Saturday, May 30, 2009

How Anger Management Counseling can Help

By: Mike Justin Anger.

One of the most charged emotions a person can feel. To some, it happens, but it is not an emotion that takes them over. It is maybe a slight irritation. It is something they can get under control.

For other people, it can cause rage and an intense fury. When that occurs it will turn destructive and quickly get out of control. This causes problems in relationships, work, and in your general quality of life.

A person is at the mercy of this emotion and its unpredictableness if they let it get out of control.

With my experience in anger management counseling I would like to explore a couple of ways to control this emotion. The goal of is to reduce the emotional feelings the physical arousal that anger causes.

1.First thing to try to do is relax. One relaxation technique is to breathe deeply. You can uses calming images as well. Another tool to use is to repeat slow calming words.
Don't just use these techniques when you do get angry. Try to make it a practice everyday if you feel you have an anger issue.

2.Second you have to change the way you think. Simply put, the anger may cause you to talk loudly, swear, and cause you to express yourself colorfully. These just express your inner thoughts. What you are going to have to do is change the angry irrational thoughts into more reasonable rational ones.
Instead of allowing yourself to feel you have been wronged, try to tell yourself that this is not the end of the world.

3. Third, communication is something you have to try to do better. When a person gets in a heated discussion or gets angry, the communications often breaks down.Rather than having a thoughtful comment, their emotions control what they say.
Slow down and think about how best to communicate.

4.Finally, try to change the environment you are in. A lot of times when we are angry or frustrated, just stopping and going someplace else can change our moods completely.
This changing of the environment may be enought time to quiet and calm your emotions and then get your anger under control.
Although not the end all, these tips will help you get a control on anger. If you find it does not, you will want to go get some professional help.

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Exercise Improves Patellofemoral Pain

From Medscape Medical News
ACSM 2009:
Jordana Bieze Foster

May 29, 2009 (Seattle, Washington) — A supervised exercise program for patellofemoral pain syndrome (PFPS) more effectively improves pain and function than usual care emphasizing rest and activity avoidance, according to a randomized clinical trial presented here at the annual meeting of the American College of Sports Medicine.

In 131 patients aged 14 to 40 years with chronic patellofemoral pain, Dutch researchers found that those who completed a 12-week exercise program reported significantly lower levels of pain and higher levels of function at 3 months and at 1 year compared with those who received "usual care" from their physicians.

The treatment intervention included exercises for quadriceps strengthening, flexibility, balance, and coordination, progressively increasing in complexity over time. Usual care, consistent with clinical guidelines for general practitioners in the Netherlands, included verbal and written information about patellofemoral pain and recommendations to avoid activities that provoke pain.

"Our outcome supports the use of supervised exercise therapy instead of a 'wait and see' approach," Robbart van Linschoten, MD, a sports medicine general practitioner at Erasmus University Medical Center in Rotterdam, the Netherlands, said during his presentation.

Monday, May 25, 2009

Avoid Alcohol in Pregnancy

Pattern of Alcohol Use Since 1991 Remains Unchanged Among Pregnant Women

From Reuters Health Information

May 21 - The use of alcohol and the prevalence of binge drinking among pregnant women and women of childbearing age changed little between 1991 and 2005, according to investigators at the US Centers for Disease Control and Prevention.

Fetal alcohol syndrome, birth defects, and low birth weight are among the poor outcomes associated with alcohol consumption during pregnancy, Dr. C. H Denny and co-authors note in the Morbidity and Mortality Weekly Report for May 22.

To examine trends in alcohol use among women of childbearing age, the researchers analyzed data from Behavioral Risk Factor Surveillance System surveys. Included were 533,506 women 18 to 44 years of age surveyed during 1991 to 2005; of these, 22,027 (4.1%) were pregnant at the time of the interview.

"The prevalence of any alcohol use and binge drinking...did not change substantially over time," the authors report. Any alcohol use was defined as having at least one drink in the past 30 days, and binge drinking as having 5 or more drinks on at least one occasion in the past 30 days.

Among pregnant women, the average annual percentage of any alcohol use was 12.2% (range: 10.2%-16.2%), while the average annual percentage for binge drinking was 1.9% (range: 0.7%-2.9%).

Corresponding values among nonpregnant women were 53.7% (range: 51.6%-56.3%) and 12.1% (range: 10.8%-13.7%).

Dr. Denny's team recommends: "Health-care providers should ask women of childbearing age about alcohol use routinely, inform them of the risks from alcohol while pregnant, and advise them not to drink alcohol while pregnant or if they might become pregnant."

