*Tips to Find a Good-Enough Doctor

Tuesday September 15, 2009

Categories: Food and Health

Inspired from all the comments she received from my interview with her on chronic illness, Dr. Elvira Aletta compiled some suggestions for finding a good-enough doctor. In her Psych Central post called "Tips to Find a Good-Enough Doctor," she throws out three basic qualities she looks for in a doctor:

Expertise, knowledge, intellectual curiosity and all the right credentials.
Warm, receptive, a good listener and communicator. The bedside manner thing.
A well-run office, with smart, efficient support & medical staff.

Then she follows up with a few more points to keep in mind while shopping for a doctor:

If you are in doubt, interview several doctors as if they were applying for a job and you are the employer. If you don't feel comfortable with your doctor or what s/he is telling you, get a second opinion. Don't even worry about hurting anyone's feelings. They are professionals and can handle it. If they can't and give you a hard time, run, do not walk, to the nearest exit.
Only the actual physical examination needs to be done in the examining room with you in a hospital gown. Any good-enough doctor would allow you to change into street clothes and sit comfortably in a chair for the important post-exam conversation.
If you want the best, search for your doctor among the medical faculty of a teaching hospital. Medical centers tied to a medical school, teaching hospitals are where the medical students and residents do their training. The faculty who teach and supervise there know the latest diagnostic procedures, tests and treatments because they have to teach it. Putting up with the gaggle of med students (who make Doogie Howser look like a geezer) is worth it as long as your doctor hears you.
A good-enough doctor will admit when he/she doesn't have the answer but will work with you to figure out a plan, maybe even try something experimental if you're willing.
Trust your gut. Filter out what others say, focus on what your physician is saying and make your own judgment. Don't micromanage your doctor, but don't just be a Yes person either.
A good listening doctor can show compassion without getting all touchy-feely. If you need someone to pet you and say "Poor baby," (and we all do) go to your mother, a friend or your spouse. Don't expect it from your doctor.
Remember that doctors, just like the rest of us, are not perfect. If you found one who is good-enough, celebrate and get to work

*New textbook on pharmacology and drug discovery
EurekAlert, 09/16/09

This unique and much needed textbook meets the rapidly emerging needs of programs training pharmacologic scientists seeking careers in basic research and drug discovery rather than such applied fields as pharmacy and medicine. While the market is crowded with many clinical and therapeutic pharmacology textbooks, the field of pharmacology is booming with the prospects of discovering new drugs, and virtually no extant textbook meets this need at the student level. The industry is so bereft of such approaches that many pharmaceutical companies will look towards this book to help train new drug researchers.

*Iloperidone: In Schizophrenia
CNS Drugs, 09/16/09

Scott LJ – Iloperidone is an atypical antipsychotic that is approved for the treatment of adult patients with schizophrenia. Iloperidone was generally well tolerated and was associated with few extrapyramidal symptoms or changes in metabolic parameters in short– and longer–term clinical trials in adult patients with schizophrenia.

*The Five-Factor Model of Personality and Borderline Personality Disorder: A Genetic Analysis of Comorbidity
Biological Psychiatry, 09/16/09 Distel MA et al. – Borderline personality shares all genetic variation with neuroticism, agreeableness, conscientiousness, and extraversion. The unique environmental influences specific to borderline personality may cause individuals with a specific pattern of personality traits to cross a threshold and develop borderline personality.

!!! * rev.news oct. metab si endocrin si medscape audio !!!

*http://www.medscape.com/infosite/osteoporosis/article-2

*Gothenburg researchers have discovered a previously unknown substance in spinal fluid that can be used to diagnose Alzheimer's disease. The findings, described in a thesis from the Sahlgrenska Academy at the University of Gothenburg, Sweden, will also be useful in research on new medications.

