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Shedding the super doctor myth
It’s been more than a year since we came face to face with an unprecedented, unrelenting pandemic. Determined to overcome, determined to forge ahead, we worked tirelessly.
Hours upon hours, days upon days, months upon months. Hoping for recovery while facing the devastation of death. We were praised, and lauded as heroes as we pleaded for essential protective gear and urged our communities to think critically, act responsibly, and distance safely. From the cities to small towns, we answered the call. Leaving long-practiced specialties, reassigned from our practices and training, we worked together uncertain of the future, but committed to safeguarding our present. Through sacrifice we toiled, leaving our families to protect against contagion, wading through halls of the sick and fighting against the threat of death.
As days swept into months, the impact of isolation and economic deceleration yielded cracks on the surface. Pay cuts loomed, furloughs abounded, and distance-learning infiltrated the medical community. Yet, COVID-19 reigned, and with it came frustration, exhaustion, and emotional defeat. Despite racial reckonings, political turmoil, and massive protests, we worked tirelessly. We persevered.
Throughout 2020, the praise of “Health Care Heroes” rang out around the world. We saw images of medical professionals diligently working through the unthinkable with grace and humility, truly sacrificing for the greater good without complaint. Day after day, hour after hour, month after month. All the while, cracks were surfacing, expanding wider, and penetrating deeper. We were weary.
During a recent appointment with my primary care physician, she looked at me, her eyes brimming with earnest compassion, and said, “If you have suicidal thoughts, please let me know. That is my biggest worry with doctors.” I knowingly looked at her, keen in understanding as I recalled the stories. Doctors overwhelmed and uncertain, released by the abrupt completion of suicide.
Although broader government agencies may regulate and enforce, it is up to us to facilitate and comply. The pressure is immense, but our calling is strong – an unspoken agreement that begins with an oath.
As a psychiatrist, I am acutely aware of the warning signs associated with suicidality. Reading through the stories of loss and seeing the bewilderment and despair of the bereft, I once again wonder whether the pressure of medicine is worth the cost. How can we be “Health Care Heroes” if we fail to recognize the fragility that resides within ourselves? Moreover, how do we see beyond the illusion of invulnerability and accept that vulnerability is not a sign of weakness but a hallmark of strength and empathy? These are some of the issues I will be exploring in this new column, Myth of the Super Doctor.
Beginning at the beginning
Addressing these issues starts with training. As a new cohort of eager students enters medical/osteopathic school, the focus should lie not only on foundations of medicine and brute memorization of copious information but also on self-care, wellness checks, and group morale. The same emphasis placed upon patient care and advocacy must also be extended toward ensuring that the next generation of physicians will understand the importance of caring for themselves as much as they care for others.
In the same manner, past stereotypes of ruthless, cut-throat, competition must also evolve. Although the spirit of hard work and perseverance is essential, the manner it propagates is just as important. Aggressive questioning, myriad testing, rigid hierarchies, blind obedience, and ego inflation may separate the pack, but it also reinforces individualism and isolation. Students may shield their internal turmoil behind a mask. The mask of the Super Doctor.
However, as the pandemic has shown, even the most durable of masks will eventually fail. So how do we recognize and accept that help is needed? How do we access support? First, it is vital to acknowledge that there is no shame in asking for help. It is both surprising and reassuring that many of us have been there, an unspoken band of brothers and sisters. Second, remember the acronym for depressive symptoms SIGECAPS (sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicide). Remember that these symptoms may develop gradually or feel sudden and overwhelming. Know that mood lability, tearfulness, and isolation may also be present but confused and disregarded as normal consequences of school, residency, or life as a physician. Third, recognize common behavioral changes associated with anxiety, such as irritability, avoidance, and physical symptoms, including headache, muscle aches, joint pain, GI discomfort, palpitations, and insomnia. Last, reach out to colleagues who have suddenly or gradually withdrawn. Schedule frequent check-ins for one another and do not be afraid to admit that you are human. There is no shame in vulnerability but there is bravery and strength.
If you are in school or residency training, reach out to health centers, training directors, supervisors, family and/or friends. Whether you are an early career physician or amid a decades-long career, connect with your peers, reach out to junior members, offer and accept support. Anonymous hotlines, listservs, email groups, virtual meetings, texts, and phone calls also provide opportunities for wellness checks, pep talks, or venting sessions. All are important. In the case where more specialized help is needed, contact your primary care physician, reach out to colleagues in mental health, contact the Suicide Prevention Lifeline at 1-800 273-8255. Know there is help; you are not alone.
In these unprecedented and uncertain times, remember the African proverb “It takes a village.” To ask for help reveals strength and fortitude. The more we advocate for ourselves and one another, the more we will prevail and shed the myth of infallibility.
Dr. Thomas is a board-certified adult psychiatrist with an interest in chronic illness, women’s behavioral health, and minority mental health. She currently practices in North Kingstown and East Providence, R.I. She has no conflicts of interest.
It’s been more than a year since we came face to face with an unprecedented, unrelenting pandemic. Determined to overcome, determined to forge ahead, we worked tirelessly.
Hours upon hours, days upon days, months upon months. Hoping for recovery while facing the devastation of death. We were praised, and lauded as heroes as we pleaded for essential protective gear and urged our communities to think critically, act responsibly, and distance safely. From the cities to small towns, we answered the call. Leaving long-practiced specialties, reassigned from our practices and training, we worked together uncertain of the future, but committed to safeguarding our present. Through sacrifice we toiled, leaving our families to protect against contagion, wading through halls of the sick and fighting against the threat of death.
As days swept into months, the impact of isolation and economic deceleration yielded cracks on the surface. Pay cuts loomed, furloughs abounded, and distance-learning infiltrated the medical community. Yet, COVID-19 reigned, and with it came frustration, exhaustion, and emotional defeat. Despite racial reckonings, political turmoil, and massive protests, we worked tirelessly. We persevered.
Throughout 2020, the praise of “Health Care Heroes” rang out around the world. We saw images of medical professionals diligently working through the unthinkable with grace and humility, truly sacrificing for the greater good without complaint. Day after day, hour after hour, month after month. All the while, cracks were surfacing, expanding wider, and penetrating deeper. We were weary.
During a recent appointment with my primary care physician, she looked at me, her eyes brimming with earnest compassion, and said, “If you have suicidal thoughts, please let me know. That is my biggest worry with doctors.” I knowingly looked at her, keen in understanding as I recalled the stories. Doctors overwhelmed and uncertain, released by the abrupt completion of suicide.
Although broader government agencies may regulate and enforce, it is up to us to facilitate and comply. The pressure is immense, but our calling is strong – an unspoken agreement that begins with an oath.
As a psychiatrist, I am acutely aware of the warning signs associated with suicidality. Reading through the stories of loss and seeing the bewilderment and despair of the bereft, I once again wonder whether the pressure of medicine is worth the cost. How can we be “Health Care Heroes” if we fail to recognize the fragility that resides within ourselves? Moreover, how do we see beyond the illusion of invulnerability and accept that vulnerability is not a sign of weakness but a hallmark of strength and empathy? These are some of the issues I will be exploring in this new column, Myth of the Super Doctor.
Beginning at the beginning
Addressing these issues starts with training. As a new cohort of eager students enters medical/osteopathic school, the focus should lie not only on foundations of medicine and brute memorization of copious information but also on self-care, wellness checks, and group morale. The same emphasis placed upon patient care and advocacy must also be extended toward ensuring that the next generation of physicians will understand the importance of caring for themselves as much as they care for others.
In the same manner, past stereotypes of ruthless, cut-throat, competition must also evolve. Although the spirit of hard work and perseverance is essential, the manner it propagates is just as important. Aggressive questioning, myriad testing, rigid hierarchies, blind obedience, and ego inflation may separate the pack, but it also reinforces individualism and isolation. Students may shield their internal turmoil behind a mask. The mask of the Super Doctor.
However, as the pandemic has shown, even the most durable of masks will eventually fail. So how do we recognize and accept that help is needed? How do we access support? First, it is vital to acknowledge that there is no shame in asking for help. It is both surprising and reassuring that many of us have been there, an unspoken band of brothers and sisters. Second, remember the acronym for depressive symptoms SIGECAPS (sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicide). Remember that these symptoms may develop gradually or feel sudden and overwhelming. Know that mood lability, tearfulness, and isolation may also be present but confused and disregarded as normal consequences of school, residency, or life as a physician. Third, recognize common behavioral changes associated with anxiety, such as irritability, avoidance, and physical symptoms, including headache, muscle aches, joint pain, GI discomfort, palpitations, and insomnia. Last, reach out to colleagues who have suddenly or gradually withdrawn. Schedule frequent check-ins for one another and do not be afraid to admit that you are human. There is no shame in vulnerability but there is bravery and strength.
If you are in school or residency training, reach out to health centers, training directors, supervisors, family and/or friends. Whether you are an early career physician or amid a decades-long career, connect with your peers, reach out to junior members, offer and accept support. Anonymous hotlines, listservs, email groups, virtual meetings, texts, and phone calls also provide opportunities for wellness checks, pep talks, or venting sessions. All are important. In the case where more specialized help is needed, contact your primary care physician, reach out to colleagues in mental health, contact the Suicide Prevention Lifeline at 1-800 273-8255. Know there is help; you are not alone.
In these unprecedented and uncertain times, remember the African proverb “It takes a village.” To ask for help reveals strength and fortitude. The more we advocate for ourselves and one another, the more we will prevail and shed the myth of infallibility.
Dr. Thomas is a board-certified adult psychiatrist with an interest in chronic illness, women’s behavioral health, and minority mental health. She currently practices in North Kingstown and East Providence, R.I. She has no conflicts of interest.
It’s been more than a year since we came face to face with an unprecedented, unrelenting pandemic. Determined to overcome, determined to forge ahead, we worked tirelessly.
Hours upon hours, days upon days, months upon months. Hoping for recovery while facing the devastation of death. We were praised, and lauded as heroes as we pleaded for essential protective gear and urged our communities to think critically, act responsibly, and distance safely. From the cities to small towns, we answered the call. Leaving long-practiced specialties, reassigned from our practices and training, we worked together uncertain of the future, but committed to safeguarding our present. Through sacrifice we toiled, leaving our families to protect against contagion, wading through halls of the sick and fighting against the threat of death.
As days swept into months, the impact of isolation and economic deceleration yielded cracks on the surface. Pay cuts loomed, furloughs abounded, and distance-learning infiltrated the medical community. Yet, COVID-19 reigned, and with it came frustration, exhaustion, and emotional defeat. Despite racial reckonings, political turmoil, and massive protests, we worked tirelessly. We persevered.
Throughout 2020, the praise of “Health Care Heroes” rang out around the world. We saw images of medical professionals diligently working through the unthinkable with grace and humility, truly sacrificing for the greater good without complaint. Day after day, hour after hour, month after month. All the while, cracks were surfacing, expanding wider, and penetrating deeper. We were weary.
During a recent appointment with my primary care physician, she looked at me, her eyes brimming with earnest compassion, and said, “If you have suicidal thoughts, please let me know. That is my biggest worry with doctors.” I knowingly looked at her, keen in understanding as I recalled the stories. Doctors overwhelmed and uncertain, released by the abrupt completion of suicide.
Although broader government agencies may regulate and enforce, it is up to us to facilitate and comply. The pressure is immense, but our calling is strong – an unspoken agreement that begins with an oath.
As a psychiatrist, I am acutely aware of the warning signs associated with suicidality. Reading through the stories of loss and seeing the bewilderment and despair of the bereft, I once again wonder whether the pressure of medicine is worth the cost. How can we be “Health Care Heroes” if we fail to recognize the fragility that resides within ourselves? Moreover, how do we see beyond the illusion of invulnerability and accept that vulnerability is not a sign of weakness but a hallmark of strength and empathy? These are some of the issues I will be exploring in this new column, Myth of the Super Doctor.
Beginning at the beginning
Addressing these issues starts with training. As a new cohort of eager students enters medical/osteopathic school, the focus should lie not only on foundations of medicine and brute memorization of copious information but also on self-care, wellness checks, and group morale. The same emphasis placed upon patient care and advocacy must also be extended toward ensuring that the next generation of physicians will understand the importance of caring for themselves as much as they care for others.
In the same manner, past stereotypes of ruthless, cut-throat, competition must also evolve. Although the spirit of hard work and perseverance is essential, the manner it propagates is just as important. Aggressive questioning, myriad testing, rigid hierarchies, blind obedience, and ego inflation may separate the pack, but it also reinforces individualism and isolation. Students may shield their internal turmoil behind a mask. The mask of the Super Doctor.
