Fool Me Twice, Shame on You; Fool Me Three Times, I’m a Medical Board

by David Epstein
ProPublica
Originally published July 15, 2016

Here is an excerpt:

The Journal-Constitution analyzed public records from every single state. The low-bar-good-news is that “the vast majority of the nation’s 900,000 licensed physicians don’t sexually abuse patients.” Hurrah. The bad news is that the AJC couldn’t determine the extent of the problem due to reporting practices that give as much information as a teenager asked about his day at school. Except minus “fine.”

What else?

Some cases were truly egregious, particularly when “hospitals … fail to report sexual misconduct to regulators, despite laws in most states requiring them to do so.” For example: the AJC reported that one doctor was fired by three Tennessee hospitals (twice for sexual misconduct), but incurred no medical board actions.

The information is here.

Why are doctors plagued by depression and suicide?

By Judith Graham @judith_graham
STAT News
Originally published July 21, 2016

Here is an excerpt:

The starkest sign of the crisis gripping medicine is the number of physicians who commit suicide every year — 300 to 400, about the size of three average medical school classes. Male doctors are 1.4 times more likely to kill themselves than men in the general population; female physicians, 2.3 times more likely.

The grim tally is probably an under-count, since many suicides aren’t listed as such on death certificates. And it doesn’t include suicides among medical students, which aren’t tracked systematically in the United States.

In one study of six medical schools, nearly 1 in 4 students reported clinically significant symptoms of depression. Almost 7 percent said they had thought of ending their lives in the last two weeks.

The article is here.

Doctors have become less empathetic, but is it their fault?

By David Scales
Aeon Magazine
Originally posted July 4, 2016

Here is an excerpt:

The key resides in the nature of clinical empathy, which requires that the practitioner be truly present. That medical professional must be curious enough to cognitively and emotionally relate to a patient’s situation, perspective and feelings, and then communicate this understanding back to the patient.

At times, empathy’s impact seems more magical than biological. When empathy scores are higher, patients recover faster from the common cold, diabetics have better blood-sugar control, people adhere more closely to treatment regimens, and patients feel more enabled to tackle their illnesses. Empathetic physicians report higher personal wellbeing and are sued less often.

If the case for empathy is clear, the way to boost it remains murky indeed. New research shows that meditation and ‘mindful communication’ can increase a physician’s empathy, spawning a niche industry of training courses. Yet this preoccupation has missed the glaring deficits in the work environment, which squelch the human empathy that doctors possess.

The article is here.

Bad News Delivered Badly

By Susan Gubar
The New York Times - Well
Originally posted May 19, 2016

Here is an excerpt:

None of us were eased by communication strategies that have evolved since 2000 when Dr. Walter F. Baile and his associates published their paradigm for delivering bad news in The Oncologist. This article advocates a program called Spikes: S stands for finding the appropriate setting; P for gauging the perceptions of the patient; I for obtaining the patient’s invitation to hear bad news; K for providing the knowledge that the patient needs to receive; E for dealing with the emotional reactions of the patient with empathy; S for concluding with a needed summary.

Despite such a thoughtful template, miscommunication does not taint only diagnosis, as I.M. realized when she went on to confide about a more recent exchange. At her last meeting with her oncologist, they had discussed the sorry fact that the current cycle of chemotherapy had not inhibited tumor growth. The doctor gave her three choices: returning to the drug used in her first cycle, trying a clinical trial or “opting to do nothing.” Alarmed and shaken by this last proposal, she felt as if he were throwing up his hands or she had somehow been fired.

The article is here.

Doctors often overestimate promise of newly approved drugs

By Dennis Thompson
HealthDay News
Originally posted April 12, 2016

Here is an excerpt:

The U.S. Congress in 2012 gave FDA the power to designate a drug as a "breakthrough therapy" if preliminary clinical evidence suggests an advantage over existing medications.

But a survey of nearly 700 doctors revealed that many tended to misinterpret "breakthrough." Doctors often believed the drugs were supported by stronger evidence than the law requires to achieve that designation, said lead author Dr. Aaron Kesselheim. He is a faculty member at Brigham and Women's Hospital in Boston.

