candy, and how it is sometimes vilified. The Candy Professor contends that candy has always been honest about what it is: a processed food, a treat, something for pleasure not for nutrition. But some people have a knee-jerk reaction against eating candy, or feeding their children candy, despite reaching for foods such as fruit juices and granola bars that have just as much sugar. Candy is seen as something forbidden, while those granola bars have a veil of nutrition.

It is an interesting look at how we make decisions about food, perhaps not always rational ones. It is also about communication and the messages we hear about candy and how that influences the decisions we make.

What do you think?

If the result is the one you want, does it matter how you get there?

The New York Times Parenting blog points to an interesting new public service announcement running in New York. The PSA encourages moms to breastfeed. But the enticement is not the health benefits for the baby. The enticement to breastfeed is that many women who breastfeed lose weight.

So the question is whether it is appropriate to entice an audience to engage in a behavior for vanity? It's not unheard of. Anti-smoking campaigns have used the approach. And breastfeeding campaigns might also mention other reasons for breastfeeding that have nothing to do with the baby's health: such as monetary savings. If a health campaign is successful in getting an audience to engage in a health behavior, does the why matter?

Pink fatigue

The New York Times Well blog had an article today about the growing number of voices expressing "pink fatigue." October is breast cancer awareness month and pink is everywhere. but some fear that the emphasis on marketing and cutesy products misses the point. Others feels the money could be better spent on actual breast cancer research rather than "awareness."

I can appreciate that this can be a difficult balance to find. You do want to raise awareness of the disease, especially since early detection can be helpful in treatment. Creative fundraising can bring in a lot of money. And it's nice for people to feel like they are doing something, even if it is just saving yogurt lids. But are we missing the point? At least one group is suggesting we need more than pink, we need a deadline. The National Breast Cancer Coalition has taken the pink gloves off and set a deadline to find a cure: January 1, 2020.

Despite the frustration, it appears the sea of pink is here for now. But let's continue to highlight research efforts as much as we highlight baseball players with pink bats.

How we talk about food

Two stories from the last week have highlighted the complexities regarding communication about food. The Corn Refiners Association is looking a new word for high-fructose corn syrup, preferring the name corn sugar. But there are a lot of skeptics about the reason for the rebranding, as seen in the comments in the New York Times Health blog. While the Corn Refiners Association says they are looking for a more accurate name, some health advocates think the move is an effort to confuse consumers into thinking corn syrup is healthy.

The other story is about carrots. The baby carrot association is spending $25 million on a new advertising campaign to market the bite-sized carrots as a fun snack, even as fun as junk food. But it seems no matter how much health advocates push vegetables, it seems we are not eating them.

So why is communication about food so difficult? What strategies would you suggest to communicate about healthy food?

Communication through touch

The New York Times Well blog has an interesting discussion today about a recent JAMA essay. In the JAMA essay, a medical student contemplates even and when it is appropriate to hold a patient's hand. Some of the Well commenters were mystified that a medical student would even need to ask if it is appropriate to hold a patient's hand and show compassion. But in the current medical culture, students are taught to be very aware of how actions, even as simple an action as holding a hand, may be viewed.

It is the reality of physician-patient communication, that the physician may always have some level of concern about communication being misconstrued. And this fear has the real potential to limit high-quality communication between physician and patient. All communication involves some risk, the risk of being misunderstood. But a physician taking a risk and offering a hand to a patient at a difficult moment can mean the world to a patient.

Learning to talk the talk

Theresa Brown, a registered nurse and regular contributor to the New York Times wrote an article this week about nurses learning how to talk quickly in emergent patient settings. The style of speech values speed, with elements of persuasion, especially when trying to get a patient a needed bed in the ICU.

But the article does not explore the potential pitfalls of such rapid fire conversation. The possibility of mistakes was acknowledged, but more than mistakes, the rapid conversation can have long term implications for the health of communication between colleagues. Short, clipped conversation does not allow for collaboration or learning and working together to support and care for patients. Certainly there are time when this style may be very necessary, and it does fall on health care workers to learn how to communicate that way. But there is a time for longer, thought out conversations as well, even on a busy hospital floor. We are all better off if health care providers are able to develop multiple communication tools and styles and not just depend on one quick style to get all things done.

