Thursday, May 3, 2007

HospiceBlog; Hurwitz Update; Lying; Chemo Brain

1) If you have not gone over to see HospiceGuy and his HospiceBlog (www.hospiceblog.org) you are missing out on some great posts. HospiceGuy is on a roll with some insight about the role of the chaplain in hospice, the NHPCO conference, hospice leadership and a quick overview of the Medicare Wage Index for 2008. On the wage index, the NHPCO also has a 5 page announcement (members only) boiled down to the parts that you need to know about.

2) The verdict is in on the case of Dr. Hurwitz and he was found guilty of:

“knowingly and intentionally” distributing drugs “outside the bounds of medical practice” and engaging in drug trafficking “as conventionally understood”? (via NY Times)
Many good overviews below so I will not go into detail here but at least read one of these links because this can impact palliativists in the USA, and you will want to know about it. The frustrating part is noted in John Tierney's NY Times blog (link #2 below):
They (the jurors) said that the jury considered Dr. William Hurwitz to be a doctor dedicated to treating pain who didn’t intentionally prescribe drugs to be resold or abused. They said he didn’t appear to benefit financially from his patients’ drug dealing and that he wasn’t what they considered a conventional drug trafficker.
Hurwitz links:
NY Times
NY Times # 2
Reason Magazine

3) Although the day has passed, apparently April 30th is National Honesty Day. An article written by Shankar Vedantam from the Washington Post about lying and the Libby trial had this interesting conclusion which any HPM provider would say is a familiar situation:
DePaulo once conducted a study in which she asked people to recall the worst lie they had ever told and the worst lie ever told to them. In a reflection of how much our perceptions of lying depend on our particular points of view, the psychologist found that many young people reported that the worst lie ever told to them was by a parent who concealed news that someone they loved was sick or dying. (emphasis mine) By contrast, DePaulo found, parents never thought of such deceptions as particularly serious ethical breaches -- in fact, they saw them as acts of love.

If you look at Bella DePaulo's website, you'll find many studies on deception (she is a social psychologist at UCSB). A study exploring themes of deception among family members, patients, and staff at the end of life would likely find many instances of 'scrupulous lying' in order to protect someone from emotional harm.

4) The NY Times had an article on "chemo brain" showing that the cognitive decline that may accompany chemotherapy is a real phenomena:
“The disparity plays out in all kinds of ways,” said Ellen Coleman, the associate executive director of CancerCare, which provides free support services. “They don’t approach their health care person because they don’t expect help.”

But approaching a doctor does not guarantee help. Susan Mitchell, 48, who does freelance research on economic trends, complained to her oncologist in Jackson, Miss., that her income had been halved since her breast cancer treatment last year because everything took longer for her to accomplish.

She said his reply was a shrug.

“They see their job as keeping us alive, and we appreciate that,” Ms. Mitchell said. “But it’s like everything else is a luxury. These are survivor issues, and they need to get used to the fact that lots of us are surviving.”

As a fan of semantics, I find the choice of 'chemo brain' troubling. It sounds kind of cute, or minor like 'broken heart' or 'upset tummy.' We don't call Alzheimer's 'fuzzy old brain'? I wonder if this label discouraged attempts to research the syndrome. How about Chemotherapy Associated Cognitive Impairment?

(Don't you think that tree looks like neurons? Photo courtesy of flickr.com user Victoriano)


5) And just in case you needed a picture for your PowerPoint presentation, the Mental_Floss magazine blog has a post on odd street names, such as the following:

I would make sure your hospice offices were not on this street.

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