Staying with a doctor you’re not happy with is as harmful as staying in a toxic relationship. If a visit…
Staying with a doctor you’re not happy with is as harmful as staying in a toxic relationship. If a visit to your doctor regularly leaves you feeling unsatisfied, unheard or even worse, it’s likely time to move on.
Medical needs and circumstances shift, calling for a health care provider who aligns with your current situation. Even if you like your doctor, you may need to find a new one if your physician leaves your health plan.
Whatever the reason, while it may feel uncomfortable, terminating the doctor-patient relationship may be the healthiest decision you make.
10 Reasons to Terminate the Doctor-Patient Relationship
These red flags mean it’s time to rethink the relationship with your primary care doctor:
— You and your doctor don’t mesh.
— Communication between you and your doctor is challenging.
— Your doctor isn’t available.
— Your doctor doesn’t advocate for you.
— Your physician doesn’t respect your time.
— The doctor’s office staff is unprofessional.
— Your physician doesn’t coordinate with other doctors.
— Your doctor is a reluctant learner.
— Your doctor won’t allow you to bring someone to important appointments.
— Your doctor has a pattern of bad patient reviews.
You and your doctor don’t mesh.
One of the most important factors in any doctor-patient relationship is a sense of comfort and trust. Doctors need to know intimate details about your health that you may not even share with friends or family members. If you’re not comfortable sharing this information, you and your doctor may not be the right match.
“You certainly don’t need to be friends — and probably shouldn’t be, in order to maintain professional boundaries,” says Jennifer L. FitzPatrick, a certified speaking professional based in Chester, Maryland, and author of the book “Reimagining Customer Service in Healthcare.” “But you should feel like they care about your well-being.”
At the bare minimum, you want to respect your primary health care provider and believe they respect you. That means your physician listens to you, responds promptly when you reach out and cares about your overall health.
Signs that you’re not comfortable with your doctor can include:
— Feeling rushed during appointments.
— Not feeling heard or understood.
— Feeling judged or dismissed.
— Simply feeling uneasy around your physician for reasons you may or may not be able to articulate.
“Not feeling comfortable with your doctor is an absolute red flag,” says Jeremy Gurewitz, chief executive officer of Solace, a digital health platform company that connects people with patient advocates, based in Redwood City, California. “If you don’t feel at ease, how can you trust what they have to say?”
A lack of trust may cause you to not feel confident in their abilities or second-guess their judgment.
Beyond establishing mutual respect with your doctor, it helps to have a list of non-negotiables and to ask them how they feel about certain issues that are important to you. For example, if you like to do your own research and discuss what you’ve discovered about heart disease, cancer, high blood pressure or another health condition, it’s important to make sure your physician doesn’t have an autocratic demeanor. You want a doctor who will listen to you and who will not be condescending because you conducted your own research.
Communication between you and your doctor is challenging.
Listening is one of the most important skills a physician can have, says Dr. Neel Anand, professor of orthopedic surgery and co-director of spine trauma at Cedars-Sinai Spine Center Center in Los Angeles.
A good doctor listens to their patient’s description of pain and other symptoms. Your physician should also provide time for you to ask questions so you’ll be able to make well-informed decisions about your treatment.
“As physicians, we’re a busy bunch,” Anand says. But doctors’ most important time is spent with their patients. “If we don’t allow them to supply us a complete picture of their overall health, we can’t help them effectively maximize it.”
Your doctor should also be able to talk to you in simple language that clearly explains why they are recommending a particular treatment or are ordering a certain test.
Being able to explain treatment approaches for different medical conditions in a way that is easy to understand is an important skill. For example, your doctor should be able to clearly explain how changes in diet and exercise and the use of medication could all be useful approaches to treating or warding off diabetes without using overly complex, technical terminology.
Your doctor isn’t available.
A doctor who is not available can lead to missed diagnoses, delayed treatment and frustration. If you find yourself struggling to get an appointment, waiting a long time to see your doctor or unable to get your questions answered in a timely manner, it may be time to sever your doctor-patient relationship. A good doctor is accessible and willing to make time for their patients, whether it’s through in-person visits, phone consultations or email correspondence.
“Unfortunately, the U.S. medical system overwhelms doctors with bureaucracy and far more patients than they can handle, often times as many as 50 a day,” Gurewitz says.
However, your doctor’s office should still have a system in place to allow you to get in touch regarding medical issues, prescriptions or test result questions, even if your physician isn’t readily available. Your doctor, one of their partners or the office should be able to respond to you via phone call, email portal, text message or telehealth platforms within 72 hours or sooner.
[READ: Primary Doctors for Men.]
Your doctor doesn’t advocate for you.
Let’s say your health insurance company is giving you a hard time about a test, medication or procedure you and your doctor agree is necessary. Does your physician advocate on your behalf with the insurance company, or do they quickly supply up?
While it’s not always essential for your physician to personally make the calls or write a letter to your health insurance company explaining why you need a costly procedure or diagnostic test, they should have someone in the office who is assigned to advocating for you to make sure your health care needs are being met, FitzPatrick says.
Your physician doesn’t respect your time.
Do you routinely wait an hour to see your physician, only to feel like they are is speed-doctoring through the visit? Does your physician start looking at their watch at some point during your appointment?
You should never feel like you’re being rushed. If your doctor doesn’t take the time to answer your questions about your medical condition or address other concerns, there’s a problem.
“If your doctor’s not giving you the time you need, they’re not listening to you fully because they’re rushing,” says Michael Urban, senior lecturer and program director of the doctor of occupational therapy program at the University of New Haven in Connecticut. “They’re not giving you the full care that you need.”
If your doctor’s chronic tardiness makes you grind your teeth, it may be time to find a new physician.
The doctor’s office staff is unprofessional.
Office staff members are the link between you and your physician, so it’s important to feel you can trust them. Even if you like your doctor, a bad office staff could signal it’s time to end the doctor-patient relationship.
Here are some common red flags to watch out for:
— Staff isn’t responsive to your needs and questions or is rude and unprofessional.
— Staff seems disinterested about your concerns.
— Staff neglects to supply your message to the physician about your medication’s side effects or other concern.
— A staff member doesn’t introduce themselves to you before taking your vitals.
