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Are We Missing the Most Important Aspect of Health Care?
Physician Danielle Ofri argues that honest conversation is the most powerful mechanism for healing.
Danielle Ofri was confused the first time she heard the term ‘expired.’ The first-year medical student envisioned her family’s shabby air mattress used for camping trips in the Catskill Mountains. The revelation took a moment.
Now a veteran physician at New York’s Bellevue hospital, Ofri laughs at her earlier ignorance. Language, and more importantly communication, is at the center of her new book, What Patients Say, What Doctors Hear (Beacon Press). How doctors and patients interact plays a greater role in medicine than we might believe.
As the medical industry strives for a virtual world in which diagnoses are made and prescriptions rendered on a smartphone app, Ofri argues that successful conversation is the primary driver of healing. Sadly dialectics remain a longstanding elephant in the office: doctors enter with opinions, patients their own, the ticking clock on the wall in plain view of both parties.
This creates resentment in the patient, who, as it turns out, is interrupted by the doctor within twelve seconds on an average visit. Likewise the physician quickly grows impatient due to noncompliance: 50-75 percent of subjects do not adhere to physician advice. A vicious cycle commences in which neither side feels heard. Healing becomes difficult when anxiety rests at the foundation of this relationship.
This particular exchange is often fraught with problems from the beginning. A perpetual fear of litigation on one side and long wait times and snap judgments on the other create an insurmountable gulf. Marriage counselors recognize that by the time a couple seeks guidance it’s often too late. No comparable therapy exists for a patient that wants to break up with their doctor (or vice-versa).
Yet this mysterious distance is avoidable. Ofri writes that talking through emotional challenges alleviates tension for both parties. When physicians avoid the psychological and emotional aspects of illness the risk of nonadherence to medications triples. Factor in particularly stressful situations—unemployment, housing issues, romantic quandaries—and that risk is six-fold higher.
An inability to quantify conversation seems embedded in a system in which blood pressure and cholesterol levels are promptly displayed. But it’s not. One Canadian study showed that electrical stimulation for back problems resulted in a 45 percent reduction in pain. The other group received a sham treatment but talked extensively with their therapist. The result was 55 percent pain reduction.
It comes down to time. Doctors get caught on clinical hamster wheels; patients demand prompt answers to complex problems. Ofri believes this is mitigated when both parties take a deep breath. As she writes, “effective communication needn’t take an unconscionably long time; it just needs full and intense focus.”
Ofri’s narrative is not factual alone. Her personal experiences of bias, uncertainty, fear, and confusion are woven into the fabric of this challenging tale. She openly discusses her unconscious intolerance of obesity, avoidance of junkies, ethnic favoritism, the sheer emotional and cognitive magnitude of dealing with death and suffering on a daily basis. In the process she humanizes her profession, an essential step in reversing favoritism and bigotry in hospitals and clinics.
Delivering a death sentence, Ofri promises, does not become easier with practice. She’s broken down in tears on more than one occasion regardless of how together she tries to remain. She’s misread charts on long shifts and missed clear signs of domestic abuse. For an entire year she never realized one particularly challenging patient who never took the proper medication was illiterate.
Yet she argues that you can’t be a good doctor with a lousy bedside manner. Empathy matters. Spending six figures on an education makes some feel mighty, though research knocks such an attitude down. A study conducted at Waterbury Hospital in Connecticut revealed that while 73 percent of patients knew they had one primary care doctor during their visit, only 18 percent could name them. Incredibly, two-thirds of doctors believed their patients knew their name.
What if expectations shift? One of the most illuminating aspects of Ofri’s book is that expectations can be as influential as medication. The placebo effect works on such a premise. What we believe about a drug or doctor can actually block the biological effect of a pharmaceutical. This knowledge potentially shifts the patient-doctor relationship—so long as both parties recognize and act as if they’re in a relationship.
Which of course requires empathy. Ofri’s most potent revelation resides in its simplicity: the patient is not the same as the illness. In one racially-motivated study nurses offered less pain medication to African Americans than to white patients when instructed to use their best clinical judgment. When told to envision how pain affected their patients’ lives, dosages were more judicial. When they imagined feeling their suffering nurses complied with the Golden Rule.
