Doug Brunk

NEW ORLEANS — The proton pump inhibitor esomeprazole was no more effective than placebo in resolving signs and symptoms of suspected reflux laryngitis in a 16-week multicenter study.

“Although this study shows there is no response, I don't want to give the impression that there is no such thing as reflux laryngitis,” Michael Vaezi, M.D., said at the annual Digestive Disease Week. “There is such a thing, it's just that it is not as prevalent as perhaps once believed. That's what this study is showing.”

He added that the diagnosis of reflux laryngitis “based on laryngeal sign is unpredictable.”

Dr. Vaezi and his associates enrolled patients with suspected reflux laryngitis based on one or more symptoms: throat clearing, cough, globus, sore throat, or hoarseness for more than 3 consecutive months, or a score of at least 5 on a laryngeal sign index based on a videostroboscopic evaluation of erythema and other laryngeal signs suggesting reflux etiology.

A 1-week run-in period identified patients with moderate symptom severity for at least 3 of 7 days. Patients with moderate to severe heartburn were excluded.

Of the 145 patients in the study, 95 received 40 mg esomeprazole (Nexium) twice daily and 50 received placebo. The researchers assessed symptoms by patient diary, and laryngoscopy was repeated at weeks 8 and 16. Baseline symptoms were similar between groups: In each, 50% had throat clearing, 20% had hoarseness, 13% had cough, 9% had globus, and 8% had sore throat.

By the end of the study, 42% of patients in the esomeprazole group reported improvement of suspected reflux laryngitis symptoms, compared with 46% of patients in the placebo group, while reported resolution of symptoms occurred in 14·7% of patients in the esomeprazole group and 16% of patients in the placebo group.

Improvement in the reflux laryngitis index over time was also similar between groups, said Dr. Vaezi of the department of gastroenterology and hepatology at the Cleveland Clinic Foundation.

AstraZeneca, which manufactures Nexium, sponsored the trial.

NEW ORLEANS — The proton pump inhibitor esomeprazole was no more effective than placebo in resolving signs and symptoms of suspected reflux laryngitis in a 16-week multicenter study.

“Although this study shows there is no response, I don't want to give the impression that there is no such thing as reflux laryngitis,” Michael Vaezi, M.D., said at the annual Digestive Disease Week. “There is such a thing, it's just that it is not as prevalent as perhaps once believed. That's what this study is showing.”

He added that the diagnosis of reflux laryngitis “based on laryngeal sign is unpredictable.”

Dr. Vaezi and his associates enrolled patients with suspected reflux laryngitis based on one or more symptoms: throat clearing, cough, globus, sore throat, or hoarseness for more than 3 consecutive months, or a score of at least 5 on a laryngeal sign index based on a videostroboscopic evaluation of erythema and other laryngeal signs suggesting reflux etiology.

A 1-week run-in period identified patients with moderate symptom severity for at least 3 of 7 days. Patients with moderate to severe heartburn were excluded.

Of the 145 patients in the study, 95 received 40 mg esomeprazole (Nexium) twice daily and 50 received placebo. The researchers assessed symptoms by patient diary, and laryngoscopy was repeated at weeks 8 and 16. Baseline symptoms were similar between groups: In each, 50% had throat clearing, 20% had hoarseness, 13% had cough, 9% had globus, and 8% had sore throat.

By the end of the study, 42% of patients in the esomeprazole group reported improvement of suspected reflux laryngitis symptoms, compared with 46% of patients in the placebo group, while reported resolution of symptoms occurred in 14·7% of patients in the esomeprazole group and 16% of patients in the placebo group.

Improvement in the reflux laryngitis index over time was also similar between groups, said Dr. Vaezi of the department of gastroenterology and hepatology at the Cleveland Clinic Foundation.

AstraZeneca, which manufactures Nexium, sponsored the trial.

NEW ORLEANS — The proton pump inhibitor esomeprazole was no more effective than placebo in resolving signs and symptoms of suspected reflux laryngitis in a 16-week multicenter study.

“Although this study shows there is no response, I don't want to give the impression that there is no such thing as reflux laryngitis,” Michael Vaezi, M.D., said at the annual Digestive Disease Week. “There is such a thing, it's just that it is not as prevalent as perhaps once believed. That's what this study is showing.”

He added that the diagnosis of reflux laryngitis “based on laryngeal sign is unpredictable.”

Dr. Vaezi and his associates enrolled patients with suspected reflux laryngitis based on one or more symptoms: throat clearing, cough, globus, sore throat, or hoarseness for more than 3 consecutive months, or a score of at least 5 on a laryngeal sign index based on a videostroboscopic evaluation of erythema and other laryngeal signs suggesting reflux etiology.

A 1-week run-in period identified patients with moderate symptom severity for at least 3 of 7 days. Patients with moderate to severe heartburn were excluded.

Of the 145 patients in the study, 95 received 40 mg esomeprazole (Nexium) twice daily and 50 received placebo. The researchers assessed symptoms by patient diary, and laryngoscopy was repeated at weeks 8 and 16. Baseline symptoms were similar between groups: In each, 50% had throat clearing, 20% had hoarseness, 13% had cough, 9% had globus, and 8% had sore throat.

By the end of the study, 42% of patients in the esomeprazole group reported improvement of suspected reflux laryngitis symptoms, compared with 46% of patients in the placebo group, while reported resolution of symptoms occurred in 14·7% of patients in the esomeprazole group and 16% of patients in the placebo group.

