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.