Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Many Teens Believe They’ll Die Prematurely

There was a very interesting article in Reuters Health in June that has stayed with me all summer, and I finally decided to share it with my readers – in hopes that writing about it will help me quit thinking about it!

The data for this study came from more than 20,000 teens involved in the 1995 – 2002 National Longitudinal Study of Adolescent Health, a nationally representative school-based survey done with students in 7th through 12th grades.

The results from this disturbing study suggested that about 15% of teens believed they were likely to die prematurely, which predicted increased involvement in risky behavior and poor health outcomes during young adulthood. The question apparently asks if teens think there is at least a 50/50 chance that they will die before the age of 35, and the students who believed they would die prematurely were more likely to report illicit drug use, suicide attempts, fight-related injuries, police arrests, unsafe sexual activity, and a diagnosis of HIV at subsequent data collection points.

I guess I am not sure what to do with this information. On one hand, it suggests that all of the adults in teenagers’ lives – parents, teachers, coaches, doctors, neighbors, and family members – should pay attention to what teens think about premature death, calling for more communication, which I am supportive of, but how exactly would this subject come up?

I do not think asking how long they expect to live is the answer, but instead I do believe that adults can focus more on staying connected with teens and promoting optimism and hope in youth. I do not believe this means not talking about youth in meetings, but actually spending time with those youth where they spend their time, teaching them skills, sharing a sense of accomplishment, and making a physical and meaningful connection with each of them. Every teen needs to have multiple adults they can talk to and spend time with, especially during times of stress or interpersonal conflict.

Listening to teens talk about their friends, their futures, and their insecurities is a window into their expected life course, and being present enough to hear comments reflecting a “why bother” attitude may be the key! Please listen to your teens and help them feel positive about themselves today!

This post, Many Teens Believe They’ll Die Prematurely, was originally published on by Nancy Brown, Ph.D..

Controversy: Can Twitter Cause Memory Damage?

At this year’s British Science FestivalTracy Alloway, a psychologist from Stirling University, said the following:

Some examples of what can hurt or harm working memory include things like Twitter. When you’re receiving an endless stream of information when you’re a ‘tweeter’, it’s also very succinct, so there’s no need to process or manipulate that information, it’s not a dialogue unlike something like Facebook where you might be updating your status and so on.

british science assoc

Fortunately, Mark Henderson at Times Online puts things in the right place:

Most people I know who use Twitter see it as an interactive tool for conversing with wide groups, and for drawing like-minded people’s attention to information that might interest them. It’s interactive, full of links, and information-rich. It’s a misconception that the 140-character limit makes depth impossible. In fact, to me, Twitter seems to build social networks just as effectively as Facebook, which Alloway thinks might improve working memory.

Mark is right, and I have a few examples that can explain why I think so:

*This blog post was originally published at ScienceRoll*

Plus Size Teens, Positive Role Models, And The Media

For the first time I am starting to see teen literature including successful and positive plus-size characters, and all I can say is, “it is about time!” Finally, there are large teens who are perceived as heroes and successful people.

While our culture keeps getting larger and childhood obesity and eating disorder rates keep climbing, the fact that there were no large, fat, plump, curvy, plush, whatever term you prefer, main characters with positive self-esteem, was really ridiculous. But all that seems to be changing.

There are now books with titles like “Looks,” Models Don’t Eat Chocolate Cookies,” “Food, Girls, and Other Things I Can’t Have,” “All About Vee,” and “This Book Isn’t Fat It’s Fabulous,” that include large teens in positive roles for large people. There are also blogs our there, like “Diary of a Fat Teenager,” for teens looking for support about being happy with there bodies and not spending their energy trying to be thin!

Some days I think there is hope!

This post, Plus Size Teens, Positive Role Models, And The Media, was originally published on by Nancy Brown, Ph.D..

Good Medicine Is About Good Relationships

By Edwin Leap, M.D.

An emergency physician, like me, may be the worst possible person to discuss relationships with patients.  I mean, one of the reasons I chose this specialty was that I didn’t want long-term relationships with my patients.  I see, now, that God has a great sense of humor.

See, the county I landed in after residency is small enough that I do know many of my patients, and I do see them more often than you might imagine.  After all, our hospital is ‘the only game in town.’

There are some patients I know quite well, and thus I know with reasonable accuracy who is sick and who isn’t, based on how they looked or behaved before.  It doesn’t always work, but frequently it does.

Which brings me to trends in primary care.  I don’t know if I’m really a primary care provider or not.  Some years we are, some years we’re considered specialists.  Whatever.  It doesn’t really change the work.  It might change the pay, as administrations place different emphasis from time to time.  But I do see a lot of primary care.  I watch internists and pediatricians, family physicians and ob/gyns do their work.  And what I see, from the standpoint of the emergency room, is a drift away from relationship.

The thing that brings it up most poignantly is the trend towards hospitalists.  For those of you not acquainted, the hospitalist is a physician whose practice is focused on admitting patients to the hospital, caring for them, and discharging them back to their regular physicians (if they have one) when the acute situation is over.

Now, I know some great hospitalists.  And I understand the need for them.  As hospital care becomes more complex, as offices suffer when their docs are at the hospital, as the goal becomes ‘discharge as soon as possible,’ wherein utilization review committees are prime-movers, the idea of the hospitalists makes great sense, and probably bears much fruit.

