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May 1, 2006 -- Most doctors think it is appropriate for them to discuss religious or spiritual issues with patients who start those conversations, a new study shows.
The majority of doctors don't bring those topics up with their patients, but those with strong religious or spiritual beliefs are more likely to do so, the study also notes.
The study is based on a survey of 1,144 U.S. doctors younger than 65. The doctors work in various specialties including internal medicine, family practice, obstetrics and gynecology, pediatrics, psychiatry, and surgery.
The University of Chicago's Farr Curlin, MD, and colleagues published the results in the journal Medical Care.
Survey's Results
Most doctors in the survey were Protestant, followed by Catholics and Jews. Only about 13% were from other religions. About 11% of the doctors called themselves atheists, agnostics, or those with no religious affiliation.
Participants also rated how strongly their religious or spiritual beliefs affect their lives.
The study's findings include:
- 91% of doctors say it's "always" or "usually" appropriate to discuss religious/spiritual issues if their patient brings those issues up.
- 66% say they "never" or "rarely" inquire about patients' religious or spiritual issues.
- 81% say they "never" or "rarely" pray with their patients.
- 59% say they "never" or "rarely" share their own religious ideas and experiences with their patients.
Doctors' Beliefs Important?
Doctors who noted that religion and spirituality played a big role in their lives were more likely to say they have ever prayed with their patients or asked about a patient's religion or spirituality. That pattern was strongest among Protestant participants, the study shows.
"Contemporary medicine is often applied in areas about which different religious (or secular) traditions provide rival explanations and resources for healing," write Curlin and colleagues.
The researchers add that "the time may be ripe for a deeper and more fundamental examination of the influence of religion in the lives of doctors, the lives of patients, and in the complex culture of health care.""
SOURCES: Curlin, F. Medical Care, May 2006; vol 44: pp 446-453. News release, University of Chicago Hospitals
Verbal Medical Order Errors Reduced To Zero With Simple Change, Cincinnati Children's Study
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Article Date: 01 May 2006 - 0:00am (PDT)
Hospitals have spent millions of dollars on computerized physician order entry systems to reduce medical errors, but a simple change in the way verbal orders are entered in the system -- so simple that it cost nothing to implement -- has reduced errors to zero, according to a new Cincinnati Children's Hospital Medical Center study.
"By simply having the resident read back the order before he or she entered it into the computer, we reduced verbal order errors from 9.1 percent to zero," says Michael Vossmeyer, M.D., a pediatrician at Cincinnati Children's and the study's main author. "Although this was a small study, these results are very encouraging."
The study will be presented at 5:15 p.m. Pacific time Saturday, April 29, at the annual meeting of the Pediatric Academic Societies in San Francisco.
At Cincinnati Children's, rounds are conducted inside patients' rooms to make care more family-centered, and orders are entered into the computer system right at the bedside. The attending physician or chief resident verbally communicates the order and a resident physician enters it into the system.
For the study, the team on rounds took 70 consecutive orders. After rounds, they examined the orders for errors. They discovered errors in 9.1 percent of all orders. Most of the errors were in dosages that would not have affected safety. In two instances, however, the intern wrote down the wrong drug.
Dr. Vossmeyer and his research colleagues instituted a process of order read back: Before leaving a patient's room, the resident reads back the order entered to verify its accuracy. The attending physician or chief resident then verifies its accuracy. After instituting this process, the researchers examined 75 orders for errors. There were none. Moreover, the process added only seconds to each visit to a patient's room, so it did not slow down the process of physician rounding.
"We're doing a follow-up study to determine if the results are sustainable and the process is reliable," says Dr. Vossmeyer, "but they appear to be very generalizable. That's particularly important for tertiary patients, such as children with organ transplants, where proper doses mean so much."
The study was conducted on a general, acute pediatric inpatient unit. Cincinnati Children's is now spreading the read back process to family-centered rounds throughout the organization.
