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Time management and study skills counseling is available for all medical students with our Learning Specialist, Ms. Judith Olson-Hammer. She meets with medical students to discuss strategies for time management, studying, and note-taking relevant to our problem-based curriculum. She meets with students weekly by appointment throughout the fall and spring semesters. Students may self-schedule appointments at the School of Medicine and email her directly with questions or concerns.

Time Management Resources & Articles

"5 time-management hacks for medical students"

"8 Practical Time Management and Study Strategies for Medical Students"

Mon, 05 Dec 2022 15:44:00 -0600 en text/html https://case.edu/medicine/students/student-affairs/academic-advising/learning-specialist
Killexams : Medical jargon is often misunderstood by the general public, according to a new study

Students learning medicine must learn a whole new language to allow them to express their clinical impressions to others accurately. In time, this becomes second nature and soon they can be heard babbling away confidently and sounding quite the part. Communication skills are a standard part of medical education and the teachers take great care to ensure that these newly found linguistic skills do not impinge on their communication with patients. Most seem to take this on board and do their utmost not to confuse patients.

With all of this good education going on, why is it that we hear of misunderstandings between doctors and ? Do doctors really throw up verbal smokescreens to confound others? A recent paper from the University of Minnesota would suggest so.

A survey of 215 members of the public examined their understanding of some common phases used by doctors in their consultations. Words such as "your cancer screening test came back and the results were negative" were correctly interpreted by 97.7% of the people. However, only 21% correctly understood that a doctor saying their radiography was "impressive" was generally bad news. And "Have you been febrile?" was understood by just 9.3%.

The researchers concluded that medical jargon is alive and well and living in consulting rooms in Minnesota—and presumably a lot of other places as well.

Before we all take the view that doctors need yet more browbeating about their , let us look at this paper in context. The study participants were members of the public visiting the Minnesota State Fair. Presumably, they were looking forward to a day of candyfloss and helter-skelter rides rather than being accosted by researchers offering university-branded backpacks as inducements to participate. They were not expecting to be patients that day and may even have been there to get away from worries about health.

The questions were multiple choice, with no opportunity to ask for clarification. Medically qualified readers will all be familiar with patients who ask for immediate explanations of terms and most, I hope, will understand the power of the phrase: "By which I mean … "

Somehow, the study methods used by these researchers seem not to accurately replicate the conditions found in your average clinic and, in fairness, they acknowledge this.

Don't infantilize

Why use certain terms and phrases in the first place? Oddly, the answer is not wholly straightforward. Today's internet-enabled patient is better informed than ever. Popular TV programs show doctors and patients in action, using copious quantities of medical jargon for realism and artistic effect. The public lap it up.

In the clinic, patients like to be treated as adults and communicated with accordingly. They don't want to be infantilized or patronized—and they certainly let doctors know if they are made to feel that way. Skilled know this and will introduce terms followed (hopefully) by immediate explanations to ensure understanding. Too slow with an explanation and the wily patient will ask: "Can I have that in English please?"

Whatever the words used and however they are put, some patients are not in a position to take it all in. Fear and anxiety cloud the comprehension of messages in any consultation, and this must be accounted for. There should be adequate adjuncts, such as information leaflets, web links, and that all-important opportunity to ask questions at the time or on a subsequent occasion.

Nobody should leave a healthcare consultation confused and none the wiser because of the use of medical jargon, and none should be spoken down to or patronized. The skill of the doctor is to find the happy medium and make patients feel informed and respected—even if they can't always offer a cure.

This article is republished from The Conversation under a Creative Commons license. Read the original article.The Conversation

Citation: Medical jargon is often misunderstood by the general public, according to a new study (2022, December 6) retrieved 13 December 2022 from https://medicalxpress.com/news/2022-12-medical-jargon-misunderstood-general.html

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Tue, 06 Dec 2022 03:28:00 -0600 en text/html https://medicalxpress.com/news/2022-12-medical-jargon-misunderstood-general.html
Killexams : existing doctors shun infectious diseases specialty

Thousands of doctors ready to continue their training celebrated Match Day for specialty fellowships on Nov. 30, but one group lamented its results: infectious diseases physicians. Despite its central role in the COVID pandemic, the infectious diseases specialty saw 44% of its training programs go unfilled.

"I'm bummed out," says Dr. Carlos Del Rio, a professor at the Emory School of Medicine and president of the Infectious Diseases Society of America. "I love my field, I love what I do. And it's upsetting to know that my field may not be as attractive to trainees as I would like it to be."

At the University of Washington, which has one of the nation's top-ranked programs, administrators were scrambling to find suitable candidates for two fellowship spots that were still open after the match process. "It feels unsettling," says Dr. Paul Pottinger, director of UW's infectious diseases fellowship training program, "Typically, we match our full eight slots on the first go."

At Boston Medical Center, affiliated with Boston University, none of their three fellowship positions got filled in this year's Match – a "challenging" and unprecedented situation for Dr. Daniel Bourque, who runs their fellowship program: "There was a decrease in the number of applicants this year, and that decrease appears to be a trend."

Becoming an infectious diseases specialist takes years of training. Generally, after four years of medical school, followed by several years in a medical residency, an aspiring ID physician applies to a fellowship program of at least two years. The field hit a low point in recruiting for fellowships in 2016. In the past five years, it was somewhat stable, with around 65%-70% of training programs getting filled.

