Clinician's Roundtable

In 1999 the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) declared pain the fifth vital sign. Chronic pain affects more people than diabetes, heart disease and cancer combined. Has there been any real improvement in identifying and treating pain since the JCAHO edict? Join us to hear from neurosurgeon Dr. Joe Sam Robinson, clinical professor at the Medical College of Georgia, explore the treatment of pain with host Dr. Leslie Lundt.

Medicine and spirituality have always been linked, we have struggled as a profession with how to introduce spirituality and religion into the general hospital setting. Host Dr. Leslie Lundt discusses such a program with Dr. Mark Galanter, professor of psychiatry at New York University School of Medicine, and author of Spirituality and the Healthy Mind: Science, Therapy and the Need for Personal Meaning.

All the technology and advances in medical science hasn't changed the most difficult thing we do as physicians - relay emotionally charged diagnostic and prognostic information to our patients. How can we do a better job? Communication skills do not automatically improve with increasing physician experience. Dr. Alan Astrow, the director of the division of hematology and medical oncology at Maimonides Cancer Center in New York City explains how we can break bad news to patients in a more effective and supportive way.

In all fields of medicine, we have all encountered patients who are ultra-challenging to manage. There can be those who can find dissatisfaction in any outcome that isn't ‘perfect,' according to their standards. There are others who have seen a series of healthcare providers who, despite their efforts, haven't been able to meet their needs and requests. Host Dr. Michael Epstein welcomes Dr. Peter Adamson, professor of otolaryngology-head and neck surgery, and head of facial plastic and reconstructive surgery at the University of Toronto, to talk through a range of these potentially sticky situations, and how they impact our practice and in some cases, our practice habits.

Avoiding potential problem patients in cosmetic surgery: It's a concern that many practitioners face on a regular basis, reminding us of the importance of patient selection and informed consent. How can we minimize the number of problem patients in our practice, and how can we limit the influence of those who are already in our practice? On the flipside, who is an ideal candidate for surgery? Dr. Peter Adamson, professor of otolaryngology-head and neck surgery, and head of facial plastic and reconstructive surgery at the University of Toronto, shares advice for staying on the lookout for the various categories of patients. Dr. Michael Epstein hosts.

There may be many reasons for a patient to consider elective aesthetic surgery, but whatever the reason, they are often linked to the patient's expectations for the surgical outcome. While we know that most patients maintain a reasonable outlook for their care, how can we work to maintain an affable relationship with those who have unrealistic post-surgery expectations? Dr. Peter Adamson, professor of otolaryngology-head and neck surgery, and head of facial plastic and reconstructive surgery at the University of Toronto, details his experiences and his extensive research on patient relations with host Dr. Michael Epstein. How often does the thought of turning away a patient come into play in a typical practice? Are more of the so-called "problem patients" specific to certain procedures?

A patient in your office describes the knee pain they have been feeling for an extended period of time. The MRI that you order on their knee reveals meniscal damage. New research is telling us that meniscal tears may be more common than we realize, and further, raises questions as to whether the meniscal tear is really the source of your patient's knee pain. Dr. David Felson, professor of medicine at the Boston University (BU) School of Medicine and professor of epidemiology at the BU School of Public Health, explains that damaged meniscal cartilage may not be directly linked to knee pain. Dr. Mark Nolan Hill hosts.

Despite previous evidence to suggest that arthroscopic surgery does not improve symptoms associated with osteoarthritis of the knee, the procedure continues to be a common treatment for arthritis. Now, novel data is backing up this earlier research on arthroscopy. Going forward, how will this development impact practice? Host Dr. Mark Nolan Hill talks with Dr. David Felson, professor of medicine at the Boston University (BU) School of Medicine and professor of epidemiology at the BU School of Public Health, about the utility of the procedure, and explores alternative thoughts on the pathogenesis of the pain experienced by this class of patients.

It seems fewer and fewer physicians want to go into internal medicine, with a recent study showing only two percent of 4th-year medical students elect to enter this field. Kurt Mosley, Vice President of Business Development for Merritt, Hawkins & Associates, the largest physician search and consulting firm in the country with more than two decades in the business, tells the Chicago Tribune's Bruce Japsen about the trend away from internal medicine, despite the national movement toward finding patients a medical home and the continued emphasis by policy makers on the importance of primary care medicine.

More than 90 percent of new physicians coming into the job market received at least 10 job solicitations and face a much different employment dynamic than older doctors. Kurt Mosley, vice president of business development for Merritt, Hawkins & Associates, the largest physician search and consulting firm in the country, tells the Chicago Tribune's Bruce Japsen what doctors face in today's complex employment market and shares his insights into navigating it.