Longer reads: Connecting with patients; obesity origins; children with chronic disease

Jan 17 2014

Every week reporter Ankita Rao selects interesting reading from around the Web.

NPR: 5 Simple Habits Can Help Doctors Connect With Patients
I'd never [before] been encouraged to sit at a patient's bedside -; to stop hurrying for even a moment. Our medical teachers put a premium on accuracy and efficiency, which became conflated with speed. Everything had to be fast. In 2014, doctors still value speed and technical accuracy, but we also do more to consider the quality of care we give and whether patients are satisfied with it. Those goals aren't just the right thing to do. There are often financial strings attached to getting them right (John Henning Schumann, 1/11).

MedPage Today: 10 Questions: Lucian Leape, MD
What's the biggest barrier to practicing medicine today? That's just one of the 10 questions the MedPage Today staff is asking clinicians, researchers, and leaders in their community to get their personal views on their chosen profession. Here's the answer to that question and the other nine from Lucian Leape, MD, of the Harvard School of Public Health. Leape graduated with honors from Harvard Medical School in 1959 and later trained in general and thoracic surgery at the Massachusetts General Hospital and pediatric surgery at Boston Children's Hospital. Leape is recognized as a leader of the patient safety movement. He published the seminal article "Error in Medicine" in the Journal of the Ameri­can Medical Association in 1994 (David Pittman, 1/12).

The Atlantic: Where Does Obesity Come From
A new article by John Cawley in NBER Reporter, "The Economics of Obesity," poses an interesting question right at the top. Why study obesity like an economic problem, anyway? There are two broad answers. The first is simply methodological. Understanding the causes and consequences of obesity is hard because scientists like randomized experiments -- e.g.: give one group drug X, give another group a placebo, and observe the difference. But this is almost impossible to do with weight. It's unethical to randomly make participants obese just to watch what happens to them. So, it's useful to study compare data and try to find out how income and obesity are actually related. Essentially: To study weight like an economist (Derek Thompson, 1/14).

The New Yorker: Lives Less Ordinary
Gwen Lorimier is eleven years old and has been in and out of hospitals all her life. When she was one and a half, she was given a diagnosis of a rare disorder of the mitochondria, the tiny structures within cells that generate most of the body's energy. Viewed under a microscope, her muscle fibers, rather than being neatly arranged in rows, are frayed and disorganized. In cases like Gwen's, the condition takes an especially hard toll on the liver, the gastrointestinal tract, and other organs and tissues that require large amounts of energy. But when we first met, in the dark-wood surgery library at Boston Children's Hospital, Gwen showed no outward traces of being sick. She has long chestnut hair, a bright face, and horn-rimmed reading glasses, and she was animated and uncannily sharp. When we sat down to talk, she glanced at her parents, Kim and Sue, to let them know that she was in charge of the conversation (Jerome Groopman, 1/20).

Modern Healthcare: Kindred Seeks To Shake Up Post-Acute Care Continuum
Kindred Healthcare, the nation's largest provider of post-acute care, traditionally focused its business on running skilled-nursing facilities. Just three years ago, SNFs accounted for nearly 47% of the publicly traded company's total business. Fast forward to 2013, when the Louisville-based firm completed the first phase of a repositioning strategy that will reduce its SNF operations to about 21% of total business this year. Since 2010, it has steadily expanded its home health and rehabilitation services divisions through acquisitions of smaller providers. The goal is to develop a coordinated model for acute and post-acute care that experts say represents the future for post-acute providers (Steven Ross Johnson, 1/11).

The New York Times: His Heart, My Sleeve: Writing About My Brother
On my 40th birthday, I began writing an essay about my brother, Robert, who, for the previous 16 years, had been in and out of mental hospitals. My intention was to write about his life as a patient, and also about the life he'd led before, when he was a bright, gifted young man who showed no signs, until his first breakdown at the age of 19, that any mental problems were likely or inevitable. When I began to write, though, I found I was writing as much about what it was like to be the brother of someone afflicted with mental illness as I was about Robert. I wrote about my frustrations in trying to get decent care and treatment for him, and I wrote -- more -- about my feelings of guilt. ... To publish the essay, I quickly came to believe, would be to exploit the misery of his life in order to advance my life as a writer. I abandoned the project and decided to stick with fiction (Jay Neugeboren, 1/13).

Health Affairs: Speaking Up About The Dangers Of The Hidden Curriculum
A medical student's fear of raising questions endangered a patient. Here, as a resident, he explores the dangers of this "hidden curriculum" with his advisers. ... Andrea had suffered a minor vaginal laceration, a common complication that many women experience during labor. The resident turned to close the tear, calling me back to the foot of the bed to deliver the placenta (that is, to remove the placenta from the uterus as a part of standard postdelivery care). I paused for several seconds. I'd never delivered one before, I eventually said aloud. I'd only observed. ... The cord came out smoothly at first ... until suddenly, without warning, the cord went slack. I glanced down in disbelief at its torn edge, dangling from my hand. Jets of blood sprayed across my gown. "Oh my God," the resident said from behind me. She looked into my eyes. "You tore the cord" (Joshua M. Liao, Eric J. Thomas and Sigall K. Bell, 1/14).