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Health News Updated Daily by Internist and Allergist at Cleveland Clinic Florida

Last Build Date: Tue, 17 Jan 2017 05:26:06 PST


Patient-centered communication: what are the basic skills?

Tue, 17 Jan 2017 05:26:06 PST

Communication skills needed for patient-centered care include:

- eliciting the patient's agenda with open-ended questions, especially early on
- not interrupting the patient
- engaging in focused active listening

Practice this at least in the first 60-seconds, the so-called "golden minute".

Understand patient's perspective

Understanding the patient's perspective of the illness and expressing empathy are key features of patient-centered communication.

Understanding the patient's perspective entails exploring the patient's:

- feelings
- ideas
- concerns
- experience regarding the impact of the illness
- expectations from the physician


Patient-centered communication - basic skills (click here to enlarge the image).


Empathy can be expressed by:

- naming the feeling
- communicating understanding, respect, and support
- exploring the patient's illness experience and emotions

Before and after a diagnosis

Before revealing a new diagnosis, the patient's prior knowledge and preferences for the depth of information desired should be assessed.

After disclosing a diagnosis, physicians should explore the patient's emotional response.

Treatment options

Shared decision making empowers patients by inviting them to consider:

- pros and cons of different treatment options
- no treatment

Instead of overwhelming the patient with medical information, small chunks of data should be provided using repeated cycles of the "ask-tell-ask" approach. Using "tell-tell-tell" does not engage patients.


1. Ask permission to start a conversation
3. Ask what the patient thinks about their health
4. Ask questions to find out what the patient already knows
5. Tell the patient information in a way that is easy to understand
6. Gauge the patient’s understanding by asking questions after you tell

What Is “Ask, Tell, Ask”? video:

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Patient-Centered Communication: Basic Skills. Hashim MJ. Am Fam Physician. 2017 Jan 1;95(1):29-34.
The 10 Building Blocks of Primary Care - “Ask Tell Ask” Sample Curriculum - UCSF
Ask-Tell-Ask: Simple Technique Can Help Hospitalists Communicate Difficult Messages

Media Files:

Percentage of U.S. residents with up-to-date screening for colorectal cancer remains at 60% - what options, other than colonoscopy, do we have?

Mon, 16 Jan 2017 05:24:02 PST

From the NEJM:

The percentage of U.S. residents with up-to-date screening for colorectal cancer has not increased appreciably since 2010 and remains at approximately 60%. To achieve the highest level of adherence to colorectal cancer screening, it may be best to provide participants a choice, because the “best” strategy is the one that they will adhere to consistently.

The NEJM reviews all the options in this table:

Full article is here:

Screening for Colorectal Neoplasia - Now@NEJM

Physician ratings at Cleveland Clinic (video)

Tue, 10 Jan 2017 05:00:09 PST

The CEO and the Chief Experience Officer explain the rationale behind the physician ratings at Cleveland Clinic:

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Disclaimer: I am an allergist at Cleveland Clinic Florida.(image)

Problem solver

Sun, 08 Jan 2017 20:22:53 PST

From Italian: Pedro and Domenico jump, but Oreste thinks about it a bit... and finds another solution.
#donkey #problemsolving

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This little video even made it to Daily Mail: Donkey shows off his brains by using his TEETH to remove a fence

Gadgets Galore - Best of CES 2017

Fri, 06 Jan 2017 05:39:55 PST

From WSJ: As the tech world reveals the products that will impact the year ahead, Personal Tech columnists Geoffrey A. Fowler and Joanna Stern hunt for the most exciting and unusual, from AR glasses to breast pumps (video is below):

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Minutes Count in the Cleveland Clinic Florida Emergency Room: Patient Story

Fri, 16 Dec 2016 05:00:07 PST

"A Florida woman is rushed to the emergency room with life-threatening injuries and only minutes to live. Experience her story as the Cleveland Clinic Florida Emergency Department team springs into action to save her":

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Disclaimer: I work at Cleveland Clinic Florida, but I am not paid for this post.


“99 percent of all claims of being 115 or older are false.”

Fri, 18 Nov 2016 04:00:01 PST

(image) An engaging story from the NYTimes about runners older than 90, and more.

Among the quotes:

“99 percent of all claims of being 115 or older are false.”

“Old age always wins. It’s shocking. No matter how hard you try, it beats you.”