Improvement in the reflux laryngitis index over time was also similar between groups, said Dr. Vaezi of the department of gastroenterology and hepatology at the Cleveland Clinic Foundation.

AstraZeneca, which manufactures Nexium, sponsored the trial.

SEATTLE — Elderly patients with community-acquired pneumonia who took moxifloxacin were more likely to have symptom relief by day 3-5 of therapy than were those who took levofloxacin, results from a prospective trial have found.

Investigators observed trends that favored moxifloxacin (Avelox) over levofloxacin (Levaquin) in severely ill patients and those aged 75 years and older, but all other efficacy and safety comparisons between the two agents were similar, Michael Niederman, M.D., said at the annual meeting of the American College of Chest Physicians.

“The safety and efficacy of both of these drugs was demonstrated and shown to be equivalent,” he said in a later interview.

Dr. Niederman and his associates studied 281 patients aged 65 years and older who were hospitalized with community-acquired pneumonia and required initial IV therapy. Most had multiple comorbidities, especially cardiac disease (74%), chronic obstructive pulmonary disease (63%), and diabetes (29%). Also, 18% had severe pneumonia as defined by American Thoracic Society criteria. Slightly more than half (51%) were male, and their mean age was 78 years, said Dr. Niederman of Winthrop University Hospital, Mineola, N.Y.

At baseline, all patients had a 12-lead electrocardiogram and a repeat ECG at 72 hours. In the interim, they had a 72-hour period of Holter monitoring.

Of the total group, 141 patients were randomized to moxifloxacin 400 mg/day, and 140 received levofloxacin 500 mg/day. Nearly all patients (98%) in the moxifloxacin group had symptom relief by day 3-5 of therapy, compared with 90% of patients in the levofloxacin group.

Overall cure rates were similar between the moxifloxacin group and the levofloxacin group (93% vs. 88%). The cure rates among patients with mild to moderate pneumonia at baseline were also similar (93% vs. 89%).

The cure rates among patients with severe pneumonia were 95% in the moxifloxacin group, compared with 85% in the levofloxacin group—a difference that trended toward statistical significance. Cure rates among patients aged 75 years and older were higher in the moxifloxacin group, compared with those in the levofloxacin group (95% vs. 90%), but the difference was not statistically significant.

Cardiac events considered by the investigators as potentially drug-related were reported in 1% of patients in the moxifloxacin group, compared with 4% of patients in the levofloxacin group. The differences were not statistically significant.

The study was sponsored by Bayer Pharmaceuticals Corp., which manufactures moxifloxacin.

SEATTLE — Elderly patients with community-acquired pneumonia who took moxifloxacin were more likely to have symptom relief by day 3-5 of therapy than were those who took levofloxacin, results from a prospective trial have found.

Investigators observed trends that favored moxifloxacin (Avelox) over levofloxacin (Levaquin) in severely ill patients and those aged 75 years and older, but all other efficacy and safety comparisons between the two agents were similar, Michael Niederman, M.D., said at the annual meeting of the American College of Chest Physicians.

“The safety and efficacy of both of these drugs was demonstrated and shown to be equivalent,” he said in a later interview.

Dr. Niederman and his associates studied 281 patients aged 65 years and older who were hospitalized with community-acquired pneumonia and required initial IV therapy. Most had multiple comorbidities, especially cardiac disease (74%), chronic obstructive pulmonary disease (63%), and diabetes (29%). Also, 18% had severe pneumonia as defined by American Thoracic Society criteria. Slightly more than half (51%) were male, and their mean age was 78 years, said Dr. Niederman of Winthrop University Hospital, Mineola, N.Y.

At baseline, all patients had a 12-lead electrocardiogram and a repeat ECG at 72 hours. In the interim, they had a 72-hour period of Holter monitoring.

Of the total group, 141 patients were randomized to moxifloxacin 400 mg/day, and 140 received levofloxacin 500 mg/day. Nearly all patients (98%) in the moxifloxacin group had symptom relief by day 3-5 of therapy, compared with 90% of patients in the levofloxacin group.

Overall cure rates were similar between the moxifloxacin group and the levofloxacin group (93% vs. 88%). The cure rates among patients with mild to moderate pneumonia at baseline were also similar (93% vs. 89%).

The cure rates among patients with severe pneumonia were 95% in the moxifloxacin group, compared with 85% in the levofloxacin group—a difference that trended toward statistical significance. Cure rates among patients aged 75 years and older were higher in the moxifloxacin group, compared with those in the levofloxacin group (95% vs. 90%), but the difference was not statistically significant.

Cardiac events considered by the investigators as potentially drug-related were reported in 1% of patients in the moxifloxacin group, compared with 4% of patients in the levofloxacin group. The differences were not statistically significant.

The study was sponsored by Bayer Pharmaceuticals Corp., which manufactures moxifloxacin.

SEATTLE — Elderly patients with community-acquired pneumonia who took moxifloxacin were more likely to have symptom relief by day 3-5 of therapy than were those who took levofloxacin, results from a prospective trial have found.

Investigators observed trends that favored moxifloxacin (Avelox) over levofloxacin (Levaquin) in severely ill patients and those aged 75 years and older, but all other efficacy and safety comparisons between the two agents were similar, Michael Niederman, M.D., said at the annual meeting of the American College of Chest Physicians.

“The safety and efficacy of both of these drugs was demonstrated and shown to be equivalent,” he said in a later interview.

