ABC News recently posted two articles online, one identifying the six things patients do that frustrates doctors the most and one identifying the six things doctors do that frustrates patients the most.  The doctors’ frustrations, first published in the February issue of the Archives of Internal Medicine, were addressed in a survey of 449 family practitioners and internists.  Patients’ frustrations were gleaned from the online comments posted to that story.

Here’s a view from both sides of the issue.

Doctors felt the most frustration when their patients seemed to be dissatisfied with the care they’re getting or when they have unrealistic expectations.  Their top six frustrations:

• Family members in the exam room.  Doctors often find themselves settling family squabbles, speaking to the concerns and confusion of too many people at once, and trying to overcome unwanted distractions when trying to address just the patient.
• No word on supplements, herbal remedies, and alternative treatments.  These substances or practices are not officially recognized as drugs or scientifically proven practices so doctors don’t always give them credence but patients don’t always tell their doctors what they’re doing, in addition to the therapies he or she is prescribing.  They may not be drugs but they often do produce interactions with prescription drugs that affect patient outcomes.
• Patients discontinuing medications without alerting their doctors.  Sometimes the reason is adverse side effects, sometimes it’s money.  Either way, every time a doctor prescribes a medication, the prescription is written with an expected outcome.  When the prescription is stopped or dosage altered without the doctor’s knowledge or guidance, serious and unanticipated consequences can occur.  Some of these unexpected consequences can be life threatening but difficult to diagnose under a veil of secrecy.
• Patients prefer pills, surgery, and medical devices when simple lifestyle changes would eliminate or ease the condition more appropriately.  Obesity, bad diet, smoking, lack of exercise, and excess alcohol intake are just some of the lifestyle choices that produce very clear but unwanted consequences to our health.  They involve work and personal commitment but making changes to these habits is more effective than anything in a doctor’s pharmacopeia or medicine bag.  In many cases, the doctor is faced not with disease and a known treatment regimen but with a self-induced lack of health.
• Patients asking for prescriptions based on the advertising they’ve seen.  Some patients are so insistent on leaving the doctor’s office with the desired prescription in hand they pay no attention to the advise of their doctor, even when warned the medication will have no effect or will only add to the patient’s problems.
• Demands for unnecessary tests or procedures.  These don’t come as often as requests for highly advertised drugs but they are not uncommon, either.  Satisfying these demands can be costly but the demands themselves may be masking underlying fears of past bad experiences, life stressors, or even psychological issues.

On the other hand, the top six frustrations expressed by patients against their doctors include:

• Doctors who value their own time over the value of the patient’s time.  No one likes to arrive on time to an appointment - any appointment, anywhere - only to be left waiting half an hour or longer.  Patient frustrations only grow stronger when the doctor finally sees them but rushes through the appointment so fast the patient feels overlooked or invisible.
• Not being heard.  Appointments are too rushed, leaving too little time for constructive conversation.  Doctors often don’t listen to patient questions, cut the patient off in mid-sentence, or ignore the patient almost entirely, relying on charts instead of preferred person-to-person communications.
• Hearing the problem is all in the head.  Most patients have no mental problems but some of them do have ailments that are uncharacteristic of their medical history, age, or gender.  These patients want to feel their doctor is making the effort to see them as the unique individuals they are instead of lumping them with the very few psycho cases that should be getting treatment elsewhere.
• Never learning test results.  In some cases, no news is good news but that’s never the case where one’s health is concerned.  If a patient undergoes a test ordered by a physician, the physician simply must report the outcome of the test to the patient.  Every test, every patient, every time.  Period.
• Doctors who won’t consult the patient’s other doctors.  Some people have a primary care physician but special medical needs require specialists.  When doctors don’t communicate with each other and share their knowledge of a given patient, the patient often pays for multiple copies of expensive tests or medical histories, undergoes unneeded uncomfortable procedures, and gets too many prescription drugs that may produce devastating interactions.  Coordinated care eases patient fears and frustrations and leads to more desirable outcomes for everyone.
• Doctors who belittle patients for turning to alternative remedies.  The soaring cost of traditional medical care and the patient frustrations listed above lead more and more Americans to look for something they have more control over.  Sometimes that means alternative therapies.  Full disclosure is required to avoid harmful interactions but patients don’t want to be ridiculed because of the measures they’ve gone to to take care of themselves when traditional medicine falls short.  Doctors say they want full disclosure from their patients but they frequently insult the patient when full disclosure is made.  The cycle of silence, and frustration, repeats.

Healthcare reform doesn’t involve just doctors and patients.  Surely nurses, caregivers, and administrators have their own list of doctor-patient frustrations, too.  ABC News has yet to tackle the issue from those angles but they’re all a part of improving the nation’s current healthcare system.

