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This page shows you the most recent publications within this specialty of the MedWorm directory. This is page number 3.

An open letter to MPs of Malaysia
13 November 2015 An open letter to the Members of Parliament of Malaysia  We, the undersigned medical professional bodies and non-governmental organisations, would like to register our concern regarding the increasing presence of electronic cigarettes and vaping in our society. We note with dismay the Cabinet’s rejection of the Ministry of Health’s proposal to ban the sales and use of electronic cigarettes.  1. Malaysia proudly signed and ratified the World Health Organisation’s Framework Convention on Tobacco Control (FCTC). This is a reflection of the nation’s commitment to protect present and futu...
Source: Malaysian Medical Resources - November 13, 2015 Category: Global & Universal Authors: palmdoc Tags: Miscellaneous Source Type: blogs

Maybe medical school applications should come with a warning label
I did some pretty crazy things to get into medical school (don’t worry Mom, nothing illegal). For several years before applying I became a medicine groupie. I read books about being a doctor, watched documentaries about medicine, shadowed physicians for hours on end so I could imagine what it might be like. I watched many a friend go off to med school and graduate … and I waited, I hoped. I did research (which involved a little too much rat killing for my liking), I worked in a peach orchard to demonstrate my dedication to migrant farm worker health. I became an EMT; I got three master’s degrees. I got as close to me...
Source: Kevin, M.D. - Medical Weblog - November 13, 2015 Category: Journals (General) Authors: Tags: Education Medical school Psychiatry Source Type: blogs

Who’s to blame for this psychiatric failure?
Jerry once killed a man, his best friend.  He told me about it, unemotionally, but as if it had just happened. He wandered the street like a refugee in a war-torn country, except he was in mid-America: Louisville, Kentucky, as it were.  He was homeless.  I’ve known him for five years, anyway.  He’s approaching fifty, a rough-looking man, large, with thick gray hair, which is quite long now.  He has lost a lot of weight recently, and I’m not sure why.  He is slightly mentally retarded and very mentally ill.  Schizophrenia is his diagnosis, I believe, along with several other classifications, includi...
Source: Kevin, M.D. - Medical Weblog - November 12, 2015 Category: Journals (General) Authors: Tags: Conditions Psychiatry Source Type: blogs

Trial By Error, Continued: Why has the PACE Study’s “Sister Trial” been “Disappeared” and Forgotten?
By David Tuller, DrPH David Tuller is academic coordinator of the concurrent masters degree program in public health and journalism at the University of California, Berkeley. In 2010, the BMJ published the results of the Fatigue Intervention by Nurses Evaluation, or FINE. The investigators for this companion trial to PACE, also funded by the Medical Research Council, reported no benefits to ME/CFS patients from the interventions tested.  In medical research, null findings often get ignored in favor or more exciting “positive” results. In this vein, the FINE trial seems to have vanished from the public discussion over ...
Source: virology blog - November 9, 2015 Category: Virology Authors: Vincent Racaniello Tags: Commentary Information adaptive pacing therapy CFS chronic fatigue syndrome clinical trial cognitive behavior therapy Dave Tuller exercise Fatigue Intervention by Nurses Evaluation FINE graded exercise therapy mecfs myalgic encep Source Type: blogs

It’s dangerous. It can kill. But physicians don’t want to talk about it.
“You need to come to the ED ASAP.” A new patient was admitted at 2 a.m. and requested for a crisis counselor. Unlike with cases of sexual assault, survivors of domestic violence had to specifically request for the presence of an advocate when I was volunteering in NYC back in 2009. This woman, I’ll call her Sadie, had already taken the first courageous step to seek help. I briskly walked past distressed family members looking anxiously around for a glimpse of a messenger bearing good news. After knocking on the door asking for permission to enter, I walked in to find Sadie struggling to rest her left leg cove...
Source: Kevin, M.D. - Medical Weblog - November 8, 2015 Category: Journals (General) Authors: Tags: Conditions Emergency Psychiatry Source Type: blogs

Mental health in America requires a collaborative solution
Getting mental health right for all Americans is a huge undertaking. For the last 150 years, our “solutions” to mental illness can, at best, be characterized as a series of good intentions that were poorly, if not disastrously, implemented. But while there may be a conversation that needs to happen about how we got here, what’s important right now is how we go about shoring up a system that is on the verge of collapse. This year, one in five adults in the United States will suffer from a diagnosable mental disorder. Some will be mild, some severe and some chronic, and more than 68 percent of these patients will also ...
Source: Kevin, M.D. - Medical Weblog - November 7, 2015 Category: Journals (General) Authors: Tags: Conditions Psychiatry Source Type: blogs

