Summary of “How Do You Talk to Your Patients About Death?”

Instead of admitting patients from the emergency room and addressing all of their medical problems throughout their hospital stay, I saw patients only when another doctor requested a consultation for a patient, usually to treat certain symptoms and to talk with patients and families about their treatment goals-what patients considered most important and dear to them when living with a serious illness.
I’d gone from assuming that many of my patients would live for years after their hospital stays to knowing that some of my patients would die within the coming weeks or months after returning home.
“No, it’s your first day! So on our team we have two nurses and an attending physician and me. Everyone usually shows up for rounds at 9:30 or so, and we will talk about each of the patients on our list. The attending this month is Dr. Harris, and she’ll assign you a few patients to see. Oh, and you’ll need that,” she said, motioning to a pager on the corner of my cubicle.
Businesslike and efficient as she introduced herself, Dr. Harris told me that her day was packed with meetings, but that she would assign me several patients to see and we would talk about them later in the afternoon.
Almost all of our patients required family meetings, and some also required better control of pain.
The biggest shift was my new relationship to language, my attention newly focused on the words I used with patients and colleagues, and the words I heard them use.
“Take note of how long the oncology fellow talks before allowing the family to speak.” The oncologist, a brown-haired man with a kind face, spoke for twenty-five minutes about the gravity of the patient’s diagnosis, the chemotherapies that theoretically could be used, and all the reasons why the patient was too sick to qualify for them.
A patient with a failing liver asked me how much time I thought he had to live and begged me not to mince my words.

The orginal article.

Summary of “This is what it’s like waking up during surgery”

Nearly all the patients included said they heard voices or other sounds under general anaesthesia.
Estimates of how often anaesthesia awareness happens have varied depending on the methods used, but those relying on patient reports had tended to suggest it was very rare indeed.
The results, published in 2014, found that the overall prevalence was just 1 in 19,000 patients undergoing anaesthesia.
During the induction of the anaesthesia, the staff place a cuff around the patient’s upper arm that delays the passage of the neuromuscular agent through the arm.
“My view is that the patient is expecting to be unconscious, and, as a researcher who wants to understand the mechanisms at play, but also a clinician who wants to deliver high-quality care and meet the expectations of the patient, we are duty-bound to understand this balance and to find out the true rates and the true impact of those events, whether they have any impact or not, and the ways we can curtail them.”
Having gained strength in the years following the trauma, Donna is now trying to remedy the problem, by working with Canadian universities to educate doctors about the risks of anaesthesia awareness and the best ways to treat patients.
Although widespread signalling across the brain appears to be impaired when people are under general anaesthesia, there is evidence that certain areas – including the auditory cortex – remain responsive, suggesting that medical staff might be able to send suggestions and encouragement, while a patient is unconscious, to reduce their pain after surgery.
Clearly, no one is suggesting that you would keep a patient fully aware on purpose, but perhaps one day more anaesthetists will be able to make use of the brain’s ability to absorb information on the operating table.

The orginal article.

Summary of “”Mom, When They Look at Me, They See Dollar Signs” – Mother Jones”

The brokers, often current or former drug users, troll for customers on social media, at Narcotics Anonymous meetings, and on the streets of treatment hubs such as the Florida coast and Southern California’s “Rehab Riviera.” The rehabs themselves exist in a quasi-medical realm where evidence-based care is rare, licensed medical staffers are optional, conflicts of interest are rampant, and regulation is stunningly lax.
The demand for treatment, the increasingly white face of addiction, and recent laws requiring insurers to cover substance use services have all resulted in a surge in rehab spending and private investment.
Dozens of drug users and parents I spoke with had tales like Brianne’s, and “There are probably thousands” of others, according to Karen Hardy, a Maine addiction counselor whose own son shuffled among dozens of rehabs.
Overdose fatalities are soaring Deaths Money is pouring into addiction treatment Private insurance claims for opioid users And for-profit providers are increasing their market share Rehab attendance.
Not so with addiction treatment: “If I’m a Malibu rehab, I get to bill the insurance company when you come,” says Greg Williams, executive vice president of the nonprofit advocacy group Facing Addiction.
“If you type in ‘heroin addiction’ or ‘methamphetamine addiction,'” he said, “You’re probably going to come across one of our websites.” These sites include rehab referral platforms such as Recovery.org and Rehabs.com.
At the time, “I’m this homeless drug addict that got clean and was offered a chance.” She said she went through 23 rehab programs before her mom learned, on Facebook, about a Florida treatment center that turned her life around, and that she is proud of having helped dozens of people find treatment-some still send Christmas cards and recovery updates: “My only intention was to help other people in a similar position to me.”
Finally, the rehab industry’s main trade group, the National Association of Addiction Treatment Providers, has revised its code of ethics to prohibit members from “Buying and sellingpatient leads” or “Offering inducements and non-clinical amenities to prospective patients.” In January 2018, the association told 76 of its roughly 800 member organizations­-including AAC, because of the website transparency issues-that they could no longer be members unless they changed their ways.

