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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_422"
                     title="Nurses Often Silent About Workplace Violence (CME/CE)"
                     score="0.014"
                     href="http://www.medpagetoday.com/HospitalBasedMedicine/WorkForce/tb/18335?impressionId=1265756191067"
                     
      The physical and verbal abuse nurses face on the job often goes unreported, according to an Australian survey.&lt;br&gt;
&lt;br&gt;Over the prior year, 52% of nurses in one community hospital said they had been physically assaulted and 69% reported being threatened with violence, according to Rose Chapman, PhD, of the University of Western Australia in Perth, and colleagues.&lt;br&gt;
&lt;br&gt;Verbal abuse was almost universal, being reported by 92% of respondents, the researchers wrote in the February issue of the &lt;em&gt;Journal of Clinical Nursing&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;However, only half mentioned the incidents to senior staff or co-workers, and just 16% filed an official report.&lt;br&gt;
&lt;br&gt;&quot;The reasons for not reporting are many and may include lack of time and management support and the belief that being attacked is &apos;just part of the job,&apos;&quot; they wrote.&lt;br&gt;
&lt;br&gt;The same is true in the U.S., where assaults and under-reporting appear just as common as suggested in the Australian survey, commented Kathleen M. McPhaul, PhD, RN, MPH, of the University of Maryland School of Nursing in Baltimore, who has been involved in such research in the U.S.&lt;br&gt;
&lt;br&gt;A culture change would likely be needed to make a real difference for nurses, Chapman&apos;s group suggested.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Hospitals would have to ensure that nurses have necessary support, education, encouragement, and time to complete official reports. Nurses who report abuse should get positive feedback from all levels of nursing, they said.&lt;/p&gt;
&lt;p&gt;&quot;If administrators and governments are serious in their intention to reduce workplace violence and provide staff with safe work environments, they should be seen to act on all reported [incidents],&quot; which is rare today, Chapman&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;However, currently there&apos;s no strong lever or incentive to address this kind of workplace abuse since hospitals focus mainly on patient safety as part of accreditation, and national and state workplace safety organizations have little mechanism for monitoring such incidents, McPhaul noted.&lt;/p&gt;
&lt;p&gt;The researchers&apos; survey was intended to reach all 332 nurses working at one nontertiary hospital across all departments  --  emergency, medical, surgical, maternity, pediatric, and mental health.&lt;/p&gt;
&lt;p&gt;The 113 nurses who responded were mainly women in their early 40s who worked part time.&lt;/p&gt;
&lt;p&gt;Among them, about three-quarters reported at least one incident of workplace violence over the preceding 12 months  --  25% said it occurred weekly, 27% said monthly, and for 25% it was rarer, at once every six months. &lt;ul&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Fully 30% of the nurses said they had been involved in an episode involving a weapon  --  often hospital equipment and more rarely a knife or gun.&lt;/p&gt;
&lt;p&gt;The number of total incidents was lowest among nurse midwives, with a mean of 1.67 per year.&lt;/p&gt;
&lt;p&gt;Not surprisingly, the rate was highest among emergency department and mental health staff, who reported an average of 46.43 and 40.39 episodes over 12 months.&lt;/p&gt;
&lt;p&gt;One reason behind the high risk in these two departments may be the &quot;shift to a community-based approach to mental health care and a reduction in mental health beds&quot; such that the same psychiatric patients that assault mental health department nurses are mainstreamed to the emergency department as their point of entry to the hospital, the researchers said.&lt;/p&gt;
&lt;p&gt;However, more years of experience or higher educational qualification didn&apos;t appear to protect nurses. Senior nurse unit managers and clinical nurse specialists actually reported more physical assaults than less senior nurses.&lt;/p&gt;
&lt;p&gt;Age and gender didn&apos;t predict occurrence or type of incident either.&lt;/p&gt;
&lt;p&gt;When nurses did report workplace violence or verbal abuse, it was most often to their immediate manager (29%), other senior nursing staff (14.5%), or to their friends and colleagues (6%).&lt;/p&gt;
&lt;p&gt;Overall, 30% of nurses who responded to the survey gave as their reason for not reporting that workplace violence happens all the time and is simply part of the job.&lt;/p&gt;
