Booster Shots

Oddities, musings and news from the health world

Category: relationships

Doctors, patients and the Internet

March 27, 2010 |  7:00 am

I think most people appreciate using the Internet for accessing health information. But an editorial published this week in the New England Journal of Medicine indicates that at least some doctors aren't as comfortable with the technology and the way it has altered doctor-patient interactions.

Internet In their commentary, Dr. Pamela Hartzband and Dr. Jerome Groopman, both from Beth Israel Deaconess Medical Center in Boston, write that the Internet's "profound effects derive from the fact that while previous technologies have been fully under doctors' control, the Internet is equally in the hands of patients. Such access is redefining the roles of physicians and patients."

Having your role redefined in such a dramatic way has to be a bit disconcerting for doctors. But the effect of the Internet on patient care can be viewed as positive or negative, as the editorial points out. On one hand, the Internet has given consumers important information to help them make good healthcare decisions and improve quality of care. On the other hand, there are many myths and false assertions on the Internet that can lead people astray. Hartzband and Groopman point out that patients can now access their lab test results online in some medical centers. But, in doing so, they receive information without their doctor's input or any context. Doctors and patients can exchange e-mails to facilitate communications, they note. But doctors aren't paid for that activity.

The authors argue that the Internet should not change the "core relationship" of face-to-face doctor-patient communication that relies on what doctor and patient bring to the table. "The doctor, in our view, will never be optional," they write.

I agree. And patient knowledge and empowerment, afforded by the Internet and other resources, will never slide back to those old days when only the doctor's brains and opinion counted.

-- Shari Roan

Glenn Koenig  /  Los Angeles Times

Doctors' hours and couples' language -- no connection whatsoever

January 30, 2010 |  8:13 am

The only connection might be that they caught my eye this week and I'm sharing. What can I say? I'm a giver.

-- Doctors apparently work less when the risk of liability increases. This conclusion is based on data, survey responses and a lot of number-crunching, but what it comes down to is that time on the job is reduced by 1.7 hours every time the liability risk rises by 10%. So say an economist at Claremont McKenna College and Rand and another from Brigham Young University.

Here's the news release and the abstract from the study, published in the Journal of Law and Economics.

-- Married couples who say "we" instead of "I" and "you" may have an edge in conflict resolution. Such language seems to reflect their view of themselves as a unit -- not independent entities or, as is sometimes the case, adversaries. Further, older couples are more likely to use such language than middle-aged couples.

The findings come from researchers at UC Berkeley. They're not brand new, but they weren't published terribly long ago either. Besides, Valentine's Day is coming up, and I'm quite the romantic. Or I find the use of language interesting.

Here's the news release and the abstract from the study, published in Psychology and Aging.

-- Tami Dennis

Most parents stay together after child's death

January 5, 2010 |  7:00 am

It’s hard to imagine a bigger strain on a marriage than the loss of a child to cancer. Conventional wisdom holds that such tragedies increase the risk of divorce, but a new study says that isn’t so.

Holdinghands Researchers from the Division of Clinical Cancer Epidemiology at Karolinska University Hospital in Stockholm tracked down 442 Swedish parents who had lost a son or daughter to cancer before the age of 25. Four to nine years after the loss, 74% of the parents were still married to or living with the child’s other parent.

To serve as controls, the researchers also found 452 parents with living children of the same age, sex and region of residence as the ones who died of cancer. Among those parents, 68% of their relationships were still intact.

Statistical analysis revealed that the bereaved mothers and fathers were 10% more likely to remain with their co-parents compared with the controls. The difference was statistically significant. The results were published today in the Archives of Pediatric and Adolescent Medicine.

There’s little doubt that caring for a terminally ill child causes great psychological distress and marital strain. But previous studies that examined how families cope with the loss of a child have had mixed findings when it comes to divorce. Based on these Swedish results, the researchers conclude that, at the very least, “parents who have lost a child to cancer are not more likely to separate than others.”

-- Karen Kaplan

Photo: Contrary to popular belief, marriages can survive the loss of a child to cancer. Credit: Robert K. Yosay / The (Youngstown, Ohio) Vindicator

This new year, resolve to be happy

January 4, 2010 |  1:53 pm

Instead of planning to lose weight, find a better job, be a better person (typical New Year’s resolutions, according to a recent Marist poll) why not use 2010 to focus on what’s really important – your own happiness?