Can Clinicians Maim Healthy Organs? The Case of Jewel Shuping
by Matthew Dias This October, reports surfaced that a psychologist deliberately blinded a North Carolina woman named Jewel Shuping, per her request. Thirty-year-old Shuping suffers from Body Integrity Identity Disorder (“BIID”), a psychiatric condition in which individuals experience an overwhelming, lifelong desire to develop a disability—most often by amputating a limb but sometimes by maiming an organ. Even if they are completely healthy, classic BIID sufferers feel that their natural body state is incomplete and that only through amputation or maiming can they achieve their “true identity.” The blinding of Sh...
Source: blog.bioethics.net - November 5, 2015 Category: Medical Ethics Authors: Matthew Dias Tags: Featured Posts Health Care BIID blinding Medical care Shuping Source Type: blogs

Meet Disruptive Woman to Watch: Linda Rosenberg
In June of this year, the American Foundation for Suicide Prevention (AFSP), the nation’s largest suicide prevention organization, publicly recognized Linda Rosenberg, the president of the National Council for Behavioral Health (NCBH), for her work in increasing access to mental health care services and in preventing suicide. In his speech explaining why Rosenberg was selected for the Allies in Action Nonprofit Partner Award, the AFSP Vice President for Public Policy said, “With contributions like Ms. Rosenberg’s and her organization, we are much closer to achieving our goal of reducing the suicide rate 20 percent by...
Source: Disruptive Women in Health Care - November 4, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Advocacy Mental Health Source Type: blogs

The Case for Expanding Physician-Assisted Death to Psychiatric Conditions
Bonnie Steinbock (Source: blog.bioethics.net)
Source: blog.bioethics.net - November 4, 2015 Category: Medical Ethics Authors: Susan Gilbert Tags: Health Care syndicated Source Type: blogs

Credulity and skepticism exist in a dynamic balance
As we grow into adulthood, each of us develops a personal comfort zone located on the continuum between paranoia and gullibility.  A few of us are highly suspicious by nature, a few are unwitting dupes; most of us are in between.  Mental health professionals are no exception, and it shows in our work.  Is a request for tranquilizers or stimulants legitimate, or are we abetting a substance abuser? When told of horrific past abuse, do we believe every word, or do we allow for possible exaggeration or distortion?  Credulity and skepticism exist in dynamic balance: Too much of either impairs clinical work. Our ...
Source: Kevin, M.D. - Medical Weblog - November 3, 2015 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs

New Codes for End-of-Life Counseling; Heaven Help Us
Poor bored Government. So much time on their hands; so little real work that needs to get done, all they can do is micromanage poor physicians like me to death. Well, they can try. For its first forty-five years, Medicare was (in)famous for the very narrow limits on things it covered. It would pay for medical care when you were sick or injured, and that was basically it. No preventive care. No shots. Counseling, coming under the rubric of Psychiatric care, was paid at 65% of the “medical” rate. On the flip side, all you had to do to get paid was bill for it. Somehow way back then, physicians were considered pro...
Source: Musings of a Dinosaur - November 1, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs

Could the Doula Model Work for Women Seeking Mental Health Care and Support through the Veteran’s Administration, Especially After Rape or Sexual Trauma?
Elayne Clift, M.A. Her first experience with childbirth was traumatic. Repeated “checks” to determine how near she was to giving birth seemed like unnecessary invasions. When she questioned their frequency she was silenced, as she was when she asked why she had to remain in bed attached to an IV. Labeled a “failure to progress” after only seven hours in labor she was given a C-section “to ensure a healthy baby.”  During her second pregnancy she chose a medical practice that included nurse-midwives and allowed for vaginal birth after Caesarean. Then she “hired” a volunteer doula to support her through labor...
Source: Disruptive Women in Health Care - November 1, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Childbirth Women Veterans Source Type: blogs

David Tuller responds to the PACE investigators
David Tuller’s three-installment investigation of the PACE trial for chronic fatigue syndrome, “Trial By Error,” has received enormous attention. Although the PACE investigators declined David’s efforts to interview them, they have now requested the right to reply. Today, virology blog posts their response to David’s story, and below, his response to their response.  According to the communications department of Queen Mary University, the PACE investigators have been receiving abuse on social media as a result of David Tuller’s posts. When I published Mr. Tuller’s articles, my intent was to provide a...
Source: virology blog - October 30, 2015 Category: Virology Authors: Vincent Racaniello Tags: Commentary Information adaptive pacing therapy CFS chronic fatigue syndrome clinical trial cognitive behavior therapy Dave Tuller exercise graded exercise therapy mecfs myalgic encephalomyelitis outcome PACE trial recovery Source Type: blogs