However, as the pandemic has shown, even the most durable of masks will eventually fail. So how do we recognize and accept that help is needed? How do we access support? First, it is vital to acknowledge that there is no shame in asking for help. It is both surprising and reassuring that many of us have been there, an unspoken band of brothers and sisters. Second, remember the acronym for depressive symptoms SIGECAPS (sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicide). Remember that these symptoms may develop gradually or feel sudden and overwhelming. Know that mood lability, tearfulness, and isolation may also be present but confused and disregarded as normal consequences of school, residency, or life as a physician. Third, recognize common behavioral changes associated with anxiety, such as irritability, avoidance, and physical symptoms, including headache, muscle aches, joint pain, GI discomfort, palpitations, and insomnia. Last, reach out to colleagues who have suddenly or gradually withdrawn. Schedule frequent check-ins for one another and do not be afraid to admit that you are human. There is no shame in vulnerability but there is bravery and strength.
If you are in school or residency training, reach out to health centers, training directors, supervisors, family and/or friends. Whether you are an early career physician or amid a decades-long career, connect with your peers, reach out to junior members, offer and accept support. Anonymous hotlines, listservs, email groups, virtual meetings, texts, and phone calls also provide opportunities for wellness checks, pep talks, or venting sessions. All are important. In the case where more specialized help is needed, contact your primary care physician, reach out to colleagues in mental health, contact the Suicide Prevention Lifeline at 1-800 273-8255. Know there is help; you are not alone.
In these unprecedented and uncertain times, remember the African proverb “It takes a village.” To ask for help reveals strength and fortitude. The more we advocate for ourselves and one another, the more we will prevail and shed the myth of infallibility.
Dr. Thomas is a board-certified adult psychiatrist with an interest in chronic illness, women’s behavioral health, and minority mental health. She currently practices in North Kingstown and East Providence, R.I. She has no conflicts of interest.
Medtronic recall of almost 240,000 ICDs is class I, FDA says
The Food and Drug Administration has declared Medtronic’s recall of seven models of defibrillating cardiac rhythm devices, caused by a risk for premature battery depletion, as class I, which implies a potential risk for serious injury or death. A total of 444 complaints, but no deaths, have been reported in association with the 239,171 affected devices, the agency said in a statement on April 12, 2021.
Physicians were notified of the company’s recall in early February. It covered implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy–defibrillator (CRT-D) models Evera, Viva, Brava, Claria, Amplia, Compia, and Visia distributed from Aug. 31, 2012 to May 9, 2018.
The devices could be subject to “an unexpected and rapid decrease in battery life” because of a possible short circuit that could lead to a device-replacement alert “earlier than expected.” Some devices may experience full battery depletion “within as little as 1 day” after such an alert.
“If the user does not respond to the first warning, the device may stop functioning. The likelihood that this issue will occur is constant after approximately 3 years after device use,” the announcement said.
Medtronic recommends device replacement no more than 1 week after such an early warning for patients who are not pacing dependent or who have them for primary prevention, but right away for pacing-dependent patients.
A version of this article first appeared on Medscape.com
The Food and Drug Administration has declared Medtronic’s recall of seven models of defibrillating cardiac rhythm devices, caused by a risk for premature battery depletion, as class I, which implies a potential risk for serious injury or death. A total of 444 complaints, but no deaths, have been reported in association with the 239,171 affected devices, the agency said in a statement on April 12, 2021.
Physicians were notified of the company’s recall in early February. It covered implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy–defibrillator (CRT-D) models Evera, Viva, Brava, Claria, Amplia, Compia, and Visia distributed from Aug. 31, 2012 to May 9, 2018.
The devices could be subject to “an unexpected and rapid decrease in battery life” because of a possible short circuit that could lead to a device-replacement alert “earlier than expected.” Some devices may experience full battery depletion “within as little as 1 day” after such an alert.
“If the user does not respond to the first warning, the device may stop functioning. The likelihood that this issue will occur is constant after approximately 3 years after device use,” the announcement said.
Medtronic recommends device replacement no more than 1 week after such an early warning for patients who are not pacing dependent or who have them for primary prevention, but right away for pacing-dependent patients.
A version of this article first appeared on Medscape.com
The Food and Drug Administration has declared Medtronic’s recall of seven models of defibrillating cardiac rhythm devices, caused by a risk for premature battery depletion, as class I, which implies a potential risk for serious injury or death. A total of 444 complaints, but no deaths, have been reported in association with the 239,171 affected devices, the agency said in a statement on April 12, 2021.
Physicians were notified of the company’s recall in early February. It covered implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy–defibrillator (CRT-D) models Evera, Viva, Brava, Claria, Amplia, Compia, and Visia distributed from Aug. 31, 2012 to May 9, 2018.
The devices could be subject to “an unexpected and rapid decrease in battery life” because of a possible short circuit that could lead to a device-replacement alert “earlier than expected.” Some devices may experience full battery depletion “within as little as 1 day” after such an alert.
“If the user does not respond to the first warning, the device may stop functioning. The likelihood that this issue will occur is constant after approximately 3 years after device use,” the announcement said.
Medtronic recommends device replacement no more than 1 week after such an early warning for patients who are not pacing dependent or who have them for primary prevention, but right away for pacing-dependent patients.
A version of this article first appeared on Medscape.com
Helping your patients navigate the coming out process
“Mom, Dad: I’m gay.” Saying these words can be difficult for anyone but especially for adolescents and young adults. The process of coming out is one filled with anticipation, angst, and hopefully relief. However, this process is not a one-time event but rather something that LGBTQ adolescents and young adults have to face every time they meet someone new or are placed in a new situation. They have to decide if that new person can be trusted with their very personal information.
Coming out is a process that begins months to years before the adolescent or young adult utters the words above. The first step in the coming out process is accepting one’s sexual orientation and/or gender identity. This period of time can be somewhat tumultuous, filled with a mix of emotions ranging from fear to excitement. The adolescent or young adult may need support in coming to terms with who they are as their authentic self. This can take the role of a therapist, a trusted friend, or a trusted family member. There may even be times that the adolescent or young adult’s physician is the only person that they are out to besides their friends. Therefore, you can play a very important role in helping your adolescent and young adult patients as they navigate the journey of coming out.
One of the most important ways that physicians can help adolescents and young adults is to spend time alone with them at as many visits as you can. This gives the patient the time to discuss confidential matters with you, including their sexual orientation and/or gender identity. It is possible that the chronic abdominal pain that your adolescent patient is experiencing may not represent an organic abdominal problem but could represent a manifestation of anxiety because that patient is afraid of his/her parent(s) finding out that he/she identifies as LGBTQ. If one of your patients comes out to you, it is important that you validate for your patient that they are normal as who they are. In addition, you can thank your patient for trusting you with that information and let them know that you are there to support them in whatever way they feel appropriate. Just as important is that you work with the adolescent on a plan for their other concerns that respects their right to privacy in regard to their gender identity and/or sexual orientation.
The adolescent or young adult should always be in control of who knows about their gender identity and/or sexual orientation. Ideally, they should also always be the one who shares that information with others. Many times, parents may react positively to finding out that their child identifies as LGBTQ and want to share that information with their friends or family members. Alternatively, the parent could use the patient’s sexual orientation or gender identity negatively against them to their family and/or friends. As the physician, you can help counsel the family that it should always be their child who gets to share that information and when it is shared.
So how can you support your LGBTQ patients as they navigate the coming out process? First, when you find out from your patient that they identify as LGBTQ, ensure that you ask them who knows about their identity. This prevents inadvertent disclosures to the parent/guardian when the patient is not ready for them to know. Second, discuss with the patient if he/she needs any resources related to their sexual orientation and/or gender identity. This includes things such as the names of local LGBTQ youth organizations or the phone number for the Trevor Project suicide hotline, for example. Third, ensure that your office and staff are a welcoming and affirmative environment for your patients. A 2017 survey by the Human Rights Campaign found that only 8% of transgender or gender-diverse adolescents and young adults were out to all of their physicians and only 5% of LGB adolescents and young adults were out to all of their physicians.1 This is likely because of past negative experiences these patients have had with previous physicians. A 2017 study from the Center for American Progress found that 8% of LGB patients and 29% of transgender or gender-diverse patients said that a doctor or health care provider had refused to see them because of their actual or perceived identity.2 Lastly, you could offer to help facilitate a discussion between the patient and his/her parents in relation to his/her sexual orientation and/or gender identity.
In summary, pediatricians can play an important role in the coming out process of their LGBTQ patients. Your office is an important source of support for the physical and mental health of these patients as they navigate this journey. You can also be a strong advocate for these patients to their parents and families. I think that we all can agree that our patients deserve better than only feeling comfortable to be out to 5%-8% of their physicians.
Dr. Cooper is assistant professor of pediatrics at the University of Texas, Dallas, and an adolescent medicine specialist at Children’s Medical Center Dallas. Contact him at [email protected].
References
1. Human Rights Campaign 2018 LGBTQ Youth Report.
2. Mirza SA and Rooney C. “Discrimination prevents LGBTQ people from accessing health care.” Center for American Progress. 2018 Jan 18.
“Mom, Dad: I’m gay.” Saying these words can be difficult for anyone but especially for adolescents and young adults. The process of coming out is one filled with anticipation, angst, and hopefully relief. However, this process is not a one-time event but rather something that LGBTQ adolescents and young adults have to face every time they meet someone new or are placed in a new situation. They have to decide if that new person can be trusted with their very personal information.
Coming out is a process that begins months to years before the adolescent or young adult utters the words above. The first step in the coming out process is accepting one’s sexual orientation and/or gender identity. This period of time can be somewhat tumultuous, filled with a mix of emotions ranging from fear to excitement. The adolescent or young adult may need support in coming to terms with who they are as their authentic self. This can take the role of a therapist, a trusted friend, or a trusted family member. There may even be times that the adolescent or young adult’s physician is the only person that they are out to besides their friends. Therefore, you can play a very important role in helping your adolescent and young adult patients as they navigate the journey of coming out.
One of the most important ways that physicians can help adolescents and young adults is to spend time alone with them at as many visits as you can. This gives the patient the time to discuss confidential matters with you, including their sexual orientation and/or gender identity. It is possible that the chronic abdominal pain that your adolescent patient is experiencing may not represent an organic abdominal problem but could represent a manifestation of anxiety because that patient is afraid of his/her parent(s) finding out that he/she identifies as LGBTQ. If one of your patients comes out to you, it is important that you validate for your patient that they are normal as who they are. In addition, you can thank your patient for trusting you with that information and let them know that you are there to support them in whatever way they feel appropriate. Just as important is that you work with the adolescent on a plan for their other concerns that respects their right to privacy in regard to their gender identity and/or sexual orientation.
The adolescent or young adult should always be in control of who knows about their gender identity and/or sexual orientation. Ideally, they should also always be the one who shares that information with others. Many times, parents may react positively to finding out that their child identifies as LGBTQ and want to share that information with their friends or family members. Alternatively, the parent could use the patient’s sexual orientation or gender identity negatively against them to their family and/or friends. As the physician, you can help counsel the family that it should always be their child who gets to share that information and when it is shared.
So how can you support your LGBTQ patients as they navigate the coming out process? First, when you find out from your patient that they identify as LGBTQ, ensure that you ask them who knows about their identity. This prevents inadvertent disclosures to the parent/guardian when the patient is not ready for them to know. Second, discuss with the patient if he/she needs any resources related to their sexual orientation and/or gender identity. This includes things such as the names of local LGBTQ youth organizations or the phone number for the Trevor Project suicide hotline, for example. Third, ensure that your office and staff are a welcoming and affirmative environment for your patients. A 2017 survey by the Human Rights Campaign found that only 8% of transgender or gender-diverse adolescents and young adults were out to all of their physicians and only 5% of LGB adolescents and young adults were out to all of their physicians.1 This is likely because of past negative experiences these patients have had with previous physicians. A 2017 study from the Center for American Progress found that 8% of LGB patients and 29% of transgender or gender-diverse patients said that a doctor or health care provider had refused to see them because of their actual or perceived identity.2 Lastly, you could offer to help facilitate a discussion between the patient and his/her parents in relation to his/her sexual orientation and/or gender identity.
In summary, pediatricians can play an important role in the coming out process of their LGBTQ patients. Your office is an important source of support for the physical and mental health of these patients as they navigate this journey. You can also be a strong advocate for these patients to their parents and families. I think that we all can agree that our patients deserve better than only feeling comfortable to be out to 5%-8% of their physicians.
Dr. Cooper is assistant professor of pediatrics at the University of Texas, Dallas, and an adolescent medicine specialist at Children’s Medical Center Dallas. Contact him at [email protected].
