Friday, March 17, 2017

The Match encourages physician passivity, which hurts health care - Slate

Friday marks another iteration of the National Resident Matching Program—"the Match"—perhaps the best-known bottleneck for aspiring U.S. physicians. Every year, this complex computerized algorithm assigns senior medical students to the next phase of their clinical training. Upon selecting a medical specialty, applicants make a list, ordered by preference, of whichever residency programs grant them an interview. After a few months of waiting, an inscrutable bit of software tells them where to go.

Binding contracts must be signed well in advance to honor these results, whatever they may be. At most American medical schools, Match Day involves the ceremonial distribution of envelopes to be opened at a designated time, sometimes onstage, in front of one's assembled family and friends. Within minutes, a full range of emotions is usually on display—elation or ambivalence, surprise or heartbreak. As a rite of passage, the whole thing requires a certain resignation to fate, the strain of which is often more visible after that fate is sealed.

The Match originated more than 60 years ago, supplanting a more traditional, decentralized market in which job offers were extended one by one, often along progressively unreasonable timelines. The original algorithm has since undergone multiple revisions, most recently in 1998 by the economist (and later Nobel laureate) Alvin E. Roth. The system maximizes efficiency as a proxy for contentedness; last year, 94 percent of participating U.S. medical students secured a residency position, and 96 percent of available training positions were filled.

I have gone through the Match twice now, first for residency and later for fellowship, and for all its aggregate expediency, I recall the individual experience as a stressful one. Both times, I felt the usually taut thread of my life slacken and begin to fray. During my interviews I was buoyed by the false sense that my life was somehow underwritten by several backup trajectories; after submitting each rank list, I settled into a prolonged funk, simultaneously questioning my preferences and wondering if they'd be honored. Not knowing if I'd be moving north or south, inland or to the coast, I settled into a dreamy headspace in which all possible outcomes seemed partially true. Match participants reckon with this peculiar fraction of agency—too little to guarantee a happy ending, too much to feel martyred by a sad one.

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Sunday, March 12, 2017

As opioid overdoses rise, police officers become counselors, doctors and social workers - The Washington Post

he nation's opioid epidemic is changing the way law enforcement does its job, with police officers acting as drug counselors and medical workers and shifting from law-and-order tactics to approaches more akin to social work.

Departments accustomed to arresting drug abusers are spearheading programs to get them into treatment, convinced that their old strategies weren't working. They're administering medication that reverses overdoses, allowing users to turn in drugs in exchange for treatment, and partnering with hospitals to intervene before abuse turns fatal.

"A lot of the officers are resistant to what we call social work. They want to go out and fight crime, put people in jail," said Capt. Ron Meyers of the police department in Chillicothe, Ohio, a 21-year veteran who is convinced that punitive tactics no longer work against drugs. "We need to make sure the officers understand this is what is going to stop the epidemic."

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Friday, March 10, 2017

First-year doctors will be allowed to work 24-hour shifts starting in July - The Washington Post

First-year doctors will be allowed to work 24-hour shifts in hospitals across the United States starting July 1, when a much-debated cap that limits the physicians to 16 consecutive hours of patient care is lifted, the organization that oversees their training announced Friday.

The Accreditation Council for Graduate Medical Education said the change will enhance patient safety because there will be fewer handoffs from doctor to doctor. It also said the longer shifts will improve the new doctors' training by allowing them to follow their patients for more extended periods, especially in the critical hours after admission.

The controversial decision ends the latest phase in a decades-old discussion over how to balance physician training with the safety and needs of patients whose care is sometimes handled by young, sleep-deprived doctors — a practice that a consumer group and a medical students' organization oppose as dangerous. The council said Friday that under the amended standards, the physicians' mental and physical health actually will be bolstered by requiring their supervisors to more closely monitor their well-being.

Those standards will allow four hours to transition patients from one doctor to the next, so first-year residents could work as long as 28 straight hours, the same as more senior medical residents. The 125,000 doctors in training, known as "residents" and "fellows" depending on how many years they've completed, are the backbone of staffs at about 800 hospitals across the country, from large medical centers to smaller community facilities.

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Tuesday, March 7, 2017

Medicine and literature: two treatments of the human condition | Aeon Essays

Every month or so, I see a patient called Fraser in my primary care clinic, a soldier who was deployed in Afghanistan. Fifteen years after coming home, he is still haunted by flashbacks of burning buildings and sniper fire. He doesn't work, rarely goes out, sleeps poorly, and to relieve his emotional anguish he sometimes slices at his own forearms. Since leaving the army, he has never had a girlfriend. Fraser was once thickly muscled, but weight has fallen off him: self-neglect has robbed him of strength and self-confidence. Prescription drugs fail to fully quieten the terror that trembles in his mind. Whenever I used to see him in clinic, he'd sit on the edge of his seat, shakily mopping sweat from his forehead and temples. I'd listen to his stories, tweak his medications, and tentatively offer advice.

When Fraser began coming to see me, I was reading Redeployment (2014) by Phil Klay – short stories about US military operations, not in Afghanistan, but in Iraq. No book can substitute for direct experience, but Klay's stories gave me a way to start talking about what Fraser was going through; when I finished the book, I offered it to him. He found reassurance in what I'd found illuminating; our conversations took new directions as we discussed aspects of the book. His road will be a long one, but I'm convinced those stories have played a part, however modest, in his recovery.

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As mental health crises soar, colleges can't meet student needs - STAT

Colleges across the country are failing to keep up with a troubling spike in demand for mental health care — leaving students stuck on waiting lists for weeks, unable to get help.

