Need More Friends? Maybe Not

“Friending” current and former patients on Facebook is probably not a good idea; in fact it’s not a good idea at all.  This is the advice the British Medical Association is handing out to physicians.

In the BMA’s social media guide they state that “because of the power imbalance that can exist in any doctor-patient relationship,” it’s important to establish a professional boundary. They state that it can be difficult to maintain those boundaries with all the personal information available on Facebook.

The BMA suggests physicians politely decline friend requests.  They write:

“Given the greater accessibility of personal information, entering into informal relationships with patients on sites like Facebook can increase the likelihood of inappropriate boundary transgressions, particularly where previously there existed only a professional relationship between a doctor and patient.

“Difficult ethical issues can arise if, for example, doctors become party to information about their patients that is not disclosed as part of a clinical consultation. The BMA recommends that doctors and medical students who receive friend requests from current or former patients should politely refuse and explain to the patient the reasons why it would be inappropriate for them to accept the request.”

For instance, what if you were to see a picture posted of your patient in a bar drinking a beer.  You know that with his medical condition he should strictly avoid alcohol.  Do you bring this up at his next visit, or let it go because he did not share this with you himself?

The BMA guidance 1) suggests that physicians adopt conservative privacy settings on their online profiles, 2) warns doctors to respect patient confidentiality, and 3) advises they declare conflict of interest.

The social media policy of the American Medical Association does not come right out and say physicians should not “friend” patients, but says they should “maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just, as they would in any other context.”  It also suggests doctors “should consider separating personal and professional content online.”   

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 23.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

What You Say Without Speaking

It’s estimated that up to 93% of all communication exchanges are nonverbal.  That means facial expressions, gestures and the way we stand all say something—of which we are often unaware.

For nearly 20 years medical schools have been required to teach communication skills, mainly due to research that links physician-patient communication with patient satisfaction and health care outcomes.  They offer everything from courses on lectures, video recording and self-assessments.

But, writes New York Times columnist Pauline Chen, few schools offer courses on facial expressions and body language, “despite a growing body of research suggesting that nonverbal communication may be as important as verbal communication. Important nonverbal cues in physician-patient interactions can include subtle body gestures, body positions, eye contact, facial expressions, and touch.”

One of the most powerful tools we have is eye contact, and how much we are willing to give to patients.  It tells patients they are being listened to (a great satisfier in patient interactions).  Do you nod to let them know they have your full attention, or does it look like you are a million miles away while they tell their story?

A recent study in the Journal of General Internal Medicine (JGIM) found that black physicians used positive nonverbal cues better than white physicians, although they sometimes gave contradictory nonverbal signals.  A 1994 study had shown that women physicians tend to give male patients conflicting nonverbal cues, like smiling while speaking in an anxious tone of voice.

Experts suggest physicians note their body language: Do you cross your arms, look away or make notes while the patient is speaking?  Or do you look engaged, touch the patient’s hand, and appear unrushed? Experts say nothing is more powerful than imagining yourself in the patient’s place to put things in perspective.  

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 23.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Not All Physicians Honest with Patients

A 2009 survey of 1,891 practicing physicians from across the US aimed to find out how many of them adhered strictly to the Charter on Medical Professionalism endorsed by 100+ professional groups around the world and the US Accreditation Council for Graduate Medical Education.  It requires openness and honesty in physician communications with patients.

A large majority agreed completely that physicians should fully inform patients about risks and benefits of interventions.  They also agreed that they should never disclose confidential information to unauthorized people.

• But about 1 in 3 did not completely agree with telling patients about serious medical errors.
• Nearly 1 in 5 did not completely agree that physicians should never tell a patient something untrue.
• Almost 2 of 5 did not completely agree that they should disclose to patients their financial relationships with drug and device companies.
• More than 1 in 10 said they had told patients something that was not true during the previous year.

The authors of the research represent Harvard Medical School, the Mongan Institute for Health Policy, University of Massachusetts and other august bodies.  They stated that, “Our findings raise concerns that some patients might not receive complete and accurate information from their physicians, and doubts about whether patient-centered care is broadly possible without more widespread physician endorsement of the core communication principles of openness and honesty with patients.”  

Source:  http://content.healthaffairs.org/content/31/2/383.abstract

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 23.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Most Cancer Docs Reach Out to Bereaved

Seventy percent of cancer physicians contact bereaved family members and caregivers of their patients who die.  But of the 162 physicians surveyed, more than two thirds do not feel adequately trained to do this sort of reaching out.  These were the results of a study presented at the 53rd Annual Meeting of the American Society for Radiation Oncology (ASTRO).

Most of those surveyed sent condolence letters, and some called or attended funeral services.  One perceived barrier to bereavement follow-up is lack of time.  Another factor was uncertainty about which family member was the most appropriate person to contract.

