Why Private Practice Will Always Survive; What Makes Some Infections Asymptomatic?; Cancer's Emotional Toll

Medscape Staff

October 03, 2022

Why Private Practice Will Always Survive

Employed physicians are often torn. Many relish the steady salary and ability to focus on being a physician rather than handle administrative duties but bemoan their employers' rules and their lack of input into key decisions. Seven physicians talked to Medscape Medical News about why they chose private practice.

Greater control: Some physicians chose private practice for the greater control it allows over decisions like scheduling, technology, and how many patients to take on. Though a large organization will always focus on revenue, at a private practice, you can consider other factors, like spending as much time with a patient as you want.

Avoiding burnout: Private practice offers some physicians a better work-life balance; control over their time means that they don't have to work at a breakneck pace, and they can see their families whenever they want.

Private practice has its tradeoffs: Your business can always fail, and you're left without a safety net. But increasingly, physicians are happily making that trade.

What Makes Some Infections Asymptomatic?

Polio, typhoid, COVID: In many patients, these diseases are deadly. But some can have them and never know. Why? The short answer: More research is needed. This question is a surprisingly thorny area of epidemiology.

In general, very young infants and older populations are more susceptible to infections because of their less functional immune systems. But the Spanish Flu, for example, targeted those in between. Why? We don't really know.

Hiding in plain sight: Typhi bacteria have capsules on their surfaces that allow them to hide from the immune system. With polio, sometimes infected cells slough off from the rest, to be ingested by other people. And not killing a victim — while remaining undetected — allows them to spread to even more hosts.

The great unknown: There's much that remains unknown about immunity. Meningococcus can live indefinitely in your nasal passages and never make you sick. Or it can send you to the hospital in hours. An individual's microbiome, T-cell immunity, inflammation: All of these are factors, but we can't explain it with any certainty.

Cancer's Emotional Toll

Only the patient has the cancer, but caregivers, patients, and clinicians alike are all victims of the emotional toll that comes with the disease. Speakers addressed the problem at a meeting of the European Society for Medical Oncology earlier this month.

Caregivers: The demands of being a full-time caregiver are intense. They can spend 32 hours a week looking after a loved one with cancer. About 30% of caregivers report having depression or anxiety, and 21% feel lonely.

Patients: Night sweats, weight loss, vomiting, and depression are all well-known side effects of cancer and its treatments. Fatigue, in particular, is a subtle curse because it worsens over time.

Clinicians: Burnout is one of the biggest problems facing oncologists and nurses, and it was made worse during the COVID-19 pandemic. Burnout is bad for both doctor and patient; the more detached and tired a physician seems, the less inclined a patient may be to open up about how they're doing.

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