&lt;p&gt;Even among those who did make a report of some sort, half said they thought hospital management failed to act on it.&lt;/p&gt;
&lt;p&gt;In fact, when the researchers audited hospital records, they found that 42 official incident reports had been filed by nurses over the prior one year period, nearly always involving injuries.&lt;/p&gt;
&lt;p&gt;In 95% of the cases, the only action taken by the hospital was making staff in the area aware of the incident. No other actions had been documented.&lt;/p&gt;
&lt;p&gt;The researchers cautioned that the voluntary nature and limited scope of the study may have limited generalizability, although the occurrence of violence against nurses is likely similar across developed countries.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers provided no information on conflicts of interest.&lt;/p&gt;&lt;p&gt;McPhaul reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_228"
                     title="Nurses Should Have a Bigger Leadership Role in Healthcare"
                     score="0"
                     href="http://www.medpagetoday.com/PracticeManagement/StaffingScheduling/tb/18080?impressionId=1265756191067"
                     
      &lt;p&gt;Opinion leaders across a wide variety of groups think nurses should have more influence in health policy, planning, and management, according to a new Gallup survey.&lt;/p&gt;
&lt;p&gt;Although nurses are viewed as being the most valued source of health information behind physicians, survey respondents rank them as the least likely of healthcare stakeholders  --  including patients  --  to have a great deal of influence in healthcare reform over the next 10 years.&lt;/p&gt;
&lt;p&gt;This despite the fact that among the 1,504 thought leaders in academia, insurance, health services, government, industry, and the corporate world polled, 51% said nurses are very important in reducing medical errors and improving patient safety, and 50% said they are very influential in improving the quality of patient care.&lt;/p&gt;
&lt;p&gt;The major barriers to increased nurse influence, nearly 70% of respondents said, are perceptions that they are lower on the totem pole than physicians when it comes to decision-making and revenue generation.&lt;/p&gt;
&lt;p&gt;When asked what could be done to ensure that nurses take on more leadership responsibility, the first priority, respondents said, was that they make their voices heard  --  56% had said that nursing lacks a single voice in speaking on national issues. More than half of respondents also noted that there was a lack of opportunities for nurses to advance into leadership positions.&lt;/p&gt;
&lt;p&gt;The survey, conducted by Gallup for the Robert Wood Johnson Foundation, examined professional views of nursing, nursing leadership, the future of the industry, and potential barriers to leadership roles for nurses among various healthcare-related groups. It included responses from opinion leaders in academia (276), health services (253), government (253), industry (253), insurance (237), and the corporate world (232).&lt;/p&gt;
&lt;p&gt;Nine out of 10 said nurses should have more influence in increasing the quality of care and reducing medical errors.&lt;/p&gt;
&lt;p&gt;About 85% said they wanted nurses to have more influence in promoting wellness and preventive care, improving efficiency and cost, coordinating care through the healthcare system, and adjusting care to meet an aging population.&lt;/p&gt;
&lt;p&gt;Additionally, 72% thought increased nurse influence would help the healthcare system adapt to the growing change in ethnic, racial, and cultural diversity in patient populations.&lt;/p&gt;
&lt;p&gt;The opinion leaders were also asked whether they feel there is a nursing shortage in the U.S. Just over 80% said Yes and of those, only 2% said it was not a serious problem.&lt;/p&gt;
&lt;p&gt;To blame for the shortage? Respondents cited a stressful/poor work environment (44% see that as a very important reason), not enough openings in nursing schools (40%), and too many nurses leaving the profession (37%). Only 22% cited low pay as very instrumental in causing the shortage.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_157"
                     title="COLUMN: Re-engineering Made Easy"
                     score="-0.004"
                     href="http://www.medpagetoday.com/Columns/17986?impressionId=1265756191067"
                     
      &lt;p&gt;Re-engineering was a catch-phrase in the business world not long ago, and it has crept into the medical &quot;business&quot; too. But what does it really mean to &quot;re-engineer your practice&quot;?&lt;/p&gt;
&lt;p&gt;According to Michael Hammer and James Champy, authors of the seminal book about re-engineering, it is &quot;the fundamental rethinking and radical redesign of business processes to achieve dramatic improvements in critical contemporary measures of performance, such as cost, quality, service, and speed.&quot;&lt;/p&gt;
