Drinking And Driving: 20 Years In Retrospect

A gripping piece by the Transport Accident Commission (TAC) in Victoria about?? drinking and driving and the use of illicit drugs. Words cannot depict this powerful and graphic piece. Take a look:

TAC Campaign: 20-Year Anniversary Retrospective Montage a??Everybody Hurtsa??

a??On December 10, 1989 the first TAC commercial went to air.??That year the road toll was 776. Twenty years on it has fallen to 303.??There is still a long way to go.a??

You’ll find more TAC Victoria videos HERE.

Your turn

We would love to hear from you.??Did this video move you in any way???Did it increase your awareness? We would love for you to share your insightful thoughts. As always, thank you for your time.

                       

Monitor Your Heart Rate With Your iPhone Headphones

Imagine jogging, listening to music, and being able to keep track of your heart rate without needing a special watch or chest belt — common forms of attempting to monitor heart rates while jogging. Now, imagine not requiring any extra peripherals at all — just your iPhone and a special set of headphones that can monitor your heart rate.

Swiss technology-transfer company CSEM has created the final prototype for their Pulsear device. Ita??s a tiny device embedded in a regular earphone and it sends infrared signals through the tissues in your ear to see how fast your heart is beating. A photo diode records the results and sends the information to your phone via the earphone wires.

Accuracy is paramount. The special earphones had to pass through the scrutiny of the European Space Agency (ESA), who they were originally designed for. The ESA wanted a non-obtrusive device for recording physiological data of astronauts. The resulting research was used to make the prototype device that can be connected to the iPhone and then data recorded using an app. Researchers are now working on giving the earphones the ability to measure O2 levels as well.

Their goal is to create a device that is non-obtrusive and can passively measure vital signs in real time via mobile form.??The vital sign recording earphones will be marketed not only for medical research, but for runners and hikers as well.

How accurate the device is will determine ita??s use and based on the device passing the ESAa??s standards, it seems this is of no concern.??These types of earphones would be a huge hit??commercially??since the two main methods used for tracking heart rate while jogging are with a chest strap or by a watch — both not ideal. The chest strap is accurate, but cumbersome, while watches can often not be as accurate.

From a research perspective, if the creators are able to add the ability to measure pulse ox,the device would have huge research implications. Adding the ability to measure o2 levels shouldna??t be difficult since similar infrared signal technology is used.??The ability to take measures of pulse ox and heart rate in real time and passively would be huge for those with respiratory issues or if researching pulmonary pharmacotherapies.

Source: European Space Agency

                       

Sharing Your Health Issues: The Responsibility Of Survivorship

This past weekend Oscar-nominated Hollywood and Broadway actress Jill Clayburgh died at age 66. The cause was chronic lymphocytic leukemia (CLL), which she had been fighting, privately, for 21 years.

As you may recall, I, too, have CLL and I was diagnosed at the same age, 45. For me, I am 16 and a half years into that a??battlea?? although, fortunately, I have been feeling very good in the ten years since I received treatment as part of a breakthrough clinical trial. While I have no symptoms and take no medicine I do not consider myself cured.

So when someone like Ms. Clayburgh dies of CLL after 21 years, I cana??t help but wonder if the disease will shorten my life too, even if I feel good now. That brings up the question of what do we do with the time we have when we know we have had a serious diagnosis and the clock may be ticking for us — or not?

In the notice of Ms. Clayburgha??s death it said she dealt with the disease privately. In my case, if you have ever come across my writings or interviews before you know I take the opposite approach. I am VERY public about my health in an effort to mentor others. I actually see it as my responsibility.

No one wants a serious diagnosis. But if you can beat it, or perhaps in my case, beat it back, can your reprieve or cure give you the chance to inspire others and to bring them helpful information? And if you are a celebrity is that part of the job? Some of it can be just with your actions. Patrick Swayze did that by starring in a television series even in his final days with pancreatic cancer. But, sadly, some other celebrities have used their illness or even a distant relativea??s as a way to make more money. These are not the actors who appear for a charity. These are usually the celebrities in medical product commercials.