“The small stuff is big stuff,” FitzPatrick says. Smiling, making eye contact, calling you by name and apologizing for delays or oversights should be the norm for office staff.
Your physician doesn’t coordinate with other doctors.
A dedicated primary care doctor is eager to understand who else is on your care team. This includes coordinating with other physicians, like cardiologists and endocrinologists.
“Ideally, he or she should know about other types of services you are receiving and who those providers are as well,” FitzPatrick says. “This includes services you get to Boost and maintain your physical health, like chiropractic and physical therapy. Your physician should also be aware if you are procuring mental health services from a clinician such as a psychologist.”
If your doctor isn’t aware of the other professionals you see, there are risks. The most obvious one is duplication of care, but medication interactions and conflicting orders are also common problems. When doctors know exactly who comprises your care team, they’re better able to assess and understand your needs as a whole person.
“While your doctor should be cooperating with your other ancillary providers on an as-needed basis by reviewing reports and through telephone consults, it’s important that he or she is also willing to coordinate with others when you seek a second opinion,” FitzPatrick says. “One doctor should never be your only source of medical advice and care.”
While many doctors are happy to cooperate with your other providers, sometimes they or their staff are just not organized enough to keep on top of all the communication needed to properly coordinate care. Make sure that your doctor’s office has a system in place so partnering with your entire care team is seamless.
Your doctor is a reluctant learner.
Whether your doctor went to medical school three or 30 years ago, it’s important they stay on top of the latest and greatest developments in their field to ensure they are continually improving and delivering the best medical care for their patients. The medical community has made significant advances in treating cancer and other conditions, for example.
You want to make sure your doctor is keeping pace, Anand says.
One way to do so is by checking his or her curriculum vitae to get a picture of how in touch your doctor is with medical advances. The CV will tell you what conferences the physician has attended, what current continuing education they’re receiving and whether they’re training other medical professionals in their field. Speaking at conferences, conducting research studies or authoring journal articles or textbook chapters on whatever their specialty is, whether it’s cardiovascular health or spinal conditions, are all positive signs that your doctor is keeping up with the latest advancements.
Your doctor won’t allow you to bring someone to important appointments.
For a period of time, the COVID-19 pandemic prompted many doctor’s offices, hospitals and health clinics to implement new policies tightening who is allowed into their facilities. Some of these policies prohibited patients from bringing someone with them to their appointments.
“COVID-19 policies essentially pushed out the family caregiver,” FitzPatrick says. “Patients deserve to have a close family member or friend accompany them to meetings with health care providers when there is a serious illness or procedure to be discussed.”
A relative or friend can provide emotional support and take notes on what the physician says. This is important because, depending on the diagnosis or treatment being discussed, the patient may not be in the best frame of mind in the moment to record important details.
Luckily, many restrictive COVID-19-related visitor policies were temporary. If your physician doesn’t allow you to bring a loved one to an important medical appointment, it’s time to find a new doctor.
Your doctor has a pattern of bad patient reviews.
There are various online tools you can use to see how other patients have rated particular doctors, including U.S. News’s doctor directory. While a handful of bad patient reviews may not be cause for alarm, if your doctor has a pattern of getting poor patient reviews, that could be a red flag.
But experts say it’s important to keep online patient reviews in context and to avoid making judgments about health care providers solely on such comments.
“When people are happy, they don’t always leave comments,” Urban notes. “I’ve seen some doctors who are great who’ve had many negative comments.”
Ask for recommendations from friends and other people in your area, which you can do in online forums. Ask a doctor you’re considering if you can come in for a quick meeting with the physician or just come to the office to get a sense of the environment. If a doctor is willing to take a few minutes to meet with you, that shows they are invested in listening to you down the road. If the office is clean and the staff is calm and professional, those are good signs too.
Importance of a Holistic Approach to Care
Ultimately, many physicians can prescribe medication, order tests or recommend a procedure. But your health isn’t just about tests and prescription meds, says Don Powell, president and chief executive officer of the American Institute for Preventive Medicine based in Farmington Hills, Michigan.
A good doctor will consider not just your physical condition, but your overall well-being. That means paying attention to mental health issues, like anxiety and depression. The best health outcomes occur when there is a solid doctor-patient relationship and you’re able to talk to your health care provider about the well-being of your “mind, body and spirit,” Powell says.
That means you should be able to talk to your physician about specific medical problems, as well as lifestyle issues, like eating habits, sleep, stress management, physical activity levels and social isolation, which is associated with depression, anxiety and shorter life expectancy.
“If the physician is not answering your questions, returning your calls or emails in a meaningful and respectful manner in order to help you be an advocate for your health and well-being, then it might be time to rethink the relationship,” Urban says.
More from U.S. News
Colorado Community College System
To close labor gaps in high-demand fields, the state of Colorado has allocated $38.5 million to cover enrollment costs for seven training programs at community and technical colleges.
Career Advance Colorado will fund current and new student tuition, fees and books starting this fall for those learning construction, education or early childhood education, firefighting, forestry, law enforcement, or nursing.
Administrators hope the open-access model will promote diversity and equal opportunities for learners of all types as well as support industry needs.
The background: In fall 2022, the Colorado Community College System (CCCS) launched Care Forward, a zero-cost program for students enrolled in a health-care certification program, including certified nursing assistant (C.N.A.), dental assistant, paramedic certificate, medical billing and coding, and more.
When the health-care workforce was stretched thin due to COVID-19, the state Legislature launched Care Forward, says Landon Pirius, vice chancellor for academic and student affairs. Senate Bill 22-226 allocated $26 million in state recovery dollars for the initiative.
Career Advance Colorado, similarly, received funding from House Bill 23-1246, which includes $5 million to launch two new short-term degree programs for nursing students.
Colorado has a growing demand for registered nurses and elementary and secondary educators across the state. Every year, there are 4,000 job openings for R.N.s and 3,700 for educators, according to data from the Colorado Talent Pipeline report.
Construction, police and sheriff’s officers, and firefighting jobs are projected to grow 20, 16 and 15 percent over the next 10 years, respectively.
Nineteen colleges, including the CCCS system and technical colleges, will offer at least one Career Advance Colorado pathway, and offerings exist in person and online.
“It’s accessible geographically, it’s accessible by modality—whether it’s online or in-person and by making it free, you make it accessible economically,” Pirius says.
