It’s been ages since Googling wasn’t the go-to method for finding information. But a new generation of contenders is hoping to put the ubiquitous search giant in our collective rear-view mirrors.
These AI-powered platforms leverage advanced language models and machine learning to understand context, generate humanlike responses, and get you what you’re looking for more quickly than ever before. Just be a little cautious about the accuracy of factual statements, since AI remains prone to hallucinations.
Perplexity
Perplexity makes searching feel more like a conversation. Instead of simply returning a series of links and leaving you to synthesize disparate information on your own, it generates actual answers.
It’s a great tool for doing specific research because its ability to understand context and provide follow-up information makes using it similar to natural dialogue.
The free version works fine for basic searching, while the $20 per month Pro version offers more detailed results, additional AI models, file analysis, and monthly API credits.
You.com
You.com focuses on a customizable search experience where you can prioritize results from specific sources like news sites or academic journals.
Tell You.com a little about yourself when you first sign up and it’ll not only be able to tailor search results to your personality but learn more about your interests as you continue to use it.
While both the free and $20 per month Pro versions provide access to the internet and real-time responses with citations, Pro offers additional advanced capabilities and customization options, including the ability to choose from a laundry list of popular AI models.
Andi
Andi is arguably the friendliest entry on the list here. It’s great for breaking complex topics down into quick, easy to understand answers.
It does this by leveraging Read, Summarize, and Explain features: Read is an ad-free, clean article viewer; Summarize is a quick breakdown of key points; Explain chunks complicated topics into simpler explanations.
Andi is free to use with no paid version. The company makes commissions from affiliate links on product searches, though you can opt out if you like.
Apply to the Most Innovative Companies Awards and be recognized as an organization driving the world forward through innovation. Early-rate deadline: Friday, August 23.
Doug Aamoth is a 20-year veteran of the tech industry and has written extensively about trends in Big Tech; innovative, new products; and personal-productivity tips.You can connect with him on Twitter/X and LinkedIn. More
Social anxiety disorder: Treatments and tips for managing this challenging condition
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SUBSCRIBE | SHOP THE BOOKSTORESocial anxiety disorder: Treatments and tips for managing this challenging condition
Many of us experience social anxiety from time to time, such as feeling uneasy before attending a cocktail party, or having “butterflies” before a presentation at work. It is normal to feel shy, nervous, or anxious in situations where we are outside of our comfort zone. But when this social anxiousness causes intense distress and starts to impact daily life, it could be indicative of a common condition called social anxiety disorder.Get your copy of Anxiety and Phobias.
Everyone worries or gets scared sometimes. But if you feel extremely worried or afraid much of the time, or if you repeatedly feel panicky, you may have an anxiety disorder. Anxiety disorders are among the most common mental illnesses, affecting roughly 40 million American adults each year. This Special Health Report, Anxiety and Stress Disorders, discusses the latest and most effective treatment approaches, including cognitive behavioral therapies, psychotherapy, and medications.
A special section delves into alternative treatments for anxiety, such as relaxation techniques, mindfulness meditation, and biofeedback. SHOW ME MORE →
What is social anxiety disorder? Social anxiety disorder (SAD), also called social phobia, is a common mental health disorder that is estimated to affect up to 7% of adults in the US every year. SAD is characterized by an extreme fear of social situations, from giving performances or speeches to attending a party. Those who suffer from SAD fear they will be scrutinized and humiliated by other people. This fear causes intense distress and can keep those affected from doing things they want to do. Symptoms of social anxiety disorder. The main symptom of social anxiety disorder is an extreme fear of being scrutinized or embarrassed by other people. The fear is so great that it can cause a person to avoid social settings altogether. There are also physical symptoms of anxiety that may accompany the fear. For example:feeling sweaty blushing having a rapid heartbeat trembling nausea feeling short of breath.There are two types of social anxiety disorder.
Most people with SAD have generalized social anxiety, meaning they fear all social situations, such as meetings or parties. In people with SAD, discomfort with social situations usually begins during the childhood or teenage years. Symptoms typically get worse over time. Symptoms of social anxiety disorder, as opposed to normal everyday nervousness, are constant and severe. This stress starts to affect relationships, jobs, daily routines, and overall quality of life.
Another type of SAD, performance-only social anxiety, is much less common.People with performance anxiety only fear times when they are the center of attention, such as giving a speech or a performance. Performance anxiety is not as impairing as generalized social anxiety and starts later in life.
