Sleep Medicine
Survey results
Last year, the Sleep Medicine NetWork sent out a survey to its members to explore their relative comfort in managing different types of patients who may be seen in practice and the degree to which they encouraged referral of such patients to their practices. Though one could certainly debate the validity of the measurement tool, there were two main goals in collecting these data: we were hoping to debunk the commonly propagated myth that pulmonary sleep specialists \""only like to manage apnea\"" and that we are also planning on developing sessions at the CHEST meeting to focus on those areas in which are members were least comfortable.
One hundred and fifty NetWork members responded to the survey. Unsurprisingly, 93% reported that they were extremely comfortable managing obstructive sleep apnea; but we were surprised to see that the next most \""comfortable\"" area was restless legs syndrome, followed by central sleep apnea, and circadian rhythm disorders. Narcolepsy, parasomnias, insomnia, and management of the psychiatric patient with sleep problems rounded out the list. Based upon these data, the steering committee is planning a broader slate of sleep-related educational opportunities at CHEST 2013, with focus on some of the areas identified by our membership as areas in which they were less comfortable.
The steering committee has also started an online journal club, available through the College\'’s e-Community. Each month, one of our members will post a brief commentary on a recent sleep medicine publication. The conversation has been robust, and we hope you will join in!
Dr. David Schulman, FCCP
Chair
Occupational and Environmental Health
Course coming in June
From respiratory health hazards in the home and workplace to outdoor air pollution and global warming, the Occupational and Environmental Lung Disease Conference 2013 will cover everything you need to know about respiratory exposures and their effects on human health. Hear the most important new knowledge in the field and the clinical updates essential for patient care. This targeted intensive educational immersion in occupational and environmental lung diseases is a ""can’’t miss"" course for pulmonary clinicians and others. This multiday conference will bring together an expert faculty of educators and investigators. The last time this course was held was in 1999 – so don’’t miss this one! Go to the College’’s website to find all the information you need about this course in Toronto, Canada, on June 21-23. Register today!
Dr. Ware Kuschner, FCCP
Palliative and End-of-Life Care
How to make ethics consultations in hospitals more helpful and accessible
The practice of hospital clinical ethics is maturing. From the earliest days of hospital ethics committees to today (Rothman. Strangers at the Bedside, 2003), the practice of hospital clinical ethics consultation (CEC) has become ubiquitous (Fox et al. Am J Bioethics. 2007;7[2]:13; Hurst et al. Health Care Annal. 2007;15[4]:321; Nagao et al. BMC Med Ethics. 2008;29[9]:2). Currently, most hospitals have ethics committees that perform consultations.
Physicians do not call ethics consultations for many reasons:they They take too much time, might make the situation worse, or will be unqualified (DuVal et al. J Gen Intern Med. 2004;19:251). These published data are inconsistent with the authors’’ experience, as we consult on over 300 cases annually, but are consistent with what physicians elsewhere report. At the North American Burn Society meeting in January,, b, ,urn surgeons said they did not typically call consults because they did not find them helpful; and when they did, the services were not available in a timely fashion. So what is the problem?
The problem, we think, is a result of how the whole field of clinical ethics has evolved. The ""facilitative"" model has dominated (ASBH Core Competencies, volume 2). One might muse that if there haven’’t been qualified clinical ethicists, then simply facilitating the relevant parties in coming to their own recommendations was prudent. But today we know what a qualified clinical ethicist looks like (Acres et al. J Clin Ethics. 2012;23[2]:156) and what processes are needed to hire one (Mokwunye et al. HEC Forum. 2010;22[1]:51). Hospitals need to stop relying completely on ethics committee members, the vast majority of whom are untrained volunteers.
Instead, hospitals need to start building clinical ethics programs, just as they do other specialty group programs (such as behavioral medicine and heart failure groups). Just hiring one qualified clinical ethicist would allow for training for the ethics committee (Edelstein et al. HEC Forum. 2009;21[4]:34; Mokwunye et al. HEC Forum. 2012;23[2]:147), hospital-wide ethics education, and the establishment of upstream clinical ethics practices (DeRenzo et al. Cambridge Quarterly of Healthcare Ethics. 2006;15[2]:207). Once a hospital makes these changes, physicians will find they have better access to a helpful, full-service clinical ethics program that provides timely consultative services.