Teaching with patients, from the beginning

The New York Times had an article today about a medical school program that is turning the traditional medical student schedule on its head. New York University is now exposing students to patients from their very first day as medical students, rather than waiting until they are third year students as many traditional programs do.

NYU is not the first program to introduce a patient element in the first year of medical school. But such efforts point to medical schools' awareness that the process of medical education can be emotionally draining. Students who lose sight of why they are training to be doctors may find themselves experiencing "empathy erosion." Patient contact from the beginning helps these physicians in training remember they are learning not to treat diseases, but to treat patients.

Battlefield humor and patient-physician communication

Dr. Michael Khan explores the pervasiveness of "battlefield humor" in this week's New York Times Cases section. Beyond being dehumanizing, and just plain rude, demeaning humor used to describe patients may have a direct impact on communication with the patient and ultimately on patient care. If a physician automatically assumes that a patient's behavior is because of some character flaw, or because the patient is a "whale" or the patient's "crazy," the physician may miss a real symptom or indication. And the humor certainly creates a barrier to building a trusting relationship between physician and patient.

Physicians certainly work in a stressful environment and certainly not all of their patients are pleasant. But what are some alternative that physician might consider to this battlefield humor? How can communication scholars demonstrate the affect this humor has on patients?

When words, and friends, fail

An essay in The New York Times today highlights the difficulty of going through a health crisis and having friends seemingly disappear. Psychologists are beginning to explore what people experience when they are witness to other's traumas. Part of the difficulty, is that words fail, and friends don't know what to say to a sick friend or how to help. The other difficulty is not so much a lack of empathy, but too much empathy. When a healthy friend can picture herself or her child as sick as the sick friend, it may give them cause to pull away from that friend in need.

Sometimes the right words and the right actions don't come naturally. But knowing our own fears and vulnerabilities may help us think twice and reach out to those in need.

The challenges of psychosocial research

An article in the New York Times today highlights some of the particular challenges of psychosocial research. The article discusses the challenges of personality analysis, specifically as it applies to research of generations. Is it possible to analyze and assess a collective generational personality? Are there flaws in how researchers try to measure personality, behavior and attitude?

Measuring attitude is a difficult task, because even at its best, you have what the participant says and some sort of scale or means of interpreting what it means. There is a lot of room for error: the participant may just say what he thinks the researcher wants to hear, the participant may says what is socially desirable, the researcher may interpret the responses incorrectly or the researcher may think he is measuring one thing when he is actually measuring something else. This is why different mechanisms for validating behavioral scales are so important. The work is extremely valuable in that it can teach us something about ourselves and how we approach our world. But it is indeed a challenge.

Should you read your doctor's notes?

The Los Angeles Times had an interesting blog post today about the notes that physicians write in patient's charts. The patient's chart ultimately belongs to the patient, and so one hospital system is starting a new project where patients can access the notes in their chart by a secure Internet portal. But will being able to read these notes cause more harm than good? Will physicians be as candid in their notes if they know the patients will read them later? But, the notes can give patients insight into their illness and how the physician is approaching it.

It is an interesting discussion and it is one that will only continue as more clinics and hospitals convert to electronic medical records.

Taking the patient into consideration when planning the medical home

Dr. Pauline Chen's article this week in the New York Times shows what happens when doctors and health systems make plans, but fail to consider the patients needs or even the patients reactions. The article examine the concept of the "patient-centered medical home," a team-based, comprehensive approach to preventative care, facilitated by electronic medical records. It sounds like an efficient system. But some practices implementing the system have found that patients do not understand and even dislike the system that was put in place to center around the patient. Now practices are playing catch-up by setting up patient advisory panels and other mechanisms for patient feedback.

The findings of the early medical home models demonstrates the importance of patient buy-in to any type of medical practice reform. Without patient buy-in, medical care comes to a sudden halt.

Two important aspects of communication

Our research team, even while plugging away on two population-scale communication research projects, is thinking about the future and how we can build on the projects we have already done. Our conversations led us to consider two important, but different, aspects of communication: content and conduct.

