Journal of general internal medicine
-
Though Asian Americans made gains in coverage following the Affordable Care Act (ACA), substantial variations in access to care remain across different ethnic subgroups. Several states are considering adoption of policies to collect health data for Asian Americans that is disaggregated by ethnic subgroup, which may identify disparities in access to care. ⋯ Disaggregated analyses identified differences in access to care for Asian American subgroups following the ACA. State policies to collect disaggregated health data for Asian Americans may reveal heterogeneity in experiences of care and inform specific policies to reduce disparities in access to care.
-
Physician-to-physician variation in electronic health record (EHR) documentation not driven by patients' clinical status could be harmful. ⋯ Physician-to-physician variation in EHR documentation impedes effective and safe use of EHRs, but there are potential strategies to mitigate negative consequences.
-
Observational Study
Statin Dosing Instructions, Medication Adherence, and Low-Density Lipoprotein Cholesterol: a Cohort Study of Incident Statin Users.
Robust evidence is lacking on optimal timing of statin administration and its impact on patient outcomes. ⋯ Among incident statin users from a real-world clinical setting, those with daily and evening dosing instructions had similar adherence rates and mean changes in LDL-c. Given potential clinical equipoise for evening and daily dosing, clinicians should consider patient-tailored statin dosing instructions to reduce potentially unnecessary regimen complexity.
-
Many approaches to burnout and compassion fatigue in medicine do not focus on the reason most physicians went into practice, namely love. And we do not explicitly think of our daily work in these terms. If we believe our job is to help others in a very task-oriented sense and we are not able to succeed or a patient has a poor outcome, we can miss the fact that often our simply being present is what is needed. Refocusing on our love of others in our work whether they are patients, colleagues, or administrators can reinvigorate our experience and make us happier people in the process.
-
During the initial consultation with a patient to communicate a diagnosis of late-stage cancer, the oncologist may refrain from giving survival statistics, redirecting the conversation from the bad news (incurability) to the practical aspects of the patient's care (treatments, timetables, appointments, and testing to monitor response to treatment). Whether conscious or unconscious, this diversion helps cushion the impact of the disturbing news. ⋯ To remedy this problem, I describe an approach to straight talk about late-stage cancer that can give a patient realistic hopes instead of false hopes that are apt to betray later on. I also propose an enhanced method of displaying and interpreting comparative efficacy data that can facilitate understanding and serve as a basis for shared decision making.