Clinical Psychiatry News

More than 1 in 5 children worldwide are at risk of developing an eating disorder such as bulimia, anorexia, or binge eating, a new analysis suggests.

The study was published in the journal JAMA Pediatrics. Researchers analyzed data for 63,181 adolescents 6-18 years old from 16 countries to look for what is called “disordered eating.” None of the children included in the study had diagnosed physical or mental disorders, and data were not included from the COVID-19 time period.

The researchers examined results from a widely used standardized eating disorder questionnaire called the Sick, Control, One, Fat, Food (SCOFF). When someone answers yes to two or more of the questions, the person is considered to have disordered eating, which “denotes a suspicion of an existing eating disorder,” the researchers write. The five questions are:

• Do you make yourself sick because you feel uncomfortably full?
• Do you worry you have lost control over how much you eat?
• Have you recently lost more than 14 pounds in a 3-month period?
• Do you believe yourself to be fat when others say you are too thin?
• Would you say that food dominates your life?

Overall, 22% of children replied yes to two or more of the questions. The proportion of children with disordered eating is likely even higher, the researchers explain, because children may hide symptoms “due to feelings of shame or stigmatization.”

The findings are a dramatic shift from the estimation that 2.7% of people ages 13-18 have an eating disorder during their adolescent years.

In this latest study, disordered eating was more common among girls, older children, and those with a higher body mass index, or BMI, which is a combined measure of height and weight.

The analysis showed that 30% of girls had disordered eating, compared with 17% of boys. When looking at responses by age, the proportion of kids with disordered eating increased by 20 percentage points between the ages of 10 and 18.

The findings regarding children who already have a high BMI confirms previous research that many of those children are already following disordered eating behaviors while trying to lose weight, the authors write.

“Although most adolescents who develop an eating disorder do not report prior excess weight problems, some adolescents could misinterpret what eating healthy consists of and engage in unhealthy behaviors (for instance, skipping meals to generate a caloric deficit), which could then lead to development of an eating disorder,” the researchers explain.

The study points to the need for parents, caregivers, and health care professionals to be on the lookout for disordered eating symptoms in children because they are linked to the risk of developing a clinical eating disorder. The symptoms to watch for include behaviors such as weight loss dieting, binge eating, self-induced vomiting, excessive exercise, and the use of laxatives or diuretics, the researchers write.

A version of this article first appeared on WebMD.com.

More than 1 in 5 children worldwide are at risk of developing an eating disorder such as bulimia, anorexia, or binge eating, a new analysis suggests.

The study was published in the journal JAMA Pediatrics. Researchers analyzed data for 63,181 adolescents 6-18 years old from 16 countries to look for what is called “disordered eating.” None of the children included in the study had diagnosed physical or mental disorders, and data were not included from the COVID-19 time period.

The researchers examined results from a widely used standardized eating disorder questionnaire called the Sick, Control, One, Fat, Food (SCOFF). When someone answers yes to two or more of the questions, the person is considered to have disordered eating, which “denotes a suspicion of an existing eating disorder,” the researchers write. The five questions are:

• Do you make yourself sick because you feel uncomfortably full?
• Do you worry you have lost control over how much you eat?
• Have you recently lost more than 14 pounds in a 3-month period?
• Do you believe yourself to be fat when others say you are too thin?
• Would you say that food dominates your life?

Overall, 22% of children replied yes to two or more of the questions. The proportion of children with disordered eating is likely even higher, the researchers explain, because children may hide symptoms “due to feelings of shame or stigmatization.”

The findings are a dramatic shift from the estimation that 2.7% of people ages 13-18 have an eating disorder during their adolescent years.

In this latest study, disordered eating was more common among girls, older children, and those with a higher body mass index, or BMI, which is a combined measure of height and weight.

The analysis showed that 30% of girls had disordered eating, compared with 17% of boys. When looking at responses by age, the proportion of kids with disordered eating increased by 20 percentage points between the ages of 10 and 18.

The findings regarding children who already have a high BMI confirms previous research that many of those children are already following disordered eating behaviors while trying to lose weight, the authors write.

“Although most adolescents who develop an eating disorder do not report prior excess weight problems, some adolescents could misinterpret what eating healthy consists of and engage in unhealthy behaviors (for instance, skipping meals to generate a caloric deficit), which could then lead to development of an eating disorder,” the researchers explain.

The study points to the need for parents, caregivers, and health care professionals to be on the lookout for disordered eating symptoms in children because they are linked to the risk of developing a clinical eating disorder. The symptoms to watch for include behaviors such as weight loss dieting, binge eating, self-induced vomiting, excessive exercise, and the use of laxatives or diuretics, the researchers write.

A version of this article first appeared on WebMD.com.

More than 1 in 5 children worldwide are at risk of developing an eating disorder such as bulimia, anorexia, or binge eating, a new analysis suggests.

The study was published in the journal JAMA Pediatrics. Researchers analyzed data for 63,181 adolescents 6-18 years old from 16 countries to look for what is called “disordered eating.” None of the children included in the study had diagnosed physical or mental disorders, and data were not included from the COVID-19 time period.

The researchers examined results from a widely used standardized eating disorder questionnaire called the Sick, Control, One, Fat, Food (SCOFF). When someone answers yes to two or more of the questions, the person is considered to have disordered eating, which “denotes a suspicion of an existing eating disorder,” the researchers write. The five questions are:

• Do you make yourself sick because you feel uncomfortably full?
• Do you worry you have lost control over how much you eat?
• Have you recently lost more than 14 pounds in a 3-month period?
• Do you believe yourself to be fat when others say you are too thin?
• Would you say that food dominates your life?

Overall, 22% of children replied yes to two or more of the questions. The proportion of children with disordered eating is likely even higher, the researchers explain, because children may hide symptoms “due to feelings of shame or stigmatization.”

The findings are a dramatic shift from the estimation that 2.7% of people ages 13-18 have an eating disorder during their adolescent years.

In this latest study, disordered eating was more common among girls, older children, and those with a higher body mass index, or BMI, which is a combined measure of height and weight.

The analysis showed that 30% of girls had disordered eating, compared with 17% of boys. When looking at responses by age, the proportion of kids with disordered eating increased by 20 percentage points between the ages of 10 and 18.

The findings regarding children who already have a high BMI confirms previous research that many of those children are already following disordered eating behaviors while trying to lose weight, the authors write.

“Although most adolescents who develop an eating disorder do not report prior excess weight problems, some adolescents could misinterpret what eating healthy consists of and engage in unhealthy behaviors (for instance, skipping meals to generate a caloric deficit), which could then lead to development of an eating disorder,” the researchers explain.

The study points to the need for parents, caregivers, and health care professionals to be on the lookout for disordered eating symptoms in children because they are linked to the risk of developing a clinical eating disorder. The symptoms to watch for include behaviors such as weight loss dieting, binge eating, self-induced vomiting, excessive exercise, and the use of laxatives or diuretics, the researchers write.

A version of this article first appeared on WebMD.com.

There are times when, as health care providers dealing with the stress of the profession, many doctors feel that tapping into a higher purpose – or even praying – might be a helpful way to cope.

Whether you’re spiritual, religious – or neither – the Medscape Physician Lifestyle & Happiness Report 2023 asked if you have a religious or spiritual belief. Turns out 69% of physicians shared that they have a spiritual or religious practice.
 

Tapping into the universe

Nick Shamie, MD, an orthopedic surgeon specializing in spine surgery at University of California, Los Angeles, says the constant challenges of making life-and-death decisions offer an opportunity to check in with a higher power.

“Sometimes when I’m going into a tough surgery or have a tough situation, I pause and think about how this isn’t about me and the situation I’m in,” says Dr. Shamie, whose family is Muslim. “It’s about the whole universe. I feel like someone, or some being, is looking over my shoulders, and if my intentions are good, I’ll be fine. The person I’m going to take care of will be fine. That’s how I use my faith.”

Having a belief in something greater than herself also fuels Jill Carnahan, MD, a family medicine physician and functional medicine expert in Boulder, Colo.

“This is key for me as a physician,” says Dr. Carnahan, author of “Unexpected: Finding Resilience Through Functional Medicine, Science, and Faith.” “I urge physicians to think about their source of strength. That’s not necessarily even religious. It could be meditation or being in nature.”

Dr. Carnahan likes to share with patients that there are lessons that can come from being ill – whether treating ill patients or struggling with one’s own illness.

“I like to teach this idea of illness as a teacher,” says Dr. Carnahan, who has Crohn’s disease and is a cancer survivor. “This is tough, but what you’re saying here is that there is meaning or purpose to this experience. It brings awareness to your life that may not have been there before.”

Often illness is our body’s way of getting our attention that our life, relationships, or work needs adjustment. Illness can be a reminder to make changes. “For example, a diagnosis of autoimmunity may be a reminder to take better care of ourselves, or a diagnosis of cancer may cause us to get out of an unhealthy relationship or change jobs to do something more fulfilling, as we have increased awareness of the brevity of life.”

When patients are affected by illness, pain, reduced functionality, and even imminent death, understanding the experience is difficult, and finding any purpose in it may seem impossible. Still, studies show that those who find meaning in the experience cope better with their illness.

Finding that meaning may be a strong driver of survival and may be positively related to hope, belief, and happiness.
 

Spirituality supports patients

Even if you’re not religious yourself, it can be helpful to support a patient who opts to pray before an arduous procedure, says Sharyar Baradaran, DDS, a periodontist specializing in gum surgery in Beverly Hills, Calif.

“I’ve had patients who go into meditation mode, or they say a prayer before I start surgery,” he says. “I take that opportunity to connect. In that instance, we hold hands. I want them to know that I understand what they’re going through and how they’re trying to find the courage to undergo surgery.”

When Dr. Shamie was a child, his father described religion as embodying the basic tenet of being good to others. “I’ve taken that to heart,” he says. “All religions, all faiths have that as a central premise.”

These doctors agree that when you take the time to stop and hold a patient’s hand, bow your head during their prayer, or acknowledge or speak for a few moments about their faith, especially during a health crisis, surgery, or challenging diagnosis, patients appreciate it and develop an even deeper connection with you.

Dr. Baradaran believes spirituality can play an important role in how health care providers care for patients. Though it may not be widely discussed or reported, and physicians may find little time and space to address patients’ spiritual needs, there is growing sensitivity regarding spirituality in health care. One study found that while physicians understand its importance, nurses are more apt to integrate spirituality into practice.

“No matter the religion, if you’re spiritual, it means you’re listening and being respectful,” says Dr. Baradaran, who is Jewish. “There are times that I’m not familiar with the prayers my patients are saying, but I always take them in, absorb them, and respect them. This allows me to have a deeper connection with them, which is wonderful.”

Dr. Shamie says that he turns to his faith in good times as well as tough ones.

“I see a lot of people who are dealing with very difficult situations, and it’s not their choice to be in this position,” he says. “At those moments, I think to myself how fortunate I am that I’m not experiencing what this individual or family is going through. I do thank God at that time. I appreciate the life I have, and when I witness hardships, it resets my appreciation.”

For Dr. Carnahan, faith is about becoming comfortable with the inevitable uncertainty of life. It’s also about finding ways to tap into the day’s stresses.

“As physicians, we’re workaholics, and one in four of us are burnt out,” she says. “One solution that really works is to step back from the day-to-day grind and find time to pray or meditate or be in nature.”

There are times when a tragedy occurs, and despite your most intense efforts, a patient may die. Those experiences can be crushing to a physician. However, to guide you through the loss of a patient or the daily juggles of managing your practice, Dr. Carnahan suggests finding time every morning to focus on the day ahead and how you connect with the universe.

“I take 15 minutes in the morning and think about how I will bring love to the world,” she says. “If you look for the miracles and the good and the unexpected, that gratitude shift allows your mind to be transformed by what’s happening. It’s often in those moments that you’ll realize again why you went into medicine in the first place.”
 

Doctors without faith

So, what does this mean if you’re among the 25% of physicians in the Medscape report who do not have a religious or spiritual leaning and aren’t apt to be spiritually minded when it comes to your patients? An article on KevinMD.com points out that atheist physicians are often in the closet about their atheism because they usually bow their heads or keep a respectful silence when a patient or their family offers a prayer request before surgery or a prayer of thanks after a procedure.

The retired atheist physician who wrote the piece reminds us that nonreligious doctors are good people with a high moral compass who may not believe in an afterlife. However, that means they try to make their patients’ quality of life the best they can.

A version of this article first appeared on Medscape.com.

There are times when, as health care providers dealing with the stress of the profession, many doctors feel that tapping into a higher purpose – or even praying – might be a helpful way to cope.

Whether you’re spiritual, religious – or neither – the Medscape Physician Lifestyle & Happiness Report 2023 asked if you have a religious or spiritual belief. Turns out 69% of physicians shared that they have a spiritual or religious practice.
 

Tapping into the universe

Nick Shamie, MD, an orthopedic surgeon specializing in spine surgery at University of California, Los Angeles, says the constant challenges of making life-and-death decisions offer an opportunity to check in with a higher power.

“Sometimes when I’m going into a tough surgery or have a tough situation, I pause and think about how this isn’t about me and the situation I’m in,” says Dr. Shamie, whose family is Muslim. “It’s about the whole universe. I feel like someone, or some being, is looking over my shoulders, and if my intentions are good, I’ll be fine. The person I’m going to take care of will be fine. That’s how I use my faith.”

Having a belief in something greater than herself also fuels Jill Carnahan, MD, a family medicine physician and functional medicine expert in Boulder, Colo.

“This is key for me as a physician,” says Dr. Carnahan, author of “Unexpected: Finding Resilience Through Functional Medicine, Science, and Faith.” “I urge physicians to think about their source of strength. That’s not necessarily even religious. It could be meditation or being in nature.”

Dr. Carnahan likes to share with patients that there are lessons that can come from being ill – whether treating ill patients or struggling with one’s own illness.

“I like to teach this idea of illness as a teacher,” says Dr. Carnahan, who has Crohn’s disease and is a cancer survivor. “This is tough, but what you’re saying here is that there is meaning or purpose to this experience. It brings awareness to your life that may not have been there before.”

Often illness is our body’s way of getting our attention that our life, relationships, or work needs adjustment. Illness can be a reminder to make changes. “For example, a diagnosis of autoimmunity may be a reminder to take better care of ourselves, or a diagnosis of cancer may cause us to get out of an unhealthy relationship or change jobs to do something more fulfilling, as we have increased awareness of the brevity of life.”