STAT surveyed dozens of universities about their mental health services. From major public institutions to small elite colleges, a striking pattern emerged: Students often have to wait weeks just for an initial intake exam to review their symptoms. The wait to see a psychiatrist who can prescribe or adjust medication — often a part-time employee — may be longer still.

Students on many campuses are so frustrated that they launched a petition last month demanding expanded services. They plan to send it to 20 top universities, including Harvard, Princeton, Yale, MIT, and Columbia, where seven students have died this school year from suicide and suspected drug overdose.

"Students are turned away every day from receiving the treatment they need, and multiple suicide attempts and deaths go virtually ignored each semester," the petition reads. More than 700 people have signed; many have left comments about their personal experiences trying to get counseling at college. "I'm signing because if a kid in crisis needs help they should not have to wait," one wrote.

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Top US hospitals aggressively promoting alternative medicine offerings - STAT

They're among the nation's premier medical centers, at the leading edge of scientific research.

Yet hospitals affiliated with Yale, Duke, Johns Hopkins, and other top medical research centers also aggressively promote alternative therapies with little or no scientific backing. They offer "energy healing" to help treat multiple sclerosis, acupuncture for infertility, and homeopathic bee venom for fibromyalgia. A public forum hosted by the University of Florida's hospital even promises to explain how herbal therapy can reverse Alzheimer's. (It can't.)

This embrace of alternative medicine has been building for years. But a STAT examination of 15 academic research centers across the US underscores just how deeply these therapies have become embedded in prestigious hospitals and medical schools.

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Monday, March 6, 2017

Organization for the Study of Sex Differences (OSSD)

OSSD is an international society for basic and clinical scientists from various scientific disciplines who share an interest in exploring sex and gender differences in all areas of biological, medical, and behavioral science. The overall mission of OSSD is to enhance the knowledge of sex and gender differences by facilitating communication and collaboration among scientists and clinicians of diverse backgrounds.

OSSD is the brain child of basic and clinical scientists with established research commitments to the study of sex differences, and staff members of the Society for Women's Health Research (SWHR). SWHR has, since 1990, been a thought leader in research on sex differences and is dedicated to improving women's health through advocacy, education, and research. Beginning in 2000, SWHR convened seven innovative meetings that focused on the emerging field of sex-based biology, the Conferences on Sex and Gene Expression (SAGE). SWHR also supported four interdisciplinary Networks in biomedical sciences to promote collaboration among scientists in areas of sex-differences and women's health (referred to as Interdisciplinary Studies in Sex Differences (ISIS) Networks).

Sunday, March 5, 2017

Drug overdose fatality rate higher than suicides, cars, guns - Axios

A new Centers for Disease Control and Prevention study shows the rate of fatal drug overdoses has more than doubled since 1999. Those between 55 and 64 years of age were the hardest hit. Rates increased for both males and females and increased across all age groups.

The 2015 rate for fatal drug overdoses is higher than deaths from suicides (13.4 deaths per 100,000) car accidents (11.1 deaths per 100,000) and firearms.

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Saturday, March 4, 2017

NYTimes: Whom Do You Tell When You’re Sick? Maybe Everyone You Know

Last year, my mother, a few weeks before a milestone birthday, learned she needed major surgery. The circumstances were not life-threatening. She would not be in the hospital long. But the recovery would still be protracted and restrict her ability to care for my father, who has Parkinson's.

No worries. Her three grown children, all of whom live in distant cities, snapped into action. We would fly in for the surgery, call in extra help, telephone a few of her friends and ask them to check in, drop off some food, otherwise be on call. We congratulated ourselves for a well-designed plan. There was only one problem.

My mother insisted we not tell a soul.

"I don't want to inconvenience my friends," she said. "Also, I don't want people to feel sorry for me, and I absolutely don't want to listen to all their medical stories. It's just so wearying."

How people decide whether to go public with their medical conditions has long been highly sensitive and deeply personal. Certain situations, like broken limbs and cancers that require chemotherapy, are virtually impossible to keep secret. Others, like H.I.V. and mental illness, are easier to keep under wraps, at least for a time. Older people, in my experience, lean more toward secrecy; younger toward disclosure.

These days, all of the old rules have been thrown out. With more and more people used to sharing even the most minute details of their daily lives on social media, centuries of customs have been upended. If you post photos of yourself emptying your cat litter, filing your taxes or getting your cavity filled, you can't as easily come out later and say, "Oh, I've had muscular dystrophy all these years and didn't want to tell you."

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When doctors know that they don’t know - The Boston Globe

Imagine that you are a medical doctor. You need to tell one of your patients that he has advanced-stage pancreatic cancer, an almost incurable condition. You learn that your patient's only daughter is getting married five months from now. Without treatment, your patient has about a year left to live. Chemotherapy would increase his chances of being alive in five years by about 20 percent but would also double his chances of dying before his daughter's wedding. What do you tell him? Of course, the choice is by no means easy or clear-cut.

Doctors are scientists who operate in a world of statistics, odds, and probability. Yet they've long been taught that when dealing with patients they should convey a reassuring level of confidence and certainty. As a result, patients expect their doctors to give them a clear diagnosis and a straightforward course of treatment.

But now that information about every medical condition imaginable is just a few clicks away, experts are asking whether doctors' apparent certainty when communicating with their patients actually does more harm than good. With the information overload brought by the progress of medicine and technology, answers are rarely black or white. Medical schools are only just starting to teach doctors how to deal with this, and patients' expectations haven't adjusted, either.

The fact is that medicine has long been steeped in uncertainty and has arguably even thrived on it. To avoid bias when testing a new drug, researchers must have no preconceived notions of which treatment, the new one, the old one, or even a placebo, is the best option. This principle, called equipoise, protects patients, doctors, and researchers alike from making assumptions before scientific proof of efficacy has been gathered.

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