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jerryking : medical_communication   7

Medical Professor Tried to Help Patients Understand Their Odds - WSJ
By James R. Hagerty
Dec. 14, 2018

Together with H. Gilbert Welch, Dr. Schwartz and Dr. Woloshin wrote a 2008 book, “Know Your Chances: Understanding Health Statistics.” They also worked with the National Cancer Institute to create the Know Your Chances website..... Lisa Schwartz [worked towards]... helping people make informed decisions about whether to try a medication or treatment.

She devoted her career to making patients smarter about assessing risks and advising doctors and journalists about how to communicate more clearly on medical issues.... She and her husband, Dr. Steven Woloshin, also coached people on how to assess odds. If a drug was found to reduce the risks of a disease by 80%, that may sound persuasive. But if those chances were only 2% to begin with, the difference made by the drug might not be sufficient to justify the side effects.....Dr. Schwartz taught junior faculty members and post-doctoral students to write and speak more effectively. Clear writing, she often said, required clear thinking. "Our goal has been to give people a realistic sense of what is known and what is not known—how hopeful or worried they should be.”
books  communicating_risks  decision_making  doctor's_visits  doctors  health_risks  medical_communication  obituaries  physicians  plain_English  probabilities  risk-assessment  smart_people  unknowns  women 
december 2018 by jerryking
Informed Patient? Don’t Bet On It
MARCH 1, 2017 | The New York Times | By MIKKAEL A. SEKERES, M.D. and TIMOTHY D. GILLIGAN, M.D.

■ Ask us to use common words and terms. If your doctor says that you’ll end up with a “simple iliac ileal conduit” or a “urostomy,” feel free to say “I don’t understand those words. Can you explain what that means?”

■ Summarize back what you heard. “So I should split my birth control pills in half and take half myself and give the other half to my boyfriend?” That way, if you’ve misunderstood what we did a poor job of explaining, there will be a chance to straighten it out: “No, that’s not right. You should take the whole pill yourself.”

■ Request written materials, or even pictures or videos. We all learn in different ways and at different paces, and “hard copies” of information that you can take time to absorb at home may be more helpful than the few minutes in our offices.

■ Ask for best-case, worst-case, and most likely scenarios, along with the chance of each one occurring.

■ Ask if you can talk to someone who has undergone the surgery, or received the chemotherapy. That person will have a different kind of understanding of what the experience was like than we do.

■ Explore alternative treatment options, along with the advantages and disadvantages of each. “If I saw 10 different experts in my condition, how many would recommend the same treatment you are recommending?”
■ Take notes, and bring someone else to your appointments to be your advocate, ask the questions you may be reluctant to, and be your “accessory brain,” to help process the information we are trying to convey.
Communicating_&_Connecting  clarity  doctor's_visits  questions  mens'_health  learning_journeys  medical  probabilities  plain_English  referrals  note_taking  appointments  advocacy  worst-case  best-case  medical_communication 
march 2017 by jerryking
‘Being Mortal’ Explores the Benefits of Setting Goals for Death - NYTimes.com
OCT. 6, 2014 | NYT |By ABIGAIL ZUGER, M.D.

Being Mortal
Medicine and What Matters in the End.
By Atul Gawande, M.D.
Metropolitan Books. 282 pages. $26. Credit Alessandra Montalto/The New York Times

Another is the author’s palpable enthusiasm as he learns that many of the most difficult conversations doctors should have with their patients can be initiated with only a few questions. (What are your fears? Your hopes? The trade-offs you will and will not make?) One suspects a new checklist may be in the offing.
Atul_Gawande  books  book_reviews  stressful  conversations  end-of-life  tradeoffs  questions  medical_communication  difficult_conversations  checklists  what_really_matters 
october 2014 by jerryking
How Not to Die
APR 24 2013 | The Atlantic | JONATHAN RAUCH.

What should have taken place was what is known in the medical profession as The Conversation. The momentum of medical maximalism should have slowed long enough for a doctor or a social worker to sit down with him and me to explain, patiently and in plain English, his condition and his treatment options, to learn what his goals were for the time he had left, and to establish how much and what kind of treatment he really desired. Alas, evidence shows that The Conversation happens much less regularly than it should, and that, when it does happen, information is typically presented in a brisk, jargony way that patients and families don’t really understand. Many doctors don’t make time for The Conversation, or aren’t good at conducting it (they’re not trained or rewarded for doing so), or worry their patients can’t handle it.