When patients are affected by illness, pain, reduced functionality, and even imminent death, understanding the experience is difficult, and finding any purpose in it may seem impossible. Still, studies show that those who find meaning in the experience cope better with their illness.

Finding that meaning may be a strong driver of survival and may be positively related to hope, belief, and happiness.
 

Spirituality supports patients

Even if you’re not religious yourself, it can be helpful to support a patient who opts to pray before an arduous procedure, says Sharyar Baradaran, DDS, a periodontist specializing in gum surgery in Beverly Hills, Calif.

“I’ve had patients who go into meditation mode, or they say a prayer before I start surgery,” he says. “I take that opportunity to connect. In that instance, we hold hands. I want them to know that I understand what they’re going through and how they’re trying to find the courage to undergo surgery.”

When Dr. Shamie was a child, his father described religion as embodying the basic tenet of being good to others. “I’ve taken that to heart,” he says. “All religions, all faiths have that as a central premise.”

These doctors agree that when you take the time to stop and hold a patient’s hand, bow your head during their prayer, or acknowledge or speak for a few moments about their faith, especially during a health crisis, surgery, or challenging diagnosis, patients appreciate it and develop an even deeper connection with you.

Dr. Baradaran believes spirituality can play an important role in how health care providers care for patients. Though it may not be widely discussed or reported, and physicians may find little time and space to address patients’ spiritual needs, there is growing sensitivity regarding spirituality in health care. One study found that while physicians understand its importance, nurses are more apt to integrate spirituality into practice.

“No matter the religion, if you’re spiritual, it means you’re listening and being respectful,” says Dr. Baradaran, who is Jewish. “There are times that I’m not familiar with the prayers my patients are saying, but I always take them in, absorb them, and respect them. This allows me to have a deeper connection with them, which is wonderful.”

Dr. Shamie says that he turns to his faith in good times as well as tough ones.

“I see a lot of people who are dealing with very difficult situations, and it’s not their choice to be in this position,” he says. “At those moments, I think to myself how fortunate I am that I’m not experiencing what this individual or family is going through. I do thank God at that time. I appreciate the life I have, and when I witness hardships, it resets my appreciation.”

For Dr. Carnahan, faith is about becoming comfortable with the inevitable uncertainty of life. It’s also about finding ways to tap into the day’s stresses.

“As physicians, we’re workaholics, and one in four of us are burnt out,” she says. “One solution that really works is to step back from the day-to-day grind and find time to pray or meditate or be in nature.”

There are times when a tragedy occurs, and despite your most intense efforts, a patient may die. Those experiences can be crushing to a physician. However, to guide you through the loss of a patient or the daily juggles of managing your practice, Dr. Carnahan suggests finding time every morning to focus on the day ahead and how you connect with the universe.

“I take 15 minutes in the morning and think about how I will bring love to the world,” she says. “If you look for the miracles and the good and the unexpected, that gratitude shift allows your mind to be transformed by what’s happening. It’s often in those moments that you’ll realize again why you went into medicine in the first place.”
 

Doctors without faith

So, what does this mean if you’re among the 25% of physicians in the Medscape report who do not have a religious or spiritual leaning and aren’t apt to be spiritually minded when it comes to your patients? An article on KevinMD.com points out that atheist physicians are often in the closet about their atheism because they usually bow their heads or keep a respectful silence when a patient or their family offers a prayer request before surgery or a prayer of thanks after a procedure.

The retired atheist physician who wrote the piece reminds us that nonreligious doctors are good people with a high moral compass who may not believe in an afterlife. However, that means they try to make their patients’ quality of life the best they can.

A version of this article first appeared on Medscape.com.

There are times when, as health care providers dealing with the stress of the profession, many doctors feel that tapping into a higher purpose – or even praying – might be a helpful way to cope.

Whether you’re spiritual, religious – or neither – the Medscape Physician Lifestyle & Happiness Report 2023 asked if you have a religious or spiritual belief. Turns out 69% of physicians shared that they have a spiritual or religious practice.
 

Tapping into the universe

Nick Shamie, MD, an orthopedic surgeon specializing in spine surgery at University of California, Los Angeles, says the constant challenges of making life-and-death decisions offer an opportunity to check in with a higher power.

“Sometimes when I’m going into a tough surgery or have a tough situation, I pause and think about how this isn’t about me and the situation I’m in,” says Dr. Shamie, whose family is Muslim. “It’s about the whole universe. I feel like someone, or some being, is looking over my shoulders, and if my intentions are good, I’ll be fine. The person I’m going to take care of will be fine. That’s how I use my faith.”

Having a belief in something greater than herself also fuels Jill Carnahan, MD, a family medicine physician and functional medicine expert in Boulder, Colo.

“This is key for me as a physician,” says Dr. Carnahan, author of “Unexpected: Finding Resilience Through Functional Medicine, Science, and Faith.” “I urge physicians to think about their source of strength. That’s not necessarily even religious. It could be meditation or being in nature.”

Dr. Carnahan likes to share with patients that there are lessons that can come from being ill – whether treating ill patients or struggling with one’s own illness.

“I like to teach this idea of illness as a teacher,” says Dr. Carnahan, who has Crohn’s disease and is a cancer survivor. “This is tough, but what you’re saying here is that there is meaning or purpose to this experience. It brings awareness to your life that may not have been there before.”

Often illness is our body’s way of getting our attention that our life, relationships, or work needs adjustment. Illness can be a reminder to make changes. “For example, a diagnosis of autoimmunity may be a reminder to take better care of ourselves, or a diagnosis of cancer may cause us to get out of an unhealthy relationship or change jobs to do something more fulfilling, as we have increased awareness of the brevity of life.”

When patients are affected by illness, pain, reduced functionality, and even imminent death, understanding the experience is difficult, and finding any purpose in it may seem impossible. Still, studies show that those who find meaning in the experience cope better with their illness.

Finding that meaning may be a strong driver of survival and may be positively related to hope, belief, and happiness.
 

Spirituality supports patients

Even if you’re not religious yourself, it can be helpful to support a patient who opts to pray before an arduous procedure, says Sharyar Baradaran, DDS, a periodontist specializing in gum surgery in Beverly Hills, Calif.

“I’ve had patients who go into meditation mode, or they say a prayer before I start surgery,” he says. “I take that opportunity to connect. In that instance, we hold hands. I want them to know that I understand what they’re going through and how they’re trying to find the courage to undergo surgery.”

When Dr. Shamie was a child, his father described religion as embodying the basic tenet of being good to others. “I’ve taken that to heart,” he says. “All religions, all faiths have that as a central premise.”

These doctors agree that when you take the time to stop and hold a patient’s hand, bow your head during their prayer, or acknowledge or speak for a few moments about their faith, especially during a health crisis, surgery, or challenging diagnosis, patients appreciate it and develop an even deeper connection with you.

Dr. Baradaran believes spirituality can play an important role in how health care providers care for patients. Though it may not be widely discussed or reported, and physicians may find little time and space to address patients’ spiritual needs, there is growing sensitivity regarding spirituality in health care. One study found that while physicians understand its importance, nurses are more apt to integrate spirituality into practice.

“No matter the religion, if you’re spiritual, it means you’re listening and being respectful,” says Dr. Baradaran, who is Jewish. “There are times that I’m not familiar with the prayers my patients are saying, but I always take them in, absorb them, and respect them. This allows me to have a deeper connection with them, which is wonderful.”

Dr. Shamie says that he turns to his faith in good times as well as tough ones.

“I see a lot of people who are dealing with very difficult situations, and it’s not their choice to be in this position,” he says. “At those moments, I think to myself how fortunate I am that I’m not experiencing what this individual or family is going through. I do thank God at that time. I appreciate the life I have, and when I witness hardships, it resets my appreciation.”

For Dr. Carnahan, faith is about becoming comfortable with the inevitable uncertainty of life. It’s also about finding ways to tap into the day’s stresses.

“As physicians, we’re workaholics, and one in four of us are burnt out,” she says. “One solution that really works is to step back from the day-to-day grind and find time to pray or meditate or be in nature.”

There are times when a tragedy occurs, and despite your most intense efforts, a patient may die. Those experiences can be crushing to a physician. However, to guide you through the loss of a patient or the daily juggles of managing your practice, Dr. Carnahan suggests finding time every morning to focus on the day ahead and how you connect with the universe.

“I take 15 minutes in the morning and think about how I will bring love to the world,” she says. “If you look for the miracles and the good and the unexpected, that gratitude shift allows your mind to be transformed by what’s happening. It’s often in those moments that you’ll realize again why you went into medicine in the first place.”
 

Doctors without faith

So, what does this mean if you’re among the 25% of physicians in the Medscape report who do not have a religious or spiritual leaning and aren’t apt to be spiritually minded when it comes to your patients? An article on KevinMD.com points out that atheist physicians are often in the closet about their atheism because they usually bow their heads or keep a respectful silence when a patient or their family offers a prayer request before surgery or a prayer of thanks after a procedure.

The retired atheist physician who wrote the piece reminds us that nonreligious doctors are good people with a high moral compass who may not believe in an afterlife. However, that means they try to make their patients’ quality of life the best they can.

A version of this article first appeared on Medscape.com.

Drinking two or more cups of coffee a day was associated with twice the risk of death from cardiovascular disease among people with severe hypertension, according to researchers at Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo.

What to know

People with severely high blood pressure who drink two or more cups of caffeinated coffee each day could double their risk of dying from a heart attack, stroke, or any type of cardiovascular disease.

Too much coffee may raise blood pressure and lead to anxiety, heart palpitations, and difficulty sleeping.

An 8-ounce cup of coffee has 80-100 mg of caffeine, while an 8-ounce cup of green or black tea has 30-50 mg.

Drinking one cup of coffee a day or any amount of green tea was not associated with risk of death across any blood pressure categories, and drinking green tea was not associated with increased risk of death related to cardiovascular disease at any blood pressure level.

Frequent consumers of coffee were more likely to be younger, current smokers, current drinkers, to eat fewer vegetables, and to have higher total cholesterol levels and lower systolic blood pressure regardless of their blood pressure category.

This is a summary of the article “Coffee and Green Tea Consumption and Cardiovascular Disease Mortality Among People With and Without Hypertension,” published in the Journal of the American Heart Association.

A version of this article first appeared on Medscape.com.

Drinking two or more cups of coffee a day was associated with twice the risk of death from cardiovascular disease among people with severe hypertension, according to researchers at Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo.

What to know

People with severely high blood pressure who drink two or more cups of caffeinated coffee each day could double their risk of dying from a heart attack, stroke, or any type of cardiovascular disease.

Too much coffee may raise blood pressure and lead to anxiety, heart palpitations, and difficulty sleeping.

An 8-ounce cup of coffee has 80-100 mg of caffeine, while an 8-ounce cup of green or black tea has 30-50 mg.

Drinking one cup of coffee a day or any amount of green tea was not associated with risk of death across any blood pressure categories, and drinking green tea was not associated with increased risk of death related to cardiovascular disease at any blood pressure level.

Frequent consumers of coffee were more likely to be younger, current smokers, current drinkers, to eat fewer vegetables, and to have higher total cholesterol levels and lower systolic blood pressure regardless of their blood pressure category.

This is a summary of the article “Coffee and Green Tea Consumption and Cardiovascular Disease Mortality Among People With and Without Hypertension,” published in the Journal of the American Heart Association.

A version of this article first appeared on Medscape.com.

Drinking two or more cups of coffee a day was associated with twice the risk of death from cardiovascular disease among people with severe hypertension, according to researchers at Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo.

What to know

People with severely high blood pressure who drink two or more cups of caffeinated coffee each day could double their risk of dying from a heart attack, stroke, or any type of cardiovascular disease.

Too much coffee may raise blood pressure and lead to anxiety, heart palpitations, and difficulty sleeping.

An 8-ounce cup of coffee has 80-100 mg of caffeine, while an 8-ounce cup of green or black tea has 30-50 mg.

Drinking one cup of coffee a day or any amount of green tea was not associated with risk of death across any blood pressure categories, and drinking green tea was not associated with increased risk of death related to cardiovascular disease at any blood pressure level.

Frequent consumers of coffee were more likely to be younger, current smokers, current drinkers, to eat fewer vegetables, and to have higher total cholesterol levels and lower systolic blood pressure regardless of their blood pressure category.

This is a summary of the article “Coffee and Green Tea Consumption and Cardiovascular Disease Mortality Among People With and Without Hypertension,” published in the Journal of the American Heart Association.

A version of this article first appeared on Medscape.com.

If a patient refuses care from a health care practitioner because of their race or sex, should their request be accommodated?

In a recent blog on Medscape titled “No, You Can’t See a Different Doctor: We Need Zero Tolerance of Patient Bias,” Cleveland Francis Jr., MD, argued no.

Dr. Francis, who is Black, is a recently retired cardiologist who practiced for 50 years. He is currently Diversity, Equity, and Inclusion Advisor at Inova Heart and Vascular Institute in Falls Church, Va.

When Francis was a medical student and was preparing to take a patient’s history and perform a medical exam, the patient refused and requested a “White doctor,” he recounted.

“I can remember the hurt and embarrassment as if it were yesterday,” he wrote.

The blog, especially the title, drew strong reactions. Close to 500 readers weighed in.

“The title of my blog sounds harsh,” Dr. Francis said, “but in reality, a simple conversation with the patient usually resolves these issues. The difference is that in the old days, there was utter silence, and the wishes of the patient would be granted”

Health care practitioners “should expect to be treated with respect,” he concluded his blog.

Readers agreed on that point, but they debated whether being uncomfortable with a health care practitioner of a different sex or race always constituted “patient bias.”

Some noted that difficulty understanding a practitioner’s accent, for example, is a legitimate reason for asking for another clinician.
 

Accents and understanding

“If I am struggling to understand you because your accent is too thick or ... because hearing aids can only do so much, I need to ask for someone else,” a reader commented.

Another chimed in: “My elderly parents changed PCPs frequently during the final years of their lives, mainly due to language barriers encountered with foreign-born providers. Due to progressive hearing loss, they simply couldn’t understand them.”

“It is important to remember that there is a Patient Bill of Rights,” she noted, “the first part of which states, ‘You have the right to safe, considerate, and respectful care, provided in a manner consistent with your beliefs.’ ”

A former charge nurse added: “If a request for change was substantive (poor communication, perceived incompetence, trauma history, etc.), I would move mountains to accommodate it, but IMHO [in my humble opinion], the belief in honoring patient preference doesn’t necessarily need to include rearranging the world in order to accommodate racism, sexism, etc.”

Bias against female doctors, male nurses

Many commenters described how they gladly traded when a patient requested a practitioner of the opposite sex.