Open access: The program has two qualifications for students to participate: they must complete a federal or state financial aid form (FAFSA or CAFSA) and they must be enrolled in one of the at-need workforce programs. There is no state residency or GPA requirement.
“We have pretty significant workforce shortages in these identified areas, [and] we need as many people who are interested … to get in through their education and into these jobs,” Pirius explains. “Putting these other limitations [in place] could narrow the number of people and then not address the workforce shortages.”
There are also no hidden costs or “tricks” associated with Career Advance Colorado, Pirius says. Students who stop out don’t have to repay back funds, for example, because officials recognize students’ lives are complicated and life happens.
Funding will be distributed on a first-come, first-served basis this fall, meeting all need after federal and state dollars are applied to student accounts.
“That doesn’t mean that the Legislature may not decide to expand it or extend it, but at least for the moment, once the money’s gone, it’s gone,” Pirius says. “I can guarantee by six years, there will be no money left in this.”
The system doesn’t have specific plans for retention of students within the programs but will continue to lean into colleges’ supports like advising and tutoring, Pirius says.
Promoting success: To attract students to the program, CCCS will spend $80,000 on marketing and recruitment. The system partnered with six media organizations to accomplish a statewide reach, including TV and digital ads as well as sponsored content, says Lindsay Sandoval, communications manager for CCCS.
CCSC will market Career Advance Colorado to all types of learners—from traditional age to those who have stopped out or seek reskilling.
Next steps: Students will begin to reap the benefits of Career Advance Colorado this fall, and in the future Pirius hopes the program can expand to cover other at-need professions, like advanced manufacturing.
CCCS leaders will measure enrollment and credentials earned to gauge success of the program, as well as job placement after graduation and early-career earnings in the field.
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In 2023, the landscape of community nursing has evolved significantly, driven by technological advancements and changing healthcare needs. Successful community nursing now relies on sophisticated tools and strategies, each designed to enhance patient care, Boost communication, and optimize overall community health. From telehealth integration to mobile clinics and outreach programs, this article delves into the pivotal tools for effective community nursing.
Telehealth and virtual care integration
One of the most transformative shifts in community nursing practices in 2023 is the seamless integration of telehealth and virtual care solutions. These technologies have not only bridged the gap between healthcare providers and patients but have also expanded access to quality care for individuals in remote or underserved areas. Community nurses now leverage video consultations, remote monitoring, and telemedicine platforms to conduct assessments, offer medical advice, and provide ongoing support.
With telehealth tools becoming increasingly sophisticated, community nurses can collaborate with certified and consult on complex cases without geographical limitations. Furthermore, the integration of electronic health records (EHRs) into telehealth platforms streamlines information sharing, ensuring that patient data remains secure yet accessible to authorized medical professionals.
Advanced health monitoring devices
Advanced health monitoring devices have emerged as indispensable tools that empower both healthcare providers and patients. These devices, ranging from wearable fitness trackers to sophisticated medical sensors, enable real-time tracking of vital signs, health metrics, and even early warning signs of potential health issues. Community nurses leverage these devices to remotely monitor patients’ conditions, promptly identify anomalies, and intervene before problems escalate.
Moreover, these devices foster a sense of patient engagement and empowerment by involving individuals in their own health management. Patients can actively track their progress, share data with their healthcare providers, and make informed decisions about their lifestyle choices. The integration of these devices into community nursing practices has resulted in proactive and personalized care plans, reducing hospital readmissions and enhancing the overall quality of life for patients.
Collaborative care platforms
Collaborative care platforms serve as centralized hubs where nurses, physicians, specialists, and other caregivers can collaborate on patient cases, share insights, and collectively devise comprehensive care plans. These platforms break down barriers that often hinder efficient care delivery, enabling multidisciplinary teams to work harmoniously toward common goals.
Such platforms also facilitate real-time updates on patient progress, reducing the likelihood of information gaps and minimizing medical errors. Community nurses can consult with colleagues across different disciplines, seek second opinions, and access a wealth of collective knowledge that enriches their decision-making process. Through these collaborative tools, community nursing has evolved into a well-coordinated symphony of expertise, ensuring that patients receive holistic care that addresses their physical, emotional, and social needs.
Patient education and engagement apps
Patient education and engagement have been revolutionized by the integration of innovative apps and digital platforms. These tools go beyond traditional methods of patient education, offering interactive and personalized experiences that empower individuals to take charge of their health. Community nurses now utilize a diverse range of apps that provide patients with easy access to accurate medical information, instructional videos, and self-care resources tailored to their specific conditions.
By incorporating gamification and user-friendly interfaces, these apps create an immersive learning environment that encourages active participation and sustained engagement. Patients can set health goals, track their progress, and receive rewards for completing educational modules or achieving milestones. Moreover, these apps often feature secure communication channels, enabling community nurses to maintain an ongoing dialogue with patients, answer queries, and provide guidance remotely. The merge of technology and patient education in this manner has not only deepened patients’ understanding of their health but has also forged stronger bonds between community nurses and the individuals they serve.
Mental health support resources
Community nurses now play a pivotal role in addressing mental health concerns, ranging from stress and anxiety to more complex conditions. A plethora of digital platforms and apps have emerged to aid in this process, offering a spectrum of mental health resources, including mindfulness exercises, cognitive-behavioral therapy modules, and virtual support groups.
These tools not only enable community nurses to provide timely interventions and guidance but also empower individuals to take proactive steps in managing their mental well-being. Patients can access self-help resources at their convenience, reducing the stigma associated with seeking help and fostering a sense of autonomy over their mental health journey. Moreover, community nurses can use these resources to tailor personalized care plans that holistically address both physical and emotional aspects of health.
Continuous professional development resources
Community nurses today have access to a rich tapestry of online courses, nursing tools, and certification programs that enable them to stay abreast of the latest medical advancements, best practices, and evolving healthcare policies. These resources go beyond traditional learning methods, fostering a culture of lifelong learning that is essential in a rapidly changing healthcare environment.
An exemplary illustration of this commitment to professional growth is Spring Arbor University’s online Master of Science in Nursing (MSN) programs. This esteemed institution offers dedicated healthcare professionals the chance to answer the call of serving others while advancing their nursing careers. Through comprehensive online courses, such as those offered by Spring Arbor University, community nurses have the opportunity to elevate their skills, broaden their perspectives, and contribute meaningfully to the well-being of their communities.
