Tuesday, June 26, 2007

Paging Dr. TMI; The Poppy Trade

TMI is "Too Much Information" if you needed to know
1) Many news outlets (WSJ and USA Today (read the comments there) and others) are noting an article in the Archives of Internal Medicine regarding physician self-disclosure during clinic visits. The study involved standardized patients secretly recording physician visits which were then later analyzed for "personal emotions and experiences, families and/or relationships, professional descriptions, and personal experiences with the patient’s diagnosis." They even managed to account for one of my favorite errors in research, the Hawthorne Effect (non-Wikipedia link!), by using unannounced, unrecognized SP's, so that the MD's would not alter their behavior. The article includes many interesting snips of conversation from the study. 73 self-disclosures were identified in 34% (38/113) of the visits. The authors even noted if the disclosure was deemed helpful, neutral or disruptive.

This study was well-designed and executed and the discussion section is a great read. It provides insight in how to look at the blurry lines among empathy and disclosure and boundaries and strengthening the clinician-patient relationship. I think these issues are very important for palliative care practitioners since it is so easy to make a quick connection with people by sharing any of your own losses, but ultimately it does turn the focus to us, and not to the patient or family. One technique if you are sharing something of your own experience, is you can always depersonalize it and mention "A patient/family that was in a similar situation thought this was important..." or whatever segue works best.

But I guess that is sharing a little too much about myself!

2)Nature is reporting a release of a innovative proposal to help fight the "war on terror" and the "war on drugs" at the same time. The program is called Poppies for Medicine (P4M) and it is being proposed by the Senlis Council, a European-based think tank dealing with health, counter-narcotics and grass roots improvement in Afghanistan. Some of the basic tenets of the plan include:

  • Afghan farmers preferring a reliable, legal means of income
  • A better price (US$140/kg) for farmers compared to illegal markets (US$92/kg)
  • A worldwide shortage of inexpensive pharmaceutical grade opioids (A very interesting read)
  • Manufacturing on a local level to provide stable jobs in rural areas
  • Close oversight for quality control
This ideas does not sound too crazy, especially since the United States backed a similar plan in Turkey in the 1960's to curb the illegal poppy/heroin trade. There is a great FAQ and a full report at the Senlis Council website if you want to read more about it. Maybe an international vote of support from hospice and palliative care programs for improved access to appropriate medical use of opioids is in order? Anyone from the IAHPC read this? Can anyone imagine morphine bottles labeled "Made in Afghanistan?" I wonder what that would do for the American opioid stigma.

The image of the button at right is courtesy of flickr.com user violinsoldier. The button is supposed to signify the poppy's firm grip on the country and people of Afghanistan. The writing has been translated as "Save your country from the occupation of drugs" in two languages.

Other tidbits:
The Virginian teen who was initially denied alternative (CAM) treatments, Abraham Cherrix, had to go in for more radiation. Two bloggers (Respectful Insolence and The Cheerful Oncologist)at ScienceBlogs comment on the report. Both are good writers with some interesting insight, so I will not try and outdo them.

Freakonomics (a good non-medicine blog and book) interviews Atul Gawande, author of Better: A Surgeon's Notes on Performance. He makes a comment that we could do better with chronic pain. (I agree!) Then states that we can cure 70% of cancers. (huh?). Despite that last statement needing some 'qualifiers', I have heard great things about his book. Any Pallimed readers get to it? If so you want to write a book review for Pallimed on how it may apply to our field?

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