Apart from that, nothing would stop him, not even a colostomy bag:

"The oldest competitor would be an Australian legend, John Gilmour, 97, a World War II veteran who was captured by the Japanese and put into forced labor. Malnutrition and the harsh conditions permanently shrouded his vision. Still, he resumed his running career after the war. He knew what a body could withstand. The pain of sport was nothing compared with the pain of capture.

In his mid-60s, he could still run a marathon under three hours."

Read the full story here:

Image source:, public domain.(image)

7 classical virtues of trust, justice, hope, temperance, wisdom, courage and compassion - and how this applies to medicine

Fri, 04 Nov 2016 06:45:13 PDT


We often receive an email from the Chief of Staff on Wednesdays. The email is meant to unite the physicians at Cleveland Clinic around a common idea/topic/thought for that week.

One of the emails mentioned "A virtuous culture built on the seven classical virtues of trust, justice, hope, temperance, wisdom, courage and compassion. These virtues offer us 25 centuries of wisdom about human conduct at its best."

As a simple exercise, try thinking about one of those each day of the week, make it the "theme of the day":

Monday - Trust
Tuesday - Justice
Wednesday - Hope
Thursday - Temperance
Friday - Wisdom
Saturday - Courage
Sunday - Compassion

These concepts are not new, of course. There have been multiple different variations proposed throughout the centuries. Some examples are references below. If you feel adventurous, don't limit yourself to 7 virtues but consider the 24 Prussian virtues below:

"Bottle-flipping" is the latest fad, see why schools are banning it - WSJ video

Mon, 31 Oct 2016 10:59:19 PDT

From WSJ: Bottle-flipping has become a worldwide phenomenon. But some schools are trying to ban the flippers:

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Easier schedule for HPV vaccine: 2 doses instead of previously recommended 3

Fri, 28 Oct 2016 05:04:34 PDT

From Mayo Clinic: To protect against cervical cancer and other cancers caused by HPV infection, the Centers for Disease Control (CDC) is now recommending that 11- and 12-year-olds receive two doses of HPV vaccine at least six months apart. This is a change from the previously recommended three-dose series.

The CDC says adolescents ages 13–14 also can receive the HPV vaccine on the new two-dose schedule. However, those who start the series later will continue to need three doses.

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Self-administered HPV Test is one of the Top 10 Medical Innovations 2017, selected by the Cleveland Clinic:

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How to administer "Emotional First Aid"

Wed, 12 Oct 2016 03:30:10 PDT

Do you know that feeling lonely impacts your ability to build up an immunity after getting the flu vaccine?

From the Google Talks lecture series: "Although we have bandages for cuts, chicken soup for colds, and ice packs for bruises, most of us have no idea how to treat day-to-day emotional injuries such as failure, rejection, and loss. But, as Guy Winch, Ph.D., points out, these kinds of emotional injuries often get worse when left untreated and can significantly impact our quality of life. In this fascinating and highly practical book he provides the emotional first aid treatments we have been lacking."

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Have you tried some chair yoga today?

Wed, 14 Sep 2016 06:00:16 PDT

Here is a list of sample exercises from the Costco magazine, which means chair yoga is hitting the mainstream:

Chair yoga is a gentle form of yoga that is practiced sitting on a chair, or standing using a chair for support. The poses, called Asanas, are often adaptations of standard Hatha yoga poses.

Chair yoga is especially suitable for busy people stuck at their desks at work, or those unable to participate in a traditional yoga class due to the effects of aging or disabilities.

Chair Yoga is one of the gentlest forms of yoga available. Complicated maneuvers and complex movements are typically not included.

Related reading:

Chair Yoga - Wikipedia, the free encyclopedia

Drummer Leonard Haze's thoughts on old age and dying

Tue, 13 Sep 2016 04:18:41 PDT

Leonard Haze was a great drummer. He passed away in his sleep last weekend at age 61. I saw him on tour with Ian Gillan in 1992 and the whole band was amazing. He had this humongous Ludwig drum kit and was a powerful drummer. Lenny Haze recorded the Toolbox album with Gillan, one of the songs from the album, Don't hold me back, is linked below:

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Considering the recent deaths of many rock and roll greats, this Facebook post by Lenny from January seems very relevant:

Leonard Haze, thinking about a lot of things.
January 2:

"That's enough. Why is it so hard to get old ? You loose friends as you go. With Bill F rates today that's for me since Christmas a total of 4 people I know passing away. Christmas eve my step daughter Danielle Galvin ' s Aunt & best friend at 36. From something she didn't know about. Lemmy two days after Christmas something he just discovered. Bill Frates today. I heard he was very I'll but still. You add on Mark Weaver & I am sorry but now I know why granny didn't want to play bingo.
I asked her if " you want a ride to the church to play bingo" ?" No " she snapped. Why ? Too many old people was the response. She explained that the last ladies she had become friends with all had died & she had lost all her friends. She was about 92 at the time & an uncle my mom & I took care of her and her older sister my greatest Aunt Mary. I can't explain how funny those two old ladies were. Best thing I ever did was 3 days a week with them.
But now granny I understand why you said more pain comes from loosing others than your body gives you getting old. Now I get it."

