tag:blogger.com,1999:blog-46219429530547369402023-11-16T06:17:44.938-05:00Psychology of MedicineSome links and readings posted by Gary B. Rollman, Emeritus Professor of Psychology, University of Western OntarioUnknownnoreply@blogger.comBlogger3148125tag:blogger.com,1999:blog-4621942953054736940.post-2257335286956094062020-10-09T12:31:00.001-04:002020-10-09T12:31:47.372-04:00It shouldn't take medical training to help a loved one get great care - STATOn the day I was supposed to start my intensive care unit rotation as a fourth-year medical student, I walked into an ICU 3,000 miles away as a visitor.
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<br>My dad, who has been living with cancer since my first year of medical school, was recovering from emergency surgery for an infection. Awake but unable to speak because of a plastic tube in his airway, he grabbed a piece of paper and scribbled, "Glad you're here." Unable to find my own voice, I nodded in agreement.
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<br>In the weeks that followed, I was reintroduced to the health care system I thought I already knew. Despite knowing how much compassionate and endless effort doctors, nurses, and other clinicians put into patient care, I was humbled by seeing my father and family struggle to understand the care he needed, and by how much effort it took on our part to ensure he received it.
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<br><a href="https://www.statnews.com/2020/10/09/it-shouldnt-take-medical-training-ensure-loved-one-gets-great-care/">https://www.statnews.com/2020/10/09/it-shouldnt-take-medical-training-ensure-loved-one-gets-great-care/</a>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-30959274083760057742020-09-14T20:08:00.001-04:002020-09-14T20:08:48.959-04:00NYTimes: ‘The Undying,’ an Extraordinary and Furious New Memoir About CancerThe pink ribbon, that ubiquitous emblem of breast cancer awareness, has long been an object of controversy and derision, but the poet and essayist Anne Boyer doesn't just pull it loose, unfastening its dainty loop; she feeds it through a shredder and lights it on fire, incinerating its remains.
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<br>"The world is blood pink with respectability politics," she writes, "as if anyone who dies from breast cancer has died of a bad attitude or eating a sausage or not trusting the word of a junior oncologist."
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<br>Boyer's extraordinary and furious new book, "The Undying," is partly a memoir of her illness, diagnosed five years ago; she was 41 years old when she learned that the lump in her breast was triple-negative cancer, one of the deadliest kinds. But her story, told with searing specificity, is just one narrative thread in a book that reflects on the possibility — or necessity — of finding common cause in individual suffering.
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<br><a href="https://www.nytimes.com/2019/09/10/books/review-undying-cancer-anne-boyer.html">https://www.nytimes.com/2019/09/10/books/review-undying-cancer-anne-boyer.html</a>?Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-63956803363638943672020-01-14T11:21:00.001-05:002020-01-14T11:21:21.750-05:00Inside Google’s Quest for Millions of Medical Records - WSJRoughly a year ago, Google offered health-data company Cerner Corp. an unusually rich proposal.
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<br>Cerner was interviewing Silicon Valley giants to pick a storage provider for 250 million health records, one of the largest collections of U.S. patient data. Google dispatched former chief executive Eric Schmidt to personally pitch Cerner over several phone calls and offered around $250 million in discounts and incentives, people familiar with the matter say.
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<br>Google had a bigger goal in pushing for the deal than dollars and cents: a way to expand its effort to collect, analyze and aggregate health data on millions of Americans. Google representatives were vague in answering questions about how Cerner's data would be used, making the health-care company's executives wary, the people say. Eventually, Cerner struck a storage deal with Amazon.com Inc. instead.
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<br>The failed Cerner deal reveals an emerging challenge to Google's move into health care: gaining the trust of health care partners and the public. So far, that has hardly slowed the search giant.
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<br>Google has struck partnerships with some of the country's largest hospital systems and most-renowned health-care providers, many of them vast in scope and few of their details previously reported. In just a few years, the company has achieved the ability to view or analyze tens of millions of patient health records in at least three-quarters of U.S. states, according to a Wall Street Journal analysis of contractual agreements.
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<br>In certain instances, the deals allow Google to access personally identifiable health information without the knowledge of patients or doctors. The company can review complete health records, including names, dates of birth, medications and other ailments, according to people familiar with the deals.
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<br>The prospect of tech giants' amassing huge troves of health records has raised concerns among lawmakers, patients and doctors, who fear such intimate data could be used without individuals' knowledge or permission, or in ways they might not anticipate.
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<br><a href="https://www.wsj.com/articles/paging-dr-google-how-the-tech-giant-is-laying-claim-to-health-data-11578719700">https://www.wsj.com/articles/paging-dr-google-how-the-tech-giant-is-laying-claim-to-health-data-11578719700</a>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-18418157521432302752020-01-14T10:31:00.001-05:002020-01-14T10:31:16.404-05:00What to Say to Someone With Cancer - The New York TimesDo you know what to say or what to do when a friend, relative or acquaintance has cancer?