But 2020 was the exception, when a flood of applicants yielded a record match rate – a phenomenon dubbed the "Fauci effect." As infectious diseases dominated the news, "a lot of us saw it as a [sign of] reinvigorated interest in ID" due to the pandemic, says Dr. Boghuma Titanji, an infectious diseases physician at Emory University. But the slide since then – capped off by this year's "alarming decline" – shows that the pandemic boost may have been a blip in the specialty's long-term struggles.

Despite guiding colleagues and the public through the COVID pandemic and the exact mpox outbreak; despite their lifesaving work in keeping hard-to-treat infections from spreading in hospitals; despite high job satisfaction and a profession that many described to NPR as "never boring": new doctors are not choosing to specialize in infectious diseases.

It's a decline that has the field's top experts searching for explanations.

Training more to get paid less

The most obvious reason is that the pay is low compared with other specialties, says Titanji at Emory University, whose Tweet kicked off a robust discussion about the Match Day results. "We're talking about a six-figure pay difference," she says, citing a 2022 Medscape report that infectious diseases certified earn an average of $260k a year, which is more than $100,000 less than the average salary for all specialists.

In some cases, doctors who specialize in infectious diseases end up making less than they would have before the extra two to three years of training – for instance, as a hospitalist, which is an internal medicine doctor that sees patients in the hospital. One can become a hospitalist – making between $200,000-$300,000 a year – after completing medical school and residency training, with no additional specialty fellowships required. "I get paid less to work more hours than I did as a hospitalist," Dr. Hannah Nam, an infectious diseases physician at UC Irvine, tweeted. "My student debt isn't going anywhere. Don't regret my choice but don't fault anyone for not choosing it either."

The pay disparities are rooted in the way the U.S. medical system is structured, Titanji and others say. "A lot of the medical compensation system is based on doing procedures or interventions that are highly reimbursed," Titanji says.

Infectious diseases doctors, on the other hand, examine and interview patients and consult with colleagues – "we think for a living," Pottinger, at the University of Washington, says, "Andbecause we don't have a surgery to do, I think that's where this legacy of reduced pay has come from."

Even if the pay is less than other specialties, "it's still very good," Pottinger says. "There's plenty of money in it, both in academic [settings] and in private practice, and our pay is rising over time."

Still, the prospect of getting extra training to take a pay cut deters many from choosing the field. "Medical education in the U.S. is incredibly expensive," says Del Rio from Emory. "If you graduate with a lot of debt, you're not going to go to a specialty that doesn't pay as much as others."

Long hours and public criticism

The relatively low pay is not the only issue, experts say. The field has long been understaffed, leading to long hours – a problem supercharged by the strain of the pandemic. "Every infectious diseases doctorcan tell you that the first year of the pandemic felt like being on call 24/7 because everyone was calling you – and relying on the knowledge that you had – to be able to respond to this," Titanji says.

The current class of doctors largely started their post-graduate residencies in the summer of 2020. All of their training happened during the COVID pandemic, Bourque from Boston Medical Center notes. The long hours and poor work-life balance they observed in ID doctors – and physicians leaving the field in droves due to burnout – may have cut the appeal. "Long hours and low pay are a dreadful combination," del Rio says.

The COVID spotlight also made prominent ID doctors targets for bitter vitriol from people who disagreed with them. "Many of us, myself included, have been attacked in the media and other places," for sharing thoughts on COVID, del Rio says. Dr. Anthony Fauci, a top COVID adviser to President Donald Trump and President Biden, was a lightning rod for criticism – and even death threats. "People [considering the field] realize there's a personal risk. When the chief infectious diseases doctor for the nation has to have bodyguards, that doesn't necessarily make you think 'Oh, this is a great profession," del Rio says.

Loan forgiveness could help

Infectious diseases had a recruiting problem before the pandemic, too: 2016 was an especially disappointing year, recalls Marcelin at University of Nebraska, who was going through her specialty training at the time. That year, 57% of programs went unfilled. "A lot of the conversations that happened then, are happening again now," Marcelin says.

It spawned some soul-searching for the field, with researchers trying to figure out how to attract more doctors. On the money front, medical associations like the IDSA have lobbied Congress for student loan repayment programs, to reduce the medical school debt for doctors who choose the field. They're also advocating for higher reimbursement rates for the work ID doctors do. If the pay gap for infectious diseases decreases, "that may make it more worthwhile for trainees to consider it as a career path," Titanji says.

They've also stepped up their efforts to bring new candidates into the infectious diseases field, with grants and mentorship programs. Still, over the past five years, "despite our recruitment and mentorship efforts, we have made minimal progress in reversing this trend," IDSA leaders wrote to Congress earlier this year. In 2020, a research paper co-authored by Dr. Rochelle Walensky, then chief of the infectious diseases division at Massachusetts General Hospital and now the CDC's director, found that 80% of U.S. counties had no infectious diseases doctors – including most counties that were hit hard by COVID in the first year.

"What I'm learning is that it's a long road ahead," says Marcelin at University of Nebraska.

And the stakes are high, leaving the nation unprepared against outbreaks and health emergencies. "If we don't have enough infectious diseases physicians moving forward, it's going to impact our ability to deal with everything from recognizing and diagnosing a disease, to informing the public, to creating guidance and administering proper treatments," Marcelin says. Then there are the less visible impacts – disease outbreaks in hospitals that could have been prevented in consultation with ID physicians; deaths from infections with treatment-resistant bacteria and viruses that could have been stopped by ID physicians.