The orginal article.

Summary of “100 million Americans have chronic pain. Very few use one of the best tools to treat it.”

Golson was lucky; few chronic pain patients ever get the chance to understand the psychological dimensions of their pain or try psychological therapies.
There are 100 million Americans who suffer from chronic pain, and an unknown number of them are like Golson, with back pain, neck pain, fibromyalgia symptoms, or other forms of pain that have no diagnosed physical cause.
Big pharma’s aggressive marketing of pills and the minimal training doctors get in pain medicine mean that for too long, the go-to treatment for many forms of chronic pain has been opioids.
Cognitive behavioral therapy shows meaningful benefits on chronic pain – both for psychogenic pain, and for pain with a physical cause – according to systematic reviews of the research.
A malfunction at any juncture of these pain pathways can lead to chronic pain.
Some people might be more susceptible to acute pain turning into chronic pain due in part to genetics.
Research has shown that catastrophizing is associated with worse pain outcomes: more intense pain, and a greater likelihood to develop chronic pain.
Considering how dangerous and damaging the past decades of treating chronic pain with addicting opioids has been, and how risky and expensive surgery can be, they’re a worthy option, one that’s never sold to doctors by pharmaceutical representatives or advertised directly to consumers on TV. The most common psychological treatment for pain, and the most well-studied, is cognitive behavioral therapy, or CBT. Overall, it’s one of the most rigorously tested and effective tools psychology has to offer.

The orginal article.

Summary of “How Much a Dementia Patient Needs to Know”

Even before my own medical education, I learned an essential truth about doctoring from my parents, both physicians: that being a physician involves much more than handing out diagnoses and treatment; it involves playing a role in some of the most intimate decisions of a patient’s life.
If there is a serious, perhaps life-threatening or life-altering condition, what should one tell the patient, and when? How should one tell the patient? Should one tell the patient? Every situation is unique for the most part, patients want to know the truth, however dire it is.
Such telling assumes a whole other order of complexity when a patient has a form of dementia, for here one is intimating a sentence not only of death but of mental decline, confusion, and, finally, to some degree, loss of self.
A decade later, in 1982, he came back-this time as a patient with moderately advanced Alzheimer’s.
It is difficult to know how much he “Realizes,” and this fluctuates profoundly, almost from second to second.
He is always “On the go,” and for much of the time seems to imagine he is still a doctor here; will speak to other patients not as a fellow patient but as a doctor would, and will look through their charts unless stopped.
Mr. Q. was another patient, less demented than Dr. M., who resided in a nursing home, run by the Little Sisters of the Poor, where I often worked.
Should we have told Mr. Q. that he was no longer a janitor but a declining and demented patient in a nursing home? Should we have taken away his accustomed and well-rehearsed identity and replaced it with a “Reality” that, though real to us, would have been meaningless to him? It seemed not only pointless but cruel to do so-and might well have hastened his decline.

The orginal article.

Summary of “Do Jails Kill People?”

Reporters have virtually no access to the jails on Rikers Island for many years, Venters had a rare vantage point from which to observe its inner workings.
The culture clash between guards and medical staff on Rikers was apparent even in the way that the two groups spoke about the people confined there: guards called them “Inmates,” while medical workers called them “Patients.” At times, medical staff found themselves caught in an ethical dilemma: Was their primary loyalty to their patients or to the system in which they work? This conundrum is known as “Dual loyalty,” and Venters writes that, on Rikers, the “Most dramatic and tortured aspect of dual loyalty” involves the role that medical staff play in sending people to solitary confinement.
Venters describes receiving a call one day from a doctor who reported that guards had just beaten a patient in a waiting area at a clinic and that “The patient had been dragged away without receiving care and had not been seen since.” Venters went searching for him.
Even more haunting is a story Venters recounts about a night, in December, 2012, when officers attacked incarcerated people inside a clinic.
As a result, “Medical, mental health, pharmacy, and nursing staff” would be forced “To roam the halls of the jails every day physically looking for their patients.” Jail officials have begun trying to track inmates with wristbands, but the paper logbooks are still in use, and, in Venters’ view, this “Archaic paper-based approach to information management. . . may be the single greatest contributor to abuse and neglect in the jails.”
“The medical infirmary was literally the DOC bus garage before they decided to upgrade their bus fleet to another site and hand the space over to us for our sickest patients,” Venters writes.
In the end, Venters places the blame for the “Slow-rolling disaster” of the city’s jails at the very top, with City Hall.
“Having led the health service across two mayoral administrations, one a centrist Republican and the other a progressive Democrat,” Venter writes, “I have seen remarkable consistency in how the incompetence of the correctional service was not only tolerated but also supported.” Now, with “Life and Death in Rikers Island,” Venters reveals the true human cost of these colossal management failures.