A female hospitalist related how she contacted the senior male doctor working with her to arrange a patient trade, adding, “I do agree that racial discrimination ought to be discouraged.”

Similarly, a male ICU RN commented: “Over 13 years, I have had a handful of female (usually older) patients request a female nurse. I have always strived to make this happen.”

However, an older woman related how at first she “had some bias against a male nurse touching me and also felt self-conscious,” she said. “So, I tried to relax ... and let him do his job. He was one of the most compassionate, kind, and sensitive nurses I’ve ever had.”

“I think in some cases,” she noted, “some women have had a history of some sort of abuse by a male, whether it’s sexual or psychological,” but in other cases, “it’s often just a personal preference, not a bias.”

A physician assistant (PA) who worked in a rural ED recounted how “there was only one physician and one PA on at any given evening/night shift, both usually White males.”

“Sometimes, you just have to cope as best you can with whomever is available, and in doing so,” he said, “they might just end up being pleasantly surprised.”
 

Don’t take it personally, move on

“If a patient doesn’t want to see me for whatever reason, then I would rather not treat them,” was a common sentiment.

Patients “should feel comfortable with their provider even if it’s with someone other than myself,” a reader wrote.

A female physician chimed in: “I frequently have older male patients refuse to see me. ... While this is irritating on several levels, I recognize that it is the patient’s choice, sigh, and move on to the next patient.”

“There are many more patients who specifically ask to see me, so I don’t waste my time and energy on being bothered by those who refuse.”

Similarly, a female mental health provider and sometimes patient wrote: “If any patient tells me that they prefer a male ... or someone of a particular race or religion or whatever, I don’t take it personally.”

A female Hispanic doctor chimed in: “Honestly, if a patient does not want to see me due to my race, I’m OK with that. Patients need to feel comfortable with me for the relationship to be therapeutic and effective,” she said.

“Forcing the patient to see me is adding injury to insult to ME! Not to mention increase[d] workload since that patient will take [so] much more time.”

Similarly, an Asian American doctor commented: “There are people who choose not to see me because of my ethnicity. However, I strongly believe that it should always be the patient’s preference. Whatever the reason, do not force the patient to see you in the name of Diversity, Equity, Inclusion, or whatever hurts your feeling. Let the patient go.”
 

Patient bias vs. patient preference

A physician referring to Dr. Francis’s experience suggested that “perhaps there was an opportunity to explore this misconception directly with the patient. If not, your supervising senior resident or attending should have been informed and brought into the process and conversation.”

“If/when I were rejected by a patient for whatever reason,” another physician commented, “I would gracefully accede, and hope that my colleague would tactfully point out to the patient their error.”

“Having a nurse ask the patient ... what they need style-wise (keeping race, gender, etc., out of it) might help identify whether or not the underlying issue(s) are based on style/needs mismatch match rather than bias,” a reader suggested.

A health care worker commented: “We generally assure patients that we are professionals and think nothing of situations that they might find uncomfortable, but don’t realize that our comfort does not translate to theirs.”
 

Maybe a different strategy is needed

“Having been the target of bias many times,” a reader said, “I understand the pain that is inflicted. Unfortunately, a patient bias policy, while a good idea, will not prevent patient bias. This is a much larger societal problem. But we can at least tell patients that it is not okay. On the other hand, I would not want to be the provider for a patient who was biased against me and held me in disdain.”

“I do not like Zero Tolerance policies ever. They are too absolute,” another reader commented. “Sometimes, there are reasons and we do have to listen to our patients for why. ... I do not think a policy of zero tolerance will fix the problem of racism.”

“Instead of trying to educate the general public about how not to be jerks,” another reader suggested, “perhaps it would be easier to provide elective classes for doctors and employees who believe themselves to be at-risk for discrimination, providing them with a ‘toolkit’ of strategies for responding to discrimination in the moment, processing it emotionally later on, and reporting the most egregious events through designated channels.”

Another commenter agreed and wrote that, “While we as doctors need and deserve protection, we are also called to act with compassion. So, rather than ask the system for ‘zero-tolerance’ in either direction, we could encourage our health systems to provide education, support, and mediation to any party who feels or fears that they are not being well served. Such a model would include support for physicians who have been the victims of bias and hurt.”

A version of this article originally appeared on Medscape.com.

If a patient refuses care from a health care practitioner because of their race or sex, should their request be accommodated?

In a recent blog on Medscape titled “No, You Can’t See a Different Doctor: We Need Zero Tolerance of Patient Bias,” Cleveland Francis Jr., MD, argued no.

Dr. Francis, who is Black, is a recently retired cardiologist who practiced for 50 years. He is currently Diversity, Equity, and Inclusion Advisor at Inova Heart and Vascular Institute in Falls Church, Va.

When Francis was a medical student and was preparing to take a patient’s history and perform a medical exam, the patient refused and requested a “White doctor,” he recounted.

“I can remember the hurt and embarrassment as if it were yesterday,” he wrote.

The blog, especially the title, drew strong reactions. Close to 500 readers weighed in.

“The title of my blog sounds harsh,” Dr. Francis said, “but in reality, a simple conversation with the patient usually resolves these issues. The difference is that in the old days, there was utter silence, and the wishes of the patient would be granted”

Health care practitioners “should expect to be treated with respect,” he concluded his blog.

Readers agreed on that point, but they debated whether being uncomfortable with a health care practitioner of a different sex or race always constituted “patient bias.”

Some noted that difficulty understanding a practitioner’s accent, for example, is a legitimate reason for asking for another clinician.
 

Accents and understanding

“If I am struggling to understand you because your accent is too thick or ... because hearing aids can only do so much, I need to ask for someone else,” a reader commented.

Another chimed in: “My elderly parents changed PCPs frequently during the final years of their lives, mainly due to language barriers encountered with foreign-born providers. Due to progressive hearing loss, they simply couldn’t understand them.”

“It is important to remember that there is a Patient Bill of Rights,” she noted, “the first part of which states, ‘You have the right to safe, considerate, and respectful care, provided in a manner consistent with your beliefs.’ ”

A former charge nurse added: “If a request for change was substantive (poor communication, perceived incompetence, trauma history, etc.), I would move mountains to accommodate it, but IMHO [in my humble opinion], the belief in honoring patient preference doesn’t necessarily need to include rearranging the world in order to accommodate racism, sexism, etc.”

Bias against female doctors, male nurses

Many commenters described how they gladly traded when a patient requested a practitioner of the opposite sex.

A female hospitalist related how she contacted the senior male doctor working with her to arrange a patient trade, adding, “I do agree that racial discrimination ought to be discouraged.”

Similarly, a male ICU RN commented: “Over 13 years, I have had a handful of female (usually older) patients request a female nurse. I have always strived to make this happen.”

However, an older woman related how at first she “had some bias against a male nurse touching me and also felt self-conscious,” she said. “So, I tried to relax ... and let him do his job. He was one of the most compassionate, kind, and sensitive nurses I’ve ever had.”

“I think in some cases,” she noted, “some women have had a history of some sort of abuse by a male, whether it’s sexual or psychological,” but in other cases, “it’s often just a personal preference, not a bias.”

A physician assistant (PA) who worked in a rural ED recounted how “there was only one physician and one PA on at any given evening/night shift, both usually White males.”

“Sometimes, you just have to cope as best you can with whomever is available, and in doing so,” he said, “they might just end up being pleasantly surprised.”
 

Don’t take it personally, move on

“If a patient doesn’t want to see me for whatever reason, then I would rather not treat them,” was a common sentiment.

Patients “should feel comfortable with their provider even if it’s with someone other than myself,” a reader wrote.

A female physician chimed in: “I frequently have older male patients refuse to see me. ... While this is irritating on several levels, I recognize that it is the patient’s choice, sigh, and move on to the next patient.”

“There are many more patients who specifically ask to see me, so I don’t waste my time and energy on being bothered by those who refuse.”

Similarly, a female mental health provider and sometimes patient wrote: “If any patient tells me that they prefer a male ... or someone of a particular race or religion or whatever, I don’t take it personally.”

A female Hispanic doctor chimed in: “Honestly, if a patient does not want to see me due to my race, I’m OK with that. Patients need to feel comfortable with me for the relationship to be therapeutic and effective,” she said.

“Forcing the patient to see me is adding injury to insult to ME! Not to mention increase[d] workload since that patient will take [so] much more time.”

Similarly, an Asian American doctor commented: “There are people who choose not to see me because of my ethnicity. However, I strongly believe that it should always be the patient’s preference. Whatever the reason, do not force the patient to see you in the name of Diversity, Equity, Inclusion, or whatever hurts your feeling. Let the patient go.”
 

Patient bias vs. patient preference

A physician referring to Dr. Francis’s experience suggested that “perhaps there was an opportunity to explore this misconception directly with the patient. If not, your supervising senior resident or attending should have been informed and brought into the process and conversation.”

“If/when I were rejected by a patient for whatever reason,” another physician commented, “I would gracefully accede, and hope that my colleague would tactfully point out to the patient their error.”

“Having a nurse ask the patient ... what they need style-wise (keeping race, gender, etc., out of it) might help identify whether or not the underlying issue(s) are based on style/needs mismatch match rather than bias,” a reader suggested.

A health care worker commented: “We generally assure patients that we are professionals and think nothing of situations that they might find uncomfortable, but don’t realize that our comfort does not translate to theirs.”
 

Maybe a different strategy is needed

“Having been the target of bias many times,” a reader said, “I understand the pain that is inflicted. Unfortunately, a patient bias policy, while a good idea, will not prevent patient bias. This is a much larger societal problem. But we can at least tell patients that it is not okay. On the other hand, I would not want to be the provider for a patient who was biased against me and held me in disdain.”

“I do not like Zero Tolerance policies ever. They are too absolute,” another reader commented. “Sometimes, there are reasons and we do have to listen to our patients for why. ... I do not think a policy of zero tolerance will fix the problem of racism.”

“Instead of trying to educate the general public about how not to be jerks,” another reader suggested, “perhaps it would be easier to provide elective classes for doctors and employees who believe themselves to be at-risk for discrimination, providing them with a ‘toolkit’ of strategies for responding to discrimination in the moment, processing it emotionally later on, and reporting the most egregious events through designated channels.”

Another commenter agreed and wrote that, “While we as doctors need and deserve protection, we are also called to act with compassion. So, rather than ask the system for ‘zero-tolerance’ in either direction, we could encourage our health systems to provide education, support, and mediation to any party who feels or fears that they are not being well served. Such a model would include support for physicians who have been the victims of bias and hurt.”

A version of this article originally appeared on Medscape.com.

If a patient refuses care from a health care practitioner because of their race or sex, should their request be accommodated?

In a recent blog on Medscape titled “No, You Can’t See a Different Doctor: We Need Zero Tolerance of Patient Bias,” Cleveland Francis Jr., MD, argued no.

Dr. Francis, who is Black, is a recently retired cardiologist who practiced for 50 years. He is currently Diversity, Equity, and Inclusion Advisor at Inova Heart and Vascular Institute in Falls Church, Va.

When Francis was a medical student and was preparing to take a patient’s history and perform a medical exam, the patient refused and requested a “White doctor,” he recounted.

“I can remember the hurt and embarrassment as if it were yesterday,” he wrote.

The blog, especially the title, drew strong reactions. Close to 500 readers weighed in.

“The title of my blog sounds harsh,” Dr. Francis said, “but in reality, a simple conversation with the patient usually resolves these issues. The difference is that in the old days, there was utter silence, and the wishes of the patient would be granted”

Health care practitioners “should expect to be treated with respect,” he concluded his blog.

Readers agreed on that point, but they debated whether being uncomfortable with a health care practitioner of a different sex or race always constituted “patient bias.”

Some noted that difficulty understanding a practitioner’s accent, for example, is a legitimate reason for asking for another clinician.
 

Accents and understanding

“If I am struggling to understand you because your accent is too thick or ... because hearing aids can only do so much, I need to ask for someone else,” a reader commented.

Another chimed in: “My elderly parents changed PCPs frequently during the final years of their lives, mainly due to language barriers encountered with foreign-born providers. Due to progressive hearing loss, they simply couldn’t understand them.”

“It is important to remember that there is a Patient Bill of Rights,” she noted, “the first part of which states, ‘You have the right to safe, considerate, and respectful care, provided in a manner consistent with your beliefs.’ ”

A former charge nurse added: “If a request for change was substantive (poor communication, perceived incompetence, trauma history, etc.), I would move mountains to accommodate it, but IMHO [in my humble opinion], the belief in honoring patient preference doesn’t necessarily need to include rearranging the world in order to accommodate racism, sexism, etc.”

Bias against female doctors, male nurses

Many commenters described how they gladly traded when a patient requested a practitioner of the opposite sex.

A female hospitalist related how she contacted the senior male doctor working with her to arrange a patient trade, adding, “I do agree that racial discrimination ought to be discouraged.”

Similarly, a male ICU RN commented: “Over 13 years, I have had a handful of female (usually older) patients request a female nurse. I have always strived to make this happen.”

However, an older woman related how at first she “had some bias against a male nurse touching me and also felt self-conscious,” she said. “So, I tried to relax ... and let him do his job. He was one of the most compassionate, kind, and sensitive nurses I’ve ever had.”

“I think in some cases,” she noted, “some women have had a history of some sort of abuse by a male, whether it’s sexual or psychological,” but in other cases, “it’s often just a personal preference, not a bias.”

A physician assistant (PA) who worked in a rural ED recounted how “there was only one physician and one PA on at any given evening/night shift, both usually White males.”

“Sometimes, you just have to cope as best you can with whomever is available, and in doing so,” he said, “they might just end up being pleasantly surprised.”
 

Don’t take it personally, move on

“If a patient doesn’t want to see me for whatever reason, then I would rather not treat them,” was a common sentiment.

Patients “should feel comfortable with their provider even if it’s with someone other than myself,” a reader wrote.

A female physician chimed in: “I frequently have older male patients refuse to see me. ... While this is irritating on several levels, I recognize that it is the patient’s choice, sigh, and move on to the next patient.”

“There are many more patients who specifically ask to see me, so I don’t waste my time and energy on being bothered by those who refuse.”

Similarly, a female mental health provider and sometimes patient wrote: “If any patient tells me that they prefer a male ... or someone of a particular race or religion or whatever, I don’t take it personally.”

A female Hispanic doctor chimed in: “Honestly, if a patient does not want to see me due to my race, I’m OK with that. Patients need to feel comfortable with me for the relationship to be therapeutic and effective,” she said.

