While I know folks who are prone to conditions triggered by chemical intolerances….am blessed that environmental chemicals don’t seem to affect me for whatever reason..
Am posting this especially for folks with chronic conditions of any kind. Please ask your health care provider if screening, testing,prevention of, and treating for chemical intolerances is right for you.
Chemical intolerance contributes to the illnesses of 1 in 5 patients but the condition seldom figures in their diagnosis, according to clinical research directed by a UT Medicine San Antonio physician.
Clinical tools are available to identify chemical intolerance but health care practitioners may not be using them, lead author David Katerndahl, M.D., M.A., said. The study is in the July 9 issue of Annals of Family Medicine.UT Medicine is the clinical practice of the School of Medicine at The University of Texas Health Science Center San Antonio.
Avoidance of triggers
The study’s authors said physicians need to know how chemical intolerance affects certain people and understand that conventional therapies can be ineffective. Some patients would improve by avoiding certain chemicals, foods and even medical prescriptions, the authors said.
Patients with chemical intolerance go to the doctor more than others, are prone to having multi-system symptoms and are more apt to have to quit their job due to physical impairment, the authors said….
…Chemically intolerant individuals often have symptoms that affect multiple organ systems simultaneously, especially the nervous system. Symptoms commonly include fatigue, changes in mood, difficulty thinking and digestive problems.
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….
Am thinking…how does one be compassionate to a doctor who lacks good communication skills?
And how does one draw out needed information from the same doctor when one is in a confused state of mind?
Maybe a communication and or/ life skills class in high school should be required that includes body language?
…For nearly two decades, teaching good communication skills has beenmandatory for medical schools because of research showing that good patient-doctor communication can lead to improved patient satisfaction and better health care outcomes. To this end, medical educators have developed a host of communication courses and workshops that combine lectures, self-assessments, video recordings and “standardized patients,” or actors in the role of patients.
More recently, many schools have broadened their courses to include “cultural competency,” or the ability to communicate with those from different racial, ethnic and social backgrounds. Studies have shown that while a patient’s race and ethnicity can be linked to sharply different treatment courses and quality, better communication between doctors and patients of different backgrounds can reduce the disparities.
Despite these tremendous efforts, there is one area of communication to which few schools have devoted significant time or resources: body language and facial expressions.In this recent study, for example, a group of medical sociologists analyzed the interactions between 30 primary care doctors and more than 200 patients over age 65 and found that white physicians tended to treat older patients similarly, regardless of race. Black physicians, on the other hand, often gave white patients contradictory signals, mixing positive nonverbal behaviors, like prolonged smiling or eye contact, with negative ones, like creating physical barriers by crossing the arms or legs….
- What Doctors Are Telling Us Even When They’re Not Talking (well.blogs.nytimes.com)
- Doctors may paint overly rosy prognosis (cbc.ca)
- Study Finds Doctors Not Always Honest With Patients (dfw.cbslocal.com)
- Study finds doctors aren’t always honest with patients (mercurynews.com)
- 1 in 10 Doctors Admit Lying in the Past Year (livescience.com)
- Many doctors in survey admit they have lied to their patients (seattletimes.nwsource.com)
- Study finds MDs not always honest with patients (seattletimes.nwsource.com)
- Skills in medicine (slideshare.net)
- Doctors’ Honesty Put to the Test (webmd.com)
- Some physicians do not agree with, uphold standards on communication with patients (Eureka News Alert)
A significant minority of physicians responding to a national survey disagreed with or admitted not upholding accepted standards of professionalism for open and honest communication with patients. In the February issue of Health Affairs, investigators from the Mongan Institute for Health Policy at Massachusetts General Hospital (MGH) report that, among other findings, one fifth of respondents indicated they had not fully disclosed a medical error out of concern for malpractice lawsuits and about one tenth admitted telling a patient something that was not true during the preceding year….
Five questions on the survey specifically addressed attitudes related to communication – including whether physicians should fully inform patients of the risks and benefits of their treatments, disclose all significant medical errors to patients and always keep patient information confidential – and four addressed what respondents had actually done in the preceding year. The survey was sent to 3,500 U.S. physicians – 500 each in internal medicine, family practice, pediatrics, cardiology, general surgery, psychiatry and anesthesia – and almost 1,900 surveys were completed and returned.
The overhelming majority of respondents agreed that physicians should completely inform patients about risks and benefits, never disclose confidential information and never tell a patient something untrue. While 66 percent agreed that all significant medical errors should be disclosed to affected patients, one third did not completely agree. Also, about one third did not agree that financial relationships with drug and device companies should always be disclosed. When asked about their own behavior in the preceding year, almost 20 percent admitted not fully disclosing a medical error for fear of being sued,[my emphasis] 28 percent admitted revealing a patient’s health information to an unauthorized person, and 11 percent responded that they had told a patient or the parent of a child something that was not true.
As part of its ongoing efforts to ensure safe, effective and appropriate medical imaging, the American College of Radiology has joined the ABIM Foundation and eight other medical specialty societies in Choosing Wisely. The new campaign promotes wise choices by physicians and patients to improve health outcomes, avoid unnecessary interventions and make efficient use of healthcare dollars.
