Posts tagged with "Doctors"

FDA proposes that manufacturers and doctors warn women about risks of breast implants

October 24, 2019

Women considering surgery to receive breast implants should be warned in advance of the risk of serious complications, including fatigue, joint pain and the possibility of a rare type of cancer, the Food and Drug Administration (FDA) said on October 23, according to a report by The New York Times.

Agency officials are urging manufacturers to print a boxed warning on the packaging of the implants, the Times said, and to provide a checklist spelling out the risks for prospective patients to review before making a decision and putting down a deposit on the surgery.

The measures are not mandated by the agency; they are proposals now open to public comment and industry input.

Millions of women have implants—silicone sacks filled with either saltwater or silicone gel that are used to enlarge the breasts for cosmetic reasons or to rebuild them after a mastectomies for breast cancer.

Breast augmentation with implants is the most popular cosmetic surgical procedure, the news outlet notes: Some 313,000 augmentations were performed in 2018, a 4% increase over the number in 2017. Breast reconstruction after cancer surgery accounts for another 100,000 procedures.

In turn, thousands of women with implants have reported developing debilitating illnesses, such as severe muscle and joint pain, weakness, cognitive difficulties and fatigue, a constellation of symptoms some experts call “breast implant illness.”

Some of the ailments are forms of connective tissue disease, which includes lupus, rheumatoid arthritis and other serious autoimmune diseases. Implants have also been linked to a rare cancer of the immune system called anaplastic large cell lymphoma, which can be fatal. Most of the cancer cases developed in women with textured implants.

The agency warned two implant manufacturers earlier this year that they had failed to carry out adequate long-term safety studies of implants, which had been mandated as a condition of their approval.

At an advisory panel meeting in March, women with breast implants testified about their illnesses and implored the agency to take action. More than 70,000 women signed a petition demanding the F.D.A. to require the checklist.

Advocates urged agency officials to require the long-term safety studies that were promised and to start patient registries to track outcomes. Some women asked the F.D.A. to ban breast implants altogether.

According to the Times report, agency officials said they had “heard loud and clear” that there was “a distinct opportunity to do more to protect women who are considering implants.”

The F.D.A. also wants implant manufacturers to list the ingredients in implants, in an easy-to-understand format for patients, so that women know about chemicals and heavy metals in the products.

The agency also is proposing new screening recommendations for women who already have silicone gel implants, saying they should undergo imaging scans to look for ruptures beginning five to six years after the surgery and every two years after that, the Times reported.

At the request of the F.D.A., Allergan in July recalled textured breast implants linked to the unusual cancer.

 Research contact: @nytimes

You have what? 1 in 6 doctors admits to making diagnostic errors on a daily basis

September 12, 2019

Should we trust our doctors? Nearly 17% of medical professionals estimated in a Medscape poll that they make diagnostic errors each day, WebMD reported on September 11.

That number varied by specialty. Pediatricians were least likely to say they made errors in their diagnoses every day (11%), and emergency medicine specialists were most likely (26%); while family medicine practitioners (18%), physicians in general practice (22%), and internal medicine professionals (15%) came out somewhere in the middle.

Nurses, advanced practice registered nurses, and physician assistants answered similarly: In all three categories, 17% said they estimated they made diagnostic errors daily.

Respondents included 633 doctors and 118 nurse practitioners, for a total of 751. The poll was conducted after Medscape reported results from a study conducted by the Johns Hopkins School of Medicine in the Journal of General Internal Medicine that suggested doctors tend to underestimate how often they make diagnostic errors.

Researchers at the Baltimore-based school conducted a survey of doctors at nine Connecticut internal medicine training programs to assess thoughts about diagnostic uncertainty and error. Most believed diagnostic errors to be uncommon (once a month or less), although fully half of respondents said they felt diagnostic uncertainty every day. Previously published figures estimate that diagnostic errors happen in 10% to 15% of all patient encounters.

A registered nurse wrote in the comments on the Medscape poll that it’s important to make a distinction between incorrect diagnoses and uncertainty. “The latter is part of the basis for a referral to a specialist,” he noted.

Poll results showed that nurse practitioners and physician assistants reported slightly higher rates of daily diagnostic uncertainty than did doctors. Uncertainty rates were similar for male and female doctors.