Lenny had moderate to severe COPD, according to news reports.


"We'll just go in and do some work."

Fri, 09 Sep 2016 04:00:31 PDT

Angus Young from AC/DC in Rolling Stone:

"Malcolm was always one to battle through. He would look at me in times of crisis and go, "We'll just go in and do some work. We'll sit and write some songs." He had that drive, and I feel obligated to keep it going, maybe because I was there in the beginning with him.

When you sign on and say, "I'm gonna do this and that," it's always good to say at the end of it, "I've done all I said I would do." That was always the idea, especially when we were younger – me, Malcolm, Bon. You had to show up and be on time."

It's a long way to the top if you wanna rock 'n' roll, AC/DC:

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Read more here:

AC/DC's Angus Young Talks Retirement, Malcolm Young Health Update

It Pays to Be Human: communicate clearly, take initiative, problem-solve, get along with people

Thu, 01 Sep 2016 04:00:01 PDT

From WSJ:

It Pays to Be Human - The job market’s most sought-after skills can be tough to spot on a résumé. Companies across the U.S. say it is becoming increasingly difficult to find applicants who can communicate clearly, take initiative, problem-solve and get along with co-workers. Those traits, called soft skills, can make the difference between a standout employee and one who just gets by.

"Soft skills" are needed in medicine too. It is always great to be human. After all, we can't be anything else.

The top 10 in-demand soft skills are listed by LinkedIn here:

Looking at the top 10 least in-demand skills is an eye opening experience. Apparently, employers are not interested anymore in: "emotional intelligence", and some teams skills such as leadership and team building.


The ‘Soft Skills’ Employers Are Looking For
Data Reveals The Most In-demand Soft Skills Among Candidates

Tips for sun protection

Wed, 31 Aug 2016 05:10:07 PDT

(image) Tips for sun protection: ASC uS:



The best sun protection is sun avoidance. Seek shade if you can, especially between 10 AM to 4 PM, which are the peak sun hours.


Use sunscreen with an SPF (Sun Protection Factor, this is the number on most sunscreen bottles) of 30 to 50, or more, that protects from both Ultraviolet A (UVA) and Ultraviolet B (UVB) wavelength light. Even though the protection is called "broad", it is not complete. Remember: sun avoidance is the best sun protection. Sunscreens with added UVA protection should contain Titanium dioxide, Zinc oxide, or Parsol 1789, also known as Avobenzone.

Use sun protection if spending time outside for 15 minutes or more. Apply 20-30 minutes before going out and remember to reapply every 2 hours. No sunscreen is truly water proof and it will wash away with sweat, swimming and rubbing.


Wear tightly woven, loose fitting (cooler) long sleeved clothing, UV-blocking sun glasses (eyes need sun protection as well) and wide-brimmed hat. Straw hats with holes are not suitable because light still gets through. Wear UV protective "Rash Guard" shirts.


Consider monthly self-skin checks/examinations, where you check for any color/size change in skin spots/moles.

Related reading:

The Skin Cancer Foundation's Guide to Sunscreens
Sunscreen Fact Sheet - British Association of Dermatologists
Image source:, public domain.(image)

The Science of Doping: Gaming Hormones, Asthma Drugs, and More

Mon, 29 Aug 2016 05:00:16 PDT

From WSJ: Doctors often prescribe tamoxifen to breast cancer patients to keep their tumors from growing. But the drug is also used by doping athletes looking to get ahead of the competition. How does it give them an edge, biologically? Watch the video below:

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Earlier this year, British cyclist Simon Yates was caught up in a doping controversy related to terbutaline, a common asthma medication. Athletes can take the inhaled version if they get a doctor's note. But current testing methods can't differentiate between this and other banned versions. Watch the video below:

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The Science of Doping: How Testosterone-Boosting Drugs Work


R.E.D.E. Model of Communication

Mon, 15 Aug 2016 03:30:12 PDT

R.E.D.E. Model of Communication at Cleveland Clinic. Dr. Katie Neuendorf, Medical Director of the Center for Excellence in Healthcare Communication, describes the foundational program her team developed centered on their own R.E.D.E. model of communication:

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R.E.D.E stands for:



Genomic Sequencing: Pros, Cons, and Implications for You and Your Family (DocMikeEvans video)

Thu, 11 Aug 2016 03:44:25 PDT

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For more information on specific tests and treatments please visit

Check out our new website
Follow Dr. Mike for new videos!

