April 27th, 2011 by AnneHansonMD in Health Tips, Opinion
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Sideways Shrink posed a great question recently in a comment on my post “When A Thick Skin Helps.” The question was whether or not physicians are allowed to hit a patient who tries to assault them.
Certainly, physical assaults on patients are not the standard of practice in psychiatry or any other medical specialty. Psychiatrists do undergo some training about physical management of violent patients: I remember in residency we had to get trained in “take down” and restraint procedures. As a group we practiced applying pressure point joint locks on each other in order to make a patient break a grip on us, and to do two person restraints to hold someone immobile until security could arrive. None of this involved any “Crouching Tiger, Hidden Dragon”-type kung fu moves, there was no kicking or hitting or loud kiai karate yells. There was a lot of talk about the importance of being as least forceful as possible. Frankly, I’m not sure how much of that I would have remembered if I had ever been in a position to have to use it. The few times when I was actually assaulted by patients the incidents happened so fast there really wasn’t anything I could have done. (OK, so the little manic lady who hit me with a stuffed dog really couldn’t count as an assault, and she was already restrained in a geri-chair to begin with.)
But the real question is: will a doctor get into trouble for defending him or herself? Read more »
*This blog post was originally published at Shrink Rap*
April 27th, 2011 by Dr. Val Jones in Opinion, Primary Care Wednesdays, True Stories
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A friend of mine is in great physical shape but her husband (we’ll call him “Mr. B”) has gained 40 pounds since they were married five years ago. He also has familial hypercholesterolemia, and several of his relatives have had heart attacks at young ages. Mrs. B is distraught – she is worried about her husband’s health, and has tried to gently nudge him towards healthier eating habits and regular exercise (as well as taking a statin for his cholesterol). Unfortunately, the nudges were received as nagging, and a wedge has formed between them in their relationship.
Last week my friend planned a trip to a primary care physician in the hopes that he would educate Mr. B about the dangers of being overweight and not treating his high cholesterol. “Surely Mr. B will listen to an expert” she thought, “then perhaps he’ll realize that he has to change his behavior.”
Unfortunately, the primary care physician didn’t offer any health counseling to Mr. B. Not only did he not mention that Mr. B should lose weight, but he didn’t provide any warnings about the dangers of untreated, very high cholesterol levels. He merely reported that Mr. B’s total cholesterol was 300, and that a statin was indicated.
Mrs. B was crestfallen. She was depending on the physician’s authoritative input to help her come up with a strategy to steer her husband towards better health. Now Mr. B was left with the impression that things were more-or-less ok, and that his wife’s concerns were exaggerated. Read more »
April 27th, 2011 by Glenn Laffel, M.D., Ph.D. in Research
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Nowadays, a lot of folks pursue happiness as if it were their primary mission in life. But what is happiness?
Philosophers tell us there are at least 2 kinds. There is so-called “hedonic well-being” which is short-term pleasure derived from things like a tasty meal, great sex or a day in the amusement park. Then there’s “eudaimonic well-being” which comes from living with a sense of purpose, which is usually actualized by participating in meaningful activities like volunteering for a worthy cause, raising children or caring for others.
Scientists have recently joined their philosopher brethren in the analysis of happiness. Remarkably, they have produced evidence which suggests that people who are driven to achieve eudaimonic happiness actually have better health outcomes than those motivated to achieve hedonic happiness. They are more likely to remain intact cognitively, for example. They even tend to live longer.
For example, in a cohort study of 7,000 people known as MIDUS (the Mid-Life in the US National Study of Americans), Carol Ryff and colleagues at the University of Wisconsin have tried to identify social and behavioral factors that predict one’s ability to maintain good health into old age. The team has focused on sociocultural sub-populations known to be associated with poor health outcomes…things like low education level. Read more »
*This blog post was originally published at Pizaazz*
April 27th, 2011 by Edwin Leap, M.D. in Health Policy, True Stories
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Our emergency department was very busy recently. The hospital was full and we were holding patients. Three had been in the ER many hours; one waiting for a bed for six hours, another eight hours, and still one more for eleven hours. Of course, ambulance traffic hadn’t stopped and the waiting room was full, with patients waiting too long to be seen. (And we all know that the media loves to highlight bad outcomes from the ER waiting room!)
Administration set up a ‘command post’ to try to arrange beds, discharges and moves. At one point I asked one of our administrators to move those waiting the longest to hallway beds up on the patient floors. He told me that he couldn’t because each of the two floors in question already had one patient in the hall. And besides, it would violate the patients’ privacy and make it too difficult for the nurses to do their admissions assessments.
I pointed out, ‘our nurses do assessments in the hall, our patients don’t have privacy and sometimes we have to work with seven or eight patients in the hallway!’
He replied, ‘yes Dr. Leap, I know, but I won’t move anyone else to the hall upstairs. I just won’t.’ I asked why. With a slight sense of obvious discomfort he replied, ‘because there is a different standard. When patients leave the ER, they expect to go to a better place.’ Read more »
*This blog post was originally published at edwinleap.com*
April 26th, 2011 by Steve Novella, M.D. in Quackery Exposed, True Stories
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I must say I was a bit shocked two weeks ago when I was contacted by a producer for The Dr. Oz Show inviting me on to discuss alternative medicine. We have been quite critical of Dr. Mehmet Oz over his promotion of dubious medical treatments and practitioners, and I wondered if they were aware of the extent of our criticism (they were, it turns out).
Despite the many cautions I received from friends and colleagues (along with support as well) – I am always willing to engage those with whom I disagree. I knew it was a risk going into a forum completely controlled by someone who does not appear to look kindly upon my point of view, but a risk worth taking. I could only hope I was given the opportunity to make my case (and that it would survive the editing process).
The Process
Of course, everyone was extremely friendly throughout the entire process, including Dr. Oz himself (of that I never had any doubt). The taping itself went reasonably well. I was given what seemed a good opportunity to make my points. However, Dr. Oz did reserve for himself the privilege of getting in the last word—including a rather long finale, to which I had no opportunity to respond. Fine—it’s his show, and I knew what I was getting into. It would have been classy for him to give an adversarial guest the last word, or at least an opportunity to respond, but I can’t say I expected it. Read more »
*This blog post was originally published at Science-Based Medicine*
Sideways Shrink posed a great question recently in a comment on my post “When A Thick Skin Helps.” The question was whether or not physicians are allowed to hit a patient who tries to assault them.