Dropping a few pounds and getting a raise might seem like means to that end. And happiness itself might sound like a nebulous, unachievable goal. But happiness might be worth pursuing in its own right – and, according to recent research, could be a much more measurable and tangible goal than previously thought.

Want a primer on that special feeling? A three-part PBS series, "This Emotional Life," tonight will look at why we feel what we feel, through a scientific lens and through the wisdom of such celebrities as Larry David, "Seinfeld" co-creator: "I don't think it's that much of a mystery. If you don't have a job that you like, and you're not having sex, you're just not gonna be happy."

Show host Daniel Gilbert, who sat down with NPR today for an interview, said the larger point on relationships and happiness rings true. "If you're not involved in a relationship," the Harvard psychologist said, "then indeed we see that people who aren't in romantic relationships are less happy than those who are."

Perhaps happiness is contagious, too. In an article published in the Journal of Personality and Social Psychology, researchers found that the feeling created by absence of relationships -- loneliness -- spreads like a disease:

Results indicated that loneliness occurs in clusters, extends up to three degrees of separation, is disproportionately represented at the periphery of social networks, and spreads through a contagious process.  

Another reason to pursue happiness and avoid loneliness this year – scientists say it’s just as important on the New Year’s resolution list as quitting smoking or losing weight. As Health reporter Melissa Healy blogged last month, loneliness can be as bad for your health as smoking and obesity. 

One double-take worthy theory presented in the PBS show: That, controlling for health problems, older people are generally happier than younger people. Counterintuitive as that notion might seem, it’s been gaining strength in recent years. Health reporter Shari Roan found some logical explanations for the theory in a 2007 story:

[M]ost scientists now think that experience and the mere passage of time gradually motivate people to approach life differently. The blazing-to-freezing range of emotions experienced by the young blends into something more lukewarm by later life, numerous studies show. Older people are less likely to be caught up in their emotions and more likely to focus on the positive, ignoring the negative.

In a special to The Times, Marnell Jameson explores how scientists are starting to quantify and measure happiness -- and what their conclusions are. She starts with a quick quiz: 

True or false:

___ I would be happier if I made more money, found the perfect mate, lost 10 pounds or moved to a new house.
___ Happiness is genetic. You can't change how happy you are any more than you can change how tall you are.
___ Success brings happiness.
Answers: False, false and false. 

Want to find out why? Read Jameson's story, and check out the first part of “This Emotional Life” tonight, airing at 9 p.m. on KCET.   

-- Amina Khan

Parents: Get the sex talk over with

December 9, 2009 |  4:25 pm
If you’re thinking about talking to your child about sex, you could be too late. Kids appear to be engaging in sexual activity much earlier than they have in the past – but today’s parent hasn’t gotten with the program.

In a new study published online Monday in the journal Pediatrics, more than 40% of teens surveyed said they had had intercourse before discussing key issues with their parents. Such issues included sexually transmitted diseases, how to use a condom, and what to do if your partner refuses to use a condom. Boys had the talk even later than girls. Parental talks for both genders were still behind the times, though – which is troubling, given that medical professionals are recommending early and frequent STD screening for young women within a year of having sex for the first time.

For the reluctant parent, a handy primer from Planned Parenthood on discussing birds and bees with your child. 

-- Amina Khan

'In sickness and in health' has different odds for women than for men

November 10, 2009 |  1:16 pm

Ring Many people have assumed that men are less likely than women to stick by a seriously ill spouse. That assumption might not say much for men. Yet it appears to be true.

In a study of 515 people diagnosed with cancer or multiple sclerosis, researchers at the Fred Hutchinson Cancer Center in Seattle and elsewhere found an overall divorce or separation rate of 11.6%, about what one would expect in the general population. But women were six times more likely than men to face what the researchers called "partner abandonment." 

Among marriages in which women were the diagnosed partner, 20.8% ended in divorce or separation.

Among marriages in which men were the diagnosed partner, 2.9% ended in divorce or separation.

