To read the entire article in pdf format, please click on the FILE at left.

To read the entire article in pdf format, please click on the FILE at left.

To read the entire article in pdf format, please click on the FILE at left.

Visitors to my office often ask about the secret to maintaining "such a marvelous" 11-person staff. "You must pay them a fortune," they say.

Yes, they are compensated fairly; but that’s not why they stay. I know for a fact that many of them have turned down higher salaries at big clinics. Staff turnover is essentially nonexistent. (My most junior employee is going on 18 years.)

They remain, I believe, because I welcome their ideas; and I let them know on a regular basis that I notice and appreciate their efforts.

Soliciting employee input is a win-win; it builds loyalty and a sense of community, and you discover better ways to run your office.

I fancy myself an innovative guy, but I can’t think of everything myself. I don’t sit at the reception window; I don’t handle the phones; I don’t put patients in rooms. So, don’t let your staff keep good ideas to themselves. Your staff will only make the effort, however, if they understand that there is something in it for them, other than a token salary raise at year’s end.

The monthly office meeting is a great vehicle for brainstorming. I like my office manager to run them; or more precisely, we like to let them run themselves. We just moderate the discussion, identify problems, and solicit solutions. Usually the answer will come from the dialogue. In addition, we always leave time for airing of any proposals for general improvement of the office as a whole.

By encouraging my employees to propose solutions and suggest better methods and procedures, I demonstrate to them that they have a stake in the success of the office. And when a solution or a new suggestion is staff conceived, the staff has a stake in ensuring that it is implemented and that it works. This method also offers the opportunity to identify and work out minor problems before they become major ones.

Even in this digital age, an essential tool for me at office meetings is a good old-fashioned yellow legal pad, on which I note everything discussed. Each problem identified and each new idea offered is paired with proposed solutions and practical suggestions for implementation, and someone is assigned the responsibility of taking action. Not only does it guarantee that a problem will not continue and a good idea will not die, it also reassures staff that they are not just whistling in the dark when they point out a problem or propose a new office policy.

Some physicians hold meetings away from the office, perhaps at a local restaurant, going on the theory that staff will be more frank when outside of the office. Personally, I have never found my employees reluctant to express themselves in any setting, but if you have, consider that alternative.

Anytime someone comes up with a great idea, or calls attention to a significant issue, I make sure that the person hears – immediately and publicly – the praise that he or she deserves. That goes for all aspects of the office. Whenever I "catch someone doing something right," I note it, and praise that person.

Of course, it is also sometimes necessary to dole out constructive criticism; but as public as praise should be, criticism should be private. And the manner of the criticism is just as important as the setting. I prefer to point out the problem, ask what might have precipitated it, and suggest ways to correct it. After all, nobody is perfect. When you are understanding of your employees’ mistakes, they will be more understanding of yours.

The emphasis, however, is always on praise. When I leave at the end of the day I always thank the staff. If I can’t think of a specific thing to thank them for, I thank them for a good day. Employees thrive on praise, and will go out of their way to earn it.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. To respond to this column, email Dr. Eastern at sknews@elsevier.com.

Visitors to my office often ask about the secret to maintaining "such a marvelous" 11-person staff. "You must pay them a fortune," they say.

Yes, they are compensated fairly; but that’s not why they stay. I know for a fact that many of them have turned down higher salaries at big clinics. Staff turnover is essentially nonexistent. (My most junior employee is going on 18 years.)

They remain, I believe, because I welcome their ideas; and I let them know on a regular basis that I notice and appreciate their efforts.

Soliciting employee input is a win-win; it builds loyalty and a sense of community, and you discover better ways to run your office.

I fancy myself an innovative guy, but I can’t think of everything myself. I don’t sit at the reception window; I don’t handle the phones; I don’t put patients in rooms. So, don’t let your staff keep good ideas to themselves. Your staff will only make the effort, however, if they understand that there is something in it for them, other than a token salary raise at year’s end.

The monthly office meeting is a great vehicle for brainstorming. I like my office manager to run them; or more precisely, we like to let them run themselves. We just moderate the discussion, identify problems, and solicit solutions. Usually the answer will come from the dialogue. In addition, we always leave time for airing of any proposals for general improvement of the office as a whole.

By encouraging my employees to propose solutions and suggest better methods and procedures, I demonstrate to them that they have a stake in the success of the office. And when a solution or a new suggestion is staff conceived, the staff has a stake in ensuring that it is implemented and that it works. This method also offers the opportunity to identify and work out minor problems before they become major ones.

Even in this digital age, an essential tool for me at office meetings is a good old-fashioned yellow legal pad, on which I note everything discussed. Each problem identified and each new idea offered is paired with proposed solutions and practical suggestions for implementation, and someone is assigned the responsibility of taking action. Not only does it guarantee that a problem will not continue and a good idea will not die, it also reassures staff that they are not just whistling in the dark when they point out a problem or propose a new office policy.

Some physicians hold meetings away from the office, perhaps at a local restaurant, going on the theory that staff will be more frank when outside of the office. Personally, I have never found my employees reluctant to express themselves in any setting, but if you have, consider that alternative.

Anytime someone comes up with a great idea, or calls attention to a significant issue, I make sure that the person hears – immediately and publicly – the praise that he or she deserves. That goes for all aspects of the office. Whenever I "catch someone doing something right," I note it, and praise that person.

Of course, it is also sometimes necessary to dole out constructive criticism; but as public as praise should be, criticism should be private. And the manner of the criticism is just as important as the setting. I prefer to point out the problem, ask what might have precipitated it, and suggest ways to correct it. After all, nobody is perfect. When you are understanding of your employees’ mistakes, they will be more understanding of yours.

The emphasis, however, is always on praise. When I leave at the end of the day I always thank the staff. If I can’t think of a specific thing to thank them for, I thank them for a good day. Employees thrive on praise, and will go out of their way to earn it.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. To respond to this column, email Dr. Eastern at sknews@elsevier.com.