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<br>Chances are, like many of the people who interacted with Lynda Wolters, you may not. Ms. Wolters, author of the recently published book "Voices of Cancer," was found in midlife to have a relatively rare and currently incurable cancer called mantle cell lymphoma.
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<br>"Because people had no idea what to say to me, for me, or about me, they often avoided me instead," she wrote, prompting her to reach out to strangers in support groups for spiritual strength.
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<br>Those who did speak to Ms. Wolters too often said something unhelpful or off-putting like "Call me if you need anything" or "How are you feeling?" In her blog, she sought to reassure hesitant friends: "I would rather see your face and the pain and fear in your eyes than to have you feel too unsure and awkward to see me. I would rather hear about you, your work, your life, your kids and your puppy's antics than I would about my sickness."
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<br><a href="https://www.nytimes.com/2020/01/13/well/live/what-to-say-to-someone-with-cancer.html">https://www.nytimes.com/2020/01/13/well/live/what-to-say-to-someone-with-cancer.html</a>?Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-90250232101045295742020-01-09T21:00:00.001-05:002020-01-09T21:00:47.367-05:00These Patients Are Hard to Treat - The New York TimesIn the quest to reduce health care spending in the United States, the idea held incredible promise: By addressing the medical and social needs of the most expensive patients, you could keep them out of the hospital.
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<br>These individuals, frequently struggling with addiction or homelessness, have extremely complicated medical conditions. By finding them and connecting them to the right doctors and social services, dozens of costly hospital stays could be avoided. The idea has been adopted in numerous communities around the country.
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<br>Dr. Jeffrey Brenner, a family physician in New Jersey, founded the Camden Coalition of Healthcare Providers in 2002. He created teams of nurses, social workers and others to coordinate the care of people he saw cycle in and out of the hospital. Dr. Brenner, who was profiled in a 2011 New Yorker piece, "The Hot Spotters," and who won a MacArthur Foundation fellowship — known as a "genius" grant — in 2013, became the program's chief evangelist.
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<br>But a new study, published Wednesday in the New England Journal of Medicine, showed that the Camden program did not result in fewer hospital readmissions in the six months after a patient left the hospital. While the program appeared to lower readmissions by nearly 40 percent, the same kind of patients who received regular care saw a nearly identical decline in hospital stays.
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<br><a href="https://www.nytimes.com/2020/01/08/health/camden-coalition-chronic-illness.html">https://www.nytimes.com/2020/01/08/health/camden-coalition-chronic-illness.html</a>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-26452232929835234042020-01-05T22:07:00.001-05:002020-01-05T22:07:34.506-05:00How one medical checkup can snowball into a ‘cascade’ of tests, causing more harm than good - The Washington PostMy pager emits the same urgent beep no matter the occasion. That afternoon, it was the local preoperative clinic to say my 80-something patient, Lily, had been given an electrocardiogram (EKG) "just to be safe" before a minor office procedure.
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<br>The EKG was a little off, the page went on. Could I take a look? Lily (I'm identifying her by only her first name at her request) felt fine. No chest pain. No trouble breathing. But now that the irregularity was out there, the procedure would be delayed until we had answers.
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<br>Flash forward one borderline blood test result, several phone calls between myself, Lily, and the anesthesiologist, 14 emails, an office visit, and a completely normal stress test. Lily (and her heart) were in no better health, yet she was slightly less well off and more than slightly distressed by all the trouble she went through. I was disappointed that I'd failed her.
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<br>And this was a relatively good outcome.
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<br>"If You Give a Mouse a Cookie," Laura Numeroff's classic children's book, is a cautionary tale about the downstream consequences of a single, seemingly innocuous decision. You gave the mouse the cookie. Naturally, he wanted a glass of milk to go with it. Before long, the mouse was moving in and sharing your ­Netflix password.
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<br>This pattern is familiar to many of us, whether as doctors or as patients: A medical test spurs a "cascade" of phone calls, office visits, tests and treatments, each a logical, even inevitable, progression from the one before.
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<br><a href="https://www.washingtonpost.com/health/how-one-medical-checkup-can-snowball-into-a-cascade-of-tests-causing-more-harm-than-good/2020/01/03/0c8024fc-20eb-11ea-bed5-880264cc91a9_story.html">https://www.washingtonpost.com/health/how-one-medical-checkup-can-snowball-into-a-cascade-of-tests-causing-more-harm-than-good/2020/01/03/0c8024fc-20eb-11ea-bed5-880264cc91a9_story.html</a>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-86351917835919568932020-01-04T07:01:00.001-05:002020-01-04T07:01:14.391-05:00She Is 96 and Does Not Fear Her Death. But Do Her Children? - The New York TimesIt was the year of saying goodbye.
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<br>In 2015, The Times began following six people age 85 and up, documenting their journeys through a stage of life that is often invisible.
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<br>Four were still alive at the start of 2019. Jonas Mekas, 96, began the year at home from the hospital, tired, hoping to finish a film he was making for a performance of Verdi's Requiem. "Another year," he said last New Year's Day. "Hope it will be busy and productive."
