The Role of Doctors in the COVID-19 “Infodemic”

By Marwa Saleh, MD
May 19, 2020

In late March, several news outlets^1,2ran headlines stating that hundreds of Iranians died and others went blind after drinking adulterated alcohol for protection against COVID-19—some of them were children. On a similar note, the Journal of Histopathology documented the case³of a 41-year-old American who was hospitalized after drinking disinfectant leading to the severe injury of her small bowels.

Other stories include a father who died of COVID-19 after delaying medical help because he believed that COVID-19 was just like the flu, and the couple⁵ who ingested chloroquine (not intended for human use) leading to the death of the husband and hospitalization of the wife.

The tragic incidents were the result of misinformation and these consequences aren’t rare; A WHO report⁶ in February stated that we were facing a “massive infodemic.” The hazards of misinformation are vivid—misinformation costs lives. Continue reading “The Role of Doctors in the COVID-19 “Infodemic”” →

What Does Trauma-Informed Care Look Like?

May 11, 2018

[The following post by Monique Tello has been shared with us by Harvard Health Publishing where it originally appeared in April of 2018. In light of increased emphasis on engaging patients in shared decision making, we invite you to add your thoughts about, and experiences with, trauma-informed care in the comment section after reading this post.]

Trauma-informed care: What it is, and why it’s important

by Monique Tello, MD, MPH
Contributing editor, Harvard Health Publishing

Many years ago, when I was a trainee, I helped take care of patients at a family medicine clinic.* One day, a school-aged brother and sister came in for their annual physicals. Continue reading “What Does Trauma-Informed Care Look Like?” →

Advocating for Societal Health: An Open Letter to Physicians

By Scott Shainker, DO, MS
& Toni Golen, MD
March 22, 2018

If each of us does something, the impact we will make on achieving health will have the greatest legacy on the well being of society.

Fellow physicians, how do you define health?

We don’t believe it is merely about controlling the blood pressure of a 60-year-old patient or removing the infected appendix of a college student; rather, we as physicians need to have a deeper definition of health. Continue reading “Advocating for Societal Health: An Open Letter to Physicians” →

The Harried Doctor & Chronic Pain Patients

By Peter Grinspoon, MD
March 8, 2018

[Part two of a three-part series.]

Why do so many healthcare providers find it difficult to treat chronic pain patients? I have not seen colleagues roll their eyes or audibly groan upon hearing that a patient that is new to their panel has diabetes or cancer, so what is it about a pain patient on opiates that fills so many with dread? Continue reading “The Harried Doctor & Chronic Pain Patients” →

The Orphaned Patient: Treating Chronic Pain with Opioids

By Peter Grinspoon, M.D.
February 1, 2018

[Part 1 of a 3-part series.]

The commonly cited proverb, “The road to hell is paved with good intentions,” was coined in the twelfth century by a French abbot named Bernard of Clairvaux. In no case is this adage more apt than as applies to chronic pain patients, who have been cut off from their longstanding and stable supplies of opiates by physicians who have been convinced, cajoled, intimidated, mandated, and cowed into no longer prescribing high-dose opiates for chronic pain patients in response to the current opiate epidemic. Continue reading “The Orphaned Patient: Treating Chronic Pain with Opioids” →

Spirituality and Medicine

Ajay K. Singh, MBBS, FRCP, MBA
October 19, 2017

“Spiritual or compassionate care involves serving the whole person—the physical, emotional, social, and spiritual. Such service is inherently a spiritual activity.” —Christina Puchalski

An interview with Christina Puchalski on integrating spirituality into medicine in BigQuestionsOnline caught my eye. So I dug a bit more into this topic.

I came across a 2001 article by Puchalski titled, “The role of spirituality in health care” that I would strongly recommend to anyone who takes care of patients. In her article, Puchalski writes: “Spiritual or compassionate care involves serving the whole person—the physical, emotional, social, and spiritual. Such service is inherently a spiritual activity.”

