Bariatric Times

AUG 2016

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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23 Journal Watch Bariatric Times • August 2016 t hree-year pre-medical program titled, "Becoming a Physician." The program focuses on different aspects of medical professionalism, helping students to increase awareness and sensitivity to d isadvantaged populations, and practice sensitive effective communication skills. The curriculum includes: 1) Visits to treatment centres for people with s pecial needs, mental illnesses, substance abuse issues, physically or sexually abused, and prisoners. Students tour the facility, hold discussions with residents, and discuss e thical professional interrelations to the medical world. Students then write 'reflective diaries' summarizing their thoughts and emotions. 2) Participation in a communication c ourse that focuses on learning by practising patient-oriented communication. Qualitative data were collected from three sources: reflective diaries, students' course evaluations, a nd interviews with the students' tutors. Data indicated that the students were very satisfied with the programme. They indicated an increase in awareness of the special needs of diverse populations, and in the sense of efficacy for conducting interviews tailored to patients' needs. Tutors reported a sense of 'personal growth' following their role as mentors. The authors concluded that interactions of medical students with diverse populations, when accompanied by appropriate feedback mechanisms and strengthening of communication skills, can improve awareness and sensitivity to patients' special needs. This could help students become more sensitive and thoughtful physicians. PMID: 26481394 When patients and surgeons disagree about surgical outcome: investigating patient factors and chart note communication. Schwartz CE, Ayandeh A, Finkelstein JA. Health Qual Life Outcomes. 2015 Sep 29;13:161. Synopsis: The authors aimed to investigate indirect effects of physician-patient communication by examining the relationship between a physician-patient mismatch in perceived outcomes and content in the medical record's clinical note. They compared patient records whose perceived subjective assessment of surgery outcomes agreed or disagreed with the surgeon's perception of that outcome (Subjective Disagreement). This study included 172 spine surgery patients at a teaching hospital. Patient-reported outcomes included the Oswestry Disability Index; the Short-Form 36; and a Visual Analogue Scale items for leg and back pain. The authors content-analyzed the clinical note in the medical record, and used logistic regression to evaluate predictors of Subjective Disagreement ( n = 41 disagreed vs. 131 agreed). Patient and surgeon agreed in 76% of cases and disagreed in 24% of cases. Patients who assessed their outcome worse than their surgeons tended to be l ess educated and involved in litigation. They also tended to report worsened mental health and leg pain. Content analysis revealed group differences in surgeon communication patterns in the c hart notes related to how symptom change was emphasized, how follow-up was described, and a specific word reference. Specifically, disagreement was predicted by using "much" to e mphasize the findings and noting long-term prognosis. Agreement was predicted by use of positive emphasis terms, having an "as-needed" follow-up plan, and using "happy" in the chart n ote. The nature of measuring outcomes of surgery is based on patient perception. In surgeon-patient perspective mismatches, patient f actors may serve as barriers to improvement. Worsened change on patient-reported mental health may be an independent factor which colors the patient's general perceptions. This a spect of treatment may be missed by the spine surgeon. Chart note communication styles reflect the subjective disagreement. Investigating and/ or treating mental health d eterioration may be valuable in resolving this mismatch and for overall outcome. PMID: 26416031

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