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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...
A Look at Anaphylaxis in America

A Look at Anaphylaxis in America

Anaphylaxis is an acute, life-threating condition that typically requires an ED visit, a prescription for medication, and physician follow-up. However, data regarding the prevalence of anaphylaxis in the United States are limited and vary widely. To help shed light on the state of anaphylaxis, Robert A. Wood, MD, and colleagues conducted random telephone surveys among the general U.S. adult population between July and November 2011. Results were published in the Journal of Allergy and Clinical Immunology. Using a stringent definition, the research team found that 1.6% of survey respondents “very likely” had anaphylaxis and that 5.1% had “probable” anaphylaxis. “Anaphylaxis is clearly a common condition, perhaps more than what has been estimated in prior surveys,” says Dr. Wood. “Furthermore, anaphylaxis is common among all age groups. It has been previously thought to be a pediatric problem, but our surveys focused entirely on adults. Healthcare providers will encounter anaphylaxis on a regular basis, and therefore should be inquiring about it while taking initial or integral medical histories.” Key Findings Beyond determining the prevalence of anaphylaxis, the researchers sought to gather information on the symptoms and triggers of anaphylactic reactions as well as how patients reacted to episodes in terms of accessing healthcare and using medications. After conducting a survey of the general population (public survey), a second survey was conducted targeting a higher-risk population of subjects with a history of allergic reactions (patient survey). “The symptoms typically thought to accompany anaphylaxis, such as skin reactions and respiratory issues, were indeed the most common among both groups,” says Dr. Wood (Figure). “Other common symptoms involved the gastrointestinal, cardiovascular, and neurologic systems....

How Surveys Mislead

Do you believe that traditional hospitals will be obsolete in the future? A recent survey found that 57% of those polled believed that would happen. The survey, sponsored by the Intel Corporation, involved 12,000 subjects from the United States and seven other countries around the world. Here are some other revelations from that survey: 84% said they would be willing to share their personal health information to advance and lower costs in the healthcare system. 70% said they were receptive to using toilet sensors, prescription bottle sensors, and swallowed health monitors. 53% said they would trust a test they personally administered as much or more than if that same test was performed by a doctor. My favorite response was that 30% of people would trust themselves to perform their own ultrasounds. That made me laugh. Ultrasonography is one of the most operator-dependent tests in use today. It is not easy to perform, nor is it easy to interpret. I then began to wonder about the credibility of this survey. Before I retired, I practiced in a typical small town in the northeastern United States. Some patients Googled me, and a few searched the Internet for information about their illnesses. But for the most part, it was a technologically unsophisticated population. I just can’t envision most of my patients wanting to share their personal health information, using toilet sensors, or trusting tests they did at home. Do their own ultrasounds? Not likely. Many of them did not even know what medications they were on. After rereading the article about the survey, it occurred to me that the sample may have...
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