Monday, December 30, 2013

Personal Reflection: When The Doctor Becomes the Patient

By Winnie Natu, MSIV
While on clinical rotations, I had the good fortune of meeting a wonderful doctor, teacher, and woman. During our time together she shared a personal story that has truly affected me and the way I view the doctor-patient relationship.  As a physician, Dr. X was well aware that her mother dying at the age of 45 of breast cancer meant more than dealing with the grief that accompanies losing a parent at a young age; it meant she herself may have an increased risk of the disease. She was tested for the BRCA gene mutations that are associated with a greatly increased risk of developing breast cancer. Her test came back positive for one of the genes and without hesitation she had a preventative double mastectomy.  
She recalls only half hearing what her own physicians told her about the risks of the procedure and that there was in fact a chance that she might not develop cancer and that if she did, other treatment options may be available at that time.  Of course she was thinking about her children and husband as a motivating factor for getting the surgery but often, she thought of her mother and what her life became in the last years of her life. Dr. X could not let go of the feeling of not wanting to be the patient. After years of being in control of her education and training and later her patients’ health, she could not give up the autonomy and authority that came with that. After years of fighting other people’s illnesses, she could not face that an illness would dictate her own life and so she saw no option but to take control as she had all her life with the mastectomy. 
We as doctors want our patients to leave their WebMD facts and preconceived notions at the door and follow our advice.  Can we do the same? An article on the ACP internist recently posted results of a study that posed clinical scenarios to randomized groups of physicians. Both outcomes involved a choice between surviving a fatal illness but with sometimes crippling outcomes. Physicians were randomized to groups in which they imagined themselves as the patient facing the decision, or in which they were recommending an option to a patient. “The hypothetical scenario involved two types of surgery for colon cancer. The first type of surgery cures colon cancer without any complications in 80% of patients, results in death within two years in 16%, and 1% a piece would experience a colostomy, chronic diarrhea, intermittent bowel obstruction or a wound infection. The second type of surgery cures 80% without complications, or results in 20% mortality within two years. Among 242 respondents, 37.8% chose the treatment with a higher death rate for themselves but only 24.5% recommended this treatment to a hypothetical patient”.
These and results of other studies like this tend to highlight the same concept for me: it is imperative to get to know your patient. Doctor, lawyer, teacher, home-maker: each comes with their own set of personality traits, priorities, social/financial circumstance, and personal experiences. Knowing these characteristics as a physician allows for providing individualized medical care that will tend to have the strongest compliance and best long-term outcomes for the patient.  Our job after all, is not to always carry out what we think is right but often what is right for each patient. Moreover, what Dr. X described: the unwillingness to give up control, the thought that “I know what is best for me”, fear of vulnerability etc. is not restricted to physician patients! It is important to remind ourselves that our patients, regardless of profession, have at least some of these feelings every time they come to us and that it is a great privilege that we are entrusted with their care.

Friday, December 27, 2013

TGIF Quote of the Week

This is the last Friday in 2013! Hope everyone is able to make it a great one!
Here is the quote if the week:

"It always seems impossible until it’s done."
                            - Nelson Mandela

Think back...what did you do in 2013 that you thought was impossible? Keep on accomplishing the impossible as impossible things are happening everyday! 

Have a great weekend! 

Monday, December 23, 2013

Healthy Holidays!!

While the winter holiday season can be the most magical time of the year, it is also a time when many engage in not-so healthy behaviors. Large amounts of holiday treats, stress over holiday spending and being in large groups as cold and flu season hits can all have a negative effect on your health. The CDC has created a fun holiday song called "The Twelve Ways to Health" , providing a great way to remember all the things we sometimes forget in the rush of the holiday season. On the CDC's page, along with the lyrics, are resources to learn more about every topic are provided. Take some time to sing along and get information about a topic you may want to know more about. When you make the holidays healthy, the happiness come naturally!

Friday, December 20, 2013

TGIF Quote of the week!

Happy Friday everyone! Have a relaxing weekend! hopefully you are or soon will be having a holiday break! Here is our quote of the week, which is especially good for this time of year. While many are looking for holiday cheer; the stress of shopping, cooking and get-togethers can make people the opposite of what you would expect from this time of the year: 

A healthy attitude is contagious but don't wait to catch it from others. Be a carrier.-Tom Stoppard 

Choose the healthy many be the one to spread it!

Monday, December 16, 2013

Rheumatoid arthritis

By Justine Shum, MSIV

Rheumatoid arthritis (RA) is an autoimmune disease that most commonly presents as an inflammatory arthritis affecting the joints. Like many other autoimmune diseases, RA affects more women than men -- about 3x as many women have the disease.

RA is a chronic disease that cannot be cured, but there are now many medications that are effective in reducing symptoms and slowing the progression of the disease. These medications are classified as disease-modifying antirheumatic drugs (DMARDs), and can further be separated into conventional DMARDs such as methotrexate and sulfasalazine, and biologic DMARDs such as rituximab and adalimumab. Because of DMARD use, the severe RA that results in crippling joint deformities is fortunately becoming more rare.

