Disclosing unexpected outcomes and medical error.

Health-care professionals have a responsibility to communicate honestly and empathetically with patients and families when there has been a disappointing outcome in care. They need to understand how all parties think about, feel, and react to the situation. It is too easy for health-care providers and patients and their families to feel that their interests are no longer aligned and to have expectations go unmet.

Multiple behavioral risk factor interventions in primary care. Summary of research evidence.

Background: An important barrier to the delivery of health behavior change interventions in primary care settings is the lack of an integrated screening and intervention approach that can cut across multiple risk factors and help clinicians and patients to address these risks in an efficient and productive manner.

Methods: We review the evidence for interventions that separately address lack of physical activity, an unhealthy diet, obesity, cigarette smoking, and risky/harmful alcohol use, and evidence for interventions that address multiple behavioral risks drawn primarily from the cardiovascular and diabetes literature.

Results: There is evidence for the efficacy of interventions to reduce smoking and risky/harmful alcohol use in unselected patients, and evidence for the efficacy of medium- to high-intensity dietary counseling by specially trained clinicians in high-risk patients.

The same but different: clinician-patient communication with gay and lesbian patients.

Surveys estimate that 3-6% of the patients seen by physicians are gay or lesbian. There are unique health risks of gays and lesbians that are important to the clinician in determining an accurate diagnosis, providing patient education, and arriving at an appropriate treatment plan. One of the most significant medical risks of these populations includes avoidance of routine health care and dissatisfaction with healthcare.

Teaching clinician-patient communication in the treatment of breast diseases.

In 1998, some 179,000 women in the United States were newly diagnosed with breast cancer, and 48,500 women died from it. Early detection by mammography, physical examination, and breast self-examination improves survival rates and can decrease mortality. The clinician's level of comfort with discussing education and prevention with patients can influence patients' adherence to preventive measures.