July 29th, 2011 by RamonaBatesMD in Better Health Network
1 Comment »
It seems to me this topic of surgeons and their lack of civility gets pulled out on a fairly regular basis. This latest discussion in the news media is due to a short article in the current Archives of Surgery (full reference below).
Surgeons as a group have a reputation (which even nice ones have trouble overcoming) of arrogance and incivility.
The authors, Klein and Forni, of this article state (bold emphasis is mine):
Uncivil behavior is so present in society at large that we should not be surprised to find it among health care workers. This article is meant to raise the awareness of the costs—both in dollars and in human misery—of incivility in the practice of medicine by looking in particular at the case of surgeons.
Uncivil behavior brings misery wherever it occurs. If the individual tends to behave in an uncivil fashion prior to medical school and prior to residency, Read more »
*This blog post was originally published at Suture for a Living*
July 27th, 2011 by Elaine Schattner, M.D. in News, Opinion
No Comments »
Recently the Times ran a leading story on a new med school admission process, with multiple, mini-interviews, like speed dating. The idea is to assess applicants’ social, communication and ethical thinking (?) skills:
…It is called the multiple mini interview, or M.M.I., and its use is spreading. At least eight medical schools in the United States — including those at Stanford, the University of California, Los Angeles, and the University of Cincinnati — and 13 in Canada are using it.
At Virginia Tech Carilion, 26 candidates showed up on a Saturday in March and stood with their backs to the doors of 26 small rooms. When a bell sounded, the applicants spun around and read a sheet of paper taped to the door that described an ethical conundrum. Two minutes later, the bell sounded again and the applicants charged into the small rooms and found an interviewer waiting. A chorus of cheerful greetings rang out, and the doors shut. The candidates had eight minutes to discuss that room’s situation. Then they moved to the next room, the next surprise conundrum…
This sounds great, at first glance. Read more »
*This blog post was originally published at Medical Lessons*
July 16th, 2011 by Dinah Miller, M.D. in Opinion
No Comments »
Dr. Maureen Goldman talks about self-disclosure for psychiatrists and brings the topic up in the context of Marsha Linehan’s recent announcement that she was treated for a psychiatric disorder as a teenager.
In Clinical Psychiatry News, Dr. Goldman notes:
Psychiatric care and psychotherapy are different from the Alcoholics Anonymous fellowship, where the mutual sharing of personal experience is an integral part of helping people maintain sobriety. I believe that there is middle ground between disclosing personal information and presenting myself as a blank slate. In my practice, I show myself to be a real person. I make mistakes and admit them. I joke about my poor bookkeeping skills and inferior technological skills. I look things up during sessions if necessary, and I tell patients when I need to do research or consult with a colleague. I treat them as real people, too, not just as patients.
I do not, however, share my own story. Mostly, I think that I can help people feel heard, understood, and known, and create a therapeutic plan without personal disclosure. I communicate that “I get it” without being clear that “I really get it.”
I cannot speculate about the motivation behind Dr. Linehan’s decision to allow her mental health history to be chronicled in the New York Times. The story was a very public disclosure, and in that way quite different from a disclosure made in the context of a one-on-one, doctor-patient therapeutic relationship.
We’ve talked in detail about self-disclosure before, and specifically about whether psychiatrists should tell their patients if they’ve suffered from a psychiatric disorder. See Read more »
*This blog post was originally published at Shrink Rap*
July 13th, 2011 by admin in News, Opinion
No Comments »
In Keeping Score on How You Take Your Medicine, Tara Parker-Pope of the New York Times, reports on a new initiative from the Fair Isaac Corporation (FICO) known previously for its credit score ratings. FICO has developed a Medication Adherence Score, using publicly identifiable information (like employment status, age and gender) to determine a patient’s score, which it says “can predict which patients are at highest risk for skipping or incorrectly using prescription medications.”
Parker-Pope reports, “By the end of the year, an estimated two million to three million patients will have been given a FICO medication adherence score and a total of 10 million patients are expected to be scored during the next 12 months…FICO officials say insurance companies and other health care groups will use the score to identify those patients who could benefit the most from follow-up phone calls, letters and e-mails to encourage proper use of medication.”
The FICO medication adherence score has not received a universally warm reception: e-Patient Dave and Society for Participatory Medicine member Alexandra Albin point out that the score only accounts for whether prescriptions are purchased, not whether the pills have actually been taken.
In a related effort, Geisinger Health Systems and CVS Caremark are conducting a study to assess whether enhanced doctor-pharmacist communication can help with medication adherence. Shefali S. Kukarni reports in Tracking Down Patients Who Skip Their Drugs that, “The 18-month investigation will track a prescription from the moment it is submitted electronically to the pharmacy until it reaches the patient. If the patient does not pick up the prescription a ‘red flag’ or some form of notification will be sent to the doctor.”
But as Jessie Gruman recently blogged, there is no magic pill to cure poor medication adherence. Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
June 25th, 2011 by AnneHansonMD in Health Policy, Opinion
1 Comment »
From the New York Times today we have a story entitled, “A Schizophrenic, A Slain Worker, Troubling Questions,” a horrible story about a mentally ill man who killed a social worker in his group home. The story highlights the defendant’s longstanding history of violence with several assaults in his past. He once fractured his stepfather’s skull and his first criminal offense involved slashing and robbing a homeless man. (On another post on this blog Rob wondered why the charges were dismissed in that case; from experience I can tell you it’s probably because the victim and only witness was homeless and couldn’t be located several months later when the defendant came to trial.) The defendant, Deshawn Chappell, also used drugs while suffering from schizophrenia. Before the murder he reportedly stopped taking his depot neuroleptic and was symptomatic. The news story also suggested that he knew he was committing a crime: he got rid of the body, disposed of the car and changed out of his bloody clothes. Nevertheless, he was sufficiently symptomatic to be found incompetent to stand trial and was committed to a forensic hospital for treatment and restoration. At his competency hearing the victim’s family thought that the defendant was malingering his symptoms, while the victim’s fiance was distraught enough that he tried to attack Chappell in the courtroom. The point of the Times article appears to be an effort to link the crime to cuts in the Massachusetts mental health budget.
So what do I think about this story? Read more »
*This blog post was originally published at Shrink Rap*
