Forum Home
PC World Chat
Thread ID: 145736	2018-01-17 19:55:00	Yay!!! I can finally drink something!	Greg (193)	PC World Chat

Post ID	Timestamp	Content	User
1444963	2018-02-27 01:01:00	Previous research clearly shows that proton pump inhibitors (PPIs) are severely overprescribed and misused. Indeed, PPIs are among the most widely prescribed drugs today, with annual sales of about $14 billion8--this despite the fact that they were never intended to treat heartburn in the first place. PPIs, the most powerful class of antacid drugs, were actually designed to treat a very limited range of severe problems,9 such as bleeding ulcers, Zollinger-Ellison syndrome (a rare condition that causes excess stomach acid production), and severe acid reflux, where an endoscopy has confirmed your esophagus is damaged. PPIs were never intended for people with heartburn, and according to Mitchell Katz, director of the San Francisco Department of Public Health,10 "about 60 to 70 percent of people taking these drugs shouldn't be on them." The recommendation is to use them for a maximum of two weeks at a time, no more than three times per year, but many ignore this and stay on them far longer, which could have serious consequences. For example, reported side effects include: Pneumonia Bone loss Hip fractures Infection with Clostridium difficile, a harmful intestinal bacteria It's also important to realize that while PPIs suppress the production of stomach acid—which in some severe cases may be warranted, short-term—the vast majority (about 95 percent) of heartburn cases are not caused by too much stomach acid, but rather from having too little. Losec (Omeprazole) is the most prescribed proton pump inhibitor for adults and children alike. Hence taking these drugs will actually worsen your condition over time... Reducing stomach acid also diminishes your primary defense mechanism against food-borne pathogens, thereby increasing your risk of food poisoning. PPIs simply do nothing to treat the underlying cause of pain. More recent research12,13 has also linked PPIs with an increased risk for heart attack, even if you have no prior history of cardiovascular disease. Lead author Nigam H. Shah of Stanford University in California told Reuters Health: Heartburn is a hallmark symptom of gastroesophageal reflux disease (GERD), also known as peptic ulcer disease. But the conventional rationale that acid reflux is caused by excessive amounts of acid in your stomach is incorrect. Excessive acid production is actually extremely rare, and the vast majority of acid reflux cases are in fact related to: Hiatal hernia16 Helicobacter pylori (H. pylori) imbalance In the early 1980s, Dr. Barry Marshall, an Australian physician, discovered that an organism called helicobacter pylori (initially called campylobacter) can contribute to a chronic low-level inflammation of your stomach lining, which is largely responsible for producing many of the symptoms of acid reflux. It is only when it becomes imbalanced by other bacteria that it becomes a problem. Besides these underlying conditions, certain prescription and over-the-counter (OTC) medications can also cause heartburn. Common culprits include anxiety medications and antidepressants, antibiotics, blood pressure medications, nitroglycerin, osteoporosis drugs, and pain relievers. Everyone has specific triggers. Common triggers such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine may make heartburn worse. Avoid foods you know will trigger your heartburn. Eat smaller meals. Avoid overeating by eating smaller meals. Don't lie down after a meal. Wait at least three hours after eating before lying down or going to bed. Eating large amounts of processed foods and sugars is a way to exacerbate acid reflux as it will upset the bacterial balance in your stomach and intestine. Also, eliminate food triggers from your diet. Common culprits here include caffeine, alcohol products. Next, you need to make sure you're getting enough beneficial bacteria from your diet. This will help balance your bowel flora, which can eliminate the problem naturally. Fermented vegetables Chutneys Cultured dairy, such as yoghurt and sour cream Fish such as mackerel and Swedish gravlax	piroska (17583)
1444964	2018-02-27 01:02:00	Alfuzosin Side effectsThe most common side effects are dizziness (due to postural hypotension), upper respiratory tract infection, headache, fatigue, and abdominal disturbances. Side effects include stomach pain, heartburn, and congested nose. (which is why the stomach pill, right?)	piroska (17583)
1444965	2018-02-27 01:04:00	Virtually every family in the country, the research indicates, has been subject to overtesting and overtreatment in one form or another. My friend Bruce told me what happened when his eighty-two-year-old father developed fainting episodes. His doctors did a carotid ultrasound and a cardiac catheterization. The tests showed severe atherosclerotic blockages in three coronary arteries and both carotid arteries. He had smoked two packs of cigarettes a day since the age of seventeen, and in his retirement years was had chronic lung disease, an aortic-aneurysm repair at sixty-five, a pacemaker at seventy-four. The doctors recommended doing a three-vessel cardiac-bypass operation as soon as possible, followed, a week or two later, by surgery to open up one of his carotid arteries. The team told him that the combined procedures posed clear risks to his father—for instance, his chance of a stroke would be around fifteen per cent—but that the procedures had become very routine, and the doctors were confident that they were far more likely to be successful than not. The blockages weren’t causing his father’s fainting episodes or any