• Content is the "what" that is communicated.
• Conduct is "how" it is communicated.

It is especially important to consider both content and conduct when considering physician communication with patients. Is the physician giving correct information? Is the information appropriate for the stage of the conversation? But even if the content is correct, it is not enough if it is not communicated effectively. Does the physician use words the patient is likely to understand? Does the physician check in with the patient to see if the patient understands what is being said? Does the physician consider the patient's emotional reaction?

And so physician-patient communicators continue to seek way to measure and improve both the content and conduct of physician communication.

How hard should you try to convince a patient to do something?

The Wall Street Journal Health blog reported last week on an editorial in the Journal of the National Cancer Institute. The editorial considered whether it might be more worthwhile to invest money into improving cancer screening technologies such as mammograms, rather than spending that money on getting more patients to get existing, imperfect tests. Some patients may have a rational, logical and well thought-out reason for turning down an imperfect screening test. No amount of education campaigns is likely to change that decision.

The article points to a larger discussion of what the goal of physician counseling should be. Is the physician's goal to convince the patient to do what he or she wants the patient to do (i.e. get the screening test)? Or should the physician's goal be to simply counsel and educate the patient, and then let the patient make a decision? It is easy to say that the goal should be the latter, but in practice, this is difficult for both the physician and the patient. Physicians face the reality of practice standards and pay-for-performance schemes that say what tests a patient should get and when. And patients may not be willing to make difficult decisions or may make poor decisions no matter how much evidence is given to them. The task of counseling does not have any easy answers. But it seems that if 71% of women are getting a screening test, the reason the other 29% are not is not as simple as a lack of discussion.

The value of patient stories

The New York Times Health section had a compelling article today about the value of patient stories and memoirs. Their value may not be in their literary style, many may in fact be lacking literacy polish. The true value of these stories may be the stories themselves. There is therapeutic value to the story, both for the reader and the writer. They inform us of the human condition, the very real emotional pain that goes into illness, and perhaps remind us of the need for empathy toward each other.

Learning to communication in multi-disciplinary teams

I had the privilege to present at the ACRP Global Conference in April. You can now listen to the audio of my presentation about Communication in Multi-Disciplinary Teams here ACRP Presention.mp3

A tangible piece of the conversation with your doctor

Things have been buzzing with our physician-patient communication research group. A new topic of interest is the use of brochures and handouts, a tangible piece the patient can take away from the conversation. Specifically, we are interested in looking at how brochures and handouts can be used to aid in the conversation. Perhaps brochures can help prompt comments from both the physician and the patient, as they read through the brochure together. And when the physician or the patient actually writes something on the brochure, it may help prompt recall of the conversation later.

What do you think? What makes a brochure or handout from a doctor useful? And what make it go straight in the garbage?

Having a communication plan

Last week my team experienced a bit of a communication meltdown, which is only somewhat ironic considering we are communication researchers. So after some triage and promises to give each other "the benefit of the doubt," my thoughts now turn to how we could have better planned for communication disaster.

Those outside the field of communication sometimes dismiss it because they think that communication just occurs naturally, like breathing. But communication scholars and teachers are fond of saying that communication doesn't just happen. Communication is, among other things, a skill. If it is a skill, it is something that can be refined and improved with practice, and something that can be planned for, should things go wrong. The key is awareness and intentionality. Know how communication can go wrong on your particular team and think about what you will do if it does. Does your team respond better to discussions as a group or individual conversations? Do they respond to writing or face-to-face interactions? Thinking about your team's communication style before blow-ups occur will better equip you to address problems as they come up and even catch little problems before they become big meltdowns.

Communication theory in the informed consent process

I learned so much from the ACRP Global Conference in Tampa last month that I am already making plans for what I want to present at next year's conference (and the fact that ACRP 2011 is in Seattle is extra motivation). I realized that I bring a particular skill set to the clinical research educational setting: my background in communication theory. I was not the only presenter who discussed communication at the ACRP 2010 conference. Several other speakers focused more on the soft communication skills, but I saw a need for a discussion of how communication theory can inform the most important conversation that takes place in the research encounter: the informed consent.