"When people hear 'breakthrough,' it gives them an inappropriately elevated sense of what the drug might do," Kesselheim said. "It may give physicians false reassurance about the outcomes they might expect to receive when they prescribe it."

The article is here.

Physician Burnout Is a Public Health Crisis

Arthur L. Caplan
MedScape
Originally published on March 4, 2016

Here is an excerpt:

We've got a problem in this country with doctors. It's kind of an epidemic, but no one is talking about it. It is burnout. A recent study from the Mayo Clinic showed that in 2011, 45.5% of doctors reported that they felt burned out, and that number has now risen to 54.4% in 2014. More than half of all doctors in this country are saying, "I really feel that some aspect of my work as a doctor is making me feel burned out."

This is really trouble. It's trouble because a doctor who feels this way can commit more errors. They suffer from compassion fatigue, or just not being able to empathize with others because they have their own emotional issues. They may retire early, thereby reducing the workforce. They may have problems managing their own lives; 400 doctors committed suicide last year, which is double the rate of the population average. There's trouble for patients in having a workforce that's burned out. There's trouble for doctors in terms of their own health and well-being. We don't talk about it much. We like to think that doctors can handle everything, but it's clearly not true. It's a problem and there ought to be some solutions.

The article is here.

Cross-Sectional Analysis of the 1039 U.S. Physicians Reported to the National Practitioner Data Bank for Sexual Misconduct, 2003-2013

Azza AbuDagga , Sidney M. Wolfe , Michael Carome , Robert E. Oshel
PLoS ONE 11(2): e0147800.

Background

Little information exists on U.S. physicians who have been disciplined with licensure or restriction-of-clinical-privileges actions or have had malpractice payments because of sexual misconduct. Our objectives were to: (1) determine the number of these physicians and compare their age groups’ distribution with that of the general U.S. physician population; (2) compare the type of disciplinary actions taken against these physicians with actions taken against physicians disciplined for other offenses; (3) compare the characteristics and type of injury among victims of these physicians with those of victims in reports for physicians with other offenses in malpractice-payment reports; and (4) determine the percentages of physicians with clinical-privileges or malpractice-payment reports due to sexual misconduct who were not disciplined by medical boards.

The article is here.

Automated empathy allows doctors to check on patients daily

By Barbara Feder Ostrov
Kaiser Health News
Originally posted February 10, 2016

Here is an excerpt:

"Automating empathy" is a new healthcare buzzword for helping doctors stay in touch with patients before and after medical procedures — cheaply and with minimal effort from already overextended physicians.

It may sound like an oxymoron, but it's a powerful draw for hospitals and other health care providers scrambling to adjust to sweeping changes in how they're paid for the care they provide. Whether the emails actually trigger an empathetic connection or not, the idea of tailoring regular electronic communications to patients counts as an innovation in health care with potential to save money and improve quality.

Startups like HealthLoop are promising that their technologies will help patients stick to their treatment and recovery regimens, avoid a repeat hospital stay, and be more satisfied with their care. Similar companies in the "patient engagement" industry include Wellframe, Curaspan, and Infield Health.

The article is here.

Physician Burnout Climbs 10% in 3 Years, Hits 55%

By Diana Swift

Medscape

Originally posted December 1, 2015

Professional burnout among US physicians has reached a dangerous level, with more than half of physicians affected, according to the results of a 2014 national survey across various medical specialties and practice settings. Compared with responses from a similar survey in 2011, burnout and satisfaction with work–life balance have worsened dramatically, even though work hours have not increased overall.

"American medicine is at a tipping point," lead author Tait D. Shanafelt, MD, from the Mayo Clinic's Department of Internal Medicine in Rochester, Minnesota, told Medscape Medical News. "If a research study identified a system-based problem that potentially decreased patient safety for 50% of medical encounters, we would swiftly move to address the problem. That is precisely the circumstance we are in, and we need an appropriate system level response."

The entire article is here.

