Sunday, October 11, 2009

Top Comments & Posts for September 2009

Top Blog Posts (most viewed) from September 2009:
  1. Refining Treatment Preferences for Patients Who Want "Everything"
  2. 'Exceptional Rationalization, Denial and Resistance Techniques'
  3. Onsolis and FDA Opioid REMS: Is this the future of opioid prescribing?
  4. Huckabee, Kennedy and the Politics of Distortion
  5. Death Panel Concerns in the UK with the Liverpool Care Pathway

Top Commented Articles from August 2009:
  1. Onsolis and FDA Opioid REMS: Is this the future of opioid prescribing? - 12 comments
  2. Huckabee, Kennedy and the Politics of Distortion - 9 comments
  3. Hospice and Palliative Care Formulary, 2nd Edition - 5 comments
  4. Refining Treatment Preferences for Patients Who Want "Everything" - 5 comments
  5. Death Panel Concerns in the UK with the Liverpool Care Pathway - 4 comments
Featured Commentary from Pallimed Readers:
Anonynmous on Huckabee, Kennedy and the Politics of Distortion:
While Drew, Ron, and most of us, in the field are preaching to the choir, the PR train has left the station. The bigger problem, however, is that the train does not have an engineer on board - since G Beck's GOP is (wisely) cheering from a safe distance. We and only we are to blame for the public lack of understating what Palliative Medicine is: we were suppoosed to be the engineer. Having marketed the specialty with avoidant strategies (we are not, aah so not about dying) the mis-marketing has caught up with us.

Mike Bevins MD, PhD said on Death Panel Concerns in the UK with the Liverpool Care Pathway:
I wish they had written more in the letter, but I think they do have a point. They allude to "algorithmic banking," and we are living in an age of algorithmic medicine, where consensus guidelines and algorithms often become the standard of care, with the implication that one need only follow the algorithm to give good care. This is an example of what sociologists call the degradation of work (a too-prejorative term in my opinion), wherein complex tasks are subdivided, standardized and reduced so they can be performed by less-skilled (and lower paid) workers. This is easiest to see in manufacturing, where the previously complex job of crafting an object is divided into relatively simple tasks.

Phil Rodgers said on PC Trial in JAMA:
There is a risk, however, that a high-profile portrayal of 'palliative care' as a narrow, almost ancillary intervention with such a modest impact (mood and QOL effects notwithstanding) will lead some to doubt the effectiveness of our practice, particularly if they have pre-existing skepticism about HPM. Disease management programs are not only fading from CMS favor, but they are on the chopping block at many institutions.

Alex Smith said on Refining Treatment Preferences for Patients Who Want "Everything":
The article is thoughtfully done, and raises a different set of questions for me. 1) How can we translate these nuanced communication strategies into actionable language? These article reveals the limits of our language - "do everything", "full code", and "DNR." Yet the need to be nuanced needs to be balanced against the need for ease of communication during patient handoffs and when the patient is crashing.2) I completely agree with the authors approach to communication in an idealized form. However, imagine the intern, on admitting night, at 1am, with an unfamiliar patient, trying to establish "code status." That patient is going to be full code. These conversations take time, and I think we need to move away from having these rushed and nearly meaningless conversations on the day of admission, toward having more meaningful substantive conversations over the course of the hospitalization.

Jerry said on ICU Delirium and Prognosis: (I had to put this one in as a best comment!)
I gotta make more regular visits to your site, Drew. You folks do really good work.
I'm glad to have found this here. My ICU colleagues and I get so focused on the immediate challenges that we lose sight of the larger picture.
Lastly, lots of good back and forth on the Onsolis and REMS post so I won't post any here. It is best to read the whole exchange.

Thanks for all the comments and keep them coming!

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