There are many advantages of having access to a physician from your computer but there are also many disadvantages such as privacy reasons. Some physicians believe that it is appropriate to share professional and personal information yet some argue that physicians need to maintain appropriate online relationships and should have separate profiles for their personal lives. Many doctors found social media to be the perfect way to connect to patients and post health information for easy access. Patients are excited to be "friends" with their physicians and be able to ask a question or get in touch with them through social networks.
This article explores the risks and benefits of social media in terms of physician-patient relationship.
This article on the Atlantic Health site reminded me of a near-constant discussion that went on during my time in med school curriculum planning. Basically, as time went on, students as a whole became less and less enthused about lectures, while faculty and administrators became more and more split about the place for lectures (and their importance) in the medical school curriculum.
Frequently there would be feedback from students about lectures such as: "it was too dry", "they read off their slides for an hour", "bad pacing", "the content was unclear", or the dreaded "I just got up and left". Students who routinely went to lectures would "warn" their classmates when it was better to just read the materials provided, or to listen to the recording at double-speed (for those slow-talkers). But just as often (at least once a week), there would be glowing feedback on a particular lecturer: "really engaging", "simple and clear", "didn't have too many slides", "good use of images". There were the lecturers who could always make the students laugh, or who used songs as mnemonics (or just to entertain). There was the rogue faculty member who shirked PowerPoint altogether and kept the students engaged for an hour with just an overhead projector and his own physical acting ability. Some of the best feedback came about lecturers (like those mentioned in the article) who told vivid, real-life stories to bring the content alive, or who brought in patients and/or families to relay some of the more esoteric medical lessons to the students.
Faculty feedback regarding lectures ranged from "I don't want to be here any more than you do", to "attendance should be mandatory for every lecture", to "we need to get with the times and realize modern students don't want to learn the way we did 20 years ago". Sometimes it was a factor of age, but mostly it had to do with the faculty member's own ideas about teaching: the most effective ways, how long it should take, how much they embraced technology, and how personally rewarded they felt by teaching activities. And not surprisingly, the faculty members most open to changing didactic styles were those who were generally considered good lecturers: it's because they cared. They cared how the students heard and processed the information, about how engaging and interesting they could make it, about how materials such as slide sets or images would complement their spoken words, and about how to structure a lesson to yield the most benefit to the learner.
My experiences regarding the extremes that come along with using lectures as pedagogy in medical education mirror what is described in the article. Students don't hate lectures if they're done right, and faculty members who do it right get good reputations that follow them for years (decades, in some cases). These are the faculty who craft learning goals to start the lecture and review questions to end it, sandwiching engaging stories in between. They could bring in the human side of medicine without being "too soft", and provide pearls of wisdom and lessons in humanism and professionalism.
There is a place for lectures in medical education, and it is where the best lecturers can be found and have their talents nurtured: providing them an arena to do what they do best. But the first step is listening to the students. They know what works and what doesn't. It's time we start trusting learners to speak about the best ways to help them learn.
Two articles came out this week regarding patient satisfaction surveys, and they reflect rather differing views. The first is an opinion piece from the NEJM, which posits that patient satisfaction metrics, if gathered and analyzed properly, seem to speak to several facets of quality of care such as communication and clarity of explanations and decisions. The authors in this piece carefully lay out concerns regarding these measurements, including the fact that satisfaction ratings may reflect how closely the provider's care decisions (types of medicine, tests ordered, etc.) match to what the patient wanted for themselves before walking into the office - in other words, that the doctor did what the patient wanted them to. They also go through some of the reasons why the results of these surveys tend to be inconsistent, such as the timeliness of the survey in relation to the care event, whether it focuses on a specific visit or "overall" satisfaction, the lack of risk-adjustment of the outcome data, and the wide variety of methodologies currently being used. The authors end by stating that patient satisfaction shouldn't be ignored, and that if measurement experts can fix the underlying issues with these surveys, that a rich source of data could be gathered from the results.
