Are You Well Controlled?

by Judith Hendley, BMJ, 11.23.18
Language can convey meaning and shape understanding. It can stigmatize and label or it can empower and affirm.  Therefore, Ms. Hendley would like to be identified as a person first and not as a “diabetic patient.“

As healthcare professionals. it is important to think about the language we use when referring to or writing about people with long term conditions such as diabetes.  We must consider if they would find the language we use in referring to them empowering or disempowering?

This brief but spectacular essay is applicable to many conditions or situations that we encounter in the persons who consult us as physicians.  See: "Are You Well Controlled?"

Doctor Sahib

by Saruabh Jha

New England Journal of Medicine 11.22.18

There was a time when doctors knew their patients and their patients’ families. Medicine, then, was not a team sport: the buck ended with the GP. Saurabh Jha’s  essay about his father in the New England Journal of Medicine is brilliant reminder of a time that has, to a large extent, disappeared.

His physician father in England understood his Pakistani patient “not just because he was fluent in Urdu: as a migrant himself, he understood that most people from the Indian subcontinent  - Muslims, Hindus and Sikhs alike -  don’t see doctors unless they are  ill and don’t take their medications unless they have symptoms."

His father’s “patient trusted him because he believed my father genuinely cared about him.”

This is a moving piece that many of you will appreciate.  Link to Doctor Sahib.

Save the Germs

In the century that has passed, the use of antibiotics made many diseases disappear from the modern world. But now drug-resistant forms of some horrible bug have appeared — and we have little and sometimes nothing in our medicine chest with which to fight them. Enamored of the antibiotics’ power, medicine has over-prescribed them, making new pandemics possibles when resistant strains of bacteria have been selected.

A group of infectious disease specialists and  microbiologists have proposed the formation of a resource of the world's bacteria be established to "save the bugs."*  This Op-Ed piece in the NY Times serves as a good introduction to this topic.

See Save the Germs by Sarah Schenck (11.19.18)

Ms. Schenck is co-director and co-producer of a documentary being made about the critical role of microbes in human health. 

* Preserving microbial diversity. Bello MGD, Knight R, Gilbert JA, Blaser MJ. Science. 2018 Oct 5;362(6410):33-34

Placebo Power

The placebo is a powerful medical treatment that is ignored by doctors at their patients’ peril. It is especially important for patients with chronic stress-related conditions, such as depression, back pain, chemotherapy-related malaise, migraine, posttraumatic stress disorder, irritable bowel syndrome and other functional disorders. Many people with medically unexplained symptoms are in the group that can benefit from placebo therapy.

Gary Greenberg, a NY Times reporter, has written a useful, lucid introduction to this topic.  We have synopsized and discussed it on OJCPCD.

Dr. Leanna Wen

A few years ago, I was privileged to hear Dr. Wen, then the health commissioner of Baltimore, speak at a conference.  She is now the president of Planned Parenthood.  The NY Times had a brief interview with her in the Sunday Magazine of November 11, 2018.

About her profession as public health practitioner she says, There is a saying, “Public health saved your life today, you just don’t know it.” The work of public health works best when we are invisible. The problem is that, when we’re invisible, we are the first on the chopping block.

See NY Times article:  Leana Wen Dislikes the Politicization of Health Care

The Upgrade, by Atul Gawande

In the November 12, 2018 issue of The New Yorker, Atul Gawande has a long article about the complex relationship physicians have with computers and the electronic medical record (EMR).  As a precis, we have placed excerpts from the article with some personal observations on The Online Journal of Community and Person-Centered Dermatology.  Today, almost all health care professionals will, perforce, have to use an EMR.  Gawande's article is a useful introduction to this topic.

Digitization promises to make medical care easier and more efficient. 

But are screens coming between doctors and patients?

Image from NY Times article

On CME Programs

How Physicians Keep Up

In most states, physicians are mandated to attend C.M.E. sessions for continued licensing.  Sadly, many of these programs are just marketing opportunities for PhRMA and device makers.

In a 1905 article in the Boston Medical and Surgical Journal, Drs. RC Cabot and EA Locke wrote:

“Learning medicine is not fundamentally different from learning anything else. If one had 100 hours in which to learn to ride a horse or to speak in public, one might profitably spend perhaps an hour (in divided doses) in being told how to do it, four hours in watching a teacher do it, and the remaining 95 hours in practice, at first with close supervision, later under general oversight.”

‘nuff said,

Reference:

Cabot RC, Locke EA. The organization of a department of clinical medicine. Boston Med Surg J. 1905;153:461-5