References
1. Human Rights Campaign 2018 LGBTQ Youth Report.
2. Mirza SA and Rooney C. “Discrimination prevents LGBTQ people from accessing health care.” Center for American Progress. 2018 Jan 18.
“Mom, Dad: I’m gay.” Saying these words can be difficult for anyone but especially for adolescents and young adults. The process of coming out is one filled with anticipation, angst, and hopefully relief. However, this process is not a one-time event but rather something that LGBTQ adolescents and young adults have to face every time they meet someone new or are placed in a new situation. They have to decide if that new person can be trusted with their very personal information.
Coming out is a process that begins months to years before the adolescent or young adult utters the words above. The first step in the coming out process is accepting one’s sexual orientation and/or gender identity. This period of time can be somewhat tumultuous, filled with a mix of emotions ranging from fear to excitement. The adolescent or young adult may need support in coming to terms with who they are as their authentic self. This can take the role of a therapist, a trusted friend, or a trusted family member. There may even be times that the adolescent or young adult’s physician is the only person that they are out to besides their friends. Therefore, you can play a very important role in helping your adolescent and young adult patients as they navigate the journey of coming out.
One of the most important ways that physicians can help adolescents and young adults is to spend time alone with them at as many visits as you can. This gives the patient the time to discuss confidential matters with you, including their sexual orientation and/or gender identity. It is possible that the chronic abdominal pain that your adolescent patient is experiencing may not represent an organic abdominal problem but could represent a manifestation of anxiety because that patient is afraid of his/her parent(s) finding out that he/she identifies as LGBTQ. If one of your patients comes out to you, it is important that you validate for your patient that they are normal as who they are. In addition, you can thank your patient for trusting you with that information and let them know that you are there to support them in whatever way they feel appropriate. Just as important is that you work with the adolescent on a plan for their other concerns that respects their right to privacy in regard to their gender identity and/or sexual orientation.
The adolescent or young adult should always be in control of who knows about their gender identity and/or sexual orientation. Ideally, they should also always be the one who shares that information with others. Many times, parents may react positively to finding out that their child identifies as LGBTQ and want to share that information with their friends or family members. Alternatively, the parent could use the patient’s sexual orientation or gender identity negatively against them to their family and/or friends. As the physician, you can help counsel the family that it should always be their child who gets to share that information and when it is shared.
So how can you support your LGBTQ patients as they navigate the coming out process? First, when you find out from your patient that they identify as LGBTQ, ensure that you ask them who knows about their identity. This prevents inadvertent disclosures to the parent/guardian when the patient is not ready for them to know. Second, discuss with the patient if he/she needs any resources related to their sexual orientation and/or gender identity. This includes things such as the names of local LGBTQ youth organizations or the phone number for the Trevor Project suicide hotline, for example. Third, ensure that your office and staff are a welcoming and affirmative environment for your patients. A 2017 survey by the Human Rights Campaign found that only 8% of transgender or gender-diverse adolescents and young adults were out to all of their physicians and only 5% of LGB adolescents and young adults were out to all of their physicians.1 This is likely because of past negative experiences these patients have had with previous physicians. A 2017 study from the Center for American Progress found that 8% of LGB patients and 29% of transgender or gender-diverse patients said that a doctor or health care provider had refused to see them because of their actual or perceived identity.2 Lastly, you could offer to help facilitate a discussion between the patient and his/her parents in relation to his/her sexual orientation and/or gender identity.
In summary, pediatricians can play an important role in the coming out process of their LGBTQ patients. Your office is an important source of support for the physical and mental health of these patients as they navigate this journey. You can also be a strong advocate for these patients to their parents and families. I think that we all can agree that our patients deserve better than only feeling comfortable to be out to 5%-8% of their physicians.
Dr. Cooper is assistant professor of pediatrics at the University of Texas, Dallas, and an adolescent medicine specialist at Children’s Medical Center Dallas. Contact him at [email protected].
References
1. Human Rights Campaign 2018 LGBTQ Youth Report.
2. Mirza SA and Rooney C. “Discrimination prevents LGBTQ people from accessing health care.” Center for American Progress. 2018 Jan 18.
Family psychoeducation is critical in care of children with disabilities
Dr. Margaret G. Klitzke is a board-certified child and adolescent psychiatrist who has worked across all settings of the Center for Autism and Developmental Disabilities at Bradley Hospital in East Providence, R.I.
I spoke with Dr. Klitzke recently about her work as an outpatient psychiatrist at the center and about the important role of families in the treatment it provides. The center offers highly specialized clinical services for children and adolescents between the ages of 2 and 18 who show signs of serious emotional and behavioral problems in addition to a developmental disability, such as autism, Asperger’s, or intellectual disability.
The center’s model of care emphasizes family involvement. Dr. Klitzke was trained in family interventions by Nathan B. Epstein, MD, and Duane S. Bishop, MD, the originators of the McMaster approach and the problem-centered systems therapy of the family. This training informs much of her work with families.
ALISON M. HERU, MD: Hello, Dr. Klitzke and thank you for agreeing to this interview.
MARGARET G. KLITZKE, DO: My pleasure.
AMH: I admire your dedication to this population of children and adolescents. To me, it seems very hard to work with patients and families where there is significant disability and there is little hope of the patient “getting better.”
MGK: When parents come to us, they have great hopes their children can be helped. They often express understanding and acceptance of the child’s disability, and seek to understand the psychiatric or behavioral issues. These parents are often very dedicated to their children, giving up careers to care for them. But as professionals, we must be sensitive to the role each parent can play and how they can support each other and the family.
AMH: So much of your work focuses on family inclusion and family psychoeducation?
MGK: Yes. An example that stands out is a couple where the mother had become the voice for the family in dealing with professionals, but she was overwhelmed in this role. So, we invited the father in. He explained that medical professionals and school personnel would address their remarks to his wife and that he felt marginalized. We worked with the couple, now always including the father, and he has gone on to become a vocal advocate for children with disabilities. It is inspiring to watch families become advocates – to insist that others see the child’s strengths – not just weaknesses.
AMH: Do you feel that the families ever come to you with too high expectations of what you can do to help their child?
MGK: As a child psychiatrist, one must put oneself in the parents’ shoes. Charlie Zeanah Jr., MD, and others have done wonderful work in attachment. They have identified that parents have fantasies and beliefs about what the child will be like before the child is born. We all have fantasies about our babies before they come to us! For many families, they quickly come to understand that their child is not like other children. This new world of parenting is not what they expected. A mother once gave me a short piece called “Welcome to Holland,” written by a mother whose child has Down syndrome.
AMH: How do you begin to work with these families? There must be such a sense of loss and tragedy in their lives.
MGK: My first goal is to understand what it is like to have a child with developmental disability, not just for the parents but for the siblings, too. I strive to understand what the parents want for their child and how they see themselves as a family. I see us, the health care team, as agents to help the child and the family be the very best they can be.
AMH: How do you deal with parents who are not be on the same page?
MGK: It is important that parents are consistent and are able to work together. Even if they are divorced, I have seen families able to unite around the care of their child with a disability. This is quite an achievement given the high rates of divorce – although most of the families that I have worked with are intact. As in all families, each member has a role in helping the family function well. It means using the strength of each parent to help them become a parenting team.
AMH: What if the parents have unrealistic expectations of their child?
MGK: Yes, there are parents who come to us with unrealistic expectations, such as believing their nonverbal child will talk some day. In such a case, we must be certain that we have exhausted all methods to help this child communicate, and once we have done all we can, then we must accept where that child is; to accept and help the family accept, the child’s weaknesses and acknowledge their strengths. Change what you can and be a support for everything else.
AMH: I find it hard to imagine caring for a severely disabled child. How do these parents do this?
MGK: These are children who are nonverbal, and children who can be very fragile, even medically. What I see are parents who want to connect, who want to find that something inside that child, that special place where there is connection. That place of reciprocity. That is important to us all, helping the family find that place of reciprocal connection.
AMH: What language do you use to discuss this with families?
MGK: I say, “This is the child’s strength and this is the child’s weakness; capitalize on the strengths and let’s shore up their weaknesses.”
AMH: How do you approach the families? Where do you start?
MGK: I meet the family where they are. One cannot with these families or any families stand rigidly 10 feet away, and demand that they change. This never works, and we will be of no help to them. We must understand the family system and how they have arrived at their current place of functioning.
AMH: Can you give an example?
MGK: Yes, for example if a parent is drinking excessively, I help them understand why they are coping that way and see if they are willing to change.
AMH: What keeps you going ?
MGK: I think it comes back to the family work. For me, I believe the families are doing the very best they can. If the family is really impaired in some way, I see it as my job to figure out why that is their pattern of behavior, and I do what I can to help them facilitate change.
AMH: What inspires you about these families?
MGK: These families are able to recognize the strengths and beauty that their children bring them – the strength of these children, their personalities and their wills of steel! They are able to communicate what they need. Siblings, too, make life decisions based on their experiences. They often end up going down the path of caring for such children as professionals.
AMH: Do you have any recommendations for a young child psychiatrist who might be considering working with this population?
MGK: Developmental disabilities in child psychiatry is where medicine, neurology, and child development meet. The advances in genetics and neurology are major gifts to the field. It used to be that I would have to sell the field to medical students and residents. Now they are coming to me saying that they want to work in this area. It is an intellectually rich field in which to work. There is a real change happening. But the place where it becomes really magical is in working with the families.
AMH: What other changes have you seen?
MGK: With the closure of big institutions, it is less of an option for families to walk away. The families now feel that they need to take care of the child.
AMH: What has your career taught you?
MGK: It has taught me patience, to enter every situation without preconceived notions, and that there is something new to learn every day.
References
J Child Adolesc Psychiatry. 1975 Jun 1;14(3):387-421.
Evaluation and Treating Families: The McMaster Approach. Routledge/Taylor & Francis Group, 2005.
Movies to watch
Lorenzo’s Oil, 1992.
My Left Foot, 1989.
Dr. Heru is professor of psychiatry at the University of Colorado at Denver, Aurora. She is editor of “Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals” (Routledge, 2013). She has no conflicts of interest.
Dr. Klitkze is a 1983 graduate of the Texas College of Osteopathic Medicine, and completed her residency and fellowship training at Brown University, Providence, R.I. She is a member of the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, and the Rhode Island Medical Society, where she serves on the Physicians’ Health Committee. She is actively involved in teaching medical students, residents, and fellows, and has received several teaching awards from the department of psychiatry and human behavior at Brown.
Dr. Margaret G. Klitzke is a board-certified child and adolescent psychiatrist who has worked across all settings of the Center for Autism and Developmental Disabilities at Bradley Hospital in East Providence, R.I.
I spoke with Dr. Klitzke recently about her work as an outpatient psychiatrist at the center and about the important role of families in the treatment it provides. The center offers highly specialized clinical services for children and adolescents between the ages of 2 and 18 who show signs of serious emotional and behavioral problems in addition to a developmental disability, such as autism, Asperger’s, or intellectual disability.
The center’s model of care emphasizes family involvement. Dr. Klitzke was trained in family interventions by Nathan B. Epstein, MD, and Duane S. Bishop, MD, the originators of the McMaster approach and the problem-centered systems therapy of the family. This training informs much of her work with families.
ALISON M. HERU, MD: Hello, Dr. Klitzke and thank you for agreeing to this interview.
MARGARET G. KLITZKE, DO: My pleasure.
AMH: I admire your dedication to this population of children and adolescents. To me, it seems very hard to work with patients and families where there is significant disability and there is little hope of the patient “getting better.”
MGK: When parents come to us, they have great hopes their children can be helped. They often express understanding and acceptance of the child’s disability, and seek to understand the psychiatric or behavioral issues. These parents are often very dedicated to their children, giving up careers to care for them. But as professionals, we must be sensitive to the role each parent can play and how they can support each other and the family.
AMH: So much of your work focuses on family inclusion and family psychoeducation?
MGK: Yes. An example that stands out is a couple where the mother had become the voice for the family in dealing with professionals, but she was overwhelmed in this role. So, we invited the father in. He explained that medical professionals and school personnel would address their remarks to his wife and that he felt marginalized. We worked with the couple, now always including the father, and he has gone on to become a vocal advocate for children with disabilities. It is inspiring to watch families become advocates – to insist that others see the child’s strengths – not just weaknesses.
AMH: Do you feel that the families ever come to you with too high expectations of what you can do to help their child?
MGK: As a child psychiatrist, one must put oneself in the parents’ shoes. Charlie Zeanah Jr., MD, and others have done wonderful work in attachment. They have identified that parents have fantasies and beliefs about what the child will be like before the child is born. We all have fantasies about our babies before they come to us! For many families, they quickly come to understand that their child is not like other children. This new world of parenting is not what they expected. A mother once gave me a short piece called “Welcome to Holland,” written by a mother whose child has Down syndrome.