The researchers identified risk factors for problem drinking among 13,820 pregnant women surveyed during 2001 to 2005. For any alcohol use, these included older age (age 34-44 vs 18-24, adjusted odds ratio = 2.3), having a college degree (AOR = 1.9), being employed (AOR = 1.5), and being unmarried (AOR = 2.2).

Employment and single status were also associated with binge drinking among pregnant women (AORs 1.8 and 4.4, respectively).

As to why these factors are associated with drinking in pregnancy, authors of an editorial note suggest that "1) older women might be more likely to be alcohol dependent and have more difficulty abstaining from alcohol while pregnant; 2) more educated women and employed women might have more discretionary money for the purchase of alcohol; and 3) unmarried women might attend more social occasions where alcohol is served."

Mor Mortal Wkly Rep CDC Surveill Summ 2009;58:529-532.

Friday, May 22, 2009

Relatively Low Levels of Smoking Can Lead to Severe COPD in Women

From Reuters Health Information

NEW YORK (Reuters Health) May 19 - Women seem to be more susceptible to the harmful effects of smoking than their male counterparts, according to findings from a case-control study of subjects with chronic obstructive pulmonary disease (COPD), presented Monday at the international conference of the American Thoracic Society in San Diego

The current study is not the first to suggest that smoking-related damage is worse in women than in men, lead researcher Dr. Inga-Cecilie Soerheim, from the University of Bergen, Norway, told Reuters Health. "The novel aspect of our study is that we specifically examined subgroups of COPD subjects with either early-onset of disease or low smoking exposure."

Dr. Soerheim said that her team hypothesized that "if women are more susceptible to smoking-related lung damage, they will likely experience reduced lung function at an earlier age or after less smoking exposure than men."

To look into that, the researchers studied 954 subjects with moderate or severe COPD and 955 controls. All of the subjects were either current or former smokers.

The researchers found that women had worse lung function and more severe disease than men in subgroups with early-onset COPD (<60 years of age) and low smoking exposure COPD (<20 cigarettes/day for <20 years). "In the low exposure group in this study, half of the women actually had severe COPD," Dr. Soerheim noted in a press release.

Dr. Soerheim commented that she and her colleagues were somewhat surprised by how many female smokers had severe COPD with relatively modest smoking histories.

These findings have an important public health message, Dr. Soerheim emphasized. "Many people believe that their own smoking is too limited to be harmful -- that a few cigarettes a day represent a minimal risk. But there is no such thing as a safe amount of cigarette smoking. Our data suggest that this is particularly true for female smokers."

In addition, she said that the results, "together with other studies demonstrating similar findings, should definitely urge all physicians to be aware of COPD development in female smokers."

Wednesday, May 20, 2009

Psychology of Being Scammed

By: Dantalion Jones

I'm just reading a fascinating report on the psychology of why people fall for scams, commissioned by the UK government's Office of Fair Trading and created by Exeter University's psychology department.

It's a 260 page monster, so is not exactly bed time reading, but was drawn from in-depth interviews from scam victims, examination of scam material, two questionnaire studies and a behavioural experiment.

Here's some of the punchlines grabbed from the executive summary. The report concluded that the most successful scams involve:

* Appeals to trust and authority: people tend to obey authorities so scammers use, and victims fall for, cues that make the offer look like a legitimate one being made by a reliable official institution or established reputable business.

* Visceral triggers: scams exploit basic human desires and needs -- such as greed, fear, avoidance of physical pain, or the desire to be liked -- in order to provoke intuitive reactions and reduce the motivation of people to process the content of the scam message deeply.

* Scarcity cues. Scams are often personalised to create the impression that the offer is unique to the recipient.

* Induction of behavioural commitment. Scammers ask their potential victims to make small steps of compliance to draw them in, and thereby cause victims to feel committed to continue sending money.

The disproportionate relation between the size of the alleged reward and the cost of trying to obtain it. Scam victims are led to focus on the alleged big prize or reward in comparison to the relatively small amount of money they have to send in order to obtain their windfall.

Lack of emotional control. Compared to non-victims, scam victims report being less able to regulate and resist emotions associated with scam offers. They seem to be unduly open to persuasion, or perhaps unduly undiscriminating about who they allow to persuade them.

And here's a couple of counter-intuitive kickers:

Scam victims often have better than average background knowledge in the area of the scam content. For example, it seems that people with experience of playing legitimate prize draws and lotteries are more likely to fall for a scam in this area than people with less knowledge and experience in this field. This also applies to those with some knowledge of investments. Such knowledge can increase rather than decrease the risk of becoming a victim.