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<br>On Jan. 23, he asked his son, Sebastian, to sit him upright in a chair — a preparation, Sebastian said, for his spirit to go forward to the next adventure. He died at the small wooden table where he'd sat with so many friends.
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<br>Jonas was the last of the three men in the Times series. Of the three women, two also died in 2019. Both were 95.
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<br>In late December, Ruth Willig, 96, learned that she was the only one left. "Ohhhh," she said, taking it in. "What happened? Am I the only one? I'm going to cry."
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<br>Death had been a regular part of our conversations over the past five years, as it had been with the others. Ruth had been consistent: she did not worry much about death, but she did think about how she would go. Would it be painful or drawn out? Would she become a burden to her children?
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<br>"You saw I was almost crying before when you told me about that," she said. "It really hit me. I can't believe…." She stopped.
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<br>Finally, she said, "I'm ready, I am. But I worry about my children. They're so devoted to me. It scares me."
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<br><a href="https://www.nytimes.com/2020/01/03/nyregion/ruth-willig-oldest-death.html">https://www.nytimes.com/2020/01/03/nyregion/ruth-willig-oldest-death.html</a>?Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-59395987464571353772020-01-04T06:58:00.001-05:002020-01-04T06:58:41.404-05:00Older People Need Geriatricians. Where Will They Come From? - The New York TimesLinda Poskanzer was having a tough time in her late 60s.
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<br>"I was not doing well emotionally," she recalled. "Physically, I didn't have any stamina. I was sleeping a lot. I wasn't getting to work."
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<br>A therapist in Hackensack, N.J., Ms. Poskanzer was severely overweight and grew short of breath after walking even short distances. Her house had become disorganized, buried in unsorted paperwork. The antidepressant she was taking didn't seem to help.
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<br>Her son, visiting from Florida, called his sisters and said, "Mommy needs an intervention."
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<br>One of her daughters made an appointment with a geriatrician — a physician who specializes in the care of older adults. Dr. Manisha Parulekar, now chief of geriatrics at Hackensack University Medical Center, suggested her new patient take action on several fronts. She arranged for a sleep study, which found that Ms. Poskanzer suffered from apnea. She prescribed a different antidepressant, and physical therapy in a pool to help rebuild her stamina.
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<br>And weight loss. Eventually, the geriatrician agreed that bariatric surgery made sense. Over nine months, Ms. Poskanzer lost 75 pounds; she has shed another 15 since.
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<br>Now about to turn 80, Ms. Poskanzer is still providing therapy, 30 hours each week, feels "full of spirit" and continues to see her geriatrician every four months. "She sits and talks, which a lot of doctors don't do anymore," Ms. Poskanzer said. "And she knows me. I feel very well taken care of."
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<br>Testimonials like this spotlight the rising need for geriatricians. These doctors not only monitor and coordinate treatment for the many ailments, disabilities and medications their patients contend with, but also help them determine what's most important for their well-being and quality of life.
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<br><a href="https://www.nytimes.com/2020/01/03/health/geriatricians-shortage.html">https://www.nytimes.com/2020/01/03/health/geriatricians-shortage.html</a>?Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-31917233340109622062020-01-03T06:20:00.001-05:002020-01-03T06:20:18.162-05:00Opinion | Why Are You Publicly Sharing Your Child’s DNA Information? - The New York TimesA few years ago, Angela Evans decided she wanted to test the DNA of her 10-year-old daughter and 7-year-old son. She was interested in knowing whether they had a mutation of the MTHFR gene, as she does. The mutation is linked to a number of disorders — women with the mutation may have a higher risk of having babies with defects like spina bifida — and Ms. Evans wanted to make life changes for her children based on the results.
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<br>When doctors told her they didn't think there was a medical need to test her children, she decided to use 23andMe, the direct-to-customer genetic testing company.
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<br>To use 23andMe's services, the user simply sends in a saliva sample. Within five weeks the company returns the results, without the mediation of a doctor or genetic counselor.
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<br>Along with finding out that both her children had a mutation of the MTHFR gene, she also received 23andMe's analysis of her children's genetic susceptibility to a number of adult-onset diseases, including Parkinson's. Ms. Evans shared the results with her children, family members and friends.
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<br>Then she uploaded their DNA data to MyHeritage and GEDmatch hoping to learn more about the family's genealogy. Sites like GEDmatch and others are "open-source databases" on which people freely share their DNA online, usually in the hopes of finding long-lost relatives.
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<br><a href="https://www.nytimes.com/2020/01/02/opinion/dna-test-privacy-children.html">https://www.nytimes.com/2020/01/02/opinion/dna-test-privacy-children.html</a>?Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-61983607456038840432020-01-01T22:53:00.001-05:002020-01-01T22:53:52.765-05:00NYTimes: Doctors, Nurses and the Paperwork Crisis That Could Unite ThemBroken, wasteful, inhuman, expensive, deadly. The problems with the American health care system, or non-system, are neither subtle nor unrecognized — especially by those of us doctors and nurses who actually provide the care. And yet we all too often feel the most helpless, seeing how much of the problem is driven by drug companies and hospital networks.