AMH: How do you begin to work with these families? There must be such a sense of loss and tragedy in their lives.
MGK: My first goal is to understand what it is like to have a child with developmental disability, not just for the parents but for the siblings, too. I strive to understand what the parents want for their child and how they see themselves as a family. I see us, the health care team, as agents to help the child and the family be the very best they can be.
AMH: How do you deal with parents who are not be on the same page?
MGK: It is important that parents are consistent and are able to work together. Even if they are divorced, I have seen families able to unite around the care of their child with a disability. This is quite an achievement given the high rates of divorce – although most of the families that I have worked with are intact. As in all families, each member has a role in helping the family function well. It means using the strength of each parent to help them become a parenting team.
AMH: What if the parents have unrealistic expectations of their child?
MGK: Yes, there are parents who come to us with unrealistic expectations, such as believing their nonverbal child will talk some day. In such a case, we must be certain that we have exhausted all methods to help this child communicate, and once we have done all we can, then we must accept where that child is; to accept and help the family accept, the child’s weaknesses and acknowledge their strengths. Change what you can and be a support for everything else.
AMH: I find it hard to imagine caring for a severely disabled child. How do these parents do this?
MGK: These are children who are nonverbal, and children who can be very fragile, even medically. What I see are parents who want to connect, who want to find that something inside that child, that special place where there is connection. That place of reciprocity. That is important to us all, helping the family find that place of reciprocal connection.
AMH: What language do you use to discuss this with families?
MGK: I say, “This is the child’s strength and this is the child’s weakness; capitalize on the strengths and let’s shore up their weaknesses.”
AMH: How do you approach the families? Where do you start?
MGK: I meet the family where they are. One cannot with these families or any families stand rigidly 10 feet away, and demand that they change. This never works, and we will be of no help to them. We must understand the family system and how they have arrived at their current place of functioning.
AMH: Can you give an example?
MGK: Yes, for example if a parent is drinking excessively, I help them understand why they are coping that way and see if they are willing to change.
AMH: What keeps you going ?
MGK: I think it comes back to the family work. For me, I believe the families are doing the very best they can. If the family is really impaired in some way, I see it as my job to figure out why that is their pattern of behavior, and I do what I can to help them facilitate change.
AMH: What inspires you about these families?
MGK: These families are able to recognize the strengths and beauty that their children bring them – the strength of these children, their personalities and their wills of steel! They are able to communicate what they need. Siblings, too, make life decisions based on their experiences. They often end up going down the path of caring for such children as professionals.
AMH: Do you have any recommendations for a young child psychiatrist who might be considering working with this population?
MGK: Developmental disabilities in child psychiatry is where medicine, neurology, and child development meet. The advances in genetics and neurology are major gifts to the field. It used to be that I would have to sell the field to medical students and residents. Now they are coming to me saying that they want to work in this area. It is an intellectually rich field in which to work. There is a real change happening. But the place where it becomes really magical is in working with the families.
AMH: What other changes have you seen?
MGK: With the closure of big institutions, it is less of an option for families to walk away. The families now feel that they need to take care of the child.
AMH: What has your career taught you?
MGK: It has taught me patience, to enter every situation without preconceived notions, and that there is something new to learn every day.
References
J Child Adolesc Psychiatry. 1975 Jun 1;14(3):387-421.
Evaluation and Treating Families: The McMaster Approach. Routledge/Taylor & Francis Group, 2005.
Movies to watch
Lorenzo’s Oil, 1992.
My Left Foot, 1989.
Dr. Heru is professor of psychiatry at the University of Colorado at Denver, Aurora. She is editor of “Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals” (Routledge, 2013). She has no conflicts of interest.
Dr. Klitkze is a 1983 graduate of the Texas College of Osteopathic Medicine, and completed her residency and fellowship training at Brown University, Providence, R.I. She is a member of the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, and the Rhode Island Medical Society, where she serves on the Physicians’ Health Committee. She is actively involved in teaching medical students, residents, and fellows, and has received several teaching awards from the department of psychiatry and human behavior at Brown.
Dr. Margaret G. Klitzke is a board-certified child and adolescent psychiatrist who has worked across all settings of the Center for Autism and Developmental Disabilities at Bradley Hospital in East Providence, R.I.
I spoke with Dr. Klitzke recently about her work as an outpatient psychiatrist at the center and about the important role of families in the treatment it provides. The center offers highly specialized clinical services for children and adolescents between the ages of 2 and 18 who show signs of serious emotional and behavioral problems in addition to a developmental disability, such as autism, Asperger’s, or intellectual disability.
The center’s model of care emphasizes family involvement. Dr. Klitzke was trained in family interventions by Nathan B. Epstein, MD, and Duane S. Bishop, MD, the originators of the McMaster approach and the problem-centered systems therapy of the family. This training informs much of her work with families.
ALISON M. HERU, MD: Hello, Dr. Klitzke and thank you for agreeing to this interview.
MARGARET G. KLITZKE, DO: My pleasure.
AMH: I admire your dedication to this population of children and adolescents. To me, it seems very hard to work with patients and families where there is significant disability and there is little hope of the patient “getting better.”
MGK: When parents come to us, they have great hopes their children can be helped. They often express understanding and acceptance of the child’s disability, and seek to understand the psychiatric or behavioral issues. These parents are often very dedicated to their children, giving up careers to care for them. But as professionals, we must be sensitive to the role each parent can play and how they can support each other and the family.
AMH: So much of your work focuses on family inclusion and family psychoeducation?
MGK: Yes. An example that stands out is a couple where the mother had become the voice for the family in dealing with professionals, but she was overwhelmed in this role. So, we invited the father in. He explained that medical professionals and school personnel would address their remarks to his wife and that he felt marginalized. We worked with the couple, now always including the father, and he has gone on to become a vocal advocate for children with disabilities. It is inspiring to watch families become advocates – to insist that others see the child’s strengths – not just weaknesses.
AMH: Do you feel that the families ever come to you with too high expectations of what you can do to help their child?
MGK: As a child psychiatrist, one must put oneself in the parents’ shoes. Charlie Zeanah Jr., MD, and others have done wonderful work in attachment. They have identified that parents have fantasies and beliefs about what the child will be like before the child is born. We all have fantasies about our babies before they come to us! For many families, they quickly come to understand that their child is not like other children. This new world of parenting is not what they expected. A mother once gave me a short piece called “Welcome to Holland,” written by a mother whose child has Down syndrome.
AMH: How do you begin to work with these families? There must be such a sense of loss and tragedy in their lives.
MGK: My first goal is to understand what it is like to have a child with developmental disability, not just for the parents but for the siblings, too. I strive to understand what the parents want for their child and how they see themselves as a family. I see us, the health care team, as agents to help the child and the family be the very best they can be.
AMH: How do you deal with parents who are not be on the same page?
MGK: It is important that parents are consistent and are able to work together. Even if they are divorced, I have seen families able to unite around the care of their child with a disability. This is quite an achievement given the high rates of divorce – although most of the families that I have worked with are intact. As in all families, each member has a role in helping the family function well. It means using the strength of each parent to help them become a parenting team.
AMH: What if the parents have unrealistic expectations of their child?
MGK: Yes, there are parents who come to us with unrealistic expectations, such as believing their nonverbal child will talk some day. In such a case, we must be certain that we have exhausted all methods to help this child communicate, and once we have done all we can, then we must accept where that child is; to accept and help the family accept, the child’s weaknesses and acknowledge their strengths. Change what you can and be a support for everything else.
AMH: I find it hard to imagine caring for a severely disabled child. How do these parents do this?
MGK: These are children who are nonverbal, and children who can be very fragile, even medically. What I see are parents who want to connect, who want to find that something inside that child, that special place where there is connection. That place of reciprocity. That is important to us all, helping the family find that place of reciprocal connection.
AMH: What language do you use to discuss this with families?
MGK: I say, “This is the child’s strength and this is the child’s weakness; capitalize on the strengths and let’s shore up their weaknesses.”
AMH: How do you approach the families? Where do you start?
MGK: I meet the family where they are. One cannot with these families or any families stand rigidly 10 feet away, and demand that they change. This never works, and we will be of no help to them. We must understand the family system and how they have arrived at their current place of functioning.
AMH: Can you give an example?
MGK: Yes, for example if a parent is drinking excessively, I help them understand why they are coping that way and see if they are willing to change.
AMH: What keeps you going ?
MGK: I think it comes back to the family work. For me, I believe the families are doing the very best they can. If the family is really impaired in some way, I see it as my job to figure out why that is their pattern of behavior, and I do what I can to help them facilitate change.
AMH: What inspires you about these families?
MGK: These families are able to recognize the strengths and beauty that their children bring them – the strength of these children, their personalities and their wills of steel! They are able to communicate what they need. Siblings, too, make life decisions based on their experiences. They often end up going down the path of caring for such children as professionals.
AMH: Do you have any recommendations for a young child psychiatrist who might be considering working with this population?
MGK: Developmental disabilities in child psychiatry is where medicine, neurology, and child development meet. The advances in genetics and neurology are major gifts to the field. It used to be that I would have to sell the field to medical students and residents. Now they are coming to me saying that they want to work in this area. It is an intellectually rich field in which to work. There is a real change happening. But the place where it becomes really magical is in working with the families.
AMH: What other changes have you seen?
MGK: With the closure of big institutions, it is less of an option for families to walk away. The families now feel that they need to take care of the child.
AMH: What has your career taught you?
MGK: It has taught me patience, to enter every situation without preconceived notions, and that there is something new to learn every day.
References
J Child Adolesc Psychiatry. 1975 Jun 1;14(3):387-421.
Evaluation and Treating Families: The McMaster Approach. Routledge/Taylor & Francis Group, 2005.
Movies to watch
Lorenzo’s Oil, 1992.
My Left Foot, 1989.
Dr. Heru is professor of psychiatry at the University of Colorado at Denver, Aurora. She is editor of “Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals” (Routledge, 2013). She has no conflicts of interest.
Dr. Klitkze is a 1983 graduate of the Texas College of Osteopathic Medicine, and completed her residency and fellowship training at Brown University, Providence, R.I. She is a member of the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, and the Rhode Island Medical Society, where she serves on the Physicians’ Health Committee. She is actively involved in teaching medical students, residents, and fellows, and has received several teaching awards from the department of psychiatry and human behavior at Brown.
Survey shines light on pediatric dermatologists’ earnings
For one thing, the median total compensation for the 162 pediatric dermatologists whose survey responses were included in the final data set was a somewhat lower $335,000, the SPD said in its 2020 Pediatric Dermatology Physician Compensation Report.
Getting back to the mean, average earnings were highest, over $505,000, among those working in hospitals/health systems, followed by independent group practices at $436,000, while those working in academic hospitals/health systems – the most popular type of ownership entity (69% of all respondents) – had a mean compensation of $323,000, the SPD said in the report.
At a more basic level, average earnings tilted toward men over women, $411,000-$335,000, although a majority of the respondents (78%) were female, according to the SPD.
Patient mix produced a strong trend of increasing earnings with decreasing pediatric case load. Average compensation was lowest among those who saw 98%-100% pediatric patients ($330,000), rose for physicians who saw 80%-97% ($345,000) and 50%-79% children ($398,000), and topped out at $444,000 for those who saw fewer than 50% children, the SPD data show.
The number of pediatric dermatologists working in a practice also had an effect: Average compensation in practices with 1-2 such specialists was almost $380,000 in 2019, compared with $340,000 in groups with 6-10 pediatric dermatologists and $314,000 for those with 3-5. There were too few groups with more than 10 to meet the sample-size criteria, the SPD noted.
Average starting salary was $286,000 for the 17 respondents who reported that they were newly hired for full-time positions, with a median of $262,500, which was “22% lower than the median clinical compensation reported by pediatric dermatology physicians hired prior to 2019,” the report indicated.
Respondents also were asked about issues of satisfaction and burnout, and these data include responses from additional physicians (for a total of 193) not included in the compensation data set.
The largest share, 79%, said that patient relationships were most satisfying factor of their profession, with intellectual stimulation next at 59% and interaction with colleagues third at 42%. The least satisfying elements were regulatory/paperwork burdens (80%), inefficient EHR design/interoperability (37%), and the commoditization of medicine (21%), the SPD said.
Feelings of burnout were common among almost a quarter of pediatric dermatologists, with 3.1% saying they always have such feelings and 21.2% disclosing that they often feel burned out. Only 5.2% said that they never have feelings of burnout, the SPD reported.