Cincinnati Children's Hospital Medical Center is a 475-bed institution devoted to bringing the world the joy of healthier kids. Cincinnati Children's is dedicated to transforming the way health care is delivered by providing care that is timely, efficient, effective, family-centered, equitable and safe. Cincinnati Children's ranks third nationally among all pediatric centers in research grants from the National Institutes of Health. It is a teaching affiliate of the University of Cincinnati College of Medicine.
The Cincinnati Children's vision is to be the leader in improving child health. Additional information can be found at http://www.cincinnatichildrens.org .
Cincinnati Children's Hospital Medical Center
http://www.cincinnatichildrens.org
"Steps are necessary to ensure that the existence of dietary supplements on the market does not act as a disincentive for drug development." (FDA Task Force Report, June 15, 1993)
The Food and Drug Administration is again spending millions of tax dollars in its yearly attempt to increase drug sales by restricting the distribution of dietary supplements. These actions are contrary to the public interest.
FDA Commissioner David Kessler recently rationalized his efforts by alleging, "For every one of these products that has some value, there are thousands that are worthless." This is unsupportable. In fact, his charges are much more appropriate when applied to pharmaceutical drugs rather than to foods.
On 15 percent of the drugs on the market have been subjected to controlled testing, according to the United States Department of Technological Assessment. In fact, 85 percent of the drugs Americans take are unproven or have actually been proven ineffective!
Are these thousands of questionable drugs even safe? The prestigious Yale-New Haven hospital has published their conclusions that pharmaceuticals, properly prescribed and properly taken, account for 100,000 deaths each year in this country alone. Tens of millions more Americans are made sick or fail to seek appropriate health care every year because of chronic, ongoing drug use "taken as directed." One million are hospitalized annually solely as a result of reactions to prescriptions and over-the-counter medicines. The cost in dollars and human suffering staggers the imagination. But the FDA wants to limit peoples' access to food supplements.
These drug statistics are not acceptable. They represent an indictment of the FDA and the pharmaceutical industry. If an automobile driver had a safety record like this, responsible authorities would make certain that his license was revoked before sundown and would probably jail the culprit as well. But the FDA ignores the drug disaster and wants to restrict the distribution of food supplements.
So the cycle continues. Drugs are approved by the FDA today, distributed, then found unsafe tomorrow and withdrawn, only to be replaced with new wonder drugs that are subsequently taken off the market as health hazards. If drugs were safe and effective, would we need the $1.5 billion of mindless, hard-sell advertising every month to goad us into taking them and giving them to our children?
In contrast, with few exceptions and very little advertising, food supplements have enjoyed great safety and increasing demand for decades.
How safe are these food substances? Vitamin A is often pointed to as one of the more toxic dietary supplements. Yet according to the Merck manual, vitamin A has had no fatalities associated with its use of abuse. This includes accidental ingestion of millions of IUs at one sitting and weeks of megadosages given to infants.
The simple, incontrovertible fact is this: All drugs are dangerous; foods and supplements are safe. Anyone with a paper and pencil can quickly figure out for themselves that pharmaceuticals will sicken and kill more Americans in the next seven days than "health foods" have in the past 10 years. Drugs need to be controlled much more strictly and distributed more sparingly than they are now. Supplements should be regulated for sanitation like any other food.
Curtailing sales of dietary supplements will not protect the public. It will harm millions of intelligent, responsible people. However, pharmaceutical manufacturers and their distributors will enjoy windfall profits if these FDA propositions are allowed to become law. Whose interests are really being served by this legislation?
Every year the FDA and pharmaceutical industry misappropriate tax dollars to mount another offensive against America's health. Unchecked, eventually these unprincipled forces will prevail. The flood of drugs will continue to rise, destroying more of our parents and children. Congress must permanently stop this ongoing campaign which is subverting the enlightened efforts of Americans who want to improve their lives by reducing their dependence on medical drugs.
Jonathan B. Sevy, DC
Vancouver, Washington
Dynamic Chiropractic - December 17, 1993, Volume 11, Issue 26
