How long can U.S. doctors listen to you before they interrupt you ?

Your doctor only listens to you for 11 seconds, study says

Doctors spend an average of 11 seconds listening to you before they interrupt you, according to a new study, MOTHER NATURE NETWORK reports. Researchers examined the first few minutes of 112 consultations between patients and their doctors. The visits were videotaped and occurred in clinics throughout the United States during training sessions for doctors.
Featured image montereybayholistic.

Abstract

Background
Eliciting patient concerns and listening carefully to them contributes to patient-centered care. Yet, clinicians often fail to elicit the patient’s agenda and, when they do, they interrupt the patient’s discourse.

Objective
We aimed to describe the extent to which patients’ concerns are elicited across different clinical settings and how shared decision-making tools impact agenda elicitation.

Design and Participants
We performed a secondary analysis of a random sample of 112 clinical encounters recorded during trials testing the efficacy of shared decision-making tools.

Main Measures
Two reviewers, working independently, characterized the elicitation of the patient agenda and the time to interruption or to complete statement; we analyzed the distribution of agenda elicitation according to setting and use of shared decision-making tools.

Key Results
Clinicians elicited the patient’s agenda in 40 of 112 (36%) encounters. Agendas were elicited more often in primary care (30/61 encounters, 49%) than in specialty care (10/51 encounters, 20%); p = .058. Shared decision-making tools did not affect the likelihood of eliciting the patient’s agenda (34 vs. 37% in encounters with and without these tools; p = .09). In 27 of the 40 (67%) encounters in which clinicians elicited patient concerns, the clinician interrupted the patient after a median of 11 seconds (interquartile range 7–22; range 3 to 234 s). Uninterrupted patients took a median of 6 s (interquartile range 3–19; range 2 to 108 s) to state their concern.

Conclusions
Clinicians seldom elicit the patient’s agenda; when they do, they interrupt patients sooner than previously reported. Physicians in specialty care elicited the patient’s agenda less often compared to physicians in primary care. Failure to elicit the patient’s agenda reduces the chance that clinicians will orient the priorities of a clinical encounter toward specific aspects that matter to each patient.

Ce que les soignants doivent savoir du marketing pharmaceutique dans l’Union Européenne

Information ou influence ? Traduit en français par la Troupe du RIRE

Les professionnels de santé sont fortement exposés aux activités marketing de l’industrie pharmaceutique. Plusieurs études montrent que l’exposition à l’information provenant des laboratoires pharmaceutiques ne conduit pas à une amélioration de la prescription. Au contraire, cela peut nuire à l’objectivité de la prescription et au professionnalisme des prescripteurs.

Fait ou fiction? Ce que les professionnels de la santé doivent savoir sur le marketing pharmaceutique dans l’Union européenne

Avec un accent particulier sur la promotion pharmaceutique dans l’Union européenne, ce nouveau guide de Health Action International enseigne aux étudiants à identifier et évaluer les méthodes utilisées dans les activités de promotion pharmaceutique, ainsi que leur impact sur la pratique clinique et la santé publique. Ils développent également la capacité d’évaluer de manière critique les activités de promotion pharmaceutique d’une manière qui préserve l’accès aux médicaments.

Comprendre et répondre à la promotion pharmaceutique: un guide pratique

Publié en collaboration avec l’Organisation mondiale de la santé en 2010, ce livre enseigne aux étudiants les techniques de marketing utilisées par l’industrie pharmaceutique. Il leur donne également les compétences nécessaires pour analyser de manière critique le marketing pharmaceutique et accéder à une information de meilleure qualité, impartiale et indépendante sur les médicaments.

Le guide est largement utilisé dans le monde entier par les facultés de médecine, de dentisterie, de pharmacie, de sciences pharmaceutiques et de santé publique en tant que complément du Guide de l’OMS pour une bonne prescription.

What Healthcare Professionals Need to Know about Pharmaceutical Marketing in the European Union

Fact or Fiction ?

85.2% of medical students recently surveyed in France (n=2,101) reported feeling inadequately educated about conlicts of interest arising from interactions with the pharmaceutical industry

Healthcare professionals are highly exposed to pharmaceutical marketing activities. Evidence shows that exposure to information from pharmaceutical companies does not lead to net improvements in prescribing, but can negatively affect prescribing and professional behaviour.