Demographically speaking, 71% of those surveyed identified as White, 22% as Asian, 8.5% as Hispanic/Latino/Spanish, 2.5% as Middle Eastern or North African, and 2.5% as Black or African American. The largest age group, with 61% of all respondents, was 36-50 years, and geography gave the East a slight edge over the West, 30% to 28%, although California had the largest share by state, 17.4%, the report said.
For one thing, the median total compensation for the 162 pediatric dermatologists whose survey responses were included in the final data set was a somewhat lower $335,000, the SPD said in its 2020 Pediatric Dermatology Physician Compensation Report.
Getting back to the mean, average earnings were highest, over $505,000, among those working in hospitals/health systems, followed by independent group practices at $436,000, while those working in academic hospitals/health systems – the most popular type of ownership entity (69% of all respondents) – had a mean compensation of $323,000, the SPD said in the report.
At a more basic level, average earnings tilted toward men over women, $411,000-$335,000, although a majority of the respondents (78%) were female, according to the SPD.
Patient mix produced a strong trend of increasing earnings with decreasing pediatric case load. Average compensation was lowest among those who saw 98%-100% pediatric patients ($330,000), rose for physicians who saw 80%-97% ($345,000) and 50%-79% children ($398,000), and topped out at $444,000 for those who saw fewer than 50% children, the SPD data show.
The number of pediatric dermatologists working in a practice also had an effect: Average compensation in practices with 1-2 such specialists was almost $380,000 in 2019, compared with $340,000 in groups with 6-10 pediatric dermatologists and $314,000 for those with 3-5. There were too few groups with more than 10 to meet the sample-size criteria, the SPD noted.
Average starting salary was $286,000 for the 17 respondents who reported that they were newly hired for full-time positions, with a median of $262,500, which was “22% lower than the median clinical compensation reported by pediatric dermatology physicians hired prior to 2019,” the report indicated.
Respondents also were asked about issues of satisfaction and burnout, and these data include responses from additional physicians (for a total of 193) not included in the compensation data set.
The largest share, 79%, said that patient relationships were most satisfying factor of their profession, with intellectual stimulation next at 59% and interaction with colleagues third at 42%. The least satisfying elements were regulatory/paperwork burdens (80%), inefficient EHR design/interoperability (37%), and the commoditization of medicine (21%), the SPD said.
Feelings of burnout were common among almost a quarter of pediatric dermatologists, with 3.1% saying they always have such feelings and 21.2% disclosing that they often feel burned out. Only 5.2% said that they never have feelings of burnout, the SPD reported.
Demographically speaking, 71% of those surveyed identified as White, 22% as Asian, 8.5% as Hispanic/Latino/Spanish, 2.5% as Middle Eastern or North African, and 2.5% as Black or African American. The largest age group, with 61% of all respondents, was 36-50 years, and geography gave the East a slight edge over the West, 30% to 28%, although California had the largest share by state, 17.4%, the report said.
For one thing, the median total compensation for the 162 pediatric dermatologists whose survey responses were included in the final data set was a somewhat lower $335,000, the SPD said in its 2020 Pediatric Dermatology Physician Compensation Report.
Getting back to the mean, average earnings were highest, over $505,000, among those working in hospitals/health systems, followed by independent group practices at $436,000, while those working in academic hospitals/health systems – the most popular type of ownership entity (69% of all respondents) – had a mean compensation of $323,000, the SPD said in the report.
At a more basic level, average earnings tilted toward men over women, $411,000-$335,000, although a majority of the respondents (78%) were female, according to the SPD.
Patient mix produced a strong trend of increasing earnings with decreasing pediatric case load. Average compensation was lowest among those who saw 98%-100% pediatric patients ($330,000), rose for physicians who saw 80%-97% ($345,000) and 50%-79% children ($398,000), and topped out at $444,000 for those who saw fewer than 50% children, the SPD data show.
The number of pediatric dermatologists working in a practice also had an effect: Average compensation in practices with 1-2 such specialists was almost $380,000 in 2019, compared with $340,000 in groups with 6-10 pediatric dermatologists and $314,000 for those with 3-5. There were too few groups with more than 10 to meet the sample-size criteria, the SPD noted.
Average starting salary was $286,000 for the 17 respondents who reported that they were newly hired for full-time positions, with a median of $262,500, which was “22% lower than the median clinical compensation reported by pediatric dermatology physicians hired prior to 2019,” the report indicated.
Respondents also were asked about issues of satisfaction and burnout, and these data include responses from additional physicians (for a total of 193) not included in the compensation data set.
The largest share, 79%, said that patient relationships were most satisfying factor of their profession, with intellectual stimulation next at 59% and interaction with colleagues third at 42%. The least satisfying elements were regulatory/paperwork burdens (80%), inefficient EHR design/interoperability (37%), and the commoditization of medicine (21%), the SPD said.
Feelings of burnout were common among almost a quarter of pediatric dermatologists, with 3.1% saying they always have such feelings and 21.2% disclosing that they often feel burned out. Only 5.2% said that they never have feelings of burnout, the SPD reported.
Demographically speaking, 71% of those surveyed identified as White, 22% as Asian, 8.5% as Hispanic/Latino/Spanish, 2.5% as Middle Eastern or North African, and 2.5% as Black or African American. The largest age group, with 61% of all respondents, was 36-50 years, and geography gave the East a slight edge over the West, 30% to 28%, although California had the largest share by state, 17.4%, the report said.
Next winter may be rough: Models predict ‘considerable surge’ of COVID
It’s likely the United States will see another surge of COVID-19 this winter, warned Christopher Murray, MD, director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle.
Speaking at the national conference of State of Reform on April 8, Dr. Murray cited the seasonality of the SARS-CoV-2 virus, which wanes in the summer and waxes in the winter. The “optimistic forecast” of IHME, which has modeled the course of the pandemic for the past 13 months, is that daily deaths will rise a bit in the next month, then decline from May through August, he said.
“Summer should be fairly quiet in terms of COVID, if vaccinations rise and people don’t stop wearing masks,” Dr. Murray said.
But he added that “a considerable surge will occur over next winter,” because the new variants are more transmissible, and people will likely relax social distancing and mask wearing. The IHME predicts that the percentage of Americans who usually don masks will decline from 73% today to 21% by Aug. 1.
With a rapid decline in mask use and a rise in mobility, there will still be more than 1,000 deaths each day by July 1, Dr. Murray said. In a forecast released the day after Dr. Murray spoke, the IHME predicted that by Aug. 1, there will be a total of 618,523 U.S. deaths from COVID-19. Deaths could be as high as 696,651 if mobility among the vaccinated returns to prepandemic levels, the institute forecasts.
Based on cell phone data, Dr. Murray said, the amount of mobility in the United States has already risen to the level of March 2020, when the pandemic was just getting underway.
Decreased infections
If there’s one piece of good news in the latest IHME report, it’s that the estimated number of people infected (including those not tested) will drop from 111,581 today to a projected 17,502 on Aug. 1. But in a worst-case scenario, with sharply higher mobility among vaccinated people, the case count on that date would only fall to 73,842.
The SARS-CoV-2 variants are another factor of concern. Dr. Murray distinguished between variants like the one first identified in the U.K. (B.1.1.7) and other “escape variants.”
B.1.1.7, which is now the dominant strain in the United States, increases transmission but doesn’t necessarily escape the immune system or vaccines, he explained.
In contrast, if someone is infected with a variant such as the South African or the Brazilian mutations, he said, a previous COVID-19 infection might not protect the person, and vaccines are less effective against those variants.
Cross-variant immunity may range from 0% to 60% for escape variants, based on the slim amount of data now available, Dr. Murray said. In his view, these variants will be the long-term driver of the pandemic in the United States, while the United Kingdom variant is the short-term driver.
The latest data, he said, show that the Pfizer/BioNTech and Moderna vaccines are 75% effective against the escape variants, with lower efficacy for other vaccines. But booster shots may still be required to protect people against some variants.
Human factors
Human behavior will also help determine the course of the pandemic, he noted. Vaccine hesitancy, for example, is still high in the United States.
By the end of May, he predicted, about 180 million people will have received about two doses of vaccine. After that, he said, “vaccination will flatline due to lack of demand.” The two unknowns are how much campaigns to promote vaccination will increase vaccine confidence, and when children will be vaccinated.
In the United States, he said, 69% of adults have been vaccinated or want to get a shot. But that percentage has dropped 5 points since February, and vaccine confidence varies by state.
Dr. Murray emphasized that the winter surge he predicts can be blocked if people change their behaviors. These include a rise in vaccine confidence to 80% and continued mask wearing by most people.
However, if vaccine confidence and mask wearing decline, state governments continue to drop social distancing rules, and the uptake of boosters is low, the winter surge could be more serious, he said.
Double surge
Murray also raised the possibility of a double surge of COVID-19 and influenza this winter. Widely expected last winter, this double surge never materialized here or elsewhere, partly because of mask wearing. But Dr. Murray said it could happen this year: History shows that the flu tends to be stronger in years after weak outbreaks.
He advised hospitals to prepare now for whatever might come later this year. Public health authorities, he said, should speed up vaccination, monitor variants closely with additional sequencing, and try to modify behavior in high-risk groups.
Asked to explain the recent surge of COVID-19 cases in Michigan, Dr. Murray attributed it partly to the spread of the B.1.1.7 (U.K.) variant. But he noted that the U.K. variant has expanded even more widely in some other states that haven’t had an explosive surge like Michigan’s.
Moreover, he noted, Michigan doesn’t have low mask use or high mobility. So the upward spiral of COVID-19 infections there is very concerning, he said.
In regard to the role of children as reservoirs of the virus, Dr. Murray pointed out that views on this have changed around the world. For a while, people thought kids didn’t spread COVID-19 very much. That view shifted when U.K. data showed that child transmission of the B.1.1.7 variant increased by half to 9% of contacts in comparison with the original virus strain.
Dutch data, similarly, showed schools contributing to the latest outbreaks, and some European nations have closed schools. In the United States, the trend is to open them.
A version of this article first appeared on Medscape.com.
It’s likely the United States will see another surge of COVID-19 this winter, warned Christopher Murray, MD, director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle.
Speaking at the national conference of State of Reform on April 8, Dr. Murray cited the seasonality of the SARS-CoV-2 virus, which wanes in the summer and waxes in the winter. The “optimistic forecast” of IHME, which has modeled the course of the pandemic for the past 13 months, is that daily deaths will rise a bit in the next month, then decline from May through August, he said.
“Summer should be fairly quiet in terms of COVID, if vaccinations rise and people don’t stop wearing masks,” Dr. Murray said.
But he added that “a considerable surge will occur over next winter,” because the new variants are more transmissible, and people will likely relax social distancing and mask wearing. The IHME predicts that the percentage of Americans who usually don masks will decline from 73% today to 21% by Aug. 1.
With a rapid decline in mask use and a rise in mobility, there will still be more than 1,000 deaths each day by July 1, Dr. Murray said. In a forecast released the day after Dr. Murray spoke, the IHME predicted that by Aug. 1, there will be a total of 618,523 U.S. deaths from COVID-19. Deaths could be as high as 696,651 if mobility among the vaccinated returns to prepandemic levels, the institute forecasts.
Based on cell phone data, Dr. Murray said, the amount of mobility in the United States has already risen to the level of March 2020, when the pandemic was just getting underway.
Decreased infections
If there’s one piece of good news in the latest IHME report, it’s that the estimated number of people infected (including those not tested) will drop from 111,581 today to a projected 17,502 on Aug. 1. But in a worst-case scenario, with sharply higher mobility among vaccinated people, the case count on that date would only fall to 73,842.
The SARS-CoV-2 variants are another factor of concern. Dr. Murray distinguished between variants like the one first identified in the U.K. (B.1.1.7) and other “escape variants.”
B.1.1.7, which is now the dominant strain in the United States, increases transmission but doesn’t necessarily escape the immune system or vaccines, he explained.
In contrast, if someone is infected with a variant such as the South African or the Brazilian mutations, he said, a previous COVID-19 infection might not protect the person, and vaccines are less effective against those variants.
Cross-variant immunity may range from 0% to 60% for escape variants, based on the slim amount of data now available, Dr. Murray said. In his view, these variants will be the long-term driver of the pandemic in the United States, while the United Kingdom variant is the short-term driver.
The latest data, he said, show that the Pfizer/BioNTech and Moderna vaccines are 75% effective against the escape variants, with lower efficacy for other vaccines. But booster shots may still be required to protect people against some variants.
Human factors
Human behavior will also help determine the course of the pandemic, he noted. Vaccine hesitancy, for example, is still high in the United States.