On the one hand, I am glad they have a??gone public.a?? On the other, I think the effort should be selfless.

But you dona??t have to be a celebrity to make a difference by speaking out. For example, if someone is diagnosed with colon cancer, cana??t they make a difference by urging their friends to be screened. Now, with the latest news about the benefit of CT scans to detect early lung cancer, our biggest cancer killer and our second biggest killer overall (after heart disease), could a lung cancer survivor or family member of a current or former patient urge current or former heavy smokers to be screened? This could easily save a life.

Personally, I am very glad people are more apt these days to share their health issues. It is much less private than it used to be. However, I believe that sharing can be more for a purpose — to inform, inspire and empower others. I respect that Ms. Clayburgh didna??t feel comfortable doing that, as best we know. I wish she had, because in CLL, just the fact that she had continued acting would have given comfort to many people I know who are stopped in their tracks by the diagnosis.

So do we patients have a responsibility to others? I say, “yes.” What do you say?

By the way, I now have hosted more than 2,000 interview programs. You can find them by going to any search engine and typing in your health topic + patient power. Tell a friend!

Wishing you and your family the best of health,

Andrew

                       

Male Laptop Users: Beware Of An Overheated “Lap”

Male readers be advised! Using your laptop placed on your knees to read this post may cause your testicles to heat up quite significantly. However surprisingly, this is not due to the heat dissipated by many laptops, but rather due to the positioning of the legs. A study just published online in the journal Fertility and Sterility investigated ways to avoid the testicles from overheating while using a laptop computer.

Right and left scrotal temperatures were measured in 29 volunteers while working on the laptop in different positions: With closely approximated legs, with closely approximated legs with a lap pad below the laptop, and sitting with legs apart at a 70?° angle with a lap pad below the laptop. After 60 minutes with closed legs, temperature increased about 2.4 degrees Celsius, using the lap pad yielded a slightly smaller increase of 2.1 degrees, while spreading the legs resulted in a modest increase of 1.4 degrees.

The authors conclude that prevention of scrotal hyperthermia in laptop users is not feasible, although we would like to disagree and suggest using a flat surface, such as a table or desk, to position your laptop in order to preserve your fertility.

Article abstract: Protection from scrotal hyperthermia in laptop computer users…

Image credit: Pitel…

                       

5 Tips On How To Be A Healthcare Survivalist

There are plenty of a??survivalistsa?? out there who stock their basements with canned goods, getting ready for some unexpected (and unlikely) apocalypse. Meanwhile there are things that are much more likely to happen to you — like getting sick — which many of us dona??t prepare for at all. So to help you get started, here are five important tips on how you can become a healthcare survivalist:

1.?? Take care of your chronic conditions. Whether ita??s high blood pressure, diabetes, high cholesterol, depression, asthma or any other kind of ailment, do what it takes to manage your own care.??Take your medications and follow your doctorsa?? instructions.??Why? Because if you dona??t, your condition can get worse and lead to even more serious problems.??As much of a pain as it may (literally) be, therea??s a reason the old saying a??an ounce of preventiona?? still resonates today — because ita??s true.

2.?? Live a healthy lifestyle. Everyone gives you this advice, but with studies showing that 42% of Americans will be obese by 2050, it doesna??t seem to be getting through.??Denial can wonderfully appealing;?? but when it comes to your health, it can also kill you.??Stop smoking, exercise, and eat right.??You may find that your employer has programs in place that will help you do all of those things, and many of them work. Why not give one of them a try???You cana??t improve your life all at once, but you can start.??Your life will be happier if you keep yourself healthy.??So rather than whistling past the graveyard, jog past it.

3. Make sure you are well-insured. You may not have the greatest insurance plan through your job, but there are things you can do to protect yourself on your own. For example, most insurance doesna??t pay the full cost of long term care.??This is the kind of care you might need if you end up needing home nursing care or have to live in an assisted living facility.??That can be very costly.??You should buy long-term care insurance to cover these expenses and serve as a cornerstone of your health care survival plan.??Studies show that 60% of seniors will need long-term care at some point in their lives — and Medicare doesna??t cover it.??Oh, and ita??s not just a problem of the elderly.??About 40% of people getting long-term care are between 18 and 64.