Beyond the death count: The psychological casualties of mass violence
On October 9th , while President Obama was attempting to console the victims of the October 1st mass shooting at Umpqua Community College (UCC) in Oregon, two more students were killed, and five people were wounded at colleges in Arizona and Texas. In Flagstaff, Arizona, a gunman opened fire at Northern Arizona University. Hours later, Texas Southern University (TSU) classes were canceled at the Houston school as the campus was locked down in the fourth shooting near TSU since August. Counseling services were offered to students and faculty at both schools. On October 1, Christopher Harper-Mercer opened fire on a classroo...
Source: Kevin, M.D. - Medical Weblog - October 30, 2015 Category: Journals (General) Authors: Tags: Conditions Psychiatry Source Type: blogs

PACE trial investigators respond to David Tuller
Professors Peter White, Trudie Chalder and Michael Sharpe (co-principal investigators of the PACE trial) respond to the three blog posts by David Tuller, published here on 21st, 22nd and 23rd October 2015, about the PACE trial. Overview The PACE trial was a randomized controlled trial of four non-pharmacological treatments for 641 patients with chronic fatigue syndrome (CFS) attending secondary care clinics in the United Kingdom (UK) (http://www.wolfson.qmul.ac.uk/current-projects/pace-trial) The trial found that individually delivered cognitive behaviour therapy (CBT) and graded exercise therapy (GET) were more effecti...
Source: virology blog - October 30, 2015 Category: Virology Authors: Vincent Racaniello Tags: Commentary Information adaptive pacing therapy CFS chronic fatigue syndrome clinical trial cognitive behavior therapy Dave Tuller exercise graded exercise therapy mecfs myalgic encephalomyelitis outcome PACE trial recovery Source Type: blogs

Should he go to medical school?
I received this email last night: I am 21 and recently graduated with my BS in Computer Science this past May. I took a shining to computing at a young age, never really considering any other field to pursue. I have been working in the field for only 6 months but I don’t know if I feel fulfilled in it. Yes, it may just be this position I am currently in but I am learning about medicine, just in case.   I have been taking some Coursera.org medical courses from Stanford and other great universities online. I find that I am truly enjoying these courses and I may want to pursue this field of study. I don’t seek prest...
Source: DB's Medical Rants - October 29, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

“This is Dr H Anonymous, who said “I’m a homosexual, I am...
"This is Dr H Anonymous, who said "I'm a homosexual, I am a psychiatrist," to a convention of the American Psychiatric Association in 1972. He had to wear a #mask and a #wig to disguise himself or he would have been fired from his job at @TempleUniversity. Why would he have been fired? Because #homosexuality was still classified as a mental illness. 22 years later Dr John E Fryer revealed that he was Dr H Anonymous. Our Center for Education and Public Initiatives will celebrate this piece of #LGBThistory on Thursday 29 October 5-7pm with an @Out4STEM #Masquerade. To find out more visit @cepidirector_at_mutter or email educ...
Source: Kidney Notes - October 28, 2015 Category: Urology & Nephrology Authors: Joshua Schwimmer Source Type: blogs

TRIAL BY ERROR: The Troubling Case of the PACE Chronic Fatigue Syndrome Study (final installment)
In conclusion, they wrote in their Psychological Medicine response, cognitive behavior therapy and graded exercise therapy “should now be routinely offered to all those who may benefit from them.” *** Each published paper fueled new questions. Patients and advocates filed dozens of freedom-of-information requests for PACE-related documents and data with Queen Mary University of London, White’s institutional home and the designated administrator for such matters. How many PACE participants, patients wanted to know, were “recovered” according to the much stricter criteria in the 2007 protocol? How many participants...
Source: virology blog - October 23, 2015 Category: Virology Authors: Vincent Racaniello Tags: Information adaptive pacing therapy CFS chronic fatigue syndrome clinical trial cognitive behavior therapy Dave Tuller exercise graded exercise therapy mecfs myalgic encephalomyelitis outcome PACE trial recovery Source Type: blogs

Resist the tendency to label your patients
Several friends have pointed out to me their observations of my interactions when in public places: That people strike up random conversations with me, ask for directions, of if I could take a couple’s picture at a touristy hot spot, etc.  These types of interactions are becoming less awkward to me in the last few years, and I initially attributed my approachability to giving off a “psychiatrist” vibe, as if people can sense that I’m trained to listen to people’s issues.  Or, perhaps, as one friend pointed out, I appear to be the antithesis of “bitchy resting face” syndrome. Flashback to around twenty ...
Source: Kevin, M.D. - Medical Weblog - October 23, 2015 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs

Research & Reviews in the Fastlane 105
This study looked at the rate of central line-associated bloodstream infections (CLABSI) in ED placed lines and found the rate (2.0/1000 catheter days) to be the same as that in ICU placed lines (2.3/1000 catheter days). Additionally, they found that the introduction of a central line bundle aimed at standardizing practice was associated with a reduction in CLABSI in the ED (3.0/1000 before the bundle to 0.5/1000 after the bundle). Recommended by Anand Swaminathan Critical care Reitsma S et al. The endothelial glycocalyx: composition, functions, and visualization. Pflugers Arch 2007; 454(3): 345-59. PMID 17256154 We are...
Source: Life in the Fast Lane - October 22, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: Airway Anaesthetics Education Emergency Medicine Emergency Medicine Update Intensive Care Pre-hospital / Retrieval Psychiatry and Mental Health Resuscitation Trauma critical care R&R in the FASTLANE recommendations research and r Source Type: blogs

TRIAL BY ERROR: The Troubling Case of the PACE Chronic Fatigue Syndrome Study
By David Tuller, DrPH David Tuller is academic coordinator of the concurrent masters degree program in public health and journalism at the University of California, Berkeley.  A few years ago, Dr. Racaniello let me hijack this space for a long piece about the CDC’s persistent incompetence in its efforts to address the devastating illness the agency itself had misnamed “chronic fatigue syndrome.” Now I’m back with an even longer piece about the U.K’s controversial and highly influential PACE trial. The $8 million study, funded by British government agencies, purportedly proved that patients could “recover” fr...
Source: virology blog - October 21, 2015 Category: Virology Authors: Vincent Racaniello Tags: Information adaptive pacing therapy CFS chronic fatigue syndrome clinical trial cognitive behavior therapy Dave Tuller exercise graded exercise therapy mecfs myalgic encephalomyelitis outcome PACE trial recovery Source Type: blogs

Police and Persons with Mental Illness: The Overlooked Frontline Care Providers
<p>My original plan for this blog was to consider whether or not there remained a need for the old “Drunk Tank” way of managing persons who are acutely intoxicated by allowing them to sleep off or wait out their inebriation at the police station before determining whether or not further mental health care was needed, rather than bringing individuals to hospital emergency rooms for supervised sleep and conversation about detox services or psychiatric evaluation. Though the task of caring for acutely intoxicated persons, sometimes folks who are frequently seen in ERs repeatedly, can seem to be an inapprop...
Source: blog.bioethics.net - October 21, 2015 Category: Medical Ethics Authors: Hayley Dittus-Doria Tags: Health Care beneficence Law Enforcement mental health syndicated Source Type: blogs

de Clérambault, and Enduring Love again
Some more thoughts about the "appendix" to Ian McEwan's Enduring Love, discussed in an earlier post.  The appendix is, or, as it turns out, purports to be, a reprint from the "British Review of Psychiatry", by Wenn and Camia, about de Clérambault's syndrome.  An early review of the book,as you may remember from that earlier post, thought it was the article on which the novel was based.  But others were suspicious, noting that the journal was not one they had heard of, and also that the authors' names were an anagram of Ian McEwan.I was interested to know what would happen if you critically appraised the pap...
Source: Browsing - October 20, 2015 Category: Databases & Libraries Tags: mental health psychiatry Source Type: blogs

A medical student’s psychiatric hospitalization
“You work here?!” I nodded, a hint of a smile revealing my bemusement at his incredulity. “Well … probably not after this.” The other patients in the psych waiting area of the ER nodded in agreement. In my newly issued brown scrubs, stripped of my belongings, I was no longer a research coordinator at a top hospital, but rather one of them. And sadly, they believed being one of them meant you couldn’t be much else. I didn’t add that I was going to be a doctor, but in hindsight I wish I had. I wish I had because it’s wrong that they’d been conditioned to feel that way. I wish I had because, well, it probabl...
Source: Kevin, M.D. - Medical Weblog - October 19, 2015 Category: Journals (General) Authors: Tags: Education Medical school Psychiatry Source Type: blogs