Scam victims report that they put more cognitive effort into analysing scam content than non-victims. This contradicts the intuitive suggestion that people fall victim to scams because they invest too little cognitive energy in investigating their content, and thus overlook potential information that might betray the scam.

Interesting, people who fall for scams often have a feeling that it's dodgy. The report suggests we trust our get instincts. If it seems to good to be true, it probably is.

We like to think that only other people fall for scams, but as I'm working my way through the report it's becoming clear that those things that we think make us resistant to scams (a keen analytical mind) are not what help us avoid being a victim.

A really fascinating read and a great example of applied psychology.
Link to f r e e pdf download

Author Bio Dantalion Jones is the author of several books on mind control, hypnosis and persuasion.

Thursday, May 14, 2009

Doctors without Borders - calling for Malaysian Volunteers

Médecins Sans Frontières (MSF) is an international medical humanitarian organization that provides assistance to populations in danger. Each year,over 4,000 medical and non-medical professionals are recruited to work in over 60 countries around the world. MSF is currently looking for suitable field personnels from Malaysia. A Human Resources Drive will be organized in Kuala Lumpur, which will include presentations by experienced MSF field staff.

Experience Sharing
Date : Sunday, May 24th, 2009
Time : 4:00 pm—6:00 pm
Speakers : Hoa Nguyen, Mathina & Hemanathan
Venue : Citrus Hotel (51 Jalan Tiong Nam, Off Jalan Raja Laut, 50350
Kuala Lumpur, Malaysia)

Due to limited seating, please send your confirmation via email to

Interviews & Assessment
Interviews and Assessment exercises will be scheduled in the month of
October, 2009. Those interested in applying should submit their application (including CV, qualifications and application form). To download the application form and for further details, please visit the MSF Hong Kong website (

Recruiting positions
Medical General Surgeons, Orthopedic Surgeons, MedicalDoctors, Midwives, OT Nurses, Anesthetists, Nurse Anesthetists, Pediatricians.Non-Medical All Round Technical Logisticians, Mechanical Engineers, Civil Engineers, Water & Sanitation Experts.

Médecins Sans Frontières
Recruitment Talk and Interviews
in Kuala Lumpur, Malaysia

Reduce Overheads - ten ways

Doctors' Recession-Buster Guide: Ten Effective Ways to Lower Your Overhead

Gail Garfinkel Weiss, BBA, MSW

We sought money-saving tips from practice management consultants and practice administrators, who offered the following 10 suggestions.

1) Look at your phone bill.

Surprisingly, phone bills often contain opportunities to lower costs. Can you operate as easily with fewer phone lines? Is the practice still getting billed for numbers that were cancelled several years ago? Does your phone company offer a service plan that better suits your practice?

Hertz worked with a management services organization in which the bookkeeper conducted an audit and found almost $50,000 of erroneous billings from the phone company.

"So many practices just pay the bill when it comes in without ever really looking at it," says Hertz. "If there is something on the bill the practice doesn't recognize or understand, someone should call the phone company and ask questions." In addition, Hertz advises assigning a staff member to examine each phone bill for the following:

Excessive long distance calls. Check the area codes, the length of the calls, and the time of the calls. If calls are being made when the office is closed, who is making those calls?
Calls to Information. Discourage staff from running up charges by dialing 411. If they can't find a number in the phone book, tell them to try free Internet listing services, especially and
The phone numbers that are being billed. Often a practice continues to get charged for a number it thinks it has terminated, such as a fax number or an 800 number.
Consider other phone service plans or phone strategies. It may require a staff administrator or practice management expert to explore and recommend new saving opportunities.

2) Identify and reduce optional expenses.

"We always recommend not authorizing purchases that represent waste no matter the state of the economy," says Jeffrey J. Denning, a consultant with Practice Performance Group in La Jolla, California. "When times are lean, practices might have to reevaluate advertising and other forms of marketing to determine what is paying off and what can be scrapped.

"For example, display ads in phone directories are being rendered redundant by Google," Denning points out. "The way to know for sure is to look at how new patients answer the 'How did you hear about our practice?' question at the top of your registration form. If fewer than 10% are responding Yellow Pages, drop that ad."

3) Reduce work schedules.

