Health and Medical News and Resources

General interest items edited by Janice Flahiff

Stop Lying to Your Doctor

From the 7 March 2012 article By James Salwitz at the Health Care Blog

Doctors frighten all of us. No matter how warm and congenial they are, there is always the threat of what they may say. A few words from a physician can change your entire life. An oncologist may be the scariest of all. For this reason it can be very hard for any of us to tell our doctor the complete absolute truth.

It is easier to diminish or deny pain, then describe in detail and submit to tests. Emphasizing the balance in a diet has less risk than noting it is only 600 calories. Increasing fatigue can be blamed on stress, not progressive weakness. Everyone seems to have quit smoking, despite yellow stained nails. “Social” drinking sounds better than a daily six-pack. We carefully parcel out the information we tell our doctor. It is gut level denial and it does us no good.

Physicians understand the desire of patients to limit and control the conversation. They learn to recognize incomplete and evasive answers. They try to ask questions which produce accurate information. A compassionate doctor knows that his response to a patient’s words is as important as the question asked.

Even though it can be hard, it is in our best interests to supply good information to our caregivers. Doctors cannot make correct diagnoses or order proper treatment using erroneous data. Unneeded X-rays are frequently ordered to fill gaps in information, which the patient could have supplied.  Understanding it can be tough to disclose personal medical facts, here are several ideas that might make communication easier and more complete:

 

1) Write down a list of complaints before the visit. We tend to be more truthful with ourselves in the quiet of our home, than nervous under bright office lights.

2) Bring an “honest” friend or relative to the visit and encourage their help. Try not to snarl when they contradict what you say or fill in the blanks.

3) Take a deep breath, take your time and make a specific effort to answer completely. Do not be afraid to “take too long.”

4) Try to be objective, scientific, almost like you are answering not about yourself, but about a person in the next room.

5) When the doctor is questioning about how you feel, answer in symptoms, not in diagnoses. For example do not say “I think I have a kidney stone like I read on the Internet,” say, “I have back pain which comes in waves.”

6) Trust that the doctor is not going to gasp, faint or throw up, by what you say. While the doctor is there at that moment to take care of just you, he/she has heard it all before. The doctor will not be bored or offended.

7) Do not be bashful and do not be embarrassed. This is the place to complain, whine and focus on you. Maybe there are other people who are “worse off,” but when you are with the doctor you are the only patient.

If you still find you are hiding facts from your doctor, ask yourself whether you trust him/her.  If trust is an issue, then either discuss with your doctor or change physicians. If the doctor is distracted for a moment, pause until he/she focuses on you. If he/she never seems to focus, it is time to get a new doctor….

Conversation between doctor and patient/consumer.

Image via Wikipedia

March 14, 2012 Posted by | Consumer Health | , , | Leave a comment

Research shows 50 years of motherhood manuals set standards too high for new moms

From the press release of the University of Warwick

New research at the University of Warwick into 50 years of motherhood manuals has revealed how despite their differences they have always issued advice as orders and set unattainably high standards for new mums and babies.

Angela Davis, from the Department of History at the University of Warwick, carried out 160 interviews with women of all ages and from all backgrounds to explore their experiences of motherhood for her new book, Modern Motherhood: Women and Family in England, 1945-2000.

She spoke to women about the advice given by six childcare ‘experts’ who had all published popular books on the best way to raise a baby. Ranging from the 1940s to 2000, the authors were Frederick Truby King, John Bowlby, Donald Winnicott, Benjamin Spock, Penelope Leach and Gina Ford.

Dr Davis found although the advice from these experts changed over the decades, the one thing that didn’t change was the way it was delivered. Whatever the message for mothers, it was given as an order with a threat of dire consequences if mother or child failed to behave as expected.

Dr Davis said: “Despite all the differences in advice advocated by these childcare ‘bibles’ over the years, it is interesting that they all have striking similarities in terms of how the experts presented their advice. Whatever the message, the advice was given in the form of an order and the authors highlighted extreme consequences if mothers did not follow the methods of childrearing that they advocated.

“Levels of behaviour these childcare manuals set for mothers and babies are often unattainably high, meaning women could be left feeling like failures when these targets were not achieved. Therefore while women could find supportive messages within childcare literature, some also found the advice more troubling.”

During her research Dr Davis often spoke to women who were different generations of the same family. She found when reflecting back upon the changes that they had seen from when they were babies, to when they had their own children, and then watching their children raise their own families, they were still unsure of what had really been the best approach.

Dr Davis said: “I was struck by the cyclical nature of these childcare bibles, we start out with quite strict rules laid down by Frederick Truby King, whose influence is very much evident in the 1940s and following decades. The principal thread running through his books are that babies need strict routines. We then find the advice becomes less authoritarian and regimented as we go through the decades and the influences of Bowlby, Winnicott, Spock and Leach.

“However, when we reach the 1990s when Gina Ford came to prominence, we come back to the strict regimented approach of Frederick Truby King several decades earlier. More than 50 years on and experts still cannot agree on the best way to approach motherhood, and all this conflicting advice just leaves women feeling confused and disillusioned.”

 

March 14, 2012 Posted by | Psychology | , , | Leave a comment

How Symptoms Are Presented Online Influence People’s Reactions To Possible Medical Conditions

From the 14 March 2012 article at Medical News Today

…Today, people are more likely to go online to punch in their symptoms.

