Author Interviews, ENT / 03.06.2019
Congestion Might Mean Something Different To You and Your Doctor
MedicalResearch.com Interview with:
[caption id="attachment_49517" align="alignleft" width="138"]
Dr. McCoul[/caption]
Edward McCoul, MD, MPH, FACS
Associate Professor
Director, Rhinology and Sinus Surgery
Department of Otorhinolaryngology
Ochsner Clinic
New Orleans, Louisiana
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Although the potential for doctors and patients to misunderstand each other has been noted in other areas of medicine, the meaning of the word "congestion" had not previously been the subject of study. This paper calls attention to the relevance of potential communication gap in otolaryngology. This is particularly important since congestion is a major diagnostic criteria of sinusitis, which ranks nationwide in the top 5 reasons for clinical encounters year after year. If a communication gap is evident around this particular term, which is integral to establishing a diagnosis of sinusitis, then the likelihood increases that patients who present with "sinusitis" will be incorrectly diagnosed.
The process of congestion refers to the microscopic accumulation of blood and/or fluid within cells or the spaces between cells in a particular tissue or body part. When this occurs in the nose, the result is swelling inside the nose, which narrows the space for air to flow. A patient would perceive this as blockage or obstruction of airflow. This can be treated with anti-inflammatory medication that reduces swelling. Medications that clear up mucus generally are not great at reducing swelling. Many over-the-counter products are available that combine both types of medications, but using those products runs the risk of overmedication, which can have adverse consequences.
Dr. McCoul[/caption]
Edward McCoul, MD, MPH, FACS
Associate Professor
Director, Rhinology and Sinus Surgery
Department of Otorhinolaryngology
Ochsner Clinic
New Orleans, Louisiana
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Although the potential for doctors and patients to misunderstand each other has been noted in other areas of medicine, the meaning of the word "congestion" had not previously been the subject of study. This paper calls attention to the relevance of potential communication gap in otolaryngology. This is particularly important since congestion is a major diagnostic criteria of sinusitis, which ranks nationwide in the top 5 reasons for clinical encounters year after year. If a communication gap is evident around this particular term, which is integral to establishing a diagnosis of sinusitis, then the likelihood increases that patients who present with "sinusitis" will be incorrectly diagnosed.
The process of congestion refers to the microscopic accumulation of blood and/or fluid within cells or the spaces between cells in a particular tissue or body part. When this occurs in the nose, the result is swelling inside the nose, which narrows the space for air to flow. A patient would perceive this as blockage or obstruction of airflow. This can be treated with anti-inflammatory medication that reduces swelling. Medications that clear up mucus generally are not great at reducing swelling. Many over-the-counter products are available that combine both types of medications, but using those products runs the risk of overmedication, which can have adverse consequences.
Dr. Childers[/caption]
Chris Childers, MD, PhD
Division of General Surgery
David Geffen School of Medicine at UCLA
Los Angeles, CA 90095
MedicalResearch.com: What is the background for this study?
Response: Patients with end-stage renal disease – poorly functioning kidneys – often have to receive dialysis. This typically requires a patient to visit an outpatient clinic several times a week to have their blood filtered by a machine. Over the past few years, two for-profit companies have increased their control over the outpatient dialysis market – DaVita and Fresenius. Combined they control approximately ¾ of the market. A number of concerns have been raised against these for-profit companies suggesting that the quality of care they deliver may be worse than the care delivered at not-for-profit companies. But, because they control so much of the market and because patients have to receive dialysis so frequently, patients may not have much choice in the clinic they visit.
Medicare covers patients who are 65 years or older and also patients on dialysis regardless of age. Medicare pays a fixed rate for dialysis which they believe is adequate to cover the clinics' costs. However, if a patient also has private insurance, the insurer is required to pay for dialysis instead of Medicare. Whereas Medicare rates are fixed by the federal government, private insurers have to negotiate the price they pay, and may pay much more as a result.