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<br>Too often, each profession sees the other as fighting separate battles, and sometimes against each other. Doctors blame nurses, and vice versa, for the failings of a system that punishes us all, and our patients.
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<br>Instead, the two of us are suggesting that nurses and doctors try something unusual. Let's put our differences aside and work together to achieve real change, starting with a pernicious problem that drives so much of our mutual discontent: electronic health records.
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<br>The current system is pushing both doctors and nurses to the breaking point. Enough doctors in the United States commit suicide every year to fill two large medical school classes. A 2019 MedScape report found that 44 percent of physicians feel "burned out," driving many to alcoholism and depression, or to leave the profession entirely.
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<br>Nurse suicides are not systematically measured and reported, but a 2017 study in England found a suicide rate among nurses that was 23 percent above the national average. Half of all nurses are considering leaving the profession, according to a 2017 study by RNnetwork.
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<br>Clinicians are notoriously overworked, but ask anyone on a hospital staff, and he or she will tell you that workloads have become heavier the last several years thanks almost entirely to the arrival of electronic health records — detailed reports about a patient's medical history and care. Originally intended as a work-saving tool, the records have gone in the opposite direction, taking time away from patient care in the name of electronic box-checking.
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<br><a href="https://www.nytimes.com/2019/12/31/opinion/doctors-nurses-and-the-paperwork-crisis-that-could-unite-them.html">https://www.nytimes.com/2019/12/31/opinion/doctors-nurses-and-the-paperwork-crisis-that-could-unite-them.html</a>?Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-65621066329992414212020-01-01T12:16:00.001-05:002020-01-01T12:16:42.295-05:00When the Surgeon Is a Mom - The New York TimesAs a health care professional, Dr. Erika Rangel is trained to know when things are going wrong. That alarm went off one day in her fourth year of surgical residency. Her son, just 3 months old, had developed a fever. She couldn't be late for her operating shift, but his day care wouldn't accept him if he was sick. So she did what desperate mothers do and got inventive: She slipped liquid Tylenol into his bottle, in the hopes of lowering his temperature, and dropped him off.
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<br>Later that day, she stood in surgery with her eyes continually checking the clock, willing the operation to finish in time for pickup. She prayed that the day care wouldn't realize he was feverish. Had they noticed that his milk had turned medicine pink?
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<br>"I felt like I wasn't being a great mom or partner or resident," said Dr. Rangel, 42, now an assistant professor of surgery at Harvard Medical School. "Something had to give. I thought about quitting a lot."
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<br>When Dr. Rangel was in medical school, she searched diligently for a specialty that she liked as much as surgery. Her friends cautioned her that if she became a surgeon, she would never have a personal life. She wouldn't have time for children, they warned — and what man would want a spouse who was constantly in the operating room?
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<br>"It became a tug of war between choosing a lifestyle profession versus something I truly loved with all my heart," Dr. Rangel said. "I chose surgery in spite of all the warnings, and I've spent my whole life navigating that balance."
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<br><a href="https://www.nytimes.com/2019/12/20/science/doctors-surgery-motherhood-medical-school.html?smid=nytcore-ios-share">https://www.nytimes.com/2019/12/20/science/doctors-surgery-motherhood-medical-school.html?smid=nytcore-ios-share</a>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-55053498409787350862019-12-23T14:36:00.001-05:002019-12-23T14:36:53.041-05:00Science can’t fix dementia’s most heartbreaking problem — QuartzOn a balmy weekday afternoon around the time spring was melting into summer, my partner and I made plans to meet up after work. We picked a spot in my neighborhood, which happens to be near the Nationals baseball stadium. As we sipped our beers and chatted about the week, my partner, Ben, saw two of our friends, Tom and Hannah, on their way to a baseball game. He waved them down and invited them to join us before the opening pitch.
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<br>It would have been a perfectly forgettable evening—pleasant and ordinary. DC is small enough that it's not too uncommon to run into friends. We hadn't seen Tom and Hannah for a bit, and I knew Tom had been visiting his hometown in Connecticut. "How's your family doing?" I asked.
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<br>Tom and Hannah exchanged glances.
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<br>"Actually, not great," he said.
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<br>A few months ago, he shared, his dad had abruptly lost his short-term memory. He'd be doing something like cooking a meal and forget what he was doing; he'd put the stove on and leave the room, or he'd be driving and forget where he was going. He was only 61.
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<br><a href="https://qz.com/1754535/how-to-talk-to-loved-ones-with-dementia/">https://qz.com/1754535/how-to-talk-to-loved-ones-with-dementia/</a>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-11319905530431556982019-12-16T10:44:00.001-05:002019-12-16T10:44:23.269-05:00The Hidden Drug Epidemic Among Older People - The New York TimesWhile news reports focus on an epidemic of opioid abuse among young adults, another totally legal and usually hidden drug epidemic is occurring at the other end of the age spectrum: the fistfuls of remedies — both prescription and over-the-counter — taken by older adults.