There are other kinds of insurance you can buy, too, depending on the state in which you live.??These might be plans that supplement your health coverage, or cover other expenses of illness.??The best advice:?? Research your options, find an insurance broker you trust, and figure out a plan that helps protect you from the financial toll of illness.??Also keep in mind that your employer may offer, on a voluntary basis, a number of these kinds of programs at cheap prices — check them out and see if they make sense for you.

4.?? Know your family history. Ita??s a little hard to believe in the 21st century, but it turns out that an old-fashioned knowledge of your familya??s medical history can be some of your best protection.??It can help your doctor know whether you have a higher risk for certain illnesses.??And it can also help him or her know whether that symptom youa??re complaining about is a sign of something other than what it seems to be.??A surprising study recently showed that a family history can be better than even genetic testing at predicting your likelihood of disease.????The Surgeon General has a neat tool that can help you get started. The more you know about your familya??s medical past, the better off you and your doctors will be in your medical future.

5.?? Ask Questions. No matter how well you prepare and try to protect yourself, at some point you may still end up seriously ill. Hopefully, if youa??ve taken good care of yourself and have all of your information in order, youa??ve put yourself in the best position to make it through.??But therea??s still so much more you can and should do.??The world is full of well-intentioned, highly skilled, and hardworking doctors.??The trouble is, they work in a system that makes it very difficult for them to do their jobs.??So, ask questions, and use every resource available to you to make sure youa??re getting the right medical care.

                       

HRT And Breast Cancer: The Confusion And Debate Continue

A new analysis of long-term data from the Womena??s Health Initiative confirms what we already knew the first time around: Use of combination hormone replacement (HRT*) is associated with a small, but real, risk of breast cancer. This new 11-year followup data carries that knowledge out to its not unexpected conclusion — namely, that some (although not most) breast cancers can be fatal, and therefore the the use of HRT can increase breast cancer mortality.

While it may seem a bit of a a??duh,a?? this study was, in fact, necessary to quell the WHI critics who continued to argue that the breast cancers caused by HRT were somehow less aggressive than those occurring off HRT (which they are not.) It was also a wake-up call for many women who were continuing to use HRT and thinking that somehow its risks did not apply to them. A fair number of these women appear to be coming off of HRT, at least in my practice. Others are staying the course and accepting the risks as they have been defined. Either of which is fine with me.

The spin going on around this study — both for and against HRT use — is tremendous and ultimately confusing to women. The pro-HRT crowd (some of whom have relationships to Pharma) is using language like: a??The increased risk from using HRT for??five years is the same as if your menopause occurred??five years later,a?? which is technically true, but so what? ??The bioidentical hormone crowd (usually also selling the same) are using the study to further hype how their regimens are safer than the evil Big Pharma products — based on no data. Which leaves the rest of us to try to find ways to help our patients understand the risks, place them into perspective for themselves, and make a decision about how and if to treat their menopausal symptoms.

While the breast cancer risks associated with HRT use appear to be quite real, for a individual woman they are not that large. Herea??s how I explain the risks to my patients:

There will be??seven extra cases of breast cancer and 1.3 additional breast cancer deaths for every 10,000 women per year who use??HRT. Said another way, if you use HRT for 20 years, your risk of getting breast cancer will be increased by 1.4??percent??and your chance of dying from breast cancer will be increased by about a quarter of a percent. If you use HRT for less than 20 years, we can cut those numbers down accordingly.**

If you dona??t already know it, I do have??my own set of??rules for prescribing HRT. This??new data has not changed them.

_______________________________________________________________

* HRT means estrogen and progesterone taken together, as opposed to ERT, or estrogen alone. In the WHI, ERT use was actually associated with a lower rate of breast cancer, a finding unique to this study that begs for replication before we can bless ERT as breast-safe.

** The formula I used for cumulative risk is CR = 1 a?? e-IR*t ,where CR = cumulative risk, IR is the annual incidence and t is the number of years (in this case 20). If any statistician types reading this can confirm my methodology or numbers Ia??d appreciate it.

