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Operation room manual

Vodi? za operacijsku saluToday I published a recently finished medical manual on my website. I wrote it in collaboration with colleagues from the Department of Gynecology and Obstetrics at the University Hospital Rijeka. It is aimed at all health workers who are for the first time starting to working in an operating room and encountering aseptic work techniques. For now only Croatian language version is available, but the one in English will be appearing soon. Anyway, even if you do not speak Croatian be sure to take a look because the material is full of visual data.

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HOPKINS

On June 26th, ABC News started airing its six-part series called “Hopkins” which takes an intimate look at the men and women who work at The Johns Hopkins Hospital. Each episode follows a few characters, both healthcare workers and patients, and their stories. The series is greatly produced and is very inspiring to watch. So far, two episodes came out and here are their summaries:

Episode 1

Twenty-one years ago Dr. Alfredo Quinones-Hinjosa climbed a 20-foot border fence so he could join other illegal immigrants picking fruit in the lush valleys of central California. Today he is one of the nation’s elite brain surgeons. He tells ABC News about his remarkable journey as viewers watch him try to save a man’s life.

Karen Boyle is among the new generation of surgeons. She is the first female attending in urology at Hopkins, and determined to maintain a balance between her family and her job. But what sets her apart from other surgeons is the candid counseling about sexual health and intimacy she offers to her patients.

Brian Bethea has made it to the top of one of the most difficult residencies in medicine, cardiothoracic surgery. After nine years of apprenticeship he is ready to join the ranks of the nation’s most illustrious heart and lung surgeons. But the demands of residency have left his family life in shambles. Repairing a ruptured aorta may be easier than saving his marriage.

Episode 2

Brenda Thompson is dying from an obscure and always fatal lung disease. After two failed marriages, her third husband seems to be the man of her dreams. But time is running out. Only a lung transplant can save her. And a new lung may not become available in time. When a donor does become available in New England, there is jubilation. But events take an ominous turn when the donor lungs turn out to be damaged.

Brian Bethea, the promising cardiothoracic surgeon with marital problems, has been sent to harvest the new lungs that turn out to be damaged. Nothing seems to be going right for him. When Brian returns home, he must explain to his daughters that he and their mother are separating and he has found his own apartment.

Mustapha Saheed is in his third year of emergency medicine. At six foot, seven inches tall, this self-described “big black man” cuts a striking figure as he dashes through the ER. Despite the advice of a colleague to not marry the “girlfriend who got you through residency,” Saheed makes plans for the altar.

You can watch Hopkins on ABC News website

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Life Record EMR

Life Record is a web based electronic medical record with some pretty nice features. One of the coolest is the possibility to use your iPhone to pull up a full medical record, make updates and even write prescriptions.

Take a look at the video demonstration.

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Doctors being honest

It the last issue of Reader’s Digest two dozen of doctors revealed “41 Secrets Your Doctor Would Never Share“.

I recognized myself in quite a few of these thoughts shared by the colleagues. Here are some of their “confessions”:

  • So let me get this straight: You want a referral to three specialists, an MRI, the medication you saw on TV, and an extra hour for this visit. Gotcha. Do you want fries with that?
    –Douglas Farrago, MD
     
  • It really bugs me when people come to the ER for fairly trivial things that could be dealt with at home.
    –ER physician, Colorado Springs, Colorado
     
  • Sometimes it’s easier for a doctor to write a prescription for a medicine than to explain why the patient doesn’t need it.
    –Cardiologist, Bangor, Maine
     
  • Often the biggest names, the department chairmen, are not the best clinicians, because they spend most of their time being administrators. They no longer primarily focus on taking care of patients.
    –Heart surgeon, New York City
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Peculiar medical research – round 2

Article titled “Lying to Each Other: When Internal Medicine Residents Use Deception With Their Colleagues” was published by Dr Micheal Green and others in the Archives of Internal Medicine. I decided to present it, despite the fact it was published exactly eight years ago, because the subject it explores is still very real, and the article itself is thought provoking and well written.

Objective

Authors wanted to answer 3 questions:

  1. What is the likelihood that resident physicians say they would deceive other physicians in various circumstances?
  2. What factors increase the likelihood of using deception?
  3. Who do residents believe are more likely to deceive a colleague – themselves or their peers?