Dr. David Greening says his study of 118 men with above average levels of DNA damage to their sperm saw a drop in DNA fragmentation after each man ejaculated for seven days in a row.  Their average DNA fragmentation index was 34% at the beginning of the study but DNA damage had dropped to just 26% over the course of the seven day experiment.

Fertility experts often suggest refraining from sexual activities for several days before attempting intercourse for the sake of conception.  The supposed benefit of this short period of abstinence is that the volume of semen would increase, thereby increasing the chance of conception.  This theory has never been proven conclusively and Greening’s research suggests it is the wrong approach.

Greening doesn’t know yet how, exactly, sperm quality improves with daily ejaculation but suggests the benefit comes from the shorter length of time the sperm is exposed to reactive oxygen species, damaging molecules in the testicular ducts.  Greening, of the Sydney IVF, an in vitro fertilization (IVF) and infertility treatment center, presented his findings to the European Society of Human Reproduction and Embryology, meeting this week in Amsterdam.

Brooke’s doctor, pediatrician Lawrence Pakula, of Johns Hopkins School of Medicine in Baltimore, Maryland, describes the child as “always a surprise” and a fascination to many of today’s top scientists.  Children who fail to develop or grow, in various ways, are rare but Brooke has proven to be perhaps the rarest of them all.

Brooke has never been diagnosed with any of the genetic syndromes or chromosomal abnormalities that are usually associated with children that fail to develop and grow normally.  She defies conventional sense, according to Dr. Richard Walker, University of South Florida College of Medicine, Tampa.  Walker says the parts of Brooke that are growing are growing as independent parts out of sync with her body as a whole.    Walker, Pakula, and Maxine Sutcliffe, a geneticist at All Children’s Hospital in St. Petersburg, Florida, have chronicled their experience with Brooke in a paper recently published in the journal, Mechanisms of Ageing and Development.  The ABC television network will include a story of Brooke’s life on the June 26 broadcast of “20/20.”

At age 16, which she turned in January, Brooke is still the size of an infant and her mental capacity is said to be that of a toddler.  The teen still has baby teeth but her bone growth is more like what would be expected at 10 years of age.  She is still unable to talk and Walker says there’ve been only minimal changes to Brooke’s brain as she’s growing up.

Brooke’s mother says she loves to shop, just like all women do, and enjoys riding in her stroller as her mother shops for Brooke’s clothes in the infants’ section of their favorite stores.  To avoid lengthy and personal explanations, when asked how old her child is, Brooke’s mother converts her years to months, saying the child is now 16 months old.

Brooke has three doting sisters, two older and one younger, who all seem to be the picture of health.

Lead researcher, Dr. Jurgen Rehm, says the greatest concern is in developing nations, where the alcohol-attributable disease level is highest among the poorest populations.  The burden of disease is growing fastest in India and China but women in general are drinking more now than they were in 2000, adding to the global burden.

Many injuries are sustained as a result of alcohol consumption but excess drinking also increases the drinker’s risk of liver diseases, depression, and stroke.  Some cancers, including colorectal, mouth, throat, and breast cancers, have been linked to alcohol consumption, too.

Who’s drinking?  According to Rehm’s report:

• On a worldwide, per capita, basis, we all consume an average of 12 units each week.
• In just Europe, the average consumption rate is 21.5 units each week.
• Throughout the Americas, 17 units per week are consumed.
• In the Middle East, where consumption is lowest, the weekly average is only 1.3 units per week.

These per-capita figures are averages.  Most adults actually do not drink at all.  Rehm’s report indicates 45% of all men and 66% of all women abstain from alcohol most, if not all, of their lives.

Five percent of all years lived with disability are attributed to alcohol consumption.  These disabilities affect:

• Younger people more often than older people.
• 34% of all disabled individuals between 15 and 29 years of age.
• 31% of those between 30 and 44.
• 22% of those between 45 and 59.

In 2004, the most recent year such data is available for analysis, 3.8% of all deaths in the world were related to alcohol.  That percentage is equivalent to one in every 25 deaths.

Who’s dying because of excess alcohol consumption?

• Men are five times more likely than women to die due to causes traced to alcohol.
• In Europe, 10% of all deaths involve alcohol.
• In the former Soviet Union countries of Europe, one in every seven deaths (15%) is attributed to alcohol.
• In England, the alcohol-related death rate has climbed by one-fifth since 2000.

The study is a “global wake-up call,” according to Professor Ian Gilmore, who is president of the Royal College of Physicians and chairs the Alcohol Health Alliance UK.  He suggests immediate price increases, reduced availability, and advertising bans as means of reversing the harm caused by alcohol consumption.