Visitors to my office often ask about the secret to maintaining "such a marvelous" 11-person staff. "You must pay them a fortune," they say.

Yes, they are compensated fairly; but that’s not why they stay. I know for a fact that many of them have turned down higher salaries at big clinics. Staff turnover is essentially nonexistent. (My most junior employee is going on 18 years.)

They remain, I believe, because I welcome their ideas; and I let them know on a regular basis that I notice and appreciate their efforts.

Soliciting employee input is a win-win; it builds loyalty and a sense of community, and you discover better ways to run your office.

I fancy myself an innovative guy, but I can’t think of everything myself. I don’t sit at the reception window; I don’t handle the phones; I don’t put patients in rooms. So, don’t let your staff keep good ideas to themselves. Your staff will only make the effort, however, if they understand that there is something in it for them, other than a token salary raise at year’s end.

The monthly office meeting is a great vehicle for brainstorming. I like my office manager to run them; or more precisely, we like to let them run themselves. We just moderate the discussion, identify problems, and solicit solutions. Usually the answer will come from the dialogue. In addition, we always leave time for airing of any proposals for general improvement of the office as a whole.

By encouraging my employees to propose solutions and suggest better methods and procedures, I demonstrate to them that they have a stake in the success of the office. And when a solution or a new suggestion is staff conceived, the staff has a stake in ensuring that it is implemented and that it works. This method also offers the opportunity to identify and work out minor problems before they become major ones.

Even in this digital age, an essential tool for me at office meetings is a good old-fashioned yellow legal pad, on which I note everything discussed. Each problem identified and each new idea offered is paired with proposed solutions and practical suggestions for implementation, and someone is assigned the responsibility of taking action. Not only does it guarantee that a problem will not continue and a good idea will not die, it also reassures staff that they are not just whistling in the dark when they point out a problem or propose a new office policy.

Some physicians hold meetings away from the office, perhaps at a local restaurant, going on the theory that staff will be more frank when outside of the office. Personally, I have never found my employees reluctant to express themselves in any setting, but if you have, consider that alternative.

Anytime someone comes up with a great idea, or calls attention to a significant issue, I make sure that the person hears – immediately and publicly – the praise that he or she deserves. That goes for all aspects of the office. Whenever I "catch someone doing something right," I note it, and praise that person.

Of course, it is also sometimes necessary to dole out constructive criticism; but as public as praise should be, criticism should be private. And the manner of the criticism is just as important as the setting. I prefer to point out the problem, ask what might have precipitated it, and suggest ways to correct it. After all, nobody is perfect. When you are understanding of your employees’ mistakes, they will be more understanding of yours.

The emphasis, however, is always on praise. When I leave at the end of the day I always thank the staff. If I can’t think of a specific thing to thank them for, I thank them for a good day. Employees thrive on praise, and will go out of their way to earn it.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. To respond to this column, email Dr. Eastern at sknews@elsevier.com.

Perceived Social Support as a Predictor of Disease-Specific Quality of Life in Head-and-Neck Cancer Patients

Frank J. Penedo, PhD; Lara Traeger, PhD; Catherine Benedict, MS; Giovana Thomas, MD; Jason R. Dahn, PhD; Madeline Hernandez Krause, MS; and W. Jarrard Goodwin, MD

ABSTRACT

Background: Treatment for head-and-neck cancer (HNC) can lead to severe decrements in disease-specific quality of life (DSQOL) due to disfigurement and disability in speech, eating, and/or breathing. Psychosocial factors such as social support may explain individual variance in DSQOL outcomes.

Objective: The researchers sought to evaluate changes in perceived availability of social support from pretreatment to posttreatment and to determine whether decreases in perceived social support predicted poorer posttreatment DSQOL among HNC patients, controlling for disease-and treatment-related factors.

Methods: Participants (n equals 32) were newly diagnosed with HNC and were awaiting surgery and/or radiation treatment. Measures included the ENRICHD Social Support instrument (ESSI) to assess perceived social support and the Functional Assessment of Cancer Therapy–Head & Neck (FACT-H&N) to assess DSQOL. Paired-samples t-tests and hierarchical regression analyses were conducted to determine relationships between pretreatment and posttreatment perceived social support and DSQOL.

Results: Perceived social support decreased significantly from pre-to posttreatment (F[31] equals –2.71, P less than .01). After adjusting for relevant covariates and pretreatment DSQOL, change in perceived social support remained a significant predictor of posttreatment DSQOL (Beta equals 0.47, P less than .01).

Limitations: This study included a relatively small sample of HNC patients, which limited power to evaluate mechanisms of observed relationships.

Conclusions: Increased social isolation may be a risk factor for poorer physical recovery from, or adjustment to, treatment-related side effects. Social support may be an important target for psychosocial interventions for patients who face challenging treatment side effects.

To read the article, please see the attached pdf file.

Perceived Social Support as a Predictor of Disease-Specific Quality of Life in Head-and-Neck Cancer Patients

Frank J. Penedo, PhD; Lara Traeger, PhD; Catherine Benedict, MS; Giovana Thomas, MD; Jason R. Dahn, PhD; Madeline Hernandez Krause, MS; and W. Jarrard Goodwin, MD

ABSTRACT

Background: Treatment for head-and-neck cancer (HNC) can lead to severe decrements in disease-specific quality of life (DSQOL) due to disfigurement and disability in speech, eating, and/or breathing. Psychosocial factors such as social support may explain individual variance in DSQOL outcomes.

Objective: The researchers sought to evaluate changes in perceived availability of social support from pretreatment to posttreatment and to determine whether decreases in perceived social support predicted poorer posttreatment DSQOL among HNC patients, controlling for disease-and treatment-related factors.

Methods: Participants (n equals 32) were newly diagnosed with HNC and were awaiting surgery and/or radiation treatment. Measures included the ENRICHD Social Support instrument (ESSI) to assess perceived social support and the Functional Assessment of Cancer Therapy–Head & Neck (FACT-H&N) to assess DSQOL. Paired-samples t-tests and hierarchical regression analyses were conducted to determine relationships between pretreatment and posttreatment perceived social support and DSQOL.

