EMBARGOED FOR RELEASE UNTIL 5 P.M., EDT, MONDAY, JUNE 30, 1997
July 1, 1997, Tip Sheet
Annals of Internal Medicine is published by the American College of Physicians (ACP), more than 100,000 physicians trained in internal medicine. The following highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 1-800-523-1546, ext. 2656 or 215-351-2656. The full text of selected articles can be accessed on the Internet at http://www.acponline.org/journals/annals/annaltoc.htm
* * * Alternative Medicine Therapies
Alternative medical therapies are currently in great demand, but advising patients who use or seek alternative treatments presents a professional challenge to conventionally trained medical providers. A paper proposes a step-by-step proactive strategy for physicians and patients involving a formal discussion of patient preferences and expectations, the maintenance of symptom diaries, and follow-up visits to monitor for potentially harmful situations. (Perspective, p. 61.) The proposed management plan emphasizes patient safety, the need for documentation in patient records, and the importance of shared decision making.
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Patient Preferences for Physician Communication About End-of-Life Decisions
Most patients do not discuss preferences for end-of-life care with their physicians, and those patients who have not discussed those preferences do not want to do so, a study finds. (Article, p. 1.) A prospective cohort study of 1,832 seriously ill hospitalized adults found that communication between those patients and their physicians about preferences for cardiopulmonary resuscitation and mechanical ventilation is uncommon. The study also found the lack of patient discussion about preferences for end-of-life care may result in unwanted interventions for patients. The study found some patient characteristics, such as being black, being younger, and reporting poor quality of life are associated with wanting to discuss these preferences with one's physician but not having done so.
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Diagnosing Syncope - Part II
Part II of a paper for the American College of Physicians (ACP) Clinical Efficacy Assessment Project finds that a flexible, focused approach is required to diagnose syncope, and that features of the initial history and physical examination help guide diagnostic testing. (Position Paper, p. 76.)
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