Graph above from JAMA. 2010;304(15):1684-1692.

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Heart Smarts

From the American Heart Association’s “Scientific Sessions 2010” in Chicago (November 13-17):

Chicago Heart Smarts from Patient Power?? on Vimeo.

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Pregnancy After 45: A High-Risk Dilemma

As more older women attempt to beat the biological clock and conceive, they are at greater risk for developing birth-related complications. For women over 45, there is less than a 1 percent??chance of getting pregnant using their own eggs. Successful pregnancy for women over 45 is nearly always the result of in-vitro fertilization (IVF)??and the use of an egg donor.

Researchers at Tel Aviv University reviewed birth records from 2000 to 2008, specifically looking at the records of 177 women who gave birth at the age of 45 and beyond. The majority of the women had IVF and??received donor eggs, and 80 percent of the babies were delivered via cesarean section (C-section).

Despite their celebrity, Kelly Presley (age 47), Celine Dion (age 42), and Mariah Carey (age 40), are older pregnant women who are at risk. The premature birth of Celine Diona??s twin sons did not surprise me at all. Women over 35, and especially those over 45 with underlying medical problems, should be treated prior to becoming pregnant. I cannot emphasize this enough.

I will never forget the face of a 45-year-old pregnant hospital worker who expired during birth. She was not my patient, but I would frequently see her delivering mail in the hospital. She unfortunately expired from underlying hypertension (high blood pressure)??that was not properly treated, and for some reason her death affected me personally.

The risks of pregnancy-related deaths are sharply elevated for women 45 and older. Women who have heart disease should see their internists or cardiologists for a pre-pregnancy consultation prior to becoming pregnant. The heart system undergoes a tremendous amount of change during pregnancy that includes an increase in the circulating volume of blood both in the body and in the heart, as well as an increase in its heart rate.

Older pregnant women have the highest mortality rate. Older Caucasian women typically die from hemorrhage, an enlarged heart from pregnancy (cardiomyopathy), or a blood clot. Older pregnant African American women usually die from hypertensive disorders of pregnancy, stroke, infection, or other medical conditions.

If you are a pregnant woman who is 45 and older, please seek the medical expertise from a maternal-fetal specialist, preferably one thata??s affiliated with a teaching hospital. Your best defense is a good offense. Despite potential complications, with the guiding hands of obstetrical experts, your pregnancy should be fine.

Image credit:??PregnantHollywood.com

“Picture Your Diet” With PhotoCalorie

Although I can check the calorie content of any food on WolframAlpha, ita??s good to have a site??that focuses only on this issue:

PhotoCalorie is an application inspired by the ideas of Dr. Mark Boguski of Harvard Medical School, who realized that the current methods available to track your daily nutrient intake are monotonous and simply too complicated.?? As a result, people would lose interest in tracking their diet or stop the diet all together. Our mission is to create the easiest food journal on the planet to help dieters lose weight and monitor their diet with ease.

                       

Taking The Mystery Out Of Clinical Trials

About 10 days ago I appeared in Phoenix as a speaker at a regional education seminar put on by the Leukemia and Lymphoma Society. My topic was sharing my experience as a participant in a clinical trial. I was delighted to do so, as I feel that trial saved my life and restored me to good health.

I am hoping my words encouraged others to consider being in a trial. There are no guarantees of the result, but trials are always worth considering. Unfortunately, few patients do. That may limit their choices and certainly holds back research that could help others. What a shame.

Clinical trials are defined as human subject research.??It is through these trials that we determine if new drugs or devices can better serve patients than what is currently available.??Clinical trials are available for almost every disease — although finding these trials can be challenging.

An acquaintance of mine in Seattle named Ryan Luce has just launched a new website to help type 2 diabetes patients understand which clinical trials might be appropriate for them.??While there are almost 400 ongoing type 2 diabetes trials in the United States, each of these has additional requirements for enrolling.??These requirements might include specific medications, current blood sugar ranges, body mass index, and others.??The new website, www.corengi.com, asks some simple questions to each type 2 diabetes patient — and determines which trials might be an option.??It then organizes these options by how close they are to your home.