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<br>According to the American Association of Consultant Pharmacists, people aged 65 to 69 take an average of 15 prescriptions a year, and those aged 80 to 84 take 18 prescriptions a year. And that's in addition to the myriad over-the-counter drugs, herbal remedies, vitamins and minerals they may take, any of which — alone or in combination — could cause more problems than they cure.
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<br>Among people over 65, 44 percent of men and 57 percent of women take five or more nonprescription and/or prescription drugs a week, and 12 percent take 10 or more.
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<br><a href="https://www.nytimes.com/2019/12/16/well/live/the-hidden-drug-epidemic-among-older-people.html">https://www.nytimes.com/2019/12/16/well/live/the-hidden-drug-epidemic-among-older-people.html</a>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-57984062063185812452019-12-16T10:42:00.001-05:002019-12-16T10:42:49.203-05:00A Doctor’s Diary: The Overnight Shift in the E.R. - The New York TimesMy choices as a doctor in the emergency room are up or out. Up, for the very sick. I stabilize things that are broken, infected or infarcted, until those patients can be whisked upstairs for their definitive surgeries or stents in the hospital. Out, for everyone else. I stitch up the simple cuts, reassure those with benign viruses, prescribe Tylenol and send home.
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<br>Up or out is what the E.R. was designed for. Up or out is what it's good at. Emergency rooms are meant to have open capacity in case of a major emergency, be it a train crash, a natural disaster or a school shooting, and we are constantly clearing any beds we can in pursuit of this goal.
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<br>The problem is, traffic through the emergency room has been growing at twice the rate projected by United States population growth and has been for almost 20 straight years, despite the passage of the Affordable Care Act, and through both economic booms and recessions. Americans visit the E.R. more than 140 million times a year — 43 visits for every 100 Americans — which is more than they visit every other type of doctor's office in the hospital combined.
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<br>The demand is such that new E.R.s are already too small by the time they are built. Emergency rooms respond like overbooked restaurants during a chaotic dinner rush, with doctors pressed to turn stretchers the way waiters hurriedly turn tables. The frantic pace leaves little time for deliberating over the diagnosis or for counseling patients. Up, out.
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<br>Private exams on stretchers in hallways, patients languishing without attention for hours, nurses stretched to the breaking point; all of it has become business as usual. I think about this on nights like tonight, when I start my shift inheriting 16 patients in the waiting room. I think about what I will learn that these people need, and about what I will fail to provide.
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<br><a href="https://www.nytimes.com/2019/12/16/health/emergency-room-medicine.html">https://www.nytimes.com/2019/12/16/health/emergency-room-medicine.html</a>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-12756090627369660292019-12-14T14:19:00.001-05:002019-12-14T14:19:27.692-05:00Frail Older Patients Struggle After Even Minor Operations - The New York TimesThe patient, a man in his 70s, had abdominal pain serious enough to send him to a VA Pittsburgh Healthcare hospital. Doctors there found the culprit: a gallstone had inflamed his pancreas.
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<br>Dr. Daniel Hall, a surgeon who met with the patient, explained that pancreatitis can be fairly mild, as in this case, or severe enough to cause death. Recovery usually requires five to seven days, some of them in a hospital, during which the stone passes or a doctor uses a flexible scope to remove the blockage.
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<br>But "because it can be life-threatening, after patients recover, we usually take out the gall bladder to prevent its happening again," Dr. Hall said.
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<br>A cholecystectomy, as that operation is known, isn't high-risk surgery. When done with a laparoscope to avoid large incisions, it's usually an outpatient procedure.
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<br><a href="https://www.nytimes.com/2019/12/13/health/frail-elderly-surgery.html">https://www.nytimes.com/2019/12/13/health/frail-elderly-surgery.html</a>?Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-76459115103506406662019-12-14T14:18:00.001-05:002019-12-14T14:18:15.737-05:00A Runner Suddenly Developed Asthma. It Was Stranger Than It Seemed. - The New York TimesIt was chest pain that brought the 34-year-old woman to the emergency room at Montefiore Medical Center in the Bronx. She'd been coughing for days, but that morning the pain was so bad she was worried that it had turned into pneumonia. She tried to tough it out, but when it was no better by the end of the day, she decided to go to the E.R.
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<br>It took a few hours, but finally the physician assistant caring for her in the E.R. brought some good news. She didn't have pneumonia; she didn't have a clot in her lungs. This was just muscle strain from coughing. The year before, she was told she had asthma.
<br>She was given inhalers to stop the coughing and wheezing, but they didn't seem to do much. So she didn't use them.
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<br>The P.A. encouraged the woman to use her inhalers; they really would prevent the episodes of coughing and wheezing that had sent her to the E.R. so often that year. The woman nodded; she'd heard this speech before. The P.A. asked whether she'd like ibuprofen for the pain. Absolutely not, the patient said. After years of taking it for muscle pain after working out or racing, she had developed some kind of allergy to it. What about ketorolac? the P.A. offered. It's the same type of painkiller but a completely different compound.
