{"id":42917,"date":"2018-08-29T16:42:01","date_gmt":"2018-08-29T15:42:01","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=42917"},"modified":"2019-01-17T13:10:08","modified_gmt":"2019-01-17T12:10:08","slug":"abraar-karan-changing-way-communicate-patients","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/08\/29\/abraar-karan-changing-way-communicate-patients\/","title":{"rendered":"Abraar Karan: Changing the way we communicate about patients"},"content":{"rendered":"

The way we communicate can reinforce a culture in which people become another case of \u201cX\u201d disease<\/p>\n

\"abraar\"A 53 year old woman with right lower quadrant abdominal pain. A 36 year old acutely suicidal man off psych meds. A 21 year old opioid abuser in withdrawal. An 80 year old woman with chest pain. On a single shift, I regularly read through the \u201cone-liners\u201d of more than two dozen patients. To even keep track of who is who, I (along with most of my colleagues) end up remembering people by their presenting clinical symptom or main medical diagnosis. As much as we recognize this to be clinically necessary, what do we lose when we begin to think of patients in this way?<\/span><\/span><\/p>\n

The loss of compassion and the risk of dehumanization in medicine is a real one. Studies show that empathy <\/span>systematically decreases<\/span><\/a> over the course of residency, while <\/span>burnout increases<\/span><\/a>. As much as this is a product of challenging schedules and tough daily work, we contribute to this decline in many other ways as well\u2014notably through our routes of communication. Examples of this include how we write our medical notes, how we present cases on morning rounds, and how we talk about patients with colleagues. <\/span><\/p>\n

The way we currently communicate reinforces a culture in which people become another case of \u201cX\u201d disease. Our manner of speaking and writing about patients not only reflects, but also impacts how we feel about them. It can contribute to a steady loss of empathy and even, I\u2019d argue, <\/span>a deterioration in patient health outcomes<\/span><\/a>. Studies have already found that patients who are treated by physicians who score higher on measures of empathy have <\/span>better <\/span><\/a>outcomes<\/span><\/a>. Similarly, when the physician has a negative attitude, patients have been shown to have <\/span>worse outcomes<\/span><\/a>. While the link between language, empathy, and outcomes has not been studied, I think that they are connected. <\/span><\/p>\n

Our complacency in referring to a patient as \u201cthe pancreatitis guy\u201d or \u201cthe heart failure lady\u201d can also become a precursor for other harmful transgressions of language. On the more egregious end of the spectrum, there are many documented cases of physicians speaking <\/span>ill of their patients<\/span><\/a>. Unfortunately, these are not rare anomalies. As physicians, we know that derogatory language is a <\/span>daily occurrence<\/span><\/i> in the hospital.<\/span><\/p>\n

There are many changes that we can make to improve how we communicate about patients. One of the easiest and most critical transformations is how we write our medical notes. One of the best doctors I ever worked with did exactly this, and is famous at the Brigham (our hospital) for doing it. He systematically starts every single note with the person\u2019s social history. Who is this patient? It is not just a lady with abdominal pain. It is a mother of three, a retired teacher, and an active cyclist. That is the first thing we read about her, and so when I enter her room, I can\u2019t help but see her this way rather than as a case of appendicitis. <\/span><\/p>\n

This matters because patients deserve to be treated as people\u2014a statement that\u2019s so obvious it shouldn\u2019t need to be said, but which physician behaviour doesn\u2019t always reflect. You wouldn\u2019t expect to know the most sensitive and vulnerable aspects of someone before even knowing their most basic background, yet we do this in medicine all the time. This is also important because in many clinical presentations, it provides critical information that helps deduce how they got sick, and why they may get sick again in the same way if we don\u2019t restructure something essential in their life. For instance, if I didn\u2019t know that the 22 year old opioid addict had just been kicked out of his house and is on the street without transportation to get to his suboxone clinic, I will not have truly solved what brought him to the hospital in the first place. <\/span><\/p>\n

Another easy change is to make sure that each patient has a picture of them in their electronic medical record\u2014preferably one of when they were in better health. It is a stark reminder that the patients we are seeing were once in good health, and <\/span>it helps us to frame how their disease has affected them<\/span><\/a> not only physically, but mentally, emotionally, and spiritually. Ask any doctor how eye opening it is to see the picture of the patient who is intubated and sedated in the ICU when they were smiling and healthy just a few months earlier. Family members often bring these pictures in, but we should proactively ensure that they are in the medical chart with the permission of the patient or family member. Every doctor should be reminded of this. <\/span><\/p>\n

