Wednesday, December 5, 2018

Why Do Patients Lie to Their Doctors? Read more

Why Do Patients Lie to Their Doctors?

A new study has discovered that 60 to 80 percent of people lie to their doctors.
Many lied about their diet and exercise, while more than one-third of respondents didn’t speak up when they disagreed with their doctor’s recommendation. Another common scenario was failing to admit they didn’t understand their doctor’s instructions, researchers reported.
When patients explained why they weren’t transparent, most said that they wanted to avoid being judged and didn’t want to be lectured about how bad certain behaviors were. More than half were simply too embarrassed to tell the truth, the researchers discovered.
“Most people want their doctor to think highly of them,” said senior author Angela Fagerlin, Ph.D., chair of population health sciences at U of U Health and a research scientist with the VA Salt Lake City Health System’s Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation. “They’re worried about being pigeonholed as someone who doesn’t make good decisions.”
Scientists at University of Utah Health and Middlesex Community College led the research study in collaboration with colleagues at the University of Michigan and University of Iowa.
The researchers conducted a national online survey of two populations. One survey captured responses from 2,011 participants who averaged 36 years old. The second was administered to 2,499 participants who were 61 on average.
Those taking the survey were presented with seven common scenarios where a patient might feel inclined to conceal health behaviors from their doctor, and asked to select all that they had ever happened to them. Participants were then asked to recall why they made that choice.
The survey was developed with input from physicians, psychologists, researchers and patients, and refined through pilot testing with the general public, according to the researchers.
In both surveys, people who identified themselves as female, were younger, and self-reported as being in poor health were more likely to report having failed to disclose medically relevant information to their doctor, according to the study’s findings.
“I’m surprised that such a substantial number of people chose to withhold relatively benign information, and that they would admit to it,” said first author Andrea Gurmankin Levy, Ph.D., MBe, an associate professor in social sciences at Middlesex Community College in Middletown, Connecticut.
“We also have to consider the interesting limitation that survey participants might have withheld information about what they withheld, which would mean that our study has underestimated how prevalent this phenomenon is.”
The trouble with a patient’s dishonesty is that doctors can’t offer accurate medical advice when they don’t have all the facts, the researchers point out.
“If patients are withholding information about what they’re eating, or whether they are taking their medication, it can have significant implications for their health — especially if they have a chronic illness,” Levy said.
Understanding the issue more in-depth could point toward ways to fix the problem, according to the researchers.
Levy and Fagerlin hope to repeat the study and talk with patients immediately after clinical appointments, while the experience is still fresh in their minds. Person-to-person interviews could help identify other factors that influence doctor-patient interactions, the researchers said. For instance, are patients more open with doctors they’ve known for years?
The possibility suggests that patients may not be the only ones to blame, added Fagerlin.
“How providers are communicating in certain situations may cause patients to be hesitant to open up,” she said. “This raises the question: Is there a way to train clinicians to help their patients feel more comfortable?”
The study was published in JAMA Network Open.

