Category Archives: Internal Medicine

Internal Medicine

David Jerome Becker Obituary – – Hartford Courant

David Jerome Becker died peacefully on May 1st at VNA Hospice House in Vero Beach, surrounded by his loving family.

Born August 17th 1929 to Mildred Fischer and Harry L. Becker in Hartford Connecticut, David had a secure childhood, focused on education, hard work, Yankees ballgames, and Jewish family traditions. His scholarship was recognized early, first at Weaver High School graduation in 1947 and then at Cornell University with the highest oratory honor for his speech titled Discrimination Against the Negro and Our World Position Today.

In 1955, while at Harvard Medical School, David met and married nursing student, Jane Codington and they began their adventurous life heading to Duke University for Davids residency in internal medicine, and for further training in internal medicine and cardiology at the University of Miami.

David was a veteran, having served in the Air Force in Irumagawa Honshu, Japan -6022nd US Air Force Hospital Johnson Air Base, David and Jane had four children while he practiced medicine in Coral Gables, Florida. He later practiced medicine at the Cooper Clinic in Dallas, Texas and at the Mass General Hospital in Boston MA, raising his family in Weston, MA.

Divorced, David moved to Vero Beach in 1978. Vero Beach provided

a perfect climate, a perfect community, and a perfect companion in Marylou Ashcroft with whom he spent the rest of his life, marrying in 1999.

In Vero Beach, he practiced medicine, sharing a medical office with Gary Kantzler, MD, and began to contribute to the community he came to love for his remaining years. He served on many hospital committees, on the hospital district board, as President of the United Way of Indian River County, the board of the VNA, Bermuda Bay Board and was elected to the Indian River Town Council. Giving back to his community was as important to him as having compassion and understanding for his patients and coworkers.

Walking through the hospital, David stopped to talk to everyone asking about their childrens education or recent sporting event or their parents health. He knew every staff member by name and was interested in the details of their lives. His bedside manner included careful listening and humor and time to explain medical diagnoses in plain language. Long before visit summaries were in vogue, David dictated a letter to each patient following every visit explaining his findings, plan and instructions. He partnered with his patients and cared deeply about their values and life experience.

Introduced to running as a sport in the 1960s, David ran daily, was an early marathoner and a founding member of the Vero Beach SunRunners. Running and his running community were integral to his well-being.

David was a colorful character and a very social being. He nurtured and was buoyed by his friendships. He valued his long phone calls with his nephew, John Kupper and cousin, Alan Fischer. He loved his weekly sharing with his Lefties group of revered buddies. He liked to share a good story or joke and had intense pride in all of his children and grandchildren.

We all remember David as the great interviewer, the stranger you sat next to on a plane to whom you shared the whys of your life, the guy you met on the beach who remembered treating your father in the hospital, and the person at the party who worked the room. He leaves us checking any pretense and materialism at the door and settling into an armchair of curiosity and genuine interest and compassion for others.

David was predeceased by his parents, Mildred and Harry Becker, his sister Enid Kupper, and his first wife Jane. David will be missed by his wife, Marylou Becker and his children Marcie Becker, (Brattleboro VT,) Jan Becker, (Santa Fe, NM,) Meredith and Peter Moses (Cha rlotte, VT,) and Steven and Carrie Becker (Dallas, TX.) By his grandchildren John and wife Alison Moses (New York) Ivy, Roome, and Gwendolyn Becker of Dallas as well as by his extended family and many, many friends.

In lieu of flowers, kindly contribute to the VNA Hospice Foundation, 920 37th Place, Suite, 101, Vero Beach, FL 32960.

Arrangements by Strunk Funeral Homes & Crematory, Vero Beach, FL. A guestbook is available at http://www.strunkfuneralhome.com

Excerpt from:

David Jerome Becker Obituary - - Hartford Courant

Internal Medicine

Med students earn awards as part of Cape Fear Research Symposium – News | Campbell University – Campbell University News

Students from the Campbell University Jerry M. Wallace School of Osteopathic Medicine won awards recently for their work as part of the VIII Annual Cape Fear Research Symposium.

Alexandra Sobisch, a second-year med student, and her team won first place for Quality Improvement Poster. The title of the poster is A Combined Approach for Curricular Improvement: Using SIM for Interprofessional Collaboration on Diverse Patient Populations.

