The New York Times ran an article yesterday recalling the reaction of the public and the press to the introduction of the little blue pill, Viagra, 10 years ago. It is fascinating to read the initial reactions to this new drug, with the hindsight of knowing how much this drug would permeate the culture and change how many people view the utility of pharmaceuticals and pharmaceutical companies.
You can find the article here: http://www.nytimes.com/2008/03/30/weekinreview/30word.html?ex=1364616000&en=1f88540fc0d6b536&ei=5124&partner=permalink&exprod=permalink
Monday, March 31, 2008
Thursday, March 27, 2008
How not to talk to your doctor
Pediatrician Dr. Barney Softness writes a guest blog today on The New York Times about how not to talk to your pediatrician. Included in the recommendations are to not make promises you cannot keep and not to trick your kids into a trip to the doctor. But the recommendation that generated the most discussion was "Don't tell me your diagnosis." His point was that a thorough description of the symptoms is of more value than a parent simply coming into rule out one diagnosis that they believe is the problem. There was a spirited discussion in the comments section about this assertion. Dr. Softness later clarified that any doctor certainly wants to know about any family history, social history and even what the parent thinks the problem may be. But parents should come in with an open mind and not just to rule out a diagnosis.
As some of the commenters suggested, it is in the approach. As we have discussed before on this forum, effective patient-physician communication requires openness and honesty from both parties. Patients need to be proactive in their care, be able to clearly and honestly articulate their symptoms, and should be open to listening to what the doctor suggests. Doctors need to really listen to their patients, educate them about what they are doing, and encourage them to be engaged in their care. Both parties need to be respectful of the expertise of the other: the doctor who is in expert in medicine and the patient who is an expert on their own body.
You can find the article here: http://well.blogs.nytimes.com/2008/03/27/what-not-to-say-to-the-pediatrician/.
So what about the question one of the commenters posed: Instead of a list of don'ts, how should a patient talk to their doctor?
As some of the commenters suggested, it is in the approach. As we have discussed before on this forum, effective patient-physician communication requires openness and honesty from both parties. Patients need to be proactive in their care, be able to clearly and honestly articulate their symptoms, and should be open to listening to what the doctor suggests. Doctors need to really listen to their patients, educate them about what they are doing, and encourage them to be engaged in their care. Both parties need to be respectful of the expertise of the other: the doctor who is in expert in medicine and the patient who is an expert on their own body.
You can find the article here: http://well.blogs.nytimes.com/2008/03/27/what-not-to-say-to-the-pediatrician/.
So what about the question one of the commenters posed: Instead of a list of don'ts, how should a patient talk to their doctor?
Tuesday, March 25, 2008
Prayer. faith and doctors.
Dr. Robert Klitzman wrote a guest blog on the New York Times about the intersection of prayer, faith and doctors. This is a topic of particular interest to me, as my Master's thesis was on how personal beliefs impact how nurses communicate with patients. Dr. Klitzman says he does not think physicians need to be religious, but that they do need to realize how important religious beliefs may be to their patient. Physicians need to be aware of how personal beliefs can motivate and encourage patients and be able to pick up on it.
You can find the article here: http://well.blogs.nytimes.com/2008/03/24/prayer-faith-and-doctors/. A spirited discussion follows about the rationality of science, evidence-based medicine and religion. But I think the key thing to take away for patient-physician communication is that a doctor who realizes the importance of his or her patient's religious beliefs can be a great comfort to the patient.
You can find the article here: http://well.blogs.nytimes.com/2008/03/24/prayer-faith-and-doctors/. A spirited discussion follows about the rationality of science, evidence-based medicine and religion. But I think the key thing to take away for patient-physician communication is that a doctor who realizes the importance of his or her patient's religious beliefs can be a great comfort to the patient.
Monday, March 24, 2008
Patients like me
The New York Times Magazine ran an article on Sunday about a new web site that can potentially change how research is shared among patients with chronic illnesses. "PatientsLikeMe" is a web site devoted to helping patients with chronic illnesses share information and in the process collects a vast amount of quantifiable data about how people live with these illnesses. Because the information is shared voluntarily, the web site has the ability to gather and share a large amount of information with little worry about privacy laws. Patients are able to use this information to make decisions about their own disease management and help facilitate conversations with their own physicians.
This web site has a great potential for getting information and new research to patients and helping them manage their own care. It also is a great resource for propelling research as researchers can watch cohorts of patients who report trying new therapies. But some are concerned about patients self-medicating for complex diseases based on information they glean, and potentially misinterpret, from non-medical sources.