Results: Perceived social support decreased significantly from pre-to posttreatment (F[31] equals –2.71, P less than .01). After adjusting for relevant covariates and pretreatment DSQOL, change in perceived social support remained a significant predictor of posttreatment DSQOL (Beta equals 0.47, P less than .01).

Limitations: This study included a relatively small sample of HNC patients, which limited power to evaluate mechanisms of observed relationships.

Conclusions: Increased social isolation may be a risk factor for poorer physical recovery from, or adjustment to, treatment-related side effects. Social support may be an important target for psychosocial interventions for patients who face challenging treatment side effects.

To read the article, please see the attached pdf file.

Perceived Social Support as a Predictor of Disease-Specific Quality of Life in Head-and-Neck Cancer Patients

Frank J. Penedo, PhD; Lara Traeger, PhD; Catherine Benedict, MS; Giovana Thomas, MD; Jason R. Dahn, PhD; Madeline Hernandez Krause, MS; and W. Jarrard Goodwin, MD

ABSTRACT

Background: Treatment for head-and-neck cancer (HNC) can lead to severe decrements in disease-specific quality of life (DSQOL) due to disfigurement and disability in speech, eating, and/or breathing. Psychosocial factors such as social support may explain individual variance in DSQOL outcomes.

Objective: The researchers sought to evaluate changes in perceived availability of social support from pretreatment to posttreatment and to determine whether decreases in perceived social support predicted poorer posttreatment DSQOL among HNC patients, controlling for disease-and treatment-related factors.

Methods: Participants (n equals 32) were newly diagnosed with HNC and were awaiting surgery and/or radiation treatment. Measures included the ENRICHD Social Support instrument (ESSI) to assess perceived social support and the Functional Assessment of Cancer Therapy–Head & Neck (FACT-H&N) to assess DSQOL. Paired-samples t-tests and hierarchical regression analyses were conducted to determine relationships between pretreatment and posttreatment perceived social support and DSQOL.

Results: Perceived social support decreased significantly from pre-to posttreatment (F[31] equals –2.71, P less than .01). After adjusting for relevant covariates and pretreatment DSQOL, change in perceived social support remained a significant predictor of posttreatment DSQOL (Beta equals 0.47, P less than .01).

Limitations: This study included a relatively small sample of HNC patients, which limited power to evaluate mechanisms of observed relationships.

Conclusions: Increased social isolation may be a risk factor for poorer physical recovery from, or adjustment to, treatment-related side effects. Social support may be an important target for psychosocial interventions for patients who face challenging treatment side effects.

To read the article, please see the attached pdf file.

“I was just missing history right in front of my eyes, and missing the stories, as all my colleagues were,” says Dr. Messler, medical director at Morton Plant Hospital in Clearwater, Fla.

Not anymore.

Dr. Messler is a hospitalist historian. At HM12 in April in San Diego, he led a session titled “The History of Hospitals,” a workshop that took attendees on a guided tour of medicine, from the Egyptian vizier Imhotep to William Osler, often called the father of modern medicine. It took detours at Galen, Christian hospitals, Islamic practices, and medieval medicine. The story was told through paintings, drawings, and hours of Dr. Messler’s “midnight to 2 a.m.” research.

“The humanities is a lost piece at times,” he says. “It certainly can help shape what we do.

“[It] helps us give a different perspective, makes us think about things in a different way, and, hopefully, can add even to the day-to-day work that people still do on the ground. It’s not going to help you treat heart failure in the research sense, but it should help you treat it in how you face your patient and how you face your facility.” (Click here to listen to more of Dr. Messler's interview with The Hospitalist)

Hospitalist J. Scott Dalston, MD, of Amarillo Hospitalist Services in northwest Texas enjoyed the break from the didactic and lecture approaches taken in nearly all of the annual meeting’s other breakout sessions. Perhaps more important, he felt reminded of what made him want to be a physician in the first place.

“Before medical school, you get caught up in the higher reasons for doing medicine, the calling,” he says. “Then, when you get down and dirty on the front lines, you kind of forget about that. This, in a way, reminds you of that.”

Such was the point of the debut “potpourri” track, according to Brendon Shank, SHM’s associate vice president of communications. The track also featured such nonclinical sessions as “Using Art to Improve Your Clinical Observation Skills” and “Professionalism in the Digital Age” in an attempt to round out the meeting.

Dr. Messler says he hopes his dabble into medicine’s beginnings inspires physicians to wrap history into their present practices. He encourages teaching hospitalists to weave historical nuggets into clinical rounds. He suggests residents ask older patients what their hospital experience used to be like. And he pushes all physicians to take the time to invest in their institution’s past.

“Taking a step back, looking at the history of where we are, going through the footsteps of those people who gone before us, gives us a better appreciation for what we do day to day,” he says. “Sometimes by looking backward we know that’s the best way to look forward.”

Richard Quinn is a freelance writer based in New Jersey.

“I was just missing history right in front of my eyes, and missing the stories, as all my colleagues were,” says Dr. Messler, medical director at Morton Plant Hospital in Clearwater, Fla.

Not anymore.

Dr. Messler is a hospitalist historian. At HM12 in April in San Diego, he led a session titled “The History of Hospitals,” a workshop that took attendees on a guided tour of medicine, from the Egyptian vizier Imhotep to William Osler, often called the father of modern medicine. It took detours at Galen, Christian hospitals, Islamic practices, and medieval medicine. The story was told through paintings, drawings, and hours of Dr. Messler’s “midnight to 2 a.m.” research.

“The humanities is a lost piece at times,” he says. “It certainly can help shape what we do.

“[It] helps us give a different perspective, makes us think about things in a different way, and, hopefully, can add even to the day-to-day work that people still do on the ground. It’s not going to help you treat heart failure in the research sense, but it should help you treat it in how you face your patient and how you face your facility.” (Click here to listen to more of Dr. Messler's interview with The Hospitalist)

Hospitalist J. Scott Dalston, MD, of Amarillo Hospitalist Services in northwest Texas enjoyed the break from the didactic and lecture approaches taken in nearly all of the annual meeting’s other breakout sessions. Perhaps more important, he felt reminded of what made him want to be a physician in the first place.