Dr. Niederman and his associates studied 281 patients aged 65 years and older who were hospitalized with community-acquired pneumonia and required initial IV therapy. Most had multiple comorbidities, especially cardiac disease (74%), chronic obstructive pulmonary disease (63%), and diabetes (29%). Also, 18% had severe pneumonia as defined by American Thoracic Society criteria. Slightly more than half (51%) were male, and their mean age was 78 years, said Dr. Niederman of Winthrop University Hospital, Mineola, N.Y.

At baseline, all patients had a 12-lead electrocardiogram and a repeat ECG at 72 hours. In the interim, they had a 72-hour period of Holter monitoring.

Of the total group, 141 patients were randomized to moxifloxacin 400 mg/day, and 140 received levofloxacin 500 mg/day. Nearly all patients (98%) in the moxifloxacin group had symptom relief by day 3-5 of therapy, compared with 90% of patients in the levofloxacin group.

Overall cure rates were similar between the moxifloxacin group and the levofloxacin group (93% vs. 88%). The cure rates among patients with mild to moderate pneumonia at baseline were also similar (93% vs. 89%).

The cure rates among patients with severe pneumonia were 95% in the moxifloxacin group, compared with 85% in the levofloxacin group—a difference that trended toward statistical significance. Cure rates among patients aged 75 years and older were higher in the moxifloxacin group, compared with those in the levofloxacin group (95% vs. 90%), but the difference was not statistically significant.

Cardiac events considered by the investigators as potentially drug-related were reported in 1% of patients in the moxifloxacin group, compared with 4% of patients in the levofloxacin group. The differences were not statistically significant.

The study was sponsored by Bayer Pharmaceuticals Corp., which manufactures moxifloxacin.

Michael Myers, M.D., often hears physicians say they'd like to expand their circle of friends beyond their colleagues in medicine, but they're not sure how to go about it.

“I hear so many first-person accounts from physicians who say it's really neat to be going out with some people who have nothing to do with medicine at all,” said Dr. Myers, a psychiatrist based in Vancouver, B.C., who specializes in physician health. “Then they make statements like, 'I realize there's a whole other world out there' or 'I think my work sometimes gets me too focused on disease and illness, or death or dying, and I forget sometimes that there are other people who are doing fascinating things.'”

In fact, sometimes his psychiatry colleagues make statements such as, “When I'm with my nonmedical, no-psychiatry friends, I realize not everybody's depressed,” Dr. Myers commented. “They find it refreshing.”

For physicians, the pinch for time to sustain or cultivate friendships starts with the demands of medical school and continues with residency training, possible fellowship training, and launching a career. But some manage to carve out time for their nonmedical friends.

“It depends on how demanding the residency is and whether or not the person has gone to another medical center to do the residency,” Dr. Myers said. “Beyond that, I think it depends where people practice and how demanding their work is as to whether or not they're likely to keep up with nonmedical friends or make new nonmedical friends.”

Why care? Because interacting with people who are not doctors helps you realize that life exists outside of medicine, said Bruce Flamm, M.D., area research chairman and a practicing ob.gyn. at the Kaiser Permanente Medical Center in Riverside, Calif.

“That's not to discount those doctors who live for their career; it means everything to them,” Dr. Flamm said. “They'd live in the hospital if they could. That's fine, too. But for every one of those, there are probably 100 doctors who wish they could have more time to do other things.”

If you struggle to expand your circle of friends beyond your medical colleagues, experts interviewed for this column offered the following advice:

▸ Get involved in your community. Seek opportunities with your community center, church, synagogue, Rotary Club, or the school your children attend. James Gill, M.D., serves on his church's parish council in Wilmington, Del. In this role, he helps set church policy and also lobbies for fairness to immigrants and people who struggle to make ends meet.

He said that such involvement “gives you broader perspective on the world, which almost has to translate into your profession,” said Dr. Gill, director of health services research in the department of family and community medicine at Wilmington-based Christiana Care Health “You tend to see people at different places in their lives with different levels of education and social strata, and [different] occupations. That provides you with a richer perspective when you interact with patients.”

Becoming involved in the Wilmington community was easy for Dr. Gill because he practices in the same general area where he was raised and where he did his family medicine residency. “The people I spend most of my time with are my extended family and friends from high school,” he said. “But I got involved in other things. You're probably not going to make a lot of good friends just by sitting at the bar or passing somebody on the street. You meet people by getting involved.”

He added that people generally consider physicians as community leaders, educated people who have a broad perspective on the world. “In order to do that, you have to expand your horizons and circle of friends,” he said.

▸ Seek a support network. When Nicolette Horbach, M.D., was in her 30s, she joined a small network of women in her area who became mothers around the same time. That was 13 years ago, but today she and the dozen or so members of the group, including an FBI agent, accountants, and stay-at-home moms, still meet once a month over dinner for friendship and support. “We've had people go through the death of a husband, divorce, and difficulties with children,” said Dr. Horbach, a urogynecologist at Northern Virginia Pelvic Surgery Associates, Annandale. “It's a grounding force outside of medicine, and these people become like your extended family.”

She also expanded her circle of friends by volunteering for social activities at her son's school. She recalls arranging her schedule one day between surgeries so she could be the room mother at her son's class Valentine's Day party.

“You may not be able to be PTA president or chair the fundraising committee that's going to meet every week, but you can do specific functions, whether it's the book fair for a weekend or the school parties– something like that where you are being just like one of the other parents,” she said. “You're physically there, your kid sees you as involved in the situation, and you have the chance to meet the other families that your kids interact with.”

Another thing she did to expand her friendships was to learn tennis, a sport that her husband plays and that her 13-year-old son plays competitively. Two years ago she took lessons and eventually joined a league. “A number of my current friends now are from that group of women,” she said.