The 8 Types of Abusive Behavior... Explore

The 8 Types of Abusive Behavior

Aaron wrongly believed that the only type of abuse was physical and then only if it left a mark. This is a common misunderstanding in our culture. When he took some time to review the different types of abuse, he realized that he experienced it in his marriage, from his parents, and on occasion was guilty of abusive behavior as well.
"At the age of 17 years, Mahesh has given up his schooling to work as a salesman." Alcohol violence in the family is forcing a lot of children to join work force. We target to sensitize 500 children about the issue of alcoholism and NCDs & encourage them to continue their education. Uma's troubles became worse when her husband started using alcohol and abuse became an everyday affair. We intend to counsel, heal 240 women survivors of violence to seek help and to live healthy & productive life. 
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There are many other ways a person can be abused. Abuse can be manipulation, exploitation, maltreatment, neglect, violence, cruelty, harm, hurt, ill-treatment, and exploitive. The seven main ways it is manifested is through physical, mental, verbal, emotional, financial, sexual and spiritual. Legal abuse is very specific and is not readily seen, however, it does occur. The following list is not inclusive but rather provides an opportunity to explore, evaluate and discuss any potentially destructive behavior.
Aaron used this list as a checklist, marking up his and other’s errors in behavior. Awareness is the first step to stopping abuse.
Physical Abuse. Has the victim experienced:
  • Intimidation – Bullying by standing over, looking down, or getting “in your face” and then refusing to back off.
  • Isolation – Limiting the ability to escape from or abandoning in dangerous situations.
  • Restraint – Confines by blocking a doorway, grabbing when trying to leave, locking doors with no key, or tying up.
  • Aggression – Hitting, kicking, punching, arm twisting, pushing, beating, shoving, biting, slapping, striking with an object, throwing objects, shaking, pinching, choking, hair pulling, dragging, burning, cutting, stabbing, strangling, and force-feeding (including overdose or misuse of drugs/alcohol).
  • Endangerment – Verbal threats of killing mixed with physical violence and use of weapons.
Mental Abuse. Has the victim experienced:
  • Rage – An intense, furious anger that comes out of nowhere, usually over nothing, startling and shocking a person into compliance or silence.
  • Gaslighting – Lying about the past making a person doubt their memory, perception, and sanity. They claim and give evidence of past wrong behavior further causing doubt.
  • The Stare – An intense stare with no feeling or anger behind it frequently mixed with the silent treatment.
  • Silent Treatment – Punishing by ignoring. There is a history of cutting others out of their life permanently over small things.
  • Projection – Dumping their issues onto others as if the other person did it.
  • Twisting – When confronted, twisting things around to blame others for their actions. They will not accept responsibility for their behavior and instead insist on an apology.
  • Manipulation – Making others fear the worst such as abandonment, infidelity, rejection, or death.
  • Victim Card – When all else fails, they resort to playing the victim card to gain sympathy and further control behavior.
Verbal Abuse. Has the victim experienced:
  • Extremes in Vocal Volume and Tone – One way to increase the volume is by yelling, screaming, and raging. The second is complete silence, ignoring, and refusing to respond.
  • Intimidating Words – Swearing and threatening language are done when a person refuses to do what they want.
  • Intense Manner of Speech – This is argumentative, competitive, sarcastic, and demanding. They frequently interrupt, talk over, withhold key information, bully, and interrogate.
  • Personal Attacks – Common examples include criticizing, name-calling, mocking responses, defaming character, berating feelings, and judging opinions.
  • No Apology – They refuse to take responsibility, become hostile, invalidate or dismiss feelings of others, lie, and conveniently forget promises or commitments.
  • Blame Game – Anything that goes wrong is someone else’s fault. Accuses others of being too sensitive, is overly critical of reactions, one-up feelings and opposing opinions.
  • Browbeating – Typical sayings include: “If only you would…, then I won’t have to be this way,” “You don’t know how to take a joke,” “The problem with you is…,” and “That (verbal abuse) didn’t really happen.”
Emotional Abuse. Has the victim experienced:
  • Nitpicking – Whatever is important to others is minimized in comparison to their own agenda. They belittle accomplishments, aspirations, or personality in front of others. Teasing or sarcasm is commonly used to degrade and mock.
  • Embarrassment/Shame – They share private information without consent, treat other people like a child, or expose some shameful event. Constantly being reminded of shortcomings, often in a passive-aggressive way.
  • Increased Anxiety – It is easy to become anxious when questioned about every move, motive or aptitude. Feeling overwhelmed from the excessive responsibility being dumped, expecting others to drop everything to “cheer them up”.
  • Excessive Guilt – They claim that they should be the most important person in others life. It is selfish for others to take care of themselves.
  • Insecurity – From being held to an unrealistic, unattainable, or unsustainable standard. Then when the person fails, they are treated as inferior.
  • Confusion – Being treated as an extension of the abuser, not a separate person.
  • Alienation – Belittling friends and family and making other’s social engagements a nightmare (by contrast, they will be amazingly charming at their social engagements).
  • Anger/Fear – They generate an angry response by acting immature and selfish but then accuse the other person of behaving that way. Use of intimidation, threats, frightening behavior, or destruction of treasured possessions.
  • Hostility/Rejection – Stalking in and away from the house. Refusing to acknowledge worth by withholding love or intimacy creating a threat of rejection.
Financial Abuse. Has the victim experienced:
  • Forbidden Access – To money, checking accounts, or possessions to create a dependency on them for food, clothing, shelter, and necessities. Maintains secret accounts at various financial institutions. Depletes retirement accounts without knowledge.
  • Stealing – Steals, defrauds, or exploits from family and expects everyone to be ok with it.
  • Assets – Demands that all financial gifts, assets, or inheritances be placed in their name. Open bank accounts in their name without giving access to records. Cancels life, health, car, or house insurance without discussing.
