Tag: internal medicine

Bioethics News

Physician Recommendations About Breast Cancer Screening Vary, Survey Finds

Trust in different guidelines and a physician’s specialization affect their screening recommendations, according to the study published in the Journal of the American Medical Association Internal Medicine

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

“Seeing” the Doctor: Depicting the Physician’s Self-Identity

By Stacey McClintick

What do you what to be when you grow up?  Do I even have to?  Can I cry now?  Can I show who I am?  I can only hope you will understand and be able to take away from me all that I have… because that is what I want to give.

I am not who you think I am.  Strong on the outside… an unstoppable ramble of insecurity,  Inquisitiveness and love on the inside.  I am a mom, a Maine, a wife, a soldier, a sister, an engineer, a daughter, a student doctor, a neighbor, a college student, a carpool mom, an artist… my own self gets lost behind all these things.

I lost “rank” to save my kids and my husband, but out of curiosity and hope for challenges and to experience life, I have gained so much more.  But it hurts sometimes to not be recognized in my current position for the experiences I have had.

At the same time it is hard to focus on the facts in medicine when the very curiosity of life which pulled me in persistently tries to pull me away.  ADHD?  Maybe… I have never given up… is that my downfall?

Here, regardless, I can be what I am.  In art my mistakes open up an opportunity for something wonderful I had never thought of before.  In life/medicine my mistakes are lives… more studying and more stress.

I thought long and hard about what I wanted to do for my mask, and even now I would need two, ten, or even forty more sessions to have my mask relay everything I wanted it to say.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

What’s the Best Day to Die?

Among people receiving hospice care, the last few days of life can be intense, with progression of pain or breathing problems or other symptoms of their terminal illnesses. For those who die on Sundays, that means they are less likely to see doctors or nurses in the last days of life:

JAMA Internal Medicine

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

TRIAD VIII: Nationwide Multicenter Evaluation to Determine Whether Patient Video Testimonials Can Safely Help Ensure Appropriate Critical Versus End-of-Life Care

Ann Denny’s image on recording healthcare directives
It was a real pleasure to be part of this project on adding video testimonials / messages to advance directives.  This was released today in the Journal of Patient Safety.  This is the 8th in the series of TRIAD articles – The Realistic Interpretation of Advance Directives.

Objective: End-of-life interventions should be predicated on consensus understanding of patient wishes. Written documents are not always understood; adding a video testimonial/message (VM) might improve clarity. Goals of this study were to (1) determine baseline rates of consensus in assigning code status and resuscitation decisions in critically ill scenarios and (2) determine whether adding a VM increases consensus.

Methods: We randomly assigned 2 web-based survey links to 1366 faculty and resident physicians at institutions with graduate medical education programs in emergency medicine, family practice, and internal medicine.  Each survey asked for code status interpretation of stand-alone Physician Orders for Life-Sustaining Treatment (POLST) and living will (LW) documents in 9 scenarios. Respondents assigned code status and resuscitation decisions to each scenario. For 1 of 2 surveys, a VM was included to help clarify patient wishes.

Results: Response rate was 54%, and most were male emergency physicians who lacked formal advanced planning document interpretation training. Consensus was not achievable for stand-alone POLST or LW documents (68%–78%noted “DNR”). Two of 9 scenarios attained consensus for code status (97%–98% responses) and treatment decisions (96%–99%). Adding a VM significantly changed code status responses by 9% to 62% (P ≤ 0.026) in 7 of 9 scenarios with 4 achieving consensus. Resuscitation responses changed by 7%to 57%(P ≤ 0.005)

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Sharp Rise Reported in Older Americans’ Use of Multiple Psychotropic Drugs

February 14, 2017

(New York Times) – The number of retirement-age Americans taking at least three psychiatric drugs more than doubled between 2004 and 2013, even though almost half of them had no mental health diagnosis on record, researchers reported on Monday. The new analysis, based on data from doctors’ office visits, suggests that inappropriate prescribing to older people is more common than previously thought. Office visits are a close, if not exact, estimate of underlying patient numbers. The paper appears in the journal JAMA Internal Medicine.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Obese Patients Receive Suboptimal End-of-Life Care