▸ Find a hobby. If you engage yourself in a hobby such as record collecting or league participation in your favorite sport, “you end up meeting a lot of people from all different walks of life and all different fields, yet you share that common interest,” Dr. Flamm said.

Two years ago he joined a local astronomy club. He had dabbled in astronomy in high school, “but not seriously,” he said.

The club holds monthly meetings in a local auditorium and monthly star viewing parties in the desert. “Not viewing for Hollywood stars,” he quips. He makes every effort to attend the events.

Becoming a collector is another way to meet people, added Dr. Flamm, who is a longtime collector of calculators. “Most of the people who are into that are engineers who have no interest in medicine at all, but you can meet various people,” he said. “When I was actively collecting calculators a few years ago, my wife and I would go to a flea market almost every weekend.”

Another enriching experience for Dr. Flamm has been acquiring a springer spaniel puppy named Zoe. He and his wife brought her home after their two 14-year-old dogs passed away last year, and they recently adopted a 3-month-old puppy named Hunter. They occasionally take Zoe and Hunter to dog-friendly parks in their area, “where you meet the nicest people who are always interested in dogs,” Dr. Flamm said.

Dr. Horbach noted the danger of living only for medicine is that you become “very one-dimensional. There is difficulty keeping up physician morale because of all the things we're battling in terms of finances, paperwork, and insurance. If you have a chance to branch out and talk with other people, you understand that many industries are going through some of the same challenges that we face in medicine. They may have different aspects, but I think you get a better perspective on the demands that are made in the professional world across the board. Everyone now is expected to do more with less and still fight issues relative to compensation. Keeping that perspective is important, so you don't foster increasing frustration, resentment, or dissatisfaction,” she said.

Bruce Flamm, M.D., and his wife enjoy taking Zoe (left) and Hunter (right) to parks, where they meet fellow dog people.

A Profile in Friendship

In the mid-1990s, Dr. Toni Harris realized that pressures from her academic medicine post as chief of benign gynecology at the University of California, Davis, Medical Center were taking a personal toll.

“It was going to work at the crack of dawn and coming home after a normal person would eat dinner,” she recalled. “I didn't know the news and I didn't take care of myself physically, and I didn't sustain my interpersonal relationships outside of my immediate circle of friends and family.”

She resigned from the post in 1996 and went into private practice, but learned that the demands in that setting were greater than she expected. That segment of her career ended in 2002.

“I got into my 50s and I said, 'Life is now. One has no idea how long one's life will be,'” said Dr. Harris, who is back at the UC medical center part-time and is a partner in a medical device start-up company. “There are things I wanted in my life that weren't there.”

One of the goals she set for herself was to pursue friendships. One of her most cherished, she said, is with a teenager, Chris Benderev, who is the son of a urologist she worked with in private practice.

“He was 10 when we became friends, and we have actively cultivated that relationship,” said Dr. Harris, who does not have her own children. “I'm more than a surrogate aunt, more like a truly good friend to a young person, and a mentor. He goes on vacations with my husband and me, he comes to see us without the rest of his family, and we get to participate in the decision-making process as he's gotten older about what he wants to do in life.”

Three years ago when her husband was on duty in Kosovo with the Army Reserve, she and Chris would go to the movies nearly every Friday night. “To have a 14-year-old boy want to go out to the movies with a 55-year-old nonrelative who he considers his friend has been one of the real honors of my life,” she said. “This is not some nerdy kid hanging out with some old woman. This is a real cool kid who's a class officer, has a big crowd of friends, and goes to rock concerts. Of course when he wants to go to a rock concert, he calls me to see if I can go.”

Michael Myers, M.D., often hears physicians say they'd like to expand their circle of friends beyond their colleagues in medicine, but they're not sure how to go about it.

“I hear so many first-person accounts from physicians who say it's really neat to be going out with some people who have nothing to do with medicine at all,” said Dr. Myers, a psychiatrist based in Vancouver, B.C., who specializes in physician health. “Then they make statements like, 'I realize there's a whole other world out there' or 'I think my work sometimes gets me too focused on disease and illness, or death or dying, and I forget sometimes that there are other people who are doing fascinating things.'”

In fact, sometimes his psychiatry colleagues make statements such as, “When I'm with my nonmedical, no-psychiatry friends, I realize not everybody's depressed,” Dr. Myers commented. “They find it refreshing.”

For physicians, the pinch for time to sustain or cultivate friendships starts with the demands of medical school and continues with residency training, possible fellowship training, and launching a career. But some manage to carve out time for their nonmedical friends.

“It depends on how demanding the residency is and whether or not the person has gone to another medical center to do the residency,” Dr. Myers said. “Beyond that, I think it depends where people practice and how demanding their work is as to whether or not they're likely to keep up with nonmedical friends or make new nonmedical friends.”

Why care? Because interacting with people who are not doctors helps you realize that life exists outside of medicine, said Bruce Flamm, M.D., area research chairman and a practicing ob.gyn. at the Kaiser Permanente Medical Center in Riverside, Calif.

“That's not to discount those doctors who live for their career; it means everything to them,” Dr. Flamm said. “They'd live in the hospital if they could. That's fine, too. But for every one of those, there are probably 100 doctors who wish they could have more time to do other things.”