If you are seeing fewer patients, you can save money by cutting employees' work schedules to 4-1/2 or 4 days per week. One benefit of this strategy is that when your situation improves, you can easily restore the original hours. Some employees might welcome the shorter workweeks. Others will accept them if the alternative is unemployment.

"You have to think a little bit differently," says Cynthia Dunn, a Medical Group Management Association senior consultant based in Cocoa Beach, Florida. "Often physicians and their office managers are so overwhelmed they spend their time putting out fires. They need to stop, evaluate the efficiency of workflow, and discuss what can be done to streamline or otherwise improve these processes."

If a full-time employee resigns, consider replacing her or him with 2 part-time workers who are willing to forgo health insurance and other benefits. "Before doing that, evaluate schedules and specific workload needs," says Dunn. Practices might be able to make do with part-time employees if they change the schedule depending on patient flow -- open later in the morning and expand evening hours, for example.

"You must know your patient base and communicate with your staff regarding appropriate coverage," says Dunn.

4) Provide lower-cost staff benefits.

You can reduce overhead by providing employee-only health insurance instead of family coverage, or setting up high-deductible healthcare savings accounts.

Dental and vision plan benefits are easy cuts because most employees can afford the cost of glasses and routine dental work. Speak with your insurer about possible changes in plans. Dropping vision and dental coverage can save you $15 to $30 per month per employee, Denning estimates.

5) Cap pay increases.

At Alabama Orthopaedic Clinic, a 20-physician practice in Mobile, raises were capped at 2%, and senior management volunteered to forgo a pay increase this year, says Dean Brown, the practice's chief executive officer.

Another option is to give employees bonuses instead of raises. If you do that, your staff's base compensation doesn't go up year after year, says Will Latham.

6) Save money on supplies and equipment.

Employees often find it easier to order new staples, markers, and other day-to-day items than to ferret out existing ones. Ditto for small medical supplies such as needles and syringes.

Ask staff to develop a system for monitoring supplies. Who is responsible for ordering office and clinical supplies? Does the practice have 3 months of supplies on hand, or 3 days? Does the practice track inventory, or does the medical supply company representative say that more things are needed and the practice orders them? Are there certain seasonal supplies you can hold off purchasing until absolutely necessary?

Take advantage of discounts. Ordering medical and office supplies online is frequently cheaper than shopping at retail stores, even after shipping charges are factored in.

7) Cut patient communication expenses (postage, telephone, etc.) by developing a Website.

Cynthia Dunn recommends doing this by means of a vendor with medical practice Website design experience, such as Medfusion ( The cost for developing a site averages around $5000 to $6000, Dunn says. Costs include design, a domain name, hosting, and maintenance.

Practices should consider having an interactive site. There are costs associated with each transaction, and these vary from vendor to vendor. Dunn suggests training a resident expert (via adult education or the Internet) to oversee your Website, make changes, add content, and download information as needed.

Once your site is up and running, it can reduce mailing and telephone expenditures by allowing patients to pay you, make appointments, and request prescription refills online. In addition, you'll increase office efficiency if patients can download forms and view educational materials on the site. Specific savings estimates are hard to come by, but according to Dunn, "Anytime you can save the practice a telephone call, you save the practice money."

8) Check into lowering your rent.

If you are renting office space, consider renegotiating your lease, says Latham. Your landlord might be willing to reduce your monthly rent if you extend the lease for another year or two.

Find out the current office vacancy rate in your area. You can often get that information by checking with local realtors or using an Internet search engine (for example, go to Google and enter "office vacancy rate" and the name of your city in the search box). It is also helpful to determine the vacancy rates in other buildings your landlord owns in your area. If the landlord is having a difficult time getting tenants, he or she may be more willing to renegotiate your rent.

9) Lay off 1 employee.

"When it comes to cuts, downsizing gives you the biggest bang for the buck," says Jeff Denning. This usually isn't an option in solo practices, Denning acknowledges, but if you have 6 or more employees and you are hurting financially, he advises cutting ties with one and redistributing that person's duties to the remaining staffers.

"Select the redundant employee based on the caliber of his or her work, work attitude, and mix of duties," Denning says. "It sounds heartless, but this is business and personnel costs usually account for half the overhead. A 3-physician primary care practice employs 14 people, on average, at a cost of $540,000. Cutting one position saves the practice some $40,000 in salary and benefits."

10) Ask for employees' help and suggestions.

Established staff usually have good ideas on how to cut costs. They're just not asked, says Hertz.