You can find the article here: http://www.nytimes.com/2008/03/23/magazine/23patients-t.html?ex=1363838400&en=71acf69334c63f68&ei=5124&partner=permalink&exprod=permalink
So what's the answer? How do you balance a great resource of data and health information, with standard practice and medical expertise? How does this potentially impact the patient-physician relationship?
This web site has a great potential for getting information and new research to patients and helping them manage their own care. It also is a great resource for propelling research as researchers can watch cohorts of patients who report trying new therapies. But some are concerned about patients self-medicating for complex diseases based on information they glean, and potentially misinterpret, from non-medical sources.
You can find the article here: http://www.nytimes.com/2008/03/23/magazine/23patients-t.html?ex=1363838400&en=71acf69334c63f68&ei=5124&partner=permalink&exprod=permalink
So what's the answer? How do you balance a great resource of data and health information, with standard practice and medical expertise? How does this potentially impact the patient-physician relationship?
Thursday, March 20, 2008
risky trials
The New York Times ran an interesting article about parents choosing to enroll their child with an incurable cancer into a risky clinical trial. Clinical research professionals consider something called "therapeutic misconception" when informing potential participants in clinical trials. People sometimes go into clinical trials with unrealistic expectations of a clinical benefit and positive outcome, when really the purpose of a clinical trial is for research and there are no guarantees of benefit to participants. Though in this story, it had a good outcome, it is a reminder that as researchers we need to explain the risks of clinical trials and the reality that there are no guarantees. The parents in this story realize their daughter's story is only the beginning, and that their daughter is a part of a larger body of research in cancer tumors. And they realize the cancer could come back and say they are ready with knowledge if it does.
You can find the article here: http://www.nytimes.com/2008/03/18/health/18seco.html?ex=1363752000&en=6ee45f0ce2097996&ei=5124&partner=permalink&exprod=permalink
You can find the article here: http://www.nytimes.com/2008/03/18/health/18seco.html?ex=1363752000&en=6ee45f0ce2097996&ei=5124&partner=permalink&exprod=permalink
Wednesday, March 19, 2008
two interesting articles
Yesterday evening I was occupied at an Association of Clinical Research Professionals meeting so I didn't get a chance to post this interesting article from CNN about whether the Tuskegee syphilis trial still has repercussions for African Americans participation in clinical trials today. It is an interesting article that examines whether African Americans distrust clinical trials, or if they do not have equal access to opportunities to participate in clinical trials. You can find the article here: http://www.cnn.com/2008/HEALTH/03/17/clinical.trials.ap/index.html.
Today's New York Times ran an article today on trends in medical education, specifically the trend towards specialization in the highly competitive fields of dermatology and plastic surgery. While dermatology was once derided by other medical specialties, new research is drawing in more medical students and residents. Also enticing is the promise of high pay and stable hours as compared to other medical professions. But this has implications for medical care in that fewer doctors are specializing in primary and preventative care, which have longer hours and lower pay. The article explores these issues here: http://www.nytimes.com/2008/03/19/fashion/19beauty.html?ex=1363665600&en=6af29d977d525093&ei=5124&partner=permalink&exprod=permalink
Today's New York Times ran an article today on trends in medical education, specifically the trend towards specialization in the highly competitive fields of dermatology and plastic surgery. While dermatology was once derided by other medical specialties, new research is drawing in more medical students and residents. Also enticing is the promise of high pay and stable hours as compared to other medical professions. But this has implications for medical care in that fewer doctors are specializing in primary and preventative care, which have longer hours and lower pay. The article explores these issues here: http://www.nytimes.com/2008/03/19/fashion/19beauty.html?ex=1363665600&en=6af29d977d525093&ei=5124&partner=permalink&exprod=permalink
Monday, March 17, 2008
Bothering your doctor
The New York Times Health blog highlighted an article in this month's Annals of Internal Medicine. Dr. Faith Fitzgerald recounted in an essay her struggles to get a hold of another doctor. The exercise in futility causes her to reflect on how difficult it must be for her patients, or any patients, to contact a doctor when they need one. The culture of medicine is such that the doctor is protected from being "bothered," even by the patients who need him or here. When a patient does get through, he or she may feel the need to apologize to the doctor for being a bother, when really, it is the doctor's job to listen to the patient. The blog is here, but the link to the article requires a subscription: http://well.blogs.nytimes.com/2008/03/17/bothering-your-doctor/.
With all the other time pressures and power differentials, even the culture surrounding the doctor makes it difficult for the patient to even approach the doctor with a question, let alone engage in a meaningful dialogue.
With all the other time pressures and power differentials, even the culture surrounding the doctor makes it difficult for the patient to even approach the doctor with a question, let alone engage in a meaningful dialogue.
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