Mobile clinics and outreach programs
Mobile clinics, equipped with state-of-the-art medical facilities, now traverse areas that lack easy access to healthcare services, ensuring that even the most isolated communities receive essential medical attention. These clinics are staffed by skilled community nurses who provide a wide range of services, from preventive care and health screenings to vaccinations and chronic disease management.
Amid this landscape, the crucial role of outreach programs has also become increasingly apparent. Collaborations between community nursing teams, local organizations, and healthcare institutions have led to targeted initiatives that address the unique healthcare needs of specific populations. Whether it’s providing care to homeless individuals, conducting health education workshops in schools, or offering maternal and child health services in rural areas, these programs epitomize the dedication of community nurses and reach beyond conventional boundaries. As mobile clinics and outreach programs continue to evolve and expand, they underscore the unwavering commitment of community nursing and ensure that every individual, regardless of their circumstances, has access to high-quality healthcare services.
Emergency preparedness and disaster response
Community nurses now play a pivotal role in planning, executing, and coordinating healthcare interventions during crises, whether they are natural disasters, pandemics, or other emergencies. These nurses collaborate closely with public health agencies, local authorities, and medical organizations to ensure a swift and coordinated response that addresses both immediate and long-term healthcare needs.
The lessons learned from past events have led to the development of robust protocols and strategies that guide community nursing teams in times of adversity. These include establishing temporary medical facilities, ensuring the availability of critical medical supplies, and providing mental health support for both patients and healthcare providers. Additionally, community nurses are instrumental in disseminating accurate information to the public, dispelling misinformation, and promoting preventive measures to mitigate the impact of disasters.
As community nurses continue to leverage these tools, they not only elevate the standard of care but also reaffirm their commitment to making healthcare accessible, empathetic, and effective for all. These tools are not just instruments of efficiency but also act as bridges that connect healthcare providers with patients in a more meaningful way. Community nursing stands as a testament to the remarkable potential of blending technology, compassion, and expertise to create a healthier and more inclusive future for communities around the world.
Expert advice on nutrition delivered to patients electronically saved physicians time, improved patient satisfaction, and was reimbursable by insurance, UT Southwestern Medical Center researchers report. The findings, published in Nutrients, showcase a new model developed at UT Southwestern to feed the growing interest among patients in learning how food can affect their health.
"Diet is the top risk factor for early death in the U.S., and the cost of diet-related diseases here is in the billions of dollars. Most patients are not getting the support they need to Boost their diets in the typical clinical model," said study leader Jaclyn Albin, M.D., Associate Professor of Internal Medicine and Pediatrics at UT Southwestern and a certified culinary medicine specialist.
"We have developed a feasible, scalable, well-received, and low-resource way to bring culinary nutrition advice to patients and build culinary medicine as a reimbursable service line."
Over the past decade, patients have increasingly sought advice on changes in diet to Boost outcomes for health conditions such as high cholesterol, diabetes, arthritis, and food allergies, Dr. Albin explained. There is also a desire for information about how to eat healthfully on a budget. Physicians typically don't have the time to answer these questions during a standard clinic visit, and most have no formal training in nutrition.
Sending these patients to a registered dietitian is important and should be utilized when available, but this process is often impractical due to accessibility of appointments and unreliable reimbursement by health insurers. In addition, Dr. Albin said, some patients' questions don't necessitate a full-length appointment.
Seeking a new way to get information to patients, Dr. Albin teamed up with UTSW registered dietitian Milette Siler to apply an established electronic consultation service, eConsults, to a new specialty—culinary medicine. Culinary medicine combines the expertise of physicians, registered dietitians, and chefs to help patients Boost their personal nutrition and ease health problems through delicious foods.
Culinary medicine takes many forms, Dr. Albin said, ranging from sharing recipes and cooking techniques during standard patient care encounters to hosting group cooking classes that can be billed as shared medical appointments.
The cornerstone of this new eConsult service is the partnership between two certified certified in culinary medicine: Dr. Albin and Ms. Siler. The pair consulted with UTSW's institutional billing team and administrative leaders to design a request system for eConsults through the electronic health record.
When primary care physicians or other health care professionals at UTSW file a request for eConsults, the physician-registered dietitian team develops a personalized, lay language, single-page summary of the patient's health background and goals, personalized dietary recommendations, recipe suggestions, and tips for local resources to promote nourishing food access. The requesting physician then sends the eConsult report to the patient through the health portal.
During a pilot phase from Aug. 1, 2021, to July 31, 2022, the team recruited 11 primary care physicians to use the service. Dr. Albin and Ms. Siler delivered 25 eConsults—at least one per month and as many as four in a single month.
The primary care physicians who utilized this service reported in a qualitative survey that eConsults allowed them to provide necessary nutrition information to patients with a variety of health conditions, including diabetes, fatty liver disease, irritable bowel syndrome, eczema, rosacea, physical disabilities, and severe dietary allergies. The eConsults saved them time in patient encounters, the physicians said, and the feedback they received suggested that patients appreciated the expertise. The majority of these eConsults were covered by insurance.
One patient, a woman in her 60s, needed extra calcium in her diet to manage osteopenia, a bone-weakening condition that is often a precursor to osteoporosis. The eConsult service promptly delivered suggestions for adding high calcium foods to her diet, tips on avoiding side effects from calcium supplements, and other ways to Boost bone health, such as exercise, said her physician Bethany Agusala, M.D., Assistant Professor of Internal Medicine and Medical Director of the William T. and Gay F. Solomon General Internal Medicine Clinic.
"Dr. Albin and Ms. Siler were able to distill their expertise into an easy-to-read recommendation for my patient. It's a really helpful thing," Dr. Agusala said.
The culinary medicine eConsult service is offered for all UTSW patients through the request of their primary care or specialist physicians or advanced practice providers. The Culinary Medicine Program at UTSW also accepts appointments for in-person physician-dietitian consults at UT Southwestern Medical Center at RedBird and will soon offer group cooking classes at community kitchens.