According to Puchalski, physicians should incorporate spiritual practice into their interactions with patients. This could happen by physician’s being “fully present and attentive to their patients…actively listen and allow their patients to share “fears, hopes, pains and dreams.” She also recommends that physicians pay attention to “all dimensions of patients and their families: body, mind, and spirit.” Puchalski supports physician’s involving chaplains as members into the interdisciplinary health care team.

Puchalski is an advocate of “compassionate care,” which she defines as physicians walking “with people in the midst of their pain, to be partners with patients rather than experts dictating information to them.” Merriam-Webster defines compassion as “sympathetic consciousness of others’ distress together with a desire to alleviate it.”

Puchalski writes that compassion is important because:

While patients struggle with the physical aspects of their disease, they have other pain as well: pain related to mental and spiritual suffering, to an inability to engage the deepest questions of life. Patients may be asking questions such as the following: Why is this happening to me now? What will happen to me after I die? Will my family survive my loss? Will I be missed? Will I be remembered? Is there a God? If so, will he be there for me? Will I have time to finish my life’s work?

Studies support Puchalski’s contention that physicians generally underestimate patients’ spiritual needs. Ehman and colleagues performed a self-administered survey to 177 patients in a hospital-based pulmonary clinic: only 15% were asked about spiritual or religious beliefs. Nearly two-thirds of the patients said that they would welcome a question about whether they were spiritual from their doctors while they were taking the medical history. In another study, also a survey, but in primary care clinics of six academic medical centers in three states, MacLean and colleagues report that many patients want their physician to ask them about spiritual beliefs; indeed, this desire for inquiry about spiritual beliefs increases strongly with the severity of the illness. The MacLean study enrolled 456 patients who were dying. Seventy percent of these patients said that they would welcome physician inquiry into their religious beliefs, 55% said that they would appreciate silent prayer, and 50% believed their physician should pray with them.

So what’s the bottom-line? While most physicians focus on the physical aspects of illness, a more holistic approach may be what patients want. Arguably to be complete, physicians should consider discussing spirituality with patients. Christina Puchalski concludes: “I think we can be better physicians and true partners in our patients’ living and in their dying if we can be compassionate: if we truly listen to their hopes, their fears, and their beliefs, and incorporate these beliefs into their therapeutic plans.”

Harvard Medical School CME:
Lifestyle Medicine: Nutrition & The Metabollic Syndrome

Dr. Ajay K. Singh is the Senior Associate Dean for Global and Continuing Education and Director, Master in Medical Sciences in Clinical Investigation (MMSCI) Program at Harvard Medical School. He is also Director, Continuing Medical Education, Department of Medicine and Renal Division at Brigham and Women’s Hospital in Boston.

*OPINIONS EXPRESSED BY OUR AUTHORS ARE VALUABLE TO US AT LEAN FORWARD, BUT DO NOT REPRESENT OFFICIAL POSITIONS OR STATEMENTS FROM HARVARD MEDICAL SCHOOL.

Who is Failing Whom? Moving Towards Person-Centered Addiction Treatment

By Sarah E. Wakeman, MD, FASAM
August 11, 2017

It is not enough to simply say addiction is an illness. If we truly believe this, then we must ensure our language and approach mirror how we care for patients with other illnesses.

The need for treatment modification is a hallmark of disease management, particularly for complex, chronic illnesses like diabetes or HIV. We expect that for many patients a typical treatment course will include periods of remission and recurrence with associated adjustments in medication or other interventions. We even have a term for treatment for the most severe cases of refractory disease; we call it “salvage therapy.” For cancer, salvage therapy refers to “Treatment that is given after the cancer has not responded to other treatments.”¹ Note that the lack of response is focused on the disease, appropriately, and not the patient. Continue reading “Who is Failing Whom? Moving Towards Person-Centered Addiction Treatment” →