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Managing the malcontent patient
Otolaryngology Head and Neck Surgery Volume 112 Number 5
Instruction Courses-- Wednesday
An integrated approach combining ABR, behavioral testing, and otoacoustic emission testing will be presented.
COURSE 4538-1 One-period course ($20)
Room NOCC-101 1:15-2:15
Meniere's Disease: Biochemistry, Natural History, and Treatment HERBERTSILVERSTEIN,MD, and SETHROSENBERG,MD Sarasota, Fla.
This comprehensive course presents both experimental and clinical data regarding etiology, biochemistry, natural history, and medical and surgical treatment of Meniere's disease. The results of inner ear fluid analysis in patients and experimental hydrops in guinea pigs will be presented. Reduction of the abnormal increase in endolymph volume appears to be associated with hearing improvements in patients with Meniere's disease. However, all treatment must be compared with the natural history of the disease. Study of the natural history of patients who refused surgery for Meniere's disease over a 15-year period shows that 57% of the patients are free of their vertigo after 2.5 years, and 71% are free of vertigo after 6.5 years. With the natural history in mind, the results of medical and surgical treatment of Meniere's disease is presented. When medical treatment of at least 3 months fails, either a vestibular neurectomy or a cochleovestibular neurectomy is usually recommended, depending on the patient's hearing and physical condition. If the patients are elderly and unable to undergo major surgery, a cochleosacculotomy is recommended. The use of low-dose intramuscular streptomycin sulfate in the treatment of bilateral Meniere's and Meniere's disease in the only hearing ear will be described. Concepts for further therapy to reduce the abnormal volume of endolymph and find a cure for all the symptoms of Meniere's disease will be discussed.
COURSE 4539- I One-period course ($20)
P 171
rendered. Few medical schools or postgraduate programs provide formal instruction in managing malcontent patients and their problems. Most physicians rely on experience and advice of senior colleagues when confronted with such patients. Although no single management technique might be appropriate for all patients, certain fundamental steps can be taken to manage malcontent patients. Even when patients leave a practice the physician can have the assurance that these patients were provided appropriate management in attempts to satisfy difficult patients and their problems.
COURSE 4540-1 One-period course ($20)
Room NOCC- 103 1:15-2:15
Endoscopic Percutaneous Tracheostomy: Indications and Techniques KAREN M. KOST,MD, and ANTHONY G. ZEITOUNI,MD Westmount, Quebec, Canada, and New York, N.Y.
Educational objectives: To understand appropriate patient selection and surgical techniques of endoscopic percutaneous tracheostomy while avoiding potential complications.
Percutaneous tracheostomy has become an increasingly popular technique because it is a simple, cost-effective procedure performed at the bedside in intubated ICU patients. Although most series show that it is a safe technique, controversy has been raised by reports of serious complications. Our experience with this procedure over the last 3 years indicates that, with proper patient selection and the addition of endoscopic guidance, percutaneous tracheostomy is a safe technique. This course will discuss the importance of appropriate patient selection, along with the indications and contraindications. The major portion of the course will involve a detailed discussion of endoscopically guided percutaneous tracheostomy, the details of which will be further illustrated through a short video presentation.
Room NOCC-102 1:15-2:15
Managing the Malcontent Patient WALTERA. SCHROEDER,JR., MD C a p e Girardeau, Me.
COURSE 4541 - 1 One-period course ($20)
Room NOCC-104 1:15-2:15
Evaluating Your Staff KARENZUPKO Chicago, III.
Educational objectives: To understand the assessment of the subjective and objective factors on an initial visit and to have an objective method of managing a malcontent patient by following a logical sequence of guidelines.
Educational objectives: To improve their personnel evaluation systems and refine compensation systems.
Establishment and maintenance of a physician-patient relationship remain of paramount importance for a successful practice. Although this relationship is seldom a problem with patients who are satisfied, the malcontent patient requires appropriate management to restore trust in the care
During this fast-paced session, we will focus on personnel reviews, staff goal-setting, and compensation. Because salaries are a significant overhead component, it is important to know whether you are getting the most from your people investment.
