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Alcohol Abuse Among Physicians: Taking Control

Alcohol Abuse Among Physicians: Taking Control

Physicians, like many adults in the general public, enjoy drinking an alcoholic beverage in a socially-appropriate context when they are not taking call. But what happens when casual drinking becomes a problem? Nine out of 10 doctors recognize when they’ve reached their alcohol limit and stop drinking. However, an estimated 10% of doctors allow alcohol to adversely affect their overall well-being, health, and medical practices (1). The National Institute of Health (NIH) suggests a man—younger than 65 years of age—not have more than 14 drinks a week, and a woman—who is not pregnant or attempting to become pregnant—not exceed more than seven drinks per week (2). If you or a colleague drink more than that, an unhealthy drinking habit may be emerging. Rigorously honest self-evaluation or peer-reporting is the next necessary step to avoid developing more serious issues of alcoholism. Reporting Harmful Behaviors Benefits the Medical Community The American Medical Association (AMA) Code of Ethics, considered the most widely accepted ethics guide for physicians, requires all doctors to promote personal health and wellness and to promptly inform relevant authorities of an impaired or incompetent colleague (3). Yet, one in three (36%) physicians surveyed in a recent national poll said they’ve had firsthand knowledge of a physician struggling with drug and/or alcohol misuse and yet did nothing. Some of the reasons these surveyed doctors gave for ignoring harmful behaviors included: “someone else would take care of the problem,” “nothing would happen as a result of the report,” “fear of retribution,” and feelings of being ill-prepared to deal with an unstable colleague (4). If we are to continue safeguarding patients’ care...
Decision-Making Preferences After AMI

Decision-Making Preferences After AMI

In recent years, experts have called for greater partici­pation by patients in medical decision-making processes, but research suggests that shared decision making is not yet routinely incorporated into medical care. “In some cases, there may be a perception among patients that they need to defer decision making to their physicians,” says Harlan M. Krumholz, MD, SM. “This is certainly the sense by many cardiologists about patients hospitalized with an acute myocardial infarction (AMI).” Surveying the Scene To further investigate decision-making preferences among patients, Dr. Krumholz and colleagues conducted a study using combined data from two similar AMI registries. Published in JAMA Internal Medicine, the study group asked patients to indicate who they felt should make decisions on treatment options in AMI after they are given information about the risks and benefits of the possible treatments.   More than two-thirds of patients reported that they preferred to actively participate in decision making about their care, but about one-quarter stated that they wanted to make the decision alone. Most patients indicated that physicians and patients should have equal participation. About 15% suggested that patients should dominate the decision. “The key take-home message is that decision-making preferences vary among patients after an AMI, but many prefer an active style,” says Dr. Krumholz. Difficult to Predict Seven variables were associated with a greater likelihood of patients preferring active decision making, including female sex, Caucasian race, higher education, smoking, heart failure, lower Global Registry of Acute Coronary Events risk score, and not undergoing PCI during the hospitalization. Those who preferred an active role tended to be younger, but the majority of all age groups...
Guidance on Alternative Therapies for Lowering BP

Guidance on Alternative Therapies for Lowering BP

Hypertension affects about 26% of adults worldwide and ranks as the leading chronic risk factor for mortality. The prevalence of hypertension is projected to affect more than 1.5 billion people by 2025, according to recent estimates. About half of all strokes and ischemic heart disease events are attributable to high blood pressure (BP). “An important component of preventing the adverse consequences of hypertension is to adopt lifestyle changes that reduce BP,” says Robert D. Brook, MD. “Several lifestyle approaches have been promoted in guidelines.” These include losing weight, reducing sodium and alcohol intake, adopting a Dietary Approaches to Lower Hypertension (or DASH) eating pattern, and aerobic exercise for 30 minutes on most days per week. Several scientific statements on different approaches to caring for hypertension have been released by various organizations in an effort to address the problem. To further these efforts, the American Heart Association (AHA) published a scientific statement in 2013 that provides recommendations for alternative approaches to lowering BP that go beyond medications and diet. The AHA published the statement in Hypertension. Dr. Brook, who chaired the panel that developed the AHA scientific statement, says there are few large, well-designed studies lasting longer than a few weeks that look at alternative therapies, but he adds that many patients still ask about their value. “Patients often say that they don’t like to take medications and ask about other strategies they can use to lower their BP. The goal of the AHA scientific statement was to provide direction for clinicians when these situations come up.”   Recommendation Highlights For the AHA scientific statement, an expert panel assessed three...
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