This patient isn't usually mine, but today I'm covering for my partner in our family-practice office, so he has been slipped into my schedule.
Reading his chart, I have an ominous feeling that this visit won't be simple.
A tall, lanky man with an air of quiet dignity, he is 88. His legs are swollen, and merely talking makes him short of breath.
He suffers from both congestive heart failure and renal failure. It's a medical Catch-22: When one condition is treated and gets better, the other condition gets worse. His past year has been an endless cycle of medication adjustments carried out by dueling specialists and punctuated by emergency-room visits and hospitalizations.
Hemodialysis would break the medical stalemate, but my patient flatly refuses it. Given his frail health, and the discomfort and inconvenience involved, I can't blame him.
Now his cardiologist has referred him back to us, his primary-care providers. Why send him here and not to the ER? I wonder fleetingly.
With us is his daughter, who has driven from Philadelphia, an hour away. She seems dutiful but wary, awaiting the clinical wisdom of yet another doctor.
After 30 years of practice, I know that I can't possibly solve this man's medical conundrum.
A cardiologist and a nephrologist haven't been able to help him, I reflect, so how can I? I'm a family doctor, not a magician. I can send him back to the ER, and they'll admit him to the hospital. But that will just continue the cycle. . . .
Still, my first instinct is to do something to improve the functioning of his heart and kidneys. I start mulling over the possibilities, knowing all the while that it's useless to try.
Then I remember a visiting palliative-care physician's words about caring for the fragile elderly: "We forget to ask patients what they want from their care. What are their goals?"
I pause, then look this frail, dignified man in the eye.
"What are your goals for your care?" I ask. "How can I help you?"
More ...
http://www.washingtonpost.com/national/health-science/how-i-discovered-an-important-question-a-doctor-should-ask-a-patient/2015/03/09/ca350634-bb9c-11e4-bdfa-b8e8f594e6ee_story.html
Saturday, March 14, 2015
Pulse - Voices from the Heart of Medicine
Every Friday, Pulse--voices from the heart of medicine publishes and distributes a first-person story or poem, together with a visual image or haiku, about health care.
Launched in 2008, Pulse was created by members of the Department of Family and Social Medicine at Montefiore Medical Center and Albert Einstein College of Medicine in collaboration with colleagues and friends around the country.
At a time when the pioneering work of Rita Charon has established the value of narrative medicine--an approach that places a premium on personal perspectives within a healthcare encounter--Pulse makes narrative medicine available to all and accessible to anyone.
Pulse tells the story of health care through the personal experiences of those who live it--patients, health professionals, students and caregivers. While medical care is often rightly criticized for being cold and oblivious, Pulse highlights the humanity and vulnerability of all its actors. In doing so it promotes the humanistic practice of medicine and encourages advocacy for compassionate health care for all.
Wednesday, March 11, 2015
Why Apple’s New ResearchKit Could Have a Diversity Problem - BuzzFeed News
Of Apple's many announcements yesterday, the one with "perhaps the most profound change and positive impact," in CEO Tim Cook's words, is ResearchKit. Scientists will soon have unprecedented, real-time access to potentially tens of millions of people, who will participate in medical research by submitting data through their iPhones. Yet the very people who tend to be most affected by many of the diseases ResearchKit currently targets also tend to be the ones least likely to own an iPhone.
Apple iPhone owners are far from a representative group: They tend to be younger, better educated, and wealthier than the many millions of Americans who don't own one. This leaves some researchers wondering if the suite's user demographics will skew findings about how diseases work, who suffers, and how to cure them. What's more, there's no way to verify the accuracy of the data that users self-report.
"The Apple demographic is not all people," Ida Sim, co-director of biomedical informatics of the Clinical and Translational Science Institute at the University of California, San Francisco, told BuzzFeed News. "There are concerns about equity and lower socioeconomic populations, definitely. I think there needs to be special attention to reaching those groups so we don't overly restrict our sampling to people that are iPhone users."
More ...
Monday, March 9, 2015
Life After Cancer: How the iPhone Helped Me Achieve a Healthier Lifestyle – MacStories
I've been struggling to get back in shape after chemo.
Since being diagnosed with Hodgkin Lymphoma (Stage IV) in late 2011, my life changed. Beyond the psychological and emotional consequences of how cancer affected me, my family, and my relationships, it is undeniable and abundantly clear that cancer took its toll on me from a physical perspective.
Last year, I decided to regain control of my body, my life habits, and my health. I started tracking everything I could about my activities, my exercise routine, the food I ate, and the time I spent working with my iPad instead of walking, sleeping, or enjoying time with my family. Since then, I've made a decision to not let cancer and its consequences define me any longer.