More information: Jaclyn L. Albin et al, Culinary Medicine eConsults Pair Nutrition and Medicine: A Feasibility Pilot, Nutrients (2023). DOI: 10.3390/nu15122816
Citation: New primary care model created to dispense nutrition advice (2023, August 22) retrieved 24 August 2023 from https://medicalxpress.com/news/2023-08-primary-nutrition-advice.html
This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.
Offering solid food to your baby is an exciting time. But the excitement can suddenly end when they refuse to eat their favorite food. Nearly all kids have a period of picky eating early in life. There's even a term for it: the toddler appetite slump.
"When children are first starting on solid foods, they may have strong reactions to tastes and textures," says Cindy Gellner, MD, a board-certified physician specializing in pediatrics at University of Utah Health.
The typical “picky eating” stage is seen around ages 1-5 years. This is when toddlers begin to develop food preferences.
One of the most important tips for parents is to not get frustrated. “Just like learning how to talk, it takes time for your child to learn how to be a competent eater,” says Miranda Reynolds, a clinical dietician at University of Utah Health. This stage will eventually pass.
Here’s how you can help set your child up for success to not be so selective as they get older:
Eat at the table instead of letting your child graze and carry around food and sippy cups. Avoid giving milk and juice in between meals because it can decrease their appetite at mealtimes. Only offer a small cup of water between meals instead. If your child uses a bottle, replace it with a cup. Your child will likely drink less from a cup, leaving more room for food at mealtimes.
Prepare the same food for everyone—even if your child complains or refuses to eat it. It’s important that they learn to eat what the family eats. Offering a different meal may teach them not to try new foods because they will always receive food they like.
Respect their ability to listen to their body and let them choose what and how much to eat from what is offered. Place a small serving of a new food on their plate without forcing them to try it. It may take several attempts before your child feels comfortable accepting a new food.
Avoid forcing your child to finish their plate, and encourage them to stop eating when they feel satisfied. Children have much smaller stomachs than adults, so it is normal for them to eat less than others—or not at all.
Let them select fruits, vegetables, and other healthy foods at the grocery store. Getting them involved in meal preparation could also be fun for them. Let them choose their toppings, offer a dip, or arrange their foods in a creative way.
Eat a variety of healthy foods, avoid negative comments about foods you dislike, and create a calm and pleasant atmosphere without distractions like toys or the TV.
Using dessert or treats as a bribe for eating other foods can negatively impact your child and lead to later habits of disordered eating. Do not use food as a punishment or withhold meals.
When a child’s eating behavior suddenly changes, it can create a lot of anxiety and stress on a parent. But just because your child no longer has an interest in a particular food doesn’t mean there’s a serious, underlying issue.
“If your child is growing well with their height and weight, it most likely is behavioral picky eating and not a medically serious cause,” Gellner says. “It’s not that the child has a medical reason for not eating what a parent wants. It’s that kids naturally gravitate towards sweets and other treats and will hold out until they get those.”
So, if grandma, grandpa, or another relative is giving your child sweets and junk food, your child is probably filling up on those. According to Gellner, parents usually supply in because they get worried that their child isn’t eating and will starve. But in reality, a child is “training” the parent to supply in to what they want.
“They won’t starve, but they just might have to eat something they don’t think they like and may find out that they like it,” Gellner says.
If extreme fussiness with foods persists after age 6, it may be time to look at other causes for the picky eating. Figuring out those causes starts with talking to your child and their pediatrician.
"It may be that your child just has not been properly re-introduced to a food they dislike," Gellner says. "It can take as many as 10 times before they accept a food they encountered negatively."
In most cases, a little detective work and perseverance pays off. However, in children with mood or sensory issues, it may take a bit more.
"You also need to let your pediatrician know if your family has a history of anxiety or autism," she says. "That will help identify potential issues early on and address them."
Of course, in any situation, a child needs to eat. Once a problem is identified, it's important to work on solutions that ensure proper nutrition is being obtained. Working with a registered dietitian can help make sure your child is getting what they need to grow and develop.
OCONOMOWOC, Wis., Aug. 21, 2023 (GLOBE NEWSWIRE) -- Parkins Plastic Surgery in the Milwaukee and Madison area is pleased to announce the addition of board-eligible plastic surgeon and Wisconsin native Dr. Lucas Boehm to the team. Dr. Boehm, who started with the practice in July 2023, focuses on aesthetic surgery of the face, nose, breast, and body and specializes in rhinoplasty, skin health, and facial aging.
Upon completion of medical school and his six-year plastic surgery residency at the Medical College of Wisconsin—where he received extensive training in all forms of plastic surgery—he ultimately decided to focus his expertise on aesthetic surgery for the face and breasts. Following residency, he went on to complete a one-year fellowship with world-renowned aesthetic plastic surgeon Dr. Bradley Calobrace in Louisville, KY. During this time, Dr. Boehm travelled around the country and world learning the latest techniques in deep plane facelifting, rhinoplasty, and breast surgery from key leaders in these respective fields. Dr. Boehm is excited to bring these cutting-edge techniques—as well as his knowledge, experience, and surgical expertise—to Wisconsin and Parkins Plastic Surgery to help all patients achieve their aesthetic goals.
Cosmetic surgery alters parts of the body to enhance their appearance or reduce signs of aging. Studies have shown that these procedures can boost confidence and self-esteem for patients. Cosmetic surgery has continued to grow in popularity worldwide as a result of wider accessibility along with improvements in technology and surgical techniques.
Parkins Plastic Surgery, founded by board-certified plastic surgeon Dr. Maida Parkins, aims to provide the most patient-focused and attentive care. The practice provides a complete range of surgical and non-surgical cosmetic surgery options, including procedures for the face, breasts, and body. Breast augmentation, tummy tuck surgery, liposuction, breast lift surgery, Mommy Makeover, facelift, and rhinoplasty (nose surgery) are some of the most popular treatments available at the practice. Parkins Plastic Surgery also offers an extensive selection of non-surgical treatments such as injectables, lasers and lights, skin rejuvenation, and fat reduction.
For more advice about cosmetic procedures, contact Parkins Plastic Surgery, serving Milwaukee and Madison area patients. Call (262) 269-1050 or fill out a contact form to request a consultation.
A new health care apprenticeship program at AdventHealth is helping young adults in our area build strong careers in the medical field. These students, carefully selected from their respective communities, are gaining valuable skills and experience in phlebotomy, which is taking and preparing patient blood samples for testing.