This is the kind of tool that I am hoping will roll out in many conditions. Leta??s make it easier for all of us to learn about what trials there are for us, whether they are convenient, and whata??s required. That goes beyond the best known site, www.clinicaltrials.gov, which is helpful but Ryana??s effort makes this much more user-friendly. Diabetes is a great start given that ita??s an epidemic in the U.S. and the odds are you know someone who has it??or will soon.

One other note: As patients, we also need to bring up the topic of clinical trials at almost every visit with our doctor if we have an ongoing condition. Whata??s new? Whata??s being studied? Could a trial nearby or even at a distance be right for me? Typically, doctors never talk about this unless ita??s their own trial. But we should bring it up. Ryana??s website, starting in diabetes, can give patients the power to learn more and, hopefully, consider enrolling in a trial.

I welcome your comments on why so few of us enter trials and how we can change that. In Europe they do MUCH better. Why are we so different?

Click HERE??for links to programs I have hosted about clinical trials, especially in cancer. More programs are coming soon, including one about trials for advanced breast cancer.

Wishing you and your family the best of health,

Andrew

                       

Medicine And The Internet: 2000 Vs. 2010

Whenever I talk to doctors??about using social media in medicine, they seem to think there are more cons than pros regarding this issue. I like reminding them about some major differences between 2000 and today:

What would I do if…	In 2000	Today
I need clinical answer	Try to find a collegue who knows it	Post a question on Twitter
I want to hear patient story about a specific condition	Try to find a patient in my town	Read blogs, watch YouTube
I want to be up-to-date	Go to the library once a week	Use RSS and follow hundreds of journals
I want to work on a manuscript with my team	We gather around the table	Use Google Docs without geographical limits

Here’s what WebMD looked like in 2000 and what it looks like now:??

WebMD in 2000??

WebMD today??

The same for the website of the British Medical Journal:??

BMJ in 2000??

BMJ today??

CNN:??

CNN in 2002??

CNN today??

Sermo, the physician network:??

Sermo in 2006??

Sermo today??

Healthline:??

Healthline in 2000??

Healthline today??

Mayo Clinic:??

Mayo Clinic in 2000??

Mayo Clinic today??

There’s a long road behind us, and just imagine how these services will look like in 10 years time. Which means there’s an even longer road ahead of us. We must keep working hard to design better healthcare and to implement more efficient communication channels in medicine.

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5 Tips For Diagnosing Yourself Online

“Whata??s the highest peak in North America, Mt. McKinley or Denali?” This is a great question the Web can answer for you. a??What’s that lump on my neck?a???? This is another great question — but not one you should rely on the Web to solve.

Best Doctors recently conducted a Twitter-based poll to find out what channels of information people use to get healthcare advice.?? It turns out, 54 percent??of respondents use the Web as their primary source of information. Is this kind of do-it-yourself medicine a good idea?

Ia??m a firm believer that you should do everything you can to make sure youa??re getting the right care when youa??re sick.??But before you start your do-it-yourself journey, here are five things to keep in mind:

1. To get the right answer, you need to ask?? the right questions. If you decide that that lump on your neck is a sign of lymphoma, youa??re going to get very worried and start researching everything you can on lymphoma.??You may see your doctor and when he tells you ita??s actually a benign cyst, youa??re going to have a hard time believing him.??Now, your skepticism is a good thing, but before you start driving yourself crazy with serious conclusions, make sure you have your facts straight.

2. Consider the source. Is what youa??re reading written or sponsored by a company with its own agenda???If there are links to other information, who wrote that information???Is the article youa??re reading quoting an unknown medical journal article about a study on four people???As in every age, there are snake oil salesmen, and the Internet has many of them plying their trade. Dona??t assume that just because ita??s on the Internet ita??s true.