&lt;p&gt;The principles of re-engineering are:&lt;/p&gt;
&lt;p&gt;&amp;#8226;	Combine tasks&lt;/p&gt;
&lt;p&gt;&amp;#8226;	Empower employees&lt;/p&gt;
&lt;p&gt;&amp;#8226;	Perform process steps in a natural order&lt;/p&gt;
&lt;p&gt;&amp;#8226;	Design processes to be flexible&lt;/p&gt;
&lt;p&gt;&amp;#8226;	Minimize checks and controls&lt;/p&gt;
&lt;p&gt;&amp;#8226;	Implement hybrid centralized/decentralized operations&lt;/p&gt;
&lt;p&gt;&amp;#8226;	Manage customers (read patients) through a single point of contact&lt;/p&gt;
&lt;p&gt;How do you apply those principles to your practice? Here&apos;s where we make it easy with an example that happens over and over in different specialties across the country.&lt;/p&gt;
&lt;p&gt;Example:&lt;/p&gt;
&lt;p&gt;&lt;em&gt;Tim, a patient in an internal medicine practice, has a prescription that is due to expire about two weeks before his scheduled annual exam. On a Monday, a couple days before it expires, he calls the medical office to get his prescription reissued. About two hours later, he gets a call from the pharmacist explaining that the pharmacy doesn&apos;t have his medication in stock, but it will be arriving the next day and it will cost about $60. &lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;Tim is puzzled by this because in the past he paid only his $10 prescription copay for the medication. The pharmacist explains that the prescription that the doctor&apos;s office transmitted is not for a generic. Tim is even more puzzled because all his previous prescriptions were written for generics. &lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;So, Tim calls the practice for a second time (by now, it is midafternoon) to get the prescription written as the generic he was trying to refill.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;On Tuesday morning Tim goes to the pharmacy but they claim they have received nothing from the medical practice. So Tim calls the practice while he&apos;s at the pharmacy. He explains the situation as an extension of the previous afternoon&apos;s call.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&lt;em&gt; But the secretary who answered the call is not the person Tim spoke with yesterday. She is confused about which medication is generic but promises to have the prescription rewritten to fill with the generic and transmit that to the pharmacy. Doing so will probably take a couple of hours she tells Tim, who leaves the pharmacy knowing he&apos;ll have to make yet another trip and vows to call before going.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;So, one &quot;simple&quot; medication reissue request generated three unique phone calls from the patient to the practice, a call from the pharmacist to the patient, and two trips to the pharmacy by the patient.&lt;/p&gt;
&lt;p&gt;It is painfully obvious that we created the problem in the practice when we mishandled the initial request. Less obvious is how to re-engineer to avoid such a situation  --  how to rethink our process so that we achieve a dramatic improvement in the cost of our operation and the service to our patient.&lt;/p&gt;
&lt;p&gt;We need to stop and ask why we are getting that initial call to reissue the medication in the first place. A radical redesign of our process would be coordinating prescription expirations with follow-up appointments!&lt;/p&gt;
&lt;p&gt;In other words, Tim must be given an appointment for his annual exam that occurs before the date his prescription will expire! That&apos;s the natural order to perform medication reissues, that&apos;s re-engineering and it&apos;s that easy!&lt;/p&gt;
&lt;p&gt;So, how do you get started in your practice?&lt;/p&gt;
&lt;p&gt;Look at the re-work and duplicative activities and the waste that occurs each day. Do you get prescription re-issue requests like Tim&apos;s? Start with all appointments from this day forward and be sure that you order a follow-up appointment that falls at least two weeks before the expiration of the prescription order you&apos;re writing. If you write a 90-day prescription, order a follow-up appointment for 10 weeks from today instead of 12 weeks or three months.&lt;/p&gt;
&lt;p&gt;Look at other incoming telephone calls and examine why patients are calling  --  30% to 40% of incoming calls are from patients seen in the office in the preceding two weeks.&lt;/p&gt;
&lt;p&gt;Do patients have questions that should have been addressed during their appointment? Would a referral to a Web site with patient education material provided at the appointment reduce those calls?&lt;/p&gt;
&lt;p&gt;Are patients calling to learn about test results? Look to re-engineer the process for notifying patients about their tests and eliminate those calls.&lt;/p&gt;