If you struggle to expand your circle of friends beyond your medical colleagues, experts interviewed for this column offered the following advice:

▸ Get involved in your community. Seek opportunities with your community center, church, synagogue, Rotary Club, or the school your children attend. James Gill, M.D., serves on his church's parish council in Wilmington, Del. In this role, he helps set church policy and also lobbies for fairness to immigrants and people who struggle to make ends meet.

He said that such involvement “gives you broader perspective on the world, which almost has to translate into your profession,” said Dr. Gill, director of health services research in the department of family and community medicine at Wilmington-based Christiana Care Health “You tend to see people at different places in their lives with different levels of education and social strata, and [different] occupations. That provides you with a richer perspective when you interact with patients.”

Becoming involved in the Wilmington community was easy for Dr. Gill because he practices in the same general area where he was raised and where he did his family medicine residency. “The people I spend most of my time with are my extended family and friends from high school,” he said. “But I got involved in other things. You're probably not going to make a lot of good friends just by sitting at the bar or passing somebody on the street. You meet people by getting involved.”

He added that people generally consider physicians as community leaders, educated people who have a broad perspective on the world. “In order to do that, you have to expand your horizons and circle of friends,” he said.

▸ Seek a support network. When Nicolette Horbach, M.D., was in her 30s, she joined a small network of women in her area who became mothers around the same time. That was 13 years ago, but today she and the dozen or so members of the group, including an FBI agent, accountants, and stay-at-home moms, still meet once a month over dinner for friendship and support. “We've had people go through the death of a husband, divorce, and difficulties with children,” said Dr. Horbach, a urogynecologist at Northern Virginia Pelvic Surgery Associates, Annandale. “It's a grounding force outside of medicine, and these people become like your extended family.”

She also expanded her circle of friends by volunteering for social activities at her son's school. She recalls arranging her schedule one day between surgeries so she could be the room mother at her son's class Valentine's Day party.

“You may not be able to be PTA president or chair the fundraising committee that's going to meet every week, but you can do specific functions, whether it's the book fair for a weekend or the school parties– something like that where you are being just like one of the other parents,” she said. “You're physically there, your kid sees you as involved in the situation, and you have the chance to meet the other families that your kids interact with.”

Another thing she did to expand her friendships was to learn tennis, a sport that her husband plays and that her 13-year-old son plays competitively. Two years ago she took lessons and eventually joined a league. “A number of my current friends now are from that group of women,” she said.

▸ Find a hobby. If you engage yourself in a hobby such as record collecting or league participation in your favorite sport, “you end up meeting a lot of people from all different walks of life and all different fields, yet you share that common interest,” Dr. Flamm said.

Two years ago he joined a local astronomy club. He had dabbled in astronomy in high school, “but not seriously,” he said.

The club holds monthly meetings in a local auditorium and monthly star viewing parties in the desert. “Not viewing for Hollywood stars,” he quips. He makes every effort to attend the events.

Becoming a collector is another way to meet people, added Dr. Flamm, who is a longtime collector of calculators. “Most of the people who are into that are engineers who have no interest in medicine at all, but you can meet various people,” he said. “When I was actively collecting calculators a few years ago, my wife and I would go to a flea market almost every weekend.”

Another enriching experience for Dr. Flamm has been acquiring a springer spaniel puppy named Zoe. He and his wife brought her home after their two 14-year-old dogs passed away last year, and they recently adopted a 3-month-old puppy named Hunter. They occasionally take Zoe and Hunter to dog-friendly parks in their area, “where you meet the nicest people who are always interested in dogs,” Dr. Flamm said.

Dr. Horbach noted the danger of living only for medicine is that you become “very one-dimensional. There is difficulty keeping up physician morale because of all the things we're battling in terms of finances, paperwork, and insurance. If you have a chance to branch out and talk with other people, you understand that many industries are going through some of the same challenges that we face in medicine. They may have different aspects, but I think you get a better perspective on the demands that are made in the professional world across the board. Everyone now is expected to do more with less and still fight issues relative to compensation. Keeping that perspective is important, so you don't foster increasing frustration, resentment, or dissatisfaction,” she said.

Bruce Flamm, M.D., and his wife enjoy taking Zoe (left) and Hunter (right) to parks, where they meet fellow dog people.

A Profile in Friendship

In the mid-1990s, Dr. Toni Harris realized that pressures from her academic medicine post as chief of benign gynecology at the University of California, Davis, Medical Center were taking a personal toll.

“It was going to work at the crack of dawn and coming home after a normal person would eat dinner,” she recalled. “I didn't know the news and I didn't take care of myself physically, and I didn't sustain my interpersonal relationships outside of my immediate circle of friends and family.”

She resigned from the post in 1996 and went into private practice, but learned that the demands in that setting were greater than she expected. That segment of her career ended in 2002.

“I got into my 50s and I said, 'Life is now. One has no idea how long one's life will be,'” said Dr. Harris, who is back at the UC medical center part-time and is a partner in a medical device start-up company. “There are things I wanted in my life that weren't there.”

One of the goals she set for herself was to pursue friendships. One of her most cherished, she said, is with a teenager, Chris Benderev, who is the son of a urologist she worked with in private practice.

“He was 10 when we became friends, and we have actively cultivated that relationship,” said Dr. Harris, who does not have her own children. “I'm more than a surrogate aunt, more like a truly good friend to a young person, and a mentor. He goes on vacations with my husband and me, he comes to see us without the rest of his family, and we get to participate in the decision-making process as he's gotten older about what he wants to do in life.”

