Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Reblog] What happens to medicine when it has no heroes?

What happens to medicine when it has no heroes?.

From the 4th December 2013 KevinMD article  by  |

A few years ago, a medical journal piece about electronic medical records with built-in decision support announced that the days of super-physicians and master diagnosticians were over.

Being a doctor isn’t very glamorous anymore, and being a good one seems rather obsolete with so many guidelines and protocols telling us what to do.

A hundred years ago, William Osler, a practicing physician, had single-handedly written the leading textbook of medicine, reformed medical education, helped create and chaired Johns Hopkins and become the chair of medicine at Oxford.

Today, it is virtually necessary to be a researcher to teach at a university, let alone chair a medical school. The only other way to advance in medicine is to go into administration. Leaders in medicine are not chosen for their mastery of clinical practice, but for their managerial or business acumen.

The culture of clinical excellence has few heroes in our time. Pharmaceutical companies sometimes speak of “thought leaders” on the local level, which is more often than not only their way of building momentum for their drug sales through promoting early adoption of new medicines. Doctors today practice on a level playing field, where we are considered interchangeable providers in large organizations and insurance networks. Media doctors don’t earn their position based on clinical mastery, but rather their communication and self promotion skills.

What happens to medicine when it has no heroes? Who defends the ideals of a profession that is becoming commoditized? What keeps new physicians striving for clinical excellence with only numerical quality metrics and policy adherence as yardsticks? How are the deeper qualities of doctoring preserved for new generations of doctors, and how are they kept in focus with all the distractions of today’s health care environment — because people still worry and suffer; they are more than bodies with diseases or abnormal test results.

Every day, doctors on the front lines treat two dozen fellow human beings with every imaginable condition. How do we carry on, with only our own ideals as beacons in the fog, if we are left to ourself to defend our higher purpose, without champions, mentors, or heroes?

“A Country Doctor” is a family physician who blogs at A Country Doctor Writes:.

December 16, 2013 Posted by | health care | , , , | Leave a comment

How prevalent are false diagnoses of disease?

From the 7 July KevinMd article by 

Recently, we expressed concern about the effects on the accuracy of the diagnostic process of the increasing numbers of well and worried well entering the medical care system.

One of the consequences of this influx of well people (and the concomitant reduction in disease prevalence) is the generation of more false positive test results and false diagnoses of nonexistent diseases.

The medical literature is filled with studies on the accuracy of specific disease diagnoses but the focus has been exclusively on missed diagnoses. These studies have often used autopsy data to discover how many patients died with specific diseases overlooked in life.

While missed diagnoses certainly deserve our attention, the opposite error has been almost completely ignored: How many patients with specific diagnoses of disease do not have the named disease? How prevalent are false diagnoses of disease? And which ones?

We are puzzled that these questions are not only unanswered but seem ignored in the literature.

Read the article

August 1, 2011 Posted by | Consumer Health | , , | Leave a comment

Uncertainty a huge source of anxiety in patients

From a December 3 Reuters Health news item by Fran Lowry

CHICAGO, ILLINOIS (Reuters Health) – Uncertainty about a diagnosis causes more anxiety and can be more stressful than actually knowing that you have a serious illness, researchers reported here at the 2010 annual meeting of the Radiological Society of North America.

“Once people have the diagnosis, they gain some understanding and control, but without it, all they have is anxiety, and they do not know how to handle it,” Dr. Elvira V. Lang, from Harvard Medical School, Boston, told Reuters Health. “It is important for physicians and others who work in the health care field to realize this and find ways to alleviate this anxiety and stress. Not only will they help patients, they will also be helping their institutions to provide more cost effective care.”…

We were very surprised to see that the women having breast biopsy were significantly more anxious than the women who came for treatment for malignant cancer and those who came for fibroids,” Lang said in an interview.

Health care professionals tend not to be aware that diagnostic tests can be stressful, she added.

The researchers recognize that for a woman awaiting breast biopsy, the fear of being diagnosed with cancer and uncertainty about what the outcome will be can create higher anxiety levels than even those experienced by patients undergoing a “much riskier and invasive treatment of a known cancer.”

“People in health care and also family members may judge what is minor or major by how much risk is involved. But that is not what the patient is experiencing. That is why we want to alert them,” Lang said.

There are simple ways to diffuse this anxiety prior to procedures, she added. “People want to make patients feel better but they use language that is not helpful. For instance, they will say ‘oh, it’s not going to be that bad’, or ‘it’s just going to be a little sting’, but using such vocabulary only increases anxiety and pain.”

Training health care providers to use the right language with patients about to undergo diagnostic procedures will not only reduce their anxiety levels, it will also save the health care system money, Lang added.

“Sometimes patients are so anxious they can’t complete a test….

 

 

December 7, 2010 Posted by | Consumer Health | , , , | Leave a comment

   

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