“Before medical school, you get caught up in the higher reasons for doing medicine, the calling,” he says. “Then, when you get down and dirty on the front lines, you kind of forget about that. This, in a way, reminds you of that.”

Such was the point of the debut “potpourri” track, according to Brendon Shank, SHM’s associate vice president of communications. The track also featured such nonclinical sessions as “Using Art to Improve Your Clinical Observation Skills” and “Professionalism in the Digital Age” in an attempt to round out the meeting.

Dr. Messler says he hopes his dabble into medicine’s beginnings inspires physicians to wrap history into their present practices. He encourages teaching hospitalists to weave historical nuggets into clinical rounds. He suggests residents ask older patients what their hospital experience used to be like. And he pushes all physicians to take the time to invest in their institution’s past.

“Taking a step back, looking at the history of where we are, going through the footsteps of those people who gone before us, gives us a better appreciation for what we do day to day,” he says. “Sometimes by looking backward we know that’s the best way to look forward.”

Richard Quinn is a freelance writer based in New Jersey.

“I was just missing history right in front of my eyes, and missing the stories, as all my colleagues were,” says Dr. Messler, medical director at Morton Plant Hospital in Clearwater, Fla.

Not anymore.

Dr. Messler is a hospitalist historian. At HM12 in April in San Diego, he led a session titled “The History of Hospitals,” a workshop that took attendees on a guided tour of medicine, from the Egyptian vizier Imhotep to William Osler, often called the father of modern medicine. It took detours at Galen, Christian hospitals, Islamic practices, and medieval medicine. The story was told through paintings, drawings, and hours of Dr. Messler’s “midnight to 2 a.m.” research.

“The humanities is a lost piece at times,” he says. “It certainly can help shape what we do.

“[It] helps us give a different perspective, makes us think about things in a different way, and, hopefully, can add even to the day-to-day work that people still do on the ground. It’s not going to help you treat heart failure in the research sense, but it should help you treat it in how you face your patient and how you face your facility.” (Click here to listen to more of Dr. Messler's interview with The Hospitalist)

Hospitalist J. Scott Dalston, MD, of Amarillo Hospitalist Services in northwest Texas enjoyed the break from the didactic and lecture approaches taken in nearly all of the annual meeting’s other breakout sessions. Perhaps more important, he felt reminded of what made him want to be a physician in the first place.

“Before medical school, you get caught up in the higher reasons for doing medicine, the calling,” he says. “Then, when you get down and dirty on the front lines, you kind of forget about that. This, in a way, reminds you of that.”

Such was the point of the debut “potpourri” track, according to Brendon Shank, SHM’s associate vice president of communications. The track also featured such nonclinical sessions as “Using Art to Improve Your Clinical Observation Skills” and “Professionalism in the Digital Age” in an attempt to round out the meeting.

Dr. Messler says he hopes his dabble into medicine’s beginnings inspires physicians to wrap history into their present practices. He encourages teaching hospitalists to weave historical nuggets into clinical rounds. He suggests residents ask older patients what their hospital experience used to be like. And he pushes all physicians to take the time to invest in their institution’s past.

“Taking a step back, looking at the history of where we are, going through the footsteps of those people who gone before us, gives us a better appreciation for what we do day to day,” he says. “Sometimes by looking backward we know that’s the best way to look forward.”

Richard Quinn is a freelance writer based in New Jersey.

Early detection and advances in cancer treat­ments have resulted in improved control over progression of malignancies, turning cancer into a chronic disease for many long-term cancer survivors. Approximately 12 million people with a previous diagnosis of cancer are living in the United States, and more than two-thirds of individuals diagnosed with cancer are expected to live at least 5 years after diagnosis. The National Coalition for Cancer Survivorship notes that from “the moment of diagnosis and for the balance of life, an individual diagnosed with cancer is a survivor.” Cancer survivorship may also be described as constituting three distinct phases of treatment: the acute phase (from diag­nosis until completion of the initial treatment), the extended phase (the period of partial or com­plete remission after the initial treatment), and the permanent survival phase (a period of low likelihood of primary disease returning). Despite the advances in cancer therapies, sur­vivors face a number of challenges, including an increased risk of recurrent cancer and other med­ical treatment-related toxicities. Mariotto et al estimated that as of January 1, 2005, there were more than 300,000 survivors of childhood cancer in the United States. Of these survivors, approx­imately one-quarter have lived for more than 30 years; however, only a small fraction of survivors (3%) exceeded 60 years of age. The most com­mon cancer diagnoses among the survivors were brain cancer, acute lymphoblastic leukemia, germ cell tumors, and Hodgkin’s lymphoma. An­other report showed that 75% of childhood can­cer survivors experienced at least one adverse event.

*For a PDF of the full article and accompanying viewpoints by Tom Strouse and Howard Rosner along with Laura Audell, click in the links to the left of this introduction.

Early detection and advances in cancer treat­ments have resulted in improved control over progression of malignancies, turning cancer into a chronic disease for many long-term cancer survivors. Approximately 12 million people with a previous diagnosis of cancer are living in the United States, and more than two-thirds of individuals diagnosed with cancer are expected to live at least 5 years after diagnosis. The National Coalition for Cancer Survivorship notes that from “the moment of diagnosis and for the balance of life, an individual diagnosed with cancer is a survivor.” Cancer survivorship may also be described as constituting three distinct phases of treatment: the acute phase (from diag­nosis until completion of the initial treatment), the extended phase (the period of partial or com­plete remission after the initial treatment), and the permanent survival phase (a period of low likelihood of primary disease returning). Despite the advances in cancer therapies, sur­vivors face a number of challenges, including an increased risk of recurrent cancer and other med­ical treatment-related toxicities. Mariotto et al estimated that as of January 1, 2005, there were more than 300,000 survivors of childhood cancer in the United States. Of these survivors, approx­imately one-quarter have lived for more than 30 years; however, only a small fraction of survivors (3%) exceeded 60 years of age. The most com­mon cancer diagnoses among the survivors were brain cancer, acute lymphoblastic leukemia, germ cell tumors, and Hodgkin’s lymphoma. An­other report showed that 75% of childhood can­cer survivors experienced at least one adverse event.