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<br>Pain relief sounded appealing. But within seconds of getting the intravenous medication, the woman felt an intense pressure in her chest. Her windpipe narrowed as if she had something stuck in her throat. She tried to shout, "I can't breathe!" The only sound that came out was an unintelligible whisper.
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<br><a href="https://www.nytimes.com/2019/12/12/magazine/aspirin-exacerbated-respiratory-disease-aerd.html">https://www.nytimes.com/2019/12/12/magazine/aspirin-exacerbated-respiratory-disease-aerd.html</a>?Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-5159580437382905942019-12-13T18:22:00.001-05:002019-12-13T18:22:14.903-05:00Snapshots of My Patients - The New York TimesA little over a year ago, our electronic medical record started to include photographs of patients along with their medical information.
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<br>These thumbnail images, which appear at the top left-hand corner of the computer screen next to a name, age and birthdate, are intended as a safety measure, to help ensure that clinicians are placing orders and entering documentation for the correct patient when multiple patient records might be open simultaneously.
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<br>As I was scanning through my day's clinic schedule recently, I was struck by the different ways my patients approached taking the picture. All of them had been given a diagnosis of cancer, and many were dealing with a range of health issues. I found myself wondering whether these snapshots might give me further insight into how they viewed their medical conditions.
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<br>The standard photo is taken from a camera located at the registration desk, by the cancer center's main entrance. The photos are always taken at an upward angle, usually capturing my patients slightly off-center, with the lobby's drop ceiling and a couple of LED canister lights as an unflattering backdrop. Most don't smile — no fun fighting traffic into downtown Cleveland, searching for a parking spot, walking to our building and then having a doctor's appointment, often many times per week.
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<br>No fun having cancer.
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<br><a href="https://www.nytimes.com/2019/12/12/well/live/doctors-patients-electronic-medical-records-cancer-hospital.html">https://www.nytimes.com/2019/12/12/well/live/doctors-patients-electronic-medical-records-cancer-hospital.html</a>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-83065868530997983252019-11-29T16:55:00.001-05:002019-11-29T16:55:42.683-05:00Apple’s Reach Reshapes Medical Research - The New York TimesIn 1976, the Harvard School of Public Health and two other major medicalinstitutions started a study on nurses that has become one of the largest and longest research efforts ever conducted on women's health. They have so far enrolled more than 275,000 participants.
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<br>On Thursday, the Harvard school announced an even more ambitious women's health study, one that aims to enroll a million women over a decade.
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<br>The new ingredients allowing the huge scale: Apple's iPhones, apps and money.
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<br>Harvard's new study is just one of three new large research efforts that Apple is working on with leading academic research centers and health organizations. Together, the studies, which Apple is paying for, show how the Silicon Valley giant and its popular products are reshaping medical research.
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<br>To enroll in clinical trials, patients have often had to travel to medical centers to be briefed by researchers and fill out the study paperwork in person. Many studies also follow patients only intermittently, in periodic surveys and visits to hospitals.
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<br>But Apple tools are enabling large-scale virtual studies that can follow people as they go about their daily lives. The company has developed a research app for iPhones — which participants can download from its app store — that is helping researchers quickly and easily recruit hundreds of thousands of study volunteers.
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<br><a href="https://www.nytimes.com/2019/11/14/technology/apple-harvard-health-studies.html">https://www.nytimes.com/2019/11/14/technology/apple-harvard-health-studies.html</a>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-77688455235848575702019-11-11T11:54:00.001-05:002019-11-11T11:54:05.420-05:00Our Hospital’s New Software Frets About My ‘Deficiencies’ - The New York TimesWe had been waiting for this day for years — the day our hospital in San Francisco would shed its antiquated electronic health records system in favor of a more modern alternative called Epic, which has been, or will soon be, adopted by many of the nation's top medical centers.
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<br>Our hospital was full of strangers in turquoise T-shirts, called Epic Superusers, who provided "at the elbow support" for the staff, there to usher in the "death of the legacy system" (as the administrators' emails put it) and the birth of a new, well, epoch.
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<br>But on a recent Monday morning when I logged into so-called Epic Hyperspace for the first time, I was greeted with a pop-up box and an urgent message: "You currently have deficiencies that are either delinquent or will become delinquent within one week. Please complete at your earliest convenience."
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<br>I blinked. The words on my monitor were thick and black on a background of rich mustard yellow. On the left side of the message was an exclamation point inside a circle. Today was my first day using Epic. Had I already done something wrong?
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<br><a href="https://www.nytimes.com/2019/11/01/health/epic-electronic-health-records.html">https://www.nytimes.com/2019/11/01/health/epic-electronic-health-records.html</a>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-62802525916029080552019-11-11T11:26:00.001-05:002019-11-11T11:26:57.393-05:00Chronic Pain Eased With Meditation And Lower Doses Of Opioids : Shots - Health News : NPRThere's new evidence that mind-body interventions can help reduce pain in people who have been taking prescription opioids — and lead to reductions in the drug's dose.