Causes and risk factors: Social anxiety disorder is thought to be caused by both biological and environmental factors: an influence of both nature and nurture. Scientists believe SAD develops in response to a complex interaction of neural factors (meaning what’s going on in the brain and nervous system), as well as psychosocial factors — the influence of life events, thoughts, and behaviors. Causes of SAD related to the brain and nervous system include:a hyperactive nervous system. This means even small emotional triggers can result in the release of cortisol, a stress hormone in the body; decreased amounts of serotonin (a hormone involved in controlling mood) in the brain abnormal levels of glutamate and oxytocin in the brain. These hormones control how you respond in social settings and the intensity of anxiety symptoms; increased sensitivity in areas of the brain that control mood and emotion. Psychosocial causes of SAD include early childhood trauma, such as a history of abuse and neglect, and childhood teasing.Overprotective and hypercritical parenting styles have also been associated with the disorder.These events influence how you interact with others and respond in social situations.Other risk factors for development of social anxiety disorder include:female sex; family history of social anxiety disorder, shy personality demonstrating intense fear of new people and withdrawal from new situations during childhood.
How is social anxiety disorder diagnosed? Your doctor can help distinguish social phobia from other anxiety disorders. He or she uses certain criteria to make the diagnosis. You may be diagnosed with social anxiety disorder if you: have extreme fear of social interactions (such as having a conversation, attending a party, or meeting new people), being observed (such as while eating or drinking), or performing in front of people (such as giving a speech), worry about being judged, embarrassed, or humiliated by other people, avoid social situations because of your fear and anxiety, feel that your social anxiety hinders your social and personal life.These symptoms must be present for at least six months in order to be diagnosed with the condition. If you are concerned you may have SAD, talk with your doctor.
Because people who suffer from SAD are at increased risk of developing depression and other mental health problems, proper diagnosis and treatment are important. Treatment options:
The two most common treatment approaches for social anxiety disorder are cognitive behavioral therapy and prescription medications.
Cognitive behavioral therapy (CBT) Cognitive behavioral therapy (CBT), a type of psychotherapy, is a first-line treatment for SAD. Trained professionals help you understand your triggers and learn coping strategies. The goal of CBT is to challenge your negative thoughts and learn behaviorial strategies to overcome them.CBT can be done in an individual or group setting. Most people start with a weekly session and gradually decrease the frequency. Once your symptoms are well controlled, attending two to four sessions per year is recommended to prevent relapse. Medications Your doctor may prescribe medications to use alone or in combination with CBT. Antidepressants are usually prescribed first for social anxiety disorder.Even in people who do not have depression, these medications can help with symptoms of anxiety. The two most prescribed antidepressant drug classes are: selective serotonin reuptake inhibitors (SSRIs), such as paroxetine (Paxil) and sertraline (Zoloft)serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor).These medications help normalize the levels of hormones in the brain that contribute to SAD. It may take up to three months of treatment before you notice the full effect of these medications on your symptoms, but you should begin to notice some benefit before then. If you suffer from performance anxiety, your doctor may prescribe an anti-anxiety medication to use on an as-needed basis, such as before you give a presentation. These include: beta blockers such as propranolol (Inderal) benzodiazepines such as clonazepam (Klonopin) and lorazepam (Ativan).These medications provide short-term relief by slowing the heart rate and calming the nervous system, and can be taken as needed before an anxiety-producing situation. Complementary strategies Self-help techniques can be used to complement other treatments. Many of these measures are easy to implement and may provide benefits beyond building social confidence. Practice mindfulness. Mindfulness refers to the practice of being present without judgement. When you are mindful, you are aware of your surroundings and emotions but do not react to them. Research shows that mindfulness can improve symptoms of SAD and overall quality of life. Treat sleep problems. Studies have shown that people who suffer from social anxiety disorder have higher rates of sleep problems. Poor sleep is linked to worsening anxiety and may increase social avoidance over time. Consider creating a relaxing sleep routine and avoiding screen time later in the day to improve the quality of your sleep. Exercise. Regular exercise can help improve anxiety symptoms. Research suggests aerobic exercise is even more beneficial for social phobia when combined with CBT. Avoid or minimize alcohol and caffeine intake. Many people use alcohol as a way to lessen their social anxiety, but alcohol has been shown to worsen anxiety in the long run. Similarly, caffeine can cause or worsen anxiety, especially at higher doses. Find a support group. Talking through your fears and hearing the experiences of others can help to validate your emotions and reduce social isolation. It may also help enhance your coping skills as you practice vulnerability in a social setting. The Anxiety and Depression Association of America (ADAA) provides a list of virtual and in-person support groups, including one for individuals with social anxiety.For more on diagnosing and treating anxiety and phobias, check out Coping with Anxiety and Stress Disorders, a Special Health Report from Harvard Medical School.Image: Getty ImagesShare this story:
For the first time in decades, more people are leaving Sweden than arriving. The government explains this reversal by its restrictive migration policy.