By the end of May, he predicted, about 180 million people will have received about two doses of vaccine. After that, he said, “vaccination will flatline due to lack of demand.” The two unknowns are how much campaigns to promote vaccination will increase vaccine confidence, and when children will be vaccinated.
In the United States, he said, 69% of adults have been vaccinated or want to get a shot. But that percentage has dropped 5 points since February, and vaccine confidence varies by state.
Dr. Murray emphasized that the winter surge he predicts can be blocked if people change their behaviors. These include a rise in vaccine confidence to 80% and continued mask wearing by most people.
However, if vaccine confidence and mask wearing decline, state governments continue to drop social distancing rules, and the uptake of boosters is low, the winter surge could be more serious, he said.
Double surge
Murray also raised the possibility of a double surge of COVID-19 and influenza this winter. Widely expected last winter, this double surge never materialized here or elsewhere, partly because of mask wearing. But Dr. Murray said it could happen this year: History shows that the flu tends to be stronger in years after weak outbreaks.
He advised hospitals to prepare now for whatever might come later this year. Public health authorities, he said, should speed up vaccination, monitor variants closely with additional sequencing, and try to modify behavior in high-risk groups.
Asked to explain the recent surge of COVID-19 cases in Michigan, Dr. Murray attributed it partly to the spread of the B.1.1.7 (U.K.) variant. But he noted that the U.K. variant has expanded even more widely in some other states that haven’t had an explosive surge like Michigan’s.
Moreover, he noted, Michigan doesn’t have low mask use or high mobility. So the upward spiral of COVID-19 infections there is very concerning, he said.
In regard to the role of children as reservoirs of the virus, Dr. Murray pointed out that views on this have changed around the world. For a while, people thought kids didn’t spread COVID-19 very much. That view shifted when U.K. data showed that child transmission of the B.1.1.7 variant increased by half to 9% of contacts in comparison with the original virus strain.
Dutch data, similarly, showed schools contributing to the latest outbreaks, and some European nations have closed schools. In the United States, the trend is to open them.
A version of this article first appeared on Medscape.com.
It’s likely the United States will see another surge of COVID-19 this winter, warned Christopher Murray, MD, director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle.
Speaking at the national conference of State of Reform on April 8, Dr. Murray cited the seasonality of the SARS-CoV-2 virus, which wanes in the summer and waxes in the winter. The “optimistic forecast” of IHME, which has modeled the course of the pandemic for the past 13 months, is that daily deaths will rise a bit in the next month, then decline from May through August, he said.
“Summer should be fairly quiet in terms of COVID, if vaccinations rise and people don’t stop wearing masks,” Dr. Murray said.
But he added that “a considerable surge will occur over next winter,” because the new variants are more transmissible, and people will likely relax social distancing and mask wearing. The IHME predicts that the percentage of Americans who usually don masks will decline from 73% today to 21% by Aug. 1.
With a rapid decline in mask use and a rise in mobility, there will still be more than 1,000 deaths each day by July 1, Dr. Murray said. In a forecast released the day after Dr. Murray spoke, the IHME predicted that by Aug. 1, there will be a total of 618,523 U.S. deaths from COVID-19. Deaths could be as high as 696,651 if mobility among the vaccinated returns to prepandemic levels, the institute forecasts.
Based on cell phone data, Dr. Murray said, the amount of mobility in the United States has already risen to the level of March 2020, when the pandemic was just getting underway.
Decreased infections
If there’s one piece of good news in the latest IHME report, it’s that the estimated number of people infected (including those not tested) will drop from 111,581 today to a projected 17,502 on Aug. 1. But in a worst-case scenario, with sharply higher mobility among vaccinated people, the case count on that date would only fall to 73,842.
The SARS-CoV-2 variants are another factor of concern. Dr. Murray distinguished between variants like the one first identified in the U.K. (B.1.1.7) and other “escape variants.”
B.1.1.7, which is now the dominant strain in the United States, increases transmission but doesn’t necessarily escape the immune system or vaccines, he explained.
In contrast, if someone is infected with a variant such as the South African or the Brazilian mutations, he said, a previous COVID-19 infection might not protect the person, and vaccines are less effective against those variants.
Cross-variant immunity may range from 0% to 60% for escape variants, based on the slim amount of data now available, Dr. Murray said. In his view, these variants will be the long-term driver of the pandemic in the United States, while the United Kingdom variant is the short-term driver.
The latest data, he said, show that the Pfizer/BioNTech and Moderna vaccines are 75% effective against the escape variants, with lower efficacy for other vaccines. But booster shots may still be required to protect people against some variants.
Human factors
Human behavior will also help determine the course of the pandemic, he noted. Vaccine hesitancy, for example, is still high in the United States.
By the end of May, he predicted, about 180 million people will have received about two doses of vaccine. After that, he said, “vaccination will flatline due to lack of demand.” The two unknowns are how much campaigns to promote vaccination will increase vaccine confidence, and when children will be vaccinated.
In the United States, he said, 69% of adults have been vaccinated or want to get a shot. But that percentage has dropped 5 points since February, and vaccine confidence varies by state.
Dr. Murray emphasized that the winter surge he predicts can be blocked if people change their behaviors. These include a rise in vaccine confidence to 80% and continued mask wearing by most people.
However, if vaccine confidence and mask wearing decline, state governments continue to drop social distancing rules, and the uptake of boosters is low, the winter surge could be more serious, he said.
Double surge
Murray also raised the possibility of a double surge of COVID-19 and influenza this winter. Widely expected last winter, this double surge never materialized here or elsewhere, partly because of mask wearing. But Dr. Murray said it could happen this year: History shows that the flu tends to be stronger in years after weak outbreaks.
He advised hospitals to prepare now for whatever might come later this year. Public health authorities, he said, should speed up vaccination, monitor variants closely with additional sequencing, and try to modify behavior in high-risk groups.
Asked to explain the recent surge of COVID-19 cases in Michigan, Dr. Murray attributed it partly to the spread of the B.1.1.7 (U.K.) variant. But he noted that the U.K. variant has expanded even more widely in some other states that haven’t had an explosive surge like Michigan’s.
Moreover, he noted, Michigan doesn’t have low mask use or high mobility. So the upward spiral of COVID-19 infections there is very concerning, he said.
In regard to the role of children as reservoirs of the virus, Dr. Murray pointed out that views on this have changed around the world. For a while, people thought kids didn’t spread COVID-19 very much. That view shifted when U.K. data showed that child transmission of the B.1.1.7 variant increased by half to 9% of contacts in comparison with the original virus strain.
Dutch data, similarly, showed schools contributing to the latest outbreaks, and some European nations have closed schools. In the United States, the trend is to open them.
A version of this article first appeared on Medscape.com.
Healthy lifestyle may offset genetic risk in prostate cancer
In men at the highest risk of dying from prostate cancer, having the highest healthy lifestyle scores cut the risk of fatal disease in half, said study author Anna Plym, PhD, of Brigham and Women’s Hospital and Harvard School of Public Health, both in Boston. She presented these findings at the American Association for Cancer Research Annual Meeting 2021: Week 1 (Abstract 822).
Dr. Plym noted that about 58% of the variability in prostate cancer risk is accounted for by genetic factors, with common single-nucleotide polymorphisms (SNPs) accounting for a substantial proportion of prostate cancer susceptibility.
A recent study showed that a polygenic risk score (PRS) derived by combining information from 269 SNPs was “highly predictive” of prostate cancer, Dr. Plym said. There was a 10-fold gradient in disease risk between the lowest and highest genetic risk deciles, and the pattern was consistent across ethnic groups.
In addition, Dr. Plym noted, previous studies have suggested that a healthy lifestyle reduces lethal prostate cancer risk.
What has remained unclear is whether the risk for both developing prostate cancer and experiencing progression to lethal disease can be offset by adherence to a healthy lifestyle.
To investigate, Dr. Plym and colleagues used the 269-SNP PRS to quantify the genetic risk of prostate cancer in 10,443 men enrolled in the Health Professionals Follow-up Study. The men were divided into quartiles according to genetic risk.
The investigators also classified the men using a validated lifestyle score. For this score, one point was given for each of the following: not currently smoking or having quit 10 or more years ago, body mass index under 30 kg/m2, high vigorous physical activity, high intake of tomatoes and fatty fish, and low intake of processed meat. Patients with 1-2 points were considered the least healthy, those with 3 points were moderately healthy, and those with 4-6 points were the most healthy.
The outcomes assessed were overall prostate cancer and lethal prostate cancer (i.e., metastatic disease or prostate cancer–specific death).
No overall benefit of healthy lifestyle
At a median follow-up of 18 years, 2,111 cases of prostate cancer were observed. And at a median follow-up of 22 years, 238 lethal prostate cancer events occurred.
Men in the highest genetic risk quartile were five times more likely to develop prostate cancer (hazard ratio, 5.39; 95% confidence interval, 4.59-6.34) and three times more likely to develop lethal prostate cancer (HR, 3.43; 95% CI, 2.29-5.14), when compared with men in the lowest genetic risk quartile.
Adherence to a healthy lifestyle did not decrease the risk of prostate cancer overall (HR, 1.01; 95% CI, 0.84-1.22), nor did it affect men in the lower genetic risk quartiles.
However, healthy lifestyle did appear to affect men in the highest genetic risk quartile. Men with the highest healthy lifestyle scores had roughly half the risk of lethal prostate cancer, compared to men with the lowest lifestyle scores (3% vs. 6%).
A counterbalance to genetic risk
Dr. Plym observed that the rate of lethal disease in men with the best lifestyle scores matched the rate for the study population as a whole (3%), suggesting that healthy lifestyle may counterbalance high genetic risk.
She added that previous research has confirmed physical activity as a protective factor, but more study is needed to shed light on the relative benefit of the healthy lifestyle components.
In addition, further research is necessary to explain why the benefit was limited to lethal prostate cancer risk in men with the highest genetic risk.
Dr. Plym speculated that the genetic variants contributing to a high PRS may also be the variants that have the strongest interaction with lifestyle factors. For men with a genetic predisposition to prostate cancer, she added, these findings underscore the potential value of surveillance.
“Our findings add to current evidence suggesting that men with a high genetic risk may benefit from a targeted prostate cancer screening program, aiming at detecting a potentially lethal prostate cancer while it is still curable,” she said.
Charles Swanton, MBPhD, of the Francis Crick Institute and UCL Cancer Institute in London, raised the possibility that competing risk issues could be at play.
If a healthy lifestyle leads to longer life, he asked, does that make it more likely that patients will live long enough to die from their prostate cancer because they are not dying from cardiovascular disease, complications of diabetes, etc.? In that case, is the healthy lifestyle really affecting prostate cancer at all?
Dr. Plym responded that, among those in the highest genetic risk group with an unhealthy lifestyle, the increased risk for prostate cancer exceeded the risk for other illnesses.
This study was funded by the DiNovi Family Foundation, the National Cancer Institute, the William Casey Foundation, the Swedish Society for Medical Research, and the Prostate Cancer Foundation. Dr. Plym declared no conflicts of interest. Dr. Swanton disclosed relationships with numerous companies, including Pfizer, Novartis, and GlaxoSmithKline.
In men at the highest risk of dying from prostate cancer, having the highest healthy lifestyle scores cut the risk of fatal disease in half, said study author Anna Plym, PhD, of Brigham and Women’s Hospital and Harvard School of Public Health, both in Boston. She presented these findings at the American Association for Cancer Research Annual Meeting 2021: Week 1 (Abstract 822).
Dr. Plym noted that about 58% of the variability in prostate cancer risk is accounted for by genetic factors, with common single-nucleotide polymorphisms (SNPs) accounting for a substantial proportion of prostate cancer susceptibility.
A recent study showed that a polygenic risk score (PRS) derived by combining information from 269 SNPs was “highly predictive” of prostate cancer, Dr. Plym said. There was a 10-fold gradient in disease risk between the lowest and highest genetic risk deciles, and the pattern was consistent across ethnic groups.
In addition, Dr. Plym noted, previous studies have suggested that a healthy lifestyle reduces lethal prostate cancer risk.
What has remained unclear is whether the risk for both developing prostate cancer and experiencing progression to lethal disease can be offset by adherence to a healthy lifestyle.
To investigate, Dr. Plym and colleagues used the 269-SNP PRS to quantify the genetic risk of prostate cancer in 10,443 men enrolled in the Health Professionals Follow-up Study. The men were divided into quartiles according to genetic risk.
The investigators also classified the men using a validated lifestyle score. For this score, one point was given for each of the following: not currently smoking or having quit 10 or more years ago, body mass index under 30 kg/m2, high vigorous physical activity, high intake of tomatoes and fatty fish, and low intake of processed meat. Patients with 1-2 points were considered the least healthy, those with 3 points were moderately healthy, and those with 4-6 points were the most healthy.