Three years ago when her husband was on duty in Kosovo with the Army Reserve, she and Chris would go to the movies nearly every Friday night. “To have a 14-year-old boy want to go out to the movies with a 55-year-old nonrelative who he considers his friend has been one of the real honors of my life,” she said. “This is not some nerdy kid hanging out with some old woman. This is a real cool kid who's a class officer, has a big crowd of friends, and goes to rock concerts. Of course when he wants to go to a rock concert, he calls me to see if I can go.”

Michael Myers, M.D., often hears physicians say they'd like to expand their circle of friends beyond their colleagues in medicine, but they're not sure how to go about it.

“I hear so many first-person accounts from physicians who say it's really neat to be going out with some people who have nothing to do with medicine at all,” said Dr. Myers, a psychiatrist based in Vancouver, B.C., who specializes in physician health. “Then they make statements like, 'I realize there's a whole other world out there' or 'I think my work sometimes gets me too focused on disease and illness, or death or dying, and I forget sometimes that there are other people who are doing fascinating things.'”

In fact, sometimes his psychiatry colleagues make statements such as, “When I'm with my nonmedical, no-psychiatry friends, I realize not everybody's depressed,” Dr. Myers commented. “They find it refreshing.”

For physicians, the pinch for time to sustain or cultivate friendships starts with the demands of medical school and continues with residency training, possible fellowship training, and launching a career. But some manage to carve out time for their nonmedical friends.

“It depends on how demanding the residency is and whether or not the person has gone to another medical center to do the residency,” Dr. Myers said. “Beyond that, I think it depends where people practice and how demanding their work is as to whether or not they're likely to keep up with nonmedical friends or make new nonmedical friends.”

Why care? Because interacting with people who are not doctors helps you realize that life exists outside of medicine, said Bruce Flamm, M.D., area research chairman and a practicing ob.gyn. at the Kaiser Permanente Medical Center in Riverside, Calif.

“That's not to discount those doctors who live for their career; it means everything to them,” Dr. Flamm said. “They'd live in the hospital if they could. That's fine, too. But for every one of those, there are probably 100 doctors who wish they could have more time to do other things.”

If you struggle to expand your circle of friends beyond your medical colleagues, experts interviewed for this column offered the following advice:

▸ Get involved in your community. Seek opportunities with your community center, church, synagogue, Rotary Club, or the school your children attend. James Gill, M.D., serves on his church's parish council in Wilmington, Del. In this role, he helps set church policy and also lobbies for fairness to immigrants and people who struggle to make ends meet.

He said that such involvement “gives you broader perspective on the world, which almost has to translate into your profession,” said Dr. Gill, director of health services research in the department of family and community medicine at Wilmington-based Christiana Care Health “You tend to see people at different places in their lives with different levels of education and social strata, and [different] occupations. That provides you with a richer perspective when you interact with patients.”

Becoming involved in the Wilmington community was easy for Dr. Gill because he practices in the same general area where he was raised and where he did his family medicine residency. “The people I spend most of my time with are my extended family and friends from high school,” he said. “But I got involved in other things. You're probably not going to make a lot of good friends just by sitting at the bar or passing somebody on the street. You meet people by getting involved.”

He added that people generally consider physicians as community leaders, educated people who have a broad perspective on the world. “In order to do that, you have to expand your horizons and circle of friends,” he said.

▸ Seek a support network. When Nicolette Horbach, M.D., was in her 30s, she joined a small network of women in her area who became mothers around the same time. That was 13 years ago, but today she and the dozen or so members of the group, including an FBI agent, accountants, and stay-at-home moms, still meet once a month over dinner for friendship and support. “We've had people go through the death of a husband, divorce, and difficulties with children,” said Dr. Horbach, a urogynecologist at Northern Virginia Pelvic Surgery Associates, Annandale. “It's a grounding force outside of medicine, and these people become like your extended family.”

She also expanded her circle of friends by volunteering for social activities at her son's school. She recalls arranging her schedule one day between surgeries so she could be the room mother at her son's class Valentine's Day party.

“You may not be able to be PTA president or chair the fundraising committee that's going to meet every week, but you can do specific functions, whether it's the book fair for a weekend or the school parties– something like that where you are being just like one of the other parents,” she said. “You're physically there, your kid sees you as involved in the situation, and you have the chance to meet the other families that your kids interact with.”

Another thing she did to expand her friendships was to learn tennis, a sport that her husband plays and that her 13-year-old son plays competitively. Two years ago she took lessons and eventually joined a league. “A number of my current friends now are from that group of women,” she said.

▸ Find a hobby. If you engage yourself in a hobby such as record collecting or league participation in your favorite sport, “you end up meeting a lot of people from all different walks of life and all different fields, yet you share that common interest,” Dr. Flamm said.

Two years ago he joined a local astronomy club. He had dabbled in astronomy in high school, “but not seriously,” he said.

The club holds monthly meetings in a local auditorium and monthly star viewing parties in the desert. “Not viewing for Hollywood stars,” he quips. He makes every effort to attend the events.

Becoming a collector is another way to meet people, added Dr. Flamm, who is a longtime collector of calculators. “Most of the people who are into that are engineers who have no interest in medicine at all, but you can meet various people,” he said. “When I was actively collecting calculators a few years ago, my wife and I would go to a flea market almost every weekend.”

Another enriching experience for Dr. Flamm has been acquiring a springer spaniel puppy named Zoe. He and his wife brought her home after their two 14-year-old dogs passed away last year, and they recently adopted a 3-month-old puppy named Hunter. They occasionally take Zoe and Hunter to dog-friendly parks in their area, “where you meet the nicest people who are always interested in dogs,” Dr. Flamm said.