*For a PDF of the full article and accompanying viewpoints by Tom Strouse and Howard Rosner along with Laura Audell, click in the links to the left of this introduction.

Early detection and advances in cancer treat­ments have resulted in improved control over progression of malignancies, turning cancer into a chronic disease for many long-term cancer survivors. Approximately 12 million people with a previous diagnosis of cancer are living in the United States, and more than two-thirds of individuals diagnosed with cancer are expected to live at least 5 years after diagnosis. The National Coalition for Cancer Survivorship notes that from “the moment of diagnosis and for the balance of life, an individual diagnosed with cancer is a survivor.” Cancer survivorship may also be described as constituting three distinct phases of treatment: the acute phase (from diag­nosis until completion of the initial treatment), the extended phase (the period of partial or com­plete remission after the initial treatment), and the permanent survival phase (a period of low likelihood of primary disease returning). Despite the advances in cancer therapies, sur­vivors face a number of challenges, including an increased risk of recurrent cancer and other med­ical treatment-related toxicities. Mariotto et al estimated that as of January 1, 2005, there were more than 300,000 survivors of childhood cancer in the United States. Of these survivors, approx­imately one-quarter have lived for more than 30 years; however, only a small fraction of survivors (3%) exceeded 60 years of age. The most com­mon cancer diagnoses among the survivors were brain cancer, acute lymphoblastic leukemia, germ cell tumors, and Hodgkin’s lymphoma. An­other report showed that 75% of childhood can­cer survivors experienced at least one adverse event.

*For a PDF of the full article and accompanying viewpoints by Tom Strouse and Howard Rosner along with Laura Audell, click in the links to the left of this introduction.

CHICAGO – The best pain scales to use when assessing a child’s level of discomfort are those that have been empirically validated for the intended age and setting, according to Mark Connelly, Ph.D., the acting director of integrative pain management at Children’s Mercy Hospitals and Clinics in Kansas City, Mo.

Validated pain scales include the FLACC (Face, Legs, Activity, Cry, and Consolability) observational scale and Pieces of Hurt Tool (sometimes called the Poker Chip Tool) for toddlers, the Faces Pain Scale-Revised for school-age children aged 4-12 years, and the visual analog scale and numeric rating scale for those 8 years and older. The Non-Communicating Children’s Pain checklist is useful for the cognitively impaired, who can be particularly difficult to evaluate because of limited or lack of verbal skills as well as atypical pain behaviors like smiling when in pain.

Patrice Wendling/IMNG Medical Media

"If you don’t assess pain in children in an age-appropriate manner you can miss an important diagnosis," he said at a symposium sponsored by the American College of Rheumatology.

Pain intensity measures should only make up a very small portion of a multidimensional pediatric pain assessment. Other elements that need to be considered include current pain data such as intensity, duration and etiology, pain history, and contributing physiological, cognitive, emotional, and spiritual factors.

Dr. Connelly and his colleagues have developed a brief multidimensional pain assessment tool for pediatric rheumatology called Super-KIDZ that assesses pain features and impact on functioning, coping, and mood. When tested among 24 children aged 4-7 years and 77 youth, aged 8-18 years, completing the measure online took about 5 minutes, just slightly longer compared with a paper version. Most children preferred the computer version, as did a test group of rheumatologists and pain experts, who said they would recommend the computer summary to their colleagues (Pediatr. Rheumatol. Online J. 2012 Apr 10;10:7. [Epub ahead of print]). SuperKIDZ is still undergoing additional validation testing as well as translation. Eventually, the Child Arthritis and Research Rheumatology Alliance site may host the tool online, making it available to providers to use, Dr. Connelly said in an interview.

Among other top 10 tips Dr. Connelly offered for why kids are not just "little adults" when it comes to pain were:

• Pain behaviors vary from child to child; some kids react to pain by sleeping or eating more, other by doing so less. Some children may curl up and become inactive or cling to their parents, while others may actually run around the room to distract themselves from pain, he said.

• Minor pains are not so minor. Clinicians need to be proactive in treating kids’ pain because even pain from minor procedures can set up a child for more pain in the future, he said. Long-term consequences of undertreated pain include hypersensitivity, hyperinnervation, wind-up of pain pathways, and avoidance of health care.

• Chronic pain can be disabling. It is the minority of children that are disabled by persistent pain, but for those who are, there can be increased direct and indirect costs totaling about $12,000 per year, resulting from social and school difficulties, increased depression and anxiety, and loss of activity and disability into adulthood. When Dr. Connelly and his colleagues asked nine school-age children with juvenile idiopathic arthritis and their parents to use electronic diaries thrice daily to assess their pain, the children reported reducing up to 82% of total activities at any given assessment (J. Pain Symptom Manage. 2010;39:579-90).

• Kids live with their parents. Parents’ responses to a child’s pain can facilitate or hinder functioning. Natural protective behaviors, catastrophizing, personal distress, and modeling of disability are just some of the factors that come into play. The key here is to make parents an essential partner in lessening pediatric pain and disability.

• Children’s pain is plastic. Regardless of disease presentation, a variety of continually changing biological, social, and psychological factors can influence how children experience and express pain. They can include repeated experiences of pain in infancy, hospital experiences, understanding of health care, school or social failures, emotional lability and social isolation. Thus, pain assessment and treatment should always be based on a biopsychosocial understanding of pain.

