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'If you met me, you'd never know I was mentally ill. In fact, I've gone through most of my adult life without anyone ever knowing - except when I've had to reveal it to a doctor. And that revelation changes everything. It wipes clean the rest of my résumé, my education, my accomplishments, reduces me to a diagnosis. I was surprised when, after one of these run-ins, my psychopharmacologist said this sort of behavior was all too common. At least 14 studies have shown that patients with a serious mental illness receive worse medical care than "normal" people. Last year the World Health Organization called the stigma and discrimination endured by people with mental health conditions "a hidden human rights emergency." If you met me, you'd never know I was mentally ill. In fact, I've gone through most of my adult life without anyone ever knowing - except when I've had to reveal it to a doctor. And that revelation changes everything. It wipes clean the rest of my résumé, my education, my accomplishments, reduces me to a diagnosis. I was surprised when, after one of these run-ins, my psychopharmacologist said this sort of behavior was all too common. At least 14 studies have shown that patients with a serious mental illness receive worse medical care than "normal" people. Last year the World Health Organization called the stigma and discrimination endured by people with mental health conditions "a hidden human rights emergency." I never knew it until I started poking around, but this particular kind of discriminatory doctoring has a name. It's called "diagnostic overshadowing." According to a review of studies done by the Institute of Psychiatry at King's College, London, it happens a lot. As a result, people with a serious mental illness - including bipolar disorder, major depression, schizophrenia and schizoaffective disorder - end up with wrong diagnoses and are under-treated. That is a problem, because if yo

I refused further radiation and chemotherapy. I lay in my bed and watched the events around me - the distress of my family, the helplessness of my doctors - without anxiety, comfortable that I had made the correct decision. My doctors couldn't override it or persuade me to change my mind, but, luckily, my wife, Diana, could and did. From my mental cocoon in the hospital bed, I could sense Diana at my side. "You're going to finish the treatment," she said softly. I did not have the energy, or perhaps the will, to disagree. She wheeled me down herself to finish my radiation treatments in the basement of the hospital.

In a globalized economy, the countries that pay the most and offer the greatest chance for advancement tend to get the top talent. South America's best soccer players generally migrate to Europe, where the salaries are high and the tournaments are glitzier than those in Brazil or Argentina. Many top high-tech workers from India and China move to the United States to work for American companies. And the United States, with its high salaries and technological innovation, is also the world's most powerful magnet for doctors, attracting more every year than Britain, Canada and Australia - the next most popular destinations for migrating doctors - combined.

Autonomy has limits - pts want docs to exercise expertise.

Doctors' inertia in changing practice to fit new evidence - especially in cancer screening

by Paul Moses - Newsday - 6/29/2001 DR. FREDERICK SMITH has the usual textbooks on ambulatory care, surgery and prescription drugs in his office. But the shelves also hold D.T.Suzuki's "Essays in Zen Buddhism," a volume of Cardinal John Henry Newman's writings, books on Confucianism and Judaism, the Quran and alarge-type, 69-year-old Bible a patient gave him, so worn that its cover has fallen off. These, too, are tools of Smith's trade. As associate chief of internal medicine at North Shore University Hospital in Manhasset, the gray-bearded, 56-year-old physician has found that religious faith can help his patients,and he's trying to teach that to a generation of up-and-coming doctors. His 2-year-old course, Religion and Medicine, is part of a growing move to sensitize doctors to the role faith plays in their patients' lives. It gives residents at North Shore who've completed medical school but are still receiving some training a chance to learn about their patients' religious traditions....

Even when the system works as it's supposed to, and palliative care specialists arrive like the cavalry to provide comfort care, to stop fruitless and painful interventions and to support what patients want, their own colleagues may brand them murderers. It takes strong doctors to stand up to that kind of verbal abuse, to explain that courts and ethics committees have approved care that's intended to reduce suffering, to point out that the patient's own wishes are paramount. Perhaps they have to be stronger than we know. "The culture is changing," Dr. Matlock told me. "But it's not changed yet."