Don Shenker, chief executive officer of Alcohol Concern, says evidence proves there’s more harm caused where alcohol consumption is highest.  Shenker agrees with the alcohol-control measures identified by Gilmore.

Jonas was scheduled to testify during a hearing the following day of the Senate Homeland Security and Government Affairs Committee, meeting to discuss federal funding for diabetes research.  Other celebrities giving testimonials before the committee were world champion, Sugar Ray Leonard, said to be one of the best boxers of all time, and highly acclaimed actress, Mary Tyler Moore.  Moore, who has type 1 diabetes, serves as International Chairman of the Juvenile Diabetes Research Foundation and Leonard is an outspoken advocate for diabetes research and education.  He frequently testifies of the emotional and financial strain children face when growing up with a diabetic parent, as Leonard’s father was.

Including Jonas as a part of the discussion, diabetes advocates are hoping to draw the attention of the younger generation, many of whom consider diabetes a disease of old age.  He and his brothers founded the Change for the Children Foundation, an organization that provides financial support to charitable programs that motivate and inspire children of adversity.  One such charity is the American Diabetes Association’s Diabetes Camp.

Pancreatic cancer is almost always fatal, a factor that puts it number four in the top causes of death from cancer in the United States.  Lifestyle choices, including diet, play an important role in determining who is most likely to develop this very deadly form of cancer.  Other risk factors include diabetes, obesity, and smoking.

While controversy has surrounded the role dietary fat plays in the risk for pancreatic cancer, the cancer institute’s report describes a study that provides a significant association between high intake of animal fats and pancreatic cancer.  The institute’s report can be found in the June 26 online issue of the Journal of the National Cancer Institute.

The cancer institute’s research team gathered data from more than half a million people in 1995 and 1996.  These 308,736 men and 216,737 women completed a food survey with 124 questions as part of the National Institutes of Health-AARP Diet and Health Study.  Each survey participant was followed for an average of six years.

Over time, 1,337 people developed pancreatic cancer.  Men who at diets high in animal fats were shown to be at 53% higher risk for developing pancreatic cancer than those who ate the least amount of animal fats.  Women eating high animal fat diets were at 23% increased risk.

Saturated fats in general increased the risk for pancreatic cancer.  Those who consumed diets high in saturated fats were found to be at 36% greater risk of developing this particular form of cancer.  Almost all animal fats are saturated fats.  Any hydrogenated or partially hydrogenated vegetable fats are high in saturated fats, too.

Oncologist Brian M. Wolpin, of Boston’s Dana-Farber Cancer Institute, says people who consume diets heavily laden with red meats often make other lifestyle choices that aren’t so healthy either.  For example, maintaining excess weight increases the risk of pancreatic cancer, regardless of diet.

A recent study published in the June 24 issue of JAMA (Journal of the American Medical Association), indicates being obese or overweight during early adulthood ups the risk for pancreatic cancer and middle-aged pancreatic cancer patients who are also obese have low survival rates.  When someone is overweight during their thirties, they face a 60% increased risk for developing pancreatic cancer.  Obesity at that age increases the risk of pancreatic cancer by 200% to 300%.

Wolpin, author of an editorial that accompanies the cancer institute report, offers some very compelling reasons for making lifestyle changes to avoid pancreatic cancer.  He writes, “We know very little about pancreatic cancer and what the causes are, and we don’t do a very good job treating it.”

Each year, between 200,000 and 300,000 Americans die from sudden cardiac arrest, making it one of the leading causes of death in the country.  Contrary to common knowledge, sudden cardiac arrest is not the same thing as a heart attack.  These two cardiac events are entirely different processes but surviving a heart attack does increase one’s risk for sudden cardiac arrest.

Sudden cardiac arrest describes the end of heart beats after the heart muscle goes into ventricular fibrillation.  Fibrillation is a rapid, quivery, abnormal beating of the heart that is often of erratic rhythm (arrythmia).  During ventricular fibrillation, the heart’s pumping chambers, the ventricles, cannot pump blood adequately.  Within minutes of fibrillation, brain cells begin to die from loss of blood.  Odds of survival drop by 10% for every minute of fibrillation.  It is almost impossible to survive 10 minutes of ventricular defibrillation.

Heart attacks leave scar tissue in the heart muscle.  This scar tissue can interrupt the rhythmic beating of the heart, inducing ventricular defibrillation.

Sometimes ventricular fibrillation can be interrupted by applying a defibrillator to the heart.  Defibrillators emit an electrical impulse that shocks the heart muscle back into a healthier rhythm.  Some defibrillators are external, used in emergency situations by trained medical personnel, but others are implanted within the chest cavities of individuals known to be at high risk for sudden cardiac arrest.