Current recommendations call for treatment with DMARDs to begin once a diagnosis of RA is made. Many patients wish to delay treatment, however, recent studies have shown that early and immediate treatment of RA results in lower disease activity in patients. These studies also show that at 2 years following diagnosis, patients who received immediate treatment were less likely to have joint damage and resultant disability.

Patient education of the disease course of rheumatoid arthritis and the consequences of delaying treatment will likely make the difference in patients who are wavering on initiating DMARDs. See the links below for some basic patient education material provided by the American College of Rheumatology.


Wednesday, December 11, 2013

"Good" and "Difficult" Patients

Whether you work in healthcare, have been in the healthcare system or simply watch medical dramas on TV, many are aware of the concept of "good" and "difficult" patients. "Good" patients are simply compliant with what is happening to them, low maintenance and an have an agreeable family. "Difficult" patients may ask too many questions, insist that they need immediate care or suggest things that their providers do not agree with. The article "Good" Patients and "Difficult" Patients - Rethinking our Definitions, by Louise Aronson, M.D. Challenges these images that are bestowed on patients and families by sharing a personal sorry about an experience with her elderly father. This is a great read for physicians and patients alike. Check it out by clicking the link below!

Thursday, December 5, 2013

Wanna Get Away? - Great Exhibit in D.C.

Going to the D.C. area or wanting to plan a trip there? We have one reason you may want to get there soon! The National Geographic Museum is now hosting the exhibit, Women Of Vision, that features the works of 11 female photojournalists, whose amazing photos capture modern realities and what is means to be a human in the 21st century. 

Visit the Women of Vision Exhibit webpage  to learn more. It will be open until March 9th. Make sure to plan your next trip to D.C. around this great exhibit! 

Monday, December 2, 2013

IUDs: Myth Busters and Facts

By: Winnie Natu, MSIV

The intrauterine device (IUD) is a small plastic device that is inserted into the uterus and is one of the safest and most effective forms of reversible birth control for women. Currently there are two major options on the market: Mirena, a progestin-releasing IUD and ParaGard, a plastic T-shaped device partially wrapped in copper wire. 

Despite its safety, efficacy, and benefits, the US has one of the lowest rates of IUD use worldwide. The purpose of this blog is to resolve some common misconceptions about IUDs and to answer questions that several women, like you, may have!

Case 1: A 28- year-old female with no past medical history comes in to discuss her options for birth control. She is currently in a monogamous relationship with her boyfriend and uses Loestrin Fe for contraception. She does a lot of travelling for work and is inconvenienced by having to take a daily pill. She does not want to have children in the near future but definitely wants to have a family someday. She has heard about IUDs but is worried that getting one might prevent her from ever having children.

This is a common misconception however an IUD is a completely reversible contraceptive device: it begins working as soon as it is fitted and stops as soon as it is removed with no effect on future fertility.

Case 2: A 20-year-old college student comes in for concerns with her current birth control pills. She is experiencing spotting between periods and often forgets to take her daily pill. She has had 3 sexual partners in the past 6 months and uses condoms occasionally. She has never been pregnant or had an STI but is concerned about the possibility of both and wants more information about her contraceptive options. When you mention an IUD she says she doesn’t want that because it increases the risk of something called pelvic inflammatory disease.

The World Health Organization has done multiple studies that all conclude the same thing: overall, women using an IUD have no increased risk of pelvic infection or infertility compared with women who used other types of birth control. In fact, Mirena acts to thicken cervical mucus and suppress or reduce endometrial bleeding and may offer some protection against an already low risk of PID. However it is important to remember than neither an IUD nor birth control pills protect against STIs! Only barrier contraceptives such as condoms can achieve this. This young woman should be screened for STIs and have a pregnancy test and if negative, she would be a candidate for an IUD.

Case 3: A 39-year-old woman that has given birth to her second child 3 months ago is interested in long term but reversible birth control. She has heard about an IUD but is worried that it wont be as effective as the birth control pills she has used in the past.

A new study on perception of birth control has concluded that it's not clear whether women have an overly optimistic view of the effectiveness of the birth control pill or an overly pessimistic view of the IUD. However, the fact is that IUDs can be left implanted for years, and are more than 99% effective at preventing pregnancy. In contrast, the birth control pill has been found in real-world practice to be about 95% effective.

The Facts: 
IUDs are an excellent choice of contraception for women who are seeking a long-term and effective birth control method, particularly those wishing to avoid risks and side effects of contraceptive hormones.

  The progestin-releasing Mirena is now considered to be one of the best options for treating heavy menstrual bleeding

 The copper-releasing IUDs do not have hormonal side effects and may help protect against endometrial (uterine) cancer.

 Certain women may be poor candidates for IUDs including women with current or recent history of pelvic infection, women that may be currently pregnant, have had a recent abnormal Pap smear, have or have a history of untreated cervical or uterine cancer, and women with an anatomically abnormal uterus that is very small or large.
Please ask your doctor for information about IUD placement and review the following links for learning more about IUDs!