“Forcing the patient to see me is adding injury to insult to ME! Not to mention increase[d] workload since that patient will take [so] much more time.”

Similarly, an Asian American doctor commented: “There are people who choose not to see me because of my ethnicity. However, I strongly believe that it should always be the patient’s preference. Whatever the reason, do not force the patient to see you in the name of Diversity, Equity, Inclusion, or whatever hurts your feeling. Let the patient go.”
 

Patient bias vs. patient preference

A physician referring to Dr. Francis’s experience suggested that “perhaps there was an opportunity to explore this misconception directly with the patient. If not, your supervising senior resident or attending should have been informed and brought into the process and conversation.”

“If/when I were rejected by a patient for whatever reason,” another physician commented, “I would gracefully accede, and hope that my colleague would tactfully point out to the patient their error.”

“Having a nurse ask the patient ... what they need style-wise (keeping race, gender, etc., out of it) might help identify whether or not the underlying issue(s) are based on style/needs mismatch match rather than bias,” a reader suggested.

A health care worker commented: “We generally assure patients that we are professionals and think nothing of situations that they might find uncomfortable, but don’t realize that our comfort does not translate to theirs.”
 

Maybe a different strategy is needed

“Having been the target of bias many times,” a reader said, “I understand the pain that is inflicted. Unfortunately, a patient bias policy, while a good idea, will not prevent patient bias. This is a much larger societal problem. But we can at least tell patients that it is not okay. On the other hand, I would not want to be the provider for a patient who was biased against me and held me in disdain.”

“I do not like Zero Tolerance policies ever. They are too absolute,” another reader commented. “Sometimes, there are reasons and we do have to listen to our patients for why. ... I do not think a policy of zero tolerance will fix the problem of racism.”

“Instead of trying to educate the general public about how not to be jerks,” another reader suggested, “perhaps it would be easier to provide elective classes for doctors and employees who believe themselves to be at-risk for discrimination, providing them with a ‘toolkit’ of strategies for responding to discrimination in the moment, processing it emotionally later on, and reporting the most egregious events through designated channels.”

Another commenter agreed and wrote that, “While we as doctors need and deserve protection, we are also called to act with compassion. So, rather than ask the system for ‘zero-tolerance’ in either direction, we could encourage our health systems to provide education, support, and mediation to any party who feels or fears that they are not being well served. Such a model would include support for physicians who have been the victims of bias and hurt.”

A version of this article originally appeared on Medscape.com.

One-eyed, one-horned, flying purple veggie eater

Big Fruits and Vegetables is at it again. You notice how they’re always like “Oh, vegetables are good for your health,” and “Eating fruits every day makes you live longer,” but come on. It’s a marketing ploy, leading us astray from our personal savior, McDonald’s.

PxHere

Just look at this latest bit of research: According to researchers from Finland, eating purple vegetables can protect against diabetes. Considering nearly 40 million Americans have diabetes (and nearly 100 million have prediabetes), anything to reduce the incidence of diabetes (people with diabetes account for one-fourth of every dollar spent in U.S. health care) would be beneficial. So, let’s humor the fruits and veggies people this time and hear them out.

It all comes down to a chemical called anthocyanin, which is a pigment that gives fruits and vegetables such as blueberries, radishes, and red cabbages their purplish color. Anthocyanin also has probiotic and anti-inflammatory effects, meaning it can help improve intestinal lining health and regulate glucose and lipid metabolic pathways. Obviously, good things if you want to avoid diabetes.

The investigators also found that, while standard anthocyanin was beneficial, acylated anthocyanin (which has an acyl group added to the sugar molecules of anthocyanin) is really what you want to go for. The acylated version, found in abundance in purple potatoes, purple carrots, radishes, and red cabbages, is tougher to digest, but the positive effects it has in the body are enhanced over the standard version.

Now, this all a compelling bit of research, but at the end of the day, you’re still eating fruits and vegetables, and we are red-blooded Americans here. We don’t do healthy foods. Although, if you were to dye our burgers with anthocyanin and make them purple, you’d have our attention. Purple is our favorite color.
 

Manuka honey better as building material than antibiotic

Milk, according to the old saying, builds strong bones, but when it comes to patients with bone loss caused by various medical reasons, researchers found that manuka honey, produced only in New Zealand and some parts of Australia, may also do the job. They soaked collagen scaffolds used for bone implants in various concentrations of the honey and found that 5% led to higher mineral formation and osteoprotegerin production, which suggests increased bone production.

Marley Dewey

But, and this is a pretty big one, the other half of the study – testing manuka honey’s ability to ward off bacteria – wasn’t so successful. Bone implants, apparently, count for almost half of all hospital-acquired infections, which obviously can put a damper on the healing process. The hope was that a biomaterial would be more effective than something like metal in lessening bacteria formation. Nope.

When the researchers soaked paper disks in honey and added them to cultures of Pseudomonas aeruginosa and Staphylococcus aureus, none of the various concentrations stopped bacterial growth in the scaffolding, even when they added antibiotics.

The sticky conclusion, you could say, is more bitter than sweet.
 

It may sound like Korn, but can it play ‘Freak on a Leash’?

Like all right-thinking Americans, we love corn, corn-based products, and almost corn. Corn on the cob grilled in the husk? Mmm. Plus, we’re big fans of the band Korn. Also, we once had a reporter here named Tim Kirn. And don’t even get us started with Karn. Best Family Feud host ever.

Quorn

But what about Quorn? Oh sure, the fungi-based meat alternative is full of yummy mycoprotein, but can it prevent colorectal cancer? Can we add Quorn to our favorites list? Let’s see what Science has to say.

Researchers at Northumbria University in Newcastle upon Tyne, England, fed a group of 20 men some meat (240 g/day) for 2 weeks – hopefully, they were allowed to eat some other food as well – and then gave them the same amount of Quorn, excuse us, fungi-derived mycoprotein equivalents, for 2 more weeks, with a 4-week washout period in between.

Levels of cancer-causing chemicals known as genotoxins fell significantly in the mycoprotein phase but rose during the meat phase. The mycoprotein diet also improved gut health “by increasing the abundance of protective bacteria such as Lactobacilli, Roseburia, and Akkermansia, which are associated with offering protection against chemically induced tumours, inflammation and bowel cancer,” they said in a statement from the university.

The meat phase, on the other hand, resulted in an increase in “gut bacteria linked with issues such as cancer, cardiovascular diseases, weight gain and other negative health outcomes,” they noted.

Science, then, seems to approve of Quorn, and that’s good enough for us. We’re adding Quorn to our diet, starting with a fungi-derived mycoproteinburger tonight while we’re watching the Cornell Big Red take the court against their archrivals, the Big Green of Dartmouth College. GO RED!

One-eyed, one-horned, flying purple veggie eater

Big Fruits and Vegetables is at it again. You notice how they’re always like “Oh, vegetables are good for your health,” and “Eating fruits every day makes you live longer,” but come on. It’s a marketing ploy, leading us astray from our personal savior, McDonald’s.

PxHere

Just look at this latest bit of research: According to researchers from Finland, eating purple vegetables can protect against diabetes. Considering nearly 40 million Americans have diabetes (and nearly 100 million have prediabetes), anything to reduce the incidence of diabetes (people with diabetes account for one-fourth of every dollar spent in U.S. health care) would be beneficial. So, let’s humor the fruits and veggies people this time and hear them out.

It all comes down to a chemical called anthocyanin, which is a pigment that gives fruits and vegetables such as blueberries, radishes, and red cabbages their purplish color. Anthocyanin also has probiotic and anti-inflammatory effects, meaning it can help improve intestinal lining health and regulate glucose and lipid metabolic pathways. Obviously, good things if you want to avoid diabetes.

The investigators also found that, while standard anthocyanin was beneficial, acylated anthocyanin (which has an acyl group added to the sugar molecules of anthocyanin) is really what you want to go for. The acylated version, found in abundance in purple potatoes, purple carrots, radishes, and red cabbages, is tougher to digest, but the positive effects it has in the body are enhanced over the standard version.

Now, this all a compelling bit of research, but at the end of the day, you’re still eating fruits and vegetables, and we are red-blooded Americans here. We don’t do healthy foods. Although, if you were to dye our burgers with anthocyanin and make them purple, you’d have our attention. Purple is our favorite color.
 

Manuka honey better as building material than antibiotic

Milk, according to the old saying, builds strong bones, but when it comes to patients with bone loss caused by various medical reasons, researchers found that manuka honey, produced only in New Zealand and some parts of Australia, may also do the job. They soaked collagen scaffolds used for bone implants in various concentrations of the honey and found that 5% led to higher mineral formation and osteoprotegerin production, which suggests increased bone production.

Marley Dewey

But, and this is a pretty big one, the other half of the study – testing manuka honey’s ability to ward off bacteria – wasn’t so successful. Bone implants, apparently, count for almost half of all hospital-acquired infections, which obviously can put a damper on the healing process. The hope was that a biomaterial would be more effective than something like metal in lessening bacteria formation. Nope.

When the researchers soaked paper disks in honey and added them to cultures of Pseudomonas aeruginosa and Staphylococcus aureus, none of the various concentrations stopped bacterial growth in the scaffolding, even when they added antibiotics.

The sticky conclusion, you could say, is more bitter than sweet.
 

It may sound like Korn, but can it play ‘Freak on a Leash’?

Like all right-thinking Americans, we love corn, corn-based products, and almost corn. Corn on the cob grilled in the husk? Mmm. Plus, we’re big fans of the band Korn. Also, we once had a reporter here named Tim Kirn. And don’t even get us started with Karn. Best Family Feud host ever.

Quorn

But what about Quorn? Oh sure, the fungi-based meat alternative is full of yummy mycoprotein, but can it prevent colorectal cancer? Can we add Quorn to our favorites list? Let’s see what Science has to say.

Researchers at Northumbria University in Newcastle upon Tyne, England, fed a group of 20 men some meat (240 g/day) for 2 weeks – hopefully, they were allowed to eat some other food as well – and then gave them the same amount of Quorn, excuse us, fungi-derived mycoprotein equivalents, for 2 more weeks, with a 4-week washout period in between.

Levels of cancer-causing chemicals known as genotoxins fell significantly in the mycoprotein phase but rose during the meat phase. The mycoprotein diet also improved gut health “by increasing the abundance of protective bacteria such as Lactobacilli, Roseburia, and Akkermansia, which are associated with offering protection against chemically induced tumours, inflammation and bowel cancer,” they said in a statement from the university.

The meat phase, on the other hand, resulted in an increase in “gut bacteria linked with issues such as cancer, cardiovascular diseases, weight gain and other negative health outcomes,” they noted.

Science, then, seems to approve of Quorn, and that’s good enough for us. We’re adding Quorn to our diet, starting with a fungi-derived mycoproteinburger tonight while we’re watching the Cornell Big Red take the court against their archrivals, the Big Green of Dartmouth College. GO RED!

One-eyed, one-horned, flying purple veggie eater

Big Fruits and Vegetables is at it again. You notice how they’re always like “Oh, vegetables are good for your health,” and “Eating fruits every day makes you live longer,” but come on. It’s a marketing ploy, leading us astray from our personal savior, McDonald’s.

PxHere

Just look at this latest bit of research: According to researchers from Finland, eating purple vegetables can protect against diabetes. Considering nearly 40 million Americans have diabetes (and nearly 100 million have prediabetes), anything to reduce the incidence of diabetes (people with diabetes account for one-fourth of every dollar spent in U.S. health care) would be beneficial. So, let’s humor the fruits and veggies people this time and hear them out.

It all comes down to a chemical called anthocyanin, which is a pigment that gives fruits and vegetables such as blueberries, radishes, and red cabbages their purplish color. Anthocyanin also has probiotic and anti-inflammatory effects, meaning it can help improve intestinal lining health and regulate glucose and lipid metabolic pathways. Obviously, good things if you want to avoid diabetes.

The investigators also found that, while standard anthocyanin was beneficial, acylated anthocyanin (which has an acyl group added to the sugar molecules of anthocyanin) is really what you want to go for. The acylated version, found in abundance in purple potatoes, purple carrots, radishes, and red cabbages, is tougher to digest, but the positive effects it has in the body are enhanced over the standard version.

Now, this all a compelling bit of research, but at the end of the day, you’re still eating fruits and vegetables, and we are red-blooded Americans here. We don’t do healthy foods. Although, if you were to dye our burgers with anthocyanin and make them purple, you’d have our attention. Purple is our favorite color.
 

Manuka honey better as building material than antibiotic

Milk, according to the old saying, builds strong bones, but when it comes to patients with bone loss caused by various medical reasons, researchers found that manuka honey, produced only in New Zealand and some parts of Australia, may also do the job. They soaked collagen scaffolds used for bone implants in various concentrations of the honey and found that 5% led to higher mineral formation and osteoprotegerin production, which suggests increased bone production.

Marley Dewey

But, and this is a pretty big one, the other half of the study – testing manuka honey’s ability to ward off bacteria – wasn’t so successful. Bone implants, apparently, count for almost half of all hospital-acquired infections, which obviously can put a damper on the healing process. The hope was that a biomaterial would be more effective than something like metal in lessening bacteria formation. Nope.

When the researchers soaked paper disks in honey and added them to cultures of Pseudomonas aeruginosa and Staphylococcus aureus, none of the various concentrations stopped bacterial growth in the scaffolding, even when they added antibiotics.

The sticky conclusion, you could say, is more bitter than sweet.
 

It may sound like Korn, but can it play ‘Freak on a Leash’?

Like all right-thinking Americans, we love corn, corn-based products, and almost corn. Corn on the cob grilled in the husk? Mmm. Plus, we’re big fans of the band Korn. Also, we once had a reporter here named Tim Kirn. And don’t even get us started with Karn. Best Family Feud host ever.

Quorn

But what about Quorn? Oh sure, the fungi-based meat alternative is full of yummy mycoprotein, but can it prevent colorectal cancer? Can we add Quorn to our favorites list? Let’s see what Science has to say.

Researchers at Northumbria University in Newcastle upon Tyne, England, fed a group of 20 men some meat (240 g/day) for 2 weeks – hopefully, they were allowed to eat some other food as well – and then gave them the same amount of Quorn, excuse us, fungi-derived mycoprotein equivalents, for 2 more weeks, with a 4-week washout period in between.

Levels of cancer-causing chemicals known as genotoxins fell significantly in the mycoprotein phase but rose during the meat phase. The mycoprotein diet also improved gut health “by increasing the abundance of protective bacteria such as Lactobacilli, Roseburia, and Akkermansia, which are associated with offering protection against chemically induced tumours, inflammation and bowel cancer,” they said in a statement from the university.

