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Enough About Physician Empathy

Is anyone else tired of hearing about how important empathy is in the doctor-patient relationship? Every other day it seems a new study is talking about the therapeutic value of empathy. Enough already!

It’s not that I don’t believe that empathy is important — I do. I also believe the data that links physician empathy with improved patient outcomes, increased satisfaction, and better patient experiences.

A recent study released in Academic Medicine reported that “patients of physicians with high empathy scores were significantly more likely to have good control over their blood sugar as well as cholesterol, while the inverse was true for patients of physicians with low scores.”

Findings from this study by Hojat, et al. are consistent with a 2009 study by Rakel, et al. which found that among patients with the common cold, those with physicians displaying high empathy had a significantly shorter duration of illness and trend toward lesser severity of illness and higher levels of immune response compared to those patients whose physician displayed less empathy. Read more »

*This blog post was originally published at Mind The Gap*

Preventing Falls And “Post-Fall Syndrome” In Seniors: A Call For Anticipatory Care

We hear about stories like this all time: An elderly person falls and breaks something — a hip, a wrist, or an arm. Soon what once was a healthy, independent senior begins an inexorable downhill slide. Such is the case of my 89-year-old mother who recently fell and broke her wrist.

Turns out that 30 percent of people age 65 and older fall each year. Predictably, seniors with the following risk factors are more prone to falls:

  • Using sedatives
  • Cognitive impairment
  • Problems walking
  • Urinary tract infection
  • Eye problems
  • Balance issues

Similarly, when a person does fall, a cascading series of predictable clinical events occurs. It even has a name: “Post-fall syndrome.” This syndrome is characterized by things like fear of falling again, increased immobility, loss of muscle and control, lack of sleep, nutritional deficits, and so on. Seniors susceptible to falls also have higher rates of hospitalization and institutionalization.

What strikes me about falls among the elderly is that they are seemingly predictable events. And once a fall does occur, the consequences seem pretty predictable as well — enter post-fall syndrome. So if falls and their consequences are so predictable, why aren’t primary care physicians more proactive in terms of:

  • Preventing falls?
  • Treating post-fall syndrome?

In the case of my mother, her primary care physician and orthopedist were both very diligent at treating her episodic needs (i.e. her pain and broken bones). But little attention, if any, was given to assessing her long-term needs, such as nutrition, inability to do anything with her left hand (she’s left-handed), sensitivity to new medications (she never took drugs because they make her loopy), gait analysis, and depression counseling. Read more »

*This blog post was originally published at Mind The Gap*

When A World-Class Medical Institution Saves You Yet Fails You

Let me start by saying I really like MD Anderson Cancer Center. There is a lot to like. Take their tag line for example: “Making care history.” If anyone finds a cure for this cancer or that cancer, MD Anderson will have a hand in it, I’m sure. Hospitals could also learn a thing or two about the meaning of comprehensive care, clinical integration, and customer service from MD Anderson is well.

I have another reason why I like MD Anderson so well: They saved my wife’s life. You see, she was diagnosed back in November of 2004 with stage four non-small cell lung cancer (NSCLC). As anyone familiar with lung care knows, lung cancer is a very tough adversary. It’s an even tougher adversary when your insurance company insists that your local community hospital and oncologists are “just as good” as MD Anderson’s in terms of quality and outcomes.

You guessed it. In 2004, my wife and I had to fight long and hard to get our insurance carrier to authorize my wife care at MD Anderson, an out of network provider. I’m happy to say we won that fight back in 2004 and again just last week when my wife’s employer’s new insurance carrier refused to authorize her continued care at MD Anderson. You see, her new carrier wanted to rehash the whole medical necessity thing all over again.

Now you would think that a world-class organization like MD Anderson would do everything possible to help prospective patients deal with these kinds of insurance issues. After all, they seem to do everything for you once care is authorized. But you would be wrong. Read more »

*This blog post was originally published at Mind The Gap*

How Good Is Your Doctor At Diagnosing You?

We’ve all been there. It often starts with some kind of recurring pain or dull ache. We don’t know what’s causing the pain or ache. During the light of day we tell ourselves that it’s nothing. But at 3:00am when the pain wakes you, worry sets in: “Maybe I have cancer or heart disease or some other life-ending ailment.” The next day you make an appointment to see your doctor.

So now you’re sitting in the exam room explaining this scenario to your doctor. Based on your previous experience, what’s the first thing your doctor would do?

A. Order a battery of tests and schedule a follow-up appointment.

B. Put you in a patient gown and conduct a thorough physical examination, including asking you detailed questions about your complaint before ordering any tests.

If you answered “A,” you have a lot of company. A recent post by Robert Centor, M.D., reminded me of yet another disturbing trend in the doctor-patient interaction. The post, entitled “Many doctors order tests rather than do a history and physical,” talks about how physicians today rely more on technology for diagnosing patients than their own “hands-on” diagnostic skills — a good patient history and physical exam, for example.

Prior to the technology revolution in medicine over the last 20 years, physician training taught doctors how to diagnose patients using with a comprehensive history and physical exam. More physicians today are practicing “test-centered medicine rather than patient-centered medicine.” Medical schools focus on teaching doctors to “click as many buttons on the computer order set as we possibly can in order to cover every life-threatening diagnosis.” The problem is that medicine is still an imperfect science, and technology is not a good substitute for an experienced, hands-on diagnostician. Read more »

*This blog post was originally published at Mind The Gap*

What If All Patients Were This Engaged In Their Health?

This video is an excellent testimony of what a truly engaged and knowledgable patient with diabetes looks and sounds like. Kudos to the Mayo Clinic for sharing this wonderful piece about shared decision making.

Pay particular attention to the fact that the patient in the video was treated for diabetes by her primary care physician for eight years before being referred to a clearly “patient-centered” endocrinologist. Also note her belief that a patient-centered approach to chronic disease management probably results in shorter, more productive visits in the long run.

*This blog post was originally published at Mind The Gap*

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