What doctors are telling us, even when they’re not talking
This article by Dr. Pauline Chen highlights some of the important issues surrounding non-verbal communication between doctors and patients.
Non-verbal cues such as facial expressions and body language are deeply ingrained and very difficult for a person to change. I often get told that I have an expressive face (for example, when I'm annoyed or confused it's usually pretty obvious to those nearby), and even though I suppose I have to trust those around me when they tell me that, I still secretly think I must have a poker face.
And that gets at the complexity of this issue - many people don't realize the kinds of non-verbal communication they put forth. And patients, who can be in painful, confusing or vulnerable situations, often rely on body language and facial expressions for cues to understand what a doctor is really telling them. Dr. Chen reports in the article that not much research has been done on this aspect of the patient-doctor relationship, but I suspect that will change very soon (particularly given the issues surrounding gender, race and cultural competency discussed). But even then, I struggle with ways this could be integrated into medical school communication curricula. Perhaps a discussion about it will increase self-awareness of non-verbal language cues, and that is a good place to start.
Physician communication portal
A new clinical communication platform aims to improve health by connecting physicians and nurses. PerfectServe platform connects over 20,000 physicians and 50 hospitals. The platform is processing over 35 million communication transactions per year between physicians and nurses. This communication tools allows health systems to streamline clinician communication and possibly remove communication breakdowns which result in patient safety being negatively affected.
The system allows physicians to stay in contact and share data quick and easy. Nurses spend less time tracking physicians which improves patient care. The system provides convenient access to the portal through smart phone apps and tablets access. The system has many advantages in the clinical setting and can expend to provide additional services.
Patient Engagement
A new integrated system aims to increase communication between physician and patients and increase patient engagement in their own health. This project will enhance patient enrollment, secure patient/physician messaging, and give patients the ability to access their test results and other health records online. The system is said to improve healthcare through greater care coordination, patient-physician engagement, and information technology.
This is a great start to improving patient-physician relationship and giving patients the ability to be easily involved in their own healthcare. Allowing patients to have access to their own information at any time, gives them a sense of involvement. More systems should be created to encourage patients to be active in their health and treatments.
The importance of social and environmental factors to health
A brief essay on the importance of the patient-doctor relationship by Ricky Choi, MD posted on Kevin MD. Although he doesn't frame it that way, I feel that this is partially about the value of taking time with patients to do a thorough H&P, investing in a real conversation, and asking probing questions. I had a similar experience recently, where I was having a prolonged allergic reaction of which I couldn't pinpoint the origin. My doctor (whom I like very much and trust implicitly) spent at least 30 minutes with me, asking about pets, carpets, soap and cleaning products, my work environment, the plants in my backyard, and more. When we together were unable to determine a likely cause, he sent me for allergy testing which resulted in me learning that I had developed an allergy to cats (unfortunate, as I live with four!)
But the main point of this essay is also very important - the social and environmental factors related to our health are often overlooked or underrated. Maybe we all just need to go to doctors like House, MD - I'm always amazed and more than a little amused when the young physicians on that program are shown rooting around in people's closets and under their bathroom sinks for clues to mystery illnesses. As if! Although, he is really rather awful at the patient-doctor relationship thing, so perhaps that's not such a great idea after all.
Transforming the educational experience
There are two great articles currently on GOOD: the first is about a new kind of classroom-less college for adult learners; and the second is about transformational schools that are working to create new notions of learning and teaching.
College Unbound is a new learning system that allows students to focus their education around a particular passion, interest or goal. Individualized plans are created for each learner, incorporating online seminars, technology and team learning, and an internship or job where the student gets to master and incorporate real-world skills into their educational objectives.
Some scary information from the article:
"How broken is the system? Over the past 20 years, the United States has fallen from first to 12th in the percentage of young people with postsecondary degrees. Tuition’s doubled in the past decade, rising faster than any other item in the Consumer Price Index since 1978. Student loan default rates are increasing. Only 56 percent of students complete a four-year degree in six years. And a nationwide study last year, using a test called the Collegiate Learning Assessment, found that 36 percent of students demonstrate no gain in learning between freshman and senior year."
I think we all know that the higher-education system is broken, and there are a lot of opinions out there right now about how to fix it. But sometimes it feels like people are just throwing ideas against a wall to see what sticks, and so many are being tested right now that it will likely be decades before any one design comes out on top. But it seems more and more as though "integrated, experience-based and outcome-based" strategies like College Unbound are coming into vogue, and I hope that (with increased funding) they can start to pull together the data they need to prove that it's a worthwhile system for many adult learners.
In a similar vein, educational activist Sam Chaltain is asking his readers (and the general public) to submit the names of schools they feel are "transformational", based on the Q.E.D. Foundation's Transformational Change model. The Q.E.D. Foundation states that truly transformational education is where students find the "skills and know-how to co-create their public world, to participate in their community and help shape the local and global decisions that will impact their lives". I enjoyed reading over the 22 traits of a transformational school (and learned a lot!), and am discouraged to hear that only two schools have so far met his requirements. I truly hope that more educators, parents, and administrators read the Transformational Change Model and start brainstorming ways to incorporate the ideas there into a more progressive system for students of all ages.
