The future of medicine: 2012 edition
Livescience.com has a list of five expected medical advances for the year 2012, and they are:
- the use of vaccines in cancer treatment (not just for prevention)
- better vaccines for malaria
- better air quality regulations
- cheaper life-saving drugs
- clearer consumer information regarding health insurance plans and the nutritional content of food
What I like about this list is that it is partially focused on prevention/pro-action and not just reactive health care (which is frequently more expensive and less efficient). All good things: giving consumers more (and more comprehensible!) information regarding the food they purchase and eat, cheaper medication (such as drugs for diabetes, rheumatoid arthritis and heart disease), clear summaries and comparisons of health care plans, a wider variety of cancer treatments (which may end up being less invasive and with fewer side effects), and better vaccines for life-threatening illnesses like malaria.
2012 may have a lot to look forward to!
Avoiding medical errors
Medical errors are unfortunately a big part of our health care. Medical errors do occur and sometimes are unavoidable, however there are things that patients can do to prevent or decrease errors. Taking steps and being persistent can help avoid being a statistic. Communication, monitoring, and being involved can help patients avoid errors from happening to them. Being engaged in one’s own treatment and having access to medical records is a great start to living a healthier life.
Technology to bridge language barriers
Barriers such as access to care, no health insurance, and language create big dents in our health system and keeps patients from receiving the treatment they need. The Howard County General Hospital unveiled a tool that will stream videos to provide live interpretation services to patients. This service will be instantaneous and will cater to 170 languages including Spanish, Korean, Mandarin Chinese, and even deaf communities. The tablets access networks of interpreters and goes as far as reading patients body language and other visual cues to assist in accurate interpretations. This is a great tool to remove health barriers which prevent patients from receiving proper care.
What a concept: human-friendly hospital rooms
Michael Graves designed this bedside table with patients in mind
I've always found it a little odd that patients (disabled, blind, chronically ill, etc.) aren't consulted when hospitals, rehab facilities and doctor's offices are designed. I actually wonder if they're considered at all. I've gone to dermatologist appointments in the winter in a brand-new state of the art building that is frankly, too cold to be in fully clothed. Rooms with walls made of glass, floors of icy tile, and soaring 15+ foot ceilings aren't the best place to have a full body scan. I can't imagine being a patient going through chemo or radiation and having to be in that building multiple times a week. While I think natural light and colorful artwork definitely helps overall health and healing in an aesthetic way, there are other things to consider (like having rugs in the rooms where barefoot patients are waiting for 40 minutes to see a doctor in the middle of winter).
Renowned architect Michael Graves gave a talk regarding hospital and exam room design at the 2011 TEDMED conference, where he highlighted a lot of these issues, and gave numerous ideas for improvement and change. This article and the video of the talk itself (also at the link) are worth visiting, because it gives the perspective of a patient who is also a designer - one, in fact, who has spent his life integrating form and function. He is one of few people in the position to be able to see both sides of this issue, and be the one to know how to fix it. Now paralyzed and wheelchair-bound from an extremely rare infection, Graves can look around and see where current hospital and rehab center design has gone wrong. It may be that he is the one to show how to keep the bright, colorful and sensory-pleasing elements of current modern architecture, and incorporate sensible, patient-friendly features as well.
Allowing patients to see their EHR data..?
Over the last two days I was involved in a meeting regarding health care data - data for and about physicians, and data for and about patients. A lot of that data overlaps of course, and our discussion revolved mainly around what kinds of information health care professionals need to see about themselves in order to facilitate lifelong learning and improvement. Other aspects of the discussion included how to assure the data is accurate, timely, secure, useable, and wanted; how to incorporate quality feedback with resources and tools for learning; and how to try to create culture change around the use and availability of high-quality health care data.
Today the discussion veered into the realm of patients: how to get them actively participating in decision-making, how to get them engaged in their own health and care, and what kinds of data should patients be able to see. For example, when a patient is choosing a provider or hospital, what kinds of data would help inform their decision? Should patients be able to see certain metrics or assessments regarding their physicians? Which ones should be public, and which private? I doubt patients and doctors will ever agree on these matters, but as the openness and availability of information grows every day, they aren't soon to go away.
Today I came across this article regarding a JAMIA review of why patients can't readily see their own EHR data. It touches on many of the topics we discussed this week, and it doesn't seem to get to any firmer ground than we were able to. The author points out that research suggests sharing a patient's health data with them, when integrated with education and clear communication, tends to improve efficiency, quality and patient satisfaction. However, there are also a number of obstacles and issues regarding sharing EHR data with patients. These include:
- data fragmentation
- privacy implications and legal concerns
- when should data be shared?
- which portions of the EHR should be shared?
- whether doctors should be able to screen certain things first (like lab results)
- whether patients can understand much of what they would read, and if doctors have the time or resources to translate it for them, and
- who actually controls or owns the EHR data?