The ACR will develop a list of five things to reduce unnecessary imaging exams ordered by physicians and improve quality of care. The list names imaging exams whose necessity should be discussed before being ordered. The list also equips providers with steps to help ensure safe, appropriate use of scans.
“Medical imaging exams are a perfect fit for Choosing Wisely. Scans lower healthcare costs by replacing more invasive surgeries and allowing for shorter hospital stays. Although imaging use is down significantly since 2008 and Medicare spending on imaging is the same as in 2004, opportunities remain to ensure appropriate ordering of scans. As greater access to imaging is directly tied to increased life expectancy, ACR will identify areas where care can be improved without restricting patient access,” said John A. Patti, MD, FACR, chair of the ACR Board of Chancellors……
The ACR list, and those of other Choosing Wisely partners, will be released in April 2012. To learn more, visit ChoosingWisely.org.
This series of six video vignettes featuring physicians and patients emerged from research the ABIM Foundation conducted to better understand public and professional attitudes about stewardship of finite resources. Watch the videos.
- ACR in Choosing Wisely campaign to promote wise use of resources among physicians and patients (medicalxpress.com)
In the outpatient setting, between 8% and 26% of abnormal test results, including those suspicious for malignancy, are not followed up in a timely manner.1,2Despite the use of electronic health records (EHRs) to facilitate communication of test results, follow-up remains a significant safety challenge. In an effort to mitigate delays, some systems have adopted a time-delayed direct notification of test results to patients (ie, releasing them after 3 to 7 days to allow physicians to review them).3,4
On September 14, 2011, the Department of Health and Human Services jointly with the Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention, and the Office for Civil Rights5 proposed a rule allowing patients to access test results directly from the laboratory by request (paper or electronic). …
- When patients see their medical record (kevinMD.com, January 2012)
“The study found that doctors worried that open visit notes would result in greater confusion and worry among patients and they anticipated more patient questions between visits. But the patients overwhelmingly wanted to see the notes and were not worried about being confused. They thought seeing their own record would provide information that would help them be healthier. They could see the treatment plans and the test results directly.”
Risks and benefits of direct access to lab results (jflahiff.wordpress.com)
- Should Patients Get Direct Access to Their Laboratory Test Results? An Answer With Many Questions (jflahiff.wordpress.com)
- Risks and benefits of direct access to lab results (kevinmd.com)
Often it’s easier to just say yes. But there are ways to say no that are better for both physician and patient
Doctors routinely meet with patients who make requests for specific medicines, tests and referrals to specialists. In this era of the Internet, consumer-driven healthcare and direct-to-consumer drug marketing, this is no surprise. And while an informed patient is a good thing, what may surprise you is just how hard it is for doctors to say no when a patient makes a specific request for something he or she doesn’t really need.
Right now, Dr. Conrad Murray sits in jail because he couldn’t say no to Michael Jackson when Propofol came up in conversation between them. But even doctors who aren’t tempted by an enormous monthly retainer and access to one of the world’s biggest celebrities are challenged by the word “no.”
American medicine is a business — but a weird one. In any other sector of our economy, businesses are determined to give their customers what they want, however they want it. But in medicine, the “have it your way” mind-set doesn’t always jive. First, physicians have a duty to avoid doing harm. The choice of a drug or test based solely on a patient’s request can undermine that. Second, as everybody knows, we spend a big slice of our GDP on healthcare. Since the person who has control over expensive tests and the prescription pad is your doctor, there’s ever-increasing scrutiny to be responsible stewards of healthcare dollars….
The lesson here is that it’s best for the doctor and the patient to get everything out in the open, and for a healthcare system that affords the right amount of access and time — especially in primary care — to make that to happen.
- Dr. Conrad Murray Sentenced to Four Years Behind Bars in Death of Michael Jackson (foxnews.com)
- Why doctors need to be better negotiators (kevinmd.com)
1. Mobile health technology will increase patient engagement. Most patients do not take the responsibility they should for their own health. They are likely preoccupied with all the stresses of everyday life and might therefore take the ‘I feel good, so I must be’ approach. They possibly mutter these words after wiping their faces, hurriedly walking out of McDonald’s for lunch. Or is it because of mistrust of their physician who they get to see for a big 15 minutes that the electronic record time slot permits? Or that they are caregivers to others and sacrifice their own well-being for that higher purpose?…
- 10 IT challenges for physician practices in 2012 (listahit.wordpress.com)
- Dermatologists, Medical Oncologists are the Top Physician Specialist Groups Communicating with Patients Online (prweb.com)
’ve been involved in clinical medicine for more than 20 years and during this time I’ve come across numerous situations that created stress, or emotional upheaval within myself, and even times of burnout. At one point, I came close to permanently leaving my chosen profession. The culture of medicine is not geared towards allowing health care providers to de-stress, acquire emotional support, or discuss in an encouraging environment various conflictive work scenarios with their colleagues. The end result of this culture of medicine leads providers to either leave their chosen profession, have professional burnout, deal with work conflict and/or become emotionally broken (i.e. having a lack of integrity, honesty, emotional connectedness with others, etc.)