Doctors, nurse practitioners, and physician assistants agreed on the top three reasons diagnostic errors happen:

  • One was “lack of feedback on diagnostic accuracy” (38% of doctors and 44% of nurse practitioners/physician assistants listed that as a top reason);
  • Another was time constraints, listed by 37% of doctors and 47% of nurse practitioners and physician assistants;
  • Rounding out the top three was “a culture that discourages disclosure or errors” (according to 27% of doctors; 33% of nurse practitioners/physician assistants).

Finally, an internist said one cause of uncertainty in diagnosis was not listed as an option in the poll —”the inherent nature of biological systems.” Not all symptoms or conditions can be diagnosed, at least in a timely manner, he said.

“We are not ‘omnipotent,’ ” he wrote. “We do not understand in totality human physiology/pathology. Just because a diagnostic ‘label’ cannot be applied to a patient within a certain time, or that a reasonable diagnosis was applied that turns out to be ‘incorrect,’ does not mean an ‘error’ occurred.”

Research contact: @WebMD

Cold comfort: Incoming medical students should be tested for empathy, study says

August 5, 2019

We’ve all been there—especially the women among our readers: Sitting in a doctor’s office and explaining our symptoms to a medical professional who is completely dismissive, disinterested, and in disbelief.

Worse yet is the practitioner who blames the patient for the condition—and lets her (or him) know about it through insolent or disdainful body language and comments.

Heather Cianciolo says she can tell within minutes if she’s going to like a doctor. “Ten minutes into a doctor’s appointment and I know if it’s going to be a waste of my time,” she said. “It’s a warning sign if someone doesn’t come in and ask me about me—{but rather] just starts talking at me.

“And it happens a lot,” she told The Chicago Tribune for a recent story.

The 46-year-old Oak Park, Illinois, woman—who has long suffered from migraine headaches— said she had to “go through” several specialists who didn’t listen to her before finding one she loves who is now her primary care physician.

“She listens and then she will explain her thinking. She expresses an interest in what’s happening,” Cianciolo said. “If you’re not going to take the time to answer my questions, why would I entrust my health care to you?”

Experts say the ability for doctors to build a rapport with their patients helps build trust and, in turn, improves patient outcomes.

In fact, Mohammadreza Hojat—a research professor of psychiatry and human behavior at Sidney Kimmel Medical College of Thomas Jefferson University in Philadelphia who recently designed a questionnaire for  more than 16,000 students of osteopathic medicine—suggests that a norm-level of empathy could (and should) be required for all incoming medical students nationwide, according to the report by the Tribune.

Once a norm-level is established, Dr. Hojat suggests, medical schools should use the data to assess for empathy, alongside academic measures like college transcripts and MCAT scores, when considering medical school applicants.

 “There are two components of medicine. One component is the science of medicine and one component is the art of medicine,” Dr. Hojat told the Tribune. “When it comes to art of medicine, it is about interpersonal relationships and empathy, and we have no method in place” to measure that in medical students’ applicants.

Although empathy can be taught, Hojat said, students who already come to medical school with a strong sense of empathy will make better doctors. And he noted that, although the study focused on students of osteopathic medicine, the tool should be used by traditional medical schools.

Dr. John Prescott, chief academic officer at the Association of American Medical Colleges, said in a statement that “humanism and empathy are critical qualities required of tomorrow’s physicians.” But the statement also claimed that medical schools already look at a “holistic review of applicants … which looks beyond grades and test scores.”

And Jean Decety, a University of Chicago neuroscientist who studies empathy, told the news outlet that, although he hadn’t read the study, his work has shown that empathy only is important for “certain types of physicians.”

In fact, he said, some students will go into specialties that don’t require strong interpersonal skills—for example, radiologists who mostly read images, or surgeons who require excellent technical skills but not necessarily a lot of empathy.

“That’s what you want from your surgeon,” he said.

The study was published July 25 in The Journal of the American Osteopathic Association.

Research contact: @chicagotribune

Patients care what their doctors wear

June 26, 2018

A survey of 4,062 patients at ten major medical centers nationwide by Michigan Medicine at the University of Michigan  has found that doctors should consider their white coats as much more than a fashion statement. In fact, one-third of respondents to the study, published on June 6 in Science Daily, said that what a doctor wears influences their satisfaction with their care.