That the COVID pandemic hasn't yet inspired more doctors to go into infectious diseases might not be the end of it, says Bourque, looking back at the galvanizing effect the HIV/AIDS crisis had on the field. "There was a point in time where it felt like [infectious diseases] may be a dying subspecialty, and then HIV/AIDS demonstrated the importance of the infectious diseases specialist and really spawned a generation of doctors," including Bourque, to choose it as a career. He says COVID's effects are still unfolding: "COVID has had a tremendous impact on human life, and it continues to have an impact. I do believe that can and should inspire people to pursue careers in infectious diseases."

Copyright 2022 NPR. To see more, visit https://www.npr.org.

Mon, 12 Dec 2022 10:37:00 -0600 en text/html https://wusfnews.wusf.usf.edu/2022-12-12/newest-doctors-shun-infectious-diseases-specialty
Killexams : Kids in Detroit learn what it's like to attend medical school
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Detroit kids learn what it's like to attend medical school AJ Walker

Children in Detroit are getting the chance to find out what it's like to go to medical school. Dr. Carolyn King is one of the founders of Co-founder of the Reach out to Youth Program at Wayne State University and hopes to inspire the next generation of young doctors. The program, which began in 1990, encourages kids ages seven through eleven to consider careers in medicine.

"In order for us to know who we can be, we have to see that role model in front of us, otherwise, we think the only thing there is to be that's passion-filled is an athlete or a superstar," said King.

Second-year medical students who were a part of the program spoke about the importance of young children seeing those with similar ethnic backgrounds or genders reaching some of the highest levels in the medical field.

"I really believe that representation is super important, especially in the field of medicine, where we don't have many black doctors or many brown doctors," said Lyndsay Archer "So making sure that we just inspire the next generation to know that this field is something that they can do and that they can thrive in is super important."

Dr. King also talked about why the program is especially important for children in the Detroit area.

"Just wanting to expose the youth of Detroit specifically to what it's like to be a medical student because before you're a doctor and you're a three-year-old, five-year-old, seven-year-old, you don't even know that the largest medical school in the country, if not the world, is right here in the city," said King.

Sun, 04 Dec 2022 05:34:00 -0600 en-US text/html https://www.cbsnews.com/detroit/news/kids-in-detroit-learn-what-its-like-to-attend-medical-school/
Killexams : Local doctors think JU medical school will be massive benefit to Jacksonville

Jacksonville University expects to open its medical school in 2026.

JACKSONVILLE, Fla. — It's a first of its kind institution for the city of Jacksonville. On Wednesday Jacksonville University announced that they are starting a four-year medical school in conjunction with LECOM, which is already the largest medical college in the country.

One day after the announcement local doctors are thrilled with the possibility of a medical school in Jacksonville.

"A four-year medical school has been something that we've worked hard on for a decade," said Jacksonville University President Tim Cost during Wednesday's announcement.

There has been incredible growth at Jacksonville University just within the past year. The school already announced that they're starting the city's only law school and now its first medical school. A medical school that will partner with nearly half a dozen local healthcare providers.

One of those providers is Brooks Rehabilitation. First Coast News spoke with Howard Weiss, D.O., who says that a medical school in Jacksonville will act as a pipeline for quality doctors to learn and stay in the area.

"If you go to medical school here you're going to do your 3rd and 4th year externships in local hospitals," said Dr. Weiss, "you'll have medical students who will be here for 4 years, if they're not from here they'll fall in love with the first coast, life is good here."

Aside from Brooks Rehab, some of those other hospitals where prospective med students will likely train are Baptist Health and Flagler Health, who are also partners with LECOM and Jacksonville University's medical school.

"It's amazing to have a town where everyone would come together to do this," said Dr. Weiss.

Helping the community was one of the central tenets of JU's decision to start the med school.

"We try to create things here at the university that reflect the needs," said Cost on Wednesday.

"As the population gets older we're going to need more primary care physicians," said Dr. Weiss.

Starting in 2026 those physicians will start class at Jacksonville University's medical school.

"To have one here locally is very meaningful for the people of Jacksonville," said Dr. Weiss.

A city that will have its own medical school for the first time in history.

Fri, 02 Dec 2022 13:44:00 -0600 en-US text/html https://www.firstcoastnews.com/article/news/local/training-doctors-in-jacksonville-will-be-major-benefit-to-community/77-a169558d-4437-4151-bd35-2138f0eddac6
Killexams : Still Using Medical Jargon? Prepare to Be Misunderstood

Common medical phrases often confused individuals in ways that could affect health outcomes, a cross-sectional study found.

Among 215 adults surveyed outside the medical setting, most knew "negative" cancer screening results meant not having cancer (96%), but fewer understood that the phrase "your tumor is progressing" was bad news (79%) or that having positive lymph nodes meant the cancer has spread (67%), reported Michael Pitt, MD, of the University of Minnesota in Minneapolis, and colleagues.

Not surprisingly, participants had a significantly better understanding of common-language equivalents compared with jargon phrases (98% vs 87%, P<0.001), the authors wrote in JAMA Network Open.

Only two of the 13 survey questions showed a significant relationship between education level and the accuracy of understanding medical jargon (people with graduate degrees had greater understanding of "unremarkable" and "nothing by mouth"), which led researchers to suggest education couldn't fully account for the differences.

