Entries for February 2008

Last fall I blogged about Sick Girl, a new book by Amy Silverstein excerpted in U.S. News, that looked back at nearly 20 years, often excruciating, with a transplanted heart. I posted a selection of the E-mails and comments that rolled in, most of them slamming her for ingratitude and immaturity. Finally, I put up Silverstein's response.

Sick Girl found an audience. Moreover, last night her story was selected as winner of the "first book" category in the "Books for a Better Life" annual awards sponsored by the New York chapter of the Multiple Sclerosis Society. The competition included books like surgeon Pauline Chen's Final Exam, an intensely personal exploration of the reluctance and awkwardness of many physicians, including herself, to connect with dying patients.

There's been a lot written in the past few years about the evolution of the traditional paternalistic doctor-knows-best approach to a "patient centered" model of care in which patient and doctor are collaborators, sharing information and discussing treatment options as equal partners. It sounds nicely egalitarian, and presumably patients who are more involved in their care manage their health better than those unenlightened souls who actually want their doctor to tell them what to do. But hold on. A study in this week's Annals of Behavioral Medicine suggests it might be less effective, at least for some people.

All 189 participants, mostly older midwestern men, had high blood pressure and were taking medications to bring it down as well as other drugs to lower their LDL cholesterol, since hypertension is a risk factor for heart disease. More than half also had diabetes and were monitoring their blood sugar. They filled out a nine-item portion of a self-assessment survey called the Patient-Practitioner Orientation Scale, rating themselves from 1 to 6 on how strongly they agreed or disagreed with statements that reflected either a traditional relationship, such as "The doctor is the one who should decide what gets talked about during a visit," or a more patient-centered one, such as "Patients should be treated as if they were partners with the doctor, equal in power and status." And they were asked whether they had received information about their medications from the Internet, a friend, a pharmacist, and other specific sources.

Who says editorials in professional journals can't be fun? I'll nominate the one below in the current issue of the Journal of Family Practice. It's by editor Jeff Susman, chair of the department of family medicine at the University of Cincinnati College of Medicine. The floor is open to other nominees.

What if it's cancer?

We were really worried about our 2-year-old, Lucy. Our fears began when we picked her up and she whimpered. A little closer inspection revealed pain when we moved her right hip. She was eating well, didn't seem to have a fever, and was walking just fine. I ran through the differential diagnosis in my mind, as my wife voiced her worst fears: "What if it's cancer?" A quick call and our appointment was made. Lucky for us, Lucy's doctor has Sunday hours.

Orthopedic surgeons, neurosurgeons, and chiropractors are busier than ever, if the rising national medical bill for aching backs is any indication. Out of every $11 spent on medical care in 2005, according to a new study in the Journal of the American Medical Association, $1 of it was for our backs. After adjusting for inflation, bad backs rang up $86 billion worth of medical expenses in 2005. That's a 65 percent jump from 1997. On average, expenses for an individual with a back problem added up to $2,580 more in 2005 than for someone without one. Between 1997 and 2005, the cost of pain drugs and other back-related medications almost tripled.

So much money, so little relief. The same JAMA study cites an annual federal survey of U.S. households showing that year by year, from 1997 to 2005, the percentage of those with back problems reporting limitations on their social life, on work and school activities, or on physical functioning never dropped once and only in one year stayed the same. The increase was slow but absolutely inexorable.

A number of thoughtful comments arrived concerning my January 23 hand-washing post, about a study showing that a much-increased rate of hand-washing is no guarantee that a hospital's infection rate will budge, let alone dive. A couple of correspondents (notably anesthesiologist-blogger Counting Sheep and hospital-CEO-blogger Paul Levy of "Running a Hospital") contributed thoughts that might prevent a few infections here and there.

The following came as a real letter, if also as an E-mail attachment, from Kathy Warye, another CEO. She runs the Association for Professionals in Infection Control and Epidemiology, whose obvious interest in this subject makes her note very welcome.