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Understanding Your Hospice And Palliative Care Options

Prepared Patient - Hospice Care: What Is It, Anyway? Seeking Shelter

The word hospice originated from the Latin hospitium, which means “to host or offer a place of shelter.” In 2009, an estimated 1.56 million patients, more than 40 percent of deaths, received hospice services in the United States. But many others who might have benefited from hospice care did not seek services, perhaps due to misconceptions, fears and the lack of information of patients, caregivers and even physicians.

“Hospice is a collection of services that are designed to support the patient and family through the course of a serious or terminal illness,” said Donald Schumacher, Psy.D, president and CEO of the National Hospice and Palliative Care Organization (NHPCO). The aim of hospice is to provide physical and emotional care and comfort in the months, weeks and days before death.

It’s often hard for patients and their loved ones to acknowledge that the time to consider hospice care has come. People come to that realization differently and there are some that might never seem to face that the end of life is near. But through the ups and downs of emotions and physical status, hospice team members Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

Research Shows Some Misunderstanding Among Physicians Regarding End-Of-Life Directives

Struggling with the meaning of life is one thing. Struggling with the meaning of end-of-life directives shouldn’t be.

Physicians misidentify living wills as do-not-resuscitate (DNR) designations and DNR orders as end-of-life care directives, concluded a study. Adding code status designations to a standard advanced directive can ensure that patients receive or do not receive the care they want.

The study, “TRIAD III: Nationwide Assessment of Living Wills and Do Not Resuscitate Orders,” appeared in the Dec. 5 issue of The Journal of Emergency Medicine.

Researchers Read more »

*This blog post was originally published at ACP Hospitalist*

Waiting For Medical News That Could Change Your Life

That old Tom Petty song, “The Waiting is the Hardest Part,” keeps running through my mind. Four of my friends are waiting to hear the results of medical tests taken last week.

  • Lucas has exhausted all of the standard cancer therapies for rectal cancer and is waiting to hear if he is a candidate for any experimental treatments.
  • Sam, who has lived through aggressive treatment for multiple cancers, is waiting to hear results from a test that will tell him if the fact that he is so very, very sick is due to one of them recurring.
  • Lucy just had major abdominal surgery and is waiting to hear the results of the pathology report that will determine whether or not her cancer can be treated at all.
  • Phil, who has been in remission from two different leukemias, had Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

Are Doctors More Likely To Refuse Certain Medical Care?

No CPRA must-read piece from Ken Murray:

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.

Worth the full read.

And so true. I’ve joked about getting the above tattoo when my times comes. (I would quibble that the modern CPR success rate is better than infinitesimal, especially with hypothermia, but it still ain’t great.)

It may have to do with Read more »

*This blog post was originally published at Movin' Meat*

Constipation: A Common Problem In End-Of-Life Care

Family physicians who care for terminally ill patients must manage a wide range of bothersome symptoms, including pain, fatigue, dyspnea, delirium, and constipation. According to a Cochrane for Clinicians article in the December 1st issue of American Family Physician, constipation affects up to half of all patients receiving palliative care and nearly 9 in 10 palliative care patients who use opioid medications for pain. Unfortunately, a Cochrane systematic review found limited evidence on the effectiveness of laxatives in these patients, as Dr. William Cayley Jr. comments:

“For patients with constipation, especially those with opioid-induced constipation, there is insufficient evidence to recommend one laxative over another. The choice of laxatives should be based on past patient experience, tolerability, and adverse effects. Methylnaltrexone is a newer agent that may be useful especially for patients with opioid-induced constipation that has not responded to standard laxatives, but there is limited evidence of potential adverse effects. Therefore, judicious use preceded by a discussion with patients about known risks and benefits is warranted.”

The Cochrane Library recently discussed this review in its Journal Club feature, which includes open access to the full text of the review, a podcast by the authors, discussion points, and a Powerpoint slide presentation of the review’s main findings.

Additional resources for physicians and patients on advanced directives, hospice care, and ethical issues are available in the AFP By Topic collection on End-of-Life Care.
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The above post was first published on the AFP Community Blog.

*This blog post was originally published at Common Sense Family Doctor*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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