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Doctor Please Don’t Go By Appearances

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When Healthcare Does Not Recognise You Are Seriously Ill

It was a joy to spend time with Rebecca Trahan and Elizabeth Apelles to discuss the impact of rare disease and Spontaneous Coronary Artery Dissection (SCAD) in particular.

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You may disagree with your doctor

Respondents

Eric Last

Carly Flumer

Dana Deighton

Rod Ritchie

Daniel G Garza

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Why does a haircut cost more than a visit to a doctor?

These conversations with Diana Anderson and Cheryl Janis may be relevant in this context.

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What good is a cold?

It is often quoted that 50% of people will succumb to an upper respiratory tract infection in the course of a year. The usual pathogens involved are viruses.

Rhinoviruses with more than 100 serotypes are the most common pathogens, causing at least 25% of colds in adults. Coronaviruses may be responsible for more than 10% of cases. Parainfluenza viruses, respiratory syncytial virus, adenoviruses and influenza viruses have all been linked to the common cold syndrome. All of these organisms show seasonal variations in incidence. The cause of 30% to 40% of cold syndromes has not been determined.

Purushothama V. Dasaraju and Chien Liu.

The natural history of a cold is typically complete resolution within seven to ten days. There is no cure and regardless of what treatment is offered most people are miserable during that time with a runny nose, cough, sneezing, fatigue and sore throat. This is one of the commonest reasons people seek medical advice if not the most common reason. Colds are typically seasonal, highly infectious and responsible for a huge cost to society . Not to mention the risk of being offered inappropriate treatment, especially antibiotics.

We might ponder a philosophical question- Who benefits from a cold? Certainly viruses do- they spread from host to host at an alarming rate. However viruses that cause a cold do not mutate like the flu virus does, so spreading through the community doesn’t support their evolution. The condition is not fatal therefore it does not appear to support the host’s natural selection. So what is the point of an infection that makes us miserable up to three or four times a year? We lose time off work, we take medicines that provide temporary relief and life simply becomes a little more difficult. Possibly the only part of society that benefits are those who sell medicines!

Research now suggests that not everyone suffers to the same extent.

The epidemiologic data suggest that endurance athletes are at increased risk for URTI during periods of heavy training and the 1-to 2-week period after marathon-type race events.

Nieman

Even after adjustment for other variables, men were significantly more likely to ‘over-rate’ their symptoms in comparison with the clinical observer than were women.

Macintyre

We found that high physical activity was associated with a lower risk of contracting URTI for both men and women.

Fondell et al

Data analysis showed that higher incidence of URTI was significantly associated with increased training ( tennis) duration and load, and competition level, on a weekly basis.

Novas et al

The risk of self-reported manifestations of the common cold was higher in workers who reported symptoms of depression.

Kim et al

Most of the relevant studies show a significant relationship between psychosocial factors and the onset or progression of acute respiratory tract illness. However, the psychosocial variables were not consistently evaluated across the included studies, and different methodological approaches were used to examine the association between psychosocial factors and acute respiratory tract illness.

Falagas et al

And finally most intriguing of all

Training in meditation or exercise may be effective in reducing ARI illness burden.

Barrett et al

This suggests that the URTI may serve as a barometer for stress in many people. This perspective may help those who advise or care for people who are experiencing symptoms of an URTI to consider what if anything can be done to address the other issues in their lives that may be problematic. By corollary people presenting for help with an URTI require the most skilled healthcare and not just a lecture on how paracetamol is the only treatment available.

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Where are your finger prints in my care?

It is unlikely that you will be part of every encounter with the customer, client or patient whatever you do and wherever you work. A barista is not at the table with the customer is presented with their breakfast; a dressmaker isn’t at the checkout when the customer makes their purchase at a department store. Sooner or later you won’t be there in person. However it is likely that whatever you’ve contributed will have an impact. How do you define your role from this perspective in healthcare?

The participants—21 family physicians (fps), 15 surgeons, 12 medical oncologists, 6 radiation oncologists, and 4 general practitioners in oncology—were asked to describe both the role that fps currently play and the role that, in their opinion, fps should play in the future care of cancer patients across the cancer continuum. Participants identified 3 key roles: coordinating cancer care, managing comorbidities, and providing psychosocial care to patients and their families. However, fps and specialists discussed many challenges that prevent fps from fully performing those roles:

  • The fps described communication problems resulting from not being kept “in the loop” because they weren’t copied on patient reports and also the lack of clearly defined roles for all the various health care providers involved in providing care to cancer patients.

  • The specialists expressed concerns about a lack of patient access to fp care, leaving specialists to fill the care gaps. Easley et al

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Do something in your power to make a difference

It’s a small detail. If you are accompanying someone down a corridor as a healthcare professional- don’t stride ahead. Ideally walk alongside the person or let them lead the way if they know where you are headed. If they are wheeling a buggy and carrying a bag offer to help by wheeling the buggy.  Just try it. You might like how they respond. Apart from that you can learn so much about the person even before the consultation begins:

So instead of a doctor assessing a patient’s blood pressure, body mass index, chronic conditions, hospitalization and smoking history and use of mobility aids to estimate survival, a lab assistant could simply time the patient walking a few meters and predict just as accurately the person’s likelihood of living five or 10 more years—as well as a median life expectancy. Scientific American

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Ineffective handover can be fatal

Imagine what might lead to the worst outcomes in healthcare. It doesn’t actually have to happen but it might help to identify what could go wrong before it ever does. In most cases it will be a failure to communicate.

Ineffective hand-off communication is recognized as a critical patient safety problem in health care; in fact, an estimated 80% of serious medical errors involve miscommunication between caregivers during the transfer of patients. The hand-off process involves “senders,” those caregivers transmitting patient information and transitioning the care of a patient to the next clinician, and “receivers,” those caregivers who accept the patient information and care of that patient. In addition to causing patient harm, defective hand-offs can lead to delays in treatment, inappropriate treatment, and increased length of stay in the hospital. Joint Commission Perspectives

Much of what might make a difference needs those involved in whatever role to do basic things.

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Do you use your powers of observation?

Healthcare professionals and doctors in particular need to be observant. Many, if most are observant because it can make the difference between an early diagnosis and an early demise. I remember an ambulance crew saving a patient’s life not only by their rapid transport of a confused suicidal patient but because they noticed and reported the white mark around the lip of the glass she had been found drinking from. It turned out it was soluble aspirin and the patient was quickly diagnosed with salcylism.

The same powers of observation can be used to find new solutions or perhaps better solutions to common problems. Healthcare professionals are in contact with patients more than any policy maker or bureaucrat. If history has taught us anything it is that the most valuable solutions to healthcare problems are likely to be generated by those who don’t dismiss small details.

In a sense, curiosity is the mother of innovation. People often think that they will struggle to be innovative because they feel that they are not creative. Creativity is certainly useful, but curiosity is really all that you need to get the process started. Curiosity about what’s going on around you, and then curiosity about how an idea would work in another context. So, turn off autopilot mode in your brain, and be curious! Paul Matthews

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Your greatest value is your ability to solve problems

As a healthcare professional you may face problems that require problem solving at the least and the generation of creative solutions ideally. How do you hone your creativity?

The results revealed that leadership clarity is associated with clear team objectives, high levels of participation, commitment to excellence, and support for innovation. Team processes consistently predicted team innovation across all three samples. Team leadership predicted innovation in the latter two samples, and there was some evidence that team processes partly mediated this relationship. The results imply the need for theory that incorporates clarity and not just style of leadership. For health care teams in particular, and teams in general, the results suggest a need to ensure leadership is clear in teams when innovation is a desirable team performance outcome. West et al

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