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  • Evidence-Based Medicine

    by Danielle Ofri

    We were at the end of our visit. We’d done the full history and physical exam. We’d reviewed the status of Ms. R’s diabetes, checked her blood pressure, adjusted her three diabetes medicines, reviewed her cholesterol levels, written out all the prescriptions, arranged appointments for the eye doctor and the nutritionist. Every few minutes I turned from her to the computer to type notes of our conversation so that I’d have appropriate documentation of our visit together. I’d checked to see how her kids were doing and how things were at work. Now we had two minutes left of our allotted fifteen minutes to review “health maintenance.” I quickly reviewed the status of her vaccinations, the date of her last Pap smear, discussed the importance of regular exercise, use of sunscreen, five servings of fruits and vegetables per day. Now there was one minute left.

    “What about a mammogram?” Ms. R. asked.

    Recently, a memo had been sent to all of the physicians in our department, reminding us that mammograms were one of the “Performance Indicators” that regulatory agencies use to monitor our hospital’s quality of care. “We realize that the controversial data regarding mammograms for women aged 40-50 are not resolved,” the memo said. “However, we urge you to order this important screening test for all your patients over the age of 40.”

    To read full article click here

    About the Author

    Danielle Ofri’s is a physician at Bellevue Hospital and an associate professor of medicine at N.Y.U. School of Medicine. She is also editor-in-chief of the Bellevue Literary Review.

  •  The Physical Exam as Refuge

    by Danielle Ofri

    New York Times

    There are few situations where we expect to disrobe and have our bodies touched by relative strangers. The physical exam is one of the unique characteristics of the doctor-patient encounter; a visit to a doctor doesn’t seem the same without one. Yet, increasingly, there’s less and less of it. Visits are shorter and doctors have to spend most of their time at the computer filling out the endless electronic medical records that have come to define the modern medical transaction.

    Often, it boils down to a half-hearted plop of the stethoscope on the fully clothed patient. For the medical students who are learning to become doctors, this can be perplexing: they have spent two years exhaustively learning the detailed physical exam, and then when they get to the practical years of medical school, they see doctors all around them hardly examining patients at all.

    But the reality of the time-crunch cannot be ignored. Patients come to a typical 15-minute office visit with several chronic conditions, plus their acute concerns for that day. There are lab results to review and screening tests to discuss. There are medications to renew and drug interactions to check. There is the education and counseling that is crucial to any visit. All this must then be dutifully documented in the voracious electronic medical record. (And heaven forfend that the doctor run over time or skip steps; she will be duly dinged on efficiency and productivity reports.)

    To read the full article in New York Times, click here

     

    About the Author

    Danielle Ofri’s is a physician at Bellevue Hospital and an associate professor of medicine at N.Y.U. School of Medicine. She is also editor-in-chief of the Bellevue Literary Review.

  • Help Your Child to Eat Healthy

    A doughnut after eating a pear and a pack of chips for the broccoli! Have you been making such deals with your fussy eater?

    Many mothers have constant trouble making their child to eat the right amount of healthy food at the right time. As observed through studies, many children in the US are becoming obese because they consume much more calories than what they really need. As per recent estimates, the prevalence of obese children aged 6 to 11 years has increased from 7 percent in 1980 to nearly 18 percent in 2012. In addition, few studies have revealed that almost one-third of toddlers in the US do not consume any fruits or vegetables in a whole day. With increased demand for unhealthy fast foods and sugary drinks, children often do not get the required amounts of essential nutrients. The unhealthy lifestyle that includes too much fast food, increased screen time and no physical activity has resulted in high rates of obesity among children.

     What could be the possible reasons for increased intake of unhealthy foods among children? Do children lack the knowledge about good nutrition?

    If we want to make our children healthy eaters, we need to make them understand what healthy eating means and what are the benefits of nutrition in health? Changing someone’s dietary pattern in adulthood is often a difficult task. Therefore, the nutrition education that can improve eating habits must start in the childhood. As per the evidence obtained through studies, dietary counseling is the first step towards increasing awareness for healthy eating. Let’s try to understand what diet counseling is and what benefits can it offer?

    What Does Diet Counseling Mean?

    Diet counseling sessions for children usually involves, both, the children and their parents. The counseling usually starts with nutritional assessment, which evaluates your daily diet intake. The dietician or other professional can then provide you individualized education designed to meet your family’s needs. The diet counseling may also help you to understand different food group and importance of healthy diet in disease prevention as well general well-being. Children who need to lose weight or those with eating disorder may require special sessions that particularly focus on their condition.

    What are the Benefits of Diet Counseling?

    Nutrition counseling can significantly impacts children’s nutrition knowledge. In addition, when parents are involved in the dietary counseling, it can have even greater impact on food preferences of children. The researchers have reported that children who receive diet counseling along with their parents have better knowledge about nutrition and able to select more nutritious food.

    The evidence obtained from studies suggests that it is possible to influence children's food choices, with dietary counseling given to them. Since young children are susceptible to change in their habits, parental support is important to implement new eating habits and to make the changed eating patterns permanent in children.

    If you want to bring in change in your child’s dietary habits, it should start with you. Parent’s nutritional knowledge, parenting styles and feeding practices and meal preparations show strong modifying effects on children’s dietary behaviors all of which can be improved through diet counseling.

    Is your child a picky eater? Have you tried to adapt the healthy eating habits yourself? 

    References:

    1. Ashworth A, Ferguson E. Dietary counseling in the management of moderate malnourishment in children. Food and Nutrition Bulletin, 2009; 30(3): 405-433.
    2. .Vitolo MR, Rauber F. Maternal dietary counseling in the first year of life is associated with a higher healthy eating index in childhood. J Nutr. 2010 ; 140(11):2002-2007.
    3. M Ra¨sa¨nen, KeskinenS. Impact of nutrition counselling on nutrition knowledge and nutrient intake of 7- to 9-y-old children in an atherosclerosis prevention project European Journal of Clinical Nutrition.2004; 58:162–172.
    4. Lagstriim H, Seppanen R. The impact of child-targeted dietary counseling of parents on food (milk) preferences of preschool-aged children in the STRIP project. Scandinavian Journal of Nutrition/Naringsforskning 2001; 45:51-56.
    5. Dietary Guidelines for Americans 2010. Available online: http://www.health.gov/dietaryguidelines/dga2010/dietaryguidelines2010.pdf. Last assessed on September 8, 2014. 

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