*Hori H et al. – The results suggest that olanzapine orally disintegrating tablets are effective and well–tolerated for treatment excitement in the acute phase of schizophrenic patients. In addition, it is p
ossible that adherence to medications is improved by using olanzapine orally disintegrating tablets

* terapia cognitiva si paroxetina

Greeven A et al. – The initial treatment effect of CBT and paroxetine sustained during the follow–up period. No significant differences between CBT and paroxetine were found. Treatment course could not be predicted by psychiatric comorbidity. CBT and paroxetine are both effective treatments for hypochondriasis in the long term.

*Arul–Anandam AP et al. – Transcranial direct current stimulation (tDCS) is a non–invasive brain stimulation technique that applies mild (typically 1–2 mA) direct currents via the scalp to enhance or diminish neuronal excitability. The technique has a dual function: on the one hand, it has been used to investigate the functions of various cortical regions; on the other, it has been used as an experimental treatment modality, most notably for Major Depressive Disorder (MDD). With the growing utility of tDCS in psychiatry, it is important from the vantage of safety and effectiveness to understand its underlying neurobiological mechanisms.

*March JS et al. – The combination of fluoxetine and CBT appears to be superior to both CBT monotherapy and fluoxetine monotherapy as a treatment for moderate to severe major depressive disorder in adolescents.

*Acute changes in obsessions and compulsions following moderate-intensity aerobic exercise among patients with obsessive-compulsive disorder
Journal of Anxiety Disorders, 09/08/09

Abrantes AM et al. – Participants reported reductions in negative mood, anxiety, and OCD symptoms at the end of each exercise session relative to the beginning. Changes in the magnitude of the effect of exercise in reducing negative mood and anxiety remained fairly stable while levels of self–reported obsessions and compulsions decreased over the duration of the intervention. Results of this study point toward the promising effect of exercise for acute symptom reduction in patients with OCD.

*August 13, 2009 — The relation between major depression and coronary artery disease across the lifespan is modest, with the sustained effect of coronary disease having a larger effect on the risk of subsequent depression, research shows.

*The Treatment for Adolescents With Depression Study (TADS): Outcomes Over 1 Year of Naturalistic Follow-Up
American Journal of Psychiatry, 09/03/09

In contrast to earlier reports on short–term treatments, in which worsening after treatment is the rule, the longer treatment in the TADS was associated with persistent benefits over 1 year of naturalistic follow–up.

*A new scale for assessing the quality of randomized clinical trials of psychotherapy
Comprehensive Psychiatry, 09/03/09

Kocsis JH et al. – The scale establishes a new standard for the design and execution of psychotherapy RCTs and provides a systematic empirical method for evaluating the quality of published RCTs.

*Detecting often undiagnosed pain in people with dementia
EurekAlert, 09/03/09

The elderly who suffer from dementia aren't able to say when something hurts or is sore. They may demonstrate their pain through behaviours like rocking or striking out, and we often dismiss these actions as symptoms of the dementia instead of pain, which is usually from a different problem. Arthritis, diabetic neuropathy, fractures, muscular contractures, bruises, abdominal pain and mouth ulcers are among the list of common ailments that go undetected

* terapia comportamentala in tb.somatoforme

Kroenke K – CBT is the best established treatment for a variety of somatoform disorders, with some benefit also demonstrated for a consultation letter to the primary care physician. Preliminary but not yet conclusive evidence exists for antidepressants

*Kelly DL et al. – Clozapine is beneficial to many patients with treatment–resistant symptoms; however, nonresponse to this medication may represent a subtype of patients who may present differently with symptoms. These findings should encourage further examination of early childhood indicators and opportunities for appropriate and effective intervention

*Persistent job insecurity poses a major threat to worker health, according to a new study published in the September issue of the peer–reviewed journal Social Science and Medicine.

*Clinical and economic ramifications of switching antipsychotics in the treatment of schizophrenia
BMC Psychiatry, 09/04/09

Faries DE et al. – Switching antipsychotic medications was found to be associated with considerably poorer clinical and economic outcomes, as reflected by, more frequent and more rapid use of acute–care services compared with persons remaining on their initial treatments.