3. No health information on the Web is going to be about you. Sure, you can find lots of detailed, highly educational information, but whatever youa??re reading doesna??t take into account your specific circumstances, your medical history, your familya??s medical history.??Sometimes these can be the most important factors of all.??Use what you read to help you learn more about your condition, but remember: the most important information of all is about you.

4. Make sure what youa??ve got fresh information.??Medical science is constantly advancing, and so information that is even a year old may be terribly out of date. Check to see when what you were reading was published. If ita??s old, see if you can find a more recent version of it, or fresher references to the same subject.

5. Be careful of the tricks your mind can play on you. It is a known phenomenon that you are likely to be influenced in diagnosing yourself by your knowledge of the experience of someone you know, or something you are afraid of. For example, if you know someone who died of a heart attack, you are?? more likely to notice chest pain and think maybe youa??re having a heart attack, too.??(Shark attacks are an interesting example of this — from 1670 until 2009 there were a total of only 41 reported deaths from shark attacks in the United States — yet sharks may be the most feared creature in America.)??Dona??t fall prey to your own mind.

So, yes — use the Web, but be smart about it.??And dona??t stop with what you read. Be proactive and tap into whatever other resources are available to you.??Make sure you get the right care.

As for the highest peak in North America? Ita??s Mt. McKinley, also known as Denali.

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Patient Engagement: How Empathy Can Empower Your Patients

In my recent post on KevinMD, a??Deeply Connect and Engage Your Patients With Empathy,a?? I write about how empathy is essential to help empower our patients: a??It is with empathy that we can engage and empower our patients.a??

Doctors and nurses are leaders in health care.

Being a great leader means having a clear vision, mission or goal. It means being committed, and knowing how to listen and communicate, but it involves much more.??Ita??s about having heart, empathy, and an uplifting spirit.

I value and respect a well written post by Thomas Goetz, author of The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine recently published on KevinMD, a??How can doctors successfully engage their patients?a?? Goetz writes about a??Five things they should seek to give every patient, strategies to tap the most underutilized resource in medicine, their patient,a?? however I feel the most critical ingredient is missing, empathy.

Empathy

It is with empathy that we can engage and empower our patients. With empathy and heart we can help our patients feel good, valued and respected.??Empathy allows us to engage and empower our patients to take charge of their health and well-being.

I was recently invited to be a keynote speaker on the subject of a??Patient Empowerment: Engaging Our Patients to Take Charge of Their Healtha?? by the New York State Department of Health and Mental Hygiene a?? Bureau of Tuberculosis Control Unit 2010 a?? MD Seminar.??Chrispin Kambili, MD, Assistant Commissioner is a passionate leader who empowers his staff and patients.??Evidenced by the enthusiastic discussion in the room, the doctors and nurses present were extremely motivated and are leaders who engage their patients with empathy and heart. They listen with compassion to their patients stories, recognizing that to treat their patientsa?? disease, TB, a curable disease; they need to understand the whole story (the psychosocial issues) family issues, financial struggles, etc., since compliance and adherence to completing their medication course is critical.

Despite the disease, all patients matter.

Clinical Empathy

According to Jodi Halpern, MD, PhD author of a??What is Clinical Empathy?a?? in the Journal of General Internal Medicine:

a??Empathy involves being moved by anothera??s experiences. In contrast, a leading group from the Society for General Internal Medicine defines empathy as a??the act of correctly acknowledging the emotional state of another without experiencing that state oneself.a??

With empathy we can connect with our patients, we have an understanding of what it is they are going through, and by acknowledging their emotional state and listening attentively, we can engage our patients and empower them to be proactive and in charge of their health care.

a??The great gift of human beings is that we have the power of empathy.a??- Commencement speech to Barnard College, 2010, Meryl Streep talking about the importance of empathy

Often patients want to feel that you are there for them.??Sometimes they are not looking for lengthy discussions and overly involved detailed information.??They want simple, accurate and informative information that is pertinent to them and presented in a genuine manner. They want to feel that they matter, and any questions they may have are not insignificant. They want to feel valued and respected.

On occasion patients may only need a a??looka?? or an unspoken word that says you care.??Body language is essential in engaging with patients.??Ita??s how you make them feel, thata??s important.