&lt;p&gt;Manage all the calls through a single point of contact  --  a centralized call center. The size of your call center will vary depending on the size of your practice. A one- or two-physician practice may get by with only one person, while a practice with 20 providers may need three to five FTEs to staff the call center.&lt;/p&gt;
&lt;p&gt;Rethinking the way you handle prescriptions and refill calls can cut down on the number of times patients phone the practice, and that can save significant dollars  --  each incoming call costs the practice just under $10, on average.&lt;/p&gt;
&lt;p&gt;In the case of our hypothetical patient Tim, better timing on prescription refills or his office visit would have saved $30 and a lot of aggravation.&lt;/p&gt;
&lt;p&gt;Re-engineering is as easy as looking at the processes that you do every day over and over and rethinking how to improve them. Take time out to rethink and you&apos;ll have made re-engineering easy!&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_19_4058"
                     title="Doctor&apos;s Orders: Practicing Evidence-Based Medicine Is a Challenge"
                     score="-0.005"
                     href="http://www.medpagetoday.com/PracticeManagement/PracticeManagement/tb/17486?impressionId=1265756191067"
                     
      &lt;p&gt;Doctor&apos;s Orders &lt;em&gt;is a feature in the collaboration between &lt;/em&gt;MedPage Today&lt;em&gt; and &lt;/em&gt;ABC News.&lt;em&gt; In this monthly segment we explore medical issues of interest to physicians and patients alike. This month, we look at the difficulties physicians face in incorporating evidenced-based medicine into their practice.&lt;/em&gt;&lt;/p&gt;&lt;hr&gt;

&lt;p&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;


&lt;p&gt;With the amount of research being published in medical journals and presented at meetings, it should not be surprising when a new finding slips by a busy physician.&lt;/p&gt;
&lt;p&gt;Nor should it be surprising, then, that some decisions about patient care might be made without benefit of the most recent evidence.&lt;/p&gt;
&lt;p&gt;Although experts interviewed by &lt;em&gt;MedPage Today&lt;/em&gt; agreed that keeping up with the most current information is challenging, it&apos;s unclear exactly how widespread the phenomenon of the outdated doctor is.&lt;/p&gt;
&lt;p&gt;&quot;To some degree or another, I think it&apos;s very widespread,&quot; said Richard Deyo, MD, MPH, a professor of evidence-based family medicine at Oregon Health &amp;amp; Science University in Portland.&lt;/p&gt;
&lt;p&gt;But he added that it&apos;s not a black-and-white issue, because physicians can be up to date in one area and lagging behind in another.&lt;/p&gt;
&lt;p&gt;&quot;I think we all are sort of somewhere along a continuum,&quot; he said.&lt;/p&gt;
&lt;p&gt;Lori Heim, MD, president of the American Academy of Family Physicians, agreed that it&apos;s difficult to put a solid number on how many doctors are practicing outdated medicine.&lt;/p&gt;
&lt;p&gt;She said a good place to start would be with the numerous studies that have found that many patients do not receive recommended care for various conditions.&lt;/p&gt;
&lt;p&gt;One such study, released in the &lt;em&gt;New England Journal of Medicine&lt;/em&gt; in 2003, reviewed the care received by surveyed adults in the two years preceding a telephone interview. A review of their medical records found that only 54.9% of the time did they get the care recommended for their condition.&lt;/p&gt;
&lt;p&gt;However, Heim said, one can&apos;t conclude from that data that the other 45.1% of the care was delivered by doctors who were not up to date on the most recent evidence.&lt;/p&gt;
&lt;p&gt;Perhaps, for instance, a diabetic patient was scheduled to come in for hemoglobin A1c screening but missed the appointment. That might have been listed as a failure to get the recommended care, said Heim, a hospitalist at Scotland Memorial Hospital in Laurinburg, N.C.&lt;/p&gt;
&lt;p&gt;Board certification might provide another clue to whether a physician is keeping up to date, Heim said, although doctors who are not board certified might be keeping track of the latest findings and recommendations on their own.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Why Can&apos;t Doctors Don&apos;t Stay Up to Date?&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Regardless of how prevalent the phenomenon of outdated doctors is, experts agree that time constraints are a major reason clinicians have difficulty keeping up with the constant flow of new medical information.&lt;/p&gt;
&lt;p&gt;Although reading all of the relevant journals would keep a doctor updated, &quot;it&apos;s unrealistic to expect the majority of physicians to go back to the original literature or even to go back to systematic reviews of the original literature,&quot; said Gordon Guyatt, MD, of McMaster University in Hamilton, Ontario, who is credited with coining the term &quot;evidence-based medicine.&quot;&lt;/p&gt;