February 8, 2017

(Medscape) – Obesity is associated with diminished use of hospice services, leaving patients vulnerable to suboptimal end-of-life care, shows the first such study to explore the association. In an article published online February 7 in Annals of Internal Medicine, John Harris, MD, from the University of Pittsburgh School of Medicine, Pennsylvania, and colleagues conclude that “the disparities in hospice use and Medicare expenditures by patient BMI [body mass index] provide an excellent opportunity for improvement.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Pharma Money Reaches Guidelines Writers, Patient Groups, Even Doctors on Twitter

January 17, 2017

(Pro Publica) – The long arm of the pharmaceutical industry continues to pervade practically every area of medicine, reaching those who write guidelines that shape doctors’ practices, patient advocacy organizations, letter writers to the Centers for Disease Control and Prevention, and even oncologists on Twitter, according to a series of papers on money and influence published today in JAMA Internal Medicine.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The Medicalization of Mental Illness in Gun Violence

By Carolyn C. Meltzer, MD
Dr. Meltzer serves as the William P. Timmie Professor and Chair of the Department of Radiology and Imaging Sciences and as the Associate Dean for Research at the Emory University School of Medicine. Her work focuses on applying novel advanced imaging strategies to better understand brain structure-function relationships in normal aging, late-life depression, and Alzheimer’s disease. She is also involved in oncologic imaging research and, while at the University of Pittsburgh, oversaw the clinical evaluation of the world’s first combined PET/CT scanner. She established the Emory Center for Systems Imaging to broadly support the advance of imaging technologies in basic and translational research, including beta testing of the first human combined MRI/PET scanner. Dr. Meltzer has also served as the Chair of the Neuroradiology Commission and Chair of the Research Commission on the American College of Radiology’s Board of Chancellors, President of the Academy of Radiology Research, Trustee of the Radiological Society of North America Foundation, and President of the American Society of Neuroradiology.
On January 6, 2017, a young man pulled a semiautomatic handgun from his checked baggage and shot and killed several passengers in the Fort Lauderdale airport. In the days following the incident, information about erratic behavior and his prior involvement in incidents of domestic abuse emerged.
Image courtesy of Wikimedia Commons

The US has the highest rates of both gun-related deaths and mass-shooting incidents. In the latest available statistics from the Center for Disease Control and Prevention (CDC), 33,304 people were killed by firearms in 2014. Over the past decade (2007-2016), there have been 16 mass shootings in the US (Mother Jones’ Investigation: US Mass Shootings 1982-2016), including several — at Virginia Tech, an Aurora theatre, the Sandy Hook Elementary School, Charleston’s Emanuel African Methodist Episcopal Church, and the Pulse nightclub in Orlando – that drew substantial national attention.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Doctor as Data Entry Drone

by Craig Klugman, Ph.D.

Most people choose to go into the health professions to help others, to make a secure living, and to challenge themselves on a daily basis. Few people would rank “doing paperwork” as a reason to choose a career in health. However, according to a new study in the Annals of Internal Medicine, paperwork in the form of electronic health records (EHR) might be the activity on which doctors spend the most time. According to Sinsky et. al, who conducted direct observations, motion studies, and self reports of 57 physicians in 4 specialties in 4 states, doctors spent over 49% of their time on record keeping and 27% on direct patient care.

Two decades ago, physicians only spent one-fifth of their time on record keeping. A 1998 study of emergency departments found 21% of time was spent on records and 32% on patient care. As recently as 2014, another study found that administrative work occupied only one-sixth of physician time. This same study also found that the more time spent on administration, the less happy physicians were in their work. Perhaps this is one reason for the dramatic decline in physician satisfaction of their work life. The trend is clear: Doctors are spending less time with patients and more time with computer records.

The main move to electronic health records came about as part of the Affordable Care Act. A provision in the ACA aimed to “reducing paperwork and administrative costs” began in October 2012: “Using electronic health records will reduce paperwork and administrative burdens, cut costs, reduce medical errors and most importantly, improve the quality of care.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Hospital ICUs Overused

Hospital ICUs Overused

December 27, 2016

(Science Daily) – Intensive Care Units (ICUs), which provide the most expensive and invasive forms of care in a hospital setting, are being used too often for patients who don’t need that level of care, according to a new study by LA BioMed and UCLA researchers published in the Journal of the American Medical Association Internal Medicine today. The researchers studied 808 ICU admissions from July 1, 2015 to June 15, 2016 at Harbor-UCLA Medical Center and found that more than half the patients could have been cared for in less expensive and invasive settings.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.