Details of a new study examining how symptoms presented online influence people’s reactions to possible medical conditions will be presented in Psychological Science, a journal of the Association for Psychological Science. Researchers found that identifying symptoms in “streaks” – sequences of consecutive items on a list that are either general or specific – prompted people to perceive higher disease risk than symptoms that were not identified in an uninterrupted series. …

…A recent report by the Health Information National Trends Survey examined the use of Internet in seeking cancer-related information. More than 60 percent of individuals who are feeling ill go to the Internet to search for health information. Many decide to go to the doctor or not based on what they learn online,” Kwan said. “This is really an era of self-diagnosis. To our knowledge, our study is the first to examine the impact of online presentation formats on medical decision making.” ..

..”The length of the list matters,” Kwan said. “This is analogous to a dilution effect. If you don’t have that many symptoms, you may not experience concern about getting that disease if you’re looking at a long list.”

Medical implications of the study include insight into how symptoms may be presented online, depending on goals. For instance, if someone wants to increase awareness of an emerging medical issue that requires treatment, symptoms that are more likely to be checked off in sequence can be grouped together, Kwan said.

According to Votruba, “If there are concerns that the perceptions of disease risk are too high, possibly resulting in over utilization of health services, then symptom lists should alternate common and specific symptoms or create longer symptom lists.”

“Previous research shows that perception of risk of disease is a powerful predictor of health preventative behavior (such as going to the doctor),” Kwan said. “How information is presented online will make a substantive difference in behavior.”

March 14, 2012 Posted by | Medical and Health Research News | , , | Leave a comment

What Doctors Don’t Know & Journalists Don’t Convey About Screening May Harm Patients

From the 8 March 2012 blog item by Gary Schwitzerat at HeatlhNewsReview.org

A paper in the Annals of Internal Medicine this week asked (and partially answered): “Do Physicians Understand Cancer Screening Statistics?

The authors – familiar names like Woloshin, Schwartz, Gigerenzer – are from the Harding Center for Risk Literacy at the Max Planck Institute for Human Development in Berlin and from the Dartmouth Institute for Health Policy and Clinical Practice.

It’s a shame this paper isn’t freely, publicly available to all readers because it may help explain some of the foundation of the dilemma we face in this country about miscommunication about the tradeoffs involved in screening tests.

Reuters Health reported:

“…three-quarters of the more than 400 doctors surveyed believed better survival rates prove screening is a lifesaver although that’s not the case, researchers say.

And nearly half thought early detection translates into saving lives — another common misperception.

“This is really unfortunate because one of the things we always say is, ‘Discuss it with your doctor,’” said Dr. Otis Brawley, chief medical officer of the American Cancer Society. “This is evidence that your doctor doesn’t know.”…

Dr. Steven Woloshin, of Dartmouth Medical School in Hanover, New Hampshire, who worked on the new survey…told Reuters Health that death rates gleaned from clinical trials are the only reliable way to judge if a screening test is effective. But organizations that promote screening, such as the breast cancer charity Susan G. Komen for the Cure, tend to prefer survival rates, which sound more impressive…

 Dr. Virginia Moyer of Baylor, also chair of the US Preventive Services Task Force, wrote an accompanying editorial, “What We Don’t Know Can Hurt Our Patients: Physician Innumeracy and Overuse of Screening Tests.“  In it, she mentioned our work:

“Excellent work on how to effectively communicate statistical data to both patients and physicians has been done, but more is needed. Work of this sort is being supported by the Agency for Healthcare Research and Quality and such groups as the Foundation for Informed Medical Decision Making. To temper the unbridled enthusiasm of patients for screening tests, and especially for cancer screening, we need to reach beyond medicine to the public, which of course gets a substantial amount of medical information from the media. Educational efforts should focus not just on medical students and physicians but also on journalists. Several medical journals have taken the lead in making it easier for journalists to get the statistics right and to recognize the limitations of the studies they report. Watchdog groups, such as HealthNewsReview.org, help to monitor press reports and should be encouraged to add interpretation of screening statistics to the criteria they use to assess health news stories.”…

 

March 14, 2012 Posted by | health care | , , , , | Leave a comment

How Smartphones Could Impact Public Health

(Chart via Pew.)Smartphone owners now outnumber regular cell phone owners for the first time, according to a new study.

From the March 3, 2012 article in the Boston Globe

This smartphone proliferation has tremendous potential from a public health perspective. When Ispoke with Frank Moss at Bluefin Labs for the story, he described a day when doctors would simultaneously prescribe medicine with an app to help patients better monitor their care (you can read more of Moss’s ideas about mobile health in his New York Times op-ed). When you consider that smartphone penetration is already higher in African American and Latino communities (49 percent in each group vs. a national average of 46 percent) and that these two groups are historically disadvantaged when it comes to accessing health care (just browse the February headline roundup from the Kaiser Family Foundation for examples of these disparities), it would be revolutionary to begin targeting health care apps and devices to these populations.

When we consider looking that the gadgets being pushed into the marketplace to help us monitor our health (many of which I tried while reporting the story) we forget that they’re all targeting ”fairly affluent people,” says Jane Sarasohn-Kahn, a health economist who often blogs about public health at Health Populi. “When we look at the burden of chronic disease, it’s the African Americans and Latinos, the poor and less-educated, and very old or very young that don’t have access to healthy food or safe places. These populations have spent as much money on their mobile phones [as the rest of the country], but the platform technology hasn’t penetrated into poor urban areas.”

Sarasohn-Kahn hopes that Medicaid will start developing applications to target these populations, and points to the recent move by a former CDC scientist to develop an asthma inhaler outfitted with GPS and Wifi enabled sensors. When distributed in urban populations, the inhalers allow the doctors to better track their patients, and allow epidemiologists to learn more about the health of these groups. Right now, the smartphones are spreading at a rapid clip through the country. We just need to be smart enough to know how to help them nudge us all toward better health….

March 14, 2012 Posted by | Public Health | , , , , | Leave a comment

   

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