An example of medicine’s culture which needs to be changed and causes conflict is one of its many unwritten rules of professional conduct. It states that the hospital attending is the only one who is supposed to go in and tell a patient their medical diagnosis and treatment. Anyone else on the medical team is just supposed to pretend as though they don’t know anything until after the attending has discussed the diagnosis with the patient. Usually this works out, but it can also lead to a breakdown in patient’s trusting their providers and/or asking team members to lie to patients until the attending has this discussion. This can lead to dishonesty and a lack of integrity on the part of the providers…..
- The culture of medicine needs to change (kevinmd.com)
- Short waits, long consults keep most patients very happy with their physicians (Eureka news alert)
- Intuition saved this patient from a potentially fatal diagnosis (kevinmd.com)
- 6 reasons why doctors won’t call patients (with possible solutions) (jflahiff.wordpress.com)
- Patients have a part to play in their own medical care (kevinmd.com)
by GABRIEL H. TENINBAUM in the 20 November edition of KevidMD.com
To deal with the aftermath of medical errors, an increasing number of providers are encouraging injured patients to participate in “medical apology programs.” The idea, proponents say, is for patients to meet with facility representatives to learn what happened and why. It gives the patient a chance to ask questions and it gives providers a chance to apologize, and as appropriate, offer compensation. These programs are promoted as humanitarian, and, at least in terms of providing an emotional outlet for patients, they are.
The evidence also suggests that they are about something else: money. Every aspect of how they operate – from who risk managers involve, to what those involved are told to say – suggests a key goal is to dissuade patients from seeking compensation by creating an emotional connection with them. …
- We’re Only Human, Even Our Doctors and Nurses (hcfama.org)
- Patient Safety Must Be Improved (medicalnewstoday.com)
- In Touch With Patients (1 Letter) (nytimes.com)
- Medical Error Prompts Doctor to Push for Safety Measures (prweb.com)
- Health IT May Be Cause Of Patient Errors (baravaida.wordpress.com)
- How much physician guidance do patients want with medical decisions? (kevinmd.com)
From the 18th November posting by DOMINIC A. CARONE, PHDat KevinMD.com
- Useful tips when looking for a new doctor (kevinmd.com)
- Beware Picking Your Dentist (evelyngarone.wordpress.com)
- The impact of unnecessary testing and treatment on patients (jflahiff.wordpress.com)
The art of medicine, the most important part of medicine, involves several components:
- Caring for patients, showing honest concern and compassion
- Giving patient’s time, not rushing in and out of the exam clinic room, being patient with them, having a great bedside manner
- Using the evidence based medicine algorithms as a guideline, as we apply them to each and every patient we see. Understanding that every patient is an individual who has individual circumstances that affect their lives
- Helping every patient to acquire the best outcome they can for themselves by working with them, educating them, coming up with a mutually agreed upon plan of action
Evidence based medicine does not teach us how to apply them to the patients we see, only the art of medicine does that. [Flahiff’s emphasis] Much unlike evidence based medicine we don’t learn the art of medicine in a classroom. We learn the art of medicine by seeing patients, one by one, year after year. As new research comes out and the evidence based medicine algorithms change, hopefully we have refined our art of medicine skills to such a fine point that we have attained the stature of a wise mentor….
- Evidence based medicine removes a physician’s autonomy (kevinmd.com)
- Compassionate care is a crucial component of care (kevinmd.com)
- Using Social Media For Practicing Evidence Based Medicine (drneel.wordpress.com)
- Substitutes for evidence based (and science based) medicine (doctorrw.blogspot.com)
- 5 tips to evaluate medical websites (kevinmd.com)
Dr. Mohammodieza Hojat and a multidisciplinary team at Jefferson Medical College in Philadelphia have previously published 5 articles validating an objective and reproducible measure of empathy exhibited by physicians in the context of medical education and patient care. They hypothesized that a physician’s empathy would positively effect clinical outcome, not just patient satisfaction.
To test their theory, they chose patients with diabetes, a chronic disease that requires frequent engagement between patient and doctor, much patient education and communication as well as strict compliance to designated treatment protocols. Moreover, there are definable and easily measurable indicators of improved clinical outcomes. Appropriate statistical controls were used to separate the effect of empathy from other know determinants of outcome such as gender, age and socioeconomic status.
They followed 891 diabetic patients for 3 years and conclusively showed that physicians’ empathy itself resulted in a 40-50% improvement in the measured results. Finally, in their concluding remarks, the researchers acknowledged any limitations to their methodology, but stated that their results do provide sufficient evidence warranting replication of this line of investigation at other institutions and with a variety of diseases….