A LIGHT BENEATH THEIR FEET Bridges Between Mental Health, Home Health Workers and Bioethics
A Light Beneath Their Feet is a coming of age story for both a daughter and a mother. Valerie Weiss’s directorial skill is remarkable. She uses a spotlight halo soft focus to keep the viewer tied to the amazing performances of Tayrn Manning (Gloria, the mother)  and Madison Davenport (Beth, the daughter). It is fortunate for the viewer that the director is able to keep up with the sophistication of the script and actors she has chosen to direct. Writer Moira McMahon Leeper has brilliantly clarified an inverted mother and daughter  relationship, occurring against the backdrop of mental illness. This film mak...
Source: blog.bioethics.net - October 16, 2015 Category: Medical Ethics Authors: September Williams, MD Tags: Health Care syndicated Source Type: blogs

The day I went to work and met a real vampire
It all started out seeming like a pretty routine visit. My patient was in her early 30s and had come into the emergency department for weakness and was in no distress. As I was talking with her about her symptoms she would flash the occasional smile. It was then I noticed that she had fangs. Not the kind that some people naturally have from misaligned teeth, but she had really long, sharp canine teeth. She had some tattoos and a variety of piercings, so I just figured that the fangs were also a part of her look, perhaps a new trend that I’d never seen before. She was coherent, articulate, had good hygiene and had no psyc...
Source: Kevin, M.D. - Medical Weblog - October 15, 2015 Category: Journals (General) Authors: Tags: Conditions Emergency Source Type: blogs

Sukkot and last week's Catholic Gospel
Last Sunday, we had for me the harshest Gospel. It was about the man who asked Jesus what he needed to do to have eternal life. Jesus mentions Mosaic Commandments and was pleased by the man's response that he followed them but then was crestfallen when Christ told him to give away what he had to the poor and follow him. The man left. The Jewish holiday of Sukkot happened the week before. In that festival, people sit around outside in a temporary shelter and symbolically are represented by four fruits, one represents Torah learning, another good deeds; one of them however represents being a nothing. All of the individuals o...
Source: a psychiatrist who learned from veterans - October 15, 2015 Category: Psychiatry Source Type: blogs

Sukkot and last week's Catholic Gospel, Mark 10: 17-30
Last Sunday, we had for me the harshest Gospel. It was about the man who asked Jesus what he needed to do to have eternal life. Jesus mentions Mosaic Commandments and was pleased by the man's response that he followed them but then was crestfallen when Christ told him to give away what he had to the poor and follow him. The man left. The Jewish holiday of Sukkot happened the week before. In that festival, people sit around outside in a temporary shelter and symbolically are represented by four fruits, one represents Torah learning, another good deeds; one of them however represents being a nothing. All of the individuals o...
Source: a psychiatrist who learned from veterans - October 15, 2015 Category: Psychiatry Source Type: blogs

People are people — whether manic, suicidal, or delusional — and it is a privilege to care for them
It’s not always obvious. Sometimes patients register with a chief complaint like “headache.” They tell the nurse their head has been hurting for months and deny fevers, etc. They get put in a room, and when you take the history, there’s nothing remarkable until you ask just the right question: “So, what do you think is wrong? Are you worried about anything in particular?” “Well, I think it’s probably the plate they put in my head.” “You have a plate in your head?” “Yes.” “Why? Were you in an accident?” “Well, I was abducted, and I don’t remember much, but I know they put a plate in my head...
Source: Kevin, M.D. - Medical Weblog - October 13, 2015 Category: Journals (General) Authors: Tags: Conditions Psychiatry Source Type: blogs

A surgeon conquers her anxiety. See how she did it.
Can anxiety be severe enough to cause a physician to leave medicine?  Absolutely.  I know a number of physicians who have left for this reason.  In my coaching practice I am increasingly aware of the toll anxiety takes on many doctors and am making it my mission to bring more attention to this problem and to find solutions.  The physicians I have talked to are just the tip of the iceberg in terms of those “suffering in silence” from anxiety. For this blog, I interviewed one of my clients who agreed to discuss her difficulties with anxiety.  Identifying details, including her name, have been changed to protect her ...
Source: Kevin, M.D. - Medical Weblog - October 12, 2015 Category: Journals (General) Authors: Tags: Physician Psychiatry Surgery Source Type: blogs

Narrative Matters: Poetry Meets Health Care
This month you might notice something a little different about the Narrative Matters section of Health Affairs. For October, instead of the personal stories about health care that readers typically find in the section, we’re featuring three thought-provoking poems about health and health care experiences. The poems were submitted as part of our first-ever poetry contest, held earlier this year, which had an incredible response. Out of more than 500 poems submitted, we chose the three winning poems with the help of a panel of poet judges, Hakim Bellamy, Serena Fox, and Natalie Lyalin. With gorgeous illustrations from Bret...
Source: Health Affairs Blog - October 8, 2015 Category: Health Management Authors: Jessica Bylander Tags: Elsewhere@ Health Affairs Health Professionals Narrative Matters Slideshow Narrative Matters poetry narrative medicine patients Source Type: blogs