  • Paychecks – Forces paychecks to be handed over and deposited it in their account.
  • Bills/Credit – Puts all the bills or credit cards in other’s name. The assets are in their name, but debt is in someone else’s name. Maxes out credit cards without knowledge and ruins other’s credit rating.
  • Taxes – Falsifies tax records to show greater reductions and expects others to sign documents without question.
  • Budget – Puts others on a strict allowance with an impossible “budget” thereby setting them up for failure. Punishes spending with verbal, physical, sexual or emotional abuse.
  • Career – Forbids others from earning money, attending school, or advancing careers.
  • Work – Interferes in a work environment by calling the boss. Insists on having access to work emails and calendar knowing details about the job that is excessive, unprofessional, and violates confidentiality. Harasses while at work through unannounced visits, excessive phone calls, or texting to negatively impact the job.
Sexual Abuse. Has the victim experienced:
  • Grooming – Doing an unwanted or embarrassing sexual act designed to catch others off-guard, create a feeling of trepidation, and see if others comply.
  • Jealousy Rages – Demands to be told everything about previous sexual partners. Then uses the information to call them a slut. Frequent accusations of being attracted to others, flirting, flaunting your body, and cheating.
  • Coercion Tactics – Use of harassment, guilt, shame, blame, or rage to coerce others into having sex. They nag, insult, become disruptive, and refuse to allow sleep until they concede.
  • Threatens Infidelity – Dangles the possibility of another person in order to bully into doing uncomfortable sexual acts.
  • Inciting Fear – Others submit to unwanted sexual acts out of fear that they will hit, leave, humiliate, punish, betray, or withhold money.
  • Selfish Appeals – A classic example of selfish sex is unprotected sex. Because intercourse is all about how they feel, they refuse to use condoms and insist others take full responsibility for birth control or STD/STI protection.
  • Sexual Withdraw – Some completely withdraw all sex from the relationship. Any requests for sex are met with ridicule, rants about performance, and excessive excuses for abstinence.
  • Ultimatums – For them, others body is theirs and their body is theirs. Ultimatums include demands to lose weight, groom a certain way, forced pregnancy or an abortion, and forbidding breastfeeding.
  • Destroying Principles – Previous sexual standards are obliterated. For instance, participating in pornography, prostitution, having multiple partners at one time, or sex with animals was completely out of the question but now are common.
  • Rape – The FBI defines rape as “Penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.”
  • Degrading Acts – Degradation is in the eye of the beholder. They will not view these acts as degrading, but others might. Here are a couple of examples: urinating on a person, having sex while on the toilet, or forced sex in public places.
  • Sadistic Sex – There are two forms of sadistic sexual acts: mild (also known as S&M) and severe which can lead to death. Mild examples include: master-slave role playing, immobilizing others through drugs or alcohol, administering pain (whipping) during sex, confining others to a cage, typing up, blindfolding, or clamping sexual organs. The severe examples include: physical beatings, choking, psychological torture, burning, cutting, stabbing, vampirism, and murder before, during or after sex.
Spiritual Abuse. Has the victim experienced:
  • Dichotomous Thinking – Dividing people into two parts. Those who agree with them and those who don’t. They make fun of, belittle, and show prejudice towards other beliefs.
  • Elitists – Refusing to associate with people or groups they consider impure or unholy.
  • Submission – Requires that others completely adopt their point of view. There is no room for differing opinions or questioning their authority. Name calling, chastising, and the silent treatment are common maneuvers into compliance.
  • Labeling – People who don’t comply with their beliefs are disobedient, rebellious, lacking faith, demons, or enemies of the faith.
  • Public Performance – Demand perfection and happiness always. Religious activities such as attending church have extreme demands, excessive expectations, and rigidity.
  • Legalistic – Strict adherence to their rules and regulations are commanded with absolute statements about insignificant issues such as hair color or style. Non-compliance is met with severe discipline and even excommunication.
  • Segregation – Use secrecy or withholds information to a few select worthy individuals. Estrangement from extended family members and friends outside of the religion. This includes shunning, alienation, or persecution.
  • Blind Obedience – Is expected. They have replaced religion with themselves and people are expected to worship them.
  • Abuse of Authority – Use position or authority to connive for their personal benefit which is often financial. They justify the behavior by saying they deserve it.
  • Fraud – Engaging in criminal misconduct or cover up the transgressions of others in the name of their religion. This includes covering up sexual abuse, physical abuse, financial felonies, and misdemeanors.
Legal Abuse. Has the victim experienced:
  • Frivolous Lawsuits – Filing senseless lawsuits that have little merit for the point of forcing the opposing party to hire an attorney and incur unnecessary expenses
  • False Accusations – Bearing their opponent to court by falsely projecting their issues onto the opponent.
  • Entrapment – Inciting and encouraging victims to act irrationally and then call the police on them. This event is then later used as a threat in another lawsuit or civil action.
  • Gaming the System. Using the laws designed to protect a person as a point of manipulation against them. For instance, not allowing a child to see or speak to the other parent on “their time” because that would give the other parent more time than them.
  • Senseless motions/hearings. In order to delay the process, filing senseless motions, excessive hearings, and multiple postponements. This is done to drain the financial resources of the opponent and create an atmosphere of the never-ending-lawsuit.
  • Committing Perjury. Lying about matters that are not material and are inconsequential to the case just to anger their opponent.
  • Using Loopholes. Finding loopholes in the law and using it their favor.
  • Jury Tampering. Bribing or intimidating members of a jury to decide a certain way. While this is usually the stuff movies are made of, it still does happen in the courtroom.
As a reminder, this list is a starting point to bring about the discussion of abusive behavior. There are many more ways a person can be abused other than the items listed here. Acknowledgment is the first step towards healing

