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Physician-specific traits such as empathy, trust and personality play a pivotal role in the outcome of treatments. These traits may also have an impact on medicalization; however, little is known about this subject. A physician's personality has an impact on his or her general outlook on life and how s/he acts as a doctor; this may result in errors of judgement and bias. This risk of errors of judgement and bias can potentially have a significant impact on patient-physician contacts and treatment choices. In this article, I describe possible negative consequences of pathological personality traits on treatments and I cover certain errors of judgement and sources of bias that can have an impact on medicalization.

Objective: To investigate whether language used in science abstracts can skew towards the use of strikingly positive and negative words over time., Design: Retrospective analysis of all scientific abstracts in PubMed between 1974 and 2014., Methods: The yearly frequencies of positive, negative, and neutral words (25 preselected words in each category), plus 100 randomly selected words were normalised for the total number of abstracts. Subanalyses included pattern quantification of individual words, specificity for selected high impact journals, and comparison between author affiliations within or outside countries with English as the official majority language. Frequency patterns were compared with 4% of all books ever printed and digitised by use of Google Books Ngram Viewer., Main Outcome Measures: Frequencies of positive and negative words in abstracts compared with frequencies of words with a neutral and random connotation, expressed as relative change since 1980., Results: The absolute frequency of positive words increased from 2.0% (1974-80) to 17.5% (2014), a relative increase of 880% over four decades. All 25 individual positive words contributed to the increase, particularly the words "robust," "novel," "innovative," and "unprecedented," which increased in relative frequency up to 15,000%. Comparable but less pronounced results were obtained when restricting the analysis to selected journals with high impact factors. Authors affiliated to an institute in a non-English speaking country used significantly more positive words. Negative word frequencies increased from 1.3% (1974-80) to 3.2% (2014), a relative increase of 257%. Over the same time period, no apparent increase was found in neutral or random word use, or in the frequency of positive word use in published books., Conclusions: Our lexicographic analysis indicates that scientific abstracts are currently written with more positive and negative words, and provides an insight into the evolution of scientific writing. Apparently scientists look on the bright side of research results. But whether this perception fits reality should be questioned., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

This article describes the role played by a patient's mental competency in the assessment and treatment of patients who are under the influence of alcohol and expressing suicidal thoughts. The factors that should be taken into consideration in the assessment of suicidality are not always clear: somatic complications or possible discharge from the emergency room. The treating physician at the emergency department should evaluate the mental competency. The risk of suicide should also be assessed by a psychiatrist. In order to make the right decisions about treatment and mental competency, the key concepts of proportionality, effectiveness and subsidiarity in the assessment of mental competency are crucial. These concepts require a personalized, multidisciplinary approach and result in unique decisions which may differ from case to case. In the assessment and treatment of patients under the influence of alcohol who are suicidal and do not want to have a proper medical evaluation, communication between the emergency physician, internist and psychiatrist is crucial to optimize both evaluation and treatment. In this context, tasks and responsibilities should be clearly defined in order to minimize the risk of errors and complications.

Patient autonomy is a fundamental issue. Sometimes it is unclear whether a patient is capable to consent to a treatment decision. The treating physician judges whether a patient is able to provide informed consent. This judgement is a medical and not a legal decision. Considerations as to whether a patient can provide informed consent should always be systematically and in detail included in the medical records and should be periodically re-evaluated. Even if a patient incapable to consent to a particular medical decision, efforts should be put into finding the optimal treatment (proportional, effective and least substantial). It can be useful to involve a psychiatrist as a second and independent judge of a patient's ability to provide informed consent. A psychiatrist can also judge whether a psychiatric or cognitive disorder influences the ability to consent.

The journal impact factor (JIF) and the Hirsch index, are two widely used parameters for evaluating scientific achievement. The JIF is a parameter which shows the citation score of a journal over the previous two years. The Hirsch index is a simple index to measure the citation performance of individual scientists. These achievement indicators can be used to evaluate research and are thus an indicator for scientific output. Nevertheless, they should not be used as a measurement of scientific quality. Scientific quality not only depends on citation scores, but also on originality, societal and scientific impact, robust methodology and validity and should therefore be evaluated on these parameters. Little is known about the influence that these factors have on science in general and on scientists but there is some evidence suggesting detrimental effects on scientific practice and quality.

Introduction: The H-index is a frequently used scale to rank scientists on their scientific output. Whether subjective feeling of happiness is influenced by the level of the H-index on scientists has never been investigated., Objective: To investigate the relation between the level of the H index as a measure of scientific success and feelings of unhappiness among Dutch professors., Design: Descriptive; national online questionnaire., Method: All medical professors working at the Dutch university medical centres were invited to participate in an online questionnaire. Pressure to publish was measured by a questionnaire developed for this purpose and signs of burnout were measured on the Utrecht Burnout Scale. The area of emotional exhaustion on this scale was used to measure feelings of unhappiness. Every professor was asked for his or her H-index as an outcome measure., Results: A total of 437 professors completed the questionnaire. Those in the highest tertile of the H index had significantly lower scores for emotional exhaustion (p < 0.025). Younger age was correlated with an, on average, higher score for emotional exhaustion. Professors with children living at home had a 25% higher score on emotional exhaustion than those who did not (p < 0.01)., Conclusion: The H index appears to be of influence on emotional exhaustion: a lower H index is associated with higher scores on emotional exhaustion while a high H index is associated with lower scores.

There is a discrepancy between the recommendation for caution and daily practice in the prescription of benzodiazepines. Although there is heterogeneity in the registered indications, all benzodiazepine agonists have almost the same mechanism of action. There are, however, substantial pharmacokinetic differences between individual benzodiazepine agonists. During short-term use of benzodiazepines, the elimination half-life is no measure of duration of action. Benzodiazepine lipophilicity determines the speed of action. If a rapid effect is desired, for instance in acute anxiety or agitation, then regarding oral medication the use of a lipophilic benzodiazepine such as diazepam is a rational choice. An accumulation factor can be used to estimate benzodiazepine accumulation during chronic use. In theory, accumulation does not occur with once-daily dosage of benzodiazepines that have an elimination half-life markedly shorter than 24 h, such as oxazepam, temazepam, and lorazepam.