Without empathy, all of the a??Five thingsa?? that Goetz writes about, perhaps may serve no purpose; or very little.??Goetz writes about the five things doctors should give their patients; transparency, repetition, resources, patience and goals; however without empathy, without feeling a connection and understanding your patients, achieving those a??five thingsa?? may be difficult.

Recognizing how a patient feels is essential.

Patients want to feel trust, a connection, and comfort with their health professionals.??When doctors and nurses recognize how patients feel, it will help enhance the doctor/patient and nurse/patient relationship; it will facilitate a connection with their patient, which is essential.

If doctors and nurses are not genuine, if they are unengaged, cold, stilted, and do not sense how patients feel; communication may be hindered and patients will miss out on the opportunity to become engaged and empowered patients.

Barriers to empathy

While there are several barriers to empathy, we can educate ourselves to overcome them so that we may provide our patients the best quality care. According to a??What is Clinical Empathya?? by Jodi Halpern, MD, PhD, the barriers to empathy include:

First, anxiety interferes with empathy. Time pressure is invoked as a concrete barrier to listening to patients, but probably functions more as a psychological barrier, making physicians anxious. This can be addressed in part by showing physicians that listening can make care more efficient.

A second barrier to empathy is that many physicians still do not see patientsa?? emotional needs as a core aspect of illness and care.?? Research shows that doctors who regularly include the psychosocial dimensions of care communicate better overall.

A third barrier to empathy comes from the negative emotions that arise when there are tensions between patients and physicians. Physicians who feel angry with patients and yet find such feelings unacceptable face barriers to thinking about the patienta??s perspective.

Despite the barriers, empathy is critical and enhances communication.

Engaging patients with empathy can lead to a better doctor/patient and nurse/patient relationship.??By listening and communicating we can understand and guide our patients.??Empathy enhances patient-physician communication and trust, and therefore treatment effectiveness.

Why is engagement so important? When patients are engaged with their doctors and nurses they can feel empowered and are better able to participate in their own health and well-being.

Understanding and guidance is essential.

Patients need understanding and guidance.??They need to learn that ita??s okay to ask questions and to take charge.??They need to learn that they can be empowered, proactive and in charge of their health and well-being no matter who they are.??While some patients are savvy, there are patients who feel intimidated to be assertive.??They dona??t know how to ask questions or to speak up, but they can learn.??As professionals we can help them.??We can guide them and encourage them to take to charge of their health care.

We can let them know that ita??s okay to write their questions in a notebook, and to take important notes so that they dona??t forget what is being told to them. I love talking with patients and families.??And whenever a patient or family member has many questions, typically, they apologize for asking so many questions, but I encourage it.??Ita??s wonderful that they have so many; it demonstrates to me that they are interested in their health care, and I let them know that they do not need to apologize for asking questions. a??Ita??s great that youa??re taking charge of your health, you are an empowered patient,a?? I emphatically state to them.

We can empower our patients to manage their disease, to take control of their lives and their own care.

Leta??s look at how advertising agencies engage consumers, and how doctors and nurses can learn from them.

Advertising agencies are masters at connecting with consumers.??They easily engage them.

How do ads engage consumers? (Picture a commercial you would see during the super bowl or an ad in your favorite magazine.)

• Capture attention


• Engage the consumer


• Make them act, to buy a product or behave in a certain way

How do doctors, nurses and other clinicians capture their patientsa?? attention, engage them and help them react to take charge of their health care?

Capture attention: Though a genuine and motivating conversation.??Foster trust and respect. Talk with patients listen to them and understand them, hear their story, and know your patients.

Engage patient: With empathy, heart and compassion.

Help them react: Inspire them to value their health with understanding and guidance.??Help them become compliant; help them improve adherence, follow treatment plan. The way advertisers want consumers to react to buy productsa?|health professionals want patients to reacta?|.they want them to be compliant and adhere to their treatment plan; and to become empowered to take charge and well-being.

Engage with empathy and heart

If we engage with empathy and heart we can help empower patients to take charge of their health and well-being. It is how we make them feel that counts.

