Inside Medicine: Doctors torn by end-of-life philosophies

Doctors and the American public are afraid to let people die – and even help them do so – with comfort and dignity.

That has become clear to me over my 20 years of practice and through the stories that my colleagues have shared with me.

One doctor e-mailed me about his patient, a woman of 80, who found herself dying of emphysema. Despite being tethered to green oxygen cylinders and having her face constantly enmeshed in clear plastic face masks, she was continually short of breath.

Talking was very difficult and walking even short distances was out of the question. Faced with a terminal illness, she chose hospice care rather than spend her last days in a hospital.

She asked for a pill to end her life. The doctor told her she was depressed (which, given her situation, she might well have been). He offered antidepressant medications. She refused – "no more treatments."

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Depression in Young Doctors Tied to Medication Errors

Medical residents who are depressed are about six times more likely to make medication errors than those who aren't depressed, says a study that looked a 123 pediatric residents at three children's hospitals in the United States.

Researchers found that 20 percent of the residents were depressed, and 74 percent were burned out. During the study period, the residents made a total of 45 medications errors, and those who were depressed made 6.2 times more medication errors than those who weren't depressed.

There didn't appear to be any link between higher medication error rates and burnout. The study was published online Feb. 7 in the British Medical Journal.

These findings suggest that doctors' mental health may play a more significant role in patient safety than previously suspected, the study authors said. In addition, the high burnout rate among residents in this study -- consistent with other studies -- indicates that methods of training doctors may cause stress that harms residents' health.

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Facing lawsuit, state revisited prescription drug data law

A new Vermont law restricting the drug industry's use of data on doctors' drug prescribing habits is facing a federal lawsuit and a new round of scrutiny.
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The law, which was amended in the waning days of last year's legislative session after a federal court struck down a similar measure in New Hampshire, contains several provisions aimed at slowing cost increases for prescription drugs.

One target of the measure was companies that gather information on which drugs doctors prescribe most often and then sell that information to pharmaceutical companies. The information allows the drug companies to develop sophisticated sales pitches, called "detailing," to entice doctors to switch to their medications, said Julie Brill, an assistant attorney general who worked on the legislation.

Brill called the so-called "data.m.ining" restrictions "one piece of a larger effort by the state to ensure that marketing that goes on with respect to pharmaceutical products is appropriate and ... also to protect the privacy concerns prescribers have."

READ MORE @ BOSTON GLOBE