The orginal article.

Summary of “Evidence-Based Medicine Shouldn’t Mean Treating Everyone the Same”

In theory, evidence-based medicine does not assume that when faced with two treatment options, patients should always receive the treatment that was more effective in randomized controlled trials, this tends to be what happens in practice.
Treatments shown to be inferior, on average, in randomized controlled trials are assumed by many to be inferior for all patients – so much so that keeping a given patient, or a large population of patients, on the inferior treatment is viewed as a departure from evidence-based medicine.
Ultimately, because of heterogeneity in how patients respond to treatment, it is possible, and likely, that physicians who are informed about the evidence may still appropriately offer some patients a treatment that many would consider to be inferior on the basis of clinical trial data alone.
Since the publishing of the landmark COURAGE trial and subsequent studies, many have argued that the ongoing use of PCI in patients with stable coronary disease contradicts evidence-based medicine.
Empirical evidence on whether the clinically optimal rate of PCI should be zero requires, at the very least, an investigation of how patient outcomes differ between physicians who vary in their propensity to perform PCI in patients with stable coronary artery disease.
Ultimately, the successful application of evidence-based medicine is an art that requires first and foremost, an awareness of the evidence, and also an ability to determine how well the evidence applies to any given patient.
Skilled and informed physicians applying the art of evidence-based medicine may “Deviate” from the evidence base because they find there are patients for whom evidence-defining studies are not generalizable, who have comorbidities or complexities that were not captured in the relevant trials, who have limited life expectancies, or who have preferences not to undergo the “More effective” treatment.
The optimal application of evidence is as important as awareness of that evidence, and physicians must be artists, using their best judgment to determine which evidence applies best and which treatments will most likely benefit individual patients.

The orginal article.

Summary of “The Weird Power of the Placebo Effect, Explained”

“The placebo effect is the most interesting phenomenon in all of science,” Mogil says.
As Ted Kaptchuk at Harvard, who is regarded as one of the world’s leading experts on placebo, put it to me in a recent interview, the study of the placebo effect is about “Finding out what is it that’s usually not paid attention to in medicine – the intangible that we often forget when we rely on good drugs and procedures. The placebo effect is a surrogate marker for everything that surrounds a pill. And that includes rituals, symbols, doctor-patient encounters.”
The placebo response is something we learn via cause and effect.
A 2010 systematic review looked at 202 drug trials where a placebo group was compared to patients who received neither placebo nor active drug.
Kaptchuk has studied the placebo effect for decades, and something always bothered him: deception.
Kaptchuk’s work adds a few new mysteries to the placebo effect.
Colloca wonders if the placebo effect can also be harnessed so that the millions living with chronic pain can feel the same therapeutic effects with a lower dosage of opioid treatments that are both ineffective and deadly.
Like side effects: Just as a placebo can mimic a drug, it can also mimic a side effect.

The orginal article.

Summary of “The breakthroughs that could save our lives”

Then doctors at the US National Cancer Institute tried an experimental living drug.
A patient’s immune system will already be attacking the tumour, it’s just losing the fight between white blood cells and cancer.
The scientists screened her white blood cells and extracted those capable of attacking the cancer.
Scientists have taken a step towards one of the biggest goals in medicine – a universal blood test for cancer.
The vision is an annual test designed to catch cancer early and save lives.
This year, the most common type of cancer in children was pinned on our modern germ-free lives.
The food on your plate can alter cancer’s growth and spread and scientists hope to take advantage of cancer’s “Culinary addictions” to improve treatment.
About 70% of women with the most common form of early stage breast cancer can be spared the “Agony of chemotherapy” thanks to a new test that analyses the danger of a tumour.

The orginal article.

Summary of “Emergency room bills: what I learned from reading 1,182 ER bills”

For the past 15 months, I’ve asked Vox readers to submit emergency room bills to our database.
I’ve read emergency room bills from all 50 states and the District of Columbia.
I’ve even submitted one of my own emergency room bills for an unexpected visit this past summer.
Since we started this project, multiple senators have introduced bills to prevent surprise emergency room bills – including one directly inspired by our project.
I’ll stop collecting emergency room bills on December 31.
According to GoodRX, a website that tracks drug prices, an entire vial of this drug can be purchased at a retail pharmacy for between $15 and $50. This is something that I saw over and over again reading emergency room bills: high prices for items that a patient could have picked up at a drugstore.
As many as 34 percent of emergency room visits lead to out-of-network bills in Texas – way above the national average of 20 percent.
4) It is really hard for patients to advocate for themselves in an emergency room setting Since I started working on this project, one of the questions I get most frequently is: How do I avoid a surprise ER bill? Or how can I get my ER bill lowered?

The orginal article.