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The Etiquette of Help

The Etiquette of Help

“Any surgeon to OR 6 STAT. Any surgeon to OR 6 STAT.” No surgeon wants to hear or respond to a call like that. It means someone is in deep kimchee and needs help right away. I was in the locker room, just about to strip off my scrubs and dress to go out with my wife for the evening. We had finished a full day of routine surgery—two gallbladders and a colon resection—and had plans for dinner. Our older son was home from college and had offered to watch his younger brother for us. I closed my locker and walked back out to the OR control desk. Michele, my wife and first assistant, was already there. A glance at the control board showed me that Dr. S was in room 6. She was a gynecologist, and according to the board, was doing a routine diagnostic laparoscopy. The bustle of technicians and nurses running in and out of the room indicated that it was anything but routine. We made our way to the room, and I stuck my head in. My friend Jon was the anesthesiologist. He was squeezing a bag of packed red blood cells to make them run into the IV faster. “We could use some help,” he said, calmly as ever. But he rolled his eyes toward the table. Dr S. stood there, blood coating her arms and chest, her eyes looking at me but somehow also looking far away, the thousand yard stare of someone out of their depth and very afraid. “Hey, Lou,” I said, using her first name as I stepped into the...
Physician Rapport With Obese Patients

Physician Rapport With Obese Patients

Recent studies suggest that obese patients may be vulnerable to poorer physician–patient communication because some doctors may hold negative attitudes toward these individuals. “Prior studies have shown that some physicians have less respect for their obese patients, viewing them as being lazy or unmotivated,” explains Kimberly A. Gudzune, MD, MPH. “These negative attitudes may come across during patient encounters.” Yet, no studies had previously assessed whether patient obesity altered physician–patient interactions with regard to biomedical and psychosocial dialogue and rapport building. In a study published in Obesity, Dr. Gudzune and colleagues sought to address this research gap by analyzing audio recordings of visits by 208 patients with high blood pressure who saw 39 primary care physicians (PCPs). Empathy Matters According to the study, patient weight did not appear to play a role in the quantity of physicians’ medical questions and advice, counseling, or treatment regimen discussions. However, PCPs built significantly less emotional rapport with their obese patients than with those who were normal weight. PCPs were more likely to show empathy, concern, and understanding with patients of normal weight by using words and phrases that reassured and legitimized patients’ feelings, regardless of the medical topic being discussed.   The findings raise concern about how these low levels of emotional rapport may impact obese patients, according to Dr. Gudzune. “This may weaken the physician–patient relationship,” she says. “It may also reduce the likelihood that patients will adhere to their doctor’s recommendations and may decrease the effectiveness of behavior-change counseling, which are vital elements to helping obese patients lose weight and improve health.” Building an Alliance Patients usually resent feeling that they are...
Examining Physician Rx Drug Abuse

Examining Physician Rx Drug Abuse

Substance use is one of the most frequent causes of impairment among physicians, and some reports estimate that 10% to 15% of doctors will have a substance use disorder in their lifetime. “Substance-related impairment among physicians is a serious problem, with significant consequences for patient safety and public health,” says Lisa J. Merlo, PhD, MPE. “The rate of physician substance use is similar to that of the general population, but physicians are more likely to misuse prescription drugs. Understanding the reasons for prescription drug misuse may help us more successfully identify, treat, and monitor addicted physicians.” A key challenge to treating substance use disorders is that most physicians do not refer themselves for treatment, making it difficult to collect data on this issue. One strategy is to partner with physician health programs (PHPs) to recruit study participants. PHPs were established to ensure that distressed or impaired physicians are treated and monitored for the long term so that they can safely return to practice. “Studies have shown that nearly 80% of physicians who participate in PHPs remain substance free—with no relapse—at 5 years follow-up,” Dr. Merlo says. “Unfortunately, many doctors with substance use disorders have these problems for years before they seek help or are referred to a PHP.” Exploring the Issue Despite the impact of substance use among physicians, few analyses have looked at prescription drug misuse in this population. Studies have suggested that access to prescription medications may increase the risk of substance abuse among physicians. However, Dr. Merlo says that more information is needed to understand the reasons for prescription drug misuse among physicians and to develop...
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