Welcome to the September issue

By Julie Stauffer (julie.stauffer@rxcomms.com)

How quickly can you lay your hands on tomorrow's meeting agenda, the latest batch of clinical data, or the draft report you've been asked to review? Although de-cluttering your desk may fall low on your low priority list, disorganisation carries a hefty price tag.

A Gartner Group study revealed that the average company loses one out of every 20 documents and spends US$120 in labour to track down each one that goes missing in action. Nor are the costs strictly financial. Untidy offices are a source of stress for 43% of American workers, according to a survey by office supplies manufacturer Esselte.

Need an added incentive to get organised? Esselte also found that 52% of UK managers consider the state of your desk during employee appraisals.

If you're ready to regain control of your desktop, here's a six-step plan:

1. Clear the decks

Block off a couple of hours, haul out the recycling bin and get ready to pitch the unnecessary documents cluttering your desktop and crammed into your cabinets. To decide what stays and what goes, Barbara Hemphill, author of Taming the Paper Tiger , suggests a few key questions:

• Does this piece of paper require action?
• Is it recent enough to be useful?
• Would it be difficult to find this information somewhere else?
• Are there tax or legal implications to throwing it out?
• Can you identify a specific use for it?

If the answers are “no,” you can toss out the document with a clear conscience.

2. Organise your files

Every piece of paper in your office should have a home. Group like with like: put financial files in one place, for example, and scientific papers in another. For maximum efficiency, keep the files you're currently working on close at hand. Compiling a master list of all your files will help you locate information quickly.

3. Develop a dating habit

You'll save yourself a lot of headaches by dating every piece of paper and marking documents as either “draft” or “final.” When a project is complete, ditch all the drafts and keep just one copy of the final version.

4. Triage incoming paperwork

When a document hits your desk, decide whether to toss it, file it for future reference, or act on it. If you can't act until you've received approval or input from someone else, put the document in your “pending” file and make a note on your calendar to follow up if you haven't heard back within the allotted time.

5. Create a to-do list

While it may be tempting to leave a folder on your desk as a reminder to take action on it, file it away and add a note to your to-do list instead. If there's a specific deadline, make a note on your calendar as well.

6. Make a daily commitment

Once you have a system in place, investing just a few minutes a day will keep it running smoothly – and avoid hours of frustration hunting down misplaced documents.

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By Mary Gabb ( mary.gabb@rxcomms.com )

Are they drug addicts or the chemically dependent?

Are they old people or senior citizens?

Do health economists really need to use the politically-correct (PC) euphemisms of medicine? When is it okay to use jargon?

As noted by our editor, David Woods, euphemisms have been referred to as verbal placebos – a way of discussing unpleasant topics in a more palatable manner. But do euphemisms really change the way we think? And should Health economists be encouraged to use them when discussing their economics research of medical topics?

In a recent essay in the Archives of Neurology , the author suggested that the word ‘dementia' be replaced with actual name of the disease (e.g. corticobasal disease) or the term ‘cognitive impairment', to avoid the image of a demented individual (i.e. someone who is crazy or out of their mind). Although these terms avoid the stigma of dementia, are they any more relevant to a lay audience? Do they confer the desired information to the patient and loved ones about the condition? One could argue that they simply create more confusion.

We see many other examples of euphemisms in both lay and medical lexicons, such as cancer survivor, instead of cancer patient; people with diabetes, instead of diabetics; differently abled, instead of disabled. The rationale for encouraging PC euphemisms is to remind physicians (primarily) and other healthcare providers that patients are, first and foremost, people; to avoid letting the patient fall into role of ‘the sick person'; and to avoid any stigma associated with a condition.

An informal survey of a few physicians revealed that euphemisms can have a role to play in avoiding confusion with patients, but the key is honest, open communication in language that all parties understand. However, when discussing medicine among colleagues, more-direct, less-PC language is appropriate. As gynaecologist Margaret Grotzinger, MD, notes, ‘I don't think it would make a difference in terms of how a doctor views or treats a patient – I think that is rooted in the physician's personality and not by what words [he or she] uses'.