One of the theories I am going to integrate into my presentation next year is Uses and Gratifications Theory. The theory is usually used in studies of people's media use and habits, but I believe it is an important consideration when having an informed consent conversation. It is tempting for research staff to think of potential research participants as empty vessels waiting to be filled with information. But every potential participant brings their own agenda to the conversation and will seek, find and attend to selected information. It is a valuable piece of information to consider when informing potential participants about participating in a particular study. I look forward to the opportunity to bring communication theory into the research professionals conversation.

The other revolution started by "The Pill"

This article is a week old, but I still wanted to point it out. Last week was the 50th anniversary of FDA approval of the birth control pill. Approval of the birth control pill is credited being one of the events that led to the "sexual revolution." But as this article points out, the approval of the pill started another revolution, a revolution at the FDA. At the time of the pill's approval, the FDA started to take a strong role in post-market surveillance, that is, continued observation and research of drugs after they have been approved. With the pill, we also saw the beginning of the FDA's direct communication with patients, rather than communication from the FDA to patients via physicians. The approval of the pill also followed the expansion of the process of clinical trials to show safety and efficacy of a drug, procedures that are now commonplace. It's an interesting piece of research history and shows how we came to the regulations researchers now face today.

A message that resonates

I had the opportunity to present a poster and brief presentation on communication in multi-disciplinary research teams both at the Association of Clinical Research Professionals Global Conference in Tampa and at my local Southern Wisconsin ACRP chapter. I am passionate about communication education and count it a privilege to be able to share my knowledge with my clinical research colleagues.

The thing that is most encouraging to me is that this message of improving communication skills within the context of research teams is resonating with research professionals. The research professionals I met understand the importance of communication to effective team functioning. They have learned that communication is a skill that can be improved and it is encouraging that these professionals are seeking to improve their communication skills. I hope to continue to teach and encourage my clinical research colleagues about the importance of effective communication in the team work environment.

Learning to communicate in multi-disciplinary teams

I am privileged to be presenting at the Association of Clinical Research Professionals Global Conference later this week. I will be presenting a poster and a brief presentation about a topic that combines my interest, experience and expertise in the fields of communication research and clinical research: communication in multi-disciplinary research teams.

Multi-disciplinary research teams offer many advantages, the most compelling of which is having a broad range of perspectives to bring new and innovative ideas to the research table. But each of us educated in a specific discipline are taught to approach questions and problems in a certain way. When required to work with people who are educated another way, potential conflicts arise. Understanding the potential pitfalls to working with multi-disciplinary teams is the first step to maximizing the benefits of these teams. Team leaders need to work to create a supportive environment, where all members feel safe to share new and innovative ideas that may be unfamiliar to the rest of the group. Ongoing conversations about roles in the team, as well as making a conscious effort to learn from your teammates, will head off some of the potential misunderstandings.

The benefits of multi-disciplinary teams far outweigh the potential pitfalls, but being prepared for the pitfalls makes success all the more likely.

The problems patients have with reporting symptoms

The New York Times reported on a New England Journal of Medicine article about how patient-reported data about drug side effects can be a tremendous source of information. But physicians and patients often have trouble discussing potential side effects because of limited time in consultations and limited understanding of what side effects and their causes may be.

So we have a great potential source of data about emerging drugs. But we have a communication gap in getting that information from patients to doctors to researchers. Many hope that opening new lines of communication for patients to report symptoms they are unsure about to others may help facilitate the reporting process. Information coming directly from patients will increase understanding of new and emerging drugs and technologies. And giving patients another means of expressing their concerns helps the patients be heard as they pursue their own health care.

Picturing life after cancer

The New York Times is working on a compelling project to collect stories and pictures of cancer patients. Cancer survivors are encouraged to "picture life after cancer" by submitting photos and thoughts about what life means after cancer. You can see the first of the submissions here.

The power of the face in communication

The New York Times had a very interesting article today about research on the importance of the face in conveying non-verbal messages and how even those without control of their facial expressions can read facial messages. While those who are not able to control their face cannot mimic facial expression, they can adapt and still learn to read and respond to non-verbal cues. Further research will explore how these adaptations can be used with other groups who struggle with non-verbal cues.