This guide and its workshop series build on the publication, Understanding and Responding to Pharmaceutical Promotion: A Practical Guide, produced by Health Action International, in collaboration with the World Health Organization, in 2009, as a companion to the WHO’s Guide to Good Prescribing.

Understanding and Responding to Pharmaceutical Promotion

A Practical Guide, 2010

Patients place great trust in doctors and pharmacists to properly prescribe and dispense medicines. But health professionals receive little to no instruction on how to critically assess pharmaceutical marketing. Many of them underestimate the influence that industry marketing has on their prescribing and dispensing practices.

Published in collaboration with the World Health Organization in 2010, this book teaches students about the marketing techniques used by the pharmaceutical industry. It also equips them with skills to critically analyse pharmaceutical marketing and access better-quality, unbiased and independent information on medicines.

Understanding and Responding to Pharmaceutical Promotion: A Practical Guide is used widely around the world by faculties of medicine, dentistry, pharmacy, pharmaceutical sciences and public health as a companion to the WHO’s Guide to Good Prescribing.

Guide to Good Prescribing – A Practical Manual

A World Health Organization resource, 1994

Abstract

Pharmacology training for most medical students concentrates more on theory than on practice. The material is often drug centred and focuses on indications and side effects of different drugs. But in clinical practice the reverse approach has to be taken, from the diagnosis to the drug. Moreover patients vary in age, gender, size and sociocultural characteristics, all of which may affect treatment choices. Patients also have their own perception of appropriate treatment and should be fully informed partners in therapy. All this is not always taught in medical schools, where the number of hours spent on therapeutics may be low compared to traditional pharmacology teaching. As a result although pharmacological knowledge is acquired, practical skills remain weak.

This training manual meets that need. It provides step by step guidance to rational prescribing and teaches skills that are not time limited but which remain valid throughout a clinical career. It demonstrates that prescribing a drug is part of a process that includes many other components. The manual explains the principles of drug selection and how to develop and become familiar with a set of drugs for regular use in practice, called P(personal)-drugs. Practical examples illustrate how to select, prescribe and monitor treatment, and how to communicate effectively with patients. The advantages and disadvantages of different sources of drug information are also described. The manual can be used for self-study or as part of a formal training programme.

Although intended primarily for undergraduate medical students who are about to enter the clinical phase of their studies, postgraduate students and practising doctors may also find it a source of new ideas and perhaps an incentive for change.

Industry Payments to Physician Specialists Who Prescribe Repository Corticotropin

Medicare spent $2 billion for one drug as the manufacturer paid doctors millions

2018 Study Key Points

Question
What is the association of industry payments to physicians and prescriptions for repository corticotropin (H. P. Acthar Gel; Mallinckrodt Pharmaceuticals)?

Findings
In this cross-sectional study of 235 specialist physicians who frequently prescribe corticotropin to Medicare beneficiaries, 207 (88%) received a monetary payment from the drug’s maker, with more than 20% of frequent prescribers receiving more than $10 000. There was a significant association between higher dollar amounts paid to these prescribers and greater Medicare spending on their corticotropin prescriptions.

Meaning
Financial conflicts of interest among physicians may be driving corticotropin expenditures for the Medicare program.

Abstract

Importance
Despite great expense and little evidence supporting use over corticosteroids, prescriptions for repository corticotropin (H. P. Acthar Gel; Mallinckrodt Pharmaceuticals) have increased markedly. Aggressive sales tactics and payments from the manufacturer may influence prescribing behavior for this expensive medication.

Objective
To characterize industry payments to physician specialists who prescribe corticotropin in the Medicare program.

Design, Setting, and Participants
This study was a cross-sectional analysis of Centers for Medicare & Medicaid Services 2015 Part D prescribing data linked to 2015 Open Payments data. Nephrologists, neurologists, and rheumatologists with more than 10 corticotropin prescriptions (frequent prescribers) in 2015 were included.

Exposures
Frequency, category, and magnitude of corticotropin-related payments from Mallinckrodt recorded in the Open Payments database.

Main Outcomes and Measures
Frequency, category, and magnitude of corticotropin-related payments from Mallinckrodt, as well as corticotropin prescriptions and expenditures for Medicare beneficiaries.

