The pressures when the patient is a VIP

The New York Times Well blog had a guest column today exploring the potential problems and pressures when a patient is a VIP. A VIP patient may cause a physician to second guess their course of treatment or a VIP may insist on a treatment that the physician knows may cause harm. But if a physician fears losing the prestige or the monetary benefit of having a VIP patient, that fear may cloud the physician's sound medical judgement.

From a communication perspective, it demonstrates how extreme power imbalance in a relationship impairs effective and honest communication. When physicians hold all the power, patients have trouble finding this voice. When patients have the power in the relationship, physicians have the some trouble.

The lasting trauma of having a child in the NICU

I wanted to be sure and highlight The New York Times article today discussing the long-term potential trauma associated with having a child in the neonatal intensive care unit. These are the kind of underlying issues that physicians and nurses need to be aware of when speaking with patients and parents about treatment and health care decisions. Communication is not just about the current conversation, but all the previous conversations and experiences that color our perspective. And having a child in the NICU can make a lifelong impression.

Experiencing a patient's perspective firsthand

The New York Times featured an article today about an innovative geriatric education program, in which medical students have the opportunity to experience life in a nursing home. Medical students at the University of New England are given a diagnosis that an elderly patient might have and spend two weeks living as a patient with that diagnosis, including medical exams, being assisted in and out of bed, and passing the time with other nursing home residents. The goal of the program is that the two week experience better equips future geriatric doctors to interact with and understand their elderly patients. When clinicians can empathize with their patient's situation and actions, they will be better able to communicate with their patients about their medical and quality of life needs.

Talking about end-of-life care

A provision in the proposed health care reform legislation to reimburse physicians for discussions with patients about their wishes at the end of life has been misunderstood and even misinterpreted as government intervention to ration care to elderly patients near the end of life. The provision is gone now, but the provision has started conversations about end-of-life care in homes and doctors offices across the country. Conversations about what the kind of care patients want at the end of life should be ongoing, both with the patient's physician and the patient's family. But when a patient is near the end, often the person to have the difficult end-of-life conversation with the patient is a palliative care specialist. The New York Times had a compelling article today about palliative care doctors and how they approach their difficult job. I think the most important part of this article is the conversations that it is capable of generating, both online and in hospitals and physicians offices and homes across the country. The only way to assure that you or a loved one will reach the kind of end-of-life care you want at the end is to have ongoing, respectful and honest conversations.

Talking to your doctor about conflicts of interest

The Wall Street Journal Health blog pointed to an interesting article this morning in the Washington Post about potential physician conflict of interests and the difficulty patients have in asking their physicians about them. Patients don't want to ask questions that might alienate their physicians, but many express interest in knowing just how much influence pharmaceutical companies may have on their physician. There are some mechanisms for finding out this information on your own, such as physician and practice profiles online, especially if your physicians works for an academic medical center. And there is now proposed legislation to create greater transparency by disclosing all pharmaceutical company payments of more than $100. This transparency will equip patients to ask their physician more about their prescribing habits.

Of course, being able to find this information yourself is good, but it doesn't replace the real need for conversation between physicians and patients. Patients need to be able to express their concerns about potential physician conflicts of interest. Physicians need to know that their patients have concerns and perhaps help the patients gain insight into the physician's prescribing thought process. But the question is how to start these conversations between physicians and patients. Ideas?

Another great source for information on the health care debate

The Association of Healthcare Journalists offers a great resource page for finding facts of the health care policy debate. It's a great source for journalists and all citizens looking to get beyond the shouting.

Making sense of the health care reform debate

The New York Times has taken an extra step to help inform readers about the health care reform debate. The online edition has added a new blog in the Health section called "Prescriptions" devoted to the dissecting the health care debate. The writers are off to a fast start, filling the page with articles about the key players in the health care debate, criticisms of policy proposals, and even analysis of advertisements and public service announcements.

This kind of analysis is long overdue. There has been so much shouting and arguing over the possibility of health care reform that there has been little time devoted to what the actual proposals are and what changes may or may not occur. I especially like the informative graphic showing how the different proposals would affect Americans in different economic and marital situations. The availability of this kind of information probably won't stop the shouting and arguing, but it does give the rest of us a chance to consider the future of health care in this country.