Even highly effective people fear displeasing doc by speaking up

>"...Offering a default option of opting in, rather than opting out (as many have suggested with organ donations as well) doesn't take away choice but guides us to make better ones, according to Richard H. Thaler, an economics professor at the University of Chicago, and Cass R. Sunstein, a professor at Chicago's law school, authors of "Nudge: Improving Decisions About Health, Wealth and Happiness". Making choices can be most difficult in the area of health. While we don't want to go back to the days when doctors unilaterally determined what was best, there may be ways of changing policy so that families are not forced to make unbearable choices. >Professor Iyengar and some colleagues compared how American and French families coped after making the heart-wrenching decision to withdraw life-sustaining treatment from an infant. In the United States, parents must make the decision to end the treatment, while in France, the doctors decide, unless explicitly challenged by the parents. >French families weren't as angry or confused about what had happened, and focused much less on how things might have been or should have been than the American parents.

'...the Cochrane Collaboration reported last year that patients who used tools to guide their decisions had a better grasp of their choices and risks. They were also more likely to select less intense or invasive treatment when considering major elective surgery, though results were mixed for other decisions. The influence of decision aids on adherence to medication or overall costs was "inconclusive," according to the report. 'But that uncertainty does not reduce the ethical obligation to better inform patients, or lessen the promise of tools that help patients understand their options and identify their values, some doctors say. "It is the right thing to do," said Dr. Victor Montori, associate director of the Health Care Delivery Research Program at the Mayo Clinic Center for the Science of Health Care Delivery....'

Most people in health care understand and accept the need for clinical hierarchies. The problem is that we aren't usually prepared for them; nor are we given protocols for resolving the inevitable tensions that arise over appropriate care. Doctors and nurses are trained differently, and our sense of priorities can conflict. When that happens, the lack of an established, neutral way of resolving such clashes works to everyone's detriment. This isn't about hurt feelings or bruised egos. Modern health care is complex, highly technical and dangerous, and the lack of flexible, dynamic protocols to facilitate communication along the medical hierarchy can be deadly. Indeed, preventable medical errors kill 100,000 patients a year, or a million people a decade, wrote Rosemary Gordon and Janardan Prasad Singh in their book "Wall of Silence."

Jud Newborn, a Holocaust scholar who lives in Plainview, was doing research in Munich as a graduate student in the early 1980s when he became intrigued with the story of the White Rose resistance movement. The small, student-based group wrote and printed anonymous anti-Nazi leaflets in Munich and distributed them in that city and beyond before its key members were captured and executed in 1943. Dr. Newborn, who earned a doctorate in cultural anthropology from the University of Chicago, is the co-author with Annette Dumbach of a book on the White Rose and has developed a multimedia lecture on the subject. In recognition of Holocaust Remembrance Day (April 8 this year), he will present the lecture at two Long Island synagogues. The lecture will be accompanied by nearly 80 historical images, including photographs, posters and newspaper articles, as well as recorded music. Dr. Newborn may also occasionally speak with a mock-German accent when quoting Nazi officials, in the service of his White Rose presentation. (The second half of the program focuses on more contemporary figures who have acted heroically against great odds.)

The Affordable Care Act's updated versions of HMOs are based on flawed assumptions about doctor and patient behavior.

cosmetic plastics attracting more doctors in training

Bob Doherty is the main Washington lobbyist of the ACP - after the AMA, the largest organization of US doctors (representing internal medicine physicians, whether primary care or subspecialist). He's had some very interesting posts since the Massachusetts Senate upset. His blog is a finalist in the sixth annual Medical Weblog Awards for the Best Health Policies/Ethics Weblog. Doherty articulates the ACP's case for supporting the current Senate&House Health Care Reform legislation (whose failure he & many others will end up leading eventually to more draconian limits on doctors & patients, in order to control the currently unsustainable growth in US health care costs (now approaching 20% of GDP).

Pho is a fairly conservative primary care doctor in New Hampshire, but believes that defeat of the current Senate/House legislation will eventually lead to more draconian restrictions on doctors and patients, since the cost of medical care will otherwise become untenable in the U.S.

A nun at a Catholic hospital in Phoenix has been excommunicated for allowing an abortion to be performed on a woman who doctors say would otherwise have died. Sister Margaret McBride may also be expelled from her order. Now, there's a debate about the church's quick, severe penalty while it waited years to punish pedophile priests.">