- Doctors can learn empathy through a computer-based tutorial (eurekalert.org)
- Is medical school an empathotoxin? (mindhacks.com)
- We need to talk about Kevin’s lack of empathy (guardian.co.uk)
- ¿Do you have empathy? (vae20.wordpress.com)
The American Board of Medical Specialties (ABMS) has begun publicly reporting whether specialists are meeting the continuing education requirements necessary for maintaining board certification.
Seven member boards — the American Boards of Dermatology, Family Medicine, Nuclear Medicine, Otolaryngology, Physical Medicine and Rehabilitation, Plastic Surgery, and Surgery — are the first to report via the ABMS.
Information is available on physicians certified by those boards at www.certificationmatters.org.
Search results show the name of the certifying board, and a “yes” or “no” as to whether the physician is meeting the maintenance of certification (MOC) requirements for that board. A link will take the searcher to the certifying board’s explanation of its specific requirements.
The remaining 17 member specialty boards will make maintenance of certification status available through the ABMS by August 2012.
- Clinical Informatics Wins Official Recognition (informationweek.com)
- Physicians Oppose Increased Certification Requirements (bsurgmed.wordpress.com)
- National Medical Society Advises How to Choose a Pain Specialist (prweb.com)
- Universal board certification can solve the Doctor Nurse controversy (kevinmd.com)
(CNN) – As much as she would like to, Dr. Lissa Rankin, a gynecologist, will never forget the woman who planned her wedding while lying naked on her examining table.
“Every 15 seconds, her cell phone was going off, and she was answering it!” Rankin recalls. “It was like, ‘That’s not the cake I ordered,’ and, ‘No, it’s the other gown,’ and I said to her, ‘Is this a bad time? Should I come back later?’ ”
From the Hospitals and Health Networks summary (at http://www.hhnmag.com)
House calls have arrived
Sue Paone, Executive IT Director at University of Pittsburgh Medical Center, talks to H&HN senior editor Suzanna Hoppszallern about UPMC’s use of e-visits, which patients use to connect with physicians online on more than 20 conditions and earned UPMC a 2011 Most Wired Innovator Award. Video running time: 4:47.
- Doctors Screen for Cervical Cancer Too Often (nlm.nih.gov)
- Why is it so difficult for doctors to stay on time? (kevinmd.com)
- iPads used for diagnosis and treatment in Texas hospital (tuaw.com)
- The value of time in medicine (medrants.com)
Patients want to know why they can’t get a return call from their doctor’s office – here are six reasons why the calls have increased and physician offices are having trouble meeting the needs of their patients.
- Medication questions and requests for a prescriptions change. The average number of retail prescriptions per capita increased from 10.1 in 1999 to 12.6 in 2009. (Kaiser Family Foundation calculations using data from IMS Health, http://www.imshealth.com.) Because it is not easy to access prescription cost by payer in the exam room, medical practices get lots of callbacks from patients asking to change their prescriptions once they arrive at the pharmacy and find out how much the prescription costs. Related issue: Many national-chain pharmacies have electronic systems that automatically request a new prescription when the patient is out of refills. Also related: Patients calling to ask for additional medication samples.
- Patients are delaying coming to the physician’s office by calling the practice with questions. Patients want to forestall paying their co-pay or their high-deductible by getting their care questions answered without coming to the doctor’s office.
- Patients call back with questions about what they heard or didn’t hear in the exam room.They may not remember what the physician told them, they may not have understood the medical jargon, or they may have a hearing problem and were not comfortable asking the physician to repeat something….
- Implications of a Technology-Based Medical Encounter (medicineandtechnology.com)
- How to Save on Prescription Drug Costs (savings.com)
- Medication Dispensing is Now Available to Patients Before They Leave the Office (prweb.com)
- Medical Docotors Will Issue You A Prescription With No Prescription Ahead Of Time (bigsexymedia.com)
- Pharmacists’ role could expand (cbc.ca)
- Doctors’ use of e-prescriptions soars (seattletimes.nwsource.com)
There are multiple costs to non-compliance, including financial, both personal and societal, and physical-emotional. When patients fail to comply with treatment protocols, fail to get prescribed tests, or fail to stop destructive behaviors, there is a societal cost.
Today, I want to address the physical and emotional costs of non-compliance. I just read a brilliant article by Roxanne Sukol, MD. Dr. Sukol’s article discussed the fact that diabetes starts 10 years prior to your doctor making a diagnosis and, if addressed early, often can be avoided. In her article, Dr. Sukol states, “I like my patient vertical. Not horizontal.” Most doctors have favorite sayings. My favorite is, “May you be so blessed as to never know what disease you prevented.” I’ll add Dr. Sukol’s to my favorite list.
Another one of my favorite sayings is “There is no such thing as pre-diabetes. Pre-diabetes is like being pre-pregnant.” …
(readers responses here, along with responses to other cases)
When patients develop this trust, they are more likely to comply with doctors recommendations and therefore get better care. If you passively take in what the doctor tells you, you’re not involved and less likely to be on-board with your treatment and less likely to follow her instructions. So, it was not surprising how doctors responded to a survey from Consumers Report, and reported in the Washington Post, about their professional challenges and about what patients could do to get the most out of their “relationship” with their doctors….
