Issue link: https://beckershealthcare.uberflip.com/i/1439541
43 FINANCE CMO / CARE DELIVERY Helping patients understand the complex nature of medicine "Patients who seek second opinions usually have complex issues that don't have clear-cut solutions, so being conflicted is expected to some degree," Dr. Crawford said. In medicine, there's oen more than one interpretation of a prob- lem, and it's part of a physician's job to help patients understand this to avoid confusing them, Dr. Crawford explained. us, physicians delivering second opinions should overtly communicate the dy- namic nature of medicine, focus on why they believe their diagnosis or treatment plan is in the patient's best interest, and explain the evidence behind it. "Comparing it to other [diagnoses] and treatment options is helpful for the patient as well," Dr. Crawford said. When delivering a second opinion, it's critical to describe the circum- stances surrounding the diagnosis and the evidence available at the time. "It's important to recognize that medical opinions are based on all the information available at a given time and that we are able to affirm a prior opinion, augment it or even disagree with it in the most profes- sional of ways," Dr. Bahr said, noting that physicians must acknowl- edge that the same resources or experiences may be viewed differently by the clinician providing a second opinion. And while physicians who deliver second opinions frequently agree with the initial opinion of another provider, "We try to walk the pa- tient through the risks and benefits of each of the opinions offered" in the case of disagreement, Dr. Bahr said. "Every option is carefully considered, and we focus on person- alizing the medical options provided. Ultimately, we want the patient to make a decision that is best suited for him or her and collaborate to guide individuals toward the most suitable option," he said. A physician's word choice is especially key at this time and can help maintain the integrity of the first physician. "You don't want to offend or put down any other specialist," Dr. El-Farra said. "I would never use the language that they were wrong." Dr. El-Farra uses language that doesn't dismiss what the other physi- cian said, but emphasizes that it was their opinion, and she has a dif- ferent opinion. She said she tends to use phrases such as, "In my opin- ion, aer reviewing all the records," "Yes, but from my standpoint," and, "Based on the information I have, this is what I recommend." Focus on the path forward Sometimes, to move forward, things in the past must be minimized. Subtle differences between physicians should be de-emphasized, according to Jenny Chang, MD, director of the Houston Method- ist Cancer Center and the Emily Herrmann Chair in Cancer Re- search. It's rare that a patient treatment plan is just plainly incor- rect. Remembering the patient comes first will help the second physician realign the treatment plan accordingly, Dr. Chang said. Dr. El-Farra underscored the need for constant assurance from both herself and other members of the medical team. Some- times she calls in additional specialists to boost patient confi- dence. She also highlighted the importance of physician-patient communication and picking up on patient body language and facial expressions. "If they look conflicted, I just take more time to go through everything with them and give reassurance, whether it's data, answering ques- tions or bringing in another specialist," Dr. El-Farra said. "ese discussions with the patient need to be thoughtful and mindful of these long relationships that he or she may have had with their initial physi- cian," Dr. Chang advised. She noted that while it is very rare that a previous treatment was harmful to the patient, it does happen, and such situations require additional skills to navigate. In that situation, physicians should es- tablish a treatment path forward without embellishing past missteps. "It is more important to look forward in the treatment plan and not backward," the physician said. "I welcome patients who want a second opinion for me so that we can evaluate the different strategies that may be available," Dr. Chang said. "Additionally, in some academic centers, the availability of clinical tri- als, which may further the understanding of the biology of the disease and hopefully better the outcomes for patients is critical for patients seeking a second opinion." Patient-centered care — always "A physician's ego shouldn't be a main determinant in treatment deci- sions for patients," Dr. Crawford said. "I truly believe that patients do best when they're comfortable with the treatment plan and don't have lingering doubts or questions." Physicians should always ask each patient about their goals and prior- ities, rather than making assumptions, to help guide them to the path that's best for them. e bottom line is simple — the most important part of care is the patient. Focusing on the patient, not another physician, will help phy- sicians give the best diagnosis and care. n Coronavirus can infect inner ear, study finds By Erica Carbajal C ertain types of cells in the inner ear produce the proteins needed for SARS-CoV-2 entry — a poten- tial explanation for why some COVID-19 patients experience audiovestibular symptoms, according to re- search published Oct. 29 in Communications Medicine. The study included 10 adult COVID-19 patients who developed audiovestibular symptoms such as hearing loss, tinnitus or dizziness within three weeks of their COVID-19 diagnosis. Researchers analyzed both human and mouse inner ear tissue and generated in vitro cellu- lar models of the human inner ear. They found human inner ear tissue contains the "molec- ular machinery to allow SARS-CoV-2 entry," including the ACE2 receptor. Findings also showed the virus can infect hair cells and Schwann cells found in the inner ear. "Our findings suggest that inner ear infection may un- derline COVID-19-associated problems with hearing and balance," researchers said. n