&lt;p&gt;He said that aside from lack of time, training might explain some of the problem as well.&lt;/p&gt;
&lt;p&gt;Most physicians practicing today were not trained in an era of evidence-based practice, Guyatt said, and thus, they didn&apos;t learn the skills necessary to keep updated or learn the best sources to reference.&lt;/p&gt;
&lt;p&gt;&quot;There&apos;s some evidence that we tend to practice much the way we were taught in medical school,&quot; Deyo agreed.&lt;/p&gt;
&lt;p&gt;There&apos;s also some indication that the failure to remain updated might become more of a problem the longer a clinician has been out of medical school.&lt;/p&gt;
&lt;p&gt;In a 2005 systematic review in the &lt;em&gt;Archives of Internal Medicine&lt;/em&gt;, most studies found a correlation between increasing years in practice and decreasing quality of care.&lt;/p&gt;
&lt;p&gt;&quot;Although based on heterogeneous studies, our systematic review of empirical studies evaluating the relationship between clinical experience and performance suggests that physicians who have been in practice for more years and older physicians possess less factual knowledge, are less likely to adhere to appropriate standards of care, and may also have poorer patient outcomes,&quot; the study authors wrote.&lt;/p&gt;
&lt;p&gt;Deyo didn&apos;t discount intellectual curiosity as a contributing factor either.&lt;/p&gt;
&lt;p&gt;&quot;Doctors who are more curious and more skeptical are more likely to question what they&apos;ve been doing routinely and to be open to new ways of approaching problems,&quot; he said.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Helping Doctors Keep Track Of It All&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;As the use of technology becomes more ubiquitous in all facets of daily life, many physicians are turning to electronic resources available on the Internet and on handheld devices to access the most recent clinical trial findings and guidelines.&lt;/p&gt;
&lt;p&gt;&lt;em&gt;MedPage Today&lt;/em&gt; and other clinical news services fill part of the need, providing reports of key trials and changes in guidelines on a daily basis.&lt;/p&gt;
&lt;p&gt;&lt;em&gt;UpToDate&lt;/em&gt; appears to be one of the more popular choices for finding information on a wide range of specialties and Epocrates is a widely used resource for medication information, including drug interactions, contraindications, and dosing.&lt;/p&gt;
&lt;p&gt;Other such services include Micromedex, &lt;em&gt;BMJ Clinical Evidence&lt;/em&gt;, First Consult, Bandolier, and the American College of Physicians&apos; PIER (Physicians&apos; Information and Education Resource).&lt;/p&gt;
&lt;p&gt;In addition, Heim said, guidelines, such as those from the U.S. Preventive Services Task Force, are available to be downloaded to handheld devices for quick reference.&lt;/p&gt;
&lt;p&gt;In the future, she said, information will be embedded in patients&apos; electronic medical records, alerting physicians to optimal medications, current recommendations, or the need for certain tests.&lt;/p&gt;
&lt;p&gt;Some of that is already in place  --  for example, some records include drug interaction alerts  --  but more can be done along those lines, Deyo said.&lt;/p&gt;
&lt;p&gt;Presumably, the requirement for clinicians to obtain continuing medical education credits also contributes to disseminating the most up-to-date medical information.&lt;/p&gt;
&lt;p&gt;However, Guyatt said this might not be enough to ensure the practice of evidence-based medicine because there is no requirement to provide proof that the activities had any effect.&lt;/p&gt;
&lt;p&gt;&quot;A more aggressive approach to this would be actually testing people,&quot; he said.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Not All Questions Have a Single Answer&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;But even if strategies could be designed to enhance physicians&apos; abilities to remain up to date, that wouldn&apos;t necessarily help when the right approach to a problem is not clear-cut.&lt;/p&gt;
&lt;p&gt;As an example, the AAFP&apos;s Heim pointed to the recent controversy sparked by the USPSTF&apos;s mammography guidelines, which state that women should delay routine screening for breast cancer until age 50. (See &lt;a href=&quot;http://www.medpagetoday.com/HematologyOncology/BreastCancer/17045&quot; mce_href=&quot;http://www.medpagetoday.com/HematologyOncology/BreastCancer/17045&quot; target=&quot;_blank&quot;&gt;Panel Puts Off Mammography until Age 50&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Other groups, such as the American Cancer Society, have reaffirmed their support for routine screening to begin at age 40.&lt;/p&gt;