Enduring love, especially the appendix
I have made reference to this book by Ian McEwan in two previous posts, one about autobiography and biography as health literature, and one about mental health in film.  In that latter post I said I would write about Enduring love again.  Here at last is that post.As an appendix to Enduring love, there is a scientific paper, a case report, about the condition that one of the characters in the story is living with, De Clerambault's syndrome.    A review of the book in Psychiatric Bulletin talks of the book as based on this case report.   But a later letter to the same journal rings an alar...
Source: Browsing - October 7, 2015 Category: Databases & Libraries Tags: critical appraisal mental health Source Type: blogs

What is normal and what is disease?
Future generations of doctors will face different challenges than I did. When I started training, disease was easier to spot than it is now. Today, the line between sickness and wellness has blurred–and it gets blurrier all the time. The quantified self movement stands to make this worse. In a profit-driven healthcare climate, disease feeds the business model. One way to drive sales of drugs and procedures is to create more diseases. And to do that, one has only to medicalize the human condition. Why doctors (and patients) discount the resilience of the human body perplexes me. I had the pleasure of meeting Dr. Allen...
Source: Dr John M - October 7, 2015 Category: Cardiology Authors: Dr John Source Type: blogs

Mindfulness
is paying attention to your thoughts and feelings in the present moment.   It can be a way to develop resilience and cope with the demands of an academic or clinical course.  Here is a not very systematic selection of useful looking links:NHS Behind the Headlines, on mindfulness to prevent a relapse of depression.NHS Choices: Mindfulness for mental wellbeingUseful looking articles include this systematic review of systematic reviews, published in PLoS One by Dutch and American researchers, and a systematic review of mindfulness for reducing stress in health individuals, published in the Journal of Psychosomatic ...
Source: Browsing - September 30, 2015 Category: Databases & Libraries Tags: mental health mindfulness students Source Type: blogs

Remembering Oliver Sacks, A Pioneer Of Narrative Medicine
Hasn’t he brought us through the decades, guiding us stage by stage toward the present? Hasn’t he opened the way toward a health care loyal to the singular stories of those for whom we care? Hasn’t he opened the way toward a kind of writing loyal to the singular situation of those of whom we write? Dr. Oliver Sacks has been an always-present presence for the worlds of literature, medicine, narrative, and health. I certainly don’t know this world of ours without him in it. When he died, even though he had been so tender toward us in his gentle warnings that the end was near, I was shocked. It was as if one of th...
Source: Health Affairs Blog - September 30, 2015 Category: Health Management Authors: Rita Charon Tags: Featured Health Professionals Narrative Matters Quality City Island Columbia University narrative medicine Oliver Sacks Source Type: blogs

How to fix physician burnout? Start with a culture of acceptance and support.
“Thou must be like a promontory of the sea, against which, though the waves beat continually, yet it both itself stands, and about it are those swelling waves stilled and quieted.” – Marcus Aurelius My reaction to this quote, which begins Osler’s Aequanimitas, has changed over the years. When I first heard it, I was filled with a sense of pride and anticipation. I would be that rock, for my patients, for my family, never wavering, never eroding. Eight years on, as I start my career as a practicing internist, I have come to interpret it as a lovely image, and a lovely fairy tale, but just like the idea that a ro...
Source: Kevin, M.D. - Medical Weblog - September 29, 2015 Category: Journals (General) Authors: Tags: Physician Psychiatry Residency Source Type: blogs

When a doctor is in doubt, she asks a family member
I learned a valuable lesson recently about how difficult it can be to make the correct diagnosis when you see a patient for a very short period of time. In the acute rehab setting, I admit patients who are recovering from severe, life-altering brain events such as strokes, head injuries, and complex medical illnesses. It is challenging to know what these patients’ usual mental function was prior to their injuries, and so I rely on my knowledge of neuroanatomy, infectious disease, and pharmacology to guide my work up. However, I have learned that asking the patient’s family members about what they were like (in their he...
Source: Kevin, M.D. - Medical Weblog - September 24, 2015 Category: Journals (General) Authors: Tags: Physician Hospital Source Type: blogs