Sweden, with its population of just over 10.5 million, has seen migration numbers drop over the last decadeImage: Emma-Sofia Olsson/AP/picture alliance
The number of immigrants in Sweden is lower than it has been for a long time.
In early August, Migration Minister Maria Malmer Stenergard said Statistics Sweden, the government’s official statistics agency, had found that 5,700 more people had emigrated than immigrated in the period from January to May 2024. Stenergard said the trend was expected to continue, adding that the number of asylum applications had not been as low since 1997.
It’s not the first time that Sweden has seen a dramatic drop in asylum applications. In 2016, 28,939 people applied for asylum in the country of just over 10.5 million— significantly down from the 162,877 applications in 2015.
Sweden was once known as a very welcoming place for migrants from conflict-ridden countriesImage: Jens Christian/TT NEWS AGENCY/picture alliance
Government tightened migration policies in 2016
The lower figures can be attributed to the government’s decision to change course. At the end of 2015, the ruling Social Democrats ended Sweden’s previously liberal immigration and integration policies, whereby many asylum-seekers from crisis-ridden countries such as the former Yugoslavia, Afghanistan, Syria, Iraq and Somalia had been accepted, and significantly tightened migration policies.
In a report by the German Federal Agency for Civic Education, Swedish migration expert Bernd Parusel wrote that Sweden introduced various measures against a backdrop of major “bottlenecks in registering, finding accommodation for, and caring for asylum-seekers entering the country.”
Often, asylum-seekers can wait for a long time to know their fate in Sweden. In 2015, refugees had to wait outside the Migration Agency’s arrival center in the coldImage: Stig-Ake Jonsson/TT/picture alliance
Parusel explained that the measures first concerned access to Swedish territory in order to apply for asylum. Secondly, they were about granting asylum and the legal consequences. Thirdly, the idea was that people should be encouraged to return voluntarily, and deportations should be carried out consistently.
Iraqis, Somalis and Syrians leaving Sweden
According to the Swedish government’s most recent press release, there are now more and more people who originally came from Iraq, Somalia or Syria leaving the country. It remains open how many of these voluntary returnees figure in the latest migration statistics. But Stenergard seems convinced that the current figures are down to the more restrictive policies of the past eight years. “The government’s efforts are bearing fruit,” she said.
The motives of departing immigrants also remain unclear. In 2017, Parusel explained that “making life difficult for asylum-seekers forced to leave the country” is not a suitable method of encouraging people to leave Sweden on a voluntary basis. On the contrary, he said there would be more social hardship if they were deprived of benefits and accommodation.
“The trend toward manageable immigration is crucial if we want to improve integration,” said Migration Minister Sternegard.
Prime Minister Ulf Kristersson wants to crack down on gang crimeImage: Pontus Lundahl/TT NYHETSBYRÅN/picture alliance
At first glance, it might appear logical that it’s easier to integrate migrants if there are fewer people. However, according to Parusel, the system of making Sweden as unattractive as possible for immigrants by keeping them in the dark about their prospects, while at the same time promoting better and faster integration into society, does not work.
Sweden struggling to deal with organized crime
But one sign that tougher restriction have not solved all problems is the continued problem of organized crime. Prime Minister Kristersson has set himself the goal of combating the issue, attributing it the previous government’s “irresponsible immigration policy and a failed integration.”
These incidents tend to take place in poorer neighborhoods, where there is a higher proportion of migrants. But experts have attributed the crime largely to high levels of unemployment, lack of prospects and poverty.
New pills to combat obesity are threatening Eli Lilly and Novo Nordisk on the stock market. The two pharmaceutical companies are the dominant players in the weight loss market, since (for the time being) they are the only ones producing and marketing anti-obesity drugs. However, this is a very greedy business and in recent months other laboratories, attracted by this millionaire empire, have made progress with their own drugs, arousing the interest of the market and sparking doubts about the empire of the two giants, which have seen shares fall.
Last week, Viking Therapeutics presented the latest results of its anti-obesity drug. It is an injection that is in the final stages of study. It also announced that it is working on an oral version, which is currently in a mid-stage trial. After presenting the results of its anti-obesity drug, the company’s shares soared 39% in a single day. So far this year, its stocks have risen by 235%.