The meat phase, on the other hand, resulted in an increase in “gut bacteria linked with issues such as cancer, cardiovascular diseases, weight gain and other negative health outcomes,” they noted.

Science, then, seems to approve of Quorn, and that’s good enough for us. We’re adding Quorn to our diet, starting with a fungi-derived mycoproteinburger tonight while we’re watching the Cornell Big Red take the court against their archrivals, the Big Green of Dartmouth College. GO RED!

Physician groups saw staff-to-physician ratios decline even as their workforce expenses rose between 2019 and 2021, according to recent reports from the American Medical Group Association (AMGA) and the Medical Group Management Association (MGMA).

As patients started to return to doctors’ offices as the pandemic eased in 2021, physician groups found it increasingly difficult to recruit and retain lower-level clinicians, including medical assistants and LPNs, officials from both associations told this news organization. Many clinics had to raise their pay scales to be competitive with employers in other fields, and some had to hire higher-priced RNs to keep their practices running.

The AMGA report was based largely on data from groups of over 500 physicians, mostly affiliated with health systems. According to a news release accompanying the report, the ratio between full-time equivalent (FTE) clinic staff and health care professionals in direct patient care dropped by 11.3% between 2019 and 2021. The ratio of medical assistants (MAs) to clinicians declined by a greater percentage.

In the MGMA report, which represented about 4,000 practices ranging from very small (two doctors) to very large groups, total support staff per FTE primary-care physician dropped by 18% from 2019 to 2021 in independent groups and by 13% in hospital-affiliated groups. The ratios decreased by smaller amounts in surgical practices.

In contrast, nonsurgical specialty groups under both types of ownership saw their staffing ratios rise slightly.

Although it’s unclear why medical specialties increased their staff while other types of specialties lost employees, Ron Holder, MHA, chief operating officer of MGMA, said that some specialists may have opened more ancillary facilities and hired new employees to recoup revenue lost during the pandemic.
 

Expenses rise sharply

The AMGA report found that staffing expenses for the surveyed groups increased by 15% between 2019 and 2021.

“We saw a decrease in staff and an increase in expenses during that time period, and there are a few reasons for that,” Rose Wagner, RN, chief operating officer of AMGA, said. “Groups increased salaries to maintain staff. We also saw lower-paid staff find other jobs outside of health care. For example, medical assistants and receptionists could find jobs outside of health care that paid more. [Open positions] got back-filled with other higher paid staff, such as RNs, doing lower skilled jobs.”

Mr. Holder added that rising wages in other sectors made leaving physician groups more attractive for employees.

“Three years ago, there weren’t many positions in a medical practice where you were competing with Chick-fil-A or Taco Bell,” he said. In Denver, where Mr. Holder is based, “every restaurant in town is now advertising $17-$19 [hourly] starting pay just to do fast food. That causes practices to either lose employees or pay more for the employees they have. So that raises per-employee expense significantly,” he said.

Mr. Holder noted that inflation also has driven up wages as employees demand higher pay to keep up with the cost of living.
 

Unusual exodus of employees

Fred Horton, MHA, president of AMGA Consulting, said he has never seen so many people leaving health care for other occupations.

Some exits resulted from practices laying people off early in the pandemic, but most staff members who left practices were seeking higher pay, he said. In addition, Ms. Wagner noted, some staff members didn’t want to be exposed to COVID at work.

“There was an exodus from health care that was different from what we’d experienced in the past,” Mr. Horton added. “It’s still extremely challenging to get up to the staffing levels that are appropriate.”

Mr. Holder, however, said that the situation is slowly improving. “Health care is fairly recession-proof, because people need it. So when you see companies in other industries closing shop or reducing their head count, that actually helps health care recruiting in some jobs. And people are coming back to the workplace who previously were worried about COVID or didn’t want to get the vaccine.”
 

Paying more for nurses

In 2021, groups adopted a variety of tactics to adapt to the pandemic and respond to patient demand, the AMGA survey shows. Forty percent of system-affiliated groups and 18% of independent practices changed registered nurses’ responsibilities, in many cases having them do the work of medical assistants who were in short supply.

Some practices hired RNs, who have historically been utilized less by primary care than by surgical specialties, Mr. Holder noted. Other clinics paid temp agencies to supply nurses at a steep cost.

“When you’re short staffed, you end up paying more overtime, you end up paying temporary agencies at higher dollars, and you hire higher skilled people to do lower-skilled work,” Ms. Wagner said.

Meanwhile, many physician groups tried to cope with the physician shortage by bringing on more advanced practice clinicians (APCs), including nurse practitioners (NPs) and physician assistants (PAs). Seventy percent of the AMGA groups used this strategy, the report revealed.

“The use of APCs has been steadily increasing as groups try to adopt a lower-cost care model in the midst of a nationwide physician shortage,” Ms. Wagner said in the press release.
 

Changes in patient care

About half of the groups in the AMGA survey said they changed their staff structure to allow APCs to carry their own patient panels. Although most of these clinicians were probably under physician supervision, nearly half of the states now allow NPs to practice autonomously.

Mr. Horton cautioned that APCs can’t fully substitute for physicians and require the same support staff that doctors do if they have their own panels. In primary care groups, Mr. Holder noted, the average salary of an APC “is continuing to rise, and there isn’t a huge difference between what they and doctors make.”

Nevertheless, he added, “there are more NPs and PAs being added to the marketplace all the time, whereas [physician] residency programs aren’t really growing. There are caps on the number of residency positions, and some physicians are retiring. So the clock is ticking to the point where someday doctors will be grossly outnumbered by NPs.”

A version of this article first appeared on Medscape.com.

Physician groups saw staff-to-physician ratios decline even as their workforce expenses rose between 2019 and 2021, according to recent reports from the American Medical Group Association (AMGA) and the Medical Group Management Association (MGMA).

As patients started to return to doctors’ offices as the pandemic eased in 2021, physician groups found it increasingly difficult to recruit and retain lower-level clinicians, including medical assistants and LPNs, officials from both associations told this news organization. Many clinics had to raise their pay scales to be competitive with employers in other fields, and some had to hire higher-priced RNs to keep their practices running.

The AMGA report was based largely on data from groups of over 500 physicians, mostly affiliated with health systems. According to a news release accompanying the report, the ratio between full-time equivalent (FTE) clinic staff and health care professionals in direct patient care dropped by 11.3% between 2019 and 2021. The ratio of medical assistants (MAs) to clinicians declined by a greater percentage.

In the MGMA report, which represented about 4,000 practices ranging from very small (two doctors) to very large groups, total support staff per FTE primary-care physician dropped by 18% from 2019 to 2021 in independent groups and by 13% in hospital-affiliated groups. The ratios decreased by smaller amounts in surgical practices.

In contrast, nonsurgical specialty groups under both types of ownership saw their staffing ratios rise slightly.

Although it’s unclear why medical specialties increased their staff while other types of specialties lost employees, Ron Holder, MHA, chief operating officer of MGMA, said that some specialists may have opened more ancillary facilities and hired new employees to recoup revenue lost during the pandemic.
 

Expenses rise sharply

The AMGA report found that staffing expenses for the surveyed groups increased by 15% between 2019 and 2021.

“We saw a decrease in staff and an increase in expenses during that time period, and there are a few reasons for that,” Rose Wagner, RN, chief operating officer of AMGA, said. “Groups increased salaries to maintain staff. We also saw lower-paid staff find other jobs outside of health care. For example, medical assistants and receptionists could find jobs outside of health care that paid more. [Open positions] got back-filled with other higher paid staff, such as RNs, doing lower skilled jobs.”

Mr. Holder added that rising wages in other sectors made leaving physician groups more attractive for employees.

“Three years ago, there weren’t many positions in a medical practice where you were competing with Chick-fil-A or Taco Bell,” he said. In Denver, where Mr. Holder is based, “every restaurant in town is now advertising $17-$19 [hourly] starting pay just to do fast food. That causes practices to either lose employees or pay more for the employees they have. So that raises per-employee expense significantly,” he said.

Mr. Holder noted that inflation also has driven up wages as employees demand higher pay to keep up with the cost of living.
 

Unusual exodus of employees

Fred Horton, MHA, president of AMGA Consulting, said he has never seen so many people leaving health care for other occupations.

Some exits resulted from practices laying people off early in the pandemic, but most staff members who left practices were seeking higher pay, he said. In addition, Ms. Wagner noted, some staff members didn’t want to be exposed to COVID at work.

“There was an exodus from health care that was different from what we’d experienced in the past,” Mr. Horton added. “It’s still extremely challenging to get up to the staffing levels that are appropriate.”

Mr. Holder, however, said that the situation is slowly improving. “Health care is fairly recession-proof, because people need it. So when you see companies in other industries closing shop or reducing their head count, that actually helps health care recruiting in some jobs. And people are coming back to the workplace who previously were worried about COVID or didn’t want to get the vaccine.”
 

Paying more for nurses

In 2021, groups adopted a variety of tactics to adapt to the pandemic and respond to patient demand, the AMGA survey shows. Forty percent of system-affiliated groups and 18% of independent practices changed registered nurses’ responsibilities, in many cases having them do the work of medical assistants who were in short supply.

Some practices hired RNs, who have historically been utilized less by primary care than by surgical specialties, Mr. Holder noted. Other clinics paid temp agencies to supply nurses at a steep cost.

“When you’re short staffed, you end up paying more overtime, you end up paying temporary agencies at higher dollars, and you hire higher skilled people to do lower-skilled work,” Ms. Wagner said.

Meanwhile, many physician groups tried to cope with the physician shortage by bringing on more advanced practice clinicians (APCs), including nurse practitioners (NPs) and physician assistants (PAs). Seventy percent of the AMGA groups used this strategy, the report revealed.

“The use of APCs has been steadily increasing as groups try to adopt a lower-cost care model in the midst of a nationwide physician shortage,” Ms. Wagner said in the press release.
 

Changes in patient care

About half of the groups in the AMGA survey said they changed their staff structure to allow APCs to carry their own patient panels. Although most of these clinicians were probably under physician supervision, nearly half of the states now allow NPs to practice autonomously.

Mr. Horton cautioned that APCs can’t fully substitute for physicians and require the same support staff that doctors do if they have their own panels. In primary care groups, Mr. Holder noted, the average salary of an APC “is continuing to rise, and there isn’t a huge difference between what they and doctors make.”

Nevertheless, he added, “there are more NPs and PAs being added to the marketplace all the time, whereas [physician] residency programs aren’t really growing. There are caps on the number of residency positions, and some physicians are retiring. So the clock is ticking to the point where someday doctors will be grossly outnumbered by NPs.”

A version of this article first appeared on Medscape.com.

Physician groups saw staff-to-physician ratios decline even as their workforce expenses rose between 2019 and 2021, according to recent reports from the American Medical Group Association (AMGA) and the Medical Group Management Association (MGMA).

As patients started to return to doctors’ offices as the pandemic eased in 2021, physician groups found it increasingly difficult to recruit and retain lower-level clinicians, including medical assistants and LPNs, officials from both associations told this news organization. Many clinics had to raise their pay scales to be competitive with employers in other fields, and some had to hire higher-priced RNs to keep their practices running.

The AMGA report was based largely on data from groups of over 500 physicians, mostly affiliated with health systems. According to a news release accompanying the report, the ratio between full-time equivalent (FTE) clinic staff and health care professionals in direct patient care dropped by 11.3% between 2019 and 2021. The ratio of medical assistants (MAs) to clinicians declined by a greater percentage.

In the MGMA report, which represented about 4,000 practices ranging from very small (two doctors) to very large groups, total support staff per FTE primary-care physician dropped by 18% from 2019 to 2021 in independent groups and by 13% in hospital-affiliated groups. The ratios decreased by smaller amounts in surgical practices.

In contrast, nonsurgical specialty groups under both types of ownership saw their staffing ratios rise slightly.

Although it’s unclear why medical specialties increased their staff while other types of specialties lost employees, Ron Holder, MHA, chief operating officer of MGMA, said that some specialists may have opened more ancillary facilities and hired new employees to recoup revenue lost during the pandemic.
 

Expenses rise sharply

The AMGA report found that staffing expenses for the surveyed groups increased by 15% between 2019 and 2021.

“We saw a decrease in staff and an increase in expenses during that time period, and there are a few reasons for that,” Rose Wagner, RN, chief operating officer of AMGA, said. “Groups increased salaries to maintain staff. We also saw lower-paid staff find other jobs outside of health care. For example, medical assistants and receptionists could find jobs outside of health care that paid more. [Open positions] got back-filled with other higher paid staff, such as RNs, doing lower skilled jobs.”

Mr. Holder added that rising wages in other sectors made leaving physician groups more attractive for employees.

“Three years ago, there weren’t many positions in a medical practice where you were competing with Chick-fil-A or Taco Bell,” he said. In Denver, where Mr. Holder is based, “every restaurant in town is now advertising $17-$19 [hourly] starting pay just to do fast food. That causes practices to either lose employees or pay more for the employees they have. So that raises per-employee expense significantly,” he said.

Mr. Holder noted that inflation also has driven up wages as employees demand higher pay to keep up with the cost of living.
 

Unusual exodus of employees

Fred Horton, MHA, president of AMGA Consulting, said he has never seen so many people leaving health care for other occupations.

Some exits resulted from practices laying people off early in the pandemic, but most staff members who left practices were seeking higher pay, he said. In addition, Ms. Wagner noted, some staff members didn’t want to be exposed to COVID at work.

“There was an exodus from health care that was different from what we’d experienced in the past,” Mr. Horton added. “It’s still extremely challenging to get up to the staffing levels that are appropriate.”

Mr. Holder, however, said that the situation is slowly improving. “Health care is fairly recession-proof, because people need it. So when you see companies in other industries closing shop or reducing their head count, that actually helps health care recruiting in some jobs. And people are coming back to the workplace who previously were worried about COVID or didn’t want to get the vaccine.”
 

Paying more for nurses

In 2021, groups adopted a variety of tactics to adapt to the pandemic and respond to patient demand, the AMGA survey shows. Forty percent of system-affiliated groups and 18% of independent practices changed registered nurses’ responsibilities, in many cases having them do the work of medical assistants who were in short supply.

Some practices hired RNs, who have historically been utilized less by primary care than by surgical specialties, Mr. Holder noted. Other clinics paid temp agencies to supply nurses at a steep cost.

“When you’re short staffed, you end up paying more overtime, you end up paying temporary agencies at higher dollars, and you hire higher skilled people to do lower-skilled work,” Ms. Wagner said.