“This study highlights the need to more clearly define the physicians’ role in bereavement activities and address bereavement activities in providers’ postgraduate training as we work to improve the multidisciplinary treatment of cancer patients and their families,” said lead author Aaron S. Kusano, MD, a radiation oncology resident at the University of Washington School of Medicine in Seattle. 

Source:  www.medicexchange.com/ASTRO-2011/most-cancer-physicians-reach-out-to-bereaved-family-caregivers-astro-2011.html.

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 23.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Breaking Bad News to Asian Patients

Cultural Differences

Only 30% of Asian patients want to discuss life expectancy, whereas 60% of Western patients do.  Of Japanese patients, 78% want a family member present when learning news about a bad prognosis, starkly contrasting with US patients, 81% of whom prefer to be alone.

These are examples of the widely varying cultural preferences highlighted in “Breaking Bad News to Asian Patients,” an article subtitled “A Primer on Asian Bioethics,” by Desiree Lie at Medscape (http://www.medscape.com/viewarticle/744651_2).  She cites several studies about communicating bad news to patients, noting the contrast in preferences of Asian patients.

The author notes that although both Asian and Western bioethics stress truth-telling and autonomy, the Asian conception of autonomy considers the family as the autonomous unit whereas the Western application of the ethical principle in medicine generally refers to the individual.  Lie states that in Asian culture, the first person to be told about a diagnosis of cancer is the head of the household—not the patient.  Lie acknowledges that traditions vary within cultures and within the same cultural group in different geographic regions.

Lie suggests 1) asking the patient what he or she prefers when having a diagnosis presented, 2) finding out who is the center of decision-making in the family, and 3) inviting the patient to share “ancestral values” about illness, the role of family members and spiritual beliefs.  These kinds of conversations may furnish you with clues to the best routes of communication.

Author Lie says, “Allowing [the patient] to make the initial decision of how to be given news about her diagnosis gives her and her family ‘face’ and is likely to improve follow-up, communication, satisfaction, adherence, and future management of her disease.”

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 23.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Hospice Facts & Figures: 2010 Snapshot

The National Hospice and Palliative Care Organization (NHPCO) has released facts and figures for 2010. Key statistics in the report, which mainly compares data from 2009 to 2010, include:

• 1.58 million hospice patients served
• Average length of service was 67.4 days
• Median length of service 19.7 days
• 66.7 % patients died at home
• 21.9% died in hospice inpatient facilities
• 11.4% died in acute care hospitals
• 87.2% of hospice patients were 65 or older: 38% were 85 or older
• 35.6% deaths with diagnosis cancer; 13% deaths with diagnosis dementia

The percentage of non-white Caucasian patients increased in every category: 11% multiracial or other race in 2010, compared to 8.7% in 2009; 8.9% v. 8.7% Black/African American; 2.5% v. 1.9% Asian, Hawaiian, other Pacific Islander; and 0.3% v. 0.2% American Indian or Alaskan native. 
 

Source: www.nhpco.org/files/public/Statistics_research/2011_Facts_Figures.pdf

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 23.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Alzheimer's Tracks Mapped

Surprising results of recent research show that Alzheimer’s disease (AD) seems to spread from one brain cell to the next.  Instead of a virus or bacteria, a distorted protein known as tau is being spread.

Theoretically the disease could be stopped in its tracks by halting transmission from cell to cell—maybe with a tau-blocking antibody.  The study results will have immediate implications for developing new treatments, according to researchers working independently at Columbia and Harvard.  They likened imagined treatments for halting the disease to treating cancer while in its early stages before it has spread.

For many years researcher tried to unravel the mystery of how AD spreads.  Did lesions pop up independently of one another throughout the brain, or did AD spread outward like contagion from the memory center where it first emerges?

The means to the solution was provided by genetically engineering mice to accumulate abnormal human tau proteins in the entorhinal cortex, where cells first start to die in AD.  Following the mice over two years yielded the information they were looking for.  Since human tau proteins could not spontaneously appear in isolated pockets of mouse brains, they could only arrive at other areas via transmission from cell to cell.

As researchers mapped the path of the human tau protein they saw it spread outward from the entorhinal cortex to hippocampus to neocortex—the same progression as seen in humans. Researchers are now asking whether other degenerative brain diseases, such as Parkinson’s, may spread the same way.

The Columbia University study was done by Karen Duff and Dr. Scott A. Small and their colleagues at the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain at Columbia University Medical Center and was published in the journal “PLoS One”.  Another study was led by Dr. Bradley T. Hyman, Director of the Alzheimer’s Disease Research Center at Massachusetts General Hospital and was published in the journal “Neuron”.

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 23.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.