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Good Health Information Can Save Lives

My colleagues at Harvard Health Publications and I have a mission: To provide accurate, reliable information that will help readers live healthier lives. We work hard to fulfill that mission, and the feedback we get from folks who read our newsletters, Special Health Reports, books, and online health information indicates we are on the right track. Every so often we hear something from a reader that makes me especially proud of the work we do.

This letter was recently sent to the editor of the Harvard Women’s Health Watch:

One of your mailings undoubtedly saved me a lot of grief. (My kids, anyway.) I was aware of a woman’s heart attack symptoms being different from a man’s, and your brochure contained a paragraph confirming that. Early in June I was packing for a trip to celebrate my brother’s 90th birthday, at the same time a ditching project was being done in my back lot. Trying to deal with several matters at the same time is a talent I’ve outgrown, at 88, so didn’t think too much of the sudden fatigue and vague aches I felt in jaw & arms. I crashed for a nap in my recliner, felt OK afterwards, and figured it was just stress. The next day I was ready to leave, but got to thinking of those symptoms, and the fact the brochure had arrived at just that time, and wondered if it was more than coincidence and maybe I should pay attention? Didn’t much like the idea of something happening out in the middle of nowhere, so took myself to the fire hall where an EMT was on duty. He ushered me into the ambulance, did an EKG, and soon I was being helicoptered on doctor’s orders to St. Joseph’s Hospital. There I had 3 stents installed, and they apparently are doing their job. Thank you! Read more »

*This blog post was originally published at Harvard Health Blog*

Is It Bad Patient Behavior Or Poor Doctor-Patient Communication?

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*

Decline In Stroke Deaths Reinforces “Brain Attack” Prevention

Stroke killed 2,000 fewer Americans in 2008 (the last year with complete numbers) than it did in 2007, the Centers for Disease Control and Prevention (CDC) said yesterday in its latest annual Deaths report. That dropped stroke from the third leading cause of death in the United States to the fourth.

Good news? Yes and no. It’s always good news when fewer people die. The reduction suggests a payoff for efforts to prevent stroke and improve the way doctors treat it.

Yet the drop from third to fourth place is due largely to an accounting change. The CDC reorganized another category, “chronic lower respiratory diseases” (mainly chronic bronchitis and emphysema), to include complications of these diseases such as pneumonia. The change substantially increased the number of deaths in this category, which had long trailed stroke as the fourth leading cause of death.

More worrisome is that the decline in deaths from stroke isn’t matched by a decline in the number of strokes. On the rise since 1988, stroke now strikes almost 800,000 Americans a year, and that is expected to grow. Read more »

*This blog post was originally published at Harvard Health Blog*

Changing Patient Behavior: Two Power Words

“I recommend.” These are two word which, when spoken by a physician to a patient have tremendous power to change behavior. That assumes of course a trusting relationship between patient and physician (but that’s a topic for another day.)
 
Take the colonoscopy. The U.S. Preventive Services Task Force (USPSTF) recommends that adults aged ≥50 years get a colonoscopy every 10 years. In 2005, 50 percent of adults aged ≥50 years in the U.S. had been screened according to these recommendations. Not surprisingly, the rate of colonoscopy screening is much lower than that of other recommended adult preventive services. I was curious: Why?
 
Here are two interesting facts:

1. Studies show that patients cite “physician recommendation” as the most important motivator of colorectal screening. In one study, 75 to 90 percent of patients who had not had a colonoscopy, said that their doctor’s recommendation would motivate them to undergo screening.

2. In that same study, in 50 percent of patients where a colonoscopy was appropriate but not done, the reason given was that the physician simply did not “bring up” the subject during the visit. Reasons included lack of time, visit was for acute problem, patient had previously declined or forget. Read more »

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

Germs, Kids, And School

Everyone knows that when it comes to germs and kids, it can sometimes be difficult to limit the spread of infection — especially in a school or daycare setting. In this video, I talked with local TV news last week about germs and kids, and about preventing infections in college students during finals week:

 

If you find this video helpful, I invite you to check out my other videos at MikeSevilla.TV. Enjoy!

*This blog post was originally published at Doctor Anonymous*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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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

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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