Meanwhile, many physician groups tried to cope with the physician shortage by bringing on more advanced practice clinicians (APCs), including nurse practitioners (NPs) and physician assistants (PAs). Seventy percent of the AMGA groups used this strategy, the report revealed.

“The use of APCs has been steadily increasing as groups try to adopt a lower-cost care model in the midst of a nationwide physician shortage,” Ms. Wagner said in the press release.
 

Changes in patient care

About half of the groups in the AMGA survey said they changed their staff structure to allow APCs to carry their own patient panels. Although most of these clinicians were probably under physician supervision, nearly half of the states now allow NPs to practice autonomously.

Mr. Horton cautioned that APCs can’t fully substitute for physicians and require the same support staff that doctors do if they have their own panels. In primary care groups, Mr. Holder noted, the average salary of an APC “is continuing to rise, and there isn’t a huge difference between what they and doctors make.”

Nevertheless, he added, “there are more NPs and PAs being added to the marketplace all the time, whereas [physician] residency programs aren’t really growing. There are caps on the number of residency positions, and some physicians are retiring. So the clock is ticking to the point where someday doctors will be grossly outnumbered by NPs.”

A version of this article first appeared on Medscape.com.

Doctors and their family members are less likely than other people to follow guidelines for taking medication, according to a study by economic professors from the Massachusetts Institute of Technology, Cambridge; Stanford (Calif.) University; and the George Gund Professor of Economics and Business Administration at Harvard University, Boston.

What to know

• Doctors’ medical knowledge may influence them and their families to often ignore medical advice while the rest of the population adheres to general medication guidelines.
• Of the 63 guidelines used in the study, doctors and their families followed the standards less than a third of the time.
• The difference in adherence to guidelines between experts and nonexperts is largest with respect to antibiotics, in which doctors and their families are 5.2 percentage points less in compliance than everyone else.
• Doctors could be more likely to prescribe broader-spectrum antibiotics for themselves and their families, whereas most patients receive more narrow-spectrum antibiotics.
• Many members of the general public don’t understand medical guidelines, finding them too complex to follow, and many people don’t trust their doctors.

This is a summary of the article, “A Taste of Their Own Medicine: Guideline Adherence and Access to Expertise,” published in the American Economic Review: Insights on December 13, 2022. The full article can be found on aeaweb.org.

A version of this article first appeared on Medscape.com.

Doctors and their family members are less likely than other people to follow guidelines for taking medication, according to a study by economic professors from the Massachusetts Institute of Technology, Cambridge; Stanford (Calif.) University; and the George Gund Professor of Economics and Business Administration at Harvard University, Boston.

What to know

• Doctors’ medical knowledge may influence them and their families to often ignore medical advice while the rest of the population adheres to general medication guidelines.
• Of the 63 guidelines used in the study, doctors and their families followed the standards less than a third of the time.
• The difference in adherence to guidelines between experts and nonexperts is largest with respect to antibiotics, in which doctors and their families are 5.2 percentage points less in compliance than everyone else.
• Doctors could be more likely to prescribe broader-spectrum antibiotics for themselves and their families, whereas most patients receive more narrow-spectrum antibiotics.
• Many members of the general public don’t understand medical guidelines, finding them too complex to follow, and many people don’t trust their doctors.

This is a summary of the article, “A Taste of Their Own Medicine: Guideline Adherence and Access to Expertise,” published in the American Economic Review: Insights on December 13, 2022. The full article can be found on aeaweb.org.

A version of this article first appeared on Medscape.com.

Doctors and their family members are less likely than other people to follow guidelines for taking medication, according to a study by economic professors from the Massachusetts Institute of Technology, Cambridge; Stanford (Calif.) University; and the George Gund Professor of Economics and Business Administration at Harvard University, Boston.

What to know

• Doctors’ medical knowledge may influence them and their families to often ignore medical advice while the rest of the population adheres to general medication guidelines.
• Of the 63 guidelines used in the study, doctors and their families followed the standards less than a third of the time.
• The difference in adherence to guidelines between experts and nonexperts is largest with respect to antibiotics, in which doctors and their families are 5.2 percentage points less in compliance than everyone else.
• Doctors could be more likely to prescribe broader-spectrum antibiotics for themselves and their families, whereas most patients receive more narrow-spectrum antibiotics.
• Many members of the general public don’t understand medical guidelines, finding them too complex to follow, and many people don’t trust their doctors.

This is a summary of the article, “A Taste of Their Own Medicine: Guideline Adherence and Access to Expertise,” published in the American Economic Review: Insights on December 13, 2022. The full article can be found on aeaweb.org.

A version of this article first appeared on Medscape.com.

A new study published in JAMA suggests that doctors with one paid malpractice claim are almost four times more likely than their peers to have additional paid claims in the future, regardless of specialty or whether a state publicly discloses paid claims.

In this retrospective case-control study, law and public health researchers from Georgetown University, the National Opinion Research Center, the University of Colorado, and Northwestern University analyzed paid malpractice claims for all licensed U.S. physicians.

The findings suggest that a single malpractice claim may not be a random stroke of bad luck but instead holds some predictive power into the risk for future paid claims.

“A four times increase in risk is huge, particularly since we observe a similar increase in both high-risk and lower-risk specialties,” David Hyman, JD, MD, professor of health law and policy at Georgetown University, Washington, and lead researcher on the study, told this news organization. “There are surely some false positives, but there must be lots of actual negligence too, or we would not see these results.”

For the 881,876 physicians analyzed, researchers looked at malpractice claims paid during two 5-year periods: 2009-2013 and 2014-2018. Nearly 96% of physicians had no paid malpractice claims between 2009 and 2013; 3% had one, and less than 1% had multiple claims. The proportion of physicians with paid claims between 2014 and 2018 was similar.

Compared with physicians with no 2009-2013 claims, a physician with just one paid claim in that time period had a 3.7 times higher risk for a future paid claim. Physicians with two paid claims were nearly 7 times more likely to have a future paid claim, and those with three or more paid claims were more than 11 times more likely to have one.

Approximately 3% of physicians with no paid claims between 2009 and 2013 had a future paid claim, growing to 12.4% of those with one paid claim during that time.

The study’s findings may have implications for medical licensing boards and hospitals granting staff privileges.

“After some number of paid claims, there should be an official response” from these entities, such as a hands-on assessment of technical skills or assignment of a peer mentor, said Dr. Hyman, who is also coauthor of a book titled “Medical Malpractice Litigation: How It Works, Why Tort Reform Hasn’t Helped.” A graduated set of interventions, whether voluntary or mandatory, can reduce future claim risk and patient harm, Dr. Hyman added.

Interventions may include error avoidance and post-error communication training, counseling to improve bedside skills, and encouragement to move into nonclinical practice. Either way, Dr. Hyman says a nuanced intervention strategy would be a welcome shift away from the current “all or nothing approach” that too often ends in the revocation of a physician’s medical license.

Although there are strategies to proactively identify physicians with excess risk for malpractice claims and implement preventive measures – like Vanderbilt University’s Patient Advocacy Reporting System, for example – most hospitals and physician groups fail to initiate even informal interventions after a malpractice settlement or verdict, which is a missed opportunity, Dr. Hyman said.

A version of this article first appeared on Medscape.com.

A new study published in JAMA suggests that doctors with one paid malpractice claim are almost four times more likely than their peers to have additional paid claims in the future, regardless of specialty or whether a state publicly discloses paid claims.

In this retrospective case-control study, law and public health researchers from Georgetown University, the National Opinion Research Center, the University of Colorado, and Northwestern University analyzed paid malpractice claims for all licensed U.S. physicians.

The findings suggest that a single malpractice claim may not be a random stroke of bad luck but instead holds some predictive power into the risk for future paid claims.

“A four times increase in risk is huge, particularly since we observe a similar increase in both high-risk and lower-risk specialties,” David Hyman, JD, MD, professor of health law and policy at Georgetown University, Washington, and lead researcher on the study, told this news organization. “There are surely some false positives, but there must be lots of actual negligence too, or we would not see these results.”

For the 881,876 physicians analyzed, researchers looked at malpractice claims paid during two 5-year periods: 2009-2013 and 2014-2018. Nearly 96% of physicians had no paid malpractice claims between 2009 and 2013; 3% had one, and less than 1% had multiple claims. The proportion of physicians with paid claims between 2014 and 2018 was similar.

Compared with physicians with no 2009-2013 claims, a physician with just one paid claim in that time period had a 3.7 times higher risk for a future paid claim. Physicians with two paid claims were nearly 7 times more likely to have a future paid claim, and those with three or more paid claims were more than 11 times more likely to have one.

Approximately 3% of physicians with no paid claims between 2009 and 2013 had a future paid claim, growing to 12.4% of those with one paid claim during that time.

The study’s findings may have implications for medical licensing boards and hospitals granting staff privileges.

“After some number of paid claims, there should be an official response” from these entities, such as a hands-on assessment of technical skills or assignment of a peer mentor, said Dr. Hyman, who is also coauthor of a book titled “Medical Malpractice Litigation: How It Works, Why Tort Reform Hasn’t Helped.” A graduated set of interventions, whether voluntary or mandatory, can reduce future claim risk and patient harm, Dr. Hyman added.

Interventions may include error avoidance and post-error communication training, counseling to improve bedside skills, and encouragement to move into nonclinical practice. Either way, Dr. Hyman says a nuanced intervention strategy would be a welcome shift away from the current “all or nothing approach” that too often ends in the revocation of a physician’s medical license.

Although there are strategies to proactively identify physicians with excess risk for malpractice claims and implement preventive measures – like Vanderbilt University’s Patient Advocacy Reporting System, for example – most hospitals and physician groups fail to initiate even informal interventions after a malpractice settlement or verdict, which is a missed opportunity, Dr. Hyman said.

A version of this article first appeared on Medscape.com.

A new study published in JAMA suggests that doctors with one paid malpractice claim are almost four times more likely than their peers to have additional paid claims in the future, regardless of specialty or whether a state publicly discloses paid claims.

In this retrospective case-control study, law and public health researchers from Georgetown University, the National Opinion Research Center, the University of Colorado, and Northwestern University analyzed paid malpractice claims for all licensed U.S. physicians.

The findings suggest that a single malpractice claim may not be a random stroke of bad luck but instead holds some predictive power into the risk for future paid claims.

“A four times increase in risk is huge, particularly since we observe a similar increase in both high-risk and lower-risk specialties,” David Hyman, JD, MD, professor of health law and policy at Georgetown University, Washington, and lead researcher on the study, told this news organization. “There are surely some false positives, but there must be lots of actual negligence too, or we would not see these results.”

For the 881,876 physicians analyzed, researchers looked at malpractice claims paid during two 5-year periods: 2009-2013 and 2014-2018. Nearly 96% of physicians had no paid malpractice claims between 2009 and 2013; 3% had one, and less than 1% had multiple claims. The proportion of physicians with paid claims between 2014 and 2018 was similar.

Compared with physicians with no 2009-2013 claims, a physician with just one paid claim in that time period had a 3.7 times higher risk for a future paid claim. Physicians with two paid claims were nearly 7 times more likely to have a future paid claim, and those with three or more paid claims were more than 11 times more likely to have one.

Approximately 3% of physicians with no paid claims between 2009 and 2013 had a future paid claim, growing to 12.4% of those with one paid claim during that time.

The study’s findings may have implications for medical licensing boards and hospitals granting staff privileges.

“After some number of paid claims, there should be an official response” from these entities, such as a hands-on assessment of technical skills or assignment of a peer mentor, said Dr. Hyman, who is also coauthor of a book titled “Medical Malpractice Litigation: How It Works, Why Tort Reform Hasn’t Helped.” A graduated set of interventions, whether voluntary or mandatory, can reduce future claim risk and patient harm, Dr. Hyman added.

Interventions may include error avoidance and post-error communication training, counseling to improve bedside skills, and encouragement to move into nonclinical practice. Either way, Dr. Hyman says a nuanced intervention strategy would be a welcome shift away from the current “all or nothing approach” that too often ends in the revocation of a physician’s medical license.

Although there are strategies to proactively identify physicians with excess risk for malpractice claims and implement preventive measures – like Vanderbilt University’s Patient Advocacy Reporting System, for example – most hospitals and physician groups fail to initiate even informal interventions after a malpractice settlement or verdict, which is a missed opportunity, Dr. Hyman said.

A version of this article first appeared on Medscape.com.

Treatment with the thiazolidinedione pioglitazone may offer the greatest protection against dementia for older adults with newly diagnosed type 2 diabetes mellitus (T2DM) who have a history of stroke or ischemic heart disease, new research suggests.

Overall, in a large cohort study from South Korea, patients who took pioglitazone were 16% less likely to develop dementia over an average of 10 years than peers who did not take the drug.

However, the dementia risk reduction was 54% among those with ischemic heart disease and 43% among those with a history of stroke.

“Our study was to see the association between pioglitazone use and incidence of dementia, not how (with what mechanisms) this drug can suppress dementia pathology,” coinvestigator Eosu Kim, MD, PhD, Yonsei University, Seoul, South Korea, said in an interview.

However, “as we found this drug is more effective in diabetic patients who have blood circulation problems in the heart or brain than in those without such problems, we speculate that pioglitazone’s antidementia action may be related to improving blood vessel’s health,” Dr. Kim said.

This finding suggests that pioglitazone could be used as a personalized treatment approach for dementia prevention in this subgroup of patients with diabetes, the researchers noted.

The results were published online in Neurology.
 

Dose-response relationship

Risk for dementia is doubled in adults with T2DM, the investigators wrote. Prior studies have suggested that pioglitazone may protect against dementia, as well as a first or recurrent stroke, in patients with T2DM.

This led Dr. Kim and colleagues to examine the effects of pioglitazone on dementia risk overall and in relation to stroke and ischemic heart disease.

Using the national Korean health database, the researchers identified 91,218 adults aged 50 and older with new-onset T2DM who did not have dementia. A total of 3,467 were treated with pioglitazone.

Pioglitazone exposure was defined as a total cumulative daily dose of 90 or more calculated from all dispensations during 4 years after T2DM diagnosis, with outcomes assessed after this period.

Over an average of 10 years, 8.3% of pioglitazone users developed dementia, compared with 10.0% of nonusers.

There was a statistically significant 16% lower risk for developing all-cause dementia among pioglitazone users than among nonusers (adjusted hazard ratio, 0.84; 95% confidence interval, 0.75-0.95).

A dose-response relationship was evident; pioglitazone users who received the highest cumulative daily dose were at lower risk for dementia (aHR, 0.72; 95% CI, 0.55-0.94).
 

