Re: Doctors can reduce Adverse Effects by listening to their patients

From: Andrew B. Chung, MD/PhD (andrew_at_heartmdphd.com)
Date: 02/21/05 

Date: Mon, 21 Feb 2005 16:03:02 -0500

In truth, once a doctor hears about an adverse effect, it has already
happened and even listening (i.e. acting on the information which most
already doctors do) will not reduce (the rate) of adverse effects.

You will remain in my prayers, dear Sharon, whom I love, in Lord
Christ's holy name.

May you reject your pride and accept Him as your personal Lord and
Savior, someday, so that you too will have eternal life and the amazing
peace of His everlasting kingdom.

Here's how:

http://makeashorterlink.com/?I22222129

Please note that God truly made this special link describing that He is
the great "I am" and that His message is as simple as the number 2 which
is a number between 1 to 9 and reminds us of His 2 commandments, the 2
arms of the cross, the 2nd part of the Trinity, the 2 finger sign of the
Prince of Peace [who remains *V*ictorious over death and satan], and the
2PD Approach. Let it not ever be written that Christ did not make His
presence known here on Usenet :-)

Also, note that Exodus 16:16 continues to remind us that 16 oz plus 16
oz makes 2 pounds, which is "a certain measure of weight," which is what
"omer" literally means in Hebrew.

Enter the 2PD-OMER Approach:

http://www.heartmdphd.com/wtloss.asp

At His service,

Andrew 

-- 
Andrew B. Chung, MD/PhD 
Board-Certified Cardiologist 
** 
Suggested Reading: 
(1) http://makeashorterlink.com/?L26062048 
(2) http://makeashorterlink.com/?O2F325D1A 
(3) http://makeashorterlink.com/?X1C62661A 
(4) http://makeashorterlink.com/?U1E13130A 
(5) http://makeashorterlink.com/?K6F72510A 
(6) http://makeashorterlink.com/?I24E5151A 
(7) http://makeashorterlink.com/?I22222129     
Sharon Hope wrote:
> 
> "Patient-reported medication symptoms in primary care."  This was published
> by the Archives of Internal Medicine, Volume 165, No. 2, January 24, 2005,
> and mentioned in the People's Pharmacy column today.
> 
> At first glance, it should be a big DUHHHH (perhaps meriting its own
> Doctoring for Dummies book), but unfortunately it is not only an important
> consideration in medicine, but too infrequent for quality care.
> 
> I attended a seminar on Medical Ethics (illustrated by the case of statins)
> last week at UCSD, and I was struck by one doctor (a ranking member of the
> medical college, both a physician and a lawyer) who absolutely categorically
> stated several times that he DID NOT BELIEVE that physicians would tell
> patients that it was "impossible" that statins could be responsible for the
> adverse effects they were experiencing.  Unable to contain myself, I spoke
> up from the audience and, holding up printouts from 5 different emails that
> I had personally received just in the past week by people who had heard just
> such pronouncement from their own physicians - each of whom refused to even
> consider statins as causitive in the symptoms the email author or his/her
> loved ones were experiencing, even though all of the symptoms were well
> documented in the medical literature as known statin adverse effects.  To
> this the dubious doctor said that, while he didn't doubt the PATIENTS
> claimed the doctors said it was impossible, he did not believe that the
> doctors ever said "impossible."  To this the presenter of the ethics seminar
> said that, while she would have been inclined to agree with his opinion
> several years ago, having consulted with several of these dubious physicians
> (at the patients' insistence), she no longer doubted the patient reports
> that their doctors said it was "impossible."   Disturbingly, the opinionated
> doctor (who instructs other doctors and doctors to be in medical school)
> then said, I do not believe you.  Effectively, branding not only the
> presenter, but all the patients referenced, liars.
> 
> Naturally, this was disproportionately disturbing to me, as there had been
> ***AMPLE OPPORTUNITIES*** for intervention during the 4 year decline on 10mg
> Lipitor when my husband's growing constellation of symptoms, increasing in
> severity, had been repeatedly discussed with his Primary Care Physician and
> his Cardiologist.  Never once did either of them relate these symptoms to
> the statin (exception: Muscle pain, he was told it was the statin, but to
> "tough it out"), nor did they explore other causes (exception, near the end
> of the 4th year, there was a carotid artery scan done at my insistence to
> eliminate a blockage of blood flow to the brain as a cause - it was clear
> and nothing else was done).
> 
> It was from this perspective that this morning's People's Pharmacy reference
> struck me as important.  Here, without further introduction, is the
> abstract:
> 
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15668373
> 
> Arch Intern Med. 2005 Jan 24;165(2):234-40.
> 
> Patient-reported medication symptoms in primary care.
> 
> Weingart SN, Gandhi TK, Seger AC, Seger DL, Borus J, Bur*** E, Leape LL,
> Bates
> DW.
> 
> Division of General Medicine and Primary Care, Beth Israel Deaconess Medical
> Center, Boston, MA, USA. saul_weingart@dfci.harvard.edu
> 
> BACKGROUND: Little is known about the prevalence and character of
> medication-related symptoms in primary care and their relationship to
> adverse
> drug events (ADEs) or about factors that affect patient-physician
> communication
> regarding medication symptoms. METHODS: The study included 661 patients who
> received prescriptions from physicians at 4 adult primary care practices. We
> interviewed patients 2 weeks and 3 months after the index visit, reviewed
> patients' medical records, and surveyed physicians whose patients identified
> medication-related symptoms. Physician reviewers determined whether
> medication
> symptoms constituted true ADEs. We used multivariable regression to examine
> factors associated with patients' decision to discuss symptoms with a
> physician
> and with physicians' decision to alter therapy. RESULTS: A total of 179
> patients
> identified 286 medication-related symptoms but discussed only 196 (69%) with
> their physicians. Physicians changed therapy in response to 76% of reported
> symptoms. Patients' failure to discuss 90 medication symptoms resulted in 19
> (21%) ameliorable and 2 (2%) preventable ADEs. Physicians' failure to change
> therapy in 48 cases resulted in 31 (65%) ameliorable ADEs. In multivariable
> analyses, patients who took more medications (odds ratio [OR] = 1.06; 95%
> confidence interval [CI] = 1.04-1.08; P<.001) and had multiple medication
> allergies (OR = 1.07; 95% CI = 1.03-1.11; P = .001) were more likely to
> discuss
> symptoms. Male physicians (OR = 1.20, 95% CI = 1.09-1.26; P = .002) and
> physicians at 2 practices were more likely to change therapy (OR = 1.24; 95%
> CI
> = 1.17-1.28; P<.001; and OR = 1.17; 95% CI = 1.08-1.24; P = .002).
> CONCLUSION:
> Primary care physicians may be able to reduce the duration and/or the
> severity
> of many ADEs by eliciting and addressing patients' medication symptoms.
> 
> Publication Types:
>     Multicenter Study
> 
> PMID: 15668373 [PubMed - indexed for MEDLINE]
> 
> So, as many of you have seen in most of my posts, if only the adverse
> effects were more widely known, and if only doctors would screen for them,
> others need not become disabled due to statin adverse effects.  A simple
> message, now worked up as a study.
> 
> Unfortunately, the situation persists.
> 
> And unfortunately for patients, doctors-to-be are being instructed by
> doctors like the one in the audience of the ethics seminar, who is so deeply
> in denial as to ignore evidence all around him (and at least he attended).
> It is little surprise that that particular physician felt the need to attain
> a law degree to go with his medical credentials - one wonders if it would
> have been a perceived need had he spent the hours listening to his patients
> that he instead expended at law school?
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