How medical students learn ethics: an online log of their learning experiences

Carolyn Johnston & Jonathan Mok
J Med Ethics doi:10.1136/medethics-2015-102716

Abstract

Medical students experience ethics learning in a wide variety of formats, delivered not just through the taught curriculum. An audit of ethics learning was carried out at a medical school through a secure website over one academic year to determine the quantity and range of medical ethics learning in the undergraduate curriculum and compare this with topics for teaching described by the Institute of Medical Ethics (IME) (2010) and the General Medical Council's (GMC) Tomorrow's Doctors (2009). The online audit captured the participants’ reflections on their learning experiences and the impact on their future practice. Results illustrate the opportunistic nature of ethics learning, especially in the clinical years, and highlight the reality of the hidden curriculum for medical students. Overall, the ethics learning was a helpful and positive experience for the participants and fulfils the GMC and IME curriculum requirements.

The entire article is here.

Teaching doctors how to engage more and lecture less

By Sandra G. Boodman
The Washington Post
Originally posted March 9, 2015

Here is an excerpt:

“Doctors are explainaholics,” Tulsky said. “Our answer to distress is more information, that if a patient just understood it better, they would come around.” In reality, bombarding a patient with information does little to alleviate the underlying worry.

The “Empathetics” program teaches doctors “how to show up, not what to say,” said Riess. “We do a lot of training in emotional recognition and self-monitoring.” That includes learning to identify seven universal facial expressions — using research pioneered by psychologist Paul Ekman — and to take stock of one’s own emotional responses to patients or situations.

The entire article is here.

Burnout Rates Soar Among Family Physicians

By Diana Philips
Medscape
Originally published January 28, 2015

Nearly half of family physicians younger than 35 years feel burned out, according to a new survey conducted by Medscape. In the 2015 Family Physician Lifestyle report, which updates a previous report on physician lifestyle and burnout, 43% of family physicians in this age group responded that they had burnout, defined as loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. This is a substantial increase over the rates documented in the 2013 report, in which fewer than 10% of the youngest family physicians said they felt burned out.

The entire article is here.

Handling of Sexual Harassment Case Poses Larger Questions at Yale

By Tamar Lewin
The New York Times
Originally posted November 1, 2014

A sexual harassment case that has been unfolding without public notice for nearly five years within the Yale School of Medicine has roiled the institution and led to new allegations that the university is insensitive to instances of harassment against women.

The case involves a former head of cardiology who professed his love to a young Italian researcher at the school and sought to intervene in her relationship with a fellow cardiologist under his supervision.

A university committee recommended that he be permanently removed from his position, but the provost reduced that penalty to an 18-month suspension.

The entire article is here.

A Contemporary Death: Death with Dignity and Autonomy

By Peggy Battin
TEDMED 2014
Originally published October 29, 2014

Philosopher and bioethicist Peggy Battin tells us the moving story of how and why her husband chose to die.  She addresses death, end of life issues, and individual choices in the process.  She shares her emotional reactions to the process.

Doctors Tell All—and It’s Bad

By Meghan O'Rourke
The Atlantic
Originally published October 14, 2014

Here is an excerpt:

But this essay isn’t about how I was right and my doctors were wrong. It’s about why it has become so difficult for so many doctors and patients to communicate with each other. Ours is a technologically proficient but emotionally deficient and inconsistent medical system that is best at treating acute, not chronic, problems: for every instance of expert treatment, skilled surgery, or innovative problem-solving, there are countless cases of substandard care, overlooked diagnoses, bureaucratic bungling, and even outright antagonism between doctor and patient. For a system that invokes “patient-centered care” as a mantra, modern medicine is startlingly inattentive—at times actively indifferent—to patients’ needs.

To my surprise, I’ve now learned that patients aren’t alone in feeling that doctors are failing them. Behind the scenes, many doctors feel the same way. And now some of them are telling their side of the story. A recent crop of books offers a fascinating and disturbing ethnography of the opaque land of medicine, told by participant-observers wearing lab coats. What’s going on is more dysfunctional than I imagined in my worst moments. Although we’re all aware of pervasive health-care problems and the coming shortage of general practitioners, few of us have a clear idea of how truly disillusioned many doctors are with a system that has shifted profoundly over the past four decades. These inside accounts should be compulsory reading for doctors, patients, and legislators alike. They reveal a crisis rooted not just in rising costs but in the very meaning and structure of care. Even the most frustrated patient will come away with respect for how difficult doctors’ work is. She may also emerge, as I did, pledging (in vain) that she will never again go to a doctor or a hospital.