• Kids go to school, except when they don’t. Having children medical homebound is generally contraindicated for treatment of persistent pain in children because of a growing body of evidence showing that regular exercise and maintenance of routines is beneficial, Dr. Connelly said. Providers can help facilitate regular school attendance by writing an accommodations plan that may include a modified physical education curriculum, additional time or rest breaks in a quiet area, extra time for tests/assignments, or a modified school day.

• Interdisciplinary treatment is recommended for pediatric pain whenever possible. Such teamwork can pull together experts in medication support and interventional pain procedures as well as such nonpharmacologic methods as pain education, pain coping skills training, family counseling, physical therapy, acupuncture, and massage.

Dr. Connelly reported research grants from the National Institute of Neurological Disorders and Stroke, National Institute of Arthritis and Musculoskeletal and Skin Diseases, and the Arthritis Foundation and Mayday Foundation.

CHICAGO – The best pain scales to use when assessing a child’s level of discomfort are those that have been empirically validated for the intended age and setting, according to Mark Connelly, Ph.D., the acting director of integrative pain management at Children’s Mercy Hospitals and Clinics in Kansas City, Mo.

Validated pain scales include the FLACC (Face, Legs, Activity, Cry, and Consolability) observational scale and Pieces of Hurt Tool (sometimes called the Poker Chip Tool) for toddlers, the Faces Pain Scale-Revised for school-age children aged 4-12 years, and the visual analog scale and numeric rating scale for those 8 years and older. The Non-Communicating Children’s Pain checklist is useful for the cognitively impaired, who can be particularly difficult to evaluate because of limited or lack of verbal skills as well as atypical pain behaviors like smiling when in pain.

Patrice Wendling/IMNG Medical Media

"If you don’t assess pain in children in an age-appropriate manner you can miss an important diagnosis," he said at a symposium sponsored by the American College of Rheumatology.

Pain intensity measures should only make up a very small portion of a multidimensional pediatric pain assessment. Other elements that need to be considered include current pain data such as intensity, duration and etiology, pain history, and contributing physiological, cognitive, emotional, and spiritual factors.

Dr. Connelly and his colleagues have developed a brief multidimensional pain assessment tool for pediatric rheumatology called Super-KIDZ that assesses pain features and impact on functioning, coping, and mood. When tested among 24 children aged 4-7 years and 77 youth, aged 8-18 years, completing the measure online took about 5 minutes, just slightly longer compared with a paper version. Most children preferred the computer version, as did a test group of rheumatologists and pain experts, who said they would recommend the computer summary to their colleagues (Pediatr. Rheumatol. Online J. 2012 Apr 10;10:7. [Epub ahead of print]). SuperKIDZ is still undergoing additional validation testing as well as translation. Eventually, the Child Arthritis and Research Rheumatology Alliance site may host the tool online, making it available to providers to use, Dr. Connelly said in an interview.

Among other top 10 tips Dr. Connelly offered for why kids are not just "little adults" when it comes to pain were:

• Pain behaviors vary from child to child; some kids react to pain by sleeping or eating more, other by doing so less. Some children may curl up and become inactive or cling to their parents, while others may actually run around the room to distract themselves from pain, he said.

• Minor pains are not so minor. Clinicians need to be proactive in treating kids’ pain because even pain from minor procedures can set up a child for more pain in the future, he said. Long-term consequences of undertreated pain include hypersensitivity, hyperinnervation, wind-up of pain pathways, and avoidance of health care.

• Chronic pain can be disabling. It is the minority of children that are disabled by persistent pain, but for those who are, there can be increased direct and indirect costs totaling about $12,000 per year, resulting from social and school difficulties, increased depression and anxiety, and loss of activity and disability into adulthood. When Dr. Connelly and his colleagues asked nine school-age children with juvenile idiopathic arthritis and their parents to use electronic diaries thrice daily to assess their pain, the children reported reducing up to 82% of total activities at any given assessment (J. Pain Symptom Manage. 2010;39:579-90).

• Kids live with their parents. Parents’ responses to a child’s pain can facilitate or hinder functioning. Natural protective behaviors, catastrophizing, personal distress, and modeling of disability are just some of the factors that come into play. The key here is to make parents an essential partner in lessening pediatric pain and disability.

• Children’s pain is plastic. Regardless of disease presentation, a variety of continually changing biological, social, and psychological factors can influence how children experience and express pain. They can include repeated experiences of pain in infancy, hospital experiences, understanding of health care, school or social failures, emotional lability and social isolation. Thus, pain assessment and treatment should always be based on a biopsychosocial understanding of pain.

• Kids go to school, except when they don’t. Having children medical homebound is generally contraindicated for treatment of persistent pain in children because of a growing body of evidence showing that regular exercise and maintenance of routines is beneficial, Dr. Connelly said. Providers can help facilitate regular school attendance by writing an accommodations plan that may include a modified physical education curriculum, additional time or rest breaks in a quiet area, extra time for tests/assignments, or a modified school day.

• Interdisciplinary treatment is recommended for pediatric pain whenever possible. Such teamwork can pull together experts in medication support and interventional pain procedures as well as such nonpharmacologic methods as pain education, pain coping skills training, family counseling, physical therapy, acupuncture, and massage.

Dr. Connelly reported research grants from the National Institute of Neurological Disorders and Stroke, National Institute of Arthritis and Musculoskeletal and Skin Diseases, and the Arthritis Foundation and Mayday Foundation.

CHICAGO – The best pain scales to use when assessing a child’s level of discomfort are those that have been empirically validated for the intended age and setting, according to Mark Connelly, Ph.D., the acting director of integrative pain management at Children’s Mercy Hospitals and Clinics in Kansas City, Mo.

Validated pain scales include the FLACC (Face, Legs, Activity, Cry, and Consolability) observational scale and Pieces of Hurt Tool (sometimes called the Poker Chip Tool) for toddlers, the Faces Pain Scale-Revised for school-age children aged 4-12 years, and the visual analog scale and numeric rating scale for those 8 years and older. The Non-Communicating Children’s Pain checklist is useful for the cognitively impaired, who can be particularly difficult to evaluate because of limited or lack of verbal skills as well as atypical pain behaviors like smiling when in pain.