Call a staff meeting. Share money-saving goals with employees and be frank about the difficulty in making ends meet. Seek staff input on the best ways to collect outstanding balances, increase co-pay collections at check-in time, and control inventory and supplies, overtime, and other expenditures. Elicit ideas on how the practice might revise policy or better use technology to save some dollars. Emphasize that now, more than ever, customer service should be at the forefront of everybody's efforts.

Reward employees whose suggestions are adopted. Alabama Orthopaedic Clinic is about to launch a program that will offer employees a percent of savings realized if their proposal is implemented.

"The reward will be based on the amount of savings," says Dean Brown. "If savings are realized, the employee will receive quarterly bonuses based on a sliding scale: 5% reward for savings from $1000 to $10,000, another 2.5% for savings from $10,000 to $50,000, and an additional 1% for savings from $50,000 to $100,000."

Alabama Orthopaedic Clinic chose this strategy to uncover potential cost savings and give employees a larger stake in the success of the practice, says Brown. "We already have a very successful bonus program that is based on patient satisfaction scores, profitability, and individual job performance," he adds. "We re hopeful the cost-savings program will be successful, too."

Saturday, May 2, 2009

Practical Measures to Reduce Swine Flu Transmission

An Expert Interview With Georges C. Benjamin, MD, FACP, FACEP (E)

Laurie Barclay, MD
From Medscape Medical News

April 30, 2009 — Editor's note: Now that the World Health Organization has raised the pandemic alert level for swine influenza A (H1N1) to phase 5, healthcare professionals must be prepared to respond effectively with case diagnosis, management, and minimizing transmission to help contain this outbreak. The US Centers for Disease Control (CDC) have issued guidance for clinicians, state public health laboratories, and public health and animal health officials.

In particular, clinicians should consider the possibility of swine influenza virus infections in patients presenting with febrile respiratory illness, collect a respiratory swab for swine influenza testing, and contact the state or local health department to facilitate timely diagnosis.
To learn more about practical advice clinicians should give their patients regarding how to minimize their chances of contracting swine influenza or spreading it to others, Medscape Infectious Diseases interviewed Georges C. Benjamin, MD, FACP, FACEP (E), executive director of the American Public Health Association.

Medscape: Once swine flu has been suspected or confirmed in a particular community, what are the most important recommendations for home isolation and household contacts, and how should patients and caregivers be counseled regarding these recommendations?

Dr. Benjamin: In a situation as rapidly changing as this one, the best thing clinicians can do is follow the advice of the local, state, and federal health officials. As we know more about the virus, recommendations will likely change and the most current recommendations are what should be passed on to patients.

In the meantime, healthcare professionals can pass on the same general guidance that is used with seasonal influenza outbreaks. They should let patients know that once the virus is in a community, people should follow basic precautions to prevent the spread of any respiratory disease. This means protecting yourself by distancing yourself from people who are coughing or sneezing; washing your hands frequently; and keeping your hands away from your eyes, nose, and mouth. It also means using good judgment in keeping your environment clean, such as doorknobs.

Health providers should let caregivers know that if someone in the household is sick, they should limit exposure to them by keeping them in a room separate from common areas, such as a spare bedroom, and limit the number of people who enter the room. Caregivers should also be given guidance on using gowns, masks, or gloves when handling infectious material. The protective barriers serve as extra layer of protection and can be used if an individual will be handling soiled tissues or other contaminated objects.

Patients should also be advised that if they have kids and they're sick, they should keep them home from school. And also that if they don't feel well, stay home from work or other group activities. Patients should consult their healthcare provider about the illness and protections for the caregiver. More specific information for caregivers can be found at

Medscape: Are there any specific guidelines or recommendations for school nurses, in terms of management of students with symptoms suggesting swine flu and in terms of isolation, school closings, or other precautions?

Dr. Benjamin: This is an evolving situation, so I recommend that people keep up with the guidelines. CDC has posted guidance on how schools and administrators should best manage this situation to protect the health of students, teachers, and workers. Follow this at

School nurses are a frontline resource and they should follow CDC clinical guidelines on identifying potential H1N1 flu cases. According to CDC, health providers should contact their state public health department to report suspected cases of swine-origin influenza A (H1N1) virus infection and to obtain information on what clinical and epidemiologic data to collect and specimen shipment protocols in their state.

Medscape: How effective are disposable face masks vs respirator masks worn by healthcare professionals, and what are the indications for appropriate use of each?

Dr. Benjamin: It's not clear just how effective face masks are in preventing transmission of the H1N1 virus. In areas with confirmed cases of the virus, a combination of actions will prove most effective in preventing further spread, including hand washing and limiting exposure to people who are ill, coughing, or sneezing.