Similarly, Roche — which had previously announced that it was working on an oral weight-loss drug — said last week that it had accelerated its launch, following promising results from its experimental study. The company’s shares are up 13% so far this year, but that rise is really due to the breakthrough in the last two weeks after it revealed its plans for an anti-obesity pill.
“Diabetes and obesity continue to dominate the healthcare sector. Goldman Sachs estimates that the market will grow from $14 billion in 2024 to more than $130 billion by 2030. Understandably, many pharmaceutical companies are conducting research in this area,” says Sebastian Hofbeck, analyst at DJE Kapital.
In addition to Viking and Roche, Danish biotech Zealand Pharma and German drugmaker Boehringer Ingelheim are jointly developing a similar drug.Terns Pharmaceuticals is investigating an oral anti-obesity drug, and expects to report its results in the second half of the year.Altimmune is also testing an injectable drug. Meanwhile, Pfizer has dropped two pills it had been working on due to the strong side effects detected at the intermediate stage, but the lab is willing to “play and win” in the weight-loss drug market. According to Bloomberg’s calculations, positive results in studies to develop an anti-obesity drug have driven $93 billion in market gains for companies so far this year.
The World Health Organization (WHO) describes obesity as “a global crisis.” According to the institution, one in eight people in the world were living with obesity in 2022. Amid the rise of the disease, Novo Nordisk and Eli Lilly were the first companies to develop and market products that help treat obesity, which have brought them millions of dollars in stock market profits. But after the emergence of new competitors, their shares have suffered in recent weeks.
Novo Nordisk markets two drugs. On the one hand, it produces Ozempic. This is a drug initially developed to treat diabetes, but among its effects, it reduces appetite and slows digestion, thus helping to reduce weight. On the other hand, it also produces Wegovy, a drug that shares the same active ingredient as Ozempic. Both have propelled Novo Nordisk to become Europe’s most valuable company, with a market capitalization of more than $570 billion. So far this year it is up 64%, but in the last month it fell 11%.
Eli Lilly markets Mounjarro and Zepbound, a drug approved in November last year for obese or overweight patients suffering from complications such as hypertension, Type 2 diabetes, cholesterol, obstructive sleep apnea or cardiovascular disease. The company expects Zepbound to become the best-selling drug in history. The firm is up 32% on the stock market so far this year, but in the last month its shares also dropped 14% due to competition that is threatening to break its duopoly with Novo Nordisk.
“The main beneficiaries of the anti-obesity drug market remain Eli Lilly and Novo Nordisk, which are the only companies already marketing their Zepbound and Wegovy products and will remain alone in this market for a few more years, as potential competitors are only in the early stages of research,” explains Sebastian Hofbeck.
Until now, the biggest challenge facing Novo Nordisk and Eli Lilly was meeting the huge demand. The weight loss market is gigantic. The WHO estimates that 43% of adults worldwide are overweight and 16% obese. In Western countries, the rates are higher (in the U.S. this figure is estimated at 70%). “The biggest challenge for the two companies remains being able to meet this huge demand. To this end, Eli Lilly and Novo Nordisk are investing a lot of money in production capacities and in acquiring other companies. It remains to be seen whether these investments will be enough. According to both companies, it will be years before they will be able to meet all the demand,” says Hofbeck.
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English nationalism is built on a lie Capitalism doesn’t care about your identity. Comment: Enlightening and essential explanation of where ethnicity becomes national and then political with Capitalism as the nucleus.
‘You can feel rejected without throwing in your lot with a lout like Tommy Robinson.’ (Drik/Getty Images)
For every Franco or Modi there is a George Washington or Mahatma Gandhi. Nationalism can salvage cultures and languages at risk of extinction, but it can also boast of their supremacy over all others. As the most successful revolutionary movement of the modern age, it has allowed disregarded nations to break on to the world stage; it has also been a form of spiritual introversion which drives them back inside their own psyches.
Some nationalists look fondly to a past utopia before the colonial invader pitched up on their shores. There were patriotic Irish scholars in the 18th century who claimed that Irish was probably the language spoken in the Garden of Eden. One shouldn’t, however, be misled by this archaic impulse. Nationalism is a thoroughly modern ideology, which stretches back no more than about two and a half centuries. It was only around then that Europe was seized by the novel idea that to be a nation entailed having one’s own political state. There was a direct hook-up between the ethnic and the political. Human beings (which didn’t for this purpose include women) had the right to self-determination not just as people but as peoples. A crucial hyphen was inserted between the words “nation” and “state”, and a new phenomenon came into existence.