Lastly, changing the way we speak about patients can make a big difference. And while finding out on rounds that, say, \u201cMrs. A is a gardener and an avid football fan\u201d may not change her clinical management, it will undoubtedly change the way we frame her in our mind. It will allow us to connect with her not only around that which brings her stress, such as her illness, but around those things that bring her joy. <\/span><\/p>\n

As practitioners, we are being trained to sift through large amounts of data to present relevant information, interpret this quickly, and create safe and effective treatment plans. In many ways, our current medical culture treats the social history and other \u201csoft\u201d data without regard. But by restructuring how we integrate this information and making it a central part of how we write, speak, and engage, we will not only become more empathetic, but also provide better care for our patients. <\/span><\/p>\n

Abraar Karan<\/strong> is an internal medicine resident at the Brigham and Women\u2019s Hospital\/ Harvard Medical School.<\/em>\u00a0Twitter\u00a0<\/em>@AbraarKaran<\/em><\/a><\/p>\n

Competing interests<\/strong>: None declared.<\/p>\n

The opinions expressed in this article are solely those of the author and do not reflect the views and opinions of Brigham and Women\u2019s Hospital.<\/div>\n","protected":false},"excerpt":{"rendered":"

The way we communicate can reinforce a culture in which people become another case of \u201cX\u201d disease […]<\/p>\n

