By V. Mojok. Institute for Transpersonal Psychology.
Often purchase 10mg loratadine with mastercard, the stress that physicians experience in their daily practice is reflected unconsciously in their tone of voice cheap loratadine 10 mg with amex. For example, the phrase, “You should have called me,” can be said in an empathic, solicitous manner or in an impatient, accusatory way. The effect that these two styles have on a patient can differ dramatically. Pause for Assimilation and Feedback When your message is complex, pause frequently, even if you do not sense confusion in the listener. A break in speech allows patients to either digest what you are saying or ask for clarification. The resulting dialogue reinforces the patients’ feeling that they are participating in their health care. Most patients will interpret this question for what it is—a sincere interest in their welfare. One of the best ways to ensure that explanations or instructions are understood is to ask patients to repeat what they have just been told. Explaining that you want to ensure their well-being can dispel the notion that you are being condescending. You might want to give the example that “50” and “15” sound very similar, but the numbers can literally spell the difference between life and death when they represent milligrams prescribed for a potent drug. Chapter 6 / Communication and Patient Safety 69 TAILOR YOUR LANGUAGE One of the most common complaints in patient attitude surveys has to do with physicians’ use of complex terminology or medical jargon. There is a substantial choice of words available for communicating with patients according to their intellectual and educational level. Whereas physicians define the stomach as a specific organ, patients complaining of a “stomach ache” might be referring to an indefinite area from the ribs to the pubis. When you describe a procedure, choose words that do not produce anxiety.
The heart’s ability to pump effectively may Although Wernicke’s encephalopathy can be compromised so that symptoms of con- occur in other conditions generic loratadine 10 mg amex, it is most com- gestive heart failure buy 10mg loratadine, such as difficulty in monly associated with chronic alcohol breathing and swelling (see Chapter 11), may abuse. It is characterized by the sudden occur as the cardiac damage increases. It often occurs in combination with Korsakoff’s syndrome Beriberi Heart Disease and, like Korsakoff’s syndrome, is related A deficiency in thiamine is thought to to thiamine deficiency. Treatment consists contribute to the development of beriberi of the replacement of thiamine. Individuals with the condi- treatment is mandatory to prevent perma- tion have a high cardiac output, even at nent deficits. Prompt treatment resolves rest, because of the dilation of the periph- many of the symptoms. Beriberi heart dis- syndrome accompanies Wernicke’s en- ease responds well to the administration cephalopathy, however, memory deficits of supplemental thiamine. Alterations in Heart Rate and Rhythm Peripheral Neuropathy Alcohol can affect both the speed at Although there are many causes of which the heart beats and the rhythm that peripheral neuropathy, a number of indi- it maintains. The direct long-term effect viduals who chronically abuse alcohol on blood pressure is variable. Alcohol develop disorders of the peripheral nerves withdrawal can put a heavy load on the (see Chapter 3). Peripheral neuropathy heart, sometimes compromising cardiac associated with chronic alcohol abuse is function so severely during detoxification thought to be the result of inadequate that death can result. Consequently, nutrition, specifically inadequate amounts detoxification should be conducted under of thiamine and the other B vitamins. Good nutrition and the administra- Alcohol can have a direct and adverse tion of supplemental B vitamins can effect on the development of red blood bring about improvement, but the cells, white blood cells, and platelets, improvement may be slow.
Although these may be the best estimates available generic 10mg loratadine with mastercard, they are extremely conservative buy 10 mg loratadine. These numbers reflect the reduced cost of health care in states with effective tort reform compared to states lacking such reforms. Califor- nia, inherently a litigious state, has a frequency of malpractice litigation that is about 50% above the national average (16), despite MICRA. Although the data indicate that effective tort reforms reduce the practice of defensive medicine, it is clearly not eliminated. This would suggest that the true costs are considerably higher than indicated by this meth- odology. Because financing the cost of health care in the United States today is a zero-sum game, these direct and indirect costs of the malpractice crisis must be subtracted from funds available to fund the care of the uninsured and underinsured (2,5,31), and for medical research and innovation. Reasonable limits on noneconomic damages, by reducing both the direct costs of malpractice insurance and the cost of defensive medicine, would save enough money to fund a prescription drug ben- efit for Medicare beneficiaries and facilitate insurance coverage for millions of uninsured Americans (2). Access to Care As direct and indirect cost drivers increase the price of health care, it becomes unaffordable for an incremental number of patients. As the cost of malpractice insurance increases, it becomes unaffordable for an incremental number of doctors, other health care providers, and medical institutions, effectively preventing them from delivering medical services. As the fear of malpractice litigation and the conse- quent increase in malpractice insurance rates affect physician behav- ior, doctors become incrementally more averse to high-risk procedures, difficult patients, and more litigious venues. They also become incre- Chapter 15 / The Case for Legal Reform 219 mentally more susceptible to practices with more benefit in litigation avoidance than patient care. The same pressures will incrementally affect the choice of specialties by medical students and investment in medical facilities and medical research (46). None of this would appear to be particularly controversial; however, for several reasons it is difficult to be precise about the magnitude of these effects or to define the exact tipping point for individual physi- cians, specialties, facilities, or communities. Third, there are no adequately defined and scaled metrics for analysis as costs and their consequential pressures continue to rise.