Healthcare professionals already know jargon should be avoided because it may lead to confusion and adverse outcomes, Pitt's group noted.

However, Pitt told MedPage Today: "As doctors, we have found that while we often use words or phrases our patients may not understand, this is often because we simply have heard them so often that we simply forget there was a time we too didn't know what they meant."

"We call this 'jargon oblivion' and feel the only cure is for us to learn from our patients when we are using terminology or phrases that are rarely understood," said Pitt.

Reached for comment, Leslie Jurecko, MD, MBA, the chief safety, quality and patient experience officer of the Cleveland Clinic, told MedPage Today that these jargon phrases studied are so embedded that "I think it will be very challenging to eliminate all of this jargon from medical care."

One thing her institution uses is coaching in the repeat-back method, she said, to "encourage them to have their patients repeat back for understanding, and that opens up the dialogue." Clarifying and validating what was said allows patients a safe place to ask further questions, she added.

"We also see in practice -- and I think this is nationally and globally -- that medical providers will use acronyms, and that has always been problematic, both in verbal and written language," Jureko said. "We are always trying to get rid of that in the medical record."

For this study, Pitt and colleagues examined data on 215 participants recruited at the 2021 Minnesota State Fair near St. Paul to complete an electronic survey. Adults who did not work or train in the medical field and were able to speak and read English were included. Participants were stratified by those who received a verbal (n=99) or written (n=116) survey.

The survey asked questions about common medical terms, such as the meaning of "febrile"; assessed participant understanding of other phrases, such as "You will need to be NPO at 8 a.m."; and inquired about the confidence level of respondents.

Participants' age averaged around 42, and 63% were women. Nearly one-third had a graduate or professional education, one-third had a bachelor's degree, and 16% had some college education.

Participants showed a varied ability to comprehend medical jargon phrases. While most understood that it was good news to have an "unremarkable chest radiography" (80%), only a few accurately understood that it was generally bad news to hear a clinician say their "radiography was impressive" (21%).

Only 41% accurately interpreted that hearing that the "neuro exam is grossly intact" meant good news.

While 29% were able to correctly interpret that "bugs in the urine" indicated a urinary tract infection, only 9% understood the term febrile. Notably, only 2% understood the meaning of an "occult" infection. "More people believed that the phrase 'had an occult infection' had something to do with a curse than understood that this meant that they had a hidden infection," the researchers pointed out.

Multivariable logistic regression linked older age to an increased understanding of the phrases "nothing by mouth" and "negative blood cultures" but a reduced understanding of the meaning of "impressive radiography findings."

"Given that increasing age comes with more opportunities to have heard these terms used in a medical context, it is somewhat surprising that older age was only associated with better understanding of two of the 13 phrases," the group wrote.

And the more confident participants were in answering the questions, the more likely they were correct.

After finding no significant difference among audio/verbal or written versions of the survey, researchers suggested this indicated "that future studies of jargon understanding may support the less time-intensive written survey approach."

The authors acknowledged limitations to the data, including possible selection bias, given the high proportion (77%) with an associate degree or higher.

"Though participation was open to all adult fairgoers who volunteered, there is likely a naturally occurring bias in selecting individuals who would visit a university research building during their visit to a fair," they noted. "Additionally, this research building had a mask mandate to mitigate the spread of SARS-CoV-2 at the time of study, whereas many other areas of the fair did not."

  • Zaina Hamza is a staff writer for MedPage Today, covering Gastroenterology and Infectious disease. She is based in Chicago.

Disclosures

This study was supported by the NIH National Center for Advancing Translational Sciences and the Driven to Discover Research Facility at the University of Minnesota.

Pitt and coauthors disclosed no competing interests.

Thu, 01 Dec 2022 06:00:00 -0600 en text/html https://www.medpagetoday.com/publichealthpolicy/medicaleducation/102004
Killexams : New doctors don't see fewer patients than 20 years ago, study finds A new study counters misconception that new doctors are working less in order to  Excellerate their work-life balance. © Carl Court/Getty Images A new study counters misconception that new doctors are working less in order to Excellerate their work-life balance.

A new study from Dalhousie University shows that family doctors who entered the profession recently are not taking on fewer patients or having less contact with patients than those who started out two decades ago.

The analysis counters a misconception that recently trained physicians think more about work-life balance than their more established colleagues, are less career-motivated or are less likely to provide comprehensive and continuous care, the study says.

The data also hints at areas where improvements could be made to increase patient access to care.

The study, published in the Canadian Medical Association Journal on Monday, analyzed data from Nova Scotia, Ontario, Manitoba and British Columbia from 1997 to 2018.

Patient volume peaks in mid-career

It showed that over the course of a family physician's career, they tend to start out with fewer patient visits. That number increases until the doctor has about 27 to 29 years of experience, then begins to drop off again. That trend has been consistent over the 20-year period of study.

"We do see peak volume around mid-career, but this has been true of preceding generations as well," said Dr. Ruth Lavergne, one of the authors of the study and an associate professor in Dalhousie's Department of Family Medicine.

"So there's always been changes over the course of physicians' careers but doctors starting out now aren't working proportionately less than those starting out some time ago."

Dr. Katherine Stringer, the head of Dalhousie's Department of Family Medicine, said one of the reasons early-career doctors across the generations tend to have fewer patients than mid-career physicians is that they are getting to know their patients, so may spend longer with them.