This last point is very intriguing to me, as again, I think there is a great deal of disagreement about it. As a patient, I believe that my data is always mine and should be available to me whenever and however I want it (besides, as was mentioned today, the EHR may contain incorrect information that I would want the opportunity to check over and fix if possible). However, I know that many physicians and health care systems (let alone EHR vendors, insurers, etc.) may disagree with that. This debate is bound to go on for the foreseeable future, with many different sides weighing in. And despite the fact that I am a patient and not a doctor, I can see both sides of the issue.
It will be very interesting to see where this conversation goes, and how it ends up.
Do “nice” doctors make better doctors
Downside of Doctors Who Feel Your Pain
Do "nice" doctors make better doctors
The relationship between a physician and a patient is a crucial factor for health improvement. When physicians possess certain skills, chances are patient will be more inclined to communicate with the doctor and be more involved in their treatment. This article debates whether communication skills can be one of the requirements of medical school entrance and if so, how can it even be measured. Assessing potential medical student’s communication skills is not easy and there is no existing evidence that states that physicians with expert communication skills are better doctors than those lacking the skill. The question is how much of a factor this is and how much emphasis should be placed on communication skills in future physicians.
Friday roundup
A diverse set of interesting articles I've come across recently:
An article describing various viewpoints on taking care of Jehovah's Witnesses in life-threatening situations. I like the idea of talking openly and honestly about sympathy, empathy, and the role of the physician in terms of the patient's personal or religious beliefs. This is a touching and insightful piece that may be a challenging read for some, but highlights the very important topic of cultural sensitivity, and how healthcare professionals can frame religion and culture within the world of medicine.
A thought-provoking piece illustrating some of the thoughts of Seth Godin regarding the future of education. He posits that the "Harvard model" is dead: high-priced institutions that hold classrooms of 15-300 students, being lectured to by professors on the "accumulating credits" system. Instead, he envisions a future of online, collaborative education where students can also be instructors, and physical space is replaced with digital space. He mentions the modern notions of online communities and the free sharing of and expansion upon data and ideas.
The AAMC has released the published responses to their 2011 "Question of the Year": "What improvements in medical education will lead to better health for individuals and populations?" The replies run the gamut from nutrition to financial incentives to competency-based education and beyond. Other topics include diversity, health disparities, leadership, professionalism and global health. Must-reads for anyone interested in medical education, public health, reforming healthcare, professionalism/humanism, patient safety, and pretty much any other healthcare-related topic.
An intriguing summary of the future of computing and IT points out the importance of Natural Language Processing programs, and where they are headed. When thinking about what the next generation of computers and applications will need to do, the ideas of detailed data analytics, human-like "thinking", situation/information comprehension, and insight into users/consumers are top on the list. Sentiment analysis, contextual understanding and those kinds of data manipulation and analysis are already being researched and developed at a frenetic rate (and with astronomical sums of money). Considering the ever-increasing amounts of data being created on a daily basis, it is no surprise that the next wave of computer innovation is going to revolve around making sense of it all.
Teaching doctors to be mindful
Mindful communication training for doctors has been shown to improve physician-patient communication, decreased exhaustion, improves attentiveness and focus, and improves over all engagement with patients. Such meditative training also decreased physician burnout. The physicians who participated in this meditative training found a sense of meaning in their practice and in their patient’s treatment resulting in a higher level of compassion towards their patients.
While there are many great benefits that result in this training, the dilemma is finding the time from physicians busy schedules to participate in such a program. With today’s health system, doctors are torn between patients and paperwork and can barely find time to spare an extra few minutes to patients. Finding time for such a program could result in effective physician-patient relationship and improving patient engagement in their own health.
Putting people before profits
A fascinating article from The Atlantic about the California-based CareMore healthcare group, which uses unorthodox methods to increase efficiency and quality of care to its patients. CareMore sees and treats elderly patients, and focuses on increasing compliance and tackling the problems that keep older adults from making appointments (by providing a free car service), keeping up with vitals and diet/exercise regimens (by phoning or visiting them at home and having scales, BP cuffs and other readers send statistics right to the office from the patient's home), and filling or refilling prescriptions (by providing daily pill box sorters and pre-set reminder alarms for free)
And, CareMore has better outcomes and lower costs than many other providers:
CareMore, through its unique approach to caring for the elderly, is routinely achieving patient outcomes that other providers can only dream about: a hospitalization rate 24 percent below average; hospital stays 38 percent shorter; an amputation rate among diabetics 60 percent lower than average. Perhaps most remarkable of all, these improved outcomes have come without increased total cost. Though they may seem expensive, CareMore’s “upstream” interventions—the wireless scales, the free rides to medical appointments, etc.—save money in the long run by preventing vastly more costly “downstream” outcomes such as hospitalizations and surgeries. As a result, CareMore’s overall member costs are actually 18 percent below the industry average.
A very interesting case study in "upstream" interventions.
Curriculum changes for School of Medicine
The University Of South Alabama College Of Medicine is taking a new approach towards medical school education. The education shift will be from lecture based classes to a more hands on approach. Classes will focus on a more system based curriculum, studying each organ individually, and working towards gaining more clinical experience. All students are said to receive instructions in the ACGME six core competencies. Students will receive more learning experiences in their years as a medical student than ever before.
The new approach is said to have many benefits to future patient care and improvement of physician education.