Just how differently can an objective medical diagnosis be viewed by physicians and their patients? In a recent study, researchers at Texas A&M and Penn State had primary care physicians and more than 200 patients fill out surveys recording their beliefs regarding the illness or condition the patient had come in for. The surveys took into account underlying causes, controllability, impact on life quality, and patient behavior as a factor.

The study’s results found a disconnect between patient beliefs and doctors’ perceptions of patient beliefs. Doctors underestimated the degree to which patients blamed themselves for illnesses, along with how well patients believed they could control the condition. Additional discrepancies were seen with regard to the perception of the ability of natural remedies to treat the condition, how much the illness impacted lives, and the patient’s desire to work with the doctor on treatment plans.

The takeaway? Obviously, there needs to be better understanding between physicians and patients. The authors contend that physicians can do a good deal to bridge the gap themselves. Their suggested starting point: taking more time to ask questions of your patients, rather than just talking at them.

Is a one-stop shop model the best way forward for your career? With the continually mounting costs of practicing medicine, primary care providers and others are increasingly looking to the multidisciplinary practice model as a means of cutting costs and giving patients what they’re looking for.

If you’re looking to practice in a multidisciplinary environment, you’ve got options. One is to join a large, multispecialty practice, which about 14 percent of primary care physicians graduating in 2009 did. Working in a larger multispecialty group gives you access to a wide array of practitioners. This means you can seek out guidance on particular patient issues from experts that are often right across the hall from you. Going this route also means that you won’t have to hire and fire employees or deal with regulatory compliance and insurance contracting.

If you’re thinking of going with a smaller multispecialty practice, you’ll likely be joining a group with fewer services. The tradeoff is that you gain more control over your own practice, and the group you join may be more focused on a particular combination of services: for instance, family practice and psychiatry. If you find that the day-to-day demands of operating a business—administrative tasks, billing, compliance, and so on—are bearable or even interesting to you, then you may want to stay in a smaller multispecialty setting.

Multispecialty practices thrive off a patient perception of ease of use and access. Need some imaging work done for a patient? Call up the specialist down the hall and coordinate the process within the group. A multidisciplinary practice also makes it easier to get your patients to adhere to treatment plans, as orders are reinforced whenever the patient sees another physician within the group. It might not be the model for everyone, but if you can work as part of a team and understand the team approach to medicine, the multidisciplinary model just might be the right fit for you.

What is the proper role of the psychiatrist with regard to palliative care? Most care focuses on halting, delaying, or reversing disease progression, but can psychiatrists play a noncurative role as well? An article in Psychiatric Times takes a look.

For patients late in life, the goal of psychiatric care is not curing or a total cessation of symptoms. Rather, patients and families can be put at greater ease if--assuming a complete cure is not possible--symptoms are at least reduced and a greater quality of life is achieved. A palliative approach isn’t an abandonment of hope. It is, instead, a shifting of expectations.

When it comes to pain treatment, care of patients should involve routine pain severity and pain-related disability assessment. If, as a psychiatrist, you are uncomfortable prescribing topical and oral analgesics, it would be useful to familiarize yourself with typical presentations and differential diagnoses of pain conditions in order to give more accurate treatment recommendations. When assessing elderly patients with pain, be aware that no one treatment fits all. Effective care requires an individualized management plan integrating analgesics, rehabilitation therapies, and more.

Dementia is an affliction that may necessitate palliative care. There are no disease-modifying treatments or preventive medications for dementia. The role of the psychiatrist is to teach families and caregivers about what to expect, including repetitive behavior, restlessness, incontinence, sleeping problems, and lack of inhibition. Caregivers should also be informed of the likely progression of the disease, as well as their options with regard to services and entitlements. Familiarize yourself with the key clinical indicators that would make hospice an option for severe patients, as the ability of families to care for loved ones in the home can vary depending on family resources and the severity of the affliction.

In taking a palliative approach, pursue treatments with the same vigor--if not more--that you would use in a curative model. While the final outcome may be certain, there is still much that can be done with regard to enhancing quality of life and lessening the impact of the disease on families and caregivers.

In a development that seems certain to quiet pediatrics offices across the nation, researchers are reporting significant progress in microneedles. These Band-Aid-like patches could someday replace traditional syringes across the medical field, virtually eliminating the cause of needle-shyness.

Over the past fifteen years, many researchers have been at work developing adhesive patches that are full of microscopic needles. Their aim has been to produce a painless means of medicine delivery. Bioengineers at the Georgia Institute of Technology are hopeful that advances with these patches will result in higher rates of flu vaccine administration, while other researchers are seeking to apply the technology to other drugs for treating conditions such as osteoporosis without the need for syringes.

The patches are typically about the size of a postage stamp and are coated with hundreds of needles, each less than a millimeter long. The needles work by penetrating the top layer of the skin, whereupon the treatments in the patch are more easily able to enter the bloodstream.