other impairments to his life. The operation would not make him feel better. Instead, “success” to the doctors meant reducing his future risk of a stroke. How long would it take for the future benefit to outweigh the immediate risk of surgery? The doctors didn’t say, but carotid surgery in a patient like Bruce’s father reduces stroke risk by about one percentage point per year. Therefore, it would take fifteen years before the benefit of the operation would exceed the fifteen-per-cent risk of the operation. Bruce’s father had a stroke during the cardiac surgery. Another had torn a meniscus in his knee doing lunges. He was referred to an orthopedic surgeon to discuss whether to do physical therapy or surgery. We’ve long assumed that if we screen a healthy population for diseases like cancer or coronary-artery disease, and catch those diseases early, we’ll be able to treat them before they get dangerously advanced, and save lives in large numbers. But it hasn’t turned out that way. For instance, cancer screening with mammography, ultrasound, and blood testing has dramatically increased the detection of breast, thyroid, and prostate cancer during the past quarter century. We’re treating hundreds of thousands more people each year for these diseases than we ever have. Yet only a tiny reduction in death, if any, has resulted. My last patient in clinic that day, Mrs. E., a woman in her fifties, had been found to have a thyroid lump. A surgeon removed it, and a biopsy was done. The lump was benign. But, under the microscope, the pathologist found a pinpoint “microcarcinoma” next to it, just five millimetres in size So when the surgeon told Mrs. E. that a cancer had been found in her thyroid, which was not exactly wrong, she believed he’d saved her life, which was not exactly right. More than a third of the population turns out to have these tiny cancers in their thyroid, but fewer than one in a hundred thousand people die from thyroid cancer a year. The surgery posed a greater risk of causing harm than any microcarcinoma we might find, I explained. There was a risk of vocal-cord paralysis and life-threatening bleeding. Removing the thyroid would require that she take a daily hormone-replacement pill for the rest of her life. We were better off just checking her nodules in a year and acting only if there was significant enlargement. Our ever more sensitive technologies turn up more and more abnormalities—cancers, clogged arteries, damaged-looking knees and backs—that aren’t actually causing problems and never will. And then we doctors try to fix them, even though the result is often more harm than good. Doctors get paid for doing more, not less. Misprescribing and Overprescribing of Drugs Seven all-too-often-deadly sins of prescribing Evidence of Misprescribing and Overprescribing The Causes of Misprescribing and Overprescribing The numbers are staggering: in 2003, an estimated 3.4 billion prescriptions were filled in retail drugstores and by mail order in the United States. That averages out to 11.7 prescriptions filled for each of the 290 million people in this country.1 But many people do not get any prescriptions filled in a given year, so it is also important to find out how many prescriptions are filled by those who fill one or more prescriptions. In a study based on data from 2000, more than twice as many prescriptions were filled for those 65 and older (23.5 prescriptions per year) than for those younger than 65 (10.1 prescriptions per year).2 Another way of looking at the high rate of prescriptions among older people is the government finding that although Medicare beneficiaries comprise only 14% of the community population, they account for more than 41% of prescription medicine expenses.3 There is no dispute that for many people, prescriptions are beneficial, even lifesaving in many instances. But hundreds of millions of these prescriptions are wrong, either entirely unnecessary or unnecessarily dangerous. Inappropriate prescribing is an academically gentle euphemism for prescriptions for which the risks outweigh the benefits, thus conferring a negative health impact on the patient. A recent comprehensive review of studies of such inappropriate prescribing in older patients found that 21.3% of community-dwelling patients 65 years or older were using at least one drug inappropriately prescribed. Much more so than age, per se, the total number of drugs being prescribed was an important predictor of inappropriate prescribing, as was female gender.4 Another study found that, conservatively—using very narrow criteria for inappropriate prescribing—elderly United States patients were prescribed at least one inappropriate drug at an estimated 16.7 million visits to physician offices or hospital outpatient departments in the year 2000.5 Examples of specific drugs that have been inappropriately prescribed, including studies involving younger adults and children, are given later in this section. At the very least, misprescribing wastes tens of billions of dollars, barely affordable by many people who pay for their own prescriptions. But there are much more serious consequences. As discussed in Adverse Drug Reactions, more than 1.5 million people are hospitalized and more than 100,000 die each year from largely preventable adverse reactions to drugs that should not have been prescribed as they were in the first place.6 What follows is a summary of the seven all-too-often-deadly sins of prescribing. First: The “disease” for which a drug is prescribed is actually an adverse reaction to another drug, masquerading as a disease but unfortunately not recognized by doctor and patient as such. Instead of lowering the dose of the offending drug or replacing