In this month's In-Depth article, Dr Peter Boling reminds physicians that the word "doctor" originally meant "teacher" (in Latin), and this should still hold true today, he emphasizes. Of course, just the mention of spending more time with each patient can invoke antagonism in some. But Dr Boling's message concerning older patients is not simply that doctors must spend more time educating their patients. Rather, his point is that when treating older patients, a dialogue with the patient is needed, by which he means not only taking a careful history (a credo well familiar to any doctor) but also asking patients about their preferences of available therapies, brand-name versus generic drugs, and so on.

This stands in contrast to Dr Alper's article, which focuses on the potential consequences to the physician more than to the patient associated with prescribing drug therapies.

Yet both points are valid, each fleshing out the risks involved in practicing medicine today.to physicians and to patients.

I was thinking of Dr Boling's article a few days ago during an unexpected visit to the emergency department with my 17-year-old son. Although he had no business "walking into a door," as the school nurse said, he did need urgent care for a just-above-the-eye laceration. I was duly impressed how quickly he was moved to the "rapid care" area, to be seen shortly. But once there, things began to fall apart. The emergency physician was busy "teaching" a young medical resident what sounded like preparation for her Boards, and was oblivious to his new patients. About 25 minutes later, both came in. A debate ensued about which treatment would be best. The doctor said it should be glued, and got clearly annoyed when I asked for evidence about glue versus stitches (which in my son's experience leave a much smaller scar; yes, he'd had both methods used on his face before). Saying there was no evidence, the doctor insisted glue was better, although it might not heal as neatly as stitches; he then walked out, giving us time "to decide." The nurse came in, looked at the site, and said she preferred stitches; the doctor returned and departed again. Just then, a friendly and "chatty" physician assistant walked in, took a quick look at the cut, joked with my son, and blurted, "No question, stitches." He proceeded with stitches, and all was well...

This personal digression in the form of anecdotal evidence does reflect the experience of many patients today. Of course doctors are busy; and of course they know more than their patients do. But a callous dismissal of the patient's wishes does not bode well for either patient or physician, a point Dr Boling articulates well in his "clinical pearls."

Another set of clinical pearls is offered in this issue by Dr William Chey, who explains why the paradigm for testing and treating Helicobacter pylori infection has changed so dramatically over the past decade, outlining an exciting new treatment regimen.

CDC expert Dr Julie L. Gerberding also focuses in this issue on the role of doctors as educators, urging them to "lead by example" and get the influenza vaccine this season as a way of encouraging their patients to do the same. She cites disappointing rates from the 2005-2006 flu season; only 60% of older people (aged ≥65) received the vaccine, and only 36% of younger patients with chronic diseases did. The vaccination rate among physicians is about 40%.

The new, long-term data (from 1990 to 2000) that have just been published (N Engl J Med. 2007;357:1373-1381) confirm the efficacy of vaccination—a 27% reduction in hospitalizations for pneumonia and 47% in death (influenza accounts for an annual excess of about 200,000 hospitalizations and 36,000 deaths).

Dr Gerberding notes that the vaccine supply this season should be abundant, and the FDA has just approved a new influenza vaccine, called Afluria, a live virus vaccine against virus subtype A and B, which is expected to be available by the end of October.

Dalia Buffery, Group Editor