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<br>In a study published this month in JAMA Internal Medicine, researchers reviewed evidence from 60 studies that included about 6,400 participants. They evaluated a range of strategies, including meditation, guided imagery, hypnosis and cognitive behavioral therapy.
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<br>"Mindfulness, cognitive behavioral therapy and clinical hypnosis appear to be the most useful for reducing pain," says study author Eric Garland, a professor at the University of Utah. The reductions in dose were modest overall, he says, but the study is a signal that this approach is beneficial.
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<br><a href="https://www.npr.org/sections/health-shots/2019/11/11/743065892/meditation-reduced-the-opioid-dose-she-needs-to-ease-chronic-pain-by-75">https://www.npr.org/sections/health-shots/2019/11/11/743065892/meditation-reduced-the-opioid-dose-she-needs-to-ease-chronic-pain-by-75</a>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-26746348754043827102019-10-23T11:13:00.001-04:002019-10-23T11:13:51.367-04:00Insurance companies aren’t doctors. So why do we keep letting them practice medicine? - The Washington Post<i class="">William E. Bennett Jr. is an associate professor of pediatrics at the Indiana University School of Medicine.</i><div class=""><i class=""><br class=""></i>We know how important it is to have insurance so that we can get health care. As a physician, parent and patient, I cannot overemphasize that having insurance is not enough.<br class=""><br class=""></div><div class="">As a gastroenterologist, I often prescribe expensive medications or tests for my patients. But for insurance companies to cover those treatments, I must submit a "prior authorization" to the companies, and it can take days or weeks to hear back. If the insurance company denies coverage, which occurs frequently, I have the option of setting up a special type of physician-to-physician appeal called a "peer-to-peer."<br class=""><br class=""></div><div class="">Here's the thing: After a few minutes of pleasant chat with a doctor or pharmacist working for the insurance company, they almost always approve coverage and give me an approval number. There's almost never a back-and-forth discussion; it's just me saying a few key words to make sure the denial is reversed.<br class=""><br class="">Because it ends up with the desired outcome, you might think this is reasonable. It's not. On most occasions the "peer" reviewer is unqualified to make an assessment about the specific services. They usually have minimal or incorrect information about the patient. Not one has examined or spoken with the patient, as I have. None of them have a long-term relationship with the patient and family, as I have.<br class=""><br class=""></div><div class="">The insurance company will say this system makes sure patients get the right medications. It doesn't. It exists so that many patients will fail to get the medications they need.<br class=""><br class="">More ...</div><div class=""><br class=""></div><div class=""><a href="https://www.washingtonpost.com/opinions/2019/10/22/insurance-companies-arent-doctors-so-why-do-we-keep-letting-them-practice-medicine/" class="">https://www.washingtonpost.com/opinions/2019/10/22/insurance-companies-arent-doctors-so-why-do-we-keep-letting-them-practice-medicine/</a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-88408262088906289662019-10-13T15:09:00.001-04:002019-10-13T15:09:56.145-04:00Overzealous in preventing falls, hospitals are producing an ‘epidemic of immobility’ in elderly patients - The Washington PostDorothy Twigg was living on her own, cooking and walking without help until a dizzy spell landed her in the emergency room. She spent three days confined to a hospital bed, allowed to get up only to use a bedside commode. Twigg, who was in her 80s, was livid about being stuck in a bed with side rails and a motion sensor alarm, said Melissa Rowley, her cousin and caretaker.
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<br>"They're not letting me get up out of bed," Twigg protested in phone calls, Rowley recalled.
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<br>In just a few days at the Ohio hospital, where she had no occupational or physical therapy, Twigg grew so weak that it took three months of rehab to regain the ability to walk and take care of herself, Rowley said. Twigg repeated the same pattern — three days in bed in a hospital, three months of rehab — at least five times in two years.
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<br>Falls remain the leading cause of fatal and nonfatal injuries for older Americans. Hospitals face financial penalties when they occur. Nurses and aides get blamed or reprimanded if a patient under their supervision hits the ground.
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<br>But hospitals have become so overzealous in fall prevention that they are producing an "epidemic of immobility," experts say. To ensure that patients will never fall, hospitalized patients who could benefit from activity are told not to get up on their own — their bedbound state reinforced by bed alarms and a lack of staff to help them move.
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<br>That's especially dangerous for older patients, often weak to begin with. After just a few days of bed rest, their muscles can deteriorate enough to bring severe long-term consequences.