Subjects and Methods

Survey to assess physicians’ attitudes toward using deception with colleagues was designed in the form of 5 vignettes. These vignettes, each with two versions, addressed 5 reasons a resident may be motivated to use deception:

  1. To avoid extra work
  2. To protect a colleague
  3. To avoid embarrassment
  4. To protect a patients’ confidentiality
  5. To cover up a mistake

In the first vignette, residents were asked to exchange call with a colleague who either wanted to (1) attend a bridal shower or (2) be with her sick father. In the second, residents were asked to substitute their own urine for a colleague’s urine drug screen, when the chance of being caught was either (1) 0% or (2) 20% to 25%. In the third, residents were asked by an attending physician to report a laboratory result, when the likelihood of being ridiculed or reprimanded for not recalling the result was either (1) high or (2) low. In the fourth, residents were asked by a patient to protect the patient’s privacy by falsifying a diagnosis in the medical record, when the diagnosis was either (1) rheumatoid arthritis or (2) genital herpes. And in the fifth, residents who failed to perform a rectal examination were asked about the presence of blood in a patient’s stool, when the patient either (1) had an uneventful night or (2) had an acute myocardial infarction due to anemia from an upper gastrointestinal tract hemorrhage.

Access the article (free full text) to read the actual content of each vignette (Figure 1) and test yourself.

Survey was distributed among all internal medicine residents at the 4 teaching hospitals.

Results

Figure 2 from the article summarizes a large part of the results.

Results / Figure 2

Additionally, women were found to be 8 times more likely to indicate they would fabricate a laboratory value when they were likely to be ridiculed than when they were not.

When it comes to witnessing deception, 22 % reported having seen a resident intentionally lie to (or deceive) a medical student in the last year, 43% had witnessed a resident lying to another resident physician, and 41% had witnessed a resident lying to an attending physician.

Conclusions

Many residents say they would lie to a colleague to avoid doing that person a favor. Deceiving colleagues
about clinical issues is less likely, but far more serious. A small percentage say they would falsify a medical
record to protect patient confidentiality, fabricate a laboratory value to avoid ridicule, and lie about performing a neglected aspect of the physical examination to cover up a mistake.

Authors offer some advice to medical educators:

  1. Address the issues of professionalism and collegiality as part of the ethics curriculum that is required for all medical residents.
  2. Be aware that residents, like any group of people, exhibit a wide range of moral behaviors, and, sadly, the possibility that the resident is not telling the truth should be included in the differential diagnosis.
  3. Educate yourself about the potential impact of teaching styles on residents’ behavior, so you can reduce the risk of being lied to.
  4. Become aware of the particular circumstances under which residents may be more likely to deceive, so you can take appropriate measures to reduce incentives for this behavior.
  5. Residents need to be exposed to excellent role models who demonstrate not only the technical skills expected of physicians but the moral ones as well.

Hope you enjoyed, and better yet found usefull the article presented in this round of peculiar research series. Be sure to read the round 1 too.

Images copyright © 2000 American Medical Association.

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Computerized Screening for Adolescent Behavioral Concerns

In the latest issue of Pediatrics, official journal of the American Academy of Pediatrics, researchers from Nationwide Children’s Hospital in Columbus, Ohio have published a paper titled “Trial of Computerized Screening for Adolescent Behavioral Concerns“. This paper talks about the potential benefits of the Health eTouch systems to help pediatricians identify injury risks, depressive symptoms, and substance use among adolescent visiting urban clinics.

A total of 878 primary care patients 11 to 20 years of age where included in the study conducted in waiting rooms of 9 urban clinics. All of the patients where given wireless devices in clinic waiting rooms to answer questions about their health and behavior. The clinics were randomly assigned to have pediatricians receive these screening results either just before face-to-face encounters with patients (immediate-results condition) or 2 to 3 business days later (delayed-results condition).

What the study eventually found was that 59% of the respondents had positive results for 1 or more of the following behavioral concerns: injury risk behaviors, significant depressive symptoms, or substance use. Sixty-eight percent of youths in the immediate-results condition who screened positive were identified as having a problem by their pediatrician. This was significantly higher than the recognition rate of 52% for youths in the delayed-results condition.

Take a look at the video, including a short interview with one of the main researchers, to learn more.

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