Results
Of the 235 included physicians, 65 were nephrologists; 59, neurologists; and 111, rheumatologists. A majority of frequent corticotropin prescribers (207 [88%]) received corticotropin-related payments from Mallinckrodt. The median (range) total payment for 2015 was $189 ($11-$138 321), with the highest payments ranging from $56 549 to $138 321 across the specialties. More than 20% of frequent prescribers received more than $10 000 and the top quartile of recipients received a median (range) of $33 190 ($9934-$138 321) in total payments per prescriber. Payments for compensation for services other than consulting contributed the most to the total amount. Mallinckrodt payments were positively associated with greater Medicare spending on corticotropin (β = 1.079; 95% CI, 1.044-1.115; P < .001), with every $10 000 in payments associated with a 7.9% increase (approximately $53 000) in Medicare spending on corticotropin. There was no association between corticotropin-related payments and spending on prescriptions for synthetic corticosteroids.

Conclusions and Relevance
In this study, most nephrologists, neurologists, and rheumatologists who frequently prescribe corticotropin received corticotropin-related payments from Mallinckrodt. These findings suggest that financial conflicts of interest may be driving use of corticotropin in the Medicare program.

Medicare spent $2 billion for one drug as the manufacturer paid doctors millions

CNN reports on Acthar : doctor payments, paid prescribers, drug sales and pricing

“More than 80% of doctors who filed Medicare claims in 2016 for H.P. Acthar Gel — a drug best known for treating a rare infant seizure disorder — received money or other perks from the drugmakers, according to a CNN analysis of publicly identified prescribers.

The analysis, which looked at doctors who filed more than 10 Part D claims, found that the drugmakers — Mallinckrodt and Questcor — paid 288 prescribers more than $6.5 million for consulting, promotional speaking and other Acthar-related services between 2013 and 2016. Mallinckrodt purchased Questcor in 2014.

At about the same time, Medicare spending on Acthar rose dramatically — more than tenfold over six years.”

continue reading about Acthar and doctor payments, paid prescribers, drug sales and pricing on CNN.

Should Doctors Consider Body Size When Prescribing Drugs ?

Does a one-size-fits-all strategy works fine for many medications ?

“Children are the special case in which weight-based dosing is always required.

For adults, shouldn’t doctors take into account body size when prescribing drugs?

As a small female, I worry about getting the same dosage of antibiotics as men who weigh 100 pounds more than I do.”

Read the debate on ASK WELL, nytimes, 2018/06/08.

When clinical guidelines do harm

From Guideline to Order Set to Patient Harm

Abstract

Clinical guidelines and standardized order sets are as integral to the practice of medicine in the digital age as the stethoscope and the chest x-ray. Rigorously developed guidelines and order sets aim to bring the most current, evidence-based medicine to the bedside and decrease unwanted variability in health care delivery. The JAMA Performance Improvement article in this issue of JAMA by Gupta and colleagues, however, illustrates the potential risks inherent in the incorporation of these tools into practice.1 In this case, a 58-year-old man with acute ST-segment elevation myocardial infarction (STEMI) was successfully treated with percutaneous coronary intervention (PCI) involving the right coronary artery but had bradycardia and complete heart block following the procedure. The patient was admitted to the coronary care unit, and the admitting physician placed orders via the electronic medical record using the “STEMI admission order set.” Within an hour of admission, the patient received medications, including atorvastatin and carvedilol, based on the order set. Over the next few hours, he developed dyspnea, bradycardia, and hypotension. This case demonstrates how a flawed guideline, incorporated into an inadequately updated order set, can undermine a physician’s intention and lead to patient harm.

Reference.

Alex CanRant Unbelievable Story of DES

“I want to show you some of the stuff I’ve learned about what’s happening right now” says Alex

In this video published 15 Sep 2017, Alex unfortunately is mixing the use of DES for poultry, cattle, women, together with its side effects for up to three generations of people.
So, his dates are confusing and Alex’s very short summary of DES is quite one of his own.

Nevertheless Alex raises some very important questions here, and tells us not to take every medical/healthcare information for granted but to keep an open mind. So, we thank Alex for his time and effort in sharing awareness.

Check the links below to learn more.

More DES DiEthylStilbestrol Resources