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<br><a href="https://www.washingtonpost.com/health/overzealous-in-preventing-falls-hospitals-are-producing-an-epidemic-of-immobility-in-elderly-patients/2019/10/11/d1894374-d8ab-11e9-a688-303693fb4b0b_story.html">https://www.washingtonpost.com/health/overzealous-in-preventing-falls-hospitals-are-producing-an-epidemic-of-immobility-in-elderly-patients/2019/10/11/d1894374-d8ab-11e9-a688-303693fb4b0b_story.html</a>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-16056386537161893282019-10-10T12:21:00.001-04:002019-10-10T12:21:27.870-04:00Doctors Limit What to Tell Patients About Their DNA Test. Should They? - WSJThe Mayo Clinic is scanning 20,000 genes for thousands of patients to study genes' role in disease. It will hand over results for just 59.
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<br>Mayo will look for certain disease-causing gene variants for heart disease or breast cancer, and offer results to patients who have them. But it doesn't look at variants for early-onset Alzheimer's or Lou Gehrig's disease, meaning patients will remain in the dark.
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<br>"There is a risk of causing undue anxiety," said Dr. Keith Stewart, director of the Mayo Clinic's Center for Individualized Medicine.
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<br>DNA sequencing is creating vast amounts of data that promise to unlock the secrets of disease. But the information is being collected faster than the medical world can interpret what it all means. That is raising a question for doctors and scientists who perform the scans: How much should they tell patients?
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<br>The answer, often, is not much. Many clinics and studies will return only a few dozen results that researchers have deemed "medically actionable"—meaning they reveal genetic causes for conditions that can be treated.
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<br>Doctors often don't analyze and return other results because the risk of a trait isn't well-understood or because there is no treatment. Not everyone with disease-causing variants will end up with a related condition, because of other genetic and environmental factors. The risk may be low for some.
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<br>If told, some patients could seek unnecessary or harmful care, or unduly worry about a disease they may not get.
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<br>Some doctors, however, say it is paternalistic to withhold information if patients want it. Several studies have suggested that most patients want to learn their own genetic results.
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<br>"It's their body and their DNA. We have a responsibility to scientific truth and clear communication," including helping patients integrate results into their care, said Dr. Robert Green, a geneticist who is a professor at Harvard Medical School. He said doctors shouldn't "take the Jack Nicholson line, 'You can't handle the truth!' "
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<br><a href="https://www.wsj.com/articles/doctors-decide-what-to-tell-patients-about-their-dna-test-should-they-11570202161">https://www.wsj.com/articles/doctors-decide-what-to-tell-patients-about-their-dna-test-should-they-11570202161</a>?Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-7003254310896659192019-09-29T17:09:00.001-04:002019-09-29T17:09:54.095-04:00‘Out here, it’s just me’: In the medical desert of rural America, one doctor for 11,000 square miles - The Washington PostHe woke up to the sound of an ambulance's siren, knowing that the ambulance would soon be delivering another patient to him. Ed Garner, 68, changed into medical scrubs and walked out to his truck. He dialed the hospital as he started driving toward the emergency room.
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<br>"Any idea what might be coming?" he asked, but all anyone knew for certain was that the ambulance was still on its way out to a patient. Sometimes the paramedics were back within minutes, and other trips took nearly two hours. Sometimes they delivered Garner a patient in minor distress, and other times they brought him unresponsive victims of car crashes, heart attacks, drug overdoses or ranching accidents.
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<br><a href="https://www.washingtonpost.com/national/out-here-its-just-me/2019/09/28/fa1df9b6-deef-11e9-be96-6adb81821e90_story.html">https://www.washingtonpost.com/national/out-here-its-just-me/2019/09/28/fa1df9b6-deef-11e9-be96-6adb81821e90_story.html</a>?Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4621942953054736940.post-39121190777620459772019-09-29T17:08:00.001-04:002019-09-29T17:08:13.028-04:00What a 'good death' actually looks like - The Washington PostAt age 86, my father had survived both colon cancer and a stroke that left him with aphasia. His mind was sharp, though, and he wasn't depressed. A crack bridge player with a passion for Italian restaurants, he was popular at his assisted living facility even though he couldn't speak much. He told me he'd lived a good life and wasn't afraid of dying, and he didn't want to go through any more medical trauma. No chemo, no radiation, no surgeries, no treatment.
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<br>His advance directive read DNR and DNI — do not resuscitate, do not intubate. No one would break his ribs doing CPR or make bruises bloom along his arms trying to find a vein. As his health-care proxy, I was completely on board. I'd read Sherwin Nuland's "How We Die," Atul Gawande's "Being Mortal," Elisabeth Kubler-Ross's "On Death and Dying." Comfort would be the priority and any pain would be "managed," which I assumed meant erased.
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<br><a href="https://www.washingtonpost.com/health/whats-a-good-death-its-not-quite-the-peaceful-drifting-off-id-imagined-for-my-dad/2019/09/27/f754c4cc-cf35-11e9-87fa-8501a456c003_story.html">https://www.washingtonpost.com/health/whats-a-good-death-its-not-quite-the-peaceful-drifting-off-id-imagined-for-my-dad/2019/09/27/f754c4cc-cf35-11e9-87fa-8501a456c003_story.html</a>?Unknownnoreply@blogger.com