When a physician becomes the patient

I want to direct readers to the latest article in the New York Times "Months to Live" series. The article features Dr. Desiree Pardi, a palliative care doctor, who when faced with the end of her own life, decided to defy the usual advice she gives patients and fight the cancer until the end. The article explores the complexities of physicians' advice and how things change when the physician becomes a patient. I definitely recommend reading and contemplating.

Listening to private calls to gain insight in therapy

The New York Times Cases article this week examined how therapists sometimes get an unintended look inside the patient's life, by the phone calls they take. Therapists now find themselves able to gain insight beyond what is said in session, by how patients react to cell phone calls from children, spouses and others.

But I can't help but feel a little odd about this. I know the patient shouldn't expect privacy if they take a call in front of his or her therapist. But is it OK to put those conversations on the analytical table? Should the patient retain some control of what the therapist and patient talk about or should the therapist be free to bring up something that is observed? Maybe they do this already and cell phone calls are just another observation.

This is just one example of how technology is changing clinician-patient communication. What are others?

Patients finding support on social networking sites

The New York Times had an article today about a new Pew Center for Internet and American Life survey about how patients with chronic illnesses are finding new ways to cope online through social networks. Patients who once felt isolated now have a forum for sharing questions, hopes and ideas for coping with the particular complications of an illness. Fellow patients are able to relate to each other, in a way that their physicians may not be able to, simply because they physicians have never experienced actually living with an illness. Patients describe being in a neighborhood or a member of a community. Now even people with rare illness can have a support group, though they may never meet in person.

You can check the survey and data out here.

What doctors and patients are NOT talking about

The New York Times Well blog had an interesting article today about the issue that physicians and patients appear to not be talking about: a patient's weight. It is a difficult, but important, conversation to have. Weight plays a pivotal role in so many health issues. But physicians seem to not be bringing it up with their overweight patients. Some physicians may be embarrassed or may feel ill-equipped to make proper recommendations for weight loss. Some may just be discouraged that the advice will fall on deaf ears. Whatever the reason, failure to bring up this important health issues can have a real impact on the clinical relationship between physician and patient, as well as the interpersonal relationship. Patients know when they are overweight and if a physician doesn't bring it up or help discuss strategies for weight loss, the patient may feel like they are not getting the care they need. The weight-loss conversation may be difficult, but the alternative is worse.

Changing hospital culture to improve patient safety

Dr Pauline Chen's Doctor and Patient column this week explores how hospitals are trying to increase patient safety by encouraging disclosure of errors, so that physicians and administrators can learn from and improve on systematic errors. But Dr. Chen explores the difficulty directors of these types of disclosure problems have encountered. It takes more than just encouraging error disclosure, you have to change an entire hospital culture of that has come to fear mistakes because of fear that it will damage a long sought after career or result in a malpractice lawsuit. The article demonstrates that you cannot change an entire organizational culture by changing a policy on paper. This kind of shift in attitude will require long-term educational efforts and open dialogue about the importance of patient safety and how disclosing errors helps achieve that safety goal. Organizational culture does not change overnight. But ongoing, effective communication, can help achieve new cultural goals.

Seeking help for a rare illness by going where the researchers are

Along with an article about an FDA orphan drug conference last month, The Wall Street Journal also explored how one mom is using the conference as a chance to seek treatment for her daughters by going where the researchers are and talking with them face-to-face. The purpose of the conference is to encourage researchers to pursue funding and research for orphan drugs, that is drugs for very rare diseases. The FDA has set aside substantial money for orphan drugs, but few researchers pursue it. So the FDA has hosted conferences to encourage researchers to seek the funding and help them with the application process.

But the conference isn't just attracting researchers. It has also attracted one persistent mom, who visited the conference to pursue research to find a treatment for a rare illness affecting her twin daughters. The conference helped "demystify the process" for this mom and the researchers, but also showed what can happen by actually meeting and talking to each other.

