American College of Physicians: Internal Medicine — Doctors for Adults ®

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Anemia often hides in plain sight

From the March ACP Internist, copyright 2013 by the American College of Physicians

Anemia can be hard to pin down in primary care. Although the disorder can indicate serious disease, patients often don’t exhibit anemia symptoms until very late if at all, and what symptoms there are can be vague. To further complicate matters, debate exists about what actually constitutes anemia, with bodies like the World Health Organization and the Centers for Disease Control and Prevention differing on some crucial clinical thresholds. Experts say primary care physicians should look to the bloodwork to determine the cause and type of anemia, as well as where to go from there. Terri D’Arrigo discusses how to diagnose anemia, when to treat, and when to refer.

Everyone wants a physician who understands what they’re feeling, but new research has added some empirical support to the clinical value of empathy. In an Italian study of diabetic patients, those whose physicians scored higher on an empathy test were also less likely to experience several diabetes complications. Other research, however, shows that medical students seem to lose empathy as they proceed through their schooling. So, if empathy has an effect on clinical practice, how can physicians cultivate it? Stacey Butterfield talks to experts to define what empathy is, how it can be developed, and why empathic role models are important.

Pulmonary embolism in the hospital sometimes seems to get the most attention, but it can be a deadly presence in outpatient practice as well. Much like with anemia, symptoms can point to several different problems and might not be recognized as pulmonary embolism until it’s too late. To help make the call, experts say, physicians can use prediction tools such as the Wells criteria to determine a patient’s risk, but it’s just as important to rely on clinical judgment. Our story provides an overview of how to accurately assess for pulmonary embolism in outpatient practice.

This issue also debuts a new column, “The Patient’s Voice,” the result of a collaboration between ACP Internist and the National Partnership for Women & Families. The column will look at the health care experience from the patient’s point of view and will explore ways in which the current system can be made better. The inaugural column in this series by Debra L. Ness, the National Partnership’s president, outlines the goals for the column and details why truly patient-centered care is worthwhile.

What are your thoughts on patient-centered care and empathy? How often do you encounter anemia and pulmonary embolism in your practice? Let us know.

Sincerely,
Jennifer Kearney-Strouse

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