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IN THIS ISSUE
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Patient-centered decision making is when the physician considers an individual patient's needs and circumstances (that is, the context) when formulating a care plan. This study evaluated audio recordings of physician visits to identify encounters in which contextual variables were contributing to medical problems. Encounters in which physicians considered these variables when formulating care plans were more often followed by health care improvements than in those where such contextualization was not considered. Further study is warranted to better understand how to best contextualize individual patient circumstances when formulating care plans.
Use of computer-aided detection (CAD) in interpreting mammograms has dramatically increased. In this study of mammography in older women, CAD interpretation resulted in more women having further diagnostic testing, including biopsy. Women were more likely to be diagnosed with ductal carcinoma in situ but not with invasive breast cancer. Cases diagnosed with use of CAD were at an earlier stage than those diagnosed without CAD. The long-term effect of CAD on breast cancer diagnosis, outcomes, and cost warrants further study.
Osteoporosis is prevalent but underdiagnosed. This study found that computed tomography (CT) scans obtained for other clinical indications can be used for detecting vertebral osteoporosis by comparing them with dual-energy x-ray absorptiometry scans performed within the previous 6 months. Approximately half of patients with CT-identified osteoporotic vertebral compression fractures had nonosteoporotic T-scores. These data suggest that CT images can be used for opportunistic osteoporosis screening without additional radiation exposure or cost.
Chronic kidney disease (CKD) is associated with an increased risk for kidney failure, cardiovascular events, and all-cause mortality. This review assessed risk prediction models for these adverse clinical outcomes in patients with CKD. It found that accurate, externally validated models for predicting risk for kidney failure in patients with CKD are available and ready for clinical testing but that further development of models for cardiovascular events and all-cause mortality is needed.
Medications to reduce risk for primary breast cancer are recommended for women at increased risk, but use is low. This review, which will serve as background for a U.S. Preventive Services Task Force recommendation, examined evidence on the effectiveness and adverse effects of breast cancer chemoprevention, its use, and methods for identifying high-risk women. It found that medications reduced the incidence of invasive breast cancer and fractures but increased thromboembolic events. Tamoxifen was more effective than raloxifene but also increased the incidence of endometrial cancer and cataracts. Use is limited by adverse effects and difficulty in identifying chemoprevention candidates.
This Update summarizes studies published in 2012 that the authors consider highly relevant to the practice of general internal medicine. Topics include venous thromboembolism, colorectal cancer screening, prostate cancer, HIV infection, and obesity.
This position paper from the American College of Physicians and the Federation of State Medical Boards discusses the influence of social media on the patient–physician relationship, their role in the public perception of physician behaviors, and strategies for physician–physician communication that preserve confidentiality while best using these technologies.
In this issue, Weiner and colleagues described an approach to analyzing the content of patient–physician communication by measuring whether physicians “contextualize” care plans. The editorialists discuss the study and its findings, which demonstrate that contextualization of patient-centered health care improves health outcomes.
Osteoporosis is associated with substantial morbidity but is underdiagnosed due to undertesting. In this issue, Pickhardt and colleagues examined whether conventional abdominal CT imaging might “incidentally” detect osteoporosis. The editorialists discuss the study and its findings and ask whether the results could be applied into clinical practice now.
As I reflected on what happened that night, I realized that no one had ever raised the possibility that I might one day be hurt by a patient's words or actions.