Cultural and spiritual beliefs haven't always played a large role in U.S. medicine, but that may soon be changing. Because of an increasingly diverse patient population, related to both demographic changes and to health care reform, clinicians are more likely to be working with patients whose backgrounds, and belief systems, are different from their own. Understanding those differences, experts say, will be key to providing optimal patient care. In our story, Paula S. Katz discusses why physicians who are comfortable with their own spirituality may find it easier to incorporate patients' beliefs into clinical practice. The story also offers tips on what to do when patients ask you to pray with them, how to address religious and spiritual preferences in the exam room and when and how to draw the line.
Proton-pump inhibitors (PPIs) have gotten a lot of negative press lately due to studies pointing out problematic potential side effects, such as increased risk for fractures and for Clostridium difficile infection. But experts continue to believe that in most cases the drugs' benefits still outweigh the risks. The trick is maintaining an appropriate risk-benefit balance and knowing when to decrease doses or stop PPIs altogether. Our next story has more.
White coat hypertension isn't an unusual phenomenon in clinical care, but patients, and physicians, shouldn't dismiss it out of hand. Studies have indicated that patients with white coat hypertension are at higher risk for true hypertension and possibly, over the long term, for stroke. Our story discusses ways to obtain accurate blood pressure readings in the office—for example, using an automated device can help—as well as the best way for patients to monitor their own blood pressure at home.
This issue's Q&A takes a closer look at a study on malpractice lawsuits, discussing which types of physicians are most likely to be sued, the likelihood of patients winning a lawsuit, and the time it takes a typical lawsuit to make its way through the legal system. And in our latest Gray Matters column, Jerome Groopman, MD, FACP, and Pamela Hartzband, MD, FACP, discuss how “anchoring error” and self-diagnosis led to serious clinical consequences for one physician.
How do you handle spirituality in your practice? E-mail your thoughts on this or any other topic. We always enjoy hearing from you.