The outcomes assessed were overall prostate cancer and lethal prostate cancer (i.e., metastatic disease or prostate cancer–specific death).
No overall benefit of healthy lifestyle
At a median follow-up of 18 years, 2,111 cases of prostate cancer were observed. And at a median follow-up of 22 years, 238 lethal prostate cancer events occurred.
Men in the highest genetic risk quartile were five times more likely to develop prostate cancer (hazard ratio, 5.39; 95% confidence interval, 4.59-6.34) and three times more likely to develop lethal prostate cancer (HR, 3.43; 95% CI, 2.29-5.14), when compared with men in the lowest genetic risk quartile.
Adherence to a healthy lifestyle did not decrease the risk of prostate cancer overall (HR, 1.01; 95% CI, 0.84-1.22), nor did it affect men in the lower genetic risk quartiles.
However, healthy lifestyle did appear to affect men in the highest genetic risk quartile. Men with the highest healthy lifestyle scores had roughly half the risk of lethal prostate cancer, compared to men with the lowest lifestyle scores (3% vs. 6%).
A counterbalance to genetic risk
Dr. Plym observed that the rate of lethal disease in men with the best lifestyle scores matched the rate for the study population as a whole (3%), suggesting that healthy lifestyle may counterbalance high genetic risk.
She added that previous research has confirmed physical activity as a protective factor, but more study is needed to shed light on the relative benefit of the healthy lifestyle components.
In addition, further research is necessary to explain why the benefit was limited to lethal prostate cancer risk in men with the highest genetic risk.
Dr. Plym speculated that the genetic variants contributing to a high PRS may also be the variants that have the strongest interaction with lifestyle factors. For men with a genetic predisposition to prostate cancer, she added, these findings underscore the potential value of surveillance.
“Our findings add to current evidence suggesting that men with a high genetic risk may benefit from a targeted prostate cancer screening program, aiming at detecting a potentially lethal prostate cancer while it is still curable,” she said.
Charles Swanton, MBPhD, of the Francis Crick Institute and UCL Cancer Institute in London, raised the possibility that competing risk issues could be at play.
If a healthy lifestyle leads to longer life, he asked, does that make it more likely that patients will live long enough to die from their prostate cancer because they are not dying from cardiovascular disease, complications of diabetes, etc.? In that case, is the healthy lifestyle really affecting prostate cancer at all?
Dr. Plym responded that, among those in the highest genetic risk group with an unhealthy lifestyle, the increased risk for prostate cancer exceeded the risk for other illnesses.
This study was funded by the DiNovi Family Foundation, the National Cancer Institute, the William Casey Foundation, the Swedish Society for Medical Research, and the Prostate Cancer Foundation. Dr. Plym declared no conflicts of interest. Dr. Swanton disclosed relationships with numerous companies, including Pfizer, Novartis, and GlaxoSmithKline.
In men at the highest risk of dying from prostate cancer, having the highest healthy lifestyle scores cut the risk of fatal disease in half, said study author Anna Plym, PhD, of Brigham and Women’s Hospital and Harvard School of Public Health, both in Boston. She presented these findings at the American Association for Cancer Research Annual Meeting 2021: Week 1 (Abstract 822).
Dr. Plym noted that about 58% of the variability in prostate cancer risk is accounted for by genetic factors, with common single-nucleotide polymorphisms (SNPs) accounting for a substantial proportion of prostate cancer susceptibility.
A recent study showed that a polygenic risk score (PRS) derived by combining information from 269 SNPs was “highly predictive” of prostate cancer, Dr. Plym said. There was a 10-fold gradient in disease risk between the lowest and highest genetic risk deciles, and the pattern was consistent across ethnic groups.
In addition, Dr. Plym noted, previous studies have suggested that a healthy lifestyle reduces lethal prostate cancer risk.
What has remained unclear is whether the risk for both developing prostate cancer and experiencing progression to lethal disease can be offset by adherence to a healthy lifestyle.
To investigate, Dr. Plym and colleagues used the 269-SNP PRS to quantify the genetic risk of prostate cancer in 10,443 men enrolled in the Health Professionals Follow-up Study. The men were divided into quartiles according to genetic risk.
The investigators also classified the men using a validated lifestyle score. For this score, one point was given for each of the following: not currently smoking or having quit 10 or more years ago, body mass index under 30 kg/m2, high vigorous physical activity, high intake of tomatoes and fatty fish, and low intake of processed meat. Patients with 1-2 points were considered the least healthy, those with 3 points were moderately healthy, and those with 4-6 points were the most healthy.
The outcomes assessed were overall prostate cancer and lethal prostate cancer (i.e., metastatic disease or prostate cancer–specific death).
No overall benefit of healthy lifestyle
At a median follow-up of 18 years, 2,111 cases of prostate cancer were observed. And at a median follow-up of 22 years, 238 lethal prostate cancer events occurred.
Men in the highest genetic risk quartile were five times more likely to develop prostate cancer (hazard ratio, 5.39; 95% confidence interval, 4.59-6.34) and three times more likely to develop lethal prostate cancer (HR, 3.43; 95% CI, 2.29-5.14), when compared with men in the lowest genetic risk quartile.
Adherence to a healthy lifestyle did not decrease the risk of prostate cancer overall (HR, 1.01; 95% CI, 0.84-1.22), nor did it affect men in the lower genetic risk quartiles.
However, healthy lifestyle did appear to affect men in the highest genetic risk quartile. Men with the highest healthy lifestyle scores had roughly half the risk of lethal prostate cancer, compared to men with the lowest lifestyle scores (3% vs. 6%).
A counterbalance to genetic risk
Dr. Plym observed that the rate of lethal disease in men with the best lifestyle scores matched the rate for the study population as a whole (3%), suggesting that healthy lifestyle may counterbalance high genetic risk.
She added that previous research has confirmed physical activity as a protective factor, but more study is needed to shed light on the relative benefit of the healthy lifestyle components.
In addition, further research is necessary to explain why the benefit was limited to lethal prostate cancer risk in men with the highest genetic risk.
Dr. Plym speculated that the genetic variants contributing to a high PRS may also be the variants that have the strongest interaction with lifestyle factors. For men with a genetic predisposition to prostate cancer, she added, these findings underscore the potential value of surveillance.
“Our findings add to current evidence suggesting that men with a high genetic risk may benefit from a targeted prostate cancer screening program, aiming at detecting a potentially lethal prostate cancer while it is still curable,” she said.
Charles Swanton, MBPhD, of the Francis Crick Institute and UCL Cancer Institute in London, raised the possibility that competing risk issues could be at play.
If a healthy lifestyle leads to longer life, he asked, does that make it more likely that patients will live long enough to die from their prostate cancer because they are not dying from cardiovascular disease, complications of diabetes, etc.? In that case, is the healthy lifestyle really affecting prostate cancer at all?
Dr. Plym responded that, among those in the highest genetic risk group with an unhealthy lifestyle, the increased risk for prostate cancer exceeded the risk for other illnesses.
This study was funded by the DiNovi Family Foundation, the National Cancer Institute, the William Casey Foundation, the Swedish Society for Medical Research, and the Prostate Cancer Foundation. Dr. Plym declared no conflicts of interest. Dr. Swanton disclosed relationships with numerous companies, including Pfizer, Novartis, and GlaxoSmithKline.
FROM AACR 2021
Let’s avoid accepting this headache paradigm as gospel
Dr. Crain’s excellent review, “Breaking the cycle of medication overuse headache” (J Fam Pract. 2021;70:20-28) provides an approach to the diagnosis and treatment of this common disorder that is consistent with most expert opinion and published guidelines. However, like most articles on this subject, it is missing a critical review of the evidence that supports the existence of this condition and the recommended treatments.
The strong association between intractable headaches and quantity of medication used makes the diagnosis of medication overuse headache (MOH) attractive with plausible (if unproven) pathophysiological mechanisms. However, reversing the direction of causation (intractable headaches lead to more medication) seems just as likely. While MOH is taken as an article of faith by most headache experts, high-quality studies in support of this theory have not yet been performed.1
On the other hand, fear of MOH often leads to rigid, arbitrary limitations of abortive medications, blaming of the patient for their symptoms, and the substitution of a host of pharmacologic and nonpharmacologic interventions that similarly lack evidence of efficacy. Patients with chronic migraine are told to take abortive medications early in the headache but not to take them more than twice per week. They hoard their medications while trying to decide if each daily headache is the “big one” that merits depleting their limited supply of medication.
Avoiding medication “overuse” and prescribing from our growing armamentarium of effective preventive medications remain important strategies. However, until we have better evidence, we need to be a little more flexible in prescribing abortive medications and avoid accepting the MOH paradigm as gospel.
David A. Silverstein, MD
Buffalo, NY
1. Vandenbussche N, Laterza D, Lisicki M, et al. Medication-overuse headache: a widely recognized entity amidst ongoing debate. J Headache Pain. 2018;19:50. https://doi.org/10.1186/s10194-018-0875-x
Dr. Crain’s excellent review, “Breaking the cycle of medication overuse headache” (J Fam Pract. 2021;70:20-28) provides an approach to the diagnosis and treatment of this common disorder that is consistent with most expert opinion and published guidelines. However, like most articles on this subject, it is missing a critical review of the evidence that supports the existence of this condition and the recommended treatments.
The strong association between intractable headaches and quantity of medication used makes the diagnosis of medication overuse headache (MOH) attractive with plausible (if unproven) pathophysiological mechanisms. However, reversing the direction of causation (intractable headaches lead to more medication) seems just as likely. While MOH is taken as an article of faith by most headache experts, high-quality studies in support of this theory have not yet been performed.1
On the other hand, fear of MOH often leads to rigid, arbitrary limitations of abortive medications, blaming of the patient for their symptoms, and the substitution of a host of pharmacologic and nonpharmacologic interventions that similarly lack evidence of efficacy. Patients with chronic migraine are told to take abortive medications early in the headache but not to take them more than twice per week. They hoard their medications while trying to decide if each daily headache is the “big one” that merits depleting their limited supply of medication.
Avoiding medication “overuse” and prescribing from our growing armamentarium of effective preventive medications remain important strategies. However, until we have better evidence, we need to be a little more flexible in prescribing abortive medications and avoid accepting the MOH paradigm as gospel.
David A. Silverstein, MD
Buffalo, NY
Dr. Crain’s excellent review, “Breaking the cycle of medication overuse headache” (J Fam Pract. 2021;70:20-28) provides an approach to the diagnosis and treatment of this common disorder that is consistent with most expert opinion and published guidelines. However, like most articles on this subject, it is missing a critical review of the evidence that supports the existence of this condition and the recommended treatments.
The strong association between intractable headaches and quantity of medication used makes the diagnosis of medication overuse headache (MOH) attractive with plausible (if unproven) pathophysiological mechanisms. However, reversing the direction of causation (intractable headaches lead to more medication) seems just as likely. While MOH is taken as an article of faith by most headache experts, high-quality studies in support of this theory have not yet been performed.1
On the other hand, fear of MOH often leads to rigid, arbitrary limitations of abortive medications, blaming of the patient for their symptoms, and the substitution of a host of pharmacologic and nonpharmacologic interventions that similarly lack evidence of efficacy. Patients with chronic migraine are told to take abortive medications early in the headache but not to take them more than twice per week. They hoard their medications while trying to decide if each daily headache is the “big one” that merits depleting their limited supply of medication.
Avoiding medication “overuse” and prescribing from our growing armamentarium of effective preventive medications remain important strategies. However, until we have better evidence, we need to be a little more flexible in prescribing abortive medications and avoid accepting the MOH paradigm as gospel.
David A. Silverstein, MD
Buffalo, NY
1. Vandenbussche N, Laterza D, Lisicki M, et al. Medication-overuse headache: a widely recognized entity amidst ongoing debate. J Headache Pain. 2018;19:50. https://doi.org/10.1186/s10194-018-0875-x
1. Vandenbussche N, Laterza D, Lisicki M, et al. Medication-overuse headache: a widely recognized entity amidst ongoing debate. J Headache Pain. 2018;19:50. https://doi.org/10.1186/s10194-018-0875-x
Mnemonics can be real lifesavers
Mnemonics are often used to help remember complex groups of individual items related to a common theme. Studies have shown that college students studying with mnemonics outperform students using rote learning, suggesting that mnemonics are useful in retention of facts. 1
In 1 study, researchers compared memory athletes and control subjects before and after mnemonic training. 2 Findings showed that mnemonics created connectivity changes in the control group similar to memory athletes at baseline. These changes persisted for as long as 4 months after training, demonstrating that mnemonics have long-lasting effects on memory capacity. 2
The most frequently used forms of medical mnemonics are acronyms or acrostics. Acronyms are words in which each letter in the word corresponds to a series of words to be remembered. 3 A familiar example of a medical acronym is “SLUDGE,” which represents the symptoms for cholinergic toxicity (salivation, lacrimation, urination, defecation, gastrointestinal upset, emesis). An acrostic involves a phrase in which the first letter of each word corresponds to the first letter of a word to be remembered. 3 A commonly used acrostic phrase for the memorization of the 12 cranial nerves is “On Old Olympus’ Towering Tops A Finn And German Viewed Some Hops”: olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, auditory (vestibulocochlear), glossopharyngeal, vagus, spinal accessory, hypoglossal.