&lt;p&gt;These types of discrepancies can be confusing for patients, Heim said.&lt;/p&gt;
&lt;p&gt;Part of the art of practicing medicine, she said, is using sets of recommendations as guidelines, rather than rigid criteria that must be followed for every patient. Doing so recognizes that each patient comes with a unique constellation of risk factors and might require a different approach, she said.&lt;/p&gt;
&lt;p&gt;For this reason, patients might have a difficult time figuring out whether their physician is keeping up to date.&lt;/p&gt;
&lt;p&gt;But both Guyatt and Heim said asking questions of a doctor could provide some clues.&lt;/p&gt;
&lt;p&gt;Asking whether certain drugs or approaches are recommended, whether a treatment plan has any downsides, and whether a certain approach is supported by solid evidence will help a patient decide how up to date their doctor is.&lt;/p&gt;
&lt;p&gt;Heim said that as long as a doctor can explain why a certain strategy has been chosen and why others have been discarded, then he or she is likely following the most recent evidence.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Patients Looking for a Change&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;If patients decide to switch doctors, they might not have many resources to help them choose the most up-to-date physician.&lt;/p&gt;
&lt;p&gt;Reliable ratings of doctors are not available, and those provided by doctor-rating Web sites that solicit patient comments might be misleading, Heim said.&lt;/p&gt;
&lt;p&gt;For example, she said, a patient might have presented with signs of a viral infection and demanded an antibiotic. If the doctor refused to prescribe an antibiotic then the patient might write a negative review, even though the physician provided appropriate care.&lt;/p&gt;
&lt;p&gt;&quot;That&apos;s one of the reasons why I think those sites have the potential for giving good information, but they equally have the potential of giving a misinterpretation,&quot; Heim said.&lt;/p&gt;
&lt;p&gt;She said that checking for board certification might help narrow the search for a new doctor, but that talking to friends and family was probably the best approach.&lt;/p&gt;
&lt;p&gt;Importantly, she said, find out how much time a doctor takes discussing things with his or her patients &quot;because I think that is the key to a successful patient-physician relationship.&quot;&lt;/p&gt;
&lt;p&gt;&quot;If you can&apos;t talk to your doc,&quot; she said, &quot;it&apos;s going to be really hard to figure out whether or not they&apos;re staying up to date.&quot; &lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Deyo reported being an author for some of the content included in &lt;em&gt;UpToDate&lt;/em&gt;.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_4100"
                     title="FDA Opens First Mexican Office"
                     score="-0.005"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/tb/17553?impressionId=1265756191067"
                     
      &lt;p&gt;WASHINGTON  --  The FDA has announced the opening of its Mexico City post, the agency&apos;s third office in Latin America and the tenth international post created in just over a year.&lt;/p&gt;
&lt;p&gt;The new site will harmonize regulatory and guidance standards, and work on other collaborative initiatives between the U.S. and Mexican governments, such as information sharing, joint workshops on food and drug safety, and training on food-borne illnesses, the agency said in a release today.&lt;/p&gt;
&lt;p&gt;FDA commissioner Margaret A. Hamburg, MD, noted that more than a third of the fresh fruits and vegetables consumed in the U.S. come from Mexico, along with a substantial number of medical devices.&lt;/p&gt;
&lt;p&gt;The FDA will work with the foreign government agencies and private companies to develop certification programs, according to Murray M. Lumpkin, MD, the FDA&apos;s Deputy Commissioner for International Programs.&lt;/p&gt;
&lt;p&gt;The new office is another element in the FDA&apos;s global initiative to regulate exports and imports between the U.S. and other countries and establish relations with foreign regulatory authorities, the agency said.&lt;/p&gt;
&lt;p&gt;The FDA&apos;s international posts are located in China, India, Europe, and Latin America, including offices in Santiago, Chile, and San Jos&amp;#233;, Costa Rica.&lt;/p&gt;
&lt;p&gt;The FDA opened its first Latin American office in Costa Rica this April. The first international office was opened in China in November 2008, with posts in Beijing, Shanghai, and Guangzhou.&lt;/p&gt;
&lt;p&gt;The FDA maintains contact with foreign regulatory agencies in Africa, Asia, and the Middle East through offices in Rockville, Md.&lt;/p&gt;

    </recommendedItem>
</recommendedContent>