- What this doctor learned when he was a patient (kevinmd.com)
- Measuring physician trust in patients (kevinmd.com)
- Is it okay to have two family doctors? (theglobeandmail.com)
…..When it came to medical decisions, almost all the respondents wanted their doctors to offer choices and consider their opinions. But a majority of patients — two out of three — also preferred that their doctors make the final decisions regarding their medical care.
“The data says decisively that most patients don’t want to make these decisions on their own” said Dr. Farr A. Curlin, an associate professor of medicine at the University of Chicago and one of the authors of the study.
The challenges appear to arise not when the medical choices are obvious, but when the best option for a patient is uncertain. In these situations, when doctors pass the burden of decision-making to a patient or family, it can exacerbate an already stressful situation. “If a physician with all of his or her clinical experience is feeling that much uncertainty,” Dr. Curlin said, “imagine what kind of serious anxiety and confusion the patient and family may be feeling.”
Patients and their families also often don’t realize that their doctors may be grappling with their own set of worries. …
- Talking about faith increases hospital patients’ overall satisfaction (esciencenews.com)
- Do Patients Have the Toughest Job in Medicine? (well.blogs.nytimes.com)
- What this doctor learned when he was a patient (kevinmd.com)
- Why doctors should stop wearing ties (kevinmd.com)
- Patients want and need to take a greater role in their medical care (kevinmd.com)
I interviewed about 150 medical leaders just a few years ago for my book The Future of Medicine – Megatrends in Healthcare. Not one mentioned wireless devices as a coming megatrend. How fast the world changes! Nowadays everyone has a cell phone and we rarely stop to think that just two decades ago almost no one had them. We have a laptop or tablet computer that can access information from the web at very high rates of speed; again it is hard to remember when this wasn’t so. And those with smart phones have numerous “apps” – to check traffic conditions, find the nearest Starbucks, or play games. But these and other devices that use wireless technology will lead to major changes in the delivery of health care in the coming years. This is another of those coming medical megatrends.
Read the rest of Wireless devices will dramatically change how medicine is practiced on KevinMD.com.
- Unintended consequences of patient portals (kevinmd.com)
- Invasion of the Body Hackers? Wireless Medical Devices Susceptible to Attacks (tjantunen.com)
- Mobile Security Requires More Than Secure Wireless Devices (aviatnetworks.com)
If you don’t share details about your life and what is important to you, you may not get the treatment that is best for you. Think about it this way: If you are a student who lives near a bus stop, you might be able to take a medicine that makes you a little sleepy because you do not need to drive. But if you are a truck driver, that medicine might make you too sleepy to do your job. Sharing details about your daily life and what’s important to you can help your doctor recommend a treatment that helps you get better and improves your quality of life.
Answer the questions below to get your own health priorities snapshot to share with your doctor.
Visit the Full Effective Health Care Program here
This program includes
- Guides for Patients and Consumers (as research reviews and research reports)
- Explanation of Comparative Effectiveness Research
- Personalization and Social Media Tools to be used with the Effective Health Care Program
(Mobile device option, email lists, Facebook, Twitter, and more)
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.
- The Wrong Results (everydayhealth.com)
All over the world, patients with chronic pain struggle to express how they feel to the doctors and health-care providers who are trying to understand and treat them.
Now, a University at Buffalo psychiatrist is attempting to help patients suffering from chronic pain and their doctors by drawing on ontology, the branch of philosophy concerned with the nature of being or existence.
The research will be discussed during a tutorial he will give at the International Conference on Biomedical Ontology, sponsored by UB, that will be held in Buffalo July 26-30.
“Pain research is very difficult because nothing allows the physician to see the patient’s pain directly,” says Werner Ceusters, MD, professor of psychiatry in UB’s School of Medicine and Biomedical Sciences, and principal investigator on a new National Institutes of Health grant, An Ontology for Pain and Related Disability, Mental Health and Quality of Life.
“The patient has to describe what he or she is feeling.”
- What Doctors don’t know about pain (thehandiestone.typepad.com)
- Well: Giving Chronic Pain a Medical Platform of Its Own (well.blogs.nytimes.com)
The emerging literature on chronic disease management suggests that successful programs rely on patient self management skills. Having been in the primary care role for 20 years, that initially seemed self evident and a bit “so what?” to me, thinking it meant that we just need to teach our patients a bit more in the primary care office.
However self-management skills refer to specific curricula of skills that can be taught to patients in formal programs, without doctors. Coordinating these activities with what goes on a primary care office, and the community, and other care-giving settings is critical. These specific skills involve patients setting their own goals, and then creating plans to reach those goals with the assistance of their primary care team and others, but not at the direction of their primary care team. This is a real mind shift for the primary care doctor also.
- The benefits of successful patient self-management programs (kevinmd.com)
- Summary Box: Trying a new approach to primary care (seattletimes.nwsource.com)
- New Brief Outlines Strategies to Put Patients at the Center of Primary Care (jflahiff.wordpress.com)
WEDNESDAY, July 20 (HealthDay News) — The behavior of surgeons in the operating room affects more than their patients’ health, new research indicates.
