Adrienne Boissy

Multiple sclerosis symptom management.

Multiple sclerosis (MS) is the most common cause of nontraumatic disability in young adults. The increasing emphasis on early treatment with disease-modifying therapies has the goal of preventing long-term disability. However, current disease treatments are only partially effective, and most patients experience a variety of neurologic symptoms at various times during their disease course. Because these symptoms often have a profound impact on social, occupational and physical performance, effective symptom management is an important component of therapy to maintain quality of life. Effective symptom management often requires a multidisciplinary team approach. This review outlines general principles of the management of MS symptoms.

The REDE Model of Healthcare Communication: Optimizing Relationship as a Therapeutic Agent:

The REDE model is a conceptual framework for teaching relationship-centered healthcare communication. Based on the premise that genuine relationships are a vital therapeutic agent, use of the framework has the potential to positively influence both patient and provider. The REDE model applies effective communication skills to optimize personal connections in three primary phases of Relationship: Establishment, Development and Engagement (REDE). This paper describes the REDE model and its application to a typical provider-patient interaction.

A touch of MS: Therapeutic mislabeling

When psychogenic symptomatology is at play, a spectrum of ethical problems and considerations arise when patients want, and at times, insist on being given an inaccurate neurologic diagnosis. We use the example of multiple sclerosis (MS) to highlight the value considerations for clinicians when they face these types of cases. Given the ambiguities involved in its diagnosis and the significant risks of its treatment, MS represents a rich case study. This discussion highlights the potential harms of mislabeling such patients with MS when the neurologist is confident they do not have MS and offers suggestions about how to approach and manage these patients. Despite being expedient and well-intentioned, labeling psychogenic symptoms with a medically inaccurate diagnosis, such as a “touch of MS,” constitutes a “therapeutic mislabeling” and sacrifices ethically important values incommensurate with the benefits gained.

Different Questions, Different Goals

Fox and her colleagues (2007) present an important and foundational study concerning the character of current ethics consultation services (ECSs). Although we have some concerns regarding the gener...

Association Between Antibiotic Prescribing for Respiratory Tract Infections and Patient Satisfaction in Direct-to-Consumer Telemedicine

increase preceded the decline in arthroscopy rates. Between 1999 and 2014, the prevalence of osteoarthritis in the US adult population more than doubled from 6.6% to 14.3%.6 Trends in per capita knee surgical procedures, which are not adjusted for the increase in the prevalence of osteoarthritis, likely understate the degree to which use of arthroscopic surgery as a treatment for knee pain has declined. Some private insurers have started to require physicians to obtain authorization before an arthroscopic knee procedure. The fee-for-service Medicare program does not require prior authorization. Private insurers covered 72% of knee arthroscopies in patients younger than 65 years, and Medicare covered 83% of these procedures in patients aged 65 years or older. I could not observe the impact of prior authorization requirements directly, but trends in arthroscopy rates in these age groups were similar, indicating that the requirements may not be a major factor behind the decline in rates. The results suggest that the accumulating evidence on the lack of benefit associated with knee arthroscopy, compared with medical management, has altered treatment decisions. Despite the lower use rates, knee arthroscopy is still a common procedure. There may be additional opportunities to reduce the use of knee arthroscopy without adversely affecting patient outcomes.

Implementing a comprehensive physician-communication-skills improvement initiative: The Cleveland Clinic experience.

186 Background: Physician communication skills are associated with important outcomes, including medical results, treatment adherence, malpractice claims, patient safety, and physician satisfaction. Recently, patient satisfaction with physicain communication became a factor influencing Medicare reimbursement. In 2010, the Cleveland Clinic began building a physician communication training program to improve doctor communication skills. METHODS Following a literature review and a survey of communication skills programs at a variety of U.S. hospitals, we collaborated with the American Academy of Communication in Healthcare (AACH) to develop a full-day course based on Frankel and Steins Four Habits model. The model emphasizes skills related to initiating the encounter, eliciting the patients story, expressing empathy, educating the patient and collaboratively developing a plan. The course was designed to be taught by physicians and was highly experiential and skills based, making extensive use of role-play exercises. An AACH consultant trained 15 physicians to teach the course during several 7-day train-the-trainer courses. RESULTS Between September 2011 and May 2013, over 800 physicians took the course. It became very popular and has been consistently oversubscribed. For the first 450 physicians trained, we reviewed patient satisfaction survey scores for the 6 months before and after they took the course. For all 13 items on the Press Ganey ambulatory patient survey used, scores were higher after taking the course. For 7 of the 13, the difference was statistically significant (p values ranging from .003 to .044). CONCLUSIONS Our experience with communication skills training indicates that such training can be well received by physicians if it is high quality. Key elements of our program that we believe contributed to its success are the following: it was developed by physicians for physicians; it is taught by physicians with substantial clinical practices so that the atmosphere is colleagues teaching colleagues; and it is skills based rather than cognitive in focus so that participants have tangible tools that they can use in their practice.