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Editor's Picks
Anne Meneghetti, MD
Director, Clinical Communications
Doctors shouldn't fear online review by patients
Short Cuts
All you need to read in the other general journals
N Engl J Med 2010;362:6-7
Doctors are nervous about being judged by their patients in public. Being rated online invokes the same kind of stomach churning anxiety as fighting your way through a desperate crowd of peers to search for your name on a "pass" list for final exams posted on a notice board, writes one doctor from the US.
Opportunities to rate doctors online are multiplying, however, and their popularity means that they are unlikely to go away. Type your name into Google and you could find scores rating personal attributes such as helpfulness, as well as scores for how much you know (or seem to know). The writer scored a disappointing 2.5 out of 5 on one site but ploughed on undeterred to look at the bigger picture. Alongside the stark numbers and not so smiley faces she found a rich narrative, "a sea of patient voices telling me how it really is." Online, people are free to express themselves in a way they simply can't do when they are sick or scared and faced with a professional who holds the lion's share of the power. Doctors could and should learn from these stories, she writes. Taken together, they are a powerful collective view of what patients want, which is much like what good doctors are trying to provide.
® 2010 BMJ Publishing Group Ltd. 
Unexplained Medical Complaints Often Remain Unexplained a Year Later
Clinical question
What is the prognosis for patients with a new, unexplained complaint to their family physician?
Bottom line
Unexplained complaints are common in primary care, and often remain unexplained. [Level of Evidence = 2b]
Reference
Koch H, van Bokhoven MA, Bindels PJ, van der Weijden T, Dinant GJ, ter Riet G. The course of newly presented unexplained complaints in general practice patients: a prospective cohort study. Fam Pract 2009;26(6):455-465
Study design: Cohort (prospective)
Setting: Outpatient (primary care)
Synopsis
Every primary care physician knows that much of their work consists of identifying the rare serious illness among the many patients with undifferentiated, common symptoms like abdominal pain, chest pain, or cough. This Dutch study enrolled adults with a new complaint that was undiagnosed by their general practitioner (GP) at the end of the initial consultation. Only patients with fatigue, musculoskeletal complaints, and abdominal complaints were included. Detailed information about their symptoms and health beliefs were collected at baseline, and again at 4 to 6 weeks, 6 months, and 12 months, when patients were instructed to return if the complaint had not resolved. The researchers enrolled a total of 444 patients of 63 GPs, of whom 73% were women with a median age of 42 years. The most common complaints were fatigue (69%), musculoskeletal (17%), and abdominal (14%). Of the 444 initial unexplained complaints, 40% were eventually diagnosed. Common diagnoses included stress, depression, infection, chronic fatigue/fibromyalgia, and irritable bowel syndrome (IBS). One could argue, of course, that calling unexplained somatic complaints chronic fatigue or fibromyalgia, and calling unexplained bowel complaints IBS, is not much of an explanation. Of the 254 patients whose complaints remained unexplained (57%), 40% had no complaints 1 year later (ie, were asymptomatic with regard to the original problem) and 43% continued to have the same complaint; the remainder were lost to follow-up or had unknown status. Independent predictors of a persistent unexplained complaint included duration of the complaint for more than 4 weeks before presentation and musculoskeletal complaint at baseline; male patients and patients the GP felt were unlikely to have a serious disease were less likely to have a persistently unexplained complaint.
Copyright ® 2010 John Wiley & Sons, Inc. www.essentialevidence.com
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Epocrates Supports Haiti Relief Efforts
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| Q: Dr. K., an obstetrician, wrote, "Epocrates says that Aldomet is discontinued, but I use it all the time."
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A: Prescribers are often unaware when brand name products have actually been off the market, sometimes for many years, because people continue to refer to the drug by the brand name. Also, pharmacists will generally just switch discontinued brand name orders to the available generics without providing feedback to prescribers that the brand name product is not available.
Epocrates Rx differs from many other drug compendia in that it is product-specific. Rather than providing a single generic monograph with a listing of several brand name synonyms, we build a distinct monograph for each brand name product and the generic (if available), based on product-specific information, such as available formulations, dosing, indications, manufacturer, and pricing, which often differ between specific products containing the same active ingredient.
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Learn more about this and other unique features of Epocrates.
This month's answer provided by: Joshua L. Conrad, Pharm.D. – Epocrates' Managing Editor, Medical Information |
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Editorial Correction
In the January 2010 issue of the Pulse, we mistakenly left out the attribution for the article "Poisons in the Kitchen Cabinet." We apologize for this oversight. The article came from The Poison Post, National Capital Poison Center eNewsletter, Copyright 2010, National Capital Poison Center. All Rights Reserved. The article was reprinted with permission. Subscribe to the free eNewsletter, The Poison Post®. |
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