Tuesday, November 27, 2018

Worldwide, 3 million deaths every year result from harmful use of alcohol....

"At the age of 17 years, Mahesh has given up his schooling to work as a salesman." Alcohol violence in the family is forcing a lot of children to join work force. We target to sensitize 500 children about the issue of alcoholism and NCDs & encourage them to continue their education. Uma's troubles became worse when her husband started using alcohol and abuse became an everyday affair. We intend to counsel, heal 240 women survivors of violence to seek help and to live healthy & productive life

Worldwide, 3 million deaths every year result from harmful use of alcohol. It can lead to a range of mental, behavioural and other non-communicable conditions (NCDs). The harmful use of alcohol also brings significant social and economic losses to individuals and society at large. The recovering addicts and their families are usually not aware of NCDs and its relation with their alcohol and drug use. Moreover, discrimination from society leads to isolation of families affected by alcohol abuse.


The project aims to meet the need to engage "patient" before they accept this new identity of "patient" and promote informed choices among people effected and affected by NCDs & alcohol. Need has been identified to overcome the stigma and social repression associated with being diseased in order to empower and ensure the entitlement of women and children to assert their right to health. Prevention of NCDs with a focus on alcohol by using treatment readiness peer based approach.

Thursday, November 8, 2018

Social Work for Inclusive Development.!

Prof. T K Thomas
06 Nov, 2018 

Way back in 1988-’89 one was visiting drug and alcohol de-addiction and rehabilitation centers in Delhi and elsewhere as part field study for research to write a 30 episode serial for All India Radio. Radio DATE [ Drugs, Alcohol, Tobacco Education] was a joint initiative of All India Radio and the Indian Council of Medical Research [ICMR]. After visiting many centres the head of a government run facility asked what was one’s next place of visit. When he heard Navjyoti Delhi Police Foundation he sarcastically commented that at that centre started by the first woman IPS officer Kiran Bedi in Sarai Rohilla police station, they were practicing “Danda Therapy”[therapy using the rod]. He was told that as a media person one would go and find out what therapy was being practiced in Navjyoti.