AdventHealth and Ultimate Medical Academy were chosen to partner with CareerSource Tampa Bay and the Hillsborough Board of County Commissioners to implement the first health care Apprenticeship-to-Career Empowerment Program (ACE). CareerSource Tampa Bay and the Hillsborough Board of County Commissioners have already worked together for three years on providing paths for other career fields, but this is the first of their programs in health care.
The program includes the opportunity for them to earn a professional career certificate, gain paid work experience, and have assistance in preparation for entering the professional workforce. It also starts them on the path to becoming a nationally certified laboratory assistant.
“The Phlebotomy program focuses specifically on phlebotomy as a part of Laboratory Assisting. These students will earn a career certificate from the National Healthcareer Association and are also learning to assist Medical Laboratory Scientists in our AdventHealth hospital laboratories,” said Mistie Palmer, AdventHealth Learning Operations Manager.“AdventHealth recognizes that these team members are crucial to the Medical Laboratory Team in providing expert, whole-person care to our community.”
Employment of phlebotomists is projected to grow 10 percent from 2021 to 2031, faster than the average for all occupations, according to the U.S. Bureau of Labor Statistics. Florida also has one of the highest employment levels for phlebotomists in the country.
This partnership between AdventHealth and UMA, combined with the support of CareerSource, has created an environment where aspiring individuals can find their footing and embark on a journey in the medical field.
This current group of students will have the chance to apply for AdventHealth positions.
MANILA, Philippines—In response to the Department of Education’s directive to rid classrooms of decorations, Jomel (not his real name), a high school teacher, started making his classroom walls “bare.”
Talking to INQUIRER.net, Jomel, who has been a teacher for over five years now, said while he was painting the classroom walls that were previously adorned with visual aids: “It is regrettable because there are instances that when they look at these [visual materials] they really learn something.”
According to Raymond Basilio, secretary general of the Alliance of Concerned Teachers (ACT), teachers should be the one to decide whether to keep or remove the learning aids.
“They are more keen on the do’s and don’ts, and the interventions needed inside their respective classrooms,” he told INQUIRER.net when asked to comment on DepEd Order No. 21, telling school officials to keep classroom walls bare.
Issued on Aug. 3, over a week before the Brigada Eskwela, the order pointed out that “classroom walls shall remain bare and devoid of posters, decorations, or other posted materials.”
This, as the DepEd said “[public] schools shall ensure that school grounds, classrooms and all its walls, and other school facilities are clean and free from unnecessary artwork, decorations, tarpaulin and posters at all times.”
Vice President and Education Secretary Sara Duterte explained that “classrooms should be clean so that the attention of our students is in their teacher, their book, or their activity.”
She told Radyo Pilipinas that decorations and everything that are attached or written on the walls of a classroom should be removed, stressing that “classrooms should be free from clutter.”
DepEd spokesperson Michael Poa told Radyo 630 that the directive to “take out everything” is “what it is,” pointing out what Duterte had said—that classrooms should be clear, even from photos of government officials, including the President, and heroes, like Dr. Jose Rizal.
Joanne Trina Moreno-Javier, member of the Board of Trustees of the Psychological Association of the Philippines, said it would be best for the DepEd to consult teachers at different levels—kindergarten, grade school, and high school.
Javier, a certified developmental psychologist, told INQUIRER.net via FB Messenger that especially among the younger age groups, having visuals and print-rich learning environments “will be helpful to further stimulate their senses, as this is how they best learn — through their senses.”
“There is truth to the matter, though, that less clutter will also be advisable,” she said.
Pamela Joy Capistrano, a university instructor, who was concerned as a parent, looked as an academic into studies regarding scrapping classroom decorations and its relation to learning.
She said on X (formerly Twitter) that there are a lot of studies looking at the relationship between architectural classroom designs and student achievements, “but there are basically only two heavily influential research projects that focus specifically on classroom decorations.”
However, she told INQUIRER.net via FB Messenger that “there is a need to return to the studies because the researchers themselves were very explicit” about (1) the limitations of the studies, which were focused on kindergarten in 2014 and in early grades in 2022; (2) how they do not endorse zero classroom decorations; and (3) recommending a minimalist approach to classroom decorations.
She said it would be beneficial for the DepEd to review the blanket directive, “especially for the welfare of young learners,” saying that for most children, the school is often a safe space where they have the chance to be kids and have fun while learning.
According to Javier, “it is then better to regulate what is being posted or have a better organized manner of arranging these visuals,” like “considering the position on where these visuals are placed, size, color, and most importantly, [the] appropriateness to the grade or age group.”
While the order is somehow advantageous, too, especially for some teachers, like Jomel, who pointed out that bare classroom walls would indicate lesser expenses, Javier said “it would be best to supply attention on how to make the classroom a better learning environment.”
She said the fact that the teacher remains to be the most important “visuals” in the classroom, “it will be futile to argue whether these decorations are placed or pulled down from walls if the best visual is not equipped to make better use of these seemingly secondary learning aids in the classroom.”
“The point here is that a trained teacher is paramount, with or without consideration of the physical classroom environment,” Javier said, stressing that the DepEd should listen to teachers’ “take and suggestions.”
According to Basilio, there are a lot of problems that the DepEd should instead address, like the lack of teachers and classrooms, which are the reasons that class sizes are bloated.
Based on an article published by the The Rensselaerville Institute, a non-profit organization based in the United States, instruction quality and delivery style, class size, parent involvement, peer relationships, assessment, and school facilities are some of the significant factors that help students learn and excel academically.
“If the government wants learners to focus on their teachers, the solution is to reduce the class size and provide teachers and students with enough and necessary teaching and learning materials,” Basilio said.
ACT previously stated that teachers with seven to eight teaching loads are handling 30 to 50 students for every class while also attending to administrative responsibilities in their schools.
Basilio pointed out that if the government wants teachers, too, to focus on teaching their students, they should be stripped of their administrative tasks and be given enough opportunities for continuing professional development.
Capistrano stressed that it is also critically important to look at other physical design elements, saying that “so many public school classrooms in the Philippines are cramped, dark, [and] badly ventilated.”