it with a safer alternative, the physician adds a second drug to the regimen to “treat” the adverse drug reaction caused by the first drug. Examples discussed on this web site (see later in this section and in Drug-Induced Diseases) include drug-induced parkinsonism, depression, sexual dysfunction, insomnia, psychoses, constipation, and many other problems. Second: A drug is used to treat a problem that, although in some cases susceptible to a pharmaceutical solution, should first be treated with commonsense lifestyle changes. Problems such as insomnia and abdominal pain often have causes that respond very well to nondrug treatment, and often the physician can uncover these causes by taking a careful history. Other examples include medical problems such as high blood pressure, mild adult-onset diabetes, obesity, anxiety, and situational depression. Doctors should recommend lifestyle changes as the first approach for these conditions, rather than automatically reach for the prescription pad. Third: The medical problem is both self-limited and completely unresponsive to treatments such as antibiotics or does not merit treatment with certain drugs. This is seen most clearly with viral infections such as colds and bronchitis in otherwise healthy children or adults. Fourth: A drug is the preferred treatment for the medical problem, but instead of the safest, most effective—and often least expensive—treatment, the physician prescribes one of the Do Not Use drugs listed on this web site or another, much less preferable alternative. An example of a less preferable alternative would be a drug to which the patient has a known allergy that the physician did not ask about. Fifth: Two drugs interact. Each on its own may be safe and effective, but together they can cause serious injury or death. Sixth: Two or more drugs in the same therapeutic category are used, the additional one(s) not adding to the effectiveness of the first but clearly increasing the risk to the patient. Sometimes the drugs come in a fixed combination pill, sometimes as two different pills. Often heart drugs or mind-affecting drugs are prescribed in this manner. Seventh: The right drug is prescribed, but the dose is dangerously high. This problem is seen most often in older adults, who cannot metabolize or excrete drugs as rapidly as younger people. This problem is also seen in small people who are usually prescribed the same dose as that prescribed to people weighing two to three times as much as they do. Thus, per pound, they are getting two to three times as much medicine as the larger person. Evidence of Misprescribing and Overprescribing Here are some examples from recent studies by a growing number of medical researchers documenting misprescribing and overprescribing of specific types of drugs: Treating Adverse Drug Reactions with More Drugs Researchers at the University of Toronto and at Harvard have clearly documented and articulated what they call the prescribing cascade. It begins when an adverse drug reaction is misinterpreted as a new medical condition. Another drug is then prescribed, and the patient is placed at risk of developing additional adverse effects relating to this potentially unnecessary treatment.7 To prevent this prescribing cascade, doctors—and patients—should follow what we call Rule 7 of the Ten Rules for Safer Drug Use (see Protecting Yourself and Your Family from Preventable Drug-induced Injury): Assume that any new symptom you develop after starting a new drug might be caused by the drug. If you have a new symptom, report it to your doctor. Some of the instances of the prescribing cascade that these and other researchers have documented include: • The increased use of anti-Parkinson’s drugs to treat drug-induced parkinsonism caused by the heartburn drug metoclopramide7 (REGLAN) or by some of the older antipsychotic drugs. • A sharply increased use of laxatives in people with decreased bowel activity that has been caused by antihistamines such as diphenhydramine (BENADRYL), antidepressants such as amitriptyline (ELAVIL)—a Do Not Use drug—or some antipsychotic drugs such as thioridazine (MELLARIL).8 • An increased use of antihypertensive drugs in people with high blood pressure that was caused or increased by very high doses of nonsteroidal anti-inflammatory drugs (NSAIDs), used as painkillers or for arthritis.9 Failing to Treat Certain Problems with Nondrug Treatments Research has shown that many doctors are too quick to pull the prescription trigger. In one study, in which doctors and nurse practitioners were presented with part of a clinical scenario—as would occur when first seeing a patient with a medical problem—and then encouraged to ask to find out more about the source of the problem, 65% of doctors recommended that a patient complaining of insomnia be treated with sleeping pills even though, had they asked more questions about the patient, they would have found that the patient was not exercising, was drinking coffee in the evening, and, although awakening at 4 a.m., was actually getting seven hours of sleep by then.10 In a similar study, doctors were presented with a patient who complained of abdominal pain and whose endoscopy showed diffuse irritation in the stomach. Sixty-five percent of the doctors recommended treating the problem with a drug—a histamine antagonist (such as Zantac, Pepcid, or Tagamet). Had they asked more questions they would have discovered that the patient was using aspirin, drinking a lot of coffee, smoking cigarettes, and was under considerable emotional stress—all potential contributing factors to abdominal pain and stomach irritation. In summarizing the origin of this overprescribing problem, the authors stated: “Apparently