Thursday, March 5, 2015

NYTimes: Their Dying Wishes

I met Mr. C. because he was dying and his wife needed someone to sit with him Saturday nights while she attended Mass. I was a relatively new hospice volunteer, not long out of training, and Mr. C. was my first assignment with a patient at home, rather than in a hospital or health care facility. He had been given a diagnosis of Parkinson's disease 25 years before I first entered their small apartment in the Baruch housing projects, which stand where the Williamsburg Bridge meets Manhattan.

After Mrs. C. slipped out, Mr. C. and I tried to get acquainted. But his disease had long ago ravaged his motor skills; his jaw, loose and roving, wouldn't obey. I couldn't understand a word he was saying. Insistent, he shifted from tell to show, waving his wandering, shaking hand at an instrument case beside the dresser. Inside I found a cuatro, a small Latin American guitar with a filigree dimple on each side. Its wooden face was worn thin as an eggshell from years of use. The neck wiggled, and it had no strings, but when I handed the instrument to Mr. C., he embraced it as if it were an old friend. He was calmed by its familiar presence. "Strings," he said, slowly and clearly.

When Mrs. C. returned, I told her what her husband, now dozing in his bedroom, had asked for. "Ah," she said with a wave of her hand — expressing the same practicality with which she had covered the living room sofa in plastic, the same practicality that had enabled her to care for her increasingly disabled husband at home for so many years. "He can't play anyway," she said.

But when I arrived the next Saturday, Mr. C. looked at me expectantly. "Strings," he said. I was empty-handed. I knew from the look on his face that I had let him down.

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By the time patients have accepted that their lives are ending, their bucket lists often shift to the simple things: music, Twinkies, a hand to hold.

Wednesday, March 4, 2015

New Physician Workforce Projections Show the Doctor Shortage Remains Significant - AAMC

The nation will face a shortage of between 46,000-90,000 physicians by 2025, according to a report released today by the AAMC (Association of American Medical Colleges). The study, which is the first comprehensive national analysis that takes into account both demographics and recent changes to care delivery and payment methods, projects shortages in both primary and specialty care, with specialty shortages particularly acute. 

"The doctor shortage is real – it's significant – and it's particularly serious for the kind of medical care that our aging population is going to need," said AAMC President and CEO Darrell G. Kirch, MD.

The study, conducted for the AAMC by the Life Science division of IHS Inc., a global information company, presents projections in ranges that reflect the potential impact of a variety of health care delivery and policy scenarios, including the rapid growth in non-physician clinicians and new payment and delivery models such as patient-centered medical homes (PCMH) and accountable care organizations (ACO).

Projections for individual specialties were aggregated into four broad categories: primary care, medical specialties, surgical specialties, and "other" specialties.  Within the overall projected physician shortage, the study estimates a shortage of 12,000-31,000 primary care physicians, and a shortfall of 28,000-63,000 non-primary care physicians, most notably among surgical specialists.

"The trends from these data are clear -- the physician shortage will grow over the next 10 years under every likely scenario," said Kirch. "Because training a doctor takes between five and 10 years, we must act now, in 2015, if we are going to avoid serious physician shortages in 2025. The solution requires a multi-pronged approach: Continuing to innovate and be more efficient in the way care is delivered as well as increased federal support for graduate medical education to train at least 3,000 more doctors a year to meet the health care needs of our nation's growing and aging population."

View the complete report. 

Monday, March 2, 2015

Most Doctors Give In to Requests by Parents to Alter Vaccine Schedules -

A wide majority of pediatricians and family physicians acquiesce to parents who wish to delay vaccinating their children, even though the doctors feel these decisions put children at risk for measleswhooping cough and other ailments, a new survey has found.

Physicians who reluctantly agreed said they did so to build trust with families and to avoid losing them as patients.

The survey, published Monday in the journal Pediatrics, asked a nationally representative sample of 534 primary care physicians in 2012 how often parents in their practices postponed one or more vaccinations for children younger than age 2.

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Sunday, March 1, 2015

NYTimes: Medicating Women’s Feelings

WOMEN are moody. By evolutionary design, we are hard-wired to be sensitive to our environments, empathic to our children's needs and intuitive of our partners' intentions. This is basic to our survival and that of our offspring. Some research suggests that women are often better at articulating their feelings than men because as the female brain develops, more capacity is reserved for language, memory, hearing and observing emotions in others.

These are observations rooted in biology, not intended to mesh with any kind of pro- or anti-feminist ideology. But they do have social implications. Women's emotionality is a sign of health, not disease; it is a source of power. But we are under constant pressure to restrain our emotional lives. We have been taught to apologize for our tears, to suppress our anger and to fear being called hysterical.
The pharmaceutical industry plays on that fear, targeting women in a barrage of advertising on daytime talk shows and in magazines. More Americans are on psychiatric medications than ever before, and in my experience they are staying on them far longer than was ever intended. Sales of antidepressants and antianxiety meds have been booming in the past two decades, and they've recently been outpaced by an antipsychotic, Abilify, that is the No. 1 seller among all drugs in the United States, not just psychiatric ones.

As a psychiatrist practicing for 20 years, I must tell you, this is insane.

At least one in four women in America now takes a psychiatric medication, compared with one in seven men. Women are nearly twice as likely to receive a diagnosis of depression or anxiety disorder than men are. For many women, these drugs greatly improve their lives. But for others they aren't necessary. The increase in prescriptions for psychiatric medications, often by doctors in other specialties, is creating a new normal, encouraging more women to seek chemical assistance. Whether a woman needs these drugs should be a medical decision, not a response to peer pressure and consumerism.
The new, medicated normal is at odds with women's dynamic biology; brain and body chemicals are meant to be in flux. To simplify things, think of serotonin as the "it's all good" brain chemical. Too high and you don't care much about anything; too low and everything seems like a problem to be fixed.

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