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Living for Yourself, Prioritizing Your Needs

Living for Yourself, Prioritizing Your Needs

Research indicates that physicians tend to put the needs of their patients before their own. “We’re never taught that we’re allowed to put any of our own needs first, or even that it’s sometimes healthy to do so,” says Robb Hicks, MD. “Unfortunately, this perception often continues when physicians are developing and maintaining a practice because it requires being as available to patients as possible.” Understanding Priorities Dr. Hicks says that physicians must ensure that their own needs are being met in order to be the best providers for their patients. “That means that physicians must prioritize their time and energy,” he says. “This requires us to put some of our own needs before those of our patients.” Providers who are unable to find a work–life balance are likely to burn out and make mistakes. “While we shouldn’t put all our needs first, we must make daily efforts to maintain our own physical, mental, spiritual, and emotional health,” Dr. Hicks says. “The key is to figure out what things are truly needs, and which are simply desires.” Once there is an understanding of priorities in their life, physicians must notice when their thoughts or behaviors are not consistent with their priorities. “It’s important for physicians to recognize when they sacrifice time with their spouse or their children, or when they give up their routine activities because of work obligations,” says Dr. Hicks. “This is when their priorities have become confused or are out of sync.” Making Positive Changes Recognizing that changes are needed and making these changes are two different things, according to Dr. Hicks. “The inability to create...
New Guidelines for Hepatitis C Testing

New Guidelines for Hepatitis C Testing

In 2003, the CDC published recommendations on the laboratory testing and reporting of hepatitis C virus (HCV) infection. The guidance focused on testing for the HCV antibody, a marker of HCV exposure. Since 2003, several efficacious antiviral drugs have been approved by the FDA for the treatment of hepatitis C. “These newer drugs are increasingly being prescribed by physicians,” says Chong-Gee Teo, MD, PhD. “They offer patients the likelihood of a cure from hepatitis C.” Rapid testing for the HCV antibody with similar sensitivity and specificity to bench testing has also become widely available in the last decade. In addition, there has been increasing evidence that many patients who are reactive to an HCV antibody test are not then tested for current HCV infection. As a result of these developments, the CDC updated its guidance on HCV testing and published it in the Morbidity and Mortality Weekly Report. Targeted Testing “The current CDC guideline is geared toward identifying current infection with hepatitis C,” says Dr. Teo, who co-authored the document. “Rather than targeting the HCV antibody as a marker of infection, the target of testing is now the actual HCV genome itself, or HCV RNA. This is a marker of the virus in the blood and, therefore, current infection.” The concern with focusing testing only on the HCV antibody is that this approach cannot distinguish between patients whose past HCV infection has resolved and those who are currently infected. A reactive result to an HCV antibody test can also be a false-positive. Accurate testing of current infection through HCV RNA testing helps identify patients who require preventive services, counseling,...
Protocols Mean No One Has to Think

Protocols Mean No One Has to Think

Let me say up front that I do not object to protocols in principle. I have been responsible for the development of several protocols, both for trauma and for critical care. At their best, protocols serve as guidelines and memory aides prompting us to do the right thing to help and protect our patients. They can be powerful reminders and guides for those who don’t often deal with a particular problem, or conversely, may keep those of us for whom certain critical interventions are routine from becoming complacent. I do object to protocols that take the place of critical thinking, especially when that is coupled with an electronic medical record that forces the physician to follow a checklist. Recently, this was brought home during an episode at my primary hospital. My patient was a 59-year-old man who had under gone a laparoscopic assisted right colectomy. He was a two pack a day smoker and had some modest high blood pressure. He did well with surgery and the initial postop period. On day 3 however, he became hypoxic (low oxygen saturation in the blood), had some tachycardia (rapid heart rate) and had a little confusion. This was enough to trigger a “sepsis alert.” Severe sepsis is an inflammatory response to severe infection. It is an exaggerated expression of the fever and normal inflammation that accompany an infection. It can cause a cascade of low blood pressure, fever, poor tissue perfusion and acidosis leading to organ failure and death. The sepsis initiative is designed to improve outcomes by identifying patients with early sepsis and providing physicians with a standard set of...
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