quite early in the formulation of the problem, the conceptual focus [of the doctor] appears to shift from broader questions like ‘What is wrong with this patient?’or ‘What can I do to help?’ to the much narrower concern, ‘Which prescription shall I write?’” They argued that this approach was supported by the “barrage” of promotional materials that only address drug treatment, not the more sensible lifestyle changes to prevent the problem.11 In both of the above scenarios, nurse practitioners were much more likely than doctors to take an adequate history that elicited the causes of the problems and, not surprisingly, were only one-third as likely as the doctors to decide on a prescription as the remedy instead of suggesting changes in the patient’s habits. Throughout this web site, in the discussions about insomnia, high blood pressure, situational depression, mild adult-onset diabetes, and other problems, you will find out about the proven-effective nondrug remedies that should first be pursued before yielding to the riskier pharmaceutical solutions. Treating Viral Infections with Antibiotics or Treating Other Diseases with Drugs That Are Not Effective for Those Problems Two recently published studies, based on nationwide data from office visits for children and adults, have decisively documented the expensive and dangerous massive overprescribing of antibiotics for conditions that, because of their viral origin, do not respond to these drugs. Forty-four percent of children under 18 years old were given antibiotics for treatment of a cold and 75% for treatment of bronchitis. Similarly, 51% of people 18 or older were treated with antibiotics for colds and 66% for bronchitis. Despite the lack of evidence of any benefit for most people from these treatments, more than 23 million prescriptions a year were written for colds, bronchitis, and upper respiratory infections. This accounted for approximately one-fifth of all prescriptions for antibiotics written for children or adults.12, 13 An accompanying editorial warned of “increased costs from unnecessary prescriptions, adverse drug reactions, and [subsequent] treatment failures in patients with antibiotic-resistant infections” as the reasons to try to reduce this epidemic of unnecessary antibiotic prescribing.14 Similar misprescribing of a drug useful and important for certain problems, but not necessary or effective, and often dangerous, for other problems can be seen in another recent study. In this case, 47% of the people admitted to a nursing home who were taking digoxin, an important drug for treating an abnormal heart rhythm called atrial fibrillation or for treating severe congestive heart failure, did not have either of these medical problems and were thereby being put at risk for life-threatening digitalis toxicity without the possibility of any benefit.15 A final example in this category involves the overuse of a certain of drugs, in this case calcium channel blockers, which have not been established as effective for treating people who have had a recent heart attack. The study shows that this prescribing pattern actually did indirect damage to patients because their use was replacing the use of beta-blockers, drugs shown to be very effective for reducing the subsequent risk of death or hospitalization following a heart attack. Use of a calcium channel blocker instead of a beta-blocker was associated with a doubled risk of death, and beta-blocker recipients were hospitalized 22% less often than nonrecipients.16 The Drug Industry The primary culprit in promoting the misprescribing and overprescribing of drugs is the pharmaceutical industry, which now sells about $216 billion worth of drugs in the United States alone. The industry uses loopholes in the law not requiring proof of superiority over existing drugs for approval, and otherwise intimidates the Food and Drug Administration (FDA) into approving record numbers of drugs that often have dangerous adverse effects. In addition, the industry spends well in excess of $21 billion a year to promote drugs using advertising and promotional tricks that push at or through the envelope of being false and misleading. The best doctors, of whom there are many, do not waste their time talking to drug sales people, toss promotional materials away, and ignore drug ads in medical journals. Too many other doctors, however, are heavily influenced by drug companies, accepting free meals, free drinks, and free medical books in exchange for letting the drug companies “educate” them at symposia in which the virtues of certain drugs are extolled. The treatments for high blood pressure, high cholesterol or diabetes could in fact be harmful, warns Professor Michael Oliver. A fit and healthy older person summoned by his GP for an annual health check can return home as a patient, scared and no longer comfortably ageing.' Professor Oliver said that even if older people feel reasonably well, the 'NHS does not always permit such euphoria'. 'They may be told they have hypertension or diabetes or high cholesterol, that they are obese, they take too little exercise, eat unhealthily and drink too much. Many of these patients are told to have more investigations. Eventually most will be started on pills. Few seem to be considered not at risk for something,' he said. He highlighted three areas of concern - antihypertensive drugs, diabetes drugs and cholesterol-lowering drugs. Antihypertensive drugs are used to reduce blood pressure and are usually prescribed for life. But as many as one in five patients experience side effects, from tiredness and fatigue to impotence and heart rhythm disturbances. Diabetes drugs can cause diarrhoea, nausea and vomiting, and stomach problems. And cholesterol-lowering drugs, known as statins, interact with some other drugs and have side effects including abdominal pain, diarrhoea and nausea. The most serious adverse reaction is muscle weakness in about one in 1,000 users, with rare complications that can lead to kidney failure and death. Busy family doctors appear to assume that because a pill cuts the relative risk of a disease by 25 per cent compared with other or no treatments, it must be prescribed. Yet the reduction in absolute risk to the individual - the chances of a medical emergency or death - may be only one or two per cent. 