It also plays a part in determining health-care costs, the number of medical errors and patient satisfaction, according to a commentary in the July issue of The Archives of Surgery. Surgeons who are civil, the report claimed, can more effectively help their patients and reduce costs…
- Polite doctors ‘make for healthier patients’ (telegraph.co.uk)
- Fewer Surgical Errors Reported at VA Medical Facilities (nlm.nih.gov)
- Medical Errors Down at U.S. Veterans’ Hospitals (nlm.nih.gov)
From the press release
AHRQ has released a new brief, The Patient-Centered Medical Home: Strategies to Put Patients at the Center of Primary Care, highlighting opportunities to improve patient engagement in primary care. The brief focuses on involvement at three levels: the engagement of patients and families in their own care, in quality improvement activities in the primary care practice, and in the development and implementation of policy and research related to the patient-centered medical home (PCMH). Strategies to Put Patients at the Center of Primary Care provides a clear and concise definition of the patient-centered medical home and outlines six strategies that can be used to support primary care practices in their efforts to engage patients and families. This brief and other resources, including white papers and a searchable database of PCMH-related articles, is available from AHRQ’s online PCMH Resource Center at PCMH_Patients at the Center of Primary Care (PDF File, PDF Help).
- Health-care model improves diabetes outcomes, health (eurekalert.org)
- More On The Synergies Between the Patient Centered Medical Home (PCMH) and Remote Telephonic Disease Management (diseasemanagementcareblog.blogspot.com)
Why Physicians Are Reluctant to Share Patient Data: Fine Line Between Protecting Privacy and Public Health
Family doctors are reluctant to disclose identifiable patient information, even in the context of an influenza pandemic, mostly in an effort to protect patient privacy. A recently published study by Dr. Khaled El Emam the Canada Research Chair in Electronic Health Information at the University of Ottawa and the Children’s Hospital of Eastern Ontario Research Institute recently found that during the peak of the H1N1 pandemic in 2009, there was still reluctance to report detailed patient information for public health purposes.
These results are important today, so we can learn from that experience and prepare for the inevitable next pandemic.
“There is a perceived tradeoff between the public good and individual privacy. If we sway too much on the public good side, then all people’s health data would be made available without conditions,” explained Dr. El Emam. “If we sway too much on the individual privacy side then no health data would be shared without consent, but then this would potentially increase public health risks. Physicians are important gatekeepers of patient information, so we need to better understand the conditions under which they are willing to provide patient data so that everyone wins; we do not need to make these tradeoffs….
The US Agency for Healthcare Research and Qualtiy (AHRQ) publishes a wealth of information for consumers and patients on staying healthy, choosing medical care, understanding diseases and conditions, and comparing medical treatments.
For example, Explore Your Treatment Options gives sound advice on
- Why one should explore treatment options
- Tips on how to start the conversation about treatment options with doctors
- Rating health priorities through a check list type tool. The questions ask you to rate ease of every day activities, concerns about treatment side effects, and basic questions about treatment time, cost, and effort. Results may be printed to share with your doctor.
- Links to Treatment Guides (cancer, diabetes, heart conditions, and more)
Ever since the Institute of Medicine issued its landmark report “To Err Is Human” in 1999, significant attention has been paid to improving patient safety in hospitals nationwide.
However, a high number of adverse events, including major injury and even death, occur in private physician offices and outpatient clinics as well. In a new study — the first of its kind — researchers at Weill Cornell Medical College found that the number and magnitude of events resulting from medical errors is surprisingly similar inside and outside hospital walls.
Published in today’s Journal of the American Medical Association (JAMA), the study ***uses malpractice claims data to assess the prevalence of adverse events in the outpatient setting. The researchers compared malpractice claims paid on behalf of physicians in hospitals versus doctors’ offices, relying on data from the National Practitioner Data Bank from 2005 through 2009.
In 2009 alone, close to 11,000 malpractice payments were made on behalf of physicians. Analysis of the data showed that about half of these were for errors that occurred in the hospital setting and half for adverse outcomes resulting from errors at the doctor’s office.
The researchers also found that adverse events in hospitals largely have to do with unsuccessful surgery, while negative outcomes in the outpatient setting are most often related to errors in diagnosis.
(Garrison, NY) In a feature article in The New Republic,(subscription only, check your local public library for availability) Daniel Callahan and Sherwin Nuland propose a radical reinvention of the American medical system requiring new ways of thinking about living, aging, and dying. They argue that a sustainable—and more humane— medical system in the U.S. will have to reprioritize to emphasize public health and prevention for the young, and care not cure for the elderly.
An interesting twist on their argument, which would aim to bring everyone’s life expectancy up to an average age of 80 years but give highest priority for medical treatment to those under 80, is that Callahan and Nuland are themselves 80 years old. Daniel Callahan, Ph.D., is cofounder and president emeritus of The Hastings Center and author most recently of Taming the Beloved Beast: How Medical Technology Costs Are Destroying Our Health Care System. Sherwin Nuland, M.D., is a retired Clinical Professor of Surgery at the Yale School of Medicine and author of How We Die and the Art of Aging. He is also a Hastings Center Fellow and Board member.