There were problems with this revolutionary notion. For one thing, almost all so-called nations were ethnically hybrid, with the odd exception such as China, so why shouldn’t each of these ethnic groups have its own state?For another thing, nations at the time were defined largely by imperialism and colonialism.These sovereign powers played a major part in drawing up the frontiers between territories, mostly in their own material interests, so wasn’t revolutionary nationalism just an inverted mirror of its antagonist?Anyway, by what mystical logic did being Tibetan or Peruvian automatically afford you the right to your own political state? There were, to be sure, forms of so-called civic nationalism for which being Peruvian meant simply being a citizen of Peru whatever your ethnic origin, and this was to be the foundation upon which most nations were constructed; but the Romantic desire to affirm your difference, uniqueness and possible superiority as a people never lost its grip, and has recently been active on the streets of Britain.
In a long historical perspective, this summer’s rioting happened because a section of the British working class had imbibed all too well the propaganda of its social superiors. For a world of empires and dynasties to give way to one of autonomous nation-states, a seismic cultural transformation was required. People who previously thought of themselves in concrete terms as tenants of a feudal landowner and more abstractly as loyal servants of the monarch had to learn how to become French or British or Portuguese citizens. Their identities had to be remoulded and reoriented. Some of the British were rich and powerful while others were semi-destitute, but there was a bond between them — Britishness — which seemed to render such divisions irrelevant. Rich and poor could forget their quarrels and unite in the face of a demonised outsider. This, needless to say, could prove highly convenient for the rich. All social classes could come together against a common enemy, and in Britain both the French and the Irish have traditionally served this function. What also proved vital to the nation’s sense of shared identity was Protestantism, which was sadly lacking in both France and Ireland.
The problem is that this robust national identity, which answered well enough at the time to the needs of mercantile and industrial capitalism, is less and less capable of doing so under current conditions. Capitalism is now a global phenomenon, and along with it the labour market. National unity is still politically and culturally imperative, but it is increasingly out of step with the contemporary global marketplace. Culture and the economy are out of sync. This, of course, is often the case, since culture usually changes with glacial slowness while the economy can shift in an instant.But this difference has been intensified by the transition from national to transnational capitalism. Working people whose mentality has been moulded by centuries of allegiance to king and country are now being implicitly asked to acknowledge the great lie of nationalism: the fact that there is no organic bond between an ethnic group and a specific terrain, that no stretch of soil belongs by divine or natural right to those who speak a particular language or have a certain skin-colour. The country was never yours to claim back. Immigrants haven’t robbed you of what was never your property in the first place. There are no exclusively British values which outsiders can’t or won’t share. You have been sold a fantasy by a national state in whose interests it was for you to buy this illusion, but which has transformed its nature while you have remained the same.
“National unity is still politically and culturally imperative, but it is increasingly out of step with the contemporary global marketplace.”
What you can’t accept is that transnational capitalism doesn’t care about culture or skin colour or what language was spoken in the Garden of Eden as long as it has someone to squeeze a profit out of. It is as woke in its own way as a Guardian editorial. It is the most impeccably liberal of set-ups, welcoming Malaysians to Denmark and Danes to Malaysia if this will suit its economic purposes. No mode of production has been more culture-blind. Unlike some of those who live under its rule, it is largely indifferent to questions of identity, including national or ethnic identity, since identity is a straitjacket which stops you from being mobile and adaptable. Only adolescents obsess about who they are. There are no natives any longer; instead, everyone is an expatriate, some of whom cling to the mirage of a mono-cultural country which vanished decades ago but which they still like to think of as home.
There has always been a conflict in modern capitalism between its drive for political unity and its economic plurality. As Marx points out in The Communist Manifesto, it is the most hybrid, mongrelised of life-forms, restlessly overriding boundaries, pitching bizarrely different phenomena together, mixing opposites and toppling hierarchies. Yet this diversity at the level of the marketplace must be sustained by unity at the level of the state. If we are anarchists in the shopping mall, we must be responsible citizens in the pew, classroom, polling booth or family hearth. This isn’t a contradiction that the current system is capable of resolving, any more than it can reconcile the need for cultural cohesion at home with great tides of migration surging in from abroad.