Turn That Door Around - A Physician Substantially Tied to the Pharmaceutical Industry Nominated to Run the FDA
It seems to be the season of the revolving door in health care.  The latest version got some media attention, because it involves one of the most important health care leadership positions in the US government, the Director of the Food and Drug Administration (FDA).  However, the case actually seems much more serious than what the media has recently reported.The BasicsFor an introduction, we turn to the Wall Street Journal from September 15, 2015:President Barack Obama plans to nominate the prominent cardiologist and medical researcher Robert Califf as the next commissioner of the Food and Drug Administration, th...
Source: Health Care Renewal - September 24, 2015 Category: Health Management Tags: boards of directors CME conflicts of interest FDA key opinion leaders logical fallacies revolving doors Source Type: blogs

Seeking help for mental health problems: Change the culture for providers
“I don’t need meds,” the young psychology major told me confidently. “Or therapy really. Maybe I’ll just touch base with you every once in a while. I should be able to handle this on my own.” The young woman’s physician had been concerned enough in a recent visit about this patient’s panic attacks and passive suicidal ideation to refer her to meet with me for a primary care psychology consultation. Yet just a few weeks later, she sat in front of me letting me know that she can “handle” these problems. For better or for worse, this young woman picked a terrible day to talk about “handling” concerns w...
Source: Kevin, M.D. - Medical Weblog - September 23, 2015 Category: Journals (General) Authors: Tags: Physician Medical school Psychiatry Source Type: blogs

When In Doubt, Ask A Family Member
The post below ran on September 9 on Better Health. I learned a valuable lesson recently about how difficult it can be to make the correct diagnosis when you see a patient for a very short period of time. In the acute rehab setting I admit patients who are recovering from severe, life-altering brain events such as strokes, head injuries, and complex medical illnesses. It is challenging to know what these patients’ usual mental function was prior to their injuries, and so I rely on my knowledge of neuroanatomy, infectious disease, and pharmacology to guide my work up. However, I have learned that asking the patient’s fa...
Source: Disruptive Women in Health Care - September 22, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Health Professions Patients Source Type: blogs

A Quiet Turn of the Revolving Door - Director of NIMH to Go Directly to Google Life Sciences
Amidst a lot of health care news, the job plans of Dr Thomas Insel, currently the director of the National Institute of Mental Health (part of the US National Institute of Health) made a very small splash.  The most comprehensive account was in the New York Times.Dr. Thomas R. Insel, the director of the National Institute of Mental Health, announced on Tuesday that he planned to step down in November, ending his 13-year tenure at the helm of the world’s leading funder of behavioral-health research to join Google Life Sciences, which seeks to develop technologies for early detection and treatment of health problems.A...
Source: Health Care Renewal - September 18, 2015 Category: Health Management Tags: NIH NIMH revolving doors Thomas Insel Source Type: blogs

You can’t tell whether a psychotherapist is impaired
Two of the most commented posts on my blog are about charging patients for missed sessions and how psychotherapies end.  As there is no single correct approach to either of these, there’s plenty of room for practices legitimately to vary, and plenty of room for patients, i.e., most of my commenters, to express their likes and dislikes.  By my reading, many commenters assume that cancelation and termination policies mainly feed their therapists’ wallets; they tend to dismiss clinical rationales that are not obvious common sense.  I’m often drawn to defend the field and their therapists, and to point out th...
Source: Kevin, M.D. - Medical Weblog - September 15, 2015 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs

When In Doubt, Ask A Family Member
Photo Cred: Max S. Gerber I learned a valuable lesson recently about how difficult it can be to make the correct diagnosis when you see a patient for a very short period of time. In the acute rehab setting I admit patients who are recovering from severe, life-altering brain events such as strokes, head injuries, and complex medical illnesses. It is challenging to know what these patients’ usual mental function was prior to their injuries, and so I rely on my knowledge of neuroanatomy, infectious disease, and pharmacology to guide my work up. However, I have learned that asking the patient’s family members about...
Source: Better Health - September 9, 2015 Category: American Health Authors: Dr. Val Jones Tags: Health Tips True Stories ARU Autism Brain Injury Family Input Inpatient Rehabilitation IRF Mental Status Changes Stroke Source Type: blogs

Do physician health programs increase physician suicides?
How do we care for the people who care for us? As doctors, we’re immersed in pain and suffering — as a career. We cry when our patients die. We feel grief anxiety, depression — even suicidal — all occupational hazards of our profession. A recent Medscape article on physician health programs suggests the people who are here to help us may actually be doing more harm than good. And they may even be increasing physician suicides. Both doctors I dated during medical school died by suicide. Eight physicians killed themselves in my town alone. I’ve become a specialist in physician suicide. My cell phone ha...
Source: Kevin, M.D. - Medical Weblog - September 7, 2015 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs

How can we measure the doctor-patient relationship?
Sixty years ago, before he became a controversial figure in the field of psychiatry, Dr. Thomas S. Szasz co-authored an article for the Archives of Internal Medicine (now JAMA Internal Medicine) on “The Basic Models of the Doctor-Patient Relationship,” which is well worth reading today, particularly for those who believe that patient empowerment/engagement is a novel and disruptive innovation of our digital times. The paper is describing three distinct relationship models (i.e., active-passive, guidance-cooperation, mutual participation) and how they flow and morph into each other based on patient ability/preferences, ...
Source: Kevin, M.D. - Medical Weblog - September 6, 2015 Category: Journals (General) Authors: Tags: Policy Primary care Source Type: blogs

Physician burnout starts in medical school. But it doesn’t have to.
I collapsed onto the rickety cot in the hospital on-call room. It was 3 a.m. Over the last twenty hours, fueled only by coffee and occasional bites to eat, I had done morning rounds on my patients, assisted with appendix and gall bladder surgeries, inserted and pulled tubes into and out of bodies, cut open a large intestine filled with feces, took patient histories in clinic, attended afternoon teaching, and finished four urgent consults in the emergency room. Just another day in the life of a clinical trainee. But when I look back on that night during medical school, I don’t remember feeling as excited as I normally fee...
Source: Kevin, M.D. - Medical Weblog - September 5, 2015 Category: Journals (General) Authors: Tags: Education Medical school Psychiatry Source Type: blogs

Is patient-centered care part of the problem?
What is the difference between a health care system and a Burger King? In a health care system, you can’t always have it your way. At some point in our training, most physicians are introduced to the Institute of Medicine’s landmark report on Crossing the Quality Chasm. The report outlines 6 key elements that are necessary for providing high-quality care: safety, timeliness, effectiveness, efficiency, equitability and patient centeredness. Although I recognize that outlining the 6 goals is a noble attempt at helping mend a broken health care system, I have to admit that, as a practicing psychiatrist, nothing is more cr...
Source: Kevin, M.D. - Medical Weblog - September 4, 2015 Category: Journals (General) Authors: Tags: Physician Primary care Source Type: blogs

The Measure of a Physician: Albert Schweitzer
By RICHARD GUNDERMAN, MD There are different ways to take the measure of a life.  John Rockefeller, the richest person in the history of mankind, once asked a neighbor, “Do you know the only thing that gives me pleasure?  It’s to see my dividends come in.”  Television magnate Ted Turner once said, “I don’t want my tombstone to read, ‘He never owned a network.’”  And musical artist Lady Gaga has described her quest as “mastering the art of fame.”  But wealth, power, and fame are not life’s only metrics, and September 4 marks the 50th anniversary of the death of one of the 20th century’s brightes...
Source: The Health Care Blog - September 4, 2015 Category: Consumer Health News Authors: Simon Nath Tags: Physicians THCB Albert Schweitzer Care of Distress Richard Gunderman University of Strasbourg Source Type: blogs

How PAs Factor Into Improved CMS Patient Satisfaction Scores
When I started work as a certified physician assistant (PA-C) 30 years ago, I provided health care for the homeless as the medical officer for an outreach mobile health team in Brooklyn, N.Y. I literally treated patients on the street, and patient satisfaction was measured by having them simply tell me they felt better. Today patient satisfaction is being dissected and analyzed many different ways by physician offices, hospitals, and Accountable Care Organizations (ACOs), driven largely by the Centers for Medicare and Medicaid Services (CMS) and a policy to tie reimbursement to patient perceptions and compliance with clini...
Source: Health Affairs Blog - September 2, 2015 Category: Health Management Authors: Dawn Morton-Rias Tags: Equity and Disparities Featured Health Professionals Hospitals Organization and Delivery Quality ACOs CAHPS HCAHPS patient satisfaction physician assistants Source Type: blogs

Why these medical interns did not die in vain
About a year ago, I wrote a piece on my blog called “How to Welcome Incoming Residents.” It was about my struggle with getting the right messaging, messaging about the reality of stress during residency and the necessity of incorporating self-care and outreach to others. This year at orientation, in addition to adding the great suggestions posted by readers of the article, I took a different tack. It was imperative. There was a huge elephant in the room. As most residents and fellows — and their educators — know, the medical community of New York City was rocked by the suicide deaths of two interns in the s...
Source: Kevin, M.D. - Medical Weblog - August 30, 2015 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs