Emergency patients with acute abdominal pain feel more confident about medical diagnoses when a doctor has ordered a computed tomography (CT) scan, and nearly three-quarters of patients underestimate the radiation risk posed by this test, reports the Annals of Emergency Medicine.
“Patients with abdominal pain are four times more confident in an exam that includes imaging than in an exam that has no testing,” said the paper’s lead author. “Most of the patients in our study had little understanding of the amount of radiation delivered by one CT scan, never mind several over the course of a lifetime. Many of the patients did not recall earlier CT scans, even though they were listed in electronic medical records.”
Researchers surveyed 1,168 patients with non-traumatic abdominal pain. Confidence in medical evaluations with increasing levels of laboratory testing and imaging was rated on a 100-point scale. Then, to assess cancer risk knowledge, participants rated their agreement with these factual statements: “Approximately two to three abdominal CTs give the same radiation exposure as experienced by Hiroshima survivors,” and “Two to three abdominal CTs over a person’s lifetime can increase cancer risk.” Read more »
*This blog post was originally published at ACP Internist*
It seem like everyone these days is focused on changing some aspect of patient health behavior. You know — getting patients to get a mammogram or PSA test, exercise more, take medications as prescribed, or simply becoming more engaged in their healthcare. If only we could change unhealthy patient health behaviors, the world would be a better place.
I agree with the sentiment, but I think that patients and their health behavior often get a “bad rap” from healthcare professionals. I would even go so far as to say that much (not all) of what we attribute to poor patient behavior is more correctly attributable to ineffective doctor communications with patients.
In my last post I talked about the link between strong physician advocacy, e.g., I recommend, and desirable health outcomes, i.e., patients getting more preventive screening.
Here’s what I mean. Mammography studies have consistently shown that screening mammograms rates would be much high if more physicians “strongly recommended” that women get screened, e.g., “I recommend” you get a mammogram. In studies where physicians advocated for screening, mammography screening rates were always higher compared to physicians that did not advocate for them. The same phenomenon can be found in studies dealing with exercise, weight loss, colorectal cancer screening, HVP immunization, and patient participation in clinical trials. Read more »
*This blog post was originally published at Mind The Gap*
The puppeteer skit features the interaction between a young man with a rash and his older physician. The patient is an informed kind of guy: He’s checked his own medical record on the doctor’s website, read up on rashes in the Boston Globe, checked pix on WebMD, seen an episode of “Gray’s Anatomy” about a rash and, most inventively, checked iDiagnose, a hypothetical app (I hope) that led him to the conclusion that he might have epidermal necrosis.
“Not to worry,” the patient informs Dr. Matthews, who meanwhile has been trying to examine him (“Say aaahhh” and more): He’s eligible for an experimental protocol. After some back-and-forth in which the doctor — who’s been quite courteous until this point, calling the patient “Mr. Horcher,” for example, and not admonishing the patient who’s got so many ideas of his own — the doctor says that the patient may be exacerbating the condition by scratching it, and questions the wisdom of taking an experimental treatment for a rash. Read more »
*This blog post was originally published at Medical Lessons*
We all want technology to improve communication between doctors and patients. We fantasize that social tools will open doors and bridge the expanding divide between doctors and patients.
I’m wondering if it’s a case of unicorns and rainbows: Fancy new tools to do the old thing in a less-effective way. I’m guessing that if Facebook was the old platform for doctor-patient dialog and the telephone was invented this year, everyone would be clamoring to use the phone (“Dude, this is amazing…you can hear them talk.”)
I like the telephone. Written copy misses intonation, timing, pitch, and all the other rich elements of human speech. Subtle changes in a parent’s voice tell me if I’ve made my point and exactly how I need to proceed [with caring for their child]. Unspoken words on a screen are so one-dimensional.
Of course, email has a tightly-defined place in patient communication. And real-time social interaction between patient and clinic will evolve to have a clear role in patient care. But for now, the phone remains one of the most effective tools for helping doctor and patient really understand one another.
To complain or “be good” is an apparent dilemma for some patients with serious illness.
Yesterday I received an email from a close friend with advanced breast cancer. She’s got a lot of symptoms: Her fatigue is so overwhelming she can’t do more than one activity each day. Yesterday, for example, she stayed home all day and did nothing because she was supposed to watch a hockey game in the evening with her teenage son and other family members. Her voice is weak, so much it’s hard to talk on the phone. She has difficulty writing, in the manual sense — meaning she can’t quite use her right arm and hand properly.
“It’s something I would never mention to the doctor because it is very subtle,” she wrote. “But it has not improved and if anything has worsened over time.”
There are more than a few possible medical explanations for why a person who’s receiving breast cancer therapy might not be able to use her right arm. But that’s not the point of today’s lesson. What’s noteworthy here is that the patient — an educated, thoughtful woman who’s in what should be the middle of her life and is trying as best she can to survive — doesn’t think these symptoms are worth mentioning. Read more »
*This blog post was originally published at Medical Lessons*
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