They also must add patients' medical information to record systems, they may be hiring staff to run a practice and learning the financial side of operating a business.

"There's a lot of stresses on our new graduates as they begin practice. So providing them with as many of those supports as possible that can potentially take some of those stresses away so that they can then focus on patient contacts, I think that the study perhaps helps a bit there."

Fewer patient visits throughout career

Yet another finding from the study is that family physicians at all career stages see fewer patients today than they did 20 years ago due to the increasing complexity of care. It notes a drop of about 25 per cent, or between 515 and 1,736 patient visits per doctor per year.

Lavergne said that doesn't mean doctors are working less. She said patients are being treated for a larger number of conditions, which might mean the average visit takes more time. Family doctors also co-ordinate referrals, imaging and labs, which amount to more time-consuming administrative work.

Dr. Leisha Hawker, the president of Doctors Nova Scotia, said patients are also discharged from hospital earlier than they used to be, due to the high demand for beds. That means some issues that normally would be dealt with by hospital staff are now dealt with by family doctors.

People stay in their homes longer while waiting for long-term care, so they rely on family physicians for medical help rather than staff at long-term care facilities.

Long wait times for certified also mean family doctors may continue dealing with patient issues until a specialist is available.

"The complexity of medicine is just so much higher than it was in the previous years and it just means that those 10-, 15-minute appointments that used to work don't really work anymore in family medicine."

More workforce planning needed

Lavergne said the study highlights the need for workforce planning. If doctors in early or late stages of their career tend to see fewer patients, more support could be offered during those periods by, for instance, using more streamlined referral systems or sharing administrative work with others.

Offering more team care to patients who can see other service providers can also help free up physicians to see more patients, Lavergne said.

Lavergne said it's important that governments think carefully about what strategies they are using to help alleviate pressure on the system.

"Oftentimes during, you know, periods of crisis like this, there's a move to try to open walk-in clinics or urgent care centres, and I fully understand the motivation to do that and that people really do need care urgently," she said.

"But if you're pulling people out of ongoing longitudinal care and into these care models where you don't see the same patient over time, that can add to duplication and reduce the efficiency of services."

Hawker said programs that pair new doctors with doctors who are about to retire can also help early-career doctors get used to the real world of practising medicine and become more efficient, more quickly.

That type of program can also provide seamless continuity of care for patients so a new doctor doesn't have to start from scratch with a patient, she said.

Mon, 12 Dec 2022 07:56:33 -0600 en-CA text/html https://www.msn.com/en-ca/health/medical/new-doctors-dont-see-fewer-patients-than-20-years-ago-study-finds/ar-AA15ccYB
Killexams : From heart disease to IUDs: How doctors dismiss women’s pain

One woman was told she was being “dramatic” when she pleaded for a brain scan after suffering months of headaches and pounding in her ears. It turned out she had a brain tumor.

Another was ignored as she cried out in pain during a 33-hour labor. She was supposed to be getting pain medication through her epidural, but it had fallen out.

Dozens of women complained of torturous pain as their vaginal walls were punctured during an egg retrieval process. They were told their pain was normal, but, in actuality, they were getting saline instead of anesthesia.

These are just some of the stories of women who say their pain and suffering has been dismissed or misdiagnosed by doctors. Although these are anecdotal reports, a number of studies support the claim that women in pain often are not taken as seriously as men.

This year, the Journal of the American Heart Association reported that women who visited emergency departments with chest pain waited 29 percent longer than men to be evaluated for possible heart attacks.

An analysis of 981 emergency room visits showed that women with acute abdominal pain were up to 25 percent less likely than their male counterparts to be treated with powerful opioid painkillers.

Another study showed that middle-aged women with chest pain and other symptoms of heart disease were twice as likely to be diagnosed with a mental illness compared with men who had the same symptoms.

“I was told I knew too much, that I was working too hard, that I was stressed out, that I was anxious,” said Ilene Ruhoy, a 53-year-old neurologist from Seattle, who had head pain and pounding in her ears.

Despite having a medical degree, Ruhoy said she struggled to get doctors to order a brain scan. By the time she got it in 2015, a tennis ball-sized tumor was pushing her brain to one side. She needed surgery, but first, she rushed home, hugged her 11-year-old daughter and wrote her a letter to tell her goodbye.

Ruhoy did not die on the operating table, but her tumor had grown so large it could not be entirely removed. Now, she has several smaller tumors that require radiation treatment.

She said many of her female patients have had experiences similar to hers. “They’re not validated with regards to their concerns; they’re gaslit; they’re not understood,” she said. “They feel like no one is listening to them.”

“There’s a pain gap, but there’s also a credibility gap. Women are not believed about their bodies — period.” Anushay Hossain, author of "The Pain Gap," Washington, D.C.

Doubts about women’s pain can affect treatment for a wide range of health issues, including heart problems, stroke, reproductive health, chronic illnesses, adolescent pain and physical pain, among other things, studies show.

Research also suggests that women are more sensitive to pain than men and are more likely to express it, so their pain is often seen as an overreaction rather than a reality, said Roger Fillingim, director of the Pain Research and Intervention Center of Excellence at the University of Florida.

Fillingim, who co-wrote a review article on sex differences in pain, said there are many possible explanations, including hormones, genetics and even social factors such as gender roles.