Phillip Long, also a second-year med student, took second place for Patient Case Report Poster. Long titled the poster, Esophagogastroduodenoscopy Risks and Optimization for Caustic Acidic Ingestion in Elderly Patients: A Case Report.

The event happened May 2 at Fort Liberty and provided a platform to showcase medical research from Cape Fears regional educational institutions, medical centers and military organizations, the Greater Fayetteville Business Journal reported.

Im very proud of our fantastic CUSOM students and their great work, said Dr. James Coppola, chair and associate professor of Internal Medicine at the med school.

This years event featured 14 podium presentations from area researchers, who talked about a number of physical, mental and cultural topics from a military focused-medical perspective, the Journal wrote.

Sobisch, the first-place winner, is part of a medical school academic enrichment pilot program, Diversity, Equity, and Inclusion through Community Engagement (DEICE), led by Dr. Brianne Holmes. Holmes is director, and assistant professor, for Professional Development at the Jerry M. Wallace School of Osteopathic Medicine.

Part of this program is to create a project of our choosing that integrates diversity and medical education or community engagement, Sobisch said.

For our project, we chose to create an interdisciplinary simulation medicine event, where Campbell University students from different health professions came together to conduct an eight-minute simulation medicine case in CUSOMs Simulation Center, Sobisch said. It was great to witness interdisciplinary collaboration among students.

Ten students are part of the pilot program, she said, and they worked together on the project. Sobisch led the project, collaborating on the idea with Jennifer Vasquez.

The other students were Nidhi Kumar, Ashlyn Chauhan, Arti Bhalani, Iris Salswach, Maya Parvathaneni, Sreenidhi Nair, Manisha Mishra and Indy Aronson.

I am so proud of all the DEICE students that committed themselves to learning more about all matters related to diversity, equity, inclusion, and how it affects their communities, clinical education, and future practices, Holmes says.

They researched and worked together to effectively create a curricular improvement project that can now be used as a framework for future simulated interprofessional educational activities that are inclusive of socially and medically diverse and complex patients.

We often speak of DEI in an abstract, statistical, or theoretical sense, but these students have created an experience that will help future clinical students bridge the gap between theory and application, and be just a little more prepared to care for the populations they might serve. It was an absolute joy working with them all.

Long, the second-place student doctor winner, said, It was really interesting to see how we can optimize and improve the care of elderly patients with gastric mucosal injury. Our poster raised issues, which larger, more formal studies, can address. The symposium was also a great place to see our fourth-year students and to hear about the future of medical practice in the military.

The Fort Liberty event featured 20 poster presentations, with researchers presenting and explaining their original research and long-term case reports, the Journal wrote.

Keynote speakers included Dr. Hershey S. Bell, founding dean for the upcoming Methodist University Cape Fear Valley Health School of Medicine and Col. Tyler E. Harris, chief of the Department of Clinical Investigation at Womack Army Medical Center in Fayetteville.

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Med students earn awards as part of Cape Fear Research Symposium - News | Campbell University - Campbell University News

Internal Medicine

UChicago Medicine residents unionize in landslide election | Evening Digest | hpherald.com – Hyde Park Herald

More than 1,000 resident physicians and fellows at the University of Chicago Medical Center voted overwhelmingly to unionize this week, joining a wave of young doctors unionizing across the city and country.

In a landslide election, about 98% of physicians, fellows and interns voted to join the Committee of Interns and Residents (CIR), a part of the Service Employees International Union (SEIU), the union announced Monday. The victory comes a little more than a month after residents and fellows filed their petition to hold an election with the National Labor Relations Board.

Residents typically work at hospitals or in other health care settings for several years after finishing medical school as part of their training, while fellows are doctors getting more training after completing residencies. Also referred to as house staff, both roles provide extensive patient care daily in a hospital and clinics workers described as understaffed and often struggle to make ends meet.

While we love our jobs and caring for our patients, we do not have an endless supply of stamina and capacity. We are human beings who must have our basic needs met, said Dr.Aisha Amuda, a fourth-year resident in internal medicine and pediatrics, in a statement. We are now in a position to advocate for necessary improvements to our working conditions that directly impact the quality of care our patients receive."

According to the CIR, resident physicians at the U. of C. Medical Center regularly work more than 80 hours a week in the hospital and its Level 1 Trauma Center the only trauma center on the South Side while carrying more than $200,000 in student debt.