Peer communication and the pressure to snack

There have a been a couple articles in the last couple weeks in The New York Times about snacking, including this Well blog article earlier this week about a recent article in Health Affairs. What I found interesting about these articles is not the data about how much children and adults snack, but the personal stories about parents who feel pressure to comply with the snacking culture. Parents may try to speak up about the endless supply of snacks at club meetings, soccer games and school, but may quickly retreat from the position when ridiculed or scorned by other parents. The stories give dramatic insight into how interpersonal and group communication impact health behaviors. As health care providers and health communicators create messages about health behaviors, they have to keep in mind the influence of peer groups. Otherwise, the messages, no matter how well crafted, may fall of deaf ears.

Trusting other patients for medical advice

The Wall Street Journal had an article today about how pharmaceutical companies are starting to rely more on true patient testimonials in their advertising efforts. The use of patients taps into the growing influence of a peer-to-peer networks and also comes at a time when pharmaceutical companies have faced criticism for use of celebrities and physicians in their advertisements.

What do you think? Do you think the use of patient testimonials is appropriate in the marketing of pharmaceuticals? Do you think it is effective?

Snow day at the hospital

I appreciated this article from regular Well contributor Theresa Brown about a snow day at the hospital. People in Wisconsin are a hardy bunch, but every once in a while, the public schools get a snow day. And I watch my friends workplaces close that day, while my academic medical center always stays open. Admittedly, I am sometimes tempted to be crabby about this, because I'm not clinical staff. I mean, I'm a psychosocial researcher! What's the point in me trudging in?

But while the work I do is not the same as a nurse providing comfort, I see the importance in moving forward with our research, despite atmospheric forces.

Besides, that's what the county bus system is for.

Doctors and patients divided about new guidelines

There was considerable confusion last fall when the United States Preventative Services Task Force changed its recommendations regarding mammogram screenings for women age 40-49. Several months later, a report in the Annals of Internal Medicine, as reported by The New York Times, says that there is a divide between physicians and patients regarding following those recommendations. Physicians are more likely to follow the guidelines, which recommend women start routine screening at age 50 and be screened every other year, while patients are more likely to want more frequent screenings as previously recommended.

The disparity points to the continued communication challenge, as physicians and patients must clearly convey their desires and reasoning for screening procedures.

Bad advice on medical dramas

CNN reported today on a new study that shows that medical dramas on television do a poor job depicting how to treat someone with a seizure. It isn't the first time that medical television shows have been criticized for how they depict medical situations. But it does raise the question about how much influence these shows have. Many viewers realize that the dramas they are watching are fiction. Actual medical care is as undramatic and calm as possible.The television writers and producers have to make these things more dramatic to make them worth watching.

But do the television writers have a responsibility, even if they are writing fiction? They have a tremendous audience, and one of those viewers may encounter someone experiencing a seizure or in need of CPR. It is conceivable that a viewer will act as they have seen the doctors act on television. Does the writer have a responsibility to medical accuracy, even at the cost of drama?

Maybe, medical reality can be as dramatic as fiction.

Whistle-blower nurse acquitted in Texas

A troubling legal case pitting two nurses against a doctor and sheriff came to an end today. Anne Mitchell, a nurse who anonymously reported a physician to the Texas Medical Board, found herself facing indictment for "misuse of official information" a 3rd degree felony which carried a possible 10 year sentence $10,000 fine. Mitchell said she was only trying to protect the safety of her patients. Today, a jury took less than an hour to acquit Mitchell of the charges.

The case, and the implications of it, are far from over. But the case points to what can, in rare cases, be a tense relationship between nurses and physicians. Physicians and nurses both have obligations to protect the health of their patients. But if either is more interested in preserving their position and authority than in protecting the patients, then the other person is put in a difficult position no matter what they do, and ultimately, everyone can get hurt.

And again we see that in the dynamics of health care delivery, where humans with all their flaws, egos and mixed motives are delivering the care, there are no easy answers.

Different priorities

The New York Times had an article this week about a paper in the Journal of General Internal Medicine examining what is sometimes a great disparity between physicians and patients: medical priorities. Physicians and patients often have different priorities for medical encounters, as well as different priorities for care of chronic conditions. The article is concrete evidence of the many anecdotes of failed patient-physician encounters. Physicians are failing to communicate with patients about the broader implications of symptoms and illnesses. Patients are failing to communicate their concerns and the reasons for their concerns. There is no easy answer to this dilemma, other than increased listening. But we all know, that is no simple task - for doctors or for patients.

