Faculty Bibliography

OBJECTIVE: E-mail use in the clinical setting has been slow to diffuse for several reasons, including providers' concerns about patients' inappropriate and inefficient use of the technology. This study examined the content of a random sample of patient-physician e-mail messages to determine the validity of those concerns. DESIGN: A qualitative analysis of patient-physician e-mail messages was performed. MEASUREMENTS: A total of 3,007 patient-physician e-mail messages were collected over 11 months as part of a randomized, controlled trial of a triage-based e-mail system in two primary care centers (including 98 physicians); 10% of messages were randomly selected for review. Messages were coded across such domains as message type, number of requests per e-mail, inclusion of sensitive content, necessity of a physician response, and message tone. RESULTS: The majority (82.8%) of messages addressed a single issue. The most common message types included information updates to the physicians (41.4%), prescription renewals (24.2%), health questions (13.2%), questions about test results (10.9%), referrals (8.8%), "other" (including thank yous, apologies) (8.8%), appointments (5.4%), requests for non-health-related information (4.8%), and billing questions (0.3%). Overall, messages were concise, formal, and medically relevant. Very few (5.1%) included sensitive content, and none included urgent messages. Less than half (43.2%) required a physician response. CONCLUSION: A triage-based e-mail system promoted e-mail exchanges appropriate for primary care. Most patients adhered to guidelines aimed at focusing content, limiting the number of requests per message, and avoiding urgent requests or highly sensitive content. Thus, physicians' concerns about the content of patients' e-mails may be unwarranted.

Scheduling patients for busy clinical practices has been an inefficient, time-consuming, and expensive process. This article relates the experience of a large primary-care group in adopting sheduling by the Internet. This has resulted in improved scheduling, economies in staffing, and greater patient satisaction. An added bonus has been the reduction of failed appointments

With hear disease and stroke accounting for one million deaths annually in the US, more individuals are becoming aware of the health risks and looking for safe and natural alternatives to medicines to help maintain and enhance overall heart health. Recently, Pycnogenol has been lauded due to the surge of research published demonstrating its significant benefit for heart and circulatory health

Network therapy (NT) employs family members and/or friends to support compliance with an addiction treatment carried out in office practice. This study was designed to ascertain whether NT is a useful psychosocial adjunct, relative to a control treatment, for achieving diminished illicit heroin use for patients on buprenorphine maintenance. Patients agreeing to randomization to either NT (N = 33) or medication management (MM, N = 33) were inducted onto short-term buprenorphine maintenance and then tapered to zero dose. NT resulted in significantly more urine toxicologies negative for opioids than MM (65% vs. 45%) and more NT than MM patients (50% vs. 23%) experienced a positive outcome relative to secondary heroin use by the end of treatment. The use of NT in office practice may therefore improve the effectiveness of eliminating secondary heroin use during buprenorphine maintenance. It may also be useful in enhancing compliance with an addiction treatment regimen in other contexts

Medical educators have a responsibility to teach students to communicate effectively, yet ways to accomplish this are not well-defined. Sixty-five percent of medical schools teach communication skills, usually in the preclinical years; however, communication skills learned in the preclinical years may decline by graduation. To address these problems the New York University School of Medicine, Case Western Reserve University School of Medicine, and the University of Massachusetts Medical School collaborated to develop, establish, and evaluate a comprehensive communication skills curriculum. This work was funded by the Josiah P. Macy, Jr. Foundation and is therefore referred to as the Macy Initiative in Health Communication. The three schools use a variety of methods to teach third-year students in each school a set of effective clinical communication skills. In a controlled trial this cross-institutional curriculum project proved effective in improving communication skills of third-year students as measured by a comprehensive, multistation, objective structured clinical examination. In this paper the authors describe the development of this unique, collaborative initiative. Grounded in a three-school consensus on the core skills and critical components of a communication skills curriculum, this article illustrates how each school tailored the curriculum to its own needs. In addition, the authors discuss the lessons learned from conducting this collaborative project, which may provide guidance to others seeking to establish effective cross-disciplinary skills curricula

Ibrahim Shekarau, the Kano state governor whose eight-month moratorium on polio vaccinations has been blamed for the spread of polio widely across Africa, said in an interview on Tuesday that he was ready to resume immunizations. Dr. David L. Heymann, director of W.H.O.'s polio program, said Wednesday that his agency ''welcomes any decision to resume polio vaccinations in [Kano].'' After a formal decision is announced, he said, W.H.O. and its partners, Rotary International and the United Nations children's fund, Unicef, would help conduct a large-scale program from June to August to immunize all children 5 years and younger in Nigeria. A Nigerian child receives a dose of the polio vaccine. The governor of the northern Nigerian state of Kano had opted out of a polio immunization drive, prompted by claims of a link between the vaccine and infertility. (Photo by European Pressphoto Agency)