Doctor-Patient Communication
By
Chip Minty
Lisa Sparks Bethea heard the call in 1997. That's the year
she watched her 58-year-old father
die of lung cancer. As a graduate student at the University
of Oklahoma, she remembers the cold November days and the
emotional roller coaster at Mercy Health Center. Walking away,
she
realized there were lessons to be learned. Now, an assistant
professor of communications
at George Mason University in Fairfax, Va., Bethea is devoting
her professional life to the disease
that took her father, John Sparks of Woodward.
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She was recently selected to serve this spring
as a cancer communication research fellow at the National Cancer
Institute near Washington, D.C. She hopes her research will
eventually help doctors bridge a communication gap that can
be treacherous in the eyes of cancer patients and their families.
"I feel like I'm on a mission, and these doors are open
to me," Bethea says. She will join other researchers at
the cancer institute's health communication and informatics
branch on projects such as opening the Internet to older patients.
For many cancer patients, the Web represents a world of information
that could help them cope, but it's often inaccessible to older
patients who don't feel comfortable with computers. Bethea,
who graduated from Woodward High School and earned her doctorate
degree from OU, says that health communication is a growing
area of research among communication specialists. Cancer, with
all the fear and pain that accompanies it, has been a focal
point of much of that work within the past decades.
In future, an increasing number of physicians will enlist the
expertise of communications specialists to help them refine
their skills. Not every patient should learn they have cancer
in the same way. There's a balance between eliminating fear
and expressing truth. Patients want their doctors to be truthful,
but they don't want the realities to extinguish hope.
Bethea's memories of 1997 are clear. There were times when bad
news was broken very poorly. Families are in pain; patients
are in pain. Truth is spoken by nurses and physicians. But it's
such a delicate, complicated process in terms of breaking bad
news. Empathy and truthfulness are the keys. Physicians are
to cautioned not to be too scientific.
Medicine is a blend of art and science, and talking to patients
is more on the art side. It's important for nurses and physicians
to be empathetic, but there's a difference between emotionally
involved and distraught. The guideline all physicians should
follow is complete truthfulness. “Informing patients they
have cancer is not easy,” says a doctor. Delivering bad
news is always stressful to doctors. It requires them to pause,
collect their thoughts and go about it with professionalism,
because education and communication are important tools for
comforting patients. Much of the anxiety patients feel comes
from the unknown. |
Practical
Tips to Reduce Stones
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On hospital rounds, a doctor doubled over
with pain from a kidney stone. He had run 10 miles and become
dehydrated. I told him of new research on stones. Kidney stones
are common. More men than women, will have at least one stone
in their lifetime, and half will have a second attack within
five years. And stones go way back -- found in Egyptian mummies
and mentioned in the Hippocratic Oath. Most kidney stones are
calcium oxalate. Seven practical tips to prevention:
Quaff water.
Urine contains calcium and oxalate. When levels get high, calcium
and oxalate join to form crystals. Crystals can grow into stones.
Water keeps urine dilute and so levels of calcium and oxalate
low. Research in doctors and nurses finds that those who hydrate
well have fewer stones. To fend off stones, drink two to three
quarts of water a day.
Cut salt. The less salt
you eat, the less calcium goes into the urine. A low-salt diet
can cut urine calcium by one- third.
Limit animal protein. Meat increases urine calcium. High-protein,
low-carb diets to lose weight boost the risk of stones. Vegetarians
have half the rate of stones as meat- eaters.
Consume citrus. Drinking two to three cups of orange juice a
day helps prevent stones by increasing urine content of citrate.
Citrate inhibits stones by binding to calcium, keeping oxalate
from doing so.
Cut oxalate. Tea is rich
in oxalate. Drink less tea. Chocolate, peanuts, spinach and
strawberries also contain oxalate.
Watch vitamin C. In the
urine, vitamin C turns partly to oxalate. Avoid large supplements
of vitamin C.
Don't cut calcium. This
reverses prior advice. In a four-year study of 45,000 men, those
eating diets rich in calcium had the lowest risk of stones.
A study of 90,000 women agrees. Why? Calcium binds dietary oxalate
in the gut and sweeps it out in the stool. So the more calcium
you eat, the less oxalate in urine. A new study bolsters this
advice. Sixty Italian men with stones were assigned to a low-
calcium diet. Another 60 were assigned to a diet normal in calcium
but low in animal protein and salt. Over five years, 23 men
on the low-calcium diet had another stone, versus only 12 men
on the normal-calcium diet.
So to stay stone-free, quaff water and cut meat and salt, not
dairy. |
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