Your turn

We would love for you to share your insights. For the health professionals, what are your feelings about engaging your patients with empathy? For patients, are your health professionals empathetic? Is there something different that you would like to see your health professionals do?

As always, thanks for your time. It is greatly appreciated.

Original Post is published on KevinMD.

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How Much Pesticide Is In That Cigarette?

I??had a fascinating discussion??with an ex-tobacco farming expert. He’s an expert because he used to grow tobacco, but not anymore. If you’re a smoker, or user of any tobacco leaf product, what he said should shock you.??I take that back — you’re a smoker: “shocked” is??never going to happen to you.

What did he say that was so striking???I’m not a farmer, so it became a little difficult to understand all the science behind the conversation.??Needless to say, he said they used to farm vegetables and tobacco side by side. He said something about potato farming being timed with tobacco crops, and when the potato market went south he got out of the tobacco farming business for good and went with just vegetables. Now he’s a full-time vegetable farmer.

While he was a tobacco farmer, how did he run his tobacco farm???Like I said, he grew vegetables and tobacco side-by-side.??He used different pesticides??for the vegetables than he did for the tobacco farming.??He farmed based on the concept that people who ate vegetables were looking for a healthy food. So he used pesticides in their lowest recommended concentration and applied them at the longest recommended time frame between applications and used the safest formulations available.??None of his chemicals carried the skull-and-crossbones warning. And what??about the tobacco farming?

His (nearly) exact words were:

Everybody knows that smoking is bad for you.??Every doctor will tell you that.??So we didn’t care about the health concerns of pesticides because everybody already knew smoking was bad for you.??Our main focus was to maximize quality and tonnage of the tobacco leaf.

What did that mean to the tobacco farming???It meant he farmed??with an entirely different mindset.??Because he felt everyone using his product already knew it was going to kill them, he applied the highest??concentration of pesticide allowed by law and applied them at the most frequent allowable, not least frequently recommended, duration of?? time.??And every pesticide carried the dreaded skull-and-crossbones danger, none of which existed on the pesticide control compounds for the fruits and vegetables. And he said every tobacco farmer farmed the tobacco leaf based on these principles. The goal was to maximize quality and tonnage of the tobacco leaf, and you did that with highly-aggressive pest control strategies.

There you have it, folks.??That’s the mindset of an ex-tobacco farmer insider??turned vegetable farmer heard straight from the ears of Happy Hospitalist.??It’s an inside look at how the industry operates. It’s sad, really.??All these tobacco farmers know that you know that tobacco kills. It appears they use that to their advantage, to justify using??the most concentrated doses of deadly chemicals to maximize product for profit.??They are out to make a legal living growing a product that prematurely kills half the people who use it. But they just grow it.??”They don’t make anyone smoke it,” said the poppy grower to the heroin addict.

If people stopped smoking, tobacco farmers would stop growing.??It’s that simple. Ban by ban, tax by tax, hopefully we can put all??of those??tobacco farmers out of business and force them to flood the market with cheap tomatoes. Even a tobacco farmer has to eat.

                       

New Cigarette Labels From The FDA

The FDA will soon require new cigarette package labeling to deter smoking. So in politically-correct governmental fashion, they are asking which labels you’d like to see. (You can pick your favorites here.) My personal favorite (so far) is the one shown to the left, but its impact factor pales in comparison to this example found in England. (That, my friends, is cancer!)

Ironically, it appears the FDA isn’t too sure how forceful it should be in these warnings about the dangers of smoking. They offer a cornucopia of milquetoast labeling options, many of which contain cartoons. Might such unrealistic portrayals defy they hard-hitting message they want to project? Worse, at least one cartoon (seen here) even seems to promote cigarettes AND drug use together!

In an even more astonishing example, some images almost make me what to take up smoking so I can blow big bubbles. Since I could never do this well before, maybe I should take up smoking! Seriously, is an empowerment message what the government wants to portray?

Make these labels big, ugly, and real. Anything else is a waste of taxpayer’s money.

-WesMusings of a cardiologist and cardiac electrophysiologist.