“The real problem is that we have medicine excessively driven by progress, which aims to rid us of death and disease and treats them as the targets of unlimited medical warfare,” said Callahan and Nuland. “That warfare, however, has come to look like the trench warfare of World War I: great human and economic cost for little progress. Neither infectious disease nor the chronic diseases of an aging society will soon be cured. Cancer, heart disease, stroke, and Alzheimer’s disease are our fate for the foreseeable future. Medicine and the public must adapt it to that reality, one that has mainly brought us lives that end poorly and expensively in old age.”
The article notes that the Affordable Care Act might ease the financial burden of this system, but not eliminate it. It reports, for example, that the cost of Alzheimer’s disease is projected to rise from $91 billion in 2005 to $189 billion in 2015, and to $1 trillion in 2025 – twice the cost of Medicare expenditures for all diseases now.
“We need to change our priorities for the elderly. Death is not the only bad thing that can happen to an elderly person,” the authors write. “An old age marked by disability, economic insecurity, and social isolation are also great evils.” They endorse a culture of care, not cure, for the elderly, with a stronger Social Security program and a Medicare program weighted toward primary care that supports preventative measures and independent living.
Callahan and Nuland point the way to a more sustainable path that reprioritizes the entire system. Among their recommendations:
- improve medicine at the level of public health and primary care, while reducing its use for expensive high-tech end-of-life care;
- shift resources for the elderly to greater economic and social security and away from more medical care;
- subsidize the education of physicians, particularly those who go into primary care, and decrease medical subspecialization;
- train physicians better to tell the truth to patients about the way excessively aggressive medicine can increase the likelihood of a poor death;
- shift the emphasis in chronic disease to care rather than cure;
- conduct a top-down, bottom-up, long-range study of the entire American system of health care, including the training of physicians, with a view toward reconstituting it along systematic lines that take science, humanistic concerns, economics, and social issues into account.
- Andrew Reinbach: Health Care Could Kill Us: We Don’t Have to Let It (huffingtonpost.com)
- New at Reason: Ronald Bailey on Health Care Reform (reason.com)
Studies Evaluate Criteria For Detecting Potentially Inappropriate Medications In Older Hospitalized Patients
Using the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria was associated with identification of adverse drug events in older patients, according to a report in the June issue of Archives of Internal Medicine, one of the JAMA/Archives journals. The article is part of the journal’s Less Is More series.
According to information in the article, adverse drug events (ADEs) are a significant issue in the older population, and are thought to represent an important cause of hospitalization and account for substantial health care expenditures. Some ADEs are associated with potentially inappropriate medications (PIMs): agents that may cause problems in older patients “because of the higher risk of intolerance related to adverse pharmacodynamics or pharmacokinetics or drug-disease interactions.” During the last two decades, the Beers criteria for judging whether a medication is appropriate for use in an older patient have become the leading standard. Nevertheless, the authors write, research into whether the Beers criteria are associated with avoidable ADEs has not generated consistent results….
…According to the authors, the results suggest that STOPP criteria were more likely than Beers criteria to reveal ADEs in general, avoidable or potentially avoidable ADEs, and ADEs that may have factored into the patient’s hospitalization. “We believe that this finding strengthens the argument for the use of STOPP criteria in everyday clinical practice as a means of reducing the risk of ADEs in older patient,” they write. …
Harmful effects of medication bring an estimated 4.5 million patients to doctors’ offices and emergency rooms yearly, according to a new study, and people who take multiple medications are particularly vulnerable to unpleasant or dangerous side effects, allergic reactions and toxicity.
Such medication mishaps are a widely recognized problem in health care, but until now, most research has focused on their incidence in the hospital.
“The outpatient setting is where 80 percent of medical care takes place-where we would expect the real burden of the problem to be,” said Urmimala Sarkar, M.D., lead study author, at the University of California, San Francisco.
Analyzing data from 2005 to 2007 from the National Center for Health Statistics, the researchers found that 13.5 million outpatient visits during this three-year period had links to negative effects from prescription medications, in the study appearing online in the journal Health Services Research. …
…While some unwanted effects are inevitable with drug treatment, “many are preventable,” Sarkar said. To reduce their incidence, she said, “medical counseling in doctors’ offices and pharmacies has to be better. Patients need to know what medications they’re on and their possible side effects, and to understand what they’re allergic to.”
Steps to alleviate drug-related problems ultimately should include changes in the health care system, such as coordinated electronic medical records to facilitate information sharing between clinicians, Sarkar said.
Sarkar U, et al. Adverse drug events in U.S. adult ambulatory medical care. Health Services Research online, 2011.
