Thursday, March 12, 2009

Doctor and Patient - When Patients Feel Abandoned by Doctors -

During my surgical training, I was taught never to abandon a patient, no matter how difficult the operation or how complex the clinical course. As one senior surgeon put it, "Once you lay your hands on a patient, that patient is yours."

At the time, I embraced the idea of sticking with my patients and believed it was the fundamental value of my chosen field. Since then, however, I have learned two things. First, that every physician, no matter his or her specialty, is taught the same thing. And second, that despite our long-held belief that doctors should never abandon their patients, many of us have already done so.

This week, The Archives of Internal Medicine published the results of a study from Seattle that examined feelings of abandonment at the end of life from the perspective of patients, caregivers, nurses and physicians. Investigators from the University of Washington and the Fred Hutchinson Cancer Research Center followed 55 patients with terminal diseases in the year leading up to their death, as well as the dozens of family caregivers, nurses and physicians involved in their care.

Most striking, and perhaps most poignant, were the discrepancies the investigators found between doctors and patients. While the doctors were aware that dying patients might feel abandoned and even took what they believed were steps to prevent it, patients and their caregivers continued to feel abandoned by their doctors both in the period leading up to and at the time of death.

One reason, according to study investigators, was that physicians were unaware of the importance for patients, and caregivers, of closure. A sense of closure helped mitigate any feelings of abandonment, they found. And efforts to achieve closure could range from openly acknowledging that a visit might be the last with the patient, to calling the family or sending a condolence note after death.

More ...

Wednesday, March 11, 2009

Can We Increase Our Intelligence? -

We'll be writing about slow and fast forces that shape the brain: natural selection, operating relatively slowly over many generations; and environmental influences, whose effects are visible across a few generations or even within one individual's lifetime.

We're often asked whether the human brain is still evolving. Taken at face value, it sounds like a silly question. People are animals, so selection pressure would presumably continue to apply across generations.

But the questioners are really concerned about a larger issue: how our brains are changing over time — and whether we have any control over these developments. This week we discuss intelligence and the "Flynn effect," a phenomenon that is too rapid to be explained by natural selection.

It used to be believed that people had a level of general intelligence with which they were born that was unaffected by environment and stayed the same, more or less, throughout life. But now it's known that environmental influences are large enough to have considerable effects on intelligence, perhaps even during your own lifetime.

More ...

Tuesday, March 10, 2009

The Health-Care Crisis Hits Home - Karen Tumulty, TIME

When you've been strong and fit your whole life, it can be easy to discount your body's first whispers of sickness as merely the side effects of daily living. Looking back over the past three years, my older brother Patrick now understands the meaning of his increasingly frequent bouts of fatigue, his fluctuating appetite and the fact that his blood pressure had crept up to 150/90. But Pat had always put off going to the doctor until he had to. Having bought health insurance that carried a $2,500 deductible, he knew he would have to pay for a checkup himself. That is no small consideration for someone who makes $9 an hour, as my brother did in his job as an administrative assistant for a lighting firm in San Antonio. He also struggles with Asperger's syndrome, a disorder sometimes described as high-functioning autism. Pat can multiply three-digit numbers in his head with ease, but he has trouble accepting the unfamiliar and adjusting to the unforeseen.

The unforeseen was exactly what turned up when Pat went in for a physical on Nov. 30, 2007, his first in five years. The doctor found high levels of blood and protein in his urine, results that were confirmed in another round of tests in December. Soon after that, Pat discovered that his urine had turned brown and foamy. In the middle of all this, he was laid off from his job, and finding a new one while doing temp work was his most pressing concern. Finally, last July my brother's doctor insisted that he see a specialist, who quickly ordered a biopsy. That's when Pat, who is now 54, learned that his kidneys were failing.

The diagnosis was only the first shock. The second came a few weeks later, in an Aug. 5 letter from Pat's health-insurance company. For six years — since losing the last job he had that provided medical coverage — Pat had been faithfully paying premiums to Assurant Health, buying a series of six-month medical policies, one after the other, always hoping he would soon find a job that would include health coverage. Until that happened, "unexpected illnesses and accidents happen every day, and the resulting medical bills can be disastrous," Assurant's website warned. "Safeguard your financial future with Short Term Medical temporary insurance. It provides the peace of mind and health care access you need at a price you can afford."

More ...,8599,1883149,00.html?imw=Y