I want to be healthier, I want to eat better, and I want to take the second chance I was given and make the most of it. What started as an experiment has become a new daily commitment to improve my lifestyle and focus.
And it wouldn't be possible without my iPhone.
More ...
Sunday, March 8, 2015
Stress Fractures | The Scientist Magazine
In 2005, Steve Cole began to peer inside the cells of lonely people, training his sights on the activity of their genomes. Cole, a psychologist turned molecular biologist at the University of California, Los Angeles, was interested in how psychological stressors such as chronic social isolation could be bad for our health, increasing our susceptibility to certain diseases. Research had already implicated stress hormones, which are produced at higher-than-average levels in people who feel lonely for long stretches. But Cole wanted to know what was going in the genes, and not just one or two. He suspected that the expression of large collections of genes might be disrupted in people who consistently reported feeling isolated. "I had an abiding mistrust of one-gene answers because genes generally work in coordinated networks in cells," he says.
Cole teamed up with University of Chicago social psychologist John Cacioppo, who had already been tracking 166 healthy middle-aged adults for three years, periodically asking them how socially isolated they felt and gathering all manner of biomedical, psychological, social, and economic data. Cole and Cacioppo took blood samples from 153 of the study subjects and focused on the eight most socially secure people and the six loneliest, who had scored highest on the UCLA Loneliness Scale for the past three years. When Cole ran these 14 subjects' white blood cells through a microarray analysis, he spotted more than 200 genes that were expressed differently between the two groups. Many of the genes dialed up in lonely individuals were involved in inflammation, while the downregulated genes tended to be associated with antiviral response, antibody production, and restraint of inflammatory responses.
It was a tiny sample, but the implications of the study, published in 2007, were great: loneliness, it seems, shapes one's health by controlling the "dimmer switch" for whole networks of immune-related genes. Indeed, this overexpression of proinflammatory genes and suppression of anti-inflammatory and antiviral genes might explain why lonely people are more likely to succumb to a variety of diseases, and why HIV ravages socially isolated people more quickly than their more connected peers. "It was gratifying to see the story [of how loneliness affects health] move beyond the genotype to include the functional aspect of the genome," says Cacioppo.
More ...
http://www.the-scientist.com/?articles.view/articleNo/41708/title/Stress-Fractures/
Cole teamed up with University of Chicago social psychologist John Cacioppo, who had already been tracking 166 healthy middle-aged adults for three years, periodically asking them how socially isolated they felt and gathering all manner of biomedical, psychological, social, and economic data. Cole and Cacioppo took blood samples from 153 of the study subjects and focused on the eight most socially secure people and the six loneliest, who had scored highest on the UCLA Loneliness Scale for the past three years. When Cole ran these 14 subjects' white blood cells through a microarray analysis, he spotted more than 200 genes that were expressed differently between the two groups. Many of the genes dialed up in lonely individuals were involved in inflammation, while the downregulated genes tended to be associated with antiviral response, antibody production, and restraint of inflammatory responses.
It was a tiny sample, but the implications of the study, published in 2007, were great: loneliness, it seems, shapes one's health by controlling the "dimmer switch" for whole networks of immune-related genes. Indeed, this overexpression of proinflammatory genes and suppression of anti-inflammatory and antiviral genes might explain why lonely people are more likely to succumb to a variety of diseases, and why HIV ravages socially isolated people more quickly than their more connected peers. "It was gratifying to see the story [of how loneliness affects health] move beyond the genotype to include the functional aspect of the genome," says Cacioppo.
More ...
http://www.the-scientist.com/?articles.view/articleNo/41708/title/Stress-Fractures/
On the Case at Mount Sinai, It’s Dr. Data - NYTimes.com
Jeffrey Hammerbacher is a number cruncher — a Harvard math major who went from a job as a Wall Street quant to a key role at Facebook to a founder of a successful data start-up.
But five years ago, he was given a diagnosis of bipolar disorder, a crisis that fueled in him a fierce curiosity in medicine — about how the body and brain work and why they sometimes fail. The more he read and talked to experts, the more he became convinced that medicine needed people like him: skilled practitioners of data science who could guide scientific discovery and decision-making.
Now Mr. Hammerbacher, 32, is on the faculty of the Icahn School of Medicine at Mount Sinai, despite the fact that he has no academic training in medicine or biology. He is there because the school has begun an ambitious, well-funded initiative to apply data science to medicine.
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