Mnemonics are an effective way for medical students, residents, and current practitioners to effortlessly recall information. For example, COVERABCD is an acronym that stands for circulation/capnograph/color, oxygen, ventilation, endotracheal tube, review of equipment, airway, breathing, circulation, and drugs. 4 Runciman et al showed that the use of the acronym COVERABCD could have prevented or mitigated 60% of 2000 anesthetic incidents. 4 Another mnemonic, FAST, used to assess for a stroke, reduced median hospital arrival times by more than an hour. 5
There are hundreds of mnemonics related to medical practice. Collections of those that might be useful for family practitioners and medical residents can be found at the following links:
https://epomedicine.com/medical-mnemonics/
www.oxfordmedicaleducation.com/medical-mnemonics/
Kristyn McKnight, PharmD candidate
Hannah Lutz, PharmD candidate
Tracy Mahvan, MBA, PharmD, BCGP
School of Pharmacy, University of Wyoming, Laramie
1. Dave H, Awasthi S. An investigation of the role of mnemonics in higher education. Paper presented at: International Conference on Digital Pedagogies (ICDP); April 1-3, 2019; New Delhi, India. +http://dx.doi.org/10.2139/ssrn.3375714
2. Dresler M, Shirer WR, Konrad BN, et al. Mnemonic training reshapes the brain networks to support memory. Neuron. 2017;93:1227-1235. https://doi.org/10.1016/j.neuron. 2017.02.003
3. Nolen J. Mnemonic. Encyclopedia Britannica. July 20, 1998. Updated September 18, 2019. Accessed March 16, 2021. www.britannica.com/science/short-term-memory
4. Runciman WB, Webb RK, Klepper ID, et al. The Australian Incident Monitoring Study. Crisis management—validation of an algorithm by analysis of 2000 incident reports. Anaesth Intensive Care. 1993;21:579-592. https://doi.org/10.1177/0310057X9302100515
5. Wolters FJ, Paul NLM, Li L, et al. Sustained impact of UK FAST-test public education on response to stroke: a population-based time-series study. Int J Stroke. 2015;10:1108-1114. https://doi.org/1111/ijs.12484
Mnemonics are often used to help remember complex groups of individual items related to a common theme. Studies have shown that college students studying with mnemonics outperform students using rote learning, suggesting that mnemonics are useful in retention of facts. 1
In 1 study, researchers compared memory athletes and control subjects before and after mnemonic training. 2 Findings showed that mnemonics created connectivity changes in the control group similar to memory athletes at baseline. These changes persisted for as long as 4 months after training, demonstrating that mnemonics have long-lasting effects on memory capacity. 2
The most frequently used forms of medical mnemonics are acronyms or acrostics. Acronyms are words in which each letter in the word corresponds to a series of words to be remembered. 3 A familiar example of a medical acronym is “SLUDGE,” which represents the symptoms for cholinergic toxicity (salivation, lacrimation, urination, defecation, gastrointestinal upset, emesis). An acrostic involves a phrase in which the first letter of each word corresponds to the first letter of a word to be remembered. 3 A commonly used acrostic phrase for the memorization of the 12 cranial nerves is “On Old Olympus’ Towering Tops A Finn And German Viewed Some Hops”: olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, auditory (vestibulocochlear), glossopharyngeal, vagus, spinal accessory, hypoglossal.
Mnemonics are an effective way for medical students, residents, and current practitioners to effortlessly recall information. For example, COVERABCD is an acronym that stands for circulation/capnograph/color, oxygen, ventilation, endotracheal tube, review of equipment, airway, breathing, circulation, and drugs. 4 Runciman et al showed that the use of the acronym COVERABCD could have prevented or mitigated 60% of 2000 anesthetic incidents. 4 Another mnemonic, FAST, used to assess for a stroke, reduced median hospital arrival times by more than an hour. 5
There are hundreds of mnemonics related to medical practice. Collections of those that might be useful for family practitioners and medical residents can be found at the following links:
https://epomedicine.com/medical-mnemonics/
www.oxfordmedicaleducation.com/medical-mnemonics/
Kristyn McKnight, PharmD candidate
Hannah Lutz, PharmD candidate
Tracy Mahvan, MBA, PharmD, BCGP
School of Pharmacy, University of Wyoming, Laramie
Mnemonics are often used to help remember complex groups of individual items related to a common theme. Studies have shown that college students studying with mnemonics outperform students using rote learning, suggesting that mnemonics are useful in retention of facts. 1
In 1 study, researchers compared memory athletes and control subjects before and after mnemonic training. 2 Findings showed that mnemonics created connectivity changes in the control group similar to memory athletes at baseline. These changes persisted for as long as 4 months after training, demonstrating that mnemonics have long-lasting effects on memory capacity. 2
The most frequently used forms of medical mnemonics are acronyms or acrostics. Acronyms are words in which each letter in the word corresponds to a series of words to be remembered. 3 A familiar example of a medical acronym is “SLUDGE,” which represents the symptoms for cholinergic toxicity (salivation, lacrimation, urination, defecation, gastrointestinal upset, emesis). An acrostic involves a phrase in which the first letter of each word corresponds to the first letter of a word to be remembered. 3 A commonly used acrostic phrase for the memorization of the 12 cranial nerves is “On Old Olympus’ Towering Tops A Finn And German Viewed Some Hops”: olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, auditory (vestibulocochlear), glossopharyngeal, vagus, spinal accessory, hypoglossal.
Mnemonics are an effective way for medical students, residents, and current practitioners to effortlessly recall information. For example, COVERABCD is an acronym that stands for circulation/capnograph/color, oxygen, ventilation, endotracheal tube, review of equipment, airway, breathing, circulation, and drugs. 4 Runciman et al showed that the use of the acronym COVERABCD could have prevented or mitigated 60% of 2000 anesthetic incidents. 4 Another mnemonic, FAST, used to assess for a stroke, reduced median hospital arrival times by more than an hour. 5
There are hundreds of mnemonics related to medical practice. Collections of those that might be useful for family practitioners and medical residents can be found at the following links:
https://epomedicine.com/medical-mnemonics/
www.oxfordmedicaleducation.com/medical-mnemonics/
Kristyn McKnight, PharmD candidate
Hannah Lutz, PharmD candidate
Tracy Mahvan, MBA, PharmD, BCGP
School of Pharmacy, University of Wyoming, Laramie
1. Dave H, Awasthi S. An investigation of the role of mnemonics in higher education. Paper presented at: International Conference on Digital Pedagogies (ICDP); April 1-3, 2019; New Delhi, India. +http://dx.doi.org/10.2139/ssrn.3375714
2. Dresler M, Shirer WR, Konrad BN, et al. Mnemonic training reshapes the brain networks to support memory. Neuron. 2017;93:1227-1235. https://doi.org/10.1016/j.neuron. 2017.02.003
3. Nolen J. Mnemonic. Encyclopedia Britannica. July 20, 1998. Updated September 18, 2019. Accessed March 16, 2021. www.britannica.com/science/short-term-memory
4. Runciman WB, Webb RK, Klepper ID, et al. The Australian Incident Monitoring Study. Crisis management—validation of an algorithm by analysis of 2000 incident reports. Anaesth Intensive Care. 1993;21:579-592. https://doi.org/10.1177/0310057X9302100515
5. Wolters FJ, Paul NLM, Li L, et al. Sustained impact of UK FAST-test public education on response to stroke: a population-based time-series study. Int J Stroke. 2015;10:1108-1114. https://doi.org/1111/ijs.12484
1. Dave H, Awasthi S. An investigation of the role of mnemonics in higher education. Paper presented at: International Conference on Digital Pedagogies (ICDP); April 1-3, 2019; New Delhi, India. +http://dx.doi.org/10.2139/ssrn.3375714
2. Dresler M, Shirer WR, Konrad BN, et al. Mnemonic training reshapes the brain networks to support memory. Neuron. 2017;93:1227-1235. https://doi.org/10.1016/j.neuron. 2017.02.003
3. Nolen J. Mnemonic. Encyclopedia Britannica. July 20, 1998. Updated September 18, 2019. Accessed March 16, 2021. www.britannica.com/science/short-term-memory
4. Runciman WB, Webb RK, Klepper ID, et al. The Australian Incident Monitoring Study. Crisis management—validation of an algorithm by analysis of 2000 incident reports. Anaesth Intensive Care. 1993;21:579-592. https://doi.org/10.1177/0310057X9302100515
5. Wolters FJ, Paul NLM, Li L, et al. Sustained impact of UK FAST-test public education on response to stroke: a population-based time-series study. Int J Stroke. 2015;10:1108-1114. https://doi.org/1111/ijs.12484
Rare Neurological Disease Special Report
Read the issue by clicking on the cover image or HERE
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This 2021 issue is our seventh annual Rare Neurological Disease Special Report. It comes at a time when the global pandemic is still very much a part of our everyday lives. While the COVID-19 crisis is the polar opposite of a rare disease, it may offer some insights into the rare disease community. Collectively, we faced a disease no one knew much about—an untreatable condition that sent us into isolation, changed our world view, and altered our daily lives in ways we never imagined. We experienced, many of us for the first time, the fear and helplessness of a medical situation that was potentially fatal. Isn’t that what patients with rare diseases and their families face every day? Fear of the unknown; the desperate search for answers; isolation from a world and, all too often, a medical community that does not understand your situation; the terror of suspecting that time may not be on your side, and the valiant effort to press on despite desperate odds—these are things the rare disease community know all too well.
In publishing the Rare Neurological Disease Special Report, our goal has always been to educate the medical community on conditions they may rarely see and offer some hope to those who battle a rare neurological disease. I hope you enjoy reading our seventh annual issue.
—Glenn S. Williams, vice president, group editor, Neurology Reviews and MDedge Neurology
Read the issue by clicking on the cover image or HERE
--
This 2021 issue is our seventh annual Rare Neurological Disease Special Report. It comes at a time when the global pandemic is still very much a part of our everyday lives. While the COVID-19 crisis is the polar opposite of a rare disease, it may offer some insights into the rare disease community. Collectively, we faced a disease no one knew much about—an untreatable condition that sent us into isolation, changed our world view, and altered our daily lives in ways we never imagined. We experienced, many of us for the first time, the fear and helplessness of a medical situation that was potentially fatal. Isn’t that what patients with rare diseases and their families face every day? Fear of the unknown; the desperate search for answers; isolation from a world and, all too often, a medical community that does not understand your situation; the terror of suspecting that time may not be on your side, and the valiant effort to press on despite desperate odds—these are things the rare disease community know all too well.
In publishing the Rare Neurological Disease Special Report, our goal has always been to educate the medical community on conditions they may rarely see and offer some hope to those who battle a rare neurological disease. I hope you enjoy reading our seventh annual issue.
—Glenn S. Williams, vice president, group editor, Neurology Reviews and MDedge Neurology
Read the issue by clicking on the cover image or HERE
--
This 2021 issue is our seventh annual Rare Neurological Disease Special Report. It comes at a time when the global pandemic is still very much a part of our everyday lives. While the COVID-19 crisis is the polar opposite of a rare disease, it may offer some insights into the rare disease community. Collectively, we faced a disease no one knew much about—an untreatable condition that sent us into isolation, changed our world view, and altered our daily lives in ways we never imagined. We experienced, many of us for the first time, the fear and helplessness of a medical situation that was potentially fatal. Isn’t that what patients with rare diseases and their families face every day? Fear of the unknown; the desperate search for answers; isolation from a world and, all too often, a medical community that does not understand your situation; the terror of suspecting that time may not be on your side, and the valiant effort to press on despite desperate odds—these are things the rare disease community know all too well.
In publishing the Rare Neurological Disease Special Report, our goal has always been to educate the medical community on conditions they may rarely see and offer some hope to those who battle a rare neurological disease. I hope you enjoy reading our seventh annual issue.
—Glenn S. Williams, vice president, group editor, Neurology Reviews and MDedge Neurology