Marxism offered working people an alternative to chauvinism. It was known as internationalism, which means that a lorry driver in Sheffield has more in common with a waiter in Seoul than he has with the millionaire proprietor of his company. Such internationally based identities aren’t an illusion — think of being a Roman Catholic — but they are harder to sustain than more local ones, given that human beings are bodily creatures bound to a particular spot. Only a tiny number of zealots are likely to throw themselves on the barricades shouting “Long Live the European Union!”, let alone “Up With World Government!”How do you develop forms of consciousness which correspond to a globalised world?This has been no problem at the level of popular culture, where Taylor Swift is as much a universal commodity as money, but there are older forms of such culture to do with national pride, resentment and fear of the Other which don’t take so easily to such cosmopolitanism.The more certain citizens feel most at home in the VIP lounge of airports, the more certain others will wrap themselves defensively in the Union flag.
Some of those who recently threw bricks at the police showed the anger and frustration of a neglected underclass, while some of them just hated foreigners and wanted to beat them up. The grotesque irony of the former’s behaviour is plain: who do you target if you are poor, humiliated, excluded and without a future? Why, the only social group (refugees) who are even poorer, more excluded and more humiliated than you are. In this sense, the centuries spent breeding patriotism and loyalty to the Empire in the common people have had a certain pay-off. The Empire was built among other things on the conviction that people of a certain culture and skin-colour were inferior to the British, a conviction that was inculcated into millions of ordinary Brits who were looking for someone to feel superior to. It’s no surprise that some of their descendants should harbour similar sentiments about Afghans and Syrians, not least when they refuse to stay obediently in their far-flung domains but have the impudence to come knocking on your door.
Our rulers look with genuine horror on the burning of hotels and the battering of the police, but they should also feel relieved that this explosion of rage isn’t directed at themselves. For it is they, after all, who run the system which causes great masses of men and women to feel that they don’t really matter. This, to be sure, is no excuse for trying to incinerate immigrants. You can feel rejected without throwing in your lot with a lout like Tommy Robinson. What the government, media and legal system don’t dare to acknowledge, however, is that this experience of rejection is entirely justified — and that unless it is addressed, the rioting will break out again.
Terry Eagleton is a critic, literary theorist, and UnHerd columnist.
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Ever read your medical record? Here’s why you should
If you’ve ever been surprised — or confused — by a health provider’s notes, read on.
July 8, 2024
By Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
Do you ever read the notes written by your doctor or health practitioner during a medical visit? If not, you might want to check them out. Usually, these medical notes are full of helpful insights about your health and reminders of recommendations discussed. And there’s medicalese, of course: hard-to-pronounce illnesses, medications, and technical terms.
But you may be surprised to see incorrect information or unexpected language, tone, or even innuendo. Was your past medical history really that “unremarkable”? Did you actually “deny” drinking alcohol? Did the note describe you as “unreliable”?
Here’s how to decipher unfamiliar lingo, understand some surprising descriptions, and flag any errors you find.
What’s in a medical note?
A standard medical note has several sections. These include
a description of current symptoms
past medical problems
a list of medications taken
family medical history
social habits such as smoking, drinking alcohol, or drug use
details of the physical examination
test results
a discussion of the big picture, along with recommendations for further evaluation or treatment.
Notes tend to be more complete for a new patient or annual exam. Follow-up notes may not cover all of these points.
What’s potentially confusing about medical notes?
Most medical notes aren’t written using plain language because they aren’t intended primarily for a nonmedical audience. So it’s common to run across:
Medical jargon: You had an upset stomach and a fever. Doctors may say “dyspepsia” (upset stomach) and “febrile” (fever).
Complicated disease names: Ever heard of “multicentric reticulohistiocytosis” or “progressive multifocal leukoencephalopathy?” These are just two of thousands of examples.
Use of common language in uncommon ways: For example, your medical history might be called “unremarkable” and test results called “within normal limits” rather than “normal.”
Abbreviations: You might see “VSS” and “RRR,” meaning “vital signs stable” with a pulse that has a “regular rate and rhythm.”
If you’re having trouble deciphering a note or understanding your health issues, tests, and recommendations, check in with your doctor’s office for clarifications. The more you understand about your health and your options for care, the better.
What if a medical note is incorrect?
Minor errors in medical notes are not rare: maybe you had your tonsils removed 30 years ago, not 10 years ago. But there can be more important errors: stating that arthritis in your left knee is severe when it’s actually the right knee that’s severe could lead to having x-rays (or even surgery!) on the wrong side. And not properly recording a family history of cancer or heart disease could mean missing out on timely screening tests or preventive treatments.
In an era of ever-increasing time pressure, use of voice recognition software, electronic record templates, drop-down menus, and ability to copy and paste text, it’s easier than ever for health care providers to make (and perpetuate) errors in the medical record.
If you do see an important error that could affect your health, ask your provider to amend it.