Surgeon assessment
The da Vinci robort is a devise that scales down a surgeons hand movement in order to allow him to perform operations using tiny incisions. This innovation allows for less tissue damage and a much quicker recovery period for patients. There are over 200,000 being used for surgical procedures today.
The newest innovation to the da Vinci Robot is the MScore which assesses the robot to more reliably predict whether new surgeons are ready to operate on patients. MScore compares the skills of novice surgeon to that of an experiences surgeon. This is a great tool for surgeon’s own assessment and continuing growth and skill.
Patient-centered care and cultural conflict
I just finished this fascinating article on cultural conflicts that can exist between patients and physicians. The case presented is simple and realistic, and the commentary provided very thought-provoking. The author touches on a wide array of cultural topics such as autonomy, privacy, and differing cultural standards, along with a thorough dissection of a variety of pre-conceived notions that both patients and physicians may bring to the clinical setting. The article ends with a rational suggestion on how cultural conflicts can still result in quality, patient-centered care, and includes a good justification for when and how to yield to a patient's wishes when they are in conflict with the physician's beliefs.
"Patient-centered medical care is not only a rejection of “my way or the highway” thinking; it is also a commitment to meeting patients on their own terms and respecting their values. We need to enhance our focus on commonality, rather than on difference, especially as the United States becomes more diverse. Providers must avoid thinking in “us versus them” terms—not only because “us versus them” is a false dichotomy but also because such thinking decreases the resolve to meet patients where they are."
3-D virtual anatomy
NYU School of Medicine designed a new and a more innovative approach for studying organs in cadavers. This approach involves a virtual cadaver projected on a screen in 3-D. With a simple click, all organs and veins are projected, allowing the capability to instantaneously navigate through the human body. The reviews of the virtual cadavers were mixed. Some students stated that dealing with a real human cadaver was difficult and often time neglects to cover all organs. The example given is dealing with a cadaver who has undergone multiple surgeries during its lifetime and is now missing its appendix and spleen. In this case the student is left without the knowledge of vital organ parts, while a virtual cadaver will always cover all organs and systems. Other students state that they believe that no computer will ever replace real cadavers. NYU administrators state that as of right now there are no plans to eliminate real cadavers as part of the curriculum but to simply use virtual cadavers to assist in the learning process.
Friday round-up
Federal investigators have released a new report stating that only about 1 in every 7 hospital errors are reported. Adverse events ranging from infections to excessive bleeding to even death are supposed to be reported through systems present at almost every hospital in the US. The systems often allow for anonymous reporting, in order to encourage hospital staff to cooperate. However, as it states in the article: "organizations that inspect and accredit hospitals generally "do not scrutinize" how hospitals keep track of medical errors and other adverse events". And if the accrediting bodies do not scrutinize the process (and results thereof), there isn't much incentive for staff to report. It also states in the article that no new federal regulations regarding this are expected.
The National Science Foundation has released the 14 winners of the "Digging into Data" challenge. The 14 winning projects all involve innovative ways to use data analysis and natural language processing (NLP) to enhance research in the humanities and social sciences. Those interested in large-scale data mining and investigation should read through the winning projects, as they all sound extremely interesting. I think my favorite might be the analysis of newspaper reporting on the 1918 flu pandemic (and not just because most of the PIs are from my alma mater!), in order to see how such reports affected public opinion and the idea of "authority" during the outbreak. I will be eagerly anticipating their results. The 14 winning research projects are sharing nearly $5 million in funds.
Dr. Matheson Harris has written a brief and clear tutorial for patients (with some help from the Chicago Tribune) on how to spot a good doctor (and a bad one!) and how to be a good, educated patient. I really like a lot of what is said here, and agree with the vast majority of it; though it might be a little harsh to tell patients not to go see a doctor who can't see them within a few days. I think it greatly depends on the type of doctor you're seeing, and what the appointment for. I make my dermatology appointments a year in advance because it is so hard to get an appointment at the practice (widely considered one of the best in the nation). And many women in the state of Pennsylvania can tell you about the difficulties in getting an OB-Gyn appointment due to the shortage of those specialists. But the gist of the advice and guidance here is very strong, and all patients should read and take it to heart.
Eight technologies for a healthier 2012
With the fast approach of the New Year, most of us have a New Year resolution. One of the biggest New Year’s resolutions is losing weight and with all the new technological advances, some say that this year may be much easier than the others to do so. The article states that the technology that may improve your health are tracking devises, exercise applications, and devices such as FitBit which counts the steps you take and calculates the calories you burn. While such devised may be extremely helpful in losing weight, the biggest contributor is motivation. Having the desire and will power are first on the list, and then technology which is used as an aide.