Dr. Horbach noted the danger of living only for medicine is that you become “very one-dimensional. There is difficulty keeping up physician morale because of all the things we're battling in terms of finances, paperwork, and insurance. If you have a chance to branch out and talk with other people, you understand that many industries are going through some of the same challenges that we face in medicine. They may have different aspects, but I think you get a better perspective on the demands that are made in the professional world across the board. Everyone now is expected to do more with less and still fight issues relative to compensation. Keeping that perspective is important, so you don't foster increasing frustration, resentment, or dissatisfaction,” she said.

Bruce Flamm, M.D., and his wife enjoy taking Zoe (left) and Hunter (right) to parks, where they meet fellow dog people.

A Profile in Friendship

In the mid-1990s, Dr. Toni Harris realized that pressures from her academic medicine post as chief of benign gynecology at the University of California, Davis, Medical Center were taking a personal toll.

“It was going to work at the crack of dawn and coming home after a normal person would eat dinner,” she recalled. “I didn't know the news and I didn't take care of myself physically, and I didn't sustain my interpersonal relationships outside of my immediate circle of friends and family.”

She resigned from the post in 1996 and went into private practice, but learned that the demands in that setting were greater than she expected. That segment of her career ended in 2002.

“I got into my 50s and I said, 'Life is now. One has no idea how long one's life will be,'” said Dr. Harris, who is back at the UC medical center part-time and is a partner in a medical device start-up company. “There are things I wanted in my life that weren't there.”

One of the goals she set for herself was to pursue friendships. One of her most cherished, she said, is with a teenager, Chris Benderev, who is the son of a urologist she worked with in private practice.

“He was 10 when we became friends, and we have actively cultivated that relationship,” said Dr. Harris, who does not have her own children. “I'm more than a surrogate aunt, more like a truly good friend to a young person, and a mentor. He goes on vacations with my husband and me, he comes to see us without the rest of his family, and we get to participate in the decision-making process as he's gotten older about what he wants to do in life.”

Three years ago when her husband was on duty in Kosovo with the Army Reserve, she and Chris would go to the movies nearly every Friday night. “To have a 14-year-old boy want to go out to the movies with a 55-year-old nonrelative who he considers his friend has been one of the real honors of my life,” she said. “This is not some nerdy kid hanging out with some old woman. This is a real cool kid who's a class officer, has a big crowd of friends, and goes to rock concerts. Of course when he wants to go to a rock concert, he calls me to see if I can go.”

SEATTLE — Few internal medicine residents show interest in pursuing a career in pulmonary and critical care medicine, Scott Lorin, M.D., reported at a press briefing during the annual meeting of the American College of Chest Physicians.

In fact, there are only two subspecialties—endocrinology and rheumatology—that are chosen less often by internal medicine residents, according to a survey conducted by Dr. Lorin of the department of medicine, Mount Sinai School of Medicine, New York, and his associates.

In 2002, they surveyed 178 internal medicine and combined internal medicine/pediatric residents about their attitudes and perceptions regarding pulmonary and critical care medicine training. The residents, whose average age was 29 years, were from Mount Sinai; the Medical University of South Carolina, Charleston; and the University of North Carolina at Chapel Hill.

Although 41% reported that they “seriously considered” a fellowship in pulmonary and critical care medicine at some point during their residency, only 3.4% actually chose to pursue a fellowship in the field.

The five most common factors that would attract the residents to a fellowship in the field were intellectual stimulation (69%), opportunities to manage critically ill patients (51%), application of complex physiologic principles (45%), number of procedures performed (31%), and academically challenging rounds (29%).

The five most common factors that would dissuade them from entering the field were a perceived lack of leisure time (54%), stress among faculty/fellows (45%), management responsibilities for chronically ill patients (30%), poor match of career with resident personality (24%), and treatment of pulmonary diseases (16%).

“If they had a positive perception of faculty and fellows, they wanted to go into pulmonary and critical care medicine,” Dr. Lorin said.

The survey also showed that few respondents had an interest in bench research. “The majority wanted to go into clinical practice,” he said.

SEATTLE — Few internal medicine residents show interest in pursuing a career in pulmonary and critical care medicine, Scott Lorin, M.D., reported at a press briefing during the annual meeting of the American College of Chest Physicians.

In fact, there are only two subspecialties—endocrinology and rheumatology—that are chosen less often by internal medicine residents, according to a survey conducted by Dr. Lorin of the department of medicine, Mount Sinai School of Medicine, New York, and his associates.

In 2002, they surveyed 178 internal medicine and combined internal medicine/pediatric residents about their attitudes and perceptions regarding pulmonary and critical care medicine training. The residents, whose average age was 29 years, were from Mount Sinai; the Medical University of South Carolina, Charleston; and the University of North Carolina at Chapel Hill.

Although 41% reported that they “seriously considered” a fellowship in pulmonary and critical care medicine at some point during their residency, only 3.4% actually chose to pursue a fellowship in the field.

The five most common factors that would attract the residents to a fellowship in the field were intellectual stimulation (69%), opportunities to manage critically ill patients (51%), application of complex physiologic principles (45%), number of procedures performed (31%), and academically challenging rounds (29%).

The five most common factors that would dissuade them from entering the field were a perceived lack of leisure time (54%), stress among faculty/fellows (45%), management responsibilities for chronically ill patients (30%), poor match of career with resident personality (24%), and treatment of pulmonary diseases (16%).

“If they had a positive perception of faculty and fellows, they wanted to go into pulmonary and critical care medicine,” Dr. Lorin said.

