What doctors won't do

There was an interesting article in UK Guardian Newspaper on Saturday http://www.guardian.co.uk/lifeandstyle/2013/jan/19/what-doctors-wont-do?INTCMP=SRCH
It's not a scientific article, but a collection of comments form British healthcare professionals about what medical treatments they would avoid or not do. It's quite a revealing and should make us reflect on why patients are reluctant and don't "adhere" in the way that are supposed too. Interestingly, and appropriately, there are contradictions between the respondents. Our healthcare professionals as patients is a subject that we need to know more about.

Is experience important?

On the subject of prescriptions, the answer might be NO? BMJ OPEN has an interesting paper on prescription errors in UK hospitals [http://bmjopen.bmj.com/content/3/1/e002036.full.pdf+html]. Of 4238 prescriptions evaluated, one or more error was observed in 1857 (43.8%) prescriptions. Of these, 1264 (41.9%) were minor, 1629 (54.1%) were significant, 109 (3.6%) were serious and 9 (0.30%) were potentially life threatening. It shouldn’t be terribly surprising that such errors can happen, but what was surprising was the fact that grade was not a significant predictor of errors being made. The paper contains lots of information about the factors influencing errors (e.g., number of medications), but the question as to why prescriber experience does not seem to be important is not fully explored. It sounds like this could be a great PhD these for a cognitive psychologist. 

Do Doc’s falsify research results?

The BMJ has an excellent short article on the issue BMJ 2012;344:e2898 doi: 10.1136/bmj.e2898. The answer seems to be yes, but the degree to which data manipulation takes place is hotly disputed. Given the pressure on physicians to publish their work, I suppose it’s not so surprising that some medics have been observed cooking their data. It would be naive to think this problem is confined to medicine. However, it’s “reassuring” to see that physicians are as human as the rest of the scientific community. There will be a tendency to view it as an individual problem (i.e., a few rotten apples in the barrel), but it might be more interesting to ask what organisational elements combine to make research misconduct appealing?

Physicians and Euthanasia

A recent paper in the journal Bioethics [doi:10.1111/j.1467-8519.2012.01968.x] looks at differences between psychiatrists and physicians with regard to euthanasia. When controlled for religious practice, psychiatrists expressed more conservative views regarding euthanasia than did physicians from other medical specialties. The authors of the research conclude that the study shows that psychiatrists are well suited to take a prominent role in evaluating such requests to die and making a decision as to the relative importance of competing variables. There is no doubt that this issue is an ethical minefield and one which is sure to exercise energy on both sides of the argument. It goes to very heart of what we consider to be reasonable suffering and pain.

UK doc’s rate hospitals poorly

A new survey from the Royal College of Physicians (RCP) found that over a quarter (28%) of consultant physicians surveyed rate their hospital’s ability to deliver continuity of care as poor or very poor. In addition, over a quarter (27%) believe that their hospital is poor or very poor at delivering stable medical teams for patient care and education.

See: http://www.rcplondon.ac.uk/press-releases/quarter-physicians-say-continuity-care-poor-their-hospital

The RCP website doesn’t provide much information regarding the survey, but its shame that we don’t know more about why physicians rate so their hospitals so badly. Is it the organisational culture or the psychological contract?  Are the reasons more related to  objective or subjective factors? 

Should doctors and nurses be taught to smile for patients?

The answer seems to be a big NO, according to a recent newspaper report http://www.dailymail.co.uk/news/article-2112712/Health-chiefs-blow-10k-telling-staff-SMILE-often.html
According to the newspaper report, the staff felt that the Active Caring for Everyone (ACE) scheme was patronizing. Staff were encouraged to show 'ACE cards' to staff that weren't smiling at patients. The newspaper report doesn't provide too much detail, but is sounds as though the scheme had a 'pop-psychology' feel about it. Indeed, the reaction of the staff may be an interesting example of extreme emotional labour.

Should doctors share their notes with patients?

The answer seems to be yes for patients, but no for some doctors, according to a recent study in the Annals of Internal Medicine [Ann Intern Med. 2011;155:811-819]. The most interesting part of the study was the fact that patients expressed considerable enthusiasm and few fears about sharing notes. However doctors who had declined to participate in the pilot worried about frightening and confusing patients; recording their thoughts candidly; and writing about such issues as mental health, substance abuse, cancer, and obesity. The sample in the study was US primary health care physicians.