Patrice Wendling/IMNG Medical Media

"If you don’t assess pain in children in an age-appropriate manner you can miss an important diagnosis," he said at a symposium sponsored by the American College of Rheumatology.

Pain intensity measures should only make up a very small portion of a multidimensional pediatric pain assessment. Other elements that need to be considered include current pain data such as intensity, duration and etiology, pain history, and contributing physiological, cognitive, emotional, and spiritual factors.

Dr. Connelly and his colleagues have developed a brief multidimensional pain assessment tool for pediatric rheumatology called Super-KIDZ that assesses pain features and impact on functioning, coping, and mood. When tested among 24 children aged 4-7 years and 77 youth, aged 8-18 years, completing the measure online took about 5 minutes, just slightly longer compared with a paper version. Most children preferred the computer version, as did a test group of rheumatologists and pain experts, who said they would recommend the computer summary to their colleagues (Pediatr. Rheumatol. Online J. 2012 Apr 10;10:7. [Epub ahead of print]). SuperKIDZ is still undergoing additional validation testing as well as translation. Eventually, the Child Arthritis and Research Rheumatology Alliance site may host the tool online, making it available to providers to use, Dr. Connelly said in an interview.

Among other top 10 tips Dr. Connelly offered for why kids are not just "little adults" when it comes to pain were:

• Pain behaviors vary from child to child; some kids react to pain by sleeping or eating more, other by doing so less. Some children may curl up and become inactive or cling to their parents, while others may actually run around the room to distract themselves from pain, he said.

• Minor pains are not so minor. Clinicians need to be proactive in treating kids’ pain because even pain from minor procedures can set up a child for more pain in the future, he said. Long-term consequences of undertreated pain include hypersensitivity, hyperinnervation, wind-up of pain pathways, and avoidance of health care.

• Chronic pain can be disabling. It is the minority of children that are disabled by persistent pain, but for those who are, there can be increased direct and indirect costs totaling about $12,000 per year, resulting from social and school difficulties, increased depression and anxiety, and loss of activity and disability into adulthood. When Dr. Connelly and his colleagues asked nine school-age children with juvenile idiopathic arthritis and their parents to use electronic diaries thrice daily to assess their pain, the children reported reducing up to 82% of total activities at any given assessment (J. Pain Symptom Manage. 2010;39:579-90).

• Kids live with their parents. Parents’ responses to a child’s pain can facilitate or hinder functioning. Natural protective behaviors, catastrophizing, personal distress, and modeling of disability are just some of the factors that come into play. The key here is to make parents an essential partner in lessening pediatric pain and disability.

• Children’s pain is plastic. Regardless of disease presentation, a variety of continually changing biological, social, and psychological factors can influence how children experience and express pain. They can include repeated experiences of pain in infancy, hospital experiences, understanding of health care, school or social failures, emotional lability and social isolation. Thus, pain assessment and treatment should always be based on a biopsychosocial understanding of pain.

• Kids go to school, except when they don’t. Having children medical homebound is generally contraindicated for treatment of persistent pain in children because of a growing body of evidence showing that regular exercise and maintenance of routines is beneficial, Dr. Connelly said. Providers can help facilitate regular school attendance by writing an accommodations plan that may include a modified physical education curriculum, additional time or rest breaks in a quiet area, extra time for tests/assignments, or a modified school day.

• Interdisciplinary treatment is recommended for pediatric pain whenever possible. Such teamwork can pull together experts in medication support and interventional pain procedures as well as such nonpharmacologic methods as pain education, pain coping skills training, family counseling, physical therapy, acupuncture, and massage.

Dr. Connelly reported research grants from the National Institute of Neurological Disorders and Stroke, National Institute of Arthritis and Musculoskeletal and Skin Diseases, and the Arthritis Foundation and Mayday Foundation.

On May 16, the American Academy of Dermatology will release appropriate use criteria for Mohs surgery. The document will be the first of its kind and "a home run for Mohs surgery," said Dr. Brett M. Coldiron, president of the American College of Mohs Surgery.

During the College's annual meeting in Chicago, Dr. Coldiron said that Mohs surgery is not being overutilized, contrary to what some may believe. The increase in utilization is, instead, the result of the nation's skin cancer epidemic, and the fact that Mohs surgery is effective both clinically and financially.

The College has retained a lobby firm in Washington, D.C. to raise Mohs surgery awareness, and is working with insurers on coverage.

In a video interview with Skin and Allergy News, Dr. Coldiron further explained  the ACMS's position.

On May 16, the American Academy of Dermatology will release appropriate use criteria for Mohs surgery. The document will be the first of its kind and "a home run for Mohs surgery," said Dr. Brett M. Coldiron, president of the American College of Mohs Surgery.

During the College's annual meeting in Chicago, Dr. Coldiron said that Mohs surgery is not being overutilized, contrary to what some may believe. The increase in utilization is, instead, the result of the nation's skin cancer epidemic, and the fact that Mohs surgery is effective both clinically and financially.

The College has retained a lobby firm in Washington, D.C. to raise Mohs surgery awareness, and is working with insurers on coverage.

In a video interview with Skin and Allergy News, Dr. Coldiron further explained  the ACMS's position.

On May 16, the American Academy of Dermatology will release appropriate use criteria for Mohs surgery. The document will be the first of its kind and "a home run for Mohs surgery," said Dr. Brett M. Coldiron, president of the American College of Mohs Surgery.

During the College's annual meeting in Chicago, Dr. Coldiron said that Mohs surgery is not being overutilized, contrary to what some may believe. The increase in utilization is, instead, the result of the nation's skin cancer epidemic, and the fact that Mohs surgery is effective both clinically and financially.

The College has retained a lobby firm in Washington, D.C. to raise Mohs surgery awareness, and is working with insurers on coverage.

In a video interview with Skin and Allergy News, Dr. Coldiron further explained  the ACMS's position.