Though these young doctors often serve as the primary health care providers for many patients, organizers said they have little say in decisions that impact patient care, arguing that a seat at the bargaining table could change this.

My colleagues and I chose UChicago because we wanted to care for this community, said Dr. Kalkidan Aseged, a first-year resident in emergency medicine, in a statement. As physicians, our first commitment is to our patients. Having a strong voice helps us advocate more effectively for their needs, as well as for our own well-being.

In a statement, a spokesperson for the medical center said administrators soon will begin collective bargaining "in order to craft a fair and equitable contract that supports the needs of our trainees, our patients and our institution."

"This group of 1,040 residents and fellows are integral members of our clinical teams, and they provide exceptional care to our patients and community," the sppkesperson continued. "Just as we did before the vote, UCMC is committed to continuing to foster an exceptional learning and care environment for our residents and fellows."

The election comes just three months after 1,300 resident physicians and fellows at Northwestern Medicine voted overwhelmingly to unionize with CIR. And last January, about 800 newly-unionized residents and fellows at the University of Illinois Chicago reached their first collective bargaining agreement with the hospital.

Since the start of the Covid-19 pandemic in 2020, which exacerbated chronic problems of understaffing and burnout in health care across the country, tens of thousands of residents and fellows have moved to unionize with CIR. Today, the union represents about 32,000 physicians, fellows and interns, making it the largest house staff union in the nation.

In Chicago alone, according to the union, more than 15,000 house staff have joined CIR/SEIU since 2020.

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UChicago Medicine residents unionize in landslide election | Evening Digest | hpherald.com - Hyde Park Herald

Internal Medicine

McKee Names New Head of Health, 5th Director in Three Years – GoLocalProv

Friday, May 10, 2024

GoLocalProv News Team

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Governor Dan McKee PHOTO: GoLocal

In March, McKees office announced an acting director Dr. Staci Fischer. She was the fourth person to serve as director since McKee became governor.

McKees office said in March, Dr. [Utpala] Bandy will be retiring on March 29th. We thank her for leadership and service to the people of Rhode Island. While we move through the final stages of the hiring process for a permanent RIDOH director, Governor McKee is appointing Dr. Staci Fischer as acting director.

Since McKee ascended to the governorship in 2021, Dr. Nicole Alexander-Scott resigned, and then Dr. James McDonald served as acting director, followed by Bandy.

Newest Director

Dr. Larkin is a proven leader in the medical field and his experience will be a vital asset to our team and to the people of Rhode Island, saidMcKee.Improving health outcomes for all Rhode Islanders is a top priority for our administration and Im confident that Dr. Larkin will help us reach that goal.

With more than thirty years of experience in the healthcare field, Larkin is a licensed medical doctor in Rhode Island and Massachusetts and currently serves as the Medical Director of Inpatient Infectious Diseases Consultation Services at Rhode Island Hospital.

He works as an associate professor of clinical medicine at the Warren Alpert Medical School of Brown University and has received numerous teaching awards during his time there.He received his medical degree from the Robert Wood Johnson Medical School at the University of Medicine and Dentistry of New Jersey and completed his undergraduate degree at Boston College.

"I look forward to working with Secretary Charest and Governor McKee, as well as the many dedicated and talented staff of the Department of Health in moving health care in Rhode Island forward, saidLarkin.

Larkin is board-certified in Internal Medicine and Infectious Diseases by the American Board of Internal Medicine and in General Pediatrics by the American Board of Pediatrics.

McKee will submit Larkins name to the Rhode Island Senate for advice and consent.

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McKee Names New Head of Health, 5th Director in Three Years - GoLocalProv

Internal Medicine

An Internal Medicine Physician & Aesthetic Specialist’s Best Tips | mindbodygreen – mindbodygreen

mbg Beauty Director

mbg Beauty Director

Alexandra Engler is the beauty director at mindbodygreen and host of the beauty podcast Clean Beauty School. Previously, she's held beauty roles at Harper's Bazaar, Marie Claire, SELF, and Cosmopolitan; her byline has appeared in Esquire, Sports Illustrated, and Allure.com.

May 07, 2024

Today's guest on the Clean Beauty School podcast specializes not only in integrative medicine but also in the high-tech world of aesthetics.

This combination makes internal medicine physician Glenicia Nosworthy, M.D., a fascinating person to talk to because her recommendations aren't just about what new treatment to trybut how to optimize your results through diet and lifestyle.

