Friday, February 13, 2015

Is it OK for doctors to 'google' patients? - Yahoo News

It's something we do to job applicants, first dates, former lovers and the quiet co-worker in the next cubicle. The practice of "googling" others for professional reasons or out of personal curiosity is so ubiquitous that the name of the popular Internet search engine has turned into a verb. In healthcare, patients often head online for diagnoses, drug information and details about their doctors. But do professional standards prevent physicians from doing the same to patients?

The authors of a new paper in the Journal of General Internal Medicine write that sometimes, the practice is acceptable. Most other times, in their opinion, it isn't. They hope their paper sparks conversation among colleagues and the American Medical Association about the possibility of guidelines for providers in the digital age, one in which most medical students can't remember a world without search engines. 

"The motivation is to protect patients and prevent harm," said Maria Baker, a Penn State Hershey Cancer Institute genetics counselor. 

Her paper lists 10 situations when physicians are justified in "googling" patients – for example, when they have a duty to warn of possible harm, if patient's story seem improbable, if information from other professionals calls a patient's story into question, if there are suspicions of abuse or concerns of suicide risk. 

"There is something worth protecting in the physician-patient relationship," said co-author Daniel George, an assistant professor in Medical Humanities at Penn State University College of Medicine. While the AMA has issued guidelines regarding physician professionalism and social media, George calls patient-targeted web searches a "blind spot" among providers.

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Wednesday, February 11, 2015

Goodbye chronic fatigue syndrome, hello SEID | Science/AAAS | News

A committee convened by the Institute of Medicine (IOM) has proposed a new name for a condition known variously as chronic fatigue syndrome or myalgic encephalomyelitis. The unwieldy new moniker: systemic exertion intolerance disease, or SEID. In a report released today, the committee also suggests a new set of diagnostic criteria for SEID.

After reviewing more than 9000 scientific studies, hearing testimony from experts, and soliciting input from the public, the committee concluded that "the name 'chronic fatigue syndrome' has done a disservice to many patients," calling it  "stigmatizing and trivializing." Myalgic encephalomyelitis (ME), they noted, "does not accurately describe the major features of the disease."

At least 20 sets of diagnostic criteria exist, the committee noted, which has confused patients, clinicians, and their families, as well as researchers studying the disease. The proposed diagnostic criteria are more focused on "the central symptoms" such as a reduced or impaired ability to work and study, malaise after exertion, and "unrefreshing" sleep.  The report, "Beyond Myalgic Encephalitis/Chronic Fatigue Syndrome: Redefining an Illness," runs 235 pages.

Peter Rowe, who heads the Chronic Fatigue Clinic at the Johns Hopkins Children's Center in Baltimore, Maryland, and was one of 15 committee members, had high praise for the process and the product. "This is a phenomenal report," Rowe said, noting that it had unanimous support. "It has the best summary of the evidence that I've ever read." The U.S. Department of Health and Human Services and the Social Security Administration sponsored the IOM study and report.

Systemic exertion intolerance disease does not exactly roll off the tongue. IOM committee member Ronald Davis, a biochemist who heads the genome center at Stanford University in Palo Alto, California, says the group considered about 100 options. "Boy, did we  struggle with that," he said. "It's hard to come up with a good name, and I don't think this is a perfect name."

But Davis thinks its essential to do away with chronic fatigue syndrome. "My son is sick with it, and when I tell people, they say, 'I had that once,' because they were tired once," he said. "ME is a better name, but there are no real data that fit the name."

Davis hopes the report will convince all clinicians that they can diagnose the disease and that it is real. "I hope it will get rid of those who may not believe it," Davis said. "They'll have to keep it to themselves. It's incompetence and it's malpractice."

The new diagnostic criteria build on what are known as the Canadian Consensus Criteria, first put forward in 2003. But the report offers a distinct, simpler definition that focuses on "the central element of this disorder," said committee chair Ellen Wright Clayton at "public release event" held at IOM this morning. "The essence of this disorder is that if patients with this disorder engage in exertioncognitive, emotional, physical, whateverthat their symptoms are made much worse and often for a prolonged period of time," said Clayton, a law professor at Vanderbilt University in Nashville. The name, she said, reflects this. "We want to name it for what it is," she said. "This is what the patients experience."

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