The entire article is here.

Why Do Doctors Commit Suicide?

By Pranay Sinha
The New York Times
Originally posted September 4, 2014

The statistics on physician suicide are frightening: Physicians are more than twice as likely to kill themselves as nonphysicians (and female physicians three times more likely than their male counterparts). Some 400 doctors commit suicide every year. Young physicians at the beginning of their training are particularly vulnerable: In a recent study, 9.4 percent of fourth-year medical students and interns — as first-year residents are called — reported having suicidal thoughts in the previous two weeks.

The entire article is here.

Should We 'Fix' Intersex Children?

Standard medical practice is often to operate to "normalize" genitals, but some families are fighting back.

By Charlotte Greenfield
The Atlantic
Originally published July 8, 2014

Here is an excerpt:

M was born with genitals that were not clearly male or female. Also known as disorders of sex development (DSDs), the best guess by researchers is that intersex conditions affect one in 2,000 children.

The response by doctors is often to carry out largely unregulated and controversial surgeries that aim to make an infant’s genitals and reproductive organs more normal but can often have unintended consequences, according to intersex adults, advocates and some doctors.

A long and gut-wrenching list of damaging side effects—painful scarring, reduced sexual sensitivity, torn genital tissue, removal of natural hormones and possible sterilization—combined with the chance of assigning children a gender they don’t feel comfortable with has left many calling for the surgeries to be heavily restricted.

The entire article is here.

Examining empathy

By Louise Aronson
The Lancet, Volume 384, Issue 9937, pp 16-17, 5 July 2014
doi:10.1016/S0140-6736(14)61115-6

Here is an excerpt:

Although some of the eleven essays in the collection relate to medicine, the book considers empathy more broadly. “Another person's pain”, Jamison writes, “registers as an experience in the perceiver: empathy as forced symmetry, a bodily echo”. Jamison examines empathy not just across life choices and illness states but also across cultures, geographical borders, gender, and socioeconomic status. She travels, among other places, to Nicaragua where she's hit in the face during a robbery; to Bolivia where a larva emerges from her ankle after a botfly bite; to West Virginia for a visit to an acquaintance in a prison; and to the wilds of Tennessee to watch a particularly sadistic ultra-marathon. Jamison considers all forms of pain—physical, emotional, and psychological; her own and that of others—and often explores topics both literally and metaphorically.

The entire article is here.

A Seattle doctor is suspended for sexting during surgery

By Lindsey Bever
The Washington Post
Originally published June 10, 2014

Here is an excerpt:

Medical authorities have suspended the license of a Seattle anesthesiologist for allegedly sending explicit “selfies” and exchanging sexy text messages during surgeries.

The findings against 47-year-old Arthur K. Zilberstein, released Monday by the Washington state Department of Health, detail nearly 250 text messages with sexual innuendo he exchanged during procedures — all kinds of procedures, including Cesarean deliveries, pediatric appendectomies, epidurals, tubal ligations, cardiac-probe insertions.

The entire article is here.

Senate challenger Milton Wolf apologizes for posting X-ray photos

By The Associated Press
The Kansas City Star
Originally published February 23, 2014

A tea party-backed Leawood radiologist who is trying to unseat longtime Republican U.S. Sen. Pat Roberts has apologized for posting X-ray photos of fatal gunshot wounds and medical injuries on his personal Facebook page several years ago. But he called the revelation about the images the work of a desperate incumbent.

In addition to the images, Milton Wolf also participated in online commentary layered with macabre jokes and descriptions of carnage, The Topeka Capital-Journal reported.

The report about the images, which came from hospitals in the Kansas City area on both sides of the state line, drew criticism from medical professionals who called their display on social media irresponsible.

The entire story is here.