There is also the shorthand that doctors use amongst themselves (e.g. an OCDer, which is a patient with obsessive-compulsive disorder, or ‘the transplant' in Room 310). Traditionally we have been taught to avoid jargon in formal communication (oral and written), but with colleagues, we often use jargon, if only because it's easy. According to veteran medical editor Edie Schwager, jargon ‘is not a pejorative term in itself. It's simply a shorthand way of communicating with colleagues, a specialised language used within specialised groups. There's good jargon and there's bad jargon. But it all depends on how it's used. If it's used to obfuscate, to defraud, it's very, very bad.'

Should this encouragement of euphemisms or PC language apply to those on the periphery of medicine (e.g. health economists, statisticians, clinical trial designers)? Should Health economists be able to use jargon when discussing their work? In true PC fashion, the answer is, it depends. The health economist, like any physician or any other speaker, must know his or her audience. After all, clarity – not soothed feelings or pedantry – is the ultimate goal. If euphemisms or jargon will best reach those targets, health economists should use them. As politicians learn, time and time again, words do mean things.

“It is a most extraordinary thing, but I never read a patent medicine advertisement without being impelled to the
conclusion that I am suffering from the particular disease therein dealt with in its most virulent form.
The diagnosis seems in every case to correspond exactly with all the sensations that I have ever felt.”
Richard Asher, British endocrinologist and author (1912–1969)

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By David Woods (david.woods@rxcomms.com)

“Since 2000, the US Food and Drug Administration (FDA) has received more than 95,000 reports of medication errors. These reports are voluntary, so the number of actual medication errors is believed to be higher,” says Carol Holquist, director of the division of medication error prevention in the FDA's Center for Drug Evaluation and Research.

The FDA works with many partners to track medication errors, one of which is the Institute for Safe Medication Practices (ISMP), based in a Philadelphia suburb. They review drug names, rejecting some 25% of the 400 submitted each year; and they examine drug labelling and packaging.

Occupying the same building as the ISMP, and a wholly-owned subsidiary of the Institute, is a company called Med-E.R.R.S – the letters standing for Error Recognition and Revision Strategies. The company's CEO, pharmacist Susan Proulx (pictured left), says that while they don't invent drug names – that's a whole other speciality – they do work with names, to test for possible confusion, and therefore error. She cites as examples the similar-sounding cholesterol drug Omacor and the anti-bleeding drug Amicar. They also had similar dosages. Eventually, in concert with the FDA, Omacor became Lovaza.

Similarly, Med-E.R.R.S works with graphics people to ensure that labelling and packaging are designed for maximum information and minimal likelihood of confusion. As Proulx puts it: “We put great emphasis on the design of the package label; it must be unambiguous... and the first priority is the name of the drug and the dosage.”

The company has worked with over a hundred pharma companies in its ten-year history, and relies on a group of doctors, nurses, pharmacists, and other professionals to review and assess names and labels. They work mainly online and receive a small honorarium for their involvement. One test is to produce a handwritten version of a new drug name and show it to pharmacists who assess its potential to be confused with another product.

Med-E.R.R.S uses a sophisticated analytical tool called FMEA. It's commonly used in the aviation and automotive industries, as well as by NASA, and stands for Failure, Mode, Effect, Analysis. Says Proulx: “If a car's steering wheel failed, you'd look at that; then see how it happened; then see the result (such as loss of control) and then find out why.”

Check www.fmeainfocentre.com for more details of how this works.

Medication errors can be approached along the same lines. Most occur for a variety of reasons, such as miscommunication of drug orders through poor handwriting, confusion between drugs with similar names, poor packaging design, and confusion of metric or other dosing units. The FDA's Holquist says that they “usually occur because of multiple complex factors. All parts of the healthcare system – including health professionals and patients – have a role to play in preventing medication errors.”

And a major part of that role is played by organisations like ISMP and Med-ERRS.

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HOC is your publication, so please send us your requests or comments to duncan.dibble@rxcomms.com

If you missed any earlier issues of HOC , email duncan.dibble@rxcomms.com for a copy. Just a few of our previous articles are The importance of the economic value message , How health economists can develop a global perspective and How to present health economics to non-economists . A full list is available at http://www.rxcomms.com/hocezine.asp