According to Duterte’s Basic Education Report 2023, which was presented last Jan. 30, the DepEd is “not blind to the reality that there is a need to build, repair, and maintain school infrastructures to accommodate the growing number of learners.”
Based on DepEd data, there are over 28 million Filipino learners in public schools for the school year 2022-2023, but there are only 327,851 school buildings. Out of which, only 104,536 are in “good condition.”
Last March, most public school teachers, who responded to a survey conducted by ACT, said students are finding it difficult to concentrate because of extreme heat during the dry season.
This, as out of the 11,706 teacher-respondents, 7,832 said they experienced “intolerable heat,” 3,813 said they experienced “bearable heat,” while only 61 said they had “pleasant” classroom conditions.
Most respondents pointed out that the extreme heat was distracting students from learning, especially when inside a classroom with 50 students, which is way higher than the standard class size of only 35 students.
Out of the 11,706 teacher-respondents, who were allowed to select more than one answer, 10,140 said children were having difficulty concentrating on lessons, 4,638 said there was increased absenteeism, while 4,352 said the extreme heat triggered pre-existing medical conditions.
Capistrano said: “Just as crucial to learning are students’ physical and emotional states. Is the classroom not too warm, is it bright, is it adapted to our needs? Is the classroom a place where students feel safe and welcome? Is school a place we learn to love, and where we love to learn?”
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In developing drugs using a platform that joins physics with machine learning, Schrödinger sees more than a passing resemblance to the studio whose Toy Story and other computer-generated movies changed the practice of animation.
Just as Pixar initially viewed its competitors as studios that produced animation using yesteryear’s hand-drawn approach, so Schrödinger pinpoints its rivals not as other users of artificial intelligence (AI) in drug discovery, but chemists who still use traditional methods for designing molecules.
“Our Toy Story in some sense is Nimbus [Therapeutics], and Morphic [Therapeutic], and now our own programs,” Schrödinger CEO Ramy Farid, PhD, analogized to GEN Edge.
Farid was referring to a pair of drug developers whose discovery platforms add computation to traditional chemistry—and which have both partnered with Schrödinger in designing new drugs. Nimbus’ structure-based engine combines computational chemistry with technologies that include X-ray crystallography and cryo-electron microscopy. Morphic integrates its MInT (Morphic Integrin Technology) platform with Schrödinger’s computational prowess to modulate the activity of integrins to treat disease.
Where Schrödinger stands out in drug discovery, Farid said, is in combining AI with physics-based first principles to identify new drugs for targets that are designed to treat a variety of diseases. Applying physics means running a molecular dynamics simulation to compute the solubility of a molecule in water, or the affinity of the molecule for a particular protein, or its permeability.
If physics can do all that and more, why does Schrödinger rely on machine learning too?
“The calculations are slow, relatively speaking. It takes about a day to compute one property on one processor, approximately 12–24 hours. And to do drug discovery, we need to explore hundreds of millions—billions, actually—of molecules,” Farid explained. “Even if you had one million computers, you couldn’t do that—and we don’t have access to one million computers! So, we need this hack, if you will, to generate training sets, with physics that’s pretty fast to generate a large enough amount of data to train a machine-learned model. Machine-learned models are really fast, but you need the data to train them.”
Schrödinger has been using forms of AI stretching back about two decades, to a precursor technology called Quantitative structure-activity relationship, or QSAR, which studied the relationship between the chemical structure (or structure-related properties) and the biological activity of a chemical. As the underlying technology improved, its name changed to deep learning, then neural networks, and now AI.
“With QSAR, you couldn’t handle as much data. And you couldn’t supply it as many descriptors because the method just couldn’t handle it,” Farid recalled. “So there have been advances, but the fundamental limitation hasn’t changed. You cannot build a training set in chemistry large enough because of the context. You have 1060 different molecules. You have 30,000 different proteins, and among each of those different proteins, you have different conformations and so on. The complexity is way, way too high for machine learning alone.”
Farid and Karen Akinsanya, PhD, Schrödinger’s president of R&D, therapeutics, discussed the company’s approach to drug discovery, its successes, and its challenges during a accurate interview with GEN Edge at the company’s New York headquarters. Schrödinger is named for a Nobel laureate honored for pioneering discoveries in quantum physics, Erwin Schrödinger, so it stands to reason that the company’s drug discovery efforts are underpinned by physics as well as machine learning.
Akinsanya and Farid said Schrödinger’s success in drug discovery stems from a two-prong approach to its business. One prong is the licensing of its software used in drug discovery and materials design, a business that has attracted some 1,750 customers to the company.
The other prong, which has two components, focuses on full-scale deployment of the platform to drug discovery: The company maintains 13 active collaboration projects with biopharma and other partners focused on drug and materials design, with nine of those partners having advanced programs into the clinic.
Schrödinger’s partners include several big pharma giants:
Among smaller biotech collaborators have been Structure Therapeutics, for which Schrödinger played a role in helping to design GSBR-1290, an oral GLP-1R in development for type 2 diabetes and obesity; Relay Therapeutics, whose Dynamo Platform™ joins computation with physics-based simulations and chemical biology insights to achieve what it calls Motion-Based Drug Design®; and Morphic, for which the company has worked in collaboration to design MORF-057, an oral ɑ4ꞵ7 inhibitor in development for ulcerative colitis and Crohn’s disease.
Earlier this month, Schrödinger acknowledged the end of a collaboration with Zai Lab to discover and develop a novel oncology program targeting DNA damage response; Zai Lab cited strategic reasons. (The program, which had been in the discovery phase, is now fully owned by Schrödinger.)
Schrödinger has also built a wholly-owned pipeline of 19 active programs, the first of which entered clinical trials last year—SGR-1505, an inhibitor of the mucosa-associated lymphoid tissue lymphoma translocation 1 gene (MALT1), now in two Phase I trials. SGR-1505 is under study in Australia in healthy adult volunteers (ACTRN12623000358640p), with preliminary data expected later this year. Another trial (NCT05544019) is assessing SGR-1505 in patients with relapsed/refractory B-cell lymphomas. The company expects to have preliminary data for the latter study next year, Akinsanya said.
Michael J. Yee, equity analyst with Jefferies, observed recently in a research note that Schrödinger executives expressed confidence that SGR-1505 can avoid the off-target toxicities seen with Johnson & Johnson’s MALT1 inhibitor candidate, safimaltib (JNJ-67856633), because of what Schrödinger said was a more attractive pharmacokinetics and pharmacodynamics (PK/PD) profile.
