Friday, January 26, 2018

A Doctor Argues That Her Profession Needs to Slow Down, Stat - The New York Times

Doctors today often complain of working in an occupational black hole in which patient encounters are compressed into smaller and smaller space and time. You can do a passable job in a 10-minute visit, they say, but it is impossible to appreciate the subtleties of patient care when you are rushing.

Enter "Slow Medicine: The Way to Healing," a wonderful new memoir by Dr. Victoria Sweet. The term "slow medicine" has different interpretations. For some it means spending more time with patients. For others it means taking the time to understand evidence so as to avoid overdiagnosis and overtreatment. For Sweet, it means "stepping back and seeing the patient in the context of his environment," and providing medical care that is "slow, methodical and step-by-step."

At the beginning of her book, she relates how her 93-year-old father was mistreated after being hospitalized for a seizure. He is put in 4-point restraints and sedated. Bloody urine drains from his bladder because it has been injured by a catheter insertion. Worse, his rushed doctors don't know that this isn't his first seizure but rather the latest in a long line that can be managed at home.

The steamroller of inpatient care takes over. Every day Sweet's father sees a different doctor. He isn't allowed to eat or get out of bed because he is on tranquilizers. He becomes septic. His symptoms are misdiagnosed as a stroke. Doctors eventually prepare to insert a feeding tube into his stomach because he cannot swallow. Sweet and her sisters get him out of the hospital just in time. When he gets home, he has a steak and a beer.

Sweet writes, "If I, as a physician, couldn't get appropriate care for a family member in a lovely community hospital with well-trained staff — who could?"

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Why do hospitals bare butts when there are better gowns around? | STAT

Every decade or so, the headlines reappear:

"Fashion designer Cynthia Rowley updates hospital wear for patients" (United Press International, June 1999)

"Diane von Furstenberg Redesigns the Hospital Gown" (GOOD, September 2010)

"The Hospital Gown Gets a Modest Redesign" (The New York Times, January 2018)

Each redesign, of course, targets the old-school, butt-baring gown that's long been a touchstone of cultural commiseration in movies, TV, and comic strips.

But if everyone agrees that the old garments are horrible, and if fashion designers — working with doctors and nurses, no less — have created better gowns, why are we still having this conversation?

The higher cost of new gowns is a big reason why many hospitals still use traditional tie-in-the-back johnnies. In addition, some fans of the old design think the new versions aren't patient-friendly enough, and the standard ones are just fine; they're convenient and functional, giving easy access to parts of the body clinicians need to poke and prod.

"There's now an effort to be more patient-centric, but really it's the institutional viewpoint of what patient-centric means, not the individual's viewpoint," said Timothy Andrews, a health industry analyst at Booz Allen Hamilton, a Virginia-based consultancy. Andrews said he visits Boston hospitals regularly for diabetes and dermatology checkups, and he continues to receive traditional tie-in-the-back gowns.

"You might as well just walk around naked," he said. "It's probably easier — just give us a belt and a loincloth."

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What to Say When You Meet the Angel of Death at a Party - The New York Times

Every 90 days I lie in a whirling CT machine, dye coursing through my veins, and the doctors look to see whether the tumors in my liver are growing. If they are not, the doctors smile and schedule another scan. The rhythm has been the same since my doctors told me I had stage IV colon cancer two and a half years ago. I live for three months, take a deep breath and hope to start over again. I will probably do this for the rest of my life. Whatever that means.

When my scan is over, I need to make clear to my friends and my family that though I pray to be declared cured, I must be grateful. I have three more months of life. Hallelujah.

So I try to put the news in a little Facebook post, that mix of sun and cloud. I am trying to clear the linguistic hurdles that show up on my chart. Noncurative. Stage IV. I want to communicate that I am hoping for a continued "durable remission" in the face of no perfect cure, but the comments section is a blurry mess of "You kicked cancer's butt!" and "God bless you in your preparations."

It feels impossible to transmit the kernel of truth. I am not dying. I am not terminal. I am keeping vigil in the place of almost death. I stand in the in-between where everyone must pass, but so few can remain.

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