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Mental Health in Youths With HIV

Mental Health in Youths With HIV

Previous research has linked poor mental health among people living with HIV to a greater likelihood of participating in risky behaviors. “Untreated mental illnesses can be detrimental to the health and well-being of younger patients with HIV and may place others at risk for being infected with the virus,” says Laura B. Whiteley, MD. Exploring Disparities Few studies have explored disparities in the receipt of mental healthcare among adolescents and young adults living with HIV. To address this issue, Dr. Whiteley and colleagues had a study published in the Journal of the International Association of Providers of AIDS Care. The researchers conducted a cross-sectional survey of 1,706 HIV-infected adolescents and young adults aged 13 to 26 who were engaged in care. According to findings, there was a significant disparity in mental healthcare utilization for psychiatrically symptomatic African-American adolescents and young adults living with HIV. “African-American youth with psychiatric symptoms were significantly less likely than non-African Americans to have received mental healthcare and psychiatric medications,” says Dr. Whiteley. Conversely, Latinos were more likely than non-Latinos to report receiving mental healthcare. The lack of disparity also extended to sexual minorities and impoverished or homeless youth and young adults. Targeting Efforts Information from the study may help clinicians target efforts to overcome barriers for managing this specific patient population. “More initiatives to engage African-American youth and young adults who are receiving medical care could be needed,” Dr. Whiteley says. She adds that efforts should be made within all HIV treatment sites to reduce disparities for minority patients. The focus of these efforts should be toward educating parents, patients, and providers about common...
Surrogate Decision Making for Older Hospitalized Adults

Surrogate Decision Making for Older Hospitalized Adults

The aging population has led to a greater number of older adults being hospitalized with various conditions, but many of these individuals have impaired cognition. “These patients often face major decisions about their medical care at a time when they can’t communicate their preferences or have trouble with decision making,” explains Alexia M. Torke, MD. Surrogate decision makers can be used when patients are unable to make their own medical decisions. These individuals are often close family members or friends who, in some cases, have been chosen by the patient as a healthcare power of attorney. “The presence of surrogates requires fundamental changes in the way that clinicians communicate and make decisions,” Dr. Torke says. Much of the research on surrogates has focused on how accurately they make decisions based on hypothetical situations or has looked at the burden and distress experienced by surrogates. Few studies, however, have assessed how often surrogates are called upon to make decisions. Research is also lacking on the types of decisions surrogates must make. Taking a Closer Look In a study published in JAMA Internal Medicine, Dr. Torke and colleagues described the scope of surrogate decision making, the hospital course, and outcomes for adults aged 65 and older in a prospective, observational analysis. The study was conducted in medicine and medical ICU services of two hospitals and involved 1,083 patients who were identified by their physicians as requiring major medical decisions. “Our goal was to better understand the issues facing surrogates,” says Dr. Torke. This data may help redesign hospital care so that clinicians can more effectively fulfill the needs of aging patients...

What’s the Point of Medical Licensing?

A surgeon emailed me the following:. OK, I know this is radical but consider my argument… Medical licensing protects no one and costs physicians hundreds to thousands of dollars each year. If a physician is negligent, can the injured party sue the state that licensed him? I’m guessing not. When I moved to my current location, I had to send lots of documentation to the state medical board so they could verify that I was a true and competent surgeon. I provided my employer with the same info so they could also verify my credentials. Now my employer can and will get sued if I commit a negligent act and absolutely should verify my credentials prior to handing me a scalpel. But the state? Its license is useless. Most people choose a surgeon based on recommendations and word-of-mouth reputation, and these are by far better indicators of quality than any credentialing board. Nobody asks to see my license, and, even if they did, it would not protect them any more than their trust in the health system in which I work. If I was in private practice and had my license displayed on my wall, it may give some reassurance to my patients, but it does not say anything about the quality of my work. Most doctors who really screw up due to negligence are licensed by the state. I contend again, that word of mouth and reputation are the best indicators of a surgeon’s ability, anything beyond that is useless. Caveat emptor, “let the buyer beware” remains the mantra of the informed consumer. Thanks for letting me vent....
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