'What kind of medicine is this?' he asks. There has also always been a trend for doctors to add new drugs to a patient's regimen: 'Let's see if this will help.' Most are then reluctant to reduce them, even if they have produced no obvious benefits, just in case something goes wrong. All of this means that some patients end up on a rather impressive number of pills they might not need, as Professor Michael Oliver says. In some cases the pills might actually put them at risk, such as blood pressure pills which could lead to too-low blood pressure if not needed. What if you'd thought for years that you were in danger of dying from heart disease because of your high blood pressure? And what if you were taking powerful blood pressure drugs – which come loaded with dangerous side effects. The current definition normal blood pressure was created in 2003 by the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Rife with drug industry conflicts of interest, both declared and indirect – this panel decided that relatively low blood pressure readings were a risk for heart disease. They acknowledged the new affliction – dubbed prehypertension – didn't necessarily equate to a need for medication. But as the New York Times reported, they still urged doctors: "…to take high blood pressure more seriously, and treat it more aggressively, often with more than one drug." And that's how an additional 45 million people, and millions more over the years, were suddenly labeled abnormal, and in need of "treatment" for a condition that didn't exist in medical literature until that panel met. Menopause – Redefined as estrogen deficiency syndrome, menopause became the cause for massive PR blitzes that resulted in millions of women going on hormone replacement therapy (HRT) – until they learned HRT drugs were causing a 26 percent increase in breast cancer (with the risk doubling every five years), a 41 percent increase in strokes, a 29 percent increase in heart disease, and double the risk of blood clots. The truth about HRT was only revealed after women began to die and lawsuits were filed. Depression – With an onslaught of new drugs and plenty of new disorders defining sadness, the DSM (psychiatry’s Diagnostic and Statistical Manual of Mental Disorders) and its industry-connected creators have managed to make depression drugs a $50-billion-a-year business. “Any symptom in an elderly patient should be considered a drug side effect until proved otherwise.” Brown University Long-term Care Quality Letter, 1995.	piroska (17583)
1444966	2018-02-27 01:08:00	As a patient and the daughter of a patient, I was amazed by how precise surgery had become and how fast healing could be. I was struck, too, by how kind many were; how smart and involved some of the doctors we met were. But I was also startled by the profound discomfort I always felt in hospitals. Physicians at times were brusque and even hostile to us (or was I imagining it?). The lighting was harsh, the food terrible, the rooms loud. Weren’t people trying to heal? That didn’t matter. What mattered was the whole busy apparatus of care—the beeping monitors and the hourly check-ins and the forced wakings, the elaborate (and frequently futile) interventions painstakingly performed on the terminally ill. In the hospital, I always felt like Alice at the Mad Hatter’s tea party: I had woken up in a world that seemed utterly logical to its inhabitants, but quite mad to me. “Everything’s probably okay,” the doctors would say, or “You have an idiopathic problem,” which is doctor-talk for “We don’t know why you suddenly have hives every day.” 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. What’s going on is more dysfunctional . 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. Spend a day in an emergency room, and chances are you’ll be struck by two things: the organizational chaos and the emotional detachment as nurses, doctors, and administrators bustle in and out, barely registering the human distress it is their job to address. Nor is there any effort to focus on the deeper reality of disease, as Atul Gawande, a surgeon and professor at Harvard Medical School, writes in his astute new exploration of geriatric medicine, Being Mortal. This absence matters, because how patients feel about their medical interactions really does influence the efficacy of the care they receive, and doctors’ emotions about their work in turn influence the quality of the care they provide. Despite our virtuosic surgical capacities, our cutting-edge technology, and our pharmaceutical advances, the patient-doctor relationship is still the heart of medicine. And it has eroded terribly. Terrence Holt, a geriatric specialist at the University of North Carolina at Chapel Hill, describes the situation in Internal Medicine, fictional fables based on his residency: Any patient in a hospital, when we take their clothes away and lay them in a bed, starts to lose identity; after a few days, they all start to merge into a single passive body, distinguishable … only by the illnesses that brought them there. But systemic changes have intensified a