Regardless, he said, “you treat the pain that the patient has, not the pain that you think the patient should have.”

(Illustration by Vanessa Saba for The Washington Post/Photos: Getty Images) (Illustration by Vanessa Saba for The Washington Post/Photos: Getty Images)

Women say reproductive health complaints are commonly ignored

Women often cite pain bias around areas of reproductive health, including endometriosis, labor pain and insertion of an intrauterine device, or IUD.

When Molly Hill made an appointment at a Connecticut clinic in 2017 to get an IUD, she said she was warned it would be uncomfortable, but she was not prepared for “horrific” pain. Hill, now 27 and living in San Francisco, recalled that during the procedure, she began crying in pain and shouted at the doctor to stop.

“We’re almost done,” she said the doctor told her and continued the procedure.

“It was full-body, electrifying, knife-stabbing pain,” she said. After it was done, she said she lay sobbing on the table in physical and emotional pain. “It felt violating, too, to have that pain that deep in your core where you feel the most vulnerable.”

Would you like to share your own experiences of coping with pain and navigating the medical system? Fill out this form, and we may include you in a collection of reader stories.

Studies consistently show that women who have not experienced vaginal birth have much higher pain during IUD insertion compared with women who have given birth. A Swedish study found that among 224 women who had not given birth, 89 percent reported moderate or severe pain. One in six of the women said the pain was severe.

Although numbing agents and local anesthetics are available, they are rarely used.

“They’re not validated with regards to their concerns; they’re gaslit; they’re not understood. They feel like no one is listening to them.” Ilene Ruhoy, neurologist, Seattle

In some cases, women have sued physicians for ignoring their pain. Dozens of women sued Yale University claiming that during an egg harvesting procedure at its infertility clinic, they were supposed to be receiving the powerful painkiller fentanyl. But some women were getting only diluted pain medication or none at all, according to lawsuits filed in the state Superior Court in Connecticut.

Later, the clinic discovered a nurse had been stealing vials of fentanyl and replacing the painkiller with saline solution. The nurse pleaded guilty last year and was sentenced for tampering with the drugs.

One of the plaintiffs, Laura Czar, wrote about her experience for Elle magazine, describing it as “a horrible, gut-wrenching pain,” and told a doctor at the time, “I can feel everything you’re doing.” Despite her protests, the doctor continued.

Yale said in a statement that it “deeply regrets” the women’s distress and has “reviewed its procedures and made changes to further oversight of pain control and controlled substances.”

(Illustration by Vanessa Saba for The Washington Post/Photos: Unsplash, Pexels) (Illustration by Vanessa Saba for The Washington Post/Photos: Unsplash, Pexels)

Racial disparities in pain management

For Sharee Turpin, the pain of sickle-cell disease sometimes feels like tiny knives slicing her open. Sickle cell disease is an inherited blood disorder that can cause suffering so severe, its attacks are called “pain crises.”

But when Turpin, who is Black, experiences a pain crisis, the 34-year-old does not rush to the ER in Rochester, N.Y. Instead, she combs her hair, mists some perfume and slips on her “Sunday best” in hopes that the doctors and nurses won’t peg her as a drug seeker, she said.

Sometimes, Turpin gets a care team that understands her pain. Other times, she is treated as a bother. “I’ve even been told ‘shut up’ by a nurse because I was screaming too loud while I was in pain,” she said.

Abundant research shows racial bias in pain treatment. A 2016 study found half of white medical students and residents held at least one false belief about biological differences between Blacks and Whites, and were more likely to underestimate Black patients’ pain.

“The management of pain is one of the largest disparities that we see between Black people and White people in the American health-care system,” said Tina Sacks, an associate professor at the University of California at Berkeley and author of “Invisible Visits: Black Middle-Class Women in the American Healthcare System.”

Labeling women “hysterical” or blaming psychological causes

Research shows men in chronic pain tend to be regarded as “stoic” while women are more likely to be considered “emotional” and “hysterical” and accused of “fabricating the pain.”

Carol Klay, a 68-year-old from Tampa, had endured years of chronic pain from arthritis, degenerative disk disease and spinal stenosis. During a hospital stay last year, her doctor noted in her medical record that she was crying “hysterically.”

Klay said she was crying because she was unable to sit, stand or walk without agony, and the doctor had removed morphine from her cocktail of pain medications. She wonders whether the doctor “would have called me hysterical if I was a man,” she said.

Tampa General Hospital said it could not discuss specific patients, but stated: “Patient treatment plans, including medication orders to reduce pain, are prescribed by multi-disciplinary clinical teams.”

Research shows women’s physical pain is also often attributed to psychological causes.

Jan Maderios, a 72-year-old Air Force veteran from Chipley, Fla., said the trauma of having pain dismissed by doctors has stayed with her for years. She saw about a dozen doctors in the early 1970s for pelvic pain. When clinicians could not identify the cause of her pain, she was referred to a psychiatrist.

“You start to doubt yourself after so many medical experts tell you there’s nothing wrong with you,” she said.

After a hysterectomy in 1976, Maderios learned that fibroid tumors in her uterus had been the source of her pain. She said learning her pain was real — and physical — “made all the difference in the world.”