In crowded settings or when close contact with people who may be sick cannot be avoided, a face mask may serve as a useful physical barrier, but one should understand that the simple surgical mask is not nearly as protective as the N-95 respirator mask. The N-95 respirator must be fitted and worn properly to be most effective. New guidance on the use of face masks may emerge as we learn more about this virus.

Currently CDC recommends that when crowded settings or close contact with others cannot be avoided, the use of face masks or respirators in areas where transmission of swine influenza A (H1N1) virus has been confirmed should be considered as follows:

1.Whenever possible, rather than relying on the use of face masks or respirators, close contact with people who might be ill and being in crowded settings should be avoided.
2.Face masks should be considered for use by individuals who enter crowded settings, both to protect their nose and mouth from other people's coughs and to reduce the wearers' likelihood of coughing on others; the time spent in crowded settings should be as short as possible.
3.Respirators should be considered for use by individuals for whom close contact with an infectious person is unavoidable. This can include selected individuals who must care for a sick person (eg, family member with a respiratory infection) at home.
More information is available at

Medscape: Are there any recommendations for precautions that could be taken by businesses, public establishments, schools, churches, etc, to minimize the likelihood of spread in these areas, both before and in the event of confirmed cases in the community?

Dr. Benjamin: There are many different lists prepared during the last several years to help people be better prepared for an emerging infectious disease or other health threat. You can find some of these lists at, and

In terms of precautions to minimize the spread of disease, using good judgment may be the first step. For example, if you're not feeling well, stay at home and avoid crowds or close contact with others. Many activities such as shopping, taking classes, or even participating in religious services can be done online via the Internet, minimizing contact with others.

Encouraging home isolation of cases is strongly recommended by CDC. The current recommendation for schools is that dismissal of students should be strongly considered in schools with a confirmed or a suspected case epidemiologically linked to a confirmed case.
More information is available here:

Medscape: Is there any evidence favoring alcohol-based hand sanitizers vs hand washing; covering a cough or sneeze with the arm or shoulder vs hand; and/or other personal hygiene measures individuals should follow?

Dr. Benjamin: People should wash their hands as frequently as possible, especially if they are visibly soiled, for at least 20 seconds. Warm water and soap will emulsify the dirt and grease, and the mechanical action of rubbing your hands together helps to eliminate the dirt and germs.
Use of alcohol-based sanitizers is a good second choice when you don't have access to soap and water. Some people may not be able to use alcohol due to skin sensitivities or other conditions.
You should also cough or sneeze into your elbow or arm to reduce the spread of germs to your hands.

Medscape: Should disinfectants or antibacterial cleansers be used on surfaces, and how often?

Dr. Benjamin: Using common sense is often the best approach. If someone in a home is sick, people will want to take extra precautions to keep others in the house from getting sick. They should throw away in the trash tissues and other disposable items used by the sick person.

Surfaces (especially bedside tables, surfaces in the bathroom and toys for children) should be kept clean by wiping them down with a household disinfectant according to directions on the product label. Thoroughly wash linens, eating utensils, and dishes belonging to those who are sick before reusing. And people shouldn't forget to wash their hands when done cleaning.

Medscape: In addition to avoiding unnecessary travel to Mexico, how should clinicians advise their patients regarding travel to Canada or to states with confirmed cases, airline travel in general, and attendance at sports events, concerts, or other large public gatherings?

Dr. Benjamin: Health providers should advise their patients to make prudent decisions about what their relative risk is and determine the best course of action. Clinicians should also take into account each patient's health status. For example, if you have a patient with a chronic illness or who is immunocompromised, it probably makes good sense to recommend that they take extra care and avoid activities or places such as a public gathering, concerts, or sports activities where risk of exposure is greater.

You should also follow the advice and guidance of your local, state, and federal public health officials. Regarding travel to Mexico, CDC offers specific guidance at

Medscape: What do you regard as the greatest challenges and priorities regarding containment of this outbreak?

Dr. Benjamin: For clinicians, a primary challenge with this outbreak is communicating adequately with patients without scaring them or inciting panic. Additionally, another challenge is staying on top of all the information. The information for clinicians is constantly changing, as are the recommendations we should pass on to patients.

For scientists, determining the best course of action with regard to vaccine development is a challenge. If this becomes a lethal pandemic, we'll obviously need to ramp up all efforts, which will present challenges for our resources and economy.

All CDC guidance documents are available at:

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