In the second piece, an article in the newest issue of Forbes, they turn to the negative aspects of patient satisfaction surveys - positing that they adversely affect health care delivery. Some recent analyses of patient satisfaction measurements have indicated that providers may be altering behavior or making decisions in unanticipated ways, in order to increase their ratings. Examples given in the article include a physician admitting a woman to the hospital after symptoms of a stroke at the insistence of her family, despite the doctor feeling it was unnecessary; and hospitals providing "Vicodin goody bags" to people being discharged from hospital stays. Both of these kinds of behaviors on the part of individual providers and hospitals have one sure-fire result: driving up the cost of care. The magnitude of the waste of resources in these scenarios is rather astounding.
But such provision of unnecessary medications or procedures may also end up harming some patients, either through complications from testing, drug interactions or side effects, or allergic reactions. The fear of bad ratings from patients should probably not be at the top of a provider's mental checklist when making care decisions - in fact, it probably shouldn't be on the list at all. But patient satisfaction surveys are everywhere. And potentially because of this "survey ubiquitousness", 0verall response rates have been declining since 2007 - people are getting over-surveyed. This leads to small sample sizes from which no reliable conclusions can be drawn, as well as to voluntary response bias: only those who feel intensely one way or another (very good or very bad) reply, over-representing those with strong opinions.
Near the end of the Forbes article, the author states what I was thinking while reading it: if providers would just take the time to explain their thought- and decision-making processes with patients (why they won't give you antibiotics for the common cold, or write out an unlimited supply of oxycodone), it may greatly clarify the care conditions, and lead to better-informed patients. This is also something brought up in the NEJM article as a category of care experiences that correlate with satsifaction! But will that extra time and attention in the form of detailed information lead to better-satisfied patients? Knowing what I know of human nature, probably not. As the article states: "You can tell people to eat their vegetables all you want; they’re still going to remember more fondly the person who gave them a slice of cake."
And yet, patient satisfaction and well-being is extremely important: it is, in fact, the point of medicine in the first place. And patients desperately need a way to voice concerns, applaud excellent care, reinforce positives, and attempt to change negatives. If satisfaction surveys are going to continue to be used (and to be used more and more), it is clear the issues surrounding the measurement of such a complex aspect of health care will need to be thoughtfully addressed.
It turns out that a couple of years ago, the Watson team at IBM thought it would be a good idea to teach Watson the entirety of the Urban Dictionary, in order to give him a more natural, true-to-human-language lexicon. But, since Watson isn't a person and evidently doesn't know how to censor himself in the workplace, he started using curse words in replies to researchers. And it would seem that some of the subtleties of language such as slang, modern acronyms (OMG), "mash-up" terms ("blog" or "twitterverse") and derivatives ("tweeps", "pokes") are beyond Watson's abilities to correctly integrate.
So the researchers went in and wiped the Urban Dictionary from poor Watson's hard drive. Now he'll never be cool!
Cerego is a new online resource that claims it will help you learn topics better and retain the information longer, using lessons gleaned from neuroscience and cognitive research. The platform offers users online sessions that act as "electronic flashcards" in over fifty topics including statistics, the periodic table and American Sign Language. The system is designed to reach all types of learners - those who learn best via text, image, repetition, or verbally. They call themselves a "memory management tool", attempting to optimize memory for "better learning".
Algorithms in the system actually learn with you, as well. It tracks your status as you progress through lessons, providing users with a strength score, based on such factors as your overall performance on an item.
The folks at Cerego are also interested in partners, either from the learning engine side (developing the platform that dynamically provides lessons to users), from the individual side (developing the progressive profile of a user), or to develop new lesson modules.
You can learn more about the capabilities of Cerego, along with the science behind it, in this super-cool video:
Happtique, the mobile health application store and app manager for health care providers, has created a system called mRx. This pilot program (which was slated to end in December) gave authorized providers a way to electronically prescribe health-related apps to their patients. The hope (and belief, for some) is that the use of medical or fitness-focused apps will improve communication between patients and providers, increase patient engagement in their own health care choices and plans, and strengthen adherence to such plans through the use of mobile technology and well-designed apps that are fun and educational.
The pilot focused on the specialties of cardiology, rheumatology, endocrinology, orthopedics, physical therapy and fitness training; and utilized the expertise of practitioners in those areas to come up with a list of approved apps. However, providers in the pilot could prescribe any app of their choosing.