Several limitations

The reduced risk for dementia was more pronounced among patients who used pioglitazone for 4 years in comparison with patients who did not use the drug (aHR, 0.63; 95% CI, 0.44-0.90).

The apparent protective effect of pioglitazone with regard to dementia was greater among those with a history of ischemic heart disease (aHR, 0.46; 95% CI, 0.24-0.90) or stroke (aHR, 0.57; 95% CI, 0.38-0.86) before diabetes diagnosis.

The incidence of stroke was also reduced with pioglitazone use (aHR, 0.81; 95% CI, 0.66-1.0).

“These results provide valuable information on who could potentially benefit from pioglitazone use for prevention of dementia,” Dr. Kim said in a news release.

However, “the risk and benefit balance of long-term use of this drug to prevent dementia should be prospectively assessed,” he said in an interview.

The researchers cautioned that the study was observational; hence, the reported associations cannot address causal relationships. Also, because of the use of claims data, drug compliance could not be guaranteed, and exposure may have been overestimated.

There is also the potential for selection bias, and no information on apolipoprotein E was available, they noted.
 

More data needed

In an accompanying editorial, Colleen J. Maxwell, PhD, University of Waterloo (Ont.), and colleagues wrote that the results “not only support previous studies showing the potential cognitive benefit of pioglitazone but also extend our understanding of this benefit through the mediating effect of reducing ischemic stroke.”

However, because of their associated risks, which include fractures, weight gain, heart failure, and bladder cancer, thiazolidinediones are not currently favored in diabetes management guidelines – and their use has significantly declined since the mid to late 2000s, the editorialists noted.

They agreed that it will be important to reassess the risk-benefit profile of pioglitazone in T2DM as additional findings emerge.

They also noted that sodium-glucose cotransporter-2 inhibitors, which have significant cardiovascular and renal benefits and minimal side effects, may also lower the risk for dementia.

“As both pioglitazone and SGLT-2 inhibitors are second-line options for physicians, the current decision would easily be in favor of SGLT-2 inhibitors given their safety profile,” Dr. Maxwell and colleagues wrote.

For now, pioglitazone “should not be used to prevent dementia in patients with T2DM,” they concluded.

The study was supported by grants from the National Research Foundation of Korea funded by the Korean government and the Ministry of Health and Welfare. The investigators and editorialists report no relevant financial relationships.

A version of this article originally appeared on Medscape.com.

Treatment with the thiazolidinedione pioglitazone may offer the greatest protection against dementia for older adults with newly diagnosed type 2 diabetes mellitus (T2DM) who have a history of stroke or ischemic heart disease, new research suggests.

Overall, in a large cohort study from South Korea, patients who took pioglitazone were 16% less likely to develop dementia over an average of 10 years than peers who did not take the drug.

However, the dementia risk reduction was 54% among those with ischemic heart disease and 43% among those with a history of stroke.

“Our study was to see the association between pioglitazone use and incidence of dementia, not how (with what mechanisms) this drug can suppress dementia pathology,” coinvestigator Eosu Kim, MD, PhD, Yonsei University, Seoul, South Korea, said in an interview.

However, “as we found this drug is more effective in diabetic patients who have blood circulation problems in the heart or brain than in those without such problems, we speculate that pioglitazone’s antidementia action may be related to improving blood vessel’s health,” Dr. Kim said.

This finding suggests that pioglitazone could be used as a personalized treatment approach for dementia prevention in this subgroup of patients with diabetes, the researchers noted.

The results were published online in Neurology.
 

Dose-response relationship

Risk for dementia is doubled in adults with T2DM, the investigators wrote. Prior studies have suggested that pioglitazone may protect against dementia, as well as a first or recurrent stroke, in patients with T2DM.

This led Dr. Kim and colleagues to examine the effects of pioglitazone on dementia risk overall and in relation to stroke and ischemic heart disease.

Using the national Korean health database, the researchers identified 91,218 adults aged 50 and older with new-onset T2DM who did not have dementia. A total of 3,467 were treated with pioglitazone.

Pioglitazone exposure was defined as a total cumulative daily dose of 90 or more calculated from all dispensations during 4 years after T2DM diagnosis, with outcomes assessed after this period.

Over an average of 10 years, 8.3% of pioglitazone users developed dementia, compared with 10.0% of nonusers.

There was a statistically significant 16% lower risk for developing all-cause dementia among pioglitazone users than among nonusers (adjusted hazard ratio, 0.84; 95% confidence interval, 0.75-0.95).

A dose-response relationship was evident; pioglitazone users who received the highest cumulative daily dose were at lower risk for dementia (aHR, 0.72; 95% CI, 0.55-0.94).
 

Several limitations

The reduced risk for dementia was more pronounced among patients who used pioglitazone for 4 years in comparison with patients who did not use the drug (aHR, 0.63; 95% CI, 0.44-0.90).

The apparent protective effect of pioglitazone with regard to dementia was greater among those with a history of ischemic heart disease (aHR, 0.46; 95% CI, 0.24-0.90) or stroke (aHR, 0.57; 95% CI, 0.38-0.86) before diabetes diagnosis.

The incidence of stroke was also reduced with pioglitazone use (aHR, 0.81; 95% CI, 0.66-1.0).

“These results provide valuable information on who could potentially benefit from pioglitazone use for prevention of dementia,” Dr. Kim said in a news release.

However, “the risk and benefit balance of long-term use of this drug to prevent dementia should be prospectively assessed,” he said in an interview.

The researchers cautioned that the study was observational; hence, the reported associations cannot address causal relationships. Also, because of the use of claims data, drug compliance could not be guaranteed, and exposure may have been overestimated.

There is also the potential for selection bias, and no information on apolipoprotein E was available, they noted.
 

More data needed

In an accompanying editorial, Colleen J. Maxwell, PhD, University of Waterloo (Ont.), and colleagues wrote that the results “not only support previous studies showing the potential cognitive benefit of pioglitazone but also extend our understanding of this benefit through the mediating effect of reducing ischemic stroke.”

However, because of their associated risks, which include fractures, weight gain, heart failure, and bladder cancer, thiazolidinediones are not currently favored in diabetes management guidelines – and their use has significantly declined since the mid to late 2000s, the editorialists noted.

They agreed that it will be important to reassess the risk-benefit profile of pioglitazone in T2DM as additional findings emerge.

They also noted that sodium-glucose cotransporter-2 inhibitors, which have significant cardiovascular and renal benefits and minimal side effects, may also lower the risk for dementia.

“As both pioglitazone and SGLT-2 inhibitors are second-line options for physicians, the current decision would easily be in favor of SGLT-2 inhibitors given their safety profile,” Dr. Maxwell and colleagues wrote.

For now, pioglitazone “should not be used to prevent dementia in patients with T2DM,” they concluded.

The study was supported by grants from the National Research Foundation of Korea funded by the Korean government and the Ministry of Health and Welfare. The investigators and editorialists report no relevant financial relationships.

A version of this article originally appeared on Medscape.com.

Treatment with the thiazolidinedione pioglitazone may offer the greatest protection against dementia for older adults with newly diagnosed type 2 diabetes mellitus (T2DM) who have a history of stroke or ischemic heart disease, new research suggests.

Overall, in a large cohort study from South Korea, patients who took pioglitazone were 16% less likely to develop dementia over an average of 10 years than peers who did not take the drug.

However, the dementia risk reduction was 54% among those with ischemic heart disease and 43% among those with a history of stroke.

“Our study was to see the association between pioglitazone use and incidence of dementia, not how (with what mechanisms) this drug can suppress dementia pathology,” coinvestigator Eosu Kim, MD, PhD, Yonsei University, Seoul, South Korea, said in an interview.

However, “as we found this drug is more effective in diabetic patients who have blood circulation problems in the heart or brain than in those without such problems, we speculate that pioglitazone’s antidementia action may be related to improving blood vessel’s health,” Dr. Kim said.

This finding suggests that pioglitazone could be used as a personalized treatment approach for dementia prevention in this subgroup of patients with diabetes, the researchers noted.

The results were published online in Neurology.
 

Dose-response relationship

Risk for dementia is doubled in adults with T2DM, the investigators wrote. Prior studies have suggested that pioglitazone may protect against dementia, as well as a first or recurrent stroke, in patients with T2DM.

This led Dr. Kim and colleagues to examine the effects of pioglitazone on dementia risk overall and in relation to stroke and ischemic heart disease.

Using the national Korean health database, the researchers identified 91,218 adults aged 50 and older with new-onset T2DM who did not have dementia. A total of 3,467 were treated with pioglitazone.

Pioglitazone exposure was defined as a total cumulative daily dose of 90 or more calculated from all dispensations during 4 years after T2DM diagnosis, with outcomes assessed after this period.

Over an average of 10 years, 8.3% of pioglitazone users developed dementia, compared with 10.0% of nonusers.

There was a statistically significant 16% lower risk for developing all-cause dementia among pioglitazone users than among nonusers (adjusted hazard ratio, 0.84; 95% confidence interval, 0.75-0.95).

A dose-response relationship was evident; pioglitazone users who received the highest cumulative daily dose were at lower risk for dementia (aHR, 0.72; 95% CI, 0.55-0.94).
 

Several limitations

The reduced risk for dementia was more pronounced among patients who used pioglitazone for 4 years in comparison with patients who did not use the drug (aHR, 0.63; 95% CI, 0.44-0.90).

The apparent protective effect of pioglitazone with regard to dementia was greater among those with a history of ischemic heart disease (aHR, 0.46; 95% CI, 0.24-0.90) or stroke (aHR, 0.57; 95% CI, 0.38-0.86) before diabetes diagnosis.

The incidence of stroke was also reduced with pioglitazone use (aHR, 0.81; 95% CI, 0.66-1.0).

“These results provide valuable information on who could potentially benefit from pioglitazone use for prevention of dementia,” Dr. Kim said in a news release.

However, “the risk and benefit balance of long-term use of this drug to prevent dementia should be prospectively assessed,” he said in an interview.

The researchers cautioned that the study was observational; hence, the reported associations cannot address causal relationships. Also, because of the use of claims data, drug compliance could not be guaranteed, and exposure may have been overestimated.

There is also the potential for selection bias, and no information on apolipoprotein E was available, they noted.
 

More data needed

In an accompanying editorial, Colleen J. Maxwell, PhD, University of Waterloo (Ont.), and colleagues wrote that the results “not only support previous studies showing the potential cognitive benefit of pioglitazone but also extend our understanding of this benefit through the mediating effect of reducing ischemic stroke.”

However, because of their associated risks, which include fractures, weight gain, heart failure, and bladder cancer, thiazolidinediones are not currently favored in diabetes management guidelines – and their use has significantly declined since the mid to late 2000s, the editorialists noted.

They agreed that it will be important to reassess the risk-benefit profile of pioglitazone in T2DM as additional findings emerge.

They also noted that sodium-glucose cotransporter-2 inhibitors, which have significant cardiovascular and renal benefits and minimal side effects, may also lower the risk for dementia.

“As both pioglitazone and SGLT-2 inhibitors are second-line options for physicians, the current decision would easily be in favor of SGLT-2 inhibitors given their safety profile,” Dr. Maxwell and colleagues wrote.

For now, pioglitazone “should not be used to prevent dementia in patients with T2DM,” they concluded.

The study was supported by grants from the National Research Foundation of Korea funded by the Korean government and the Ministry of Health and Welfare. The investigators and editorialists report no relevant financial relationships.

A version of this article originally appeared on Medscape.com.

A frustrated physician recently voiced some strong words in Medscape’s US Physician Burnout & Depression Report: “Only a sociopath could work for a large health system and not be burned out. Anyone who cares about patients is doomed to burnout.”

It’s no secret that today’s large health care organizations are leaving physicians feeling overwhelmed, beaten up, and exhausted. Medscape’s report showed that 53% of physicians feel burned out by job requirements; 65% say that burnout has impacted their relationships, and other statistics say that physicians are leaving clinical medicine because of all this pressure.

What is it about being employed by large organizations that can be so negative?  In another study, MEMO – Minimizing Error, Maximizing Outcomes – researchers at the University of Wisconsin surveyed more than 400 doctors to learn about how their working environments corresponded with medical errors. More than half of the physicians reported time pressures when conducting physical examinations. Nearly a third felt they needed at least 50% more time than was allotted for this patient care function, and nearly a quarter said they needed at least 50% more time for follow-up appointments.

Some have asked: Can anyone, then, thrive in today’s health care environment and avoid burnout?

Although the frustrated physician noted above may sardonically say that a doctor needs to be sociopathic to enjoy it – lacking in feelings for others – “It’s a very small number of doctors who get in it for the wrong reasons and therefore care about their own benefit and not their patients,” said psychiatrist Wendy Dean, MD, CEO and cofounder of Moral Injury of Healthcare, a nonprofit organization addressing workforce distress in health care. “Those are the outliers.”

The vast majority of physicians do care about their patients – deeply, said Dr. Dean. They struggle under the weight of the health care system and yet must find ways to get through. Today, thriving in an imperfect system requires honing new skills, asking for help when needed, and pushing for systemic and cultural change.

“We’ve been assessing and trying to address burnout for half a century,” said Dr. Dean. “Despite all the good intentions, and people dedicating their entire careers to solving the issue, we’ve barely made a dent.”

With the advent of new technological requirements on the job and more demands from increasingly larger health care organizations, the risk for burnout is higher than ever before. “There’s an increased burden of regulatory-mandated and cumbersome administrative workload per patient,” said Shomron Ben-Horin, MD, cofounder of Evinature. “Often the computer/paperwork before and after a procedure is much longer than the procedure itself.”

Meeting insurance requirements is increasingly cumbersome, too, and preauthorizations and debates with payers over medical approval may put physicians frustratingly in the middle.

“This increases the psychological burden for physicians who may feel responsible for wrongdoing no matter which option they deem better,” Dr. Ben-Horin said. “Add in physician accessibility around the clock via mobile phones, emails, and apps, and you end up on call even if you’re not officially on call.”
 

Why some physicians suffer more

Some physicians are more likely to suffer burnout than others, said Jessi Gold, MD, assistant professor in the department of psychiatry at Washington University in St. Louis. “The self-valuation concept comes into play here,” she said. “If you make a mistake, do you blame yourself or see it as a growth opportunity? If it’s the former, you’re more likely to burn out.”

Dr. Ben-Horin added that the most patient-centric doctors are the ones who struggle most. “These are the doctors we’d all love to have as a patient,” he said. “But they are burdened by the extra tasks of the job, and they are the most stressed by the environment.”