My watch is currently telling me to take a minute to breath. Soon it might send my vitals to the team at UCLA, which would then text me should they notice worrisome discrepancies. A refill, diagnosis, even a kind word about my day might follow. Yet it could never replace the pantomimes and personality of a real human being. As Ofri argues in her insightful book, this remains the most important aspect of medicine.
Derek's next book, Whole Motion: Training Your Brain and Body For Optimal Health, will be published on 7/4/17 by Carrel/Skyhorse Publishing. He is based in Los Angeles. Stay in touch on Facebook and Twitter.
Scientists used CT scanning and 3D-printing technology to re-create the voice of Nesyamun, an ancient Egyptian priest.
- Scientists printed a 3D replica of the vocal tract of Nesyamun, an Egyptian priest whose mummified corpse has been on display in the UK for two centuries.
- With the help of an electronic device, the reproduced voice is able to "speak" a vowel noise.
- The team behind the "Voices of the Past" project suggest reproducing ancient voices could make museum experiences more dynamic.
Howard et al.<p style="margin-left: 20px;">"While this approach has wide implications for heritage management/museum display, its relevance conforms exactly to the ancient Egyptians' fundamental belief that 'to speak the name of the dead is to make them live again'," they wrote in a <a href="https://www.nature.com/articles/s41598-019-56316-y#Fig3" target="_blank">paper</a> published in Nature Scientific Reports. "Given Nesyamun's stated desire to have his voice heard in the afterlife in order to live forever, the fulfilment of his beliefs through the synthesis of his vocal function allows us to make direct contact with ancient Egypt by listening to a sound from a vocal tract that has not been heard for over 3000 years, preserved through mummification and now restored through this new technique."</p>
Connecting modern people with history<p>It's not the first time scientists have "re-created" an ancient human's voice. In 2016, for example, Italian researchers used software to <a href="https://www.smithsonianmag.com/smart-news/hear-recreated-voice-otzi-iceman-180960570/" target="_blank">reconstruct the voice of Ötzi,</a> an iceman who was discovered in 1991 and is thought to have died more than 5,000 years ago. But the "Voices of the Past" project is different, the researchers note, because Nesyamun's mummified corpse is especially well preserved.</p><p style="margin-left: 20px;">"It was particularly suited, given its age and preservation [of its soft tissues], which is unusual," Howard told <em><a href="https://www.livescience.com/amp/ancient-egypt-mummy-voice-reconstructed.html" target="_blank">Live Science</a>.</em></p><p>As to whether Nesyamun's reconstructed voice will ever be able to speak complete sentences, Howard told <em><a href="https://abcnews.go.com/Weird/wireStory/ancient-voice-scientists-recreate-sound-egyptian-mummy-68482015" target="_blank">The Associated Press</a>, </em>that it's "something that is being worked on, so it will be possible one day."</p><p>John Schofield, an archaeologist at the University of York, said that reproducing voices from history can make museum experiences "more multidimensional."</p><p style="margin-left: 20px;">"There is nothing more personal than someone's voice," he told <em>The Associated Press.</em> "So we think that hearing a voice from so long ago will be an unforgettable experience, making heritage places like Karnak, Nesyamun's temple, come alive."</p>
Inequality in wealth, gender, and race grew to unprecedented levels across the world, according to OxFam report.
- A new report by global poverty nonprofit OxFam finds inequality has increased in every country in the world.
- The alarming trend is made worse by the coronavirus pandemic, which strained most systems and governments.
- The gap in wealth, race and gender treatment will increase until governments step in with changes.
People wait in line to receive food at a food bank on April 28, 2020 in Brooklyn.
Photo by Spencer Platt/Getty Images
Credit: Oxfam International
A supernova exploded near Earth about 2.5 million years ago, possibly causing an extinction event.
- Researchers from the University of Munich find evidence of a supernova near Earth.
- A star exploded close to our planet about 2.5 million years ago.
- The scientists deduced this by finding unusual concentrations of isotopes, created by a supernova.
This Manganese crust started to form about 20 million years ago. Growing layer by layer, it resulted in minerals precipitated out of seawater. The presence of elevated concentrations of 60 Fe and 56 Mn in layers from 2.5 million years ago hints at a nearby supernova explosion around that time.
Credit: Dominik Koll/ TUM