"I think the two [health and beauty] go hand in hand. From aesthetics, internal medicine, dermatology, plastic surgery, if you're not healthy, it will reflect in your skin and affect your quality of life," she says.

Here, three takeaways from the episode. But be sure to tune in to the episode to hear the entire conversation.

Sure, you can get the latest facial and slather on the most expensive face cream, but those things won't be as effective if you're not taking care of your body at the same time.

The same goes for aesthetic treatments: "When we are doing aesthetic treatments that are increasing collagen and elastin production, you have to consider, what do cells need to make collagen and elastin?" asks Nosworthy. "They need great forms of nutrients and proteins. These are the building blocks of DNA, cells, and molecules."

For example, collagen-boosting treatments and injectables are popular tools to help rejuvenate the skin and smooth wrinkles. But to produce collagen, the body must have an adequate supply of amino acids and other building materials.

"To make collagen and elastin, I can inject you with anything that's going to stimulate the cell. But if the cell is not getting the nourishment or the nutrients that it needs to function properly, then your response is going to be very minimal," she says. "And you're going to be paying for multiple treatments and you're not going to get maximum results."

So, if you're considering getting any sort of aesthetic treatment, think about how your lifestyle and diet play a role in those outcomes.

When we think about all the vitamins and nutrients that play a role in our skin health, vitamin D likely doesn't come to mind first. The "sunshine vitamin"as it's often calledis better known for its role in bone health, for example.

However, it can play a role in skin health. In fact, one randomized controlled trial in the journal Nutrients found a relationship between vitamin D insufficiency and dry skin1 : Researchers discovered that participants with lower vitamin D levels also had lower average skin moisture.

While more research is needed on the intersection of vitamin D and skin health, it's a promising area. And anecdotally, Nosworthy has seen a big difference in the health of her patients.

"That marriage of internal and external medicine is really important. For example, I had a patient who came in with a complaint of dark under-eye circles. We were in the process of doing an under-eye PRF treatment but hadn't started it yet. First, I recommended she take a vitamin D supplement. Within two weeks after taking the vitamin D supplement, when she came in to get the PRF, I noticed the darkness under her eyes had gotten better. In fact she noticed it first. She said, 'Look at my under-eyes. My skin and under my eyes are so much brighter and more even.'"

Eventually, they went on to do the aesthetic treatment alongside the supplementationand in the end, the results were greater than the sum of their parts.

"She was thrilled from the vitamin D alone, but we went ahead and did the PRF treatment in addition to it," she said. "But just from dealing with that vitamin deficiency, it was a game changer for her. I think getting blood work done is really important when there could potentially be other things that are leading to an aesthetic result that you're not happy with."

As Nosworthy explains, what she does daily is minimal. "I think the minute you start to add too many things and make it too complicated is when you end up with skin irritation," she says.

But she does have some key ingredients and products she loves using, which you'll see are some of the classics: a gentle cleanser, vitamins C and E, hyaluronic acid, and a lipid-rich moisturizer.

"I always use a gentle cleanser. I don't use anything too stripping or [that] has an acid in it. I keep it very, very mild," she says. This is important because it keeps the skin barrier integrity strong, without which the body can't deal with environmental stressors and inflammation.

"For serums, I use hyaluronic acid or an antioxidant serum with ferulic, vitamins C and E in it as well," she says. "It just helps deal with the free radicals and damage from UV rays."

Then she tops it off with a rich moisturizer. "This is important because about two or three times a week, I'll use a retinol at night," she says. "This helps my skin tolerate the ingredient. I don't have any dryness or irritation."

And as for how she decides what products she's using on a given day: "And there's no strict routine. It's kind of just what my skin's doing and what I feel it needs at that time," she says. "You just kind of like to listen to it and make decisions accordingly."

For more insights, listen to our entire conversation here:

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An Internal Medicine Physician & Aesthetic Specialist's Best Tips | mindbodygreen - mindbodygreen

Internal Medicine

Health-related quality of life assessment tool for cats with hyperthyroidism – DVM 360

Azaliya (Elya Vatel) / stock.adobe.com

Hyperthyroidism is the most common endocrine disease in middle-aged to older cats1 and occurs when the thyroid gland produces too many hormones. This leads to symptoms like weight loss despite eating more, vomiting, hyperactivity, increased urination and drinking, diarrhea, breathing problems, and changes in their coat.2 These symptoms can greatly affect a cat's quality of life (QoL) in addition to creating more stress for the cat and the owner. Researchers on a new study published in the Journal of Veterinary Internal Medicine,3 have seen a lack of tools to evaluate health-related quality-of-life (HRQoL) in cats suffering from hyperthyroidism. The study was aimed at measuring the HRQoL and the impact for owners.