Click here to listen to Dr. Frost

Click here to listen to Dr. Frost

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Click here to listen to Dr. Conway

Click here to listen to Dr. Conway

Click here to listen to Dr. Conway

Part-time physicians report higher work satisfaction, less burnout, and greater work control.¹ They also cite more time for family, community, and self-care activities, as well as more research time and ability to focus on career goals.²

Those are attractive benefits, to be sure. But is part time right for you?

“They need to look at all the factors of their whole life,” says Jennifer Owens, director of the Working Mother Research Institute in New York City. “Are they trying to compete to get ahead and do they feel they can’t give up hours at work? Are they taking an assignment that’s so big, they just need to be at work to try to get it going? Are there factors in their life, like their kids are sick or their spouse has an illness? It all comes down to a personal, individual assessment. There are tradeoffs.”

A major tradeoff is income. Part-time physicians earn less money and have fewer benefits, which might not be financially feasible, says Iris Grimm, creator of the Atlanta-based Balanced Physician coaching program.

Some part-time female physicians surveyed in a recent study published in Academic Medicine cited slower promotion trajectory or even demotion, getting overlooked for career opportunities, given less desirable work, or being marginalized within their division.²

Physicians who decide to work part time should set goals for themselves based on their personal definition of work-life balance, says Maria Bailey, founder and CEO of BlueSuitMom.com, a Pompano Beach, Fla.-based company that provides information on work and family balance for professional working mothers and their employers. If they haven’t reached those goals within two to three months, they should re-evaluate their part-time status.

“Some of us just have the personality where we’re going to create work for ourselves. It’s really hard to break the habits that we’ve developed over many, many years,” Bailey says. “Working part-time may be a reality check that what we thought we wanted isn’t what we wanted at all.”

Lisa Ryan is a freelance writer in New Jersey.

References

1. Mechaber FH, Levine RB, Manwell LB, et al. Part-time physicians … prevalent, connected, and satisfied. J Gen Intern Med. 2008;23(3):300-303.

2. Harrison RA, Gregg JL. A time for change: an exploration of attitudes toward part-time work in academia among women internists and their division chiefs. Acad Med. 2009;84(1):80-86.

Part-time physicians report higher work satisfaction, less burnout, and greater work control.¹ They also cite more time for family, community, and self-care activities, as well as more research time and ability to focus on career goals.²

Those are attractive benefits, to be sure. But is part time right for you?

“They need to look at all the factors of their whole life,” says Jennifer Owens, director of the Working Mother Research Institute in New York City. “Are they trying to compete to get ahead and do they feel they can’t give up hours at work? Are they taking an assignment that’s so big, they just need to be at work to try to get it going? Are there factors in their life, like their kids are sick or their spouse has an illness? It all comes down to a personal, individual assessment. There are tradeoffs.”

A major tradeoff is income. Part-time physicians earn less money and have fewer benefits, which might not be financially feasible, says Iris Grimm, creator of the Atlanta-based Balanced Physician coaching program.

Some part-time female physicians surveyed in a recent study published in Academic Medicine cited slower promotion trajectory or even demotion, getting overlooked for career opportunities, given less desirable work, or being marginalized within their division.²

Physicians who decide to work part time should set goals for themselves based on their personal definition of work-life balance, says Maria Bailey, founder and CEO of BlueSuitMom.com, a Pompano Beach, Fla.-based company that provides information on work and family balance for professional working mothers and their employers. If they haven’t reached those goals within two to three months, they should re-evaluate their part-time status.

“Some of us just have the personality where we’re going to create work for ourselves. It’s really hard to break the habits that we’ve developed over many, many years,” Bailey says. “Working part-time may be a reality check that what we thought we wanted isn’t what we wanted at all.”

Lisa Ryan is a freelance writer in New Jersey.

References

1. Mechaber FH, Levine RB, Manwell LB, et al. Part-time physicians … prevalent, connected, and satisfied. J Gen Intern Med. 2008;23(3):300-303.

2. Harrison RA, Gregg JL. A time for change: an exploration of attitudes toward part-time work in academia among women internists and their division chiefs. Acad Med. 2009;84(1):80-86.

Part-time physicians report higher work satisfaction, less burnout, and greater work control.¹ They also cite more time for family, community, and self-care activities, as well as more research time and ability to focus on career goals.²

Those are attractive benefits, to be sure. But is part time right for you?

“They need to look at all the factors of their whole life,” says Jennifer Owens, director of the Working Mother Research Institute in New York City. “Are they trying to compete to get ahead and do they feel they can’t give up hours at work? Are they taking an assignment that’s so big, they just need to be at work to try to get it going? Are there factors in their life, like their kids are sick or their spouse has an illness? It all comes down to a personal, individual assessment. There are tradeoffs.”

A major tradeoff is income. Part-time physicians earn less money and have fewer benefits, which might not be financially feasible, says Iris Grimm, creator of the Atlanta-based Balanced Physician coaching program.

Some part-time female physicians surveyed in a recent study published in Academic Medicine cited slower promotion trajectory or even demotion, getting overlooked for career opportunities, given less desirable work, or being marginalized within their division.²

Physicians who decide to work part time should set goals for themselves based on their personal definition of work-life balance, says Maria Bailey, founder and CEO of BlueSuitMom.com, a Pompano Beach, Fla.-based company that provides information on work and family balance for professional working mothers and their employers. If they haven’t reached those goals within two to three months, they should re-evaluate their part-time status.

“Some of us just have the personality where we’re going to create work for ourselves. It’s really hard to break the habits that we’ve developed over many, many years,” Bailey says. “Working part-time may be a reality check that what we thought we wanted isn’t what we wanted at all.”

Lisa Ryan is a freelance writer in New Jersey.

References

1. Mechaber FH, Levine RB, Manwell LB, et al. Part-time physicians … prevalent, connected, and satisfied. J Gen Intern Med. 2008;23(3):300-303.

2. Harrison RA, Gregg JL. A time for change: an exploration of attitudes toward part-time work in academia among women internists and their division chiefs. Acad Med. 2009;84(1):80-86.