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What Makes A Conversation “Psychotherapy?”

Years ago I had a student who repeatedly asked me how psychotherapy works. “How is it different than a conversation?”

When I think of psychotherapy, I think in terms of the talking itself as being the aspect that helps — and yes, of course it can be used in conjunction with medications. I think of it as being structured — in terms of time and place and frequency — and being all about the patient. And whether or not it’s actually discussed, some of what works is about the relationship — most people don’t get better talking to someone they despise, and the warmth, empathy, feeling listened to and cared for, well, they’re all important. And I also think of it as being a process over time. These are all parts of my definition, however, and they may not be parts of yours. Read more »

*This blog post was originally published at Shrink Rap*

Health News Consumers Tired Of Misinterpreted Studies

People aren’t dumb. Even if — or maybe especially if — news stories don’t point out the limitations of observational studies and the fact that they can’t establish cause-and-effect, many readers seem to get it.

Here are some of the online user comments in response to a CNN.com story that is headlined, “Coffee may cut risk for some cancers“:

* “I love how an article starts with something positive and then slowly becomes a little gloomy. So is it good or not? I’m still where I was with coffee, it’s all in moderation, it ain’t gonna solve your health woes.”

* “The statistics book in a class I’m taking uses coffee as an example of statistics run amuck. It seems coffee has caused all the cancers and cures them at the same time.” Read more »

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

Coffee And The Heart – Researchers Are Getting Paid Way Too Much To Rehash Old Data

This week, coffee seems to be good for the heart:

“People who are moderate coffee drinkers can be reassured that they are not doing harm because of their coffee drinking,” said Arthur Klatsky, the study’s lead investigator and a cardiologist at Kaiser’s Division of Research.

These “surprising” data are to be presented at the AHA meeting March 5th. (You’ll have to wait until then to get the REAL scoop, it seems.)

But a quick Google search on Dr. Klatsky’s earlier studies using the same questionaire database shows the problems with using questionaire data to make such sweeping conclusions. Take, for instance, these findings from 1973: Read more »

*This blog post was originally published at Dr. Wes*

ER Doc Finds Creative Way To Make Coffee During Power Outage

I like living on the edge of built-up civilization, but it means our little development has one electric line coming in.

Today it wanted some time off, fortunately only 4 hours. Didn’t get that cold inside, but having an all electric house has some drawbacks in that circumstance.

My wife figured out the electric-less coffee, thankfully.

*This blog post was originally published at GruntDoc*

Why Is Food and Drink Prohibited At The Nurse’s Station?

Over the last several weeks I have received numerous emails dictating the enforcement of work place rules regarding eating and drinking in nursing areas and other areas with patient charts. It seems everyone, from the Chief of Staff to the CEO to the Head Nurse In Charge has been making it very clear that drinking in work areas won’t be tolerated. I have at times been confronted by dutiful staff doing their jobs with a robust sense of confidence to enforce this potentially dangerous patient safety issue.

Or so I thought. Whilst speaking with one of Happy’s friendly colleagues, I learned that the issue of food and drink in the work place has nothing to do with patient safety. Like my colleague stated so eloquently, if there is data that can be presented to me that shows my action of drinking coffee at the work stations would some how harm my patient, I will gladly stop immediately. Discussion finished.

But as I learned from my colleague, the issue of food and drink at the nurse’s station or anywhere near patient charts has nothing to do with patient safety. In fact, the regulations are in place to protect ME from myself.

That’s right, the coffee Nazis are cruising the halls with reckless abandonment searching for violators of the hospital wide coffee ban on rounds not because patients could be harmed, but because I could harm myself.

You see, it turns out my distinguished colleague was told these regulations were not CMS or JCAHO regulations, but rather OSHA regulations.

So I looked it up

“OSHA does not have a general prohibition against the consumption of beverages at hospital nursing stations. However, OSHA’s bloodborne pathogens standard prohibits the consumption of food and drink in areas in which work involving exposure or potential exposure to blood or other potentially infectious material takes place, or where the potential for contamination of work surfaces exists 29 CFR 1910.1030(d)(2)(ix). Also, under 29 CFR 1910.141(g)(2), employees shall not be allowed to consume food or beverages in any area exposed to a toxic material. While you state that beverages at the nursing station might have a lid or cover, the container may also become contaminated, resulting in unsuspected contamination of the hands.

Here are the actual OSHA regulations

1910.1030(d)(2)(ix)

Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure.

1910.141(g)(2)

Eating and drinking areas. No employee shall be allowed to consume food or beverages in a toilet room nor in any area exposed to a toxic material.

In other words this is not a patient safety issue, but rather an employee safety issue. The Joint Commission has no specific standard on the issue other than for hospitals to comply with OSHA regulations.

So with that in mind, I have two comments regarding the issue:

  1. As a private practice physician who is not employed by the hospital, I would suggest that these OSHA rules do not apply to me and therefore the hospital risks no retribution for noncompliance from the accreditation arm of the Joint Commission, which is why I suspect the issue comes center stage for hospitals everywhere. If necessary, I will gladly sign a waiver to relinquish my rights to compensation should I ever contract a blood born pathogen or other communicable disease from drinking my coffee.
  2. If the hospital believes this is a patient safety issue and wishes to make their regulations stronger than those of OSHA and apply them to ALL people in areas with patient pathogens, I will gladly relinquish my daily fluids when I am shown the data regarding patient harm AND the hospital also bans all patient guests from bringing food or drink into the patient’s room. If this is a patient safety issue, it must apply to everyone should they wish to make their rules stronger than OSHA guidelines.

Until this is resolved with rational thought, perhaps over a round of coffee, I’m going to carry one of these around:

It always seems to work for patients.

*This blog post was originally published at A Happy Hospitalist*

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Latest Book Reviews

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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

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