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My Turning Point

My Turning Point

As an incurable compulsive introspect, I tend to brood, ponder, contemplate, and (of course) muse on “big ideas,” such as: • What makes people choose things which cause themselves harm? • Are some people better people than others, or are they just more skilled at hiding their problems? • Is pain really a bad thing, or is our aversion to it a sign of human weakness? • Does God ever wear a hat? • Do dogs watch Oprah? • Why did I put “big ideas” in quotes? Tough questions. Lately I’ve been contemplating the nature of human awareness: • Is self-awareness (the ability to think of ourselves in the third person) a uniquely human trait, and is lack of self-awareness the essence of mental illness? • Is empathy, or other-awareness the highest of human traits? Is this what the biblical idea of being “made in the image of God” really means? Yeah, that’s a lot deeper than about dogs watching Oprah. The second of these questions seems to be a very important dividing point in people’s ability to have good relationships with others. Our ability to put ourselves into the place of others, pondering their motives, thoughts, and emotions, goes a very long way in helping us develop deep relationships and avoiding causing inadvertent pain. It also seems to be a trait that is in short supply in our health care system. I am amazed and deeply disturbed by how callously many my patients have been treated by some of my colleagues. Patients are seemingly treated as a commodity, a necessary evil required for billing of services. Burnout and...
Opioid Backlash Threatens Sickle Cell Care

Opioid Backlash Threatens Sickle Cell Care

The well-meaning push to curb opioid prescribing could worsen healthcare for sickle cell patients. Clinicians tend to undertreat the substantial pain experienced by many sickle cell patients and treat them as drug addicts. However, research does not support increased risk of addiction in this patient population. Challenging Pain, Few Options A 2008 study in Annals of Internal Medicine revealed a vast undercurrent of chronic pain in sickle cell disease, with 29% of patients reporting pain—which is often severe—nearly every day. On top of that, vaso-occlusive episodes can trigger excruciating pain and life-threatening complications, such as organ damage. These crises prompt most ED visits for sickle cell disease. Hydroxyurea, the one drug approved by the FDA to treat the disease, is used infrequently despite being effective. The drug lessens the frequency of pain crises but does not eliminate them. In any case, opioids remain essential for treating sickle cell pain. Clinical trials testing these agents in sickle cell populations are lacking, but even less is known about possible alternatives. Inaccurate Assumptions of Pain A recent study found that most sickle cell patients delay seeking treatment until their pain nears 9 on a 10-point intensity scale. When they finally go to the ED, they face longer waits for care than others in less pain. In some research, these patients report that healthcare providers sometimes treat them without respect. Indeed, clinicians often wrongly suspect them of exaggerating their pain or abusing drugs. A Patient-Centered Approach to Treating Sickle Cell Pain Treating sickle cell pain starts with assessment, but no laboratory test or physiological marker can measure this pain. Nor can clinicians gauge...
The Impact of Poor Health Literacy in Patients with COPD

The Impact of Poor Health Literacy in Patients with COPD

Health literacy has been defined as the ability to obtain, process, and understand the basic health information that is needed to make appropriate healthcare decisions. Studies have shown that many adults in the United States have limited health literacy. This can lead to underuse of preventative services, worse self-management skills, and poor outcomes among patients with chronic diseases. “The role of health literacy in COPD and its effect on health status and outcomes have received relatively little attention in clinical studies,” says Theodore A. Omachi, MD, MBA. “Understanding the role of health literacy in COPD outcomes is critical to informing communication strategies in clinical settings and developing appropriate self-management support approaches.” Poor Health Literacy and COPD Outcomes In the Journal of General Internal Medicine, Dr. Omachi and colleagues had a study published that explored the links between poor health literacy and COPD-related health and outcomes in 277 patients with the disease. The analysis measured health literacy with a validated three-item questionnaire that can be incorporated readily into routine clinical practice: “How often do you have someone like a family member, friend, hospital or clinic worker, or caregiver help you read hospital materials?” “How often do you have problems learning about your medical condition because of difficulty understanding written information?” “How confident are you filling out medical forms by yourself?” Scores on the questionnaire were then tabulated to measure health literacy on a point scale ranging from 3 to 15. “It’s becoming increasingly clear that improving self-management is key to preventing poor outcomes in chronic diseases.” According to the study, lower health literacy scores were associated with worse outcomes, including...
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