A journal retracts an article but they can't change minds back that easily

This week The Lancet formally retracted an article published in 1998 that suggested a link between vaccinations and autism. The article has been highly publicized and had cast doubt about the safety of vaccines among many parents. The ideas in this article and subsequent research have circulated for 10 years and it will likely take more than a retraction in a British medical journal to retract the idea in the minds of many parents and many in the public. A New York Times article suggests the retraction may be little to change skeptics minds at all.

It is like the old story often used in Sunday School lessons about gossip. The setting sometimes changes, but at the crux of the lesson a minister and the town gossip go to the top of the church steeple and the minister cuts open a down pillow and scatters the feathers to the wind. He then asks the town gossip to gather every one of the feathers. It is, of course, impossible. Once the words are out there, they cannot be gathered back.

Research is about innovation. And innovative ideas are often put in the public before they are fully understood. I don't think this should stop us from exploring innovative research. But all of us who do research must realize the power of our words. Once we put the words out there, it is nearly impossible to take them back.

The role of simulated patients in medical education

Dr. Pauline Chen's Doctor and Patient column last week focused on the role of simulated patients in medical education. The article sheds light on a practice that few outside medical education get to see. The simulated patients and situations can be quite complex and allow medical educators and students to practice procedures in a safe, standardized environment. Standardization is also important in assuring that students are trained in the same way, creating an environment where best practices can be reinforced from the beginning of a student's education.

Of course, simulated patients and medical scenarios can only go so far. There is absolutely no substitute for real-life experience. But students and teachers are finding that the simulated patients can provide a valuable place to start gaining that experience.

The limitations of communicating risk

The New York Times Well blog had an article earlier this week about how elite athletes continue to use performance enhancing drugs, despite the known risk. One study mentioned in the article compared attitudes to non-athletes and were astonished at the difference in attitudes toward taking risks if it will enhance performance. Elite athletes are more willing to take huge risks.

Practitioners and physicians would do well to keep in mind that risk tolerance is not universal. Some people may have different motivations for taking risks. If the motivation is strong enough, say the motivation to win an Olympic gold medal, no amount of communication may talk that athlete out of a big risk.

Measuring what it takes to be a good doctor

Dr. Pauline Chen's Doctor and Patient column in last week's New York Times explores the tests that act as gatekeepers for those who would pursue a career in medicine. The tests are used, in part, to determine who has what it takes to be a doctor. But do these test miss some key component of personality when it comes to measuring who will be a great doctor? Or is knowing the right answers on a test more important than any measure of personality?

Putting off difficult discussions

The New York Times had an article earlier this week about the difficulty physicians have with discussing end-of-life care treatment with terminal patients. The conversations are difficult, but important, and include such decisions as aggressiveness of treatment, resuscitation and hospice. Guidelines dictate that such discussions take place when the patient has a year left to live, so the patient can make decisions along with their families. But many physicians fail to have those conversations until much later. It is easier to suggest more treatment than to have a difficult conversation with a patient about his or her impending death. But failure to have those conversations may result in more aggressive treatment than a patient desires and death in a hospital when a patient would have preferred the comforts of home. While the conversations are difficult, physicians who learn to have these conversations help their patients live their last days as they wish.

The power of non-verbal communication

As a teacher, I love light bulb moments - the moment when you can almost see a visible light turn on a students face; the moment an abstract concept becomes concrete. The New York Times Cases section has such an article today: a first year resident learns the power of non-verbal communication in conveying caring to a dying patient. Effective, compassionate communication goes beyond learning the right words from a textbook. Real communication requires seeing, feeling and giving time.

The toll of malpractice

Between the holidays and teaching at Marquette University I have still had time to keep an eye out for insights into physician and patient communication. The New York Times had an interesting article last week about the emotional toll a medical malpractice case can take on the physician involved. While the article does not offer any solutions to how malpractice cases are handled or how they should be handled, the article does offer insight into how the cases affect physicians and how the possibility of future malpractice suits affects how physicians communicate with their patients everyday.