(Illustration by Vanessa Saba for The Washington Post/Photos: iStock, Unsplash) (Illustration by Vanessa Saba for The Washington Post/Photos: iStock, Unsplash)

Why women’s pain complaints often aren’t taken seriously

During a 33-hour labor with her first child in 2011, Anushay Hossain, 42, of D.C., opted for epidural pain relief but said she still felt it all — every contraction, every cramp and every dismissal of her pain by her medical team. The doctor reassured her that she was getting the maximum dosage of pain medication.

In fact, she wasn’t getting any at all. She said her epidural had slipped out. By the time the error was caught, she was shaking uncontrollably and in need of an emergency Caesarean section, she said.

“There’s a pain gap, but there’s also a credibility gap,” said Hossain, author of “The Pain Gap: How Sexism and Racism in Healthcare Kill Women.” “Women are not believed about their bodies — period.”

“I’ve even been told ‘shut up’ by a nurse because I was screaming too loud while I was in pain.” Sharee Turpin, sickle-cell patient, Rochester, N.Y.

This pain gap may stem, in part, from the fact that women have historically been excluded from medical research. It wasn’t until 2016 that the National Institutes of Health (NIH) required sex to be considered as a biological variable in most studies it funded.

“We’re making progress,” said David Thomas, special adviser to the director of NIH’s Office of Research on Women’s Health. “But we do have a long way to go because there’s this whole institutional approach to doing research — pain and beyond — where it tends to be male-focused.”

Nearly 95 percent of U.S. medical school students said instruction on sex and gender differences in medicine should be included in curriculums, according to a 2015 survey. But only 43 percent said their curriculum had helped them understand those differences and only 34.5 percent said they felt prepared to manage them in a health-care setting.

“It is changing, but it’s changing very slowly,” said Janice Werbinski, immediate past president of the American Medical Women’s Association and chair of the mentorship committee of the association’s Sex and Gender Health Collaborative.

How women can advocate for better pain care

It took decades to solve the mystery of Maureen Woods’s chronic pain. Woods, 64, of Myersville, Md., started having joint pain in her teens and, over the years, told dozens of doctors her pain was “debilitating,” she said. Some told her it was all in her head. In 2017, she was diagnosed with hypermobile Ehlers-Danlos syndrome, a connective tissue disorder often causing loose joints, dislocations and chronic pain.

She said women who are not being heard should keep advocating for themselves. “You have to go with your gut — something is wrong and I need to find a doctor who can figure it out,” she said.

Marjorie Jenkins, dean of the University of South Carolina School of Medicine Greenville, urged women against feeling pressured to accept an “everything is normal” non-diagnosis.

“If your provider does not appear to be listening to you or believing what you’re saying, then you need a new provider,” Jenkins said. “You are the client, you are the customer and you are the owner of your health.”

“You start to doubt yourself after so many medical experts tell you there’s nothing wrong with you.” Jan Maderios, Air Force veteran, Chipley, Fla.

Women can also take a family member, friend or other support person who can corroborate their stories, said Alyson McGregor, an emergency medicine professor at the University of South Carolina School of Medicine Greenville and author of the book “Sex Matters: How Male-Centric Medicine Endangers Women’s Health and What We Can Do About It.”

Particularly in emergency departments, she said, there can be an inherent bias. “There’s this assumption that women are emotional and they’re anxious and that that’s the main issue,” she said.

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Mon, 12 Dec 2022 21:00:48 -0600 en-US text/html https://www.msn.com/en-us/health/other/from-heart-disease-to-iuds-how-doctors-dismiss-women-s-pain/ar-AA15dt1Y
Killexams : Revolutionary robot surgery device makes waves at HCA's Oviedo Medical Center

Oviedo Medical Center is getting a new robot surgery device to help women.

It’s FDA-approved to go through women’s already-existing bodily cavities, rather than through an incision.

Momentis, an Israeli company, created the new device. Chad Zaring is the company’s Chief Commercial Officer.

"This is a totally new concept in surgical robotics," said Zaring.

It isn’t quite a robot surgeon. Rather, it’s a robotic tool surgeons can use for procedures on the fallopian tubes or the ovaries, and common surgeries like laparoscopies. That latter procedure is challenging and complex. The new robotic arm is meant to make its user more accurate and intuitive with their movements.

The device mimics a human hand, wrist, and arm – but is extremely small. It can reach places a surgeon’s hand can’t.As a result, it can go through a woman’s already-existing body cavities rather than doctors having to cut through the abdomen.

Doctors in Oviedo are in the process of training on the device now, and you’ll see it implemented in the near future.

New medical device makes waves at HCA's Oviedo Medical Center (Credit: Momentis)

New medical device makes waves at HCA's Oviedo Medical Center (Credit: Momentis/HCA)

HCA’s Oviedo Medical Center is one of the first to sign on. Dr. Chris Bryat, the Director of Minimally Invasive and Robotic Surgeries for HCA in Oviedo Medical Center, says this will lead to less pain, fewer complications, and fewer infections.

"Sometimes with the disease processes of that affect the health and wellbeing a woman, they have to go down the difficult choice of undergoing surgery to Excellerate their health and wellbeing," said Dr. Bryant. "In this particular case, we would be able to offer that approach in a natural opening with almost incision-less surgery."

Zaring believes that as more doctors learn to use the product and more people accept robotics, they’ll be able to develop new procedures and applications for the robots as well. 

"The concept of controlling instruments remotely from a console sitting here, away from the bedside, is not new," Zaring explained. "But our design, our approach, our structure, our instruments, are much, much different."

