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Editorial: ‘De Dokter’ (The Doctor)

‘De Dokter’ (The Doctor)

We would like to start of this first edition by the question raised by the AMC and the NTvG when introducing  the Amsterdam Medical Student journal: Why another scientific magazine? In a time where movements like Science in Transition (http://www.scienceintransition.nl) have been established to reduce fraud in science, are we not just counteracting this transition by raising pressure for students to publish?

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Case Report: An unexpected diagnosis in a newborn with severe prolonged hyperbilirubinemia without hemolysis

An unexpected diagnosis in a newborn with severe prolonged hyperbilirubinemia without hemolysis

This case describes a full term baby boy of a healthy mother born after a normal pregnancy, who developed jaundice on the second day after birth, with a total serum bilirubin (TSB) of 25.0 mg/dL (427 μmol/L) on the ninth day.  Initial blood tests excluded common causes of neonatal hyperbilirubinemia, e.g. iso-immunization disorders, hemolysis and hypothyroidism. As bilirubin levels continued to remain high despite phototherapy, further investigation was warranted, revealing a decreased glucose 6 phosphate dehydrogenase (G6PD) activity in the red blood cells of the newborn. After eleven days of phototherapy the patient was discharged with a TSB of 21.5 mg/dL (368 μmol/L).

Background

Neonatal jaundice is commonly observed among newborn infants, caused by hyperbilirubinemia. Severe hyperbilirubinemia should be recognized and treated to prevent kernicterus, a condition characterized by irreversible neurological damage. In most cases, hyperbilirubinemia results from a physiological increase in the unconjugated bilirubin concentration, combined with immature mechanisms for conjugation and enhanced enterohepatic circulation. However, certain conditions (e.g. prolonged jaundice, onset in the first 24 hours after birth, rapid rise in serum bilirubin, etc.) should raise the suspicion of an underlying pathologic mechanism. In general, unconjugated hyperbilirubinemia can be caused by (1) an increased, pathologic production of bilirubin, (2) a deficiency of hepatic uptake, (3) an impaired conjugation of bilirubin, (4) an increased enterohepatic circulation of bilirubin, or (5) a combination of the above [1]. In case of pathologic unconjugated hyperbilirubinemia, an increased production of bilirubin due to hemolysis is the most likely cause. Therefore, a common approach in the diagnostic work-up of neonatal unconjugated hyperbilirubinemia is to differentiate between hemolytic and non-hemolytic diseases as a first step [2].

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Article: Differences in trust in physician under 50 years between native and non-native patients: a single Dutch institute experience of 170 patients

Differences in trust in physician under 50 years between native and non-native patients: a single Dutch institute experience of 170 patients

Background  Literature suggests that a patient’s ethnicity influences the degree of trust a patient has in his physician. This is of major importance, as trust influences health seeking behavior. No studies on ethnic differences in trust in physicians have been conducted yet in the Netherlands.
Objective  To compare trust in physicians between native and non-native patients.
Methods  To examine trust, we handed out questionnaires from December 2012 until April 2013, at the outpatient clinic of Internal Medicine at the AMC in Amsterdam. The questionnaires included the 10-item validated Wake Forest trust in physician scale. We examined both global trust and three different aspects: fidelity, competence and honesty.
Results  One hundred seventy patients were included in the analysis of which 111 native Dutch and 59 non-native. Natives rated trust in their physicians on average 1.1 points (on a 10 point scale) higher (P=0.002). Especially natives in the age category of 18-50 years had more trust in their physicians than non-natives (P=0.002). However, this difference could not be found in the age category of >50 years. Furthermore, non-natives rated trust in their physician less often as ‘sufficient’ (at least 7 out of 10 points) (OR 0.37, 95% CI [0.16 – 0.88]). This especially accounted for the group 18-50 years (OR 0.19, 95% CI [0.045 – 0.76]). Of the three different aspects of trust, perceived physician competence was the strongest driver of ethnic differences in physician trust (OR 0.27, P<0.001, 95% CI [-0.33 – -0.10]).
Conclusion  Native patients of 18-50 years show more trust in their physicians than non-natives. The knowledge obtained in this study should become a basis of a new strategy to improve physician trust in non-native patients.

Introduction

Cultural differences are known to cause a gap among citizens in general, but also between non-natives and their physicians1. This could affect the quality of healthcare these patients receive.

A premise for any patient-physician relationship is trust. The most important predictors of trust are similar to the predictors of patient satisfaction2. Furthermore, several studies have shown that patients who have more trust in their doctors show better therapy compliance3,4,5­. Also, research has shown that patients are more satisfied with female than male physicians6.

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Radiology Image: A 54-year-old female

A 54-year-old female

[headline_subtitle title=”” subtitle=”Can you solve the radiology image of this edition?”]
Patient data
  • Age: 54
  • Gender: Female
  • Native country: Ghana
  • Medical history: Graves’ disease, smoking and hypertension
  • Family history: Cardiovascular diseases
  • Initial presentation: Coughing, shortness of breath and no fever.
  • Examination: Normal auscultation and normal percusion
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Trial and Error: Borderline personality disorder

Borderline personality disorder

Once, I found myself in a potentially dangerous situation with a patient who has a borderline personality disorder. It is very easy and tempting to get dragged into an argument with these kinds of patients. I was aware of my own tiredness that day which made me vulnerable and perhaps somewhat rash. The patient was highly agitated and we got into an argument. I let myself get so caught up in her line of reasoning and became offended by her insinuations. My responses increased her anger and it led to an unsafe situation which I did not realize promptly, even though I knew that she was prone to physically lash out. She had demonstrated that fact only a few weeks before this incident and she was threatening me with similar actions now. I retreated to a safe environment while other colleagues tried and succeeded in their attempt to defuse the situation. The patient’s reaction was disease related so I should have known better. However, my tiredness got the better of me. Normally the patient and I get along just ne so this hit me by surprise.

I have learned a lot from that encounter. Foremost, I will remember and take heed how my own physical and mental state can in uence my work and performance. I will not be tempted to enter into an argument of which you know beforehand will only create unnecessary tension or worse. I will take better care of my own protection and call for help on time.

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Clinical Image: A 56-year-old male

A 56-year-old male

[headline_subtitle subtitle=”Can you come up with the proper diagnosis?”]

Presentation
A 56 year old male presented with malaise and loss of appetite. On physical examination his sclerae and skin were yellow. His abdomen was swollen and his liver was enlarged. Erythematous skin lesions are present on the upper thorax region and arms.

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Guest Column: Unreliable science (or scientists)?

Unreliable science (or scientists)?

It’s been a couple of years since we were confronted with one of the most impressive cases of scientific fraud in science: the Stapel-case. We recently read a book on the affair called ‘The Publication Factory’, by Ruud Abma, connected to the faculty of social sciences at Utrecht University. Although we’ve had some exposure to data and knowledge in this particular field, disbelief at the enormous scale at which Stapel committed his fraudulent behaviour struck us. Furthermore, the conclusions of the Lefelt-commision, who thoroughly investigated the Stapel-case gave more reason for doubt. They described in their report ‘a research culture that was focused too much on confirming own thoughts (‘confirmation bias’) with questionable, selective and non-critical data handling’.

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