The assessment being studied included 28 questions relating to the HRQoL of hyperthyroid cats and the influence their cat's disease might have on owners was created. Researchers initially showed their first set of questions to a group of 11 veterinarians who work with hyperthyroidism, some in general practice and others in specialty referral hospitals (3 diplomates of an EBVS accredited college, 2 primary care veterinarians, 6 internal medicine clinicians working at referral practices).3 This was structured to gain feedback from these veterinarians about the questions being included in the questionnaire. Each question consisted of 2 subquestions: (1) how often does the item apply; (2) how strongly does the item affect HRQoL.

The assessment was then made available online for owners of cats suffering from hyperthyroidism or other diseases as well as cats without any known diseases (there were no exclusion criteria regarding the eligible cats). Researchers later divided responses into 2 groups being the HT-group (cats with hyperthyroidism) and the NHT-group (cats without hyperthyroidism).

Owner-related questions ranged from how their cats health or diseases impact their daily life with emotional, physical, and financial burdens they take on as a result. Cat-related questions focused more on the potential symptoms the animals were experiencing and also the cats mood and behavior.

There were 551 valid questionnaire responses, of which 229 (41.6%) were by owners of cats in the HT-group and 322 (58.4%) by owners of cats in the NHT-group. Responses from the HT-group had a median cat age of 14years. The final HRQoL tool produced a score between 0 and 382, zero being the best possible HRQoL and 382 the worst. The median HRQoL score for HT-group was 87.5 points and was significantly higher than in the NHT-group at 27 points. Researchers also concluded that owners of cats in the NHT-group generally rated their cat's QoL better than owners of cats in the HT-group.3

After reviewing responses, the researchers decided to remove 3 questions that posed repetitive results as they were worded very similarly. This brought the final HRQoL assessment down to a 25-question tool.3 Researchers also concluded that hypothyroidism negatively affects a cats QoL and owners lives are impacted through vicarious distress.

Researchers are hoping this hyperthyroidismQoL-cat tool can be easily used by practitioners as an owner take home survey. It can be completed online as it was done in this study or printed on paper for an owner to fill out.

References

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Health-related quality of life assessment tool for cats with hyperthyroidism - DVM 360

Internal Medicine

Finding the Right Approach to Treating Asthma < Yale School of Medicine – Yale School of Medicine

Sandra Zaeh, MD, is interested in improving clinical outcomes for patients with asthma. In recent research, she found that current guideline-based asthma treatment is implemented less than 15 percent of the time for moderate to severe asthma due to various factors, including a lack of knowledge about the proper treatment approach.

In the next few months, as a newly promoted assistant professor of medicine in the Yale Department of Internal Medicine Section of Pulmonary, Critical Care, and Sleep Medicine, Zaeh will lead the recruitment of subjects from the Yale Center for Asthma and Airways Disease for a study in collaboration with Brigham and Womens Hospital. Funded by the Patient-Centered Outcomes Research Institute, the study aims to improve the quality of care for patients at risk of asthma attacks.

In an interview, Zaeh discusses the basics of asthma, different approaches to treating the inflammatory condition, and why controlling asthma is of the utmost importance to asthma physicians and pulmonologists.

Asthma is a chronic lung disease in which the bronchial airways in the lungs get narrowed and swollen, making it difficult to breathe. People with asthma can feel fine for some time, and then a trigger can cause an asthma attack, which can lead to significant health repercussions. Asthma disproportionately affects Black and Latinx people, low-income populations, and other groups.

Uncontrolled asthma with frequent exacerbations can cause adults to miss days of work and children to miss school. Asthma can impact your ability to breathe on a day-to-day basis. It can lead to hospitalizations, emergency room visits, and, in some cases, fatality.

For the past several decades, the treatment paradigm for asthma has involved control and relief medications. Controller therapy usually includes an inhaled corticosteroid that you take one to two times a day to control your symptoms. You take a reliever therapy between controller doses to minimize asthma symptoms such as cough, shortness of breath, and wheezing. The traditional reliever therapy has been albuterol, a short-acting bronchodilator that quickly opens the airways.