Dr. Mike Evans is a staff physician at St. Michael's Hospital and an Associate Professor of Family Medicine. He is a Scientist at the Li Ka Shing Knowledge Institute and has an endowed Chair in Patient Engagement in Child Nutrition at the University of Toronto.

Written, Narrated and Produced by Dr. Mike Evans
Illustrations by Liisa Sorsa
Directed and Photographed and Produced by Nick De Pencier
Editor, David Schmidt
Story/Graphic Facilitator, Disa Kauk
Production Assistant, Chris Niesing
Director of Operations, Mike Heinrich (image)

A new way to swim freestyle?

Tue, 09 Aug 2016 19:10:06 PDT

Has Ryan Lochte discovered the next big thing in swimming?

Read the story here:

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Longevity: it's truly amazing Deep Purple are still on stage in full force 45 years later at the same place where Smoke on Water was written and recorded

Sun, 17 Jul 2016 08:28:49 PDT

Photos from the concert of Deep Purple, Montreux, 2016-07-16. A great example of vitality and longevity: it's truly amazing Deep Purple are still on stage in full force 45 years later at the same place where Smoke on Water was written and recorded (1971 in Montreux).

Smoke On The Water lyrics - Deep Purple:

We all came out to Montreux
On the Lake Geneva shoreline
To make records with a mobile
We didn't have much time
Frank Zappa and the Mothers
Were at the best place around
But some stupid with a flare gun
Burned the place to the ground

Smoke on the water, a fire in the sky
Smoke on the water

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Drummer Ian Paice has recovered from the TIA he had in June 2016.

Here is a brief review of the concert:

Don't smoke on the water:

There's Always Another Day

Tue, 12 Jul 2016 18:04:21 PDT

David Cameron sings to himself after announcing resignation date - BBC News:

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As David Cameron announced his resignation date he walked away from the podium singing a song before walking inside number 10 Downing Street.(image)

A Cleveland Clinic doctor is an IBM Watson ad about healthcare applications

Mon, 06 Jun 2016 07:24:00 PDT

Dr Sikon highlights how Watson can help Cleveland Clinic doctors manage data overload, giving them more time to plan the best treatments for patients. "IBM Watson helps hospitals outthink data overload."

Here’s the ad featuring Dr Sikon:

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More videos here:

IBM Cognitive Era - YouTube

How It Works: IBM Watson:

Disclaimer: I am an allergist/immunologist at Cleveland Clinic Florida.(image)

App allows anybody to snap a photo of a passerby and discover their real name — with 70% reliability

Fri, 03 Jun 2016 06:27:20 PDT

(image) From MarketWatch:

250 million video surveillance cameras have been installed throughout the world, and chances are you’ve been seen by several of them today. We leave our “faceprints” everywhere we go.

FindFace app allows anybody to snap a photo of a passerby and discover their real name — with 70% reliability. What’s particularly unsettling are the use cases the app creators advocate: identifying strangers to send them dating requests, helping government security agencies to determine the identities of dissenters, and allowing retailers to bombard you with advertisements based on what you look at in stores.


Facial recognition will soon end your anonymity

FDA warns that fluoroquinolone antibiotics can cause damage to muscles and nerves

Sat, 14 May 2016 06:20:05 PDT

(image) The FDA updated boxed warning will inform patients that the serious side effects of the drugs generally outweigh the benefits for patients with sinusitis, bronchitis and uncomplicated urinary tract infections - if patients have other treatment options. However, why would you prescribe these antibiotics if there are other treatment options? The practical implication of this recommendation is somewhat unclear.

The side effects can involve damage to tendons, muscles, joints, nerves and the central nervous system (CNS). There was an association between fluoroquinolone antibiotic use and disabling peripheral neuropathy in a 2013 study.

Symptoms reported by patients included weakness, numbness, pain, discomfort, burning and tingling. There is also reported risk of cardiovascular disease and tendon rupture.


FDA Requires Stronger Warnings for Antibiotics’ Side Effects - WSJ

Image source: Wikipedia, GNU Free Documentation License.(image)