Mon, 12 Dec 2022 12:26:00 -0600 Marie Edinger en text/html https://www.fox35orlando.com/news/revolutionary-robot-surgery-device-makes-waves-at-hcas-oviedo-medical-center
Killexams : US experience with transparent medical records should reassure doctors
  1. Catherine DesRoches, associate professor of medicine1,
  2. Jan Walker, associate professor of medicine1,
  3. Tom Delbanco, professor of medicine1
  1. 1Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, USA

Studies generally show that patients benefit and any negative effects on doctors are limited, say Catherine DesRoches and colleagues

In the US, the expansion of patient access to electronic medical records over the past decade has been accompanied by numerous studies investigating the experiences of patients and clinicians. Starting from about 2000, the use of patient portals to display test results spread rapidly, and in 2010, 100 primary care doctors volunteered to open their free text entries to 10 000 of their patients. By 2019, more than 50 million patients in the US had access to what their clinicians wrote about their medical care—entries known widely as open notes.1

In 2021, the US federal government mandated that patients should have easy electronic access at no charge to all information held in their electronic health records.2 Today, patients can use readily available patient portals to access all the information a clinician might use to make decisions about their care in both inpatient and outpatient settings, including primary care and specialist notes, laboratory test results, and imaging reports.

What might doctors in the process of implementing transparent medical records learn from the US experience? Before the rollout of open notes, US clinicians expressed worries similar to those of doctors in England, who are at the start of opening up patient access to GP records.3 The experiences of US doctors provides reassurance in three areas: effects on workload, changes to documentation, and risk of litigation.

Workload

US clinicians anticipated increased workloads as patients gained access to test results and, a decade later, as they began studying their visit notes. Primary care doctors thinking about upset and confused patients calling the office, sending messages, asking time consuming questions during visits, and requesting changes to what the clinician had written. These worries were largely unrealised, and at the end of the year-long 2010 pilot, none of the participating doctors chose to turn off access to notes.4 In fact, their healthcare organisations chose instead to expand access to notes written by all clinicians. These results have been replicated in hundreds of provider organisations across the country, and follow-up studies indicate that clinicians’ views of open notes become more positive over time.5

Some studies suggest that clinicians are changing the way they document in the wake of open medical records.6 In one, around 37% (292/781) of doctors reported spending at least “some” more time writing notes,7 but preliminary inquiries using the timestamps from electronic health records suggest that any increase in time spent in documentation is miniscule (fractions of a second).89 It is likely that doctors learn to think differently about how to document, particularly when new to the practice of open medical records. Such additional cognitive burden may make it feel as if they are spending more time writing, even though direct measurements of the amount of time it’s taking indicate no change. As doctors become accustomed to writing in this way, such strain may well ease.

Both in England and the US, clinicians thinking initially about how transparent medical records may engender adversarial patient-clinician relationships and increase doctors’ liability. Trusting relationships are known to diminish the risk of litigation, even when errors occur, and the US’s overall experience suggests that open and transparent communication increases trust among patients, families, and clinicians.10 Moreover, the US movement to encourage disclosure and apology when problems arise provides further reassurance. Overall, studies indicate that increased transparency, disclosure, and apology may decrease the likelihood that patients and families will file lawsuits.1112 Harvard Medical School’s malpractice insurer covers 16 000 doctors practising both in neighbouring communities and at academic medical centres. In a personal communication, our insurer told us that open medical records do not seem to increase the risk that patients will allege malpractice.

Protecting vulnerable patients

Further challenges accompanying the rollout of open medical records remain. US clinicians share concerns expressed by English GPs about the wellbeing of their most vulnerable patients, such as those experiencing domestic violence or other types of interpersonal abuse.13 US regulations allow clinicians to withhold information from the patient portal if they believe it might harm an individual patient or another person.2 Yet it is unlikely that all doctors and patients are aware of this exception. Healthcare organisations, including the NHS, could help ensure the safety of such vulnerable patients by providing training to clinicians and patients. Electronic health record vendors could also design provider functions that facilitate trauma informed care, including options to create confidential notes and enhanced privacy settings that allow patients greater control over what information is available on the portal.

Another issue currently under debate in the US is when test results should be released to patients. In the past, with the expectation that clinicians would first communicate with patients, most health systems chose to delay the release of some findings, such as pathology examinations, medical imaging reports, or cardiac monitoring. In contrast, the new US rules mandate instantaneous release of virtually all results, whether or not they suggest bad news.

Challenges such as these are not insolvable, but they will take a creative combination of cultural and technical changes to resolve. All new medicines are accompanied by side effects that affect some patients adversely, and for some, fully transparent records may be contraindicated. But in the US, the benefits of open medical records for all involved seem to well outweigh the risks. Patients consistently report clinically meaningful effects, and any potentially negative effects on practitioners have been limited and manageable.

Footnotes

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following: JW has received a grant from the John A Hartford Foundation. CMDesR has received grants from the US Department of Health and Human Services Office of the National Coordinator for Health Information Technology, National Institute on Ageing, and National Cancer Institute; Cambia Foundation; CRICO Risk Management; John A Hartford Foundation; NYS Foundation; Patient Centered Outcomes Research Institute; R C Wilson Jr Foundation; and Swedish Ministry of Health and Foreign Affairs.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

Thu, 08 Dec 2022 22:48:00 -0600 en text/html https://www.bmj.com/content/379/bmj.o2969
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