More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":40868,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[18906,1357],"tags":[],"class_list":["post-42917","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-abraar-karan","category-us-health-care"],"yoast_head":"\nAbraar Karan: Changing the way we communicate about patients - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/08\/29\/abraar-karan-changing-way-communicate-patients\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Abraar Karan: Changing the way we communicate about patients - The BMJ\" \/>\n<meta property=\"og:description\" content=\"The way we communicate can reinforce a culture in which people become another case of \u201cX\u201d disease [...]More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bmj\/2018\/08\/29\/abraar-karan-changing-way-communicate-patients\/\" \/>\n<meta property=\"og:site_name\" content=\"The BMJ\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/bmjdotcom\/\" \/>\n<meta property=\"article:published_time\" content=\"2018-08-29T15:42:01+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2019-01-17T12:10:08+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/12\/talking_twoface.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"540\" \/>\n\t<meta property=\"og:image:height\" content=\"350\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:site\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2018\\\/08\\\/29\\\/abraar-karan-changing-way-communicate-patients\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2018\\\/08\\\/29\\\/abraar-karan-changing-way-communicate-patients\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"Abraar Karan: Changing the way we communicate about patients\",\"datePublished\":\"2018-08-29T15:42:01+00:00\",\"dateModified\":\"2019-01-17T12:10:08+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2018\\\/08\\\/29\\\/abraar-karan-changing-way-communicate-patients\\\/\"},\"wordCount\":1005,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2018\\\/08\\\/29\\\/abraar-karan-changing-way-communicate-patients\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2017\\\/12\\\/talking_twoface.jpg\",\"articleSection\":[\"Abraar Karan\",\"US healthcare\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2018\\\/08\\\/29\\\/abraar-karan-changing-way-communicate-patients\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2018\\\/08\\\/29\\\/abraar-karan-changing-way-communicate-patients\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2018\\\/08\\\/29\\\/abraar-karan-changing-way-communicate-patients\\\/\",\"name\":\"Abraar Karan: Changing the way we communicate about patients - The BMJ\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2018\\\/08\\\/29\\\/abraar-karan-changing-way-communicate-patients\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2018\\\/08\\\/29\\\/abraar-karan-changing-way-communicate-patients\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2017\\\/12\\\/talking_twoface.jpg\",\"datePublished\":\"2018-08-29T15:42:01+00:00\",\"dateModified\":\"2019-01-17T12:10:08+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2018\\\/08\\\/29\\\/abraar-karan-changing-way-communicate-patients\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2018\\\/08\\\/29\\\/abraar-karan-changing-way-communicate-patients\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2018\\\/08\\\/29\\\/abraar-karan-changing-way-communicate-patients\\\/#primaryimage\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2017\\\/12\\\/talking_twoface.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2017\\\/12\\\/talking_twoface.jpg\",\"width\":540,\"height\":350},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2018\\\/08\\\/29\\\/abraar-karan-changing-way-communicate-patients\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Abraar Karan: Changing the way we communicate about patients\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"name\":\"The BMJ\",\"description\":\"Helping doctors make better decisions.\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\",\"name\":\"The BMJ\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"width\":852,\"height\":568,\"caption\":\"The BMJ\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/bmjdotcom\\\/\",\"https:\\\/\\\/x.com\\\/bmj_latest\"]},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\",\"name\":\"BMJ\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"caption\":\"BMJ\"},\"sameAs\":[\"https:\\\/\\\/blogs.bmj.com\\\/\"],\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/author\\\/admin\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Abraar Karan: Changing the way we communicate about patients - The BMJ","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/bmj\/2018\/08\/29\/abraar-karan-changing-way-communicate-patients\/","og_locale":"en_US","og_type":"article","og_title":"Abraar Karan: Changing the way we communicate about patients - The BMJ","og_description":"The way we communicate can reinforce a culture in which people become another case of \u201cX\u201d disease [...]More...","og_url":"https:\/\/blogs.bmj.com\/bmj\/2018\/08\/29\/abraar-karan-changing-way-communicate-patients\/","og_site_name":"The BMJ","article_publisher":"https:\/\/www.facebook.com\/bmjdotcom\/","article_published_time":"2018-08-29T15:42:01+00:00","article_modified_time":"2019-01-17T12:10:08+00:00","og_image":[{"width":540,"height":350,"url":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/12\/talking_twoface.jpg","type":"image\/jpeg"}],"author":"BMJ","twitter_card":"summary_large_image","twitter_creator":"@bmj_latest","twitter_site":"@bmj_latest","twitter_misc":{"Written by":"BMJ","Est. reading time":"5 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/bmj\/2018\/08\/29\/abraar-karan-changing-way-communicate-patients\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2018\/08\/29\/abraar-karan-changing-way-communicate-patients\/"},"author":{"name":"BMJ","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe"},"headline":"Abraar Karan: Changing the way we communicate about patients","datePublished":"2018-08-29T15:42:01+00:00","dateModified":"2019-01-17T12:10:08+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2018\/08\/29\/abraar-karan-changing-way-communicate-patients\/"},"wordCount":1005,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2018\/08\/29\/abraar-karan-changing-way-communicate-patients\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/12\/talking_twoface.jpg","articleSection":["Abraar Karan","US healthcare"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/bmj\/2018\/08\/29\/abraar-karan-changing-way-communicate-patients\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/bmj\/2018\/08\/29\/abraar-karan-changing-way-communicate-patients\/","url":"https:\/\/blogs.bmj.com\/bmj\/2018\/08\/29\/abraar-karan-changing-way-communicate-patients\/","name":"Abraar Karan: Changing the way we communicate about patients - The BMJ","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#website"},"primaryImageOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2018\/08\/29\/abraar-karan-changing-way-communicate-patients\/#primaryimage"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2018\/08\/29\/abraar-karan-changing-way-communicate-patients\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/12\/talking_twoface.jpg","datePublished":"2018-08-29T15:42:01+00:00","dateModified":"2019-01-17T12:10:08+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2018\/08\/29\/abraar-karan-changing-way-communicate-patients\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/bmj\/2018\/08\/29\/abraar-karan-changing-way-communicate-patients\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/2018\/08\/29\/abraar-karan-changing-way-communicate-patients\/#primaryimage","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/12\/talking_twoface.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/12\/talking_twoface.jpg","width":540,"height":350},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/bmj\/2018\/08\/29\/abraar-karan-changing-way-communicate-patients\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/bmj\/"},{"@type":"ListItem","position":2,"name":"Abraar Karan: Changing the way we communicate about patients"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/bmj\/#website","url":"https:\/\/blogs.bmj.com\/bmj\/","name":"The BMJ","description":"Helping doctors make better decisions.","publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/bmj\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/bmj\/#organization","name":"The BMJ","url":"https:\/\/blogs.bmj.com\/bmj\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","width":852,"height":568,"caption":"The BMJ"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/bmjdotcom\/","https:\/\/x.com\/bmj_latest"]},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe","name":"BMJ","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","caption":"BMJ"},"sameAs":["https:\/\/blogs.bmj.com\/"],"url":"https:\/\/blogs.bmj.com\/bmj\/author\/admin\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/42917","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/comments?post=42917"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/42917\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media\/40868"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media?parent=42917"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/categories?post=42917"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/tags?post=42917"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}