Instruction Courses-- Wednesday
An integrated approach combining ABR, behavioral testing, and otoacoustic emission testing will be presented.
COURSE 4538-1 One-period course ($20)
Room NOCC-101 1:15-2:15
Meniere's Disease: Biochemistry, Natural History, and Treatment HERBERTSILVERSTEIN,MD, and SETHROSENBERG,MD Sarasota, Fla.
This comprehensive course presents both experimental and clinical data regarding etiology, biochemistry, natural history, and medical and surgical treatment of Meniere's disease. The results of inner ear fluid analysis in patients and experimental hydrops in guinea pigs will be presented. Reduction of the abnormal increase in endolymph volume appears to be associated with hearing improvements in patients with Meniere's disease. However, all treatment must be compared with the natural history of the disease. Study of the natural history of patients who refused surgery for Meniere's disease over a 15-year period shows that 57% of the patients are free of their vertigo after 2.5 years, and 71% are free of vertigo after 6.5 years. With the natural history in mind, the results of medical and surgical treatment of Meniere's disease is presented. When medical treatment of at least 3 months fails, either a vestibular neurectomy or a cochleovestibular neurectomy is usually recommended, depending on the patient's hearing and physical condition. If the patients are elderly and unable to undergo major surgery, a cochleosacculotomy is recommended. The use of low-dose intramuscular streptomycin sulfate in the treatment of bilateral Meniere's and Meniere's disease in the only hearing ear will be described. Concepts for further therapy to reduce the abnormal volume of endolymph and find a cure for all the symptoms of Meniere's disease will be discussed.
COURSE 4539- I One-period course ($20)
P 171
rendered. Few medical schools or postgraduate programs provide formal instruction in managing malcontent patients and their problems. Most physicians rely on experience and advice of senior colleagues when confronted with such patients. Although no single management technique might be appropriate for all patients, certain fundamental steps can be taken to manage malcontent patients. Even when patients leave a practice the physician can have the assurance that these patients were provided appropriate management in attempts to satisfy difficult patients and their problems.
COURSE 4540-1 One-period course ($20)
Room NOCC- 103 1:15-2:15
Endoscopic Percutaneous Tracheostomy: Indications and Techniques KAREN M. KOST,MD, and ANTHONY G. ZEITOUNI,MD Westmount, Quebec, Canada, and New York, N.Y.
Educational objectives: To understand appropriate patient selection and surgical techniques of endoscopic percutaneous tracheostomy while avoiding potential complications.
Percutaneous tracheostomy has become an increasingly popular technique because it is a simple, cost-effective procedure performed at the bedside in intubated ICU patients. Although most series show that it is a safe technique, controversy has been raised by reports of serious complications. Our experience with this procedure over the last 3 years indicates that, with proper patient selection and the addition of endoscopic guidance, percutaneous tracheostomy is a safe technique. This course will discuss the importance of appropriate patient selection, along with the indications and contraindications. The major portion of the course will involve a detailed discussion of endoscopically guided percutaneous tracheostomy, the details of which will be further illustrated through a short video presentation.
Room NOCC-102 1:15-2:15
Managing the Malcontent Patient WALTERA. SCHROEDER,JR., MD C a p e Girardeau, Me.
COURSE 4541 - 1 One-period course ($20)
Room NOCC-104 1:15-2:15
Evaluating Your Staff KARENZUPKO Chicago, III.
Educational objectives: To understand the assessment of the subjective and objective factors on an initial visit and to have an objective method of managing a malcontent patient by following a logical sequence of guidelines.
Educational objectives: To improve their personnel evaluation systems and refine compensation systems.
Establishment and maintenance of a physician-patient relationship remain of paramount importance for a successful practice. Although this relationship is seldom a problem with patients who are satisfied, the malcontent patient requires appropriate management to restore trust in the care
During this fast-paced session, we will focus on personnel reviews, staff goal-setting, and compensation. Because salaries are a significant overhead component, it is important to know whether you are getting the most from your people investment.