What if the language in a medical note seems offensive?
Depersonalization: A note might describe a patient as “a drug abusing addict” rather than a person struggling with drug addiction.
Insulting or inappropriate descriptors: Notes might contain subjective descriptions that paint the patient in an unflattering light without providing context. For example, the note might say “the patient is unkempt and is drug-seeking” rather than “the patient is experiencing homelessness and has severe, chronic pain.” If a person’s recall of medical events from the past is hazy, they may be called “unreliable.”
Dismissiveness: A medical note may suggest a symptom is not real or is exaggerated, rather than taking the complaint seriously.
An untrusting tone: Language such as “she claims she never drinks” or “he denies alcohol use” may suggest mistrust by the physician.
Why might this happen, anyway?
How does such language make its way into medical notes? (To be clear, these possible explanations are not justifications.)
Tradition and training: Medical trainees, like other learners, tend to follow the lead of their mentors. So if stigmatizing language is used by an instructor, trainees may do the same.
Time pressure: With medical documentation (as in most everything else), mistakes are more common if you’re rushing.
Bias: Like everyone else, doctors have biases, including ones they aren’t aware of. How we are taught to think about people — by family, by society — can spill over into every area of life, including work.
Frustration: Doctors may feel frustrated by patients who don’t follow their recommendations. That frustration can be reflected in their medical notes. For example, a note may say, “As expected, the patient’s blood sugar is high; he is still not checking his blood sugar or following the diet recommended by his nutritionist.”
If the language in a note is confusing or bothersome, ask about it. The Open Notes movement and federal legislation have given most of us much better access to our medical records. This has worthy goals — greater transparency and better communication with people about their medical care — and unintended consequences.
Is changing language in notes that health practitioners once shared mainly with each other a positive consequence? Mostly. Yet some doctors worry that notes will become less specific, accurate, or useful since they may leave out information that might upset a patient.
The bottom line
I encourage you to read your health providers’ notes about your care. If there is a substantial error or something you find confusing or objectionable, ask about it. By the way, a signed medical note cannot usually be revised. However, your doctor can make clarifications or correct mistakes in an addendum at the end of the note.
As more and more patients read their medical notes, it’s likely that health providers will be more conscientious about the language they use. So, wide access to medical notes may improve not only people’s understanding of their health, but also the quality of notes over time.
It’s worth remembering that the medical note is not the most important thing that happens during a visit to your doctor. A great note isn’t the same as great care, and vice versa. Still, your medical notes can be a valuable source of health information that differs from all others, including trusted health sites and social media: they’re written by your doctor and they’re all about you.
About the Author
Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio
Matthew Perry’s assistant among 5 people, including 2 doctors, charged in ‘Friends’ star’s death
A prosecutor says five people have been charged in connection with Matthew Perry’s death from a ketamine overdose last year, including the actor’s assistant and two doctors.
By ANDREW DALTON and KAITLYN HUAMANI Updated 2:24 AM GMT+1, August 16, 2024 Share
LOS ANGELES (AP) — Five people including his personal assistant and two doctors have been charged in connection with Matthew Perry’s death in what prosecutors called a “broad underground criminal network” dedicated to getting the “Friends” star the powerful surgical anesthetic that killed him.
The doctors preyed on Perry’s history of addiction in the final months of his life last year to provide him with ketamine in amounts they knew were dangerous, U.S. Attorney Martin Estrada said as he announced the charges Thursday.
“They knew what they were doing was wrong,” Estrada said. “They knew what they were doing was risking great danger to Mr. Perry. But they did it anyway.”
One doctor even wrote in a text message, “I wonder how much this moron will pay” and “Lets find out,” according to an indictment unsealed Thursday.
Perry died in October due to a ketamine overdose and prosecutors said he received several injections on the day he died from his live-in personal assistant, Kenneth Iwamasa, who found Perry dead later that day and was the first to talk to investigators.
Ketamine has seen a huge surge in use in recent years as a treatment for depression, anxiety and pain. While the drug isn’t approved for those conditions, doctors are free to prescribe drugs for so-called off-label uses.
Perry had been receiving regular ketamine infusion treatments for depression — in amounts not nearly enough to account for his death — from his regular doctors, who were not among those charged, authorities said.
When those doctors refused to give him more, he went in desperation to others.
“We are not talking about legitimate ketamine treatment,” Estrada said. “We’re talking about two doctors who abused the trust they had, abused their licenses to put another person’s life at risk.”