In the absence of a defibrillator, cardiopulmonary resuscitation (CPR) is sometimes helpful.  This procedure is easy to learn but best taught by trained professionals.  The benefit in performing it is that it helps keep the blood circulating, reducing damage to brain cells, until defibrillation can happen.

Sudden cardiac arrest often occurs in individuals who seem otherwise healthy, with no known medical conditions that affect the heart.  In some cases, an individual may have a genetic predisposition to ventricular defibrillation but accidents and surgical procedures can cause erratic heart beat, too.  Some medications affect heart rhythm and the risk for sudden cardiac arrest may be higher when these medications are taken by patients with the genetic disorders associated with ventricular defibrillation.

Nielsen FitzGerald was one of 41 people stationed at the National Science Foundation’s Amundsen-Scott South Pole Station during the winter of 1999 when she first discovered a lump in her breast.  She hoped to keep it a secret until sub-zero temperatures eased and air travel became safe again but her condition quickly grew worse, making her much too sick to remain silent about her medical condition.

When the biopsy Nielsen FitzGerald performed on herself in July proved positive for cancer, she enlisted the help of a machinist, who helped with testing slides and her IV apparatus, and a welder, who helped with her chemotherapy.  Satellite-based email service enabled Nielsen FitzGerald to communicate with doctors in the United States, who arranged for the US Air Force to deliver medical supplies and anti-cancer drugs by way of an air drop conducted during treacherous blackout conditions.

In October, when the Southern Hemisphere’s winter was turning to early spring, Nielsen FitzGerald was airlifted out of the station by a flight crew from the Air National Guard.  This risky rescue made history as one of the earliest spring flights ever made to the polar station.  Temperatures were rising and reached 58 degrees below zero at the time of rescue.

Once back in the US, Nielsen FitzGerald underwent multiple surgeries, including a mastectomy, and eventually the cancer went into remission until 2005.  She recounted her medical ordeal in a book, Ice Bound: A Doctor’s Incredible Battle for Survival at the South Pole, which became a best seller and a made-for-TV movie.  Nielsen FitzGerald spent the past ten years, since her rescue, traveling the world lecturing about how cancer changed her life and she worked as a roving doctor in hospital emergency rooms throughout the Northeast.

By last October, the cancer had spread to her brain.  Nielsen FitzGerald died on Tuesday, June 23, at her home in Southwick, Massachusetts.  She is survived by her husband of three years, her parents, two brothers, and three children from an earlier marriage.

Leading the Mayo Clinic research team is urologist Eugene Kwon, who describes the results of this current stage of clinical trial on the drug, Ipilimumab, a “holy grail” in research on prostate cancer.  Kwon said his team has invested years looking for just such a treatment.

In the phase II study, 108 patients were treated with standard treatment regimens that involve hormone and radiation therapies.  Their care was supplemented with Ipilimumab.

For both the patients in question, aggressive cancerous tumors had become so large they were invading the patients’ abdominal cavities, a situation considered inoperable.  After participation in the trial, however, the tumors shrunk dramatically, making surgery a realistic option after all.  Now that both patients have undergone surgery, they are free of all signs of cancer.

The Mayo Clinic announcement was made on Friday, prompting sales of Medarex shares to surge by 17% at the close of the market on Monday.  The recent trading price of $8.63 per share is approaching its highest price since last August, when shares sold for $10.12.  The Mayo Clinic is not a publicly owned entity; it is instead the world’s largest non-profit medical practice group.

The pharmaceutical industry has agreed to reduce the cost of individual prescription drugs by 50% or more when the Medicare beneficiary has reached the Plan D dollar-amount threshold.  The plan pays almost all prescription costs until an individual has accrued $2,700 in prescription benefits in a single year.  This $2,700 is the threshold that signals the end of prescription benefits until that same individual accrues prescription expenses of $6,100 in the same year.  After reaching the $6,100 mark, Medicare prescription benefits begin again.

The gap between $2,700 and $6,100 is the donut hole that wreaks havoc on the tightly fixed incomes of many American senior citizens.  While in this donut hole of zero prescription benefits, Medicare beneficiaries are required to pay 100% of their prescription medication needs entirely out of pocket.  Facing this gap in prescription expense coverage, many senior citizens are forced to stop life-enhancing medications or take fewer and smaller doses than their prescriptions call for.  Others forfeit food and utility money to maintain their prescriptions.

By reducing prescription costs to Medicare recipients working through this donut-hole period of no coverage, the pharmaceutical industry anticipates a nationwide savings of $80 billion over a 10-year time span.

Even though calling this initiative by drug makers a “significant breakthrough” and just the kind of compromise required to successfully reform the nation’s healthcare system, the president warned the Plan D compromise must be voted in by all Congressional committees working on healthcare reform before it becomes a reality.