The survey also showed that few respondents had an interest in bench research. “The majority wanted to go into clinical practice,” he said.

SEATTLE — Few internal medicine residents show interest in pursuing a career in pulmonary and critical care medicine, Scott Lorin, M.D., reported at a press briefing during the annual meeting of the American College of Chest Physicians.

In fact, there are only two subspecialties—endocrinology and rheumatology—that are chosen less often by internal medicine residents, according to a survey conducted by Dr. Lorin of the department of medicine, Mount Sinai School of Medicine, New York, and his associates.

In 2002, they surveyed 178 internal medicine and combined internal medicine/pediatric residents about their attitudes and perceptions regarding pulmonary and critical care medicine training. The residents, whose average age was 29 years, were from Mount Sinai; the Medical University of South Carolina, Charleston; and the University of North Carolina at Chapel Hill.

Although 41% reported that they “seriously considered” a fellowship in pulmonary and critical care medicine at some point during their residency, only 3.4% actually chose to pursue a fellowship in the field.

The five most common factors that would attract the residents to a fellowship in the field were intellectual stimulation (69%), opportunities to manage critically ill patients (51%), application of complex physiologic principles (45%), number of procedures performed (31%), and academically challenging rounds (29%).

The five most common factors that would dissuade them from entering the field were a perceived lack of leisure time (54%), stress among faculty/fellows (45%), management responsibilities for chronically ill patients (30%), poor match of career with resident personality (24%), and treatment of pulmonary diseases (16%).

“If they had a positive perception of faculty and fellows, they wanted to go into pulmonary and critical care medicine,” Dr. Lorin said.

The survey also showed that few respondents had an interest in bench research. “The majority wanted to go into clinical practice,” he said.

LAS VEGAS — When it comes to charting the success of various cosmetic procedures, dermatologists rely too much on standard clinical photos, ill-defined measurement scales, and other subjective measures, Albert M. Kligman, M.D., declared at the 13th International Symposium on Cosmetic Laser Surgery.

Such measurements "often involve vague ratio scales of 1, 2, 3, 4, or scales of various ratios that show much pigment has change or that erythema has gone down by 2 points," said Dr. Kligman, emeritus professor of dermatology at the University of Pennsylvania, Philadelphia.

"All of this is highly suggestive and highly unreliable, and the results are inconsistent. We need more quantitative estimates of what we have done. The real changes are under the surface" of the skin.

He also called for a consistent "physical definition" of skin texture. "Every woman knows what texture is when they're looking at a piece of silk or cloth, but so far, we have no real assessments of what texture is in physical terms," he reported.

Dr. Kligman listed the following technologies as more appropriate ways to measure clinical changes in the skin: UVA photography, ultrasound, polarized light, cross-polarized microscopy, blue light fluorescence, porphyrin fluorescence, glyphic lines by cyanoacrylate video imaging, fringe projection, Luna stain, Cutometer, using Sebutape to measure sebum production, optical coherence tomography, and laser Doppler imaging.

LAS VEGAS — When it comes to charting the success of various cosmetic procedures, dermatologists rely too much on standard clinical photos, ill-defined measurement scales, and other subjective measures, Albert M. Kligman, M.D., declared at the 13th International Symposium on Cosmetic Laser Surgery.

Such measurements "often involve vague ratio scales of 1, 2, 3, 4, or scales of various ratios that show much pigment has change or that erythema has gone down by 2 points," said Dr. Kligman, emeritus professor of dermatology at the University of Pennsylvania, Philadelphia.

"All of this is highly suggestive and highly unreliable, and the results are inconsistent. We need more quantitative estimates of what we have done. The real changes are under the surface" of the skin.

He also called for a consistent "physical definition" of skin texture. "Every woman knows what texture is when they're looking at a piece of silk or cloth, but so far, we have no real assessments of what texture is in physical terms," he reported.

Dr. Kligman listed the following technologies as more appropriate ways to measure clinical changes in the skin: UVA photography, ultrasound, polarized light, cross-polarized microscopy, blue light fluorescence, porphyrin fluorescence, glyphic lines by cyanoacrylate video imaging, fringe projection, Luna stain, Cutometer, using Sebutape to measure sebum production, optical coherence tomography, and laser Doppler imaging.

LAS VEGAS — When it comes to charting the success of various cosmetic procedures, dermatologists rely too much on standard clinical photos, ill-defined measurement scales, and other subjective measures, Albert M. Kligman, M.D., declared at the 13th International Symposium on Cosmetic Laser Surgery.

Such measurements "often involve vague ratio scales of 1, 2, 3, 4, or scales of various ratios that show much pigment has change or that erythema has gone down by 2 points," said Dr. Kligman, emeritus professor of dermatology at the University of Pennsylvania, Philadelphia.

"All of this is highly suggestive and highly unreliable, and the results are inconsistent. We need more quantitative estimates of what we have done. The real changes are under the surface" of the skin.

He also called for a consistent "physical definition" of skin texture. "Every woman knows what texture is when they're looking at a piece of silk or cloth, but so far, we have no real assessments of what texture is in physical terms," he reported.

Dr. Kligman listed the following technologies as more appropriate ways to measure clinical changes in the skin: UVA photography, ultrasound, polarized light, cross-polarized microscopy, blue light fluorescence, porphyrin fluorescence, glyphic lines by cyanoacrylate video imaging, fringe projection, Luna stain, Cutometer, using Sebutape to measure sebum production, optical coherence tomography, and laser Doppler imaging.