Each marriage, each patient and each spouse is different, so without further data, it's unsafe to make over-generalizations. But as the researchers point out: "Some studies have in fact suggested that men are less able to undertake a caregiving role and assume the burdens of home and family maintenance compared with women. Thus, a woman becomes willing sooner in the marriage to commit to the burdens of having a sick spouse."

Such a commitment matters. The researchers note that cancer patients who stayed married were less likely to use antidepressants and to be hospitalized -- and more likely to participate in clinical trials and to die at home.

In perhaps the most daunting element of their report, they say in their conclusion: "We believe that these findings apply generally to patients with life-altering medical illness."

The report was published in the Nov. 15 issue of the journal Cancer. Here's the abstract. And the news release.

And for a more personal look at the topic, here's a My Turn essay from author Marc Silver (it refers to an earlier study by one of the same researchers): Will a wife's breast cancer lead to husband's infidelity?

And a perhaps much-needed lighter look, also from Silver: Husbands: How to help a wife through cancer treatment

-- Tami Dennis

Photo: Longer marriages are more likely to weather the diagnosis and illness, researchers found. Credit: Los Angeles Times

Is Facebook healthy for the doctor-patient relationship?

August 12, 2009 |  2:01 pm

If you’re on Facebook, you’ve likely faced this dilemma: Someone you know through your work has asked to become your online friend. You don’t want to be rude and say no, but you’re also a bit queasy about giving professional acquaintances full access to your personal life online. What should you do?

Facebook Dr. Sachin H. Jain encountered this problem in his second week of internship, when a woman whose baby he helped deliver as a medical student asked to become his Facebook friend. As he writes in this week’s New England Journal of Medicine, he was wary of allowing his former patient to see his list of friends, view his photos or read his personal blog. On the other hand, he didn’t want to be a jerk.

“The anxiety I felt about crossing boundaries is an old problem in clinical medicine, but it has taken a different shape as it has migrated to this new medium,” he writes.

What could go wrong? Plenty, he speculates.

Patients could call a doctor’s medical judgment into question after viewing Facebook photos of a festive holiday party that involved a bit too much spiked eggnog. Or a physician who lists herself as “single” on her Facebook profile could find herself being asked out by patients who probably wouldn’t have inquired about her relationship status in person. Or a nurse might blow off steam by blogging about a difficult patient without remembering that she had friended one of the patient’s relatives, who would have access to all the gory details. These are some of the reasons medical schools now advise students to think twice about what they post on social networking sites such as Facebook and MySpace.

But without Facebook, a grassroots group called Doctors for Obama might not have persuaded thousands of physicians to flood Barack Obama’s campaign with their ideas about health policy during the 2008 presidential election. “This group of physicians continues to have a voice in the Obama administration, largely on the strength of its Facebook-created network of members,” Jain writes.

So how did he handle his patient’s request? He accepted, partly because he was curious to see how her baby was doing.

It turned out the patient did have an ulterior motive – she was thinking about applying to med school herself. Jain said he was happy to dispense advice, because that was in keeping with the doctor-patient relationship. Among his suggestions: Be careful about how you manage your online identity.

The article is also available via the New England Journal of Medicine's own Facebook page.

-- Karen Kaplan

Photo: Would you want to read your doctor's Facebook page? Credit: Don Ryan / Associated Press

Facebook drives some in relationships crazy with jealousy *

August 6, 2009 | 11:43 am

Before you log onto Facebook to check in with your honey, brace yourself for comments, exchanges and pictures that can bring out the green-eyed monster in you, prompt you to spend more time on Facebook and lead to addictive behavior as you pursue evidence of competition for your beloved's affections.

Never mind the perils of cyber-stalking, cyber-bullying and posting photos that could endanger your future job prospects: Facebook could be ruining your relationship and driving you toward compulsively jealous behavior.

The risk that an innocent peek at Facebook could set in motion this cycle of events is suggested by a new survey of college students described in the journal CyberPsychology & Behavior. * Social psychologists from the University of Guelph in Canada queried college students who were in romantic relationships about their Facebook use. Their preliminary findings, presented in the journal's "Rapid Communication" section, suggest that rather than enhancing communication between romantic partners, Facebook use may be fueling wild flights of jealous investigation, as users in relationships perceive hints of potential infidelity and then scramble to find evidence of a partner's unfaithful thoughts or behavior.

