February 9th, 2011 by IsisTheScientist in Opinion, Research
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I can already tell that this pregnancy is different from my first. When I was pregnant with Little Isis, I drank no caffeine and took no over-the-counter medication. I remember having a few headaches and Mr. Isis fighting with me to take a headache pill. I would then proclaim dramatically, “But I can’t! What if it hurts the baby?!”
This morning, now pregnant with my second, I washed down a Zyrtec and two Tylenol with a cup of coffee. The little bugger is going to have to grow up with Little Isis. He might as well start building up his tolerance to exogenous substances at some point. I figure, now that its got a closed neural tube and a beating heart, we might as well begin.
Still, you can’t blame a pregnant woman for being a bit neurotic. The feeling that one is solely responsible for the well-being of a developing creature, combined with often contradictory advice, is enough to make anyone nuts. Most online advice is completely and utterly useless. Take this answer from Russell Turk, M.D. on the popular pregnancy website BabyCenter in response to the common question, “Is it safe to drink diet soda during pregnancy?” He answers:
Diet sodas often contain both caffeine and an artificial sweetener. There are several types of artificial sweeteners you may see on nutrition labels:
Aspartame (NutraSweet): Seems to be okay when consumed in moderation (the amount found in one or two 12-ounce servings of soda per day).
Saccharin (Sweet’n Low): Saccharin was found to cause birth defects in laboratory rats when consumed in very high amounts. Because its safety in smaller amounts is hard to prove, I would advise avoiding it.
Sucralose (Splenda): This relatively new sweetener, a modified form of regular table sugar, appears to be safe. But because it hasn’t been extensively studied, it’s best used in moderation.
It’s generally bad advice and leaves one wondering: “What is moderation? Will one soda hurt my baby? Will two sodas hurt my baby? How about three?” The default answer when we don’t know seems to be to tell women to do things in “moderation.” This places the sole responsibility on her to know what moderation means, and allows her to feel the guilt if something goes wrong. I think that these imprecise answers leave many women feeling helpless and afraid. Read more »
*This blog post was originally published at The Brain Confounds Everything*
February 8th, 2011 by RyanDuBosar in Better Health Network, Research
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Physicians see nearly one in five patients as “difficult,” report researchers. Not surprisingly, these patients don’t fare as well as others after visiting their doctor.
Researchers took into account both patient and clinician factors associated with being considered “difficult,” as well as assessing the impact on patient health outcomes. They reported results in the Journal of General Internal Medicine.
Researchers assessed 750 adults prior to their visit to a primary care walk-in clinic for symptoms, expectations, and general health; for how they functioned physically, socially and emotionally; and whether they had mental disorders. Immediately after their visit, participants were asked about their satisfaction with the encounter, any unmet expectations, and their levels of trust in their doctor. Two weeks later, researchers checked symptoms again.
Also, clinicians were asked to rate how difficult the encounter was after each visit. Nearly 18 percent were “difficult.” They had more symptoms, worse functional status, used the clinic more frequently and were more likely to have an underlying psychiatric disorder than non-difficult patients. These patients were less satisfied, trusted their physicians less, and had a greater number of unmet expectations. Two weeks later, they were also more likely to experience worsening of their symptoms.
But the label works both ways, as physicians with a more open communication style and those with more experience reported fewer difficult encounters, researchers said.
On a lighter note, TV’s comedy “Seinfeld” dedicated an entire plotline from one of its many episodes to Elaine, her doctor, and the label of being a difficult patient. It’s worth watching here.
*This blog post was originally published at ACP Internist*
January 22nd, 2011 by Bryan Vartabedian, M.D. in Health Policy, True Stories
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So I’m in the exam room recently with a new patient. After some initial dialog with the child and family, I launched into the business of problem solving. Ten minutes into my history the mother politely asks: “I’m sorry, and you are?…”
I hadn’t introduced myself. I had left my ID badge at my workstation, and by order of some innocent distraction with the child or family, I hadn’t identified myself immediately on entering the room. This is rare.
Sometimes I assume people will know who I am. But I don’t wear a white coat and my stethoscope is concealed. I wear clothes only good enough to sustain the barrage of regurgitation, urine, full-frontal coughs, and sloppy hugs that mark a successful clinic day. A colleague once told me I dress like an algebra teacher. I haven’t quite processed that one, but suffice it to say it’s easy to fall into a mistaken identity.
So I apologized and made a proper introduction. What’s remarkable is how far I went without the mother having any idea about my identity. I can imagine that it took a certain amount of wherewithal to interrupt the person she suspected was the doctor to ask such a basic question. Read more »
*This blog post was originally published at 33 Charts*
January 21st, 2011 by KevinMD in Better Health Network, Opinion
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Many doctors roll their eyes whenever patients bring in a stack of research they printed out, stemming from a Google search of their symptoms. A piece by Dr. Zachary Meisel on TIME.com describes a familiar scenario:
The medical intern started her presentation with an eye roll. “The patient in Room 3 had some blood in the toilet bowl this morning and is here with a pile of Internet printouts listing all the crazy things she thinks she might have.”
The intern continued, “I think she has a hemorrhoid.”
“Another case of cyberchondria,” added the nurse behind me.
It’s time to stop debating whether patients should research their own symptoms. It’s happening already, and the medical profession would be better served to handle this new reality.
According to the Pew Internet and American Life Project, 61 percent of patients turn to the web to research health information. That number is from 2009, so presumably it’s higher today. Health information online is akin to the Wild, Wild West. Stories from questionable sites come up on Google as high — or higher — than information from reputable institutions. Read more »
*This blog post was originally published at KevinMD.com*
January 19th, 2011 by StevenWilkinsMPH in Better Health Network, Health Tips
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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*