One was warmly received by Suneel Vatsyayan, the young and dynamic Director of Navjyoti, a Master of Social Work from Jamia Millia Islamia [presently member of the governing body of NAPSWI]. He took me around for interaction with the patients. One was convinced that a professional social worker running the centre [with the guidance of a senior police officer who started Navjyoti out of a felt need when Delhi faced large scale addiction and related petty crimes] was not using ‘Danda Therapy’. It was professional social work in action and one was drawn to volunteer for Navjyoti for many years. In fact one was part of a one year programme of training recovering addicts as peer support counselors, supported by the UNODC [then UNDCP] as a trainer and Prof. Sanjai Bhatt of the Delhi School of Social Work was a consultant.

It was therefore, a learning experience and an opportunity to discern between two streams of academic disciplines by attending the three day 6th Indian Social Work Congress 2018 on the theme “Human Development and Social Inclusion: Imperatives for Social Work Education and Practice” in Delhi last week[1-3 November] organized by the National Association of Professional Social Workers in India[NAPSWI]. The earlier Congresses were held in Delhi, Pune, Rajasthan,Varanasi and Kerala and the 7th will be in Lucknow.

The focus on Human Development and Inclusion in the theme opened up food for thought for contextualizing contemporary challenges in social work. According to a Congress spokesperson ‘’Human Development is the process of enhancing the human capabilities to expand choices and opportunities, so that a person can lead a life of respect and value’’. Similarly, “Social inclusion strives for many purposes for socially excluded people. It attempts to establish an egalitarian social order based on ideas of liberty, equality, and fraternity in place of social order based on mutually exclusive social categories such as caste and race”. The above mentioned Navjyoti / UNODC programme of training recovering addicts as peer support counselors is an excellent example of social inclusion of bringing socially rejected addicts to the mainstream.

One also learn that the Congress had for its deliberations, the UN document titled “ Transforming Our World: The 2030 Agenda for Sustainable Development” marking a paradigm shift towards a more balanced model for sustainable development.

It is heartening that the Congress and the social work fraternity endeavored to contribute towards understanding, analyzing and interpreting the sustainable development goals in the context of social work education and practice towards achieving human development and social inclusion.

The Congress provided an opportunity to know more about the profession of social work and its present application. A cursory look at the sheer numbers of the Congress is proof enough to the significance and the volume of work transacted- 655 participants [from institutions/ colleges /universities and voluntary organizations from almost all states], presence of 7 vice chancellors, Vice Chairman of the Rajya Sabha, 3 Members of Parliament, 165 paper presentations and release of eight books. The speakers included a veritable who’s who from the profession and academics, besides practitioners.

To a layperson there is often no distinction between sociology and social work. Social work is generally perceived as acts of kindness, altruism or even philanthropy. Many aspiring politicians do social service to attract public support. Of course both sociology and social work education draw their knowledge base from similar body of knowledge. While sociologists are largely involved in research and study, social workers apply their knowledge in alleviating problems and concerns of individuals and families; social work is a ‘people business’ indeed.

It was difficult to catch up with all the deliberations of the three day Congress and quote from presentations by erudite scholars. However one would flag a few sessions of the Congress. The multidisciplinary approach and nature of social work were evident from the speeches, presentations and discussions. As social work deals with the problems of people, the range of deliberations encompassed almost all areas of human activity and behavior. The topics chosen for the sessions and paper presentations included, to name a few- ‘’Social Justice and Human Rights’’, “ Health and Social Work’’, “Indianisation of Social Work, “Malnutrition”, “Social Work and Child Rights”, “Corporate Social Responsibility: Social Problems, Violence and Criminal Justice”, “Gender Discourse”, “Mental Health” etc.