Based on the findings, the researched have called for more hospitals, health systems, and practice groups to look at their dress standards for physicians, or create them, if they don’t already have one.

“Professional dress on Wall Street, law and nearly every other industry is relatively clear—and it typically mirrors what applicants would wear to their job interview,” says Christopher Petrilli, M.D., lead author of the study and an assistant professor of hospital medicine at the University of Michigan Medical School, who worked in the finance industry before entering medicine. “In medicine, the dress code is quite heterogeneous, but, as physicians, we should make sure that our attire reflects a certain level of professionalism that is also mindful of patients’ preferences.”

The study asked patients to look at pictures of male and female physicians in seven different forms of attire, and to think of them in both inpatient and outpatient clinical settings. For each photo, they rated the providers on how knowledgeable, trustworthy, caring, and approachable the physician appeared, and how comfortable the attire made the patient feel.

The options were:

  • Casual: Short-sleeved collared shirt and jeans with tennis shoes, with or without white coat;
  • Scrubs: Blue short-sleeved scrub top and pants, with or without white coat;
  • Formal: Light blue long-sleeved dress shirt and navy blue suit pants, with or without white coat; with black leather shoes with one-inch heels for women, and with black leather shoes for men, and a dark blue tie for men; or
  • Business suit: Navy blue jacket and pants with the same dress shirt, tie and shoes as in the “formal” option, no white coat.

Formal attire with a white coat got the highest score on the composite of five measures, and was especially popular with people over age 65. It was followed by scrubs with a white coat, and formal attire without a white coat. Indeed, when asked directly what they thought their own doctors should wear, 44% of patients said they preferred the formal attire with white coat, and 26% said scrubs with a white coat. When asked what they would prefer surgeons and emergency physicians wear, scrubs alone got 34%  of the vote; followed by scrubs with a white coat with 23%.

The results were largely the same for physicians of either gender except for male surgeons. Patients tended to prefer that they go with formal wear, without a white coat.

The setting of care mattered, too. Sixty-two percent agreed or strongly agreed that when seeing patients in the hospital, doctors should wear a white coat, and 55% said the same for doctors seeing patients in an office setting. The percentage preferring a white coat fell to 44% for emergency physicians.

Though the surveys were conducted during business hours on weekdays, the researchers asked patients what they thought doctors should wear when seeing patients on weekends. In this case, 44% said the short-sleeved outfit with jeans was appropriate, although 56% were neutral or disapproved of such a look even on weekends.

Interestingly, patients in the Northeast (38%) and Midwest (40%) were less insistent on white coats and formal attire;, compared with those in the West (50%) and in the South (51%). Northeasterners were more than twice as likely as southerners to prefer scrubs alone for surgeons.

“This is by far the largest study to date in this area. We used the expertise gained from our previous systematic review along with a panel of psychometricians, research scientists, choice architects, survey experts, and bioethicists to develop our study instrument. Given the size, methodological rigor and representativeness of these data, local, nuanced policies addressing physician attire should be considered to improve the patient experience,” says Petrilli, who treats patients in the hospitals of Michigan Medicine, U-M’s academic medical center, and holds a position at the VA Ann Arbor Healthcare System. He is a member of the U-M Institute for Healthcare Policy and Innovation.

The researchers note that while studies have shown that while physicians’ white coats, neckties and sleeves have been shown to harbor infectious organisms—leading some countries to require physicians’ arms to be “bare below the elbow”—no studies have shown actual transmission of infection to patients through contact with physician attire.

However, other research has suggested that physicians may be more attentive to tasks when wearing their white coats, perhaps increasing patient safety.

“Patients appear to care about attire and may expect to see their doctor in certain ways. Which may explain why even white lab coats received a high rating for ‘approachability’ — patients may see a white coat similar to a physician’s ‘uniform’ and may similarly also expect formal attire in most settings,” notes Petrilli. “Patients don’t always have the opportunity to choose their doctor. In this era of appropriately increased focus on patient centeredness and satisfaction, physician attire may be an important, easily modifiable component of the patient care experience.”

Research contact: MichMedmedia@med.umich.edu