Longer looks: 'Abandoning' patients; commiting people with mental illness; treating PTSD

May 30 2014

Health Affairs: 'I Don't Want Jenny To Think I'm Abandoning Her': Views On Overtreatment
For years I had tried and failed to understand why so many of my physician colleagues persisted in ordering tests, procedures, and treatments that seemed to provide no benefit to patients and even risked harming them. I didn't buy the popular and cynical explanation: Physicians do this for the money. It fails to acknowledge the care and commitment that these same physicians demonstrate toward their patients. Besides, Jenny's oncologist would make no money from the intrathecal chemotherapy procedure. Instead, the impulse motivating him to order more tests and interventions was as an expression of his continued commitment to helping her. ... His words transformed my understanding of what I've viewed as inexplicable behavior in the face of progressive and terminal illness (Dr. Diane E. Meier, May 2014).

The Health Care Blog: Will Tech Revolutionize Health Care This Time?
After decades of bravely keeping them at bay, health care is beginning to be overwhelmed by "fast, cheap, and out of control" new technologies, from BYOD ("bring your own device") tablets in the operating room, to apps and dongles that turn your smart phone into a Star Trek Tricorder, to 3-D printed skulls. ... Each new category, we are told, will Revolutionize Health Care .... Yet the experience of the last three decades is that each new technology only adds complexity and expense. ... In an insurance-supported fee-for-service system, we don't get paid to solve problems. We get paid to do stuff that might solve a problem. The more stuff we do, and the more complex the stuff we do, the more impressive the machines we use, the more we get paid (Joe Flower, 5/28). 

The Atlantic: Confusing Mental-Health Intervention And Violence Prevention
So why didn't law enforcement detain Elliot Roger, or any of the other recent mass shooters who had some contact or had some concern raised about their wellbeing before they went on to kill? ... The question of using the civil mental health system to involuntarily detain someone who hasn't committed a crime, but who we fear may commit one at some point in the future is fundamentally one of human rights. The civil mental health system is set up the way it is now, with strict rules guiding how it can be used to treat someone without their consent and tight checks and balances against abuse including repeated hearings in front of a judge every few days to prevent someone from being unnecessarily detained, to protect citizens from others using the system against them for abusive reasons (Jeff Deeney, 5/26).

The New York Times: A Revolutionary Approach To Treating PTSD
Psychomotor therapy is neither widely practiced nor supported by clinical studies. In fact, most licensed psychiatrists probably wouldn't give it a second glance. It's hokey-sounding. It was developed by a dancer. But [Dr. Bessell] van der Kolk believes strongly that dancers -; and musicians and actors -; may have something to teach psychiatrists about healing from trauma and that even the hokey-sounding is worthy of our attention. He has spent four decades studying and trying to treat the effects of the worst atrocities we inflict on one another: war, rape, incest, torture and physical and mental abuse. ... If there's one thing he's certain about, it's that standard treatments are not working. Patients are still suffering, and so are their families. We need to do better (Jeneen Interlandi, 5/22).

The New Republic: The Media Forgets That AIDS Is Still An Epidemic, But Hollywood Doesn't
Given the paucity of coverage in the media lately, audiences can be forgiven for not thinking much about the disease. After all, AIDS is hardly the scourge it once was, and the proliferation of advanced antiretroviral medication means most people with HIV who get treatment will live long with few complications. ... Perhaps AIDS gets less coverage today because the face of the disease has changed. Today, Hispanic and African American populations are disproportionately affected, and new HIV infections appear to be rising in areas like the Deep South, where there's less access to adequate healthcare and the stigma of HIV remains high (Eric Sasson, 5/26).

Medscape: Doctors Are Talking: EHRs Destroy the Patient Encounter
There's no doubt that electronic health records (EHRs) spark strong emotions in doctors -- and many of those emotions are negative. The gripes cover three main areas: One, EHRs have made the patient encounter far more annoying and complex than it ever was before. Two, many physicians feel that EHRs take doctors who were trained to be independent thinkers and constrain their ability to make independent decisions, causing them to feel like data entry clerks, with a computer telling them how to practice medicine. Last but not least, a large number of physicians feel that EHRs erode the doctor-patient relationship by creating a barrier between the two (Neil Chesanow, 5/22).