Yee noted that safimaltib has shown dose-limiting toxicities (DLTs) as well as promising efficacy. “[Management] thinks the DLTs [dose-limiting toxicities] with the JNJ drug may be due to the property of the molecule (not the target) since it has 13x variability in PK between [patients] and a long 5-day half-life which requires loading doses even at high doses, leading to very high drug exposure,” Yee wrote.
“SDGR sees opportunities in [monotherapy] as well as combo with BTK [Bruton’s tyrosine kinase] and/or other targets, and is open to partnering with companies with these assets or presence in B-cell tumors.”
Also seeing potential in a combination therapy is J&J. A study published in February showed effectiveness in treating mantle cell lymphoma through a combination therapy of safimaltib and Eli Lilly’s Jaypirca™ (pirtobrutinib), a BTK inhibitor granted accelerated approval by the FDA in January as the first and only non-covalent (reversible) BTK inhibitor authorized by the agency.
Yee has been bullish on Schrödinger. In June, he raised his firm’s 12-month price target on Schrödinger stock 50%, from $40 to $60. “SDGR is a rare model in biotech overlapping the AI + ML theme w/ both a strong commercial software biz (beat last two years guidance) + their own internal cancer pipeline in Phase I and partnerships across pharma/biotech demonstrating increasing proof of concept.”
Indeed Schrödinger has disclosed that it received $111 million upon completion in February of Nimbus’ sale of its wholly-owned Nimbus Lakshmi subsidiary and its tyrosine kinase 2 (TYK2) inhibitor NDI-034858 to Takeda for up to $6 billion (of which $4 billion was paid upfront). Schrödinger also received another $35.79 million from Nimbus in April.
Last month, Nimbus and Schrödinger published a paper highlighting the impact of computational physics-based predictions in the identification of NDI-034858—since renamed TAK-279, which is in Phase II clinical trials for the treatment of psoriasis and psoriatic arthritis.
Also later this year, a second wholly-owned Schrödinger candidate is expected to advance into the clinic: SGR-2921, an inhibitor of the cell division cycle 7 (CDC7) gene that is a key cell cycle checkpoint for DNA repair. SGR-2921 has received FDA clearance for a Phase I study (NCT05961839) in patients with acute myeloid leukemia or myelodysplastic syndrome. “We are initiating the trial right now,” Akinsanya said.
Next year, Schrödinger expects to bring a third candidate into the clinic, SGR-3515, a Wee1 inhibitor indicated to treat gynecological cancers with additional potential in a broad range of solid tumors. SGR-3515 is now in IND-enabling studies.
Schrödinger plans additional updates on these and other candidates in December when it updates analysts and investors on its pipeline progress. “We anticipate that our team will be moving programs into the clinic and through Phase I over the course of the next decade,” Akinsanya said.
Facilitating that progression of candidates among the wholly owned pipeline is among the clinical development and regulatory strategy responsibilities of Schrödinger’s recently appointed chief medical officer, Margaret Dugan, MD.
A board-certified medical oncologist and hematologist with more than 30 years of clinical, medical research, and drug development experience, Dugan was previously chief medical officer of Dracen Pharmaceuticals, an oncology drug developer, and held roles of increasing responsibility, including senior vice president, at Novartis, where she led oncology-focused global strategic drug development.
Oncology is one of three therapeutic areas that account for most of Schrödinger’s wholly-owned pipeline; the other two are neurology and immunology. “This is a neat consequence of our physics-based methods: They are first principles methods, so they are completely agnostic to the target class, the therapeutic area,” Farid said. “It’s not just focusing on a particular target or target class or therapeutic area. But of course, it’s necessary to focus somewhere.”
Added Akinsanya: “We really focus on the types of targets that we think are amenable to our platform, and that have what we call strong human evidence.”
“We don’t think it makes sense for Schrodinger to pursue very speculative biology in Nature papers. We are influenced a lot by very interesting drug design challenges, where there’s either clinical data or even an approved drug, where there’s an opportunity for a different kind of molecule, or where there’s an opportunity to be first in class on a highly exciting but validated from a genetics point of view target.”
Schrödinger finished the second quarter with net income of $4.3 million, improved year over year (YOY) from a net loss of $47.7 million in the second quarter of 2022. Revenue, however, fell nearly 9% YOY from $38.5 million to $35.2 million.
The revenue dip largely reflects a 32% drop in drug discovery revenue, from $8.5 million in Q2 2022 to $5.8 million during April–June. Schrödinger has since lowered its guidance to investors on the drug discovery revenue it anticipates generating for all of 2023, from a range of $70–$90 million, to a range of $50–$70 million. The company finished last year with $45.4 million in drug discovery revenue, up 84% from $24.7 million in 2021.
Drug discovery revenue hinges on the timing of milestones achieved by collaboration partners, with delays largely accounting for the drop, Farid said. “Once we deliver a development candidate in the cases where we’re doing that, then it’s in the partner’s hands, and they are running the clinical trials. To the extent that some milestones are associated with clinical trials, again it’s beyond our control,” Farid added. “That means it’s really hard to predict in what quarter certain milestones are going to come in.”
Also declining YOY was software revenue, which dipped 2% to $29.4 million from an even $30 million in the second quarter of last year. But the quarterly result still placed it squarely within the company’s $27-31 million guidance range for Q2, which Schrödinger is maintaining for Q3.
“Here’s the challenge: The software business is seasonal because the revenue has to be recognized in the quarter that the customer paid for licensing the software. So what we have is most of our customers have a license that starts in Q4 or Q1,” Farid said. “That’s why Q4 and Q1 look like these really big quarters and Q2 and Q3 are smaller quarters. So, the software business is on track.”
Schrödinger has raised its 2023 investor guidance on software revenue, by projecting an overall 15%-18% increase this year, up from a range of 13–17%. The company racked up $135.6 million in software revenue last year, up 20% from $113.2 million in 2021.
A software guidance increase, according to Yee, “is rare as they never raise guidance because Q4 is the big quarter” when many customers agree to license Schrödinger’s software: “This implies visibility; things are percolating for Q4.”