However, a relationship is severed.  We have many community physicians who do not do hospital work.  And more now that the hospitalist option exists.  So let’s say I have patient X in the evening or on the weekend.  His physician doesn’t admit.  I call the hospitalist.  ‘Patient X is having chest pain.  His cardiac labs and EKG look alright, but it just seems concerning to me.  Can we admit him?’  Hospitalist:  ‘well, he doesn’t have risk factors and everything looks OK, what are we going to do?  Do a second set of labs and let him see his doc tomorrow.’

Now, that was a technically correct encounter.  But if his own doc had been on call, as in the past, he might have said ‘I’ve known him for years.  He doesn’t complain.  That isn’t like him.  Let’s keep him overnight.’  Scientific?  Maybe not.  Possibly useful?  Absolutely.

See, the hospitalist is driven by admissions and discharges.  And he or she has no abiding relationship with these patients.  In the same way, the family physician who won’t admit has severed his relationship.  ‘So, I see you were admitted last week!’  He’ll get a report.  But the next serious illness that comes around will still be a situation in which the patient is admitted to a stranger with a lack of personal interest (I don’t mean that they don’t care, just that they aren’t personally connected over a long period of time).

I see both sides.  The hospitalist has a focused mission and a busy service.  The family doc has a focused mission and a struggling office to run.  But somewhere in between is the patient, who has been left afloat between two continents.  I guess the ER is the ‘desert island’ in between.

I don’t know the answer.  But I know that when they come to my emergency department, I have

Doctor and boy looking at thermometer, Norman Rockwell

Doctor and boy looking at thermometer, Norman Rockwell

to  put together the pieces and do the right thing.  I don’t have all of the information.  But before you scream ‘EMR,’ remember that medicine is more than data points.  Even if I have the data, I don’t have the sense of the patient.  The knowledge his or her physician has from personal, repeated interaction.

So I have to put the data together, decide if it heralds something perilous, and then I have to be a salesman…just to get someone else to look at the patient.  I am, in a sense, a voice-activated robotic surrogate for everyone; from family physician to hospitalist, obstetrician to urologist, ENT to general surgeon.  But then, that’s another post altogether.

What I mean to say is, when we lose relationship, we lose some of the most important bits of information in all of medicine.  Humans are complex, and in order for us to care for them, at least in the setting of being hospitalized or discharged, it’s remarkably useful to know them.

What do we do to fix it?  I have no idea.  I don’t believe it’s a thing that can be repaired with compensation schemes.  Perhaps only philosophically, as we teach young physicians the value of relating to their patients more than scientifically.  Or if it works better, to explain to them that science is more than labs, stress-tests, x-rays and biopsies.  Science is the pursuit of knowledge.

And patients are best known by…knowing them.

How’s that for a koan?


Will The Battle Against Obesity Spur On Eating Disorders?

At a time when two thirds of Americans are either overweight or obese, health officials are correctly warning that most of us need to lose weight. But we may be setting ourselves up for a surge in eating disorders.

The two main types of eating disorders are food restricting (commonly referred to as “anorexia”) and binge eating and purging (commonly referred to as “bulimia”). The disorders typically begin in adolescence and affect women much more commonly than men.

Statistics are tough to come by – partly because of under-diagnosis and incomplete reporting – but a
recent review estimated that 500,000 women in the U.S. have anorexia and 1-2 million women have bulimia.

The National Eating Disorders Association has a higher estimate, with “as many as 10 million females and 1 million males” suffering from either one of the two disorders. Recent reviews have reported that 90 percent of patients with bulimia are female but the rate in men appears to be increasing in recent years.

A key feature of an eating disorder is the disparity between perception and reality. Over the past thirty years, obesity (BMI >= 95th percentile) in teenagers increased from 5.0 percent to 17.6 percent. While that rate has skyrocketed, it’s still much lower than the perceived rate of obesity among students.

Among children in grades nine through 12, 10 percent of females were obese and 15.5 percent were “at risk” for becoming obese (BMI >=85 percentile but <95th percentile). Yet 38.1 percent of students described themselves as overweight and 61.7 percent were trying to lose weight.

Put another way, more than half the women trying to lose weight were not overweight.

Why do people who are not overweight think they need to lose weight? There’s no simple explanation. Experts believe that genetic, environmental, psychological, and social factors can all play a role in eating disorders.
Studies suggest that movies, magazines, and television contribute to eating disorders by idealizing overly thin women and exacerbating body dissatisfaction, especially in people with low self-esteem. Fashion magazines often feature models with obvious signs of anorexia. The theme is clear: less is more.

My intuition tells me we’re at a tricky point in the national discussion of weight. Since research suggests that the wrong public message can be especially dangerous for patients at risk of an eating disorder, we need to be very careful as we develop strategies against obesity. As they create their plans, agencies such as the Centers for Disease Control (CDC) should include experts in eating disorders.

For this week’s CBS Doc Dot Com, I talk to Leslie Lipton and her father, Roger, about how Leslie has successfully battled anorexia. Click below to watch the video:

Watch CBS News Videos Online

I also interviewed Dr. B. Timothy Walsh, a renowned expert on eating disorders and Professor of Psychiatry at Columbia University Medical Center and author of the book, “If Your Adolescent Has an Eating Disorder.” Click below to watch the video:

Watch CBS Videos Online

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…

Read more »

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…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

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…

Read more »

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…

Read more »

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…

Read more »

See all book reviews »