disconnect between patients and doctors . This didn’t matter much in the 1950s, when a general practitioner coordinated most of your care and not many treatment options existed. But sophisticated new surgical techniques, and tools like the CT scan and the MRI, led to a surge in high-tech specialization. But along with new checks and balances came added bureaucracy, and frustrated doctors and patients. In Doctored: The Disillusionment of an American Physician, Sandeep Jauhar—a cardiologist who previously cast a cold eye on his medical apprenticeship in Intern—diagnoses a midlife crisis, not just in his own career but in the medical profession. Today’s physicians, he tells us, see themselves not as the “pillars of any community” but as “technicians on an assembly line,” or “pawn[s] in a money-making game for hospital administrators.” According to a 2012 survey, nearly eight out of 10 physicians are “somewhat pessimistic or very pessimistic about the future of the medical profession.” The biggest problem is time: the system ensures that doctors don’t have enough of it. And because doctors tend to get reimbursed at higher rates when they are in a network , many work for groups that require them to cram in a set number of patients a day. Hence the eight-minute appointments we’re all familiar with. Paperwork compounds the time crunch. Studies estimate that today’s doctors and “hospitalists”—medical practitioners who do most of their work in hospitals—spend just 12 to 17 percent of their day with patients. The rest of the time is devoted to processing forms, reviewing lab results, maintaining electronic medical records, dealing with other staff. Jauhar cites a prominent doctor’s adage that “One cannot do anything in medicine well on the fly,” . Jauhar notes that many doctors, working at “hyperspeed,” are so uncertain that they call in specialists just to “cover their ass”. Lacking the time to take thorough histories or apply diagnostic skills, they order tests not because they’ve carefully considered alternative approaches but to protect themselves from and their patients from the poor care they’re offering them. The alarming part is how fast doctors’ empathy wanes. Studies show that it plunges in the third year of medical school; that’s exactly when initially eager and idealistic students start seeing patients on rotation. And because the medical-education system largely ignores the emotional side of health care, as Ofri emphasizes, doctors end up distancing themselves unthinkingly from what they are seeing. Yet empathy is anything but a frill: not only is it crucial to doctors’ humanity and patients’ dignity, it can be key to medical efficacy. You may be wondering why the rise of patients’ rights in the 1970s and ’80s, hailed as a revolutionary advance in health care, hasn’t served us better. As Barron Lerner observes in The Good Doctor, he and his father, whom he followed into medicine, both staked their careers on the belief that the patient comes first. Their experience of medicine and their ideas about patient care, though, are starkly different. The elder Lerner practiced in an era when doctors unilaterally decided the treatment and often lied to patients about their prognoses. (Knowing you were dying was considered unhealthy.) Today, in the younger Lerner’s era, patient and doctor theoretically have a more collaborative relationship, based on informed consent. We take for granted that doctors will tell us our diagnosis and proceed according to carefully delineated protocols. This is a real advance, yet it is only part of the story. As Lerner comes to see, some of the overtreatment routinely found in hospitals is actually an outgrowth of the patients’-rights movement. In the past, when patients’ hearts stopped, or the terminally ill succumbed to infection, doctors typically would let them go. In our era of “defensive medicine,” unless you have signed a “do not resuscitate” order (and sometimes even if you have, but your family insists on treatment), you’ll be intubated, or defibrillated, or given antibiotics—on the off chance that last-ditch rescue is what you would want. Patients, meanwhile, want both clout and comfort; they feel both defiant and dependent. And so each side exercises power passively (or passive-aggressively), and maybe even unconsciously: I’ll listen to you, but I won’t really believe or act on what you say. I’ve heard many stories of hospitalized patients in pain yet worried that asking for more Dilaudid will be construed as entitled meddling. How far should doctors go to look for an illness they can’t initially find? Victoria Sweet, A doctor could be in “the last almshouse in America,” as she calls Laguna Honda Hospital, a funky old facility for the destitute and chronically ill, where swallows flew through open turrets and 1,200 patients lay mostly in old-fashioned “open wards,” and where she worked for 20-some years. Sweet—who is also a historian of medicine versed in the medical work of the 12th-century nun Hildegard of Bingen—calls her radical solution for our sped-up health care “slow medicine.” Here is a doctor saying what patients intuitively know: being sick is draining, healing takes time, and strong medicine often has strong side effects. In one heartbreaking case, she realizes that an elderly patient is not suffering from Alzheimer’s following a hip surgery, as doctors at the woman’s former hospital concluded—a diagnosis that led to antipsychotic medicines, her removal from her own home, and her separation from her mentally disabled daughter. Rather, she is in pain: the hip had slid out of place, and no one responsible for her follow-up care had noticed. Atul Gawande suggests much the same thing in Being Mortal, arguing