As part of highlighting just a few areas from among deliberations on a large number of issues, let’s start with the Panel Discussion on ‘Malnutrition’. It threw up important issues by experts including senior government functionaries. Rising hunger in India is a concern even as in the Global Hunger Index we rank 103 of 194 nations. People in the urban settings are more prone to malnutrition. Climate change and global warming are threatening food production and security. The increasing consumption of fast foods like pizzas, burgers and noodles is depriving children of natural food. The big shift in food crop production to commercial crops results in lesser access to locally grown natural food. Multi layer farming in small holdings would increase food production for farmers’ sustenance. There is no strict quality control on the food grains in the public distribution system and many products are packed in harmful materials. Well, these are some of the issues that call for the attention of social workers who have a task at hand for advocacy and dissemination of relevant information.

Prof. Sanjai Bhatt, introduced a topic which of late has emerged as a matter of debate- Indianization of professional social work and social work education. Evolution of Social work education in India was discussed. The credit for pioneering social work education goes to the Tatas. The Tata Institute of Social Sciences [ TISS] established in 1936 in Nagpada and then in Andheri in Bombay [now Mumbai] is the oldest institute of social work in Asia. Started as Sir Dorabji Tata Graduate School of social Work by Sir Dorabji Tata Trust, it was rechristened in 1944 as the Tata Institute of Social Sciences. TISS came to its permanent campus in Deonar and later started many other campuses. In 1964 the government of India declared TISS as a deemed university. Over the years TISS has emerged as an iconic institution and later various schools of social work like the well known Delhi School of Social Work have come up across the country with thousands of young people passing out each year to pursue professional social work.

The first director of TISS was American Sociologist Dr. Clifford Manshardt. For a new academic discipline like social work, obviously the syllabus and pedagogy came from the west and all the theories- psychosocial, psychodynamic, transpersonal, cognitive or systems were entirely western and so were readings from Sigmund Freud , Erikson or Skinner. Later Indian academics like Prof. Shankar Pathak or Prof. M Y Qureshi brought out textbooks of social work. Now, the debate in the Congress was on the relevance and suitability of western theories and texts for our social work students. Some of the senior academicians opined that it is difficult to replace time tested theories but the practices are now specific and suitably adopted for our aspiring social work practitioners. There were a few dissenting voices demanding a thorough overhauling of the syllabi, texts and practices based on Indian heritage and her ancient wisdom. This debate is sure to continue for years to come.

Whatever discussions one heard, were sadly bereft of Gandhi ji and his genre of social work with volunteers or Sathyagrahis involved in constructive work for social transformation. It was therefore a grand finale for the 6th Indian Social Work Congress 2018 to have a valedictory address by none other than the new Vice Chairman of the Rajya Sabha Harbans Narain Singh invoking the Father of the Nation in the context of social work. He specially mentioned the concept of Buniyadi Shiksha Kendras started by the Mahatma to catch children young to be self reliant. His erudition and experience were evident in his address. One would conclude with Gandhi ji’s famous Talisman as a Mantra for everyone :-

‘’ I will give you a talisman. Whenever you are in doubt or when the self becomes too much with you, apply the following test:

Recall the face of the poorest and the weakest man whom you may have seen and ask yourself if the step you contemplate is going to be of any use to him. Will he gain anything by it? Will it restore him to control over his own life and destiny? That test alone can make our plans and programmes meaningful.”

- Prof. T.K Thomas, Senior Journalist.


Monday, September 17, 2018

37 billion hours of support to family members coping with the realities of aging and illness....Most ignored contribution of caregivers

MOST OF US KNOW SOMEONE who is a caregiver. Many of us (40 million, in fact) are caregivers, providing 37 billion hours of support to family members coping with the realities of aging and illness. Twenty million new caregivers joined their ranks last year, so chances are good that you, too, could become a caregiver (if you’re not already one).

Those are just some of the eye-popping stats revealed in a new report, “The Journey of Caregiving,” produced by Merrill Lynch in partnership with Age Wave, a thought leader in the study of aging and its implications for society.

While many previous studies have looked at caregiving’s physical and emotional challenges, very few have explored its financial costs. “Many caregivers find they have to dip into their savings or take on debt to cover expenses,” notes Cynthia Hutchins, director of Financial Gerontology for Bank of America Merrill Lynch.
Read more