Interestingly, the data now supports a slightly different management strategy. The big update in asthma management is the introduction of anti-inflammatory reliever therapy for asthma. Current guidelines promote the use of the same inhaler for both control and relief for moderate to severe asthma, with a combination of an inhaled steroid and a quick-acting, long-acting beta agonist called formoterol. This approach is called SMART, or Single Maintenance and Reliever Therapy, because one inhaler does the job that two inhalers used to do.

Even though SMART is currently guideline-based care, were having difficulty implementing this approach in clinical practice. There are similar, alternative approaches that may be better for certain patients. One of those approaches, which will be tested in this study, is PARTICS, or Patient Activated Reliever-Triggered Inhaled CorticoSteroids. Every time PARTICS patients use their albuterol inhaler, theyre asked to use one puff of inhaled steroid. When they use their albuterol nebulizer as a reliever, they're asked to use five puffs of inhaled steroid. Its different than SMART because the approach uses more than one inhaler and incorporates the use of nebulizers as relievers.

Many people in the U.S. use an albuterol nebulizer as a reliever because they feel it works more effectively. The PARTICS approach incorporates those individuals.

Studied in Black and Latinx patients with moderate to severe asthma a few years ago, PARTICS was shown to reduce severe asthma exacerbations and improve asthma control and quality of life. Our study compares PARTICS to SMART, the current standard of care. The idea of the study is to test to see if the two approaches are equally effective or if one is more effective than the other.

Its important to have different asthma management approaches that can be used and tailored for each patient based on needs and preferences. For example, PARTICS is perhaps more appropriate than SMART for people who use nebulizers as their reliever. PARTICS may be more effective or better covered by insurance for some people.

Whether PARTICS or SMART, these approaches are the future of asthma management. By studying these different anti-inflammatory reliever approaches, we can improve implementation and use these therapies more efficaciously.

The more options we have to treat asthma, the better.

The Section of Pulmonary, Critical Care and Sleep Medicine is one of the eleven sections within Yale School of Medicines Department of Internal Medicine. To learn more about Yale-PCCSM, visit PCCSM's website, or follow them on Facebook and Twitter.

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Finding the Right Approach to Treating Asthma < Yale School of Medicine - Yale School of Medicine

Internal Medicine

Stigmatizing Language Common in Clinical Notes for Patients With SUD – Medpage Today

NEW YORK CITY -- Clinical notes for patients with substance use disorder (SUD) contained stigmatizing language -- such as "junkie," "dirty user," and "this drunk" -- on a regular basis, according to a study of electronic health records (EHR).

A preliminary analysis of clinical notes from a random sample of 2,700 patients with SUD or opioid use disorder (OUD) diagnoses showed that 84.4% (n=2,279) of patients had notes that contained stigmatizing language, according to Jyoti Pathak, PhD, of Weill Cornell Medical College in New York City.

The most common terms found among patients' notes were abuse (77.1% of patients), opioid abuse (63.8%), addict (41.9%), and substance dependence (36.4%), Pathak reported at the American Psychiatric Association annual meeting. Stigmatizing language was based on a list of terms and phrases identified by the National Institute on Drug Abuse (NIDA).

Pathak and colleagues also found that such language was applied to some patients more than others, and used by some care providers more than others.

"We would all agree that stigma persists in healthcare," Pathak said during a poster presentation. "Research has shown that the words that we choose in clinical documentation, in patient communication, and clinician-to-clinician documentation have consequences."

He explained that a 2022 study in the Journal of General Internal Medicine illustrated that stigmatizing language can frame the narrative around a patient's overall experience with treatment. A 2019 study in Experimental and Clinical Psychopharmacology found that patients have negative attitudes toward terms like "addict" or "substance abuser," which may negatively affect their treatment outcomes.

Pathak reported that the two age groups who experienced the most common use of stigmatizing language in their clinical notes were those ages 33-48 (32.7% of all patients) and those ages 49-64 (34.1%). Similarly, Black or African-American patients made up almost a fifth of all patients who experienced stigmatizing language in their clinical notes (18.2%), he reported.