- Prevent Medical Errors With Health Records (everydayhealth.com)
- What Is a Drug Allergy? (everydayhealth.com)
ScienceDaily (Apr. 11, 2011) — The act of making a recommendation appears to change the way physicians think regarding medical choices, and they often make different choices for themselves than what they recommend to patients, according to a survey study published in the April 11 issue of Archives of Internal Medicine, one of the JAMA/Archives journals…
[For suggestions on how to get this article for free or at low cost, click here]
..”In conclusion, when physicians make treatment recommendations, they think differently than when making decisions for themselves,” the authors conclude. “In some circumstances, making recommendations could reduce the quality of medical decisions. In at least some circumstances, however, such as when emotions interfere with optimal decision making, this change in thinking could lead to more optimal decisions. In debating when it is appropriate for physicians to make treatment recommendations to their patients, we must now recognize that the very act of making a recommendation changes the way physicians weigh medical alternatives.”
By Cole Petrochko, Staff Writer, MedPage Today
***Off-label use: In the United States, the regulations of the Food and Drug Administration (FDA) permit physicians to prescribe approved medications for other than their intended indications. This practice is known as off-label use [MedicineNet.com definition]
- Top Three Off-Label Marketing Strategies and Tactics (goodpromotionalpractices.com)
- Off-label marketing of medicines in the US is rife but difficult to control (eurekalert.org)
- More on Off-Label Promotion and the False Claims Act (druganddevicelaw.blogspot.com)
- A Godzilla Of A New Third Party Payer Dismissal (druganddevicelaw.blogspot.com)
- Off-label marketing of medicines in the US is rife but difficult to control (physorg.com)
This February 28 2011 report is published by the Pew Research Center, a “nonpartisan “fact tank” that provides information on the issues, attitudes and trends shaping America and the world. It does so by conducting public opinion polling and social science research; by analyzing news coverage; and by holding forums and briefings. It does not take positions on policy issues.” [From the Pew Research Center About Page]
Some excerpts from the report
- Many Americans turn to friends and family for support and advice when they have a health problem. This report shows how people’s
networks are expanding to include online peers, particularly in the crucible of rare disease. Health professionals remain the central
source of information for mostAmericans, but “peer‐to‐peer healthcare” is a significant supplement.
- One in five internet users have gone online to find others like them.Eighteen percent of internet users say they have gone online
to find others who might have health concerns similar to theirs.
- In the moment of need, most people turn to a health professional for information, care, or support. When asked about the last time they had a health issue, 70% of adults in the U.S. say they receivedinformation, care, or support
from a health professional.
Doctors lax in monitoring potentially addicting drugs
Study: Missed opportunity to reduce opioid-related abuse, addiction and overdose
March 3, 2011 — (BRONX, NY) — Few primary care physicians pay adequate attention to patients taking prescription opioid drugs — despite the potential for abuse, addiction and overdose, according to a new study by researchers at Albert Einstein College of Medicine of Yeshiva University.
The study, published in the March 2 online edition of the Journal of General Internal Medicine,*** found lax monitoring even of patients at high risk for opioid misuse, such as those with a history of drug abuse or dependence. The findings are especially concerning considering that prescription drug abuse now ranks second (after marijuana) among illicitly used drugs, with approximately 2.2 million Americans using pain relievers nonmedically for the first time in 2009, according to the National Institute on Drug Abuse (NIDA).
“Our study highlights a missed opportunity for identifying and reducing misuse of prescribed opioids in primary care settings,” said lead author Joanna Starrels, M.D., M.S. , assistant professor ofmedicine at Einstein. “The finding that physicians did not increase precautions for patients at highest risk for opioid misuse should be a call for a standardized approach to monitoring.”…
- Prescription drug deaths soar in Georgia (ajc.com)
- Combating Misuse and Abuse of Prescription Drugs: Q&A (everydayhealth.com)
- Study of Retired Football Players Reveals Higher Rates of Painkiller Misuse (psychweekly.wordpress.com)
- Teen Drug Addiction: Is Your Teen Misusing Meds? (aolhealth.com)
- Narcotic Pain Relief Drug Overdose Deaths a National Epidemic (addictionts.com)
The National Institutes of Health Senior Health site has new information on how to talk to your doctor.
It includes information on planning an office visit, how to get the most out of an office visit, and conversations after diagnosis.
Includes links to related videos.
Not for seniors only!
- Talking to Your Doctor links you to NIH resources that can help you make the most of your conversations with your doctor.
Communication is key to good health care.
Get tips for asking questions and talking openly about your symptoms and concerns.
Includes general guides as well specific advice in these areas: cancer, eye health, diabetes, hearing, heart health, kidney
disease, urologic conditions, weight loss, complementary and alternative medicine, and aging
- Cooperation between patient and doctor is essential today in health care (kevinmd.com)
- The Benefits of Going to a Geriatric Specialist (everydayhealth.com)
- The Hospitalists Have Become The Gatekeepers for Effective Hospital Coding & Sometimes Bear the Burden Alone (ducknetweb.blogspot.com)
- Before You Go to the Doctor (rawminimum.com)
- Prevent Medical Errors With Health Records (everydayhealth.com)
- Regular Check Up And Health Screenings Can Help Save Your Life (pro2sell.com)