that fast, solution-oriented care—particularly in the last year of life, —has, in missing the broader picture, led to a great deal of “callousness, inhumanity, and extraordinary suffering.” Medicine today values intervention far more than it values care. Gawande writes that for a clinician, “nothing is more threatening to who you think you are than a patient with a problem you cannot solve.” The result is that all too often, “medicine fails the people it is supposed to help.” The old doctor-knows-best ethos was profoundly flawed. But it was rooted in an ethic of care for the whole person, perhaps because physicians, less pressed for time, knew their patients better. Danielle Ofri notes that it was the paternalistic old doctors, still hanging around her medical school wearing “starched shirts [and] conservative ties,” who taught her the art of respecting her patients’ individuality: “For them, approaching the bedside of a patient was a sacred act.” In medicine, we label such patients “non-compliant,” a term fraught with negativity. Doctors judge. Moreover, doctors like clarity. We prefer to do something instead of nothing, and this often means prescribing medications. For the most part, patients encourage this behavior. The misuse of antibiotics to treat respiratory viruses illustrates this point. Patients want answers and clear cut solutions and doctors want to provide them. To admit how much we don’t know — how much is out of our control — is frightening for all involved. The clear bias among my doctors has been to use disease modifying medications early and aggressively. None of them have talk about other ways to manage my disease — diet, exercise, stress reduction, acupuncture, massage. None of them has ever said that taking no medication is an option, that a patient might be totally fine without pharmaceuticals; The message has been clear: Taking medications is the right thing to do, the only responsible path. The potential benefits are significant, but so are the potential side effects. I found myself wondering if this was really worth it, if my doctor understoods. For uncertain benefit, I am unwilling to give away time. I decided to join the ranks of the “non-compliant”. A week after I took my last dose, an article in The New York Times reviewed the results of a newly published study on the efficacy of a drug I was supposed to be prescribed. While the medication was shown to decrease the rate of relapses, it had “little or no effect on a patient’s progression to disability.” If I am feeling well, why lose two days out of each week if the medication won’t even help ward off disability? I understand that for some people the potential positives of these medications outweigh the potential negatives. This is a constantly shifting calculus, and tomorrow will be different from today. Being on the patient side has changed me as a doctor. Now, I see more clearly that no medical decision is simple. While my job is to make recommendations to patients based on my medical knowledge, there is no one answer. Ultimately, what is “right” is based on a multitude of factors. Living with illness is a dynamic process, and we need to make room for different, and perhaps constantly shifting, approaches. “You are in charge”, I tell my patients. (Dr. Annie Brewster is a Boston internist) Why do physicians do what they do. Two examples illuminate how precarious justifications can be: An acquaintance opined that she could not come to grips with the treatment plan for her breast cancer diagnosis. The plan was onerous and would demand energy, time and entail certain compounded complications. When she asked her physician to explain the value of the proposed multi-pronged treatment plan, she was told that her “case” had been presented to a “tumor board,” and there was complete agreement that she was getting the best treatment possible. In fact, she would be getting the “standard of care.” The final justification came from her surgeon, who stated, “I would treat a family member the same”. Another friend told me that she had been offered a new therapy to protect her “bones” and given a prescription. After leaving her appointment, she began to wonder about the new treatment and researched the drug on the Internet. She determined that there was not enough information about the drug’s benefits and harms, and decided not to take it. When she later told her physician of her decision, the physician acknowledged that the drug really did not work well and that she would not offer it to her “family member.” My friend asked why she had suggested the drug in the first place, to which the physician responded that she thought my friend would want anything that might help; she added that it was the physician’s “job” to offer treatments so patients feel they are getting something from the visit. What, after all, does “standard of care” mean? Does it mean every patient will get the same plan given the same context? In both stories, neither patient received tangible information about the added benefits and harms of recommended treatments or comparable alternatives. The patients wanted that information, but did not get it. Were the physicians simply offering treatment plans because they were trained to “do something”? The justifications and motives were confused and confusing, at best; lazy or inane, at worst. Hence, we should forgo listening to explanations and instead demand information. And, most importantly, we should not care what physicians think about their decisions, as it is not really their job to decide. It is their job to inform; it is the patient’s job to decide. It may be that patients will, given that they, may misremember and misinterpret their own thoughts, struggle with making medical decisions. But at least it is their struggles that will influence their choices rather than the misrepresentations of others, even if others think they mean well. The only path out of ambiguity for a patient is to know the absolute benefits and harms of the choices they face. Tangible information about the consequences of one treatment plan versus another is all that matters; reliable facts will allow patients to reframe their own stories and not suffer from irrelevant stories of others.	piroska (17583)