Social workers were far more likely to write clinical notes that contained stigmatizing language. Of the 390 clinical notes written by social workers in the analysis, all but one contained stigmatizing language. Comparatively, psychiatrists used stigmatizing language in 750 out of 877 clinical notes, Pathak reported.

"This is very consistent with what has been shown in other literature," he said. "There is absolutely a need for provider education in this space."

Pathak noted that people-first language is the recommended alternative. For example, instead of using "addict" a provider can use "person with substance use disorder." Similarly, the term "substance abuser" can be replaced by "patient." He pointed out that the NIDA has resources to help mental health providers with learning and implementing the appropriate language in their clinical notes.

Pathak and colleagues collected 980,194 clinical notes from the random sample of patients with either an OUD or an SUD diagnosis from 2010 through 2023 at a major academic medical center in New York City.

Using the NIDA list of stigmatizing terms and phrases, the researchers developed a rule-based natural language processing algorithm to extract clinical notes with stigmatizing language, and analyzed the incidence rates of this language in those clinical notes. Demographic characteristics of patients who had stigmatizing language used on them were compared to those without.

The researchers reported that notes authored by female providers use SL [stigmatizing language] terms more frequently (50.0% in SL cohort vs 42.4% in no SL cohort) than those authored by male providers.

Pathak highlighted that the use of natural language processing to identify notes with stigmatizing language may open the door to the use of other artificial intelligence tools to potentially address this issue.

"[When] you write your [email in] Gmail, it autocorrects your language," he said. "Can we develop similar tools that can be embedded within your [EHR], so when you are writing your note it can provide recommendations [such as] instead of using the word 'addict,' perhaps [use] the right terminologies?"

Michael DePeau-Wilson is a reporter on MedPage Todays enterprise & investigative team. He covers psychiatry, long covid, and infectious diseases, among other relevant U.S. clinical news. Follow

Primary Source

American Psychiatric Association

Source Reference: Pathak J, et al 'Words matter: Use of stigmatizing language in clinical notes of patients with opioid use disorder' APA 2024; Poster P05-090.

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Stigmatizing Language Common in Clinical Notes for Patients With SUD - Medpage Today

Internal Medicine

Patrick Hemming, MD: Depression, Anxiety Treatment by the Internal Medicine Physician – MD Magazine

This interview segment with Patrick Hemming, MD, involved a discussion of some of the major takeaways from his talk Depression and Anxiety Treatment by the Internal Medicine Physician, presented at the 2024 American College of Physicians (ACP) Internal Medicine Meeting.

During his ACP 2024 talk, Hemming described depressive disorders, anxiety disorders, recent changes to screening guidelines, and other elements he felt internists should be made aware of in the mental health space.

I go over screening guidelines, and the screening guidelines have changed in the last year, Hemming explained. If you go by the United States Preventive Services Task Force, they now recommend that really we should be screening all patients over 18 for depression, regardless of what your practice. Just last year, the recommendation that we should screen all patients 18 to 64, for anxiety disorders, that's new and has never been recommended before.

Hemming noted that the changes to guidelines for internists are not small and they do signify larger changes occurring in the mental health space.

Quality reporting for Medicare and Medicaid now starts to look at whether we're screening and whether we're getting people set up with treatment, Hemming said. Then that impacts payment schedules and things like that, that our practices are going to directly see results from in addition to our patients who are now being screened for new things.

Hemming later expressed that, while in psychiatric practices medication is adjusted and feedback will occur more rapidly, in primary care it is less possible to do so.

(We discussed) how we are going to follow up with patients, understanding the goals of treating some targets using things like our PHQ-9 or our GAD-7 for anxiety disorders, Hemming said. And, something very important for me in this talk is to point out that although we have created numbers for these things, this is not treating blood pressure. In blood pressure, we can create a goal for systolic blood pressure of 130 and get people under that and feel pretty good about ourselves

Hemming noted that unlike traditional situations with blood pressure, if internists are treating patients with a PHQ-9 number, this is not actually not what the patient cares about. He noted that they need to understand that such a patient may be having difficulties in their personal relationships, at work, or in their sense of achievement in life.

For additional information on this interview, view the full discussion posted above.

The quotes used here were edited for the purposes of clarity. Hemming has no relationships with entities whose primary business is marketing, selling, producing, re-selling, or distributing healthcare products used by or on patients.

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Patrick Hemming, MD: Depression, Anxiety Treatment by the Internal Medicine Physician - MD Magazine