Invariably, it seems, they end up feeling more jealous.

And where does this lead?  For some participants in the study, these investigations led to searching behavior they described as "addictive." And the bouts of escalating jealousy, say the researchers, cannot be good for a relationship.

While the survey was of college students, the researchers surmised that Facebook might unleash the same dynamics in adult relationships. Certainly, they noted, it's worth further research. 

The research team responsible for the latest survey has previously found that young adults' need for popularity led them to disclose far more personal information on Facebook than they would reveal in the course of ordinary social contact.

Here's your chance to add to researchers' collection of observations: has an overly friendly comment from a partner's "friend" or a posted photo depicting overly friendly friendship caused you to embark on a cyber-hunt for alleged infidelity? Did you "unfriend" a love interest as a result?

-- Melissa Healy 

* An earlier version of this story misspelled the word "peek."

The search for the perfect impotence drug won't end soon

May 18, 2009 |  1:08 pm

ViagraTaking Viagra, Levitra or Cialis improves erectile function. That much we now know. Again.

What we still don't know is which medication works best.

At the request of the American College of Physicians, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services, set out to assess the impotence drugs' effectiveness and their risk of side effects. Doctors apparently like to have as clear a picture as possible before prescribing the drugs to patients.

The report, released today, distills evidence from 126 randomized controlled trials of the drugs technically known as oral phosphodiesterase type 5 inhibitors. But only four trials compared sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) against each other, making cut-and-dried conclusions difficult.

Researchers have a pretty good idea of the drugs' benefits. And of their risks -- most common are headaches, flushing, dyspepsia (indigestion -- here's an explainer from MedicineNet) and rhinitis (inflammation of the nose's inner lining -- and another explainer). They just can't tell doctors which one should be prescribed. 
But the report does offer one-place-shopping for information on dose-response effect of the individual drugs (higher doses tended to get better results), plus less-conclusive assessments of injections, suppositories, topical treatments, hormones and drugs prescribed off-label. The researchers also tried to evaluate the usefulness of routine blood tests in identifying (and thus, treating) hormonal disorders. The limited amount of data made this problematic.

For most men, and their doctors, the report largely means: If you're looking for a thorough comparative summary of the data on these drugs, now you have one.

Of note, the big three drugs tended to work fairly well across the board. That is, they helped men regardless of the cause of erectile dysfunction. (Here's a primer on causes, courtesy of the Urology Channel.)

And men tended to prefer tadalafil (Cialis) over its cousins, partly because the drug's effects last longer.

The researchers wrote: "There is still insufficient information regarding the effectiveness and safety related to the use of different treatment modalities in various clinical subgroups of patients (e.g. diabetes, cardiovascular disease). Furthermore, there is insufficient data with regard to long-term adverse effects of oral ED medications that have been used by millions of users for over a decade."

Translation: We need more data, especially about how the drugs might affect men with diabetes and heart disease. And long-term data -- we definitely need more of that.

-- Tami Dennis

Photo: Viagra has been often discussed, but not often compared -- clinically speaking -- to its cousins Levitra and Cialis.

Credit: AFP / Getty Images

In a new relationship? Make a good first impression.

January 9, 2009 | 12:18 pm

Trust1Trust is vital to any relationship be it romantic, platonic or even business or working relationships. New research shows  that the early days of that relationship are the most sensitive to trust issues and that making a bad first impression can be tough to overcome.

The study, published in the December issue of Personality and Social Psychology Bulletin, found that an early violation of trust in a relationship can plant seeds of doubt that never go away. Researchers, from Ohio State University, conducted two experiments with college students to see how much students were willing to cooperate with a partner after trust was breached. The students played games involving the exchange of money and the willingness to trust a partner. The results showed breaching trust early led to persistent distrust while later breaches were less harmful to trust and cooperation.

"Our results suggest that immediate breaches are especially costly because they seriously damage the impressions people have about their partner, and that's hard to repair," Robert Lount, a co-author of the study and assistant professor of management and human resources, said in a news release. "Our results fly in the face of this Hollywood notion of hating someone at first sight but then developing a wonderful, passionate relationship. The likelihood of that happening in real life is pretty low."

-- Shari Roan


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