So too are those physicians who never master compartmentalizing their feelings and emotions. “We learn in training to compartmentalize our emotions,” said Dr. Dean. “You can’t allow yourself to get emotional while performing chest compressions on an 18-year-old kid. So you shut it all away; otherwise, you might lose the patient.”

This turn-off switch becomes automatic, but it also comes at a cost. “When doctors were interviewed about [Buffalo Bills player] Damar Hamlin going into cardiac arrest on the football field, they talked about how a life-and-death situation is so common that they have to put the emotions away, work on the patient, and move onto the next,” said Dr. Dean. “The next patient needs you just as much. We must lock away our feelings and manage the situation.”

Dr. Gold explained that burying feelings, however, is a symptom of burnout. “We have to remove ourselves from the situation to protect ourselves,” she said. “We can’t cry in these situations, but we can’t bury our feelings either.”

Instead, Dr. Gold suggested, a good medium may exist. “You may not be able to address them in the moment, but you should sometime after,” she said.

This is just a starting point on how to remain a dedicated, caring physician without burning out. “The system is pretty broken, and to survive it first means wanting to survive it,” Dr. Gold said. “There’s a lot of focus on resiliency and lack thereof if a physician expresses burnout, but that’s a false notion. Doctors are a resilient bunch but even they get burned out.”

Change for the better must come from several places. One is asking for help, something that can be hard for a group conditioned to keeping a stiff upper lip. “Just because your peers might look healthy (emotionally) doesn’t mean they are,” said Dr. Gold. “We’ve normalized this culture of burying feelings, but that doesn’t mean it’s right.”

Dr. Ben-Horin also advocates diversifying your work. This might include engaging in research and academics, for instance. “This not only makes you a better broad-perspective doctor but allows you to psychologically switch gears on research days,” he said.

The biggest place to make change, however, is within the health care system culture itself. The AMA created a series of recommendations to address burnout at the resident and fellow level, a good starting point to carry through into staff work. The steps include creating a well-being framework, gathering a team to support a well-being program, developing the program in a way to foster fun and connectivity among the staff, fostering individual well-being that addresses emotional and physical well-being, and confronting burnout and creating a sustainable culture of well-being.

On a personal level, it’s essential that physicians keep close tabs on themselves and peers. “Understand the signs and symptoms of burnout by taking stock of where you are emotionally,” said Dr. Gold. “Have a place and time at the end of a hard day to reflect or find a ritual that helps you and stay with it.”

You might also reach out to a therapist or a peer when you’re struggling. Having honest conversations with peers can go a long way. “Find a confidant that allows you to be vulnerable,” Dr. Gold recommended. “Acknowledge that this is hard and that you might need help taking care of yourself. The system needs to change, but we can also learn to survive in the meantime. You don’t have to be a sociopath to make it.”

A version of this article originally appeared on Medscape.com.

A frustrated physician recently voiced some strong words in Medscape’s US Physician Burnout & Depression Report: “Only a sociopath could work for a large health system and not be burned out. Anyone who cares about patients is doomed to burnout.”

It’s no secret that today’s large health care organizations are leaving physicians feeling overwhelmed, beaten up, and exhausted. Medscape’s report showed that 53% of physicians feel burned out by job requirements; 65% say that burnout has impacted their relationships, and other statistics say that physicians are leaving clinical medicine because of all this pressure.

What is it about being employed by large organizations that can be so negative?  In another study, MEMO – Minimizing Error, Maximizing Outcomes – researchers at the University of Wisconsin surveyed more than 400 doctors to learn about how their working environments corresponded with medical errors. More than half of the physicians reported time pressures when conducting physical examinations. Nearly a third felt they needed at least 50% more time than was allotted for this patient care function, and nearly a quarter said they needed at least 50% more time for follow-up appointments.

Some have asked: Can anyone, then, thrive in today’s health care environment and avoid burnout?

Although the frustrated physician noted above may sardonically say that a doctor needs to be sociopathic to enjoy it – lacking in feelings for others – “It’s a very small number of doctors who get in it for the wrong reasons and therefore care about their own benefit and not their patients,” said psychiatrist Wendy Dean, MD, CEO and cofounder of Moral Injury of Healthcare, a nonprofit organization addressing workforce distress in health care. “Those are the outliers.”

The vast majority of physicians do care about their patients – deeply, said Dr. Dean. They struggle under the weight of the health care system and yet must find ways to get through. Today, thriving in an imperfect system requires honing new skills, asking for help when needed, and pushing for systemic and cultural change.

“We’ve been assessing and trying to address burnout for half a century,” said Dr. Dean. “Despite all the good intentions, and people dedicating their entire careers to solving the issue, we’ve barely made a dent.”

With the advent of new technological requirements on the job and more demands from increasingly larger health care organizations, the risk for burnout is higher than ever before. “There’s an increased burden of regulatory-mandated and cumbersome administrative workload per patient,” said Shomron Ben-Horin, MD, cofounder of Evinature. “Often the computer/paperwork before and after a procedure is much longer than the procedure itself.”

Meeting insurance requirements is increasingly cumbersome, too, and preauthorizations and debates with payers over medical approval may put physicians frustratingly in the middle.

“This increases the psychological burden for physicians who may feel responsible for wrongdoing no matter which option they deem better,” Dr. Ben-Horin said. “Add in physician accessibility around the clock via mobile phones, emails, and apps, and you end up on call even if you’re not officially on call.”
 

Why some physicians suffer more

Some physicians are more likely to suffer burnout than others, said Jessi Gold, MD, assistant professor in the department of psychiatry at Washington University in St. Louis. “The self-valuation concept comes into play here,” she said. “If you make a mistake, do you blame yourself or see it as a growth opportunity? If it’s the former, you’re more likely to burn out.”

Dr. Ben-Horin added that the most patient-centric doctors are the ones who struggle most. “These are the doctors we’d all love to have as a patient,” he said. “But they are burdened by the extra tasks of the job, and they are the most stressed by the environment.”

So too are those physicians who never master compartmentalizing their feelings and emotions. “We learn in training to compartmentalize our emotions,” said Dr. Dean. “You can’t allow yourself to get emotional while performing chest compressions on an 18-year-old kid. So you shut it all away; otherwise, you might lose the patient.”

This turn-off switch becomes automatic, but it also comes at a cost. “When doctors were interviewed about [Buffalo Bills player] Damar Hamlin going into cardiac arrest on the football field, they talked about how a life-and-death situation is so common that they have to put the emotions away, work on the patient, and move onto the next,” said Dr. Dean. “The next patient needs you just as much. We must lock away our feelings and manage the situation.”

Dr. Gold explained that burying feelings, however, is a symptom of burnout. “We have to remove ourselves from the situation to protect ourselves,” she said. “We can’t cry in these situations, but we can’t bury our feelings either.”

Instead, Dr. Gold suggested, a good medium may exist. “You may not be able to address them in the moment, but you should sometime after,” she said.

This is just a starting point on how to remain a dedicated, caring physician without burning out. “The system is pretty broken, and to survive it first means wanting to survive it,” Dr. Gold said. “There’s a lot of focus on resiliency and lack thereof if a physician expresses burnout, but that’s a false notion. Doctors are a resilient bunch but even they get burned out.”

Change for the better must come from several places. One is asking for help, something that can be hard for a group conditioned to keeping a stiff upper lip. “Just because your peers might look healthy (emotionally) doesn’t mean they are,” said Dr. Gold. “We’ve normalized this culture of burying feelings, but that doesn’t mean it’s right.”

Dr. Ben-Horin also advocates diversifying your work. This might include engaging in research and academics, for instance. “This not only makes you a better broad-perspective doctor but allows you to psychologically switch gears on research days,” he said.

The biggest place to make change, however, is within the health care system culture itself. The AMA created a series of recommendations to address burnout at the resident and fellow level, a good starting point to carry through into staff work. The steps include creating a well-being framework, gathering a team to support a well-being program, developing the program in a way to foster fun and connectivity among the staff, fostering individual well-being that addresses emotional and physical well-being, and confronting burnout and creating a sustainable culture of well-being.

On a personal level, it’s essential that physicians keep close tabs on themselves and peers. “Understand the signs and symptoms of burnout by taking stock of where you are emotionally,” said Dr. Gold. “Have a place and time at the end of a hard day to reflect or find a ritual that helps you and stay with it.”

You might also reach out to a therapist or a peer when you’re struggling. Having honest conversations with peers can go a long way. “Find a confidant that allows you to be vulnerable,” Dr. Gold recommended. “Acknowledge that this is hard and that you might need help taking care of yourself. The system needs to change, but we can also learn to survive in the meantime. You don’t have to be a sociopath to make it.”

A version of this article originally appeared on Medscape.com.

A frustrated physician recently voiced some strong words in Medscape’s US Physician Burnout & Depression Report: “Only a sociopath could work for a large health system and not be burned out. Anyone who cares about patients is doomed to burnout.”

It’s no secret that today’s large health care organizations are leaving physicians feeling overwhelmed, beaten up, and exhausted. Medscape’s report showed that 53% of physicians feel burned out by job requirements; 65% say that burnout has impacted their relationships, and other statistics say that physicians are leaving clinical medicine because of all this pressure.

What is it about being employed by large organizations that can be so negative?  In another study, MEMO – Minimizing Error, Maximizing Outcomes – researchers at the University of Wisconsin surveyed more than 400 doctors to learn about how their working environments corresponded with medical errors. More than half of the physicians reported time pressures when conducting physical examinations. Nearly a third felt they needed at least 50% more time than was allotted for this patient care function, and nearly a quarter said they needed at least 50% more time for follow-up appointments.

Some have asked: Can anyone, then, thrive in today’s health care environment and avoid burnout?

Although the frustrated physician noted above may sardonically say that a doctor needs to be sociopathic to enjoy it – lacking in feelings for others – “It’s a very small number of doctors who get in it for the wrong reasons and therefore care about their own benefit and not their patients,” said psychiatrist Wendy Dean, MD, CEO and cofounder of Moral Injury of Healthcare, a nonprofit organization addressing workforce distress in health care. “Those are the outliers.”

The vast majority of physicians do care about their patients – deeply, said Dr. Dean. They struggle under the weight of the health care system and yet must find ways to get through. Today, thriving in an imperfect system requires honing new skills, asking for help when needed, and pushing for systemic and cultural change.

“We’ve been assessing and trying to address burnout for half a century,” said Dr. Dean. “Despite all the good intentions, and people dedicating their entire careers to solving the issue, we’ve barely made a dent.”

With the advent of new technological requirements on the job and more demands from increasingly larger health care organizations, the risk for burnout is higher than ever before. “There’s an increased burden of regulatory-mandated and cumbersome administrative workload per patient,” said Shomron Ben-Horin, MD, cofounder of Evinature. “Often the computer/paperwork before and after a procedure is much longer than the procedure itself.”

Meeting insurance requirements is increasingly cumbersome, too, and preauthorizations and debates with payers over medical approval may put physicians frustratingly in the middle.

“This increases the psychological burden for physicians who may feel responsible for wrongdoing no matter which option they deem better,” Dr. Ben-Horin said. “Add in physician accessibility around the clock via mobile phones, emails, and apps, and you end up on call even if you’re not officially on call.”
 

Why some physicians suffer more

Some physicians are more likely to suffer burnout than others, said Jessi Gold, MD, assistant professor in the department of psychiatry at Washington University in St. Louis. “The self-valuation concept comes into play here,” she said. “If you make a mistake, do you blame yourself or see it as a growth opportunity? If it’s the former, you’re more likely to burn out.”

Dr. Ben-Horin added that the most patient-centric doctors are the ones who struggle most. “These are the doctors we’d all love to have as a patient,” he said. “But they are burdened by the extra tasks of the job, and they are the most stressed by the environment.”

So too are those physicians who never master compartmentalizing their feelings and emotions. “We learn in training to compartmentalize our emotions,” said Dr. Dean. “You can’t allow yourself to get emotional while performing chest compressions on an 18-year-old kid. So you shut it all away; otherwise, you might lose the patient.”

This turn-off switch becomes automatic, but it also comes at a cost. “When doctors were interviewed about [Buffalo Bills player] Damar Hamlin going into cardiac arrest on the football field, they talked about how a life-and-death situation is so common that they have to put the emotions away, work on the patient, and move onto the next,” said Dr. Dean. “The next patient needs you just as much. We must lock away our feelings and manage the situation.”

Dr. Gold explained that burying feelings, however, is a symptom of burnout. “We have to remove ourselves from the situation to protect ourselves,” she said. “We can’t cry in these situations, but we can’t bury our feelings either.”

Instead, Dr. Gold suggested, a good medium may exist. “You may not be able to address them in the moment, but you should sometime after,” she said.

This is just a starting point on how to remain a dedicated, caring physician without burning out. “The system is pretty broken, and to survive it first means wanting to survive it,” Dr. Gold said. “There’s a lot of focus on resiliency and lack thereof if a physician expresses burnout, but that’s a false notion. Doctors are a resilient bunch but even they get burned out.”

Change for the better must come from several places. One is asking for help, something that can be hard for a group conditioned to keeping a stiff upper lip. “Just because your peers might look healthy (emotionally) doesn’t mean they are,” said Dr. Gold. “We’ve normalized this culture of burying feelings, but that doesn’t mean it’s right.”

Dr. Ben-Horin also advocates diversifying your work. This might include engaging in research and academics, for instance. “This not only makes you a better broad-perspective doctor but allows you to psychologically switch gears on research days,” he said.

The biggest place to make change, however, is within the health care system culture itself. The AMA created a series of recommendations to address burnout at the resident and fellow level, a good starting point to carry through into staff work. The steps include creating a well-being framework, gathering a team to support a well-being program, developing the program in a way to foster fun and connectivity among the staff, fostering individual well-being that addresses emotional and physical well-being, and confronting burnout and creating a sustainable culture of well-being.

On a personal level, it’s essential that physicians keep close tabs on themselves and peers. “Understand the signs and symptoms of burnout by taking stock of where you are emotionally,” said Dr. Gold. “Have a place and time at the end of a hard day to reflect or find a ritual that helps you and stay with it.”

You might also reach out to a therapist or a peer when you’re struggling. Having honest conversations with peers can go a long way. “Find a confidant that allows you to be vulnerable,” Dr. Gold recommended. “Acknowledge that this is hard and that you might need help taking care of yourself. The system needs to change, but we can also learn to survive in the meantime. You don’t have to be a sociopath to make it.”

A version of this article originally appeared on Medscape.com.