I look forward to reading about the results of the pilot, and feedback from providers who utilized the system. There are loads of apps out in the market for everything imaginable, and having a way to sort out the bad from the good from the best will be invaluable for patients. I foresee this as a great resource not just for patients, but for providers as well - a place everyone can go to learn about new apps and widgets, leave or read feedback from users, and try out apps to determine the best one for individual needs.
That subject line makes it sound like I'm trying to start some sci-fi-esque war.
Which isn't the case, I promise (despite loving sci-fi as I do). This article from the New York Times health section has gotten me thinking, though. The human subject of the article, Dr. Gurpreet Dhaliwal, is clearly a master diagnostician. Understanding how he uses, synthesizes, ignores, and prioritizes information to come to accurate and timely diagnoses is very important. There are a number of people doing research in micro-decisions, micro-assessments and mind-mapping: trying to sort out and categorize how experts' minds work. What makes an expert quickly ascertain that they can dismiss certain information, while a trainee may be sidetracked by this unimportant noise? Mapping the minds of experts like Dr. Dhaliwal and carefully plotting their internal rubrics and organizational schemes is something researchers in many topic areas (medicine, education, neurology, cognitive psychology, computational engineering) are putting a great deal of resources into.
I think much of that work will end up going to inform the design of AI/software programs to assist in diagnosis and planning for treatment. And it's true that computers can do this much faster than humans. It is pointed out in the article that there is no way a person can keep up with all of the publications, literature, articles and guidelines that are continuously released. Whereas a computer can be fed every new piece of information almost instanteously, and then begin to use that data to analyze and make decisions.
However, I really want to believe that these tools are being developed to work in conjunction with human caregivers, and not as a replacement of them in any way. I spent the last two days being privy to an expansive and fascinating conversation about the importance of human beings in medical care, and how to optimize those who provide it. It would be great if some of the work in expert mind-mapping and micro-decision-making could be used to teach future human doctors and caregivers how to think like experts too.
We all agree that each year, some of our best and brightest enter medical school. It would be a severe disservice to those future physicians AND their patients if they end up heavily dependent on software-based diganostic programs, instead of using our knowledge and resources to improve their human ability to recognize patterns, second-guess, consult with others (human or otherwise), and... think. I feel as though what is being written now about projects such as Watson Health Care read as somewhat of an either-or: computers to take over where humans fail or err. However, I think we can learn from the research being done and integrate the processes of experts (not just in diagnosing, but in communication skills, empathy and humanism, literature analysis, and so on) to create "gold standards", from which humans can learn and improve.
We had our advisory committee meeting this week, which resulted in nearly two full days of excellent discussions. One of the discussions revolved around the use of games in health care - what is already being done, and what else could we envision being done in the future?
It was agreed that games and play are an innate part of human nature, and that there are many people (more every day, if you look generationally) who understand, value and deeply enjoy games in their lives. With the rise of gamification in many realms (business, education, personal improvement, social impact) and the need for new ways to both engage patients and give them feedback and instruction on their care and choices, it seems obvious that innovating new health-related games for both patients and providers is an important future focus.
I have blogged before about health-related gamified sites; but was really excited and inspired during our committee's conversation, and ended up recording many more ideas that came up in the discussion. They include:
- simulations for providers (surgery or other procedures, communicating with patients or team members, etc.)
- simulations for patients (shared decision-making, simulations of difficult procedures or treatments, compliance with care regimens, etc.)
- compliance with hand-washing protocols in hospitals and other sites of care
- milestones and competency-based progression schemes in medical education and training
- improving skills in systems-based practice, team-based care and learning, and other hospital/institution issues
- improving skills in giving and receiving feedback, and rating/assessing learners or team members
Obviously if work is to be done in any of these areas, it will have to be done very carefully and thoughtfully. But it was enlightening and informative to be able to get reactions from educators and practitioners about the potential future for this innovative new domain.
This is a very interesting article by the New York Times about the pros and cons of Electronic Health Records. The start of electronic health records has resulted in patient safety along with other beneficial contributions; however there have been many unintended consequences as well. From copying and pasting inaccurate information to false documentation of services, electronic medical records have been linked to both positive and negative outcomes.