DEA Administrator Anne Milgram said in one instance the actor paid $2,000 for a vial of ketamine that cost one of the physicians about $12. Perry paid the doctors about $55,000 in cash in the two months before his death, Estrada said.
Two of the people, including one of the doctors charged, were arrested Thursday, Estrada said. Two of the defendants, including Iwamasa, have pleaded guilty to charges already, and a third person has agreed to plead guilty.
Among those arrested Thursday are Dr. Salvador Plasencia, who is charged with seven counts of distribution of ketamine and also two charges related to allegations he falsified records after Perry’s death.
Plasencia appeared in court briefly Thursday afternoon and pleaded not guilty. He can be released after posting a $100,000 bond.
Plasencia’s attorney Stefan Sacks asked that his client be allowed to keep seeing patients at his practice when he’s released, saying he had already turned over his DEA license to prescribe dangerous drugs and that the Perry case was “isolated.”
Assistant U.S. Attorney Ian V. Yanniello objected, saying Plasencia had “essentially acted as a street corner drug dealer.”
Magistrate Judge Alka Sagar ruled that Plasencia could treat patients only if they sign a document saying they had been informed of the charges against him.
“Ultimately, Dr. Plasencia was operating with what he thought were the best of medical intentions,” and his actions “certainly didn’t rise to the level of criminal misconduct,” Sacks said outside the courthouse. “His only concern was to give the best medical treatment and to do no harm,” Sacks said. “Unfortunately harm was done. But it was after his involvement.”
The other person arraigned in the case Thursday was Jasveen Sangha, who prosecutors described as a drug dealer known to customers as the “Ketamine Queen” — a moniker her attorney derided as made-for-media consumption during her court hearing. Ketamine supplied by Sangha caused Perry’s death, authorities said.
Sangha pleaded not guilty and was denied bond. She had first been arrested in the case, charged with possession of ketamine with intent to distribute and released on bond in March, with authorities keeping Perry’s involvement quiet. But a new indictment unsealed Thursday alleges a direct connection to the actor’s death, and the judge ruled she should remain in custody due to her concern over prosecutors’ contentions that she destroyed evidence and has used money from drug sales to fund a lavish lifestyle.
Plasencia could get up to 120 years in prison if convicted, prosecutors said, and Sangha could get life in prison.
Records show Plasencia’s medical license has been in good standing with no records of complaints, though it is set to expire in October.
A San Diego physician, Dr. Mark Chavez, has agreed to plead guilty to conspiracy to distribute ketamine. Prosecutors allege Chavez funneled ketamine to Plasencia, securing some of the drug from a wholesale distributor through a fraudulent prescription.
The prosecutor said the defendants exchanged messages soon after Perry’s death referencing ketamine as the cause of death. Estrada said they deleted messages and falsified medical records in an attempt to cover up their involvement.
Los Angeles police said in May that they were working with the U.S. Drug Enforcement Administration and the U.S. Postal Inspection Service with a probe into why the 54-year-old had so much of the surgical anesthetic in his system.
Iwamasa found the actor face down in his hot tub on Oct. 28, and paramedics who were called immediately declared him dead.
The assistant received the ketamine from Erik Fleming, who has pleaded guilty to obtaining the drug from Sangha and delivering them to Iwamasa. In all, he delivered 50 vials of ketamine for Perry’s use, including 25 handed over four days before the actor’s death.
But it had been 1 1/2 weeks since his previous legitimate treatment, the medical examiner said, and the drug is typically metabolized in a matter of hours.
Estrada said that Plasencia had witnessed Perry freeze up and saw his blood pressure spike after injecting him with the drug, but still left several vials with Iwamura for the actor to inject later.
Multiple requests for comment from lawyers for Chavez, Iwamasa and Fleming were not returned Thursday.
The medical examiner listed ketamine as the primary cause of death, which was ruled an accident with no foul play suspected, the report said. Drowning and other medical issues were contributing factors, the coroner said.
Perry had years of struggles with addiction dating back to his time on “Friends,” when he became one of the biggest television stars of his generation as Chandler Bing alongside Jennifer Aniston, Courteney Cox, Lisa Kudrow, Matt LeBlanc and David Schwimmer for 10 seasons from 1994 to 2004 on NBC’s megahit sitcom.
Drug-related celebrity deaths have in other cases led authorities to prosecute the people who supplied them.
And after Michael Jackson died in 2009 from a lethal dose of propofol, a drug intended for use only during surgery and other medical procedures, not for the insomnia the singer sought it for, his doctor, Conrad Murray, was convicted of involuntary manslaughter in 2011. Murray has maintained his innocence.
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