This is a problem, because the assumption that doctors know what their patients want turns out to be wrong: when doctors try to predict the goals and preferences of their patients, they are “highly inaccurate,” according to one summary of the research, published by Benjamin Moulton and Jaime S. King in The Journal of Law, Medicine & Ethics. Patients are “routinely asked to make decisions about treatment choices in the face of what can only be described as avoidable ignorance,” Moulton and King write. “In the absence of complete information, individuals frequently opt for procedures they would not otherwise choose.”
end-of-life  medicine  dying  palliative_care  Communicating_&_Connecting  conversations  plain_English  clarity  doctor's_visits  medical_communication 
may 2014 by jerryking
Can we just relax about our breasts? - The Globe and Mail
MARGARET WENTE

The Globe and Mail

Last updated Wednesday, Oct. 31 2012

the real problem isn’t jet fuel in our breasts. It’s chemophobia – a fear so rampant that it has infected an entire generation of women. Ms. Williams is right that our bodies contain trace amounts of pretty much everything that’s in our environment. But toxicity is a matter of degree. And technology is so advanced that we can measure trace amounts in parts per trillion. As yet, research has found no trace of harm. For example, after a comprehensive review of environmental causes and risk factors for breast cancer, the U.S. Institute of Medicine found no conclusive link between any of these chemicals and an increased risk of breast cancer. According to Scientific American, “some research shows the toxic load in breast milk to be smaller than that in the air most city dwellers breathe inside their homes.”

So what are the biggest risks for breast cancer? Getting old, and being female. “If you parse out all the things that cause breast cancer, about 75 per cent of it is living,” Harvey Schipper, one of Canada’s leading breast cancer doctors, told me. Much of the rest is hereditary. Other risk factors are bound up with our Western lifestyle – high-protein diets, early puberty, later and less frequent childbearing. “Societies with poor nutrition don’t get breast cancer,” he says.

This is not to say there’s no impact from environmental factors. But these effects are small and uncertain. To eliminate them all, we’d have to eliminate modernity and return to being hunter-gatherers again.

But I’m afraid chemophobia is here to stay. Fear sells. Fear of chemicals manufactured by rapacious, greedy, money-sucking capitalist enterprises sells even better.
ageing  cancers  chemicals  fear  hunter-gatherers  Margaret_Wente  medical_communication  rapaciousness  risk_factors  toxicity 
february 2013 by jerryking
Informed Patient - WSJ.com
OCTOBER 31, 2007 | WSJ | By LAURA LANDRO.

Talking Points: Making the Most Of Doctor Visits

* What going on? What ails you? What else could it be?
* Could two things be going on at once?" and "Are there any findings (from the physical exam, blood tests, x rays, etc.) that don't add up?"
* Is that the root problem or is that a symptom?

* Probabilistic reasoning is especially important in medical decision-making. Imagine, for example, your doctor tells you that you need to take a cholesterol-lowering drug. Most people would likely assent based on their physician’s recommendation, he says. But if you were to weigh the odds of that drug having a positive effect against the odds of experiencing side effects, you might find it wiser to decide otherwise.

“What I advocate is a more active role in medical care where you would say to the doctor, ‘Well, what are the chances that I’ll benefit from it? How many people take this medication with no benefit?’” Levitin says. Although doctors tend to be trained to think in terms of diagnosing and treating illnesses, they are not typically trained to think probabilistically, he adds. This becomes problematic when faced with the latest treatment options with questionable odds of a cure. “The way medical care is going in this country and in other countries, I think we need to become more proactive about knowing which questions to ask and working through the answers.”

Questions when you're concerned that you're facing a misdiagnosis (cbc Dr. Danielle Martin)
* OK....then in your opinion, what should be the normal progression of the diseases from this point onwards?
* What signs should we look for that tell us that it's time to return to the emergency room?
* Q: when should we come back.....if the flu how should case typically progress ? What are the signs that something is wrong and you should come back to the emergency room?
* what is the most likely course, when should we come back if there is a deviation?
*
medical  appointments  visits  Communicating_&_Connecting  tips  advice  Laura_Landro  doctors  doctor's_visits  questions  root_cause  symptoms  probabilities  simultaneity  investigative_workups  multiple_stressors  dual-consciousness  medical_communication  misdiagnosis  warning_signs 
november 2011 by jerryking

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