1444967	2018-02-27 01:12:00	Well it might be a bit of a rant, but it's not my writings, it's various people in the medical profession. It's bit of a thing with me cause of what happened with husband. For 5 years he was given a medication that caused stage 1 kidney failure and an nasty allergic reaction. Depsite him mentioning it, no-one took any notice, no-one paid attention to the endless blood tests showing this. Until I found out and queried it. There have been a number of similar things too, not just with him. My brother now has Dupuytren's contracture as a result of a long term medication. Too late now to do anything about it. recently husband was told he would be getting more blood tests, and a new pill. I checked the pill and have to say I was horrified, its contadicted for him anyway, and the lsit of very nasty things it can cause were incredible, hence the blood tests, huh. he declined both. You can't cure old age and you can't cure death. medicine should stick with acute conditions, which is what it is best at.	piroska (17583)
1444968	2018-02-27 03:35:00	To much information..... Ken :(	kenj (9738)
1444969	2018-02-27 04:04:00	Believe it or not --- I actually read all that you printed here and I - agree with most - and don't know about the rest . NOTE: I typed a LOT of information here - stuff that isn't in par to the OP's post . MY conditions are nowhere near - on the seriousness scale - the reason for which this post was originally conceived . I could be seduced to paste it back into here - maybe not . I'll see . I'll just go out on a limb here with this: I have a slight elevation of lipids - hence the statin . We'll see what happens . I am dizzy most of the time - cannot feel where my feet are or what they are doing . I need optical input to help me stand, walk or even pull one leg of my pants on before the other . I have one leg considerably shorter than the other (displaced L . hip, unresolvable, B/O a shredded left knee joint-thingy . I have a fractured pubis synthesis (sp?) . Peripheral neuropathy requires I take Lyrica . It's good . Real good! I also have a destroyed left knee requiring TKR again . My right eye - frankly scares the poop outta me . It can rupture when it wants to and kill me in a couple of months . It is also my good eye . (A nevus on the retina, next to the optical nerve) The strokes I've had - have caused me some cognitive losses, balance problems, lexicographical losses, memory lapses beyond just losing my keys . The GERD is bothersome at least - cancerous at worst . It hurts and disrupts my sleep . Ice cream helps a lot . Vanilla . I have terrifically bad headaches and muscle spasms in my neck at the end of each day --- from holding up my big brain .	SurferJoe46 (51)
1444970	2018-02-27 05:27:00	Well it might be a bit of a rant, but it's not my writings, it's various people in the medical profession.You should make it clear you are copying and pasting from another source in your posts otherwise it looks like you are the author. A simple statement and a link to the original website would cover this.	Jen (38)
1444971	2018-02-27 06:12:00	Yes Jen, where I remember I did - ie. Atul Gawande. But a lot of it, I kept the info as document and don't have all the links anymore.	piroska (17583)
1444972	2018-02-27 06:20:00	Believe it or not --- I actually read all that you printed here and I - agree with most - and don't know about the rest. I am dizzy most of the time - cannot feel where my feet are or what they are doing. Peripheral neuropathy requires I take Lyrica. It's good. Real good! The GERD is bothersome at least - cancerous at worst. It hurts and disrupts my sleep. Ice cream helps a lot. Vanilla. [/LIST] Right, not staying you should ditch the lot. The GERD, the medication can aggravate it, well not aggravate, add to the problem....SIL has it, she had these pills too, and now she doesn't. After severe bleeding another GP worked it out, scans show she now has permanent scarring etc from them and has no choice but to manage on diet alone now. It works - to a point. Some days better than others. The neuropathy, OK, if the pill is better than the problem, fair enough. But my main point was, they hand stuff out, whether it helps or not, rarely check on side effects and frequently, when you do get them, just hand out another pill to "fix" the side effect. Friend had that issue. She has type 2 diabetes and a hell of a lot of spinal damage. But she got this pill, that pill, etc...one to fix stomach issues caused by another, that led her to lactate, so yet another and so on, then she started to throw up after eating or drinking, they freaked out and said her blood tests showed this type of blood cancer (not leukemia), and booked her to the hospital. She got me to look it up, being terrified, but she didn't have the symptoms for it. LOng story short, she cut out several of the pills, the weird blood results went away, her problems stopped and they cancelled the hospital. Thats my point. Well and several medical peoples...there was a doco on TV recently, BBC one...similar stuff. Can't remember docs name, he has a twin, also a doc, if you want to bother googling.	piroska (17583)
1 2 3 4 5 6 7 8 9 10