Your doctor has sold his practice: 6 tips for patients (tips are also good for doctors not selling their practice!)

Conversation between doctor and patient/consumer. (Photo credit: Wikipedia)

I’m not sure I’d have the chutzpah to ask about performance requirements or conflicts of interest.
But maybe if I went to an office visit with these types of questions written down, I would be more likely to ask them!

(As an aside, I accompanied my mom to outpatient surgery yesterday. The only way I could assure myself I would
ask the surgeon a few questions while mom was in post-op…was to write them down and have them “on display” in what is now called the “interview room”. The surgeon did take note of the scrawled questions and was ever so patient and answered each one completely.
Granted, these were questions related to how to take care of my mom, not his performance requirements or conflicts of interest.
Still, I think I could build on writing down questions about how to take care of oneself or others to include questions relating the necessity of a medical test or procedure.)

I am not sure about two of the points.
Would anyone in the doctor’s office really be candid about performance requirements? Or even know about them?
The office staff has at least the potential about conflict of interest. They work for the doctor (and by extension any health organization the doctor belongs to which could be the source of a conflict of interest!) Maybe it would be best to ask the doctor directly.

Online databases and forums are most likely not objective. They only record input from folks. And the input is not evaluated for “truth”.
Crowdsourcing at times can point to the truth, but I believe at times crowds can be misinformed (and act on rumors). And I don’t think that online databases/forums can readily distinguish when reports are based on fact or falsehoods.

From the 3 January 2013 article by Cary Present, MD at KevinMD.com

When doctors sell their practices to hospitals or networks, the practices are typically restructured. When they restructure, the new arrangement can put the doctor under more pressure to treat you (the patient) more “economically,” so as to generate more income. This can mean ordering tests or prescribing medicines that you may or may not need – things that are more for “let’s just be safe” and would be avoided in a private practice.

What does this all mean for you as a patient? Other than potentially higher medical costs, possible deterioration in treatment, and a lack of personal attention as a person, it boils down simply to a conflict of interest. In other words, there is greater potential for disagreement regarding what is in your best interest according to convention and how the doctor or hospital treats you…

..

• First, when your doctor is recommending tests or treatments or hospitalization for you, take the time to ask if you really the treatments – ask if the doctor would do the same for a family member
• Second, ask for a second opinion to determine if you need the recommended care – this should be your standard reaction when tests are ordered…

Read the entire article here

Related articles

• Doctors took money, wrote treatment guidelines (HeraldReview.com)
• Doc faulted for overmedicating patient made big bucks teaching other docs how to prescribe (Syracuse.com)
• Physicians Cautioned about Divided Loyalty between Patients and Hospitals (labsoftnews.typepad.com)
• Physicians fail to disclose conflicts of interest on social media (medicalxpress.com)
• Patient power troubles GPs (theage.com.au)
• The empowered patient (theage.com.au)
• Follow the Money: Hospitals and Doctors Put Profits over Care (mcntalk.com)
• UVa Med Center Gets “D” Grade for Patient Safety (newsplex.com)
• AMA Reaches Out to Doctors To Remind Them Patient Welfare Must Come First As Rising Pressures From Insurers and Hospitals Can Surmount At Times (ducknetweb.blogspot.com)
• One in three have online medical record, many without knowledge – Telegraph [del.icio.us] (telegraph.co.uk)
• Medical bill saga is tip of morass of healthcare issues (gazette.com)
• Beyond Informed Consent: Shared Decision-Making|Harriet Hall|Science-Based Medicine (sciencebasedmedicine.org)

You’re seeing the wrong gynecologist: 6 red flags

 

From the 9 August 2012 article at KevinMD.com

As a doctor, I appreciate that I am at an advantage when I seek medical care. Knowing terminology and basic medical principles helps a lot. In addition, when you’ve been practicing medicine for a while you get a feeling from how a doctor discusses options if the care seems valid or if a second opinion is in order. Other things I look for are board certification and a doctor who explains their treatment plan in the context of recommended guidelines.

 

Summarizing everything that combines to make good medical care is very hard. However, from time to time I take unfortunate histories from patients or hear stories of medical misadventures from friends and I just cringe. Actually, they make me want to shout, “Your doctor did/said what?!” These are red flags, because not only are these recommendations potentially harmful, but if your doctor recommends one thing that is so flagrantly bad, well, uh, um, how can you trust the rest of their care?

So, these are six red flags that would make me stop and not pass go. They would make me get up, get dressed, and say, “Thanks but no thanks,” and walk out the door looking for a second opinion:

1. A prescription for estrogen containing birth control (pills, patch, or ring) with no inquiry about migraines. Why? Migraines with aura are an absolute contraindication to estrogen containing birth control (do to an increased risk of stroke) and if your doctor were up to date on the WHO/CDC guidelines he/she would know that. I want my doctor to be up to date on guidelines, you know?

2. B….

Click here to read the entire article

 

Related articles

• 6 warning signs you’re seeing the wrong gyno (drjengunter.wordpress.com)
• Migraine 101: Menstural Migraine (somebodyhealme.dianalee.net)
• Prolonged Periods: A Cause for Concern? (everydayhealth.com)

 

The problem with transformative technologies in medicine

http://www.healthxchange.com.sg/healthyliving/HealthatWork/Pages/top-5-health-apps-to-download.aspx

Yesterday I reflagged an item about the  Free UMSkinCheck Mobile App.
While these self check apps are wonderful consumer and patient tools, they are not without “problems”.
This KevinMD.com post outlines health app use challenges as folks gathering data without knowing what to do with and reimbursement issues (physician consultations outside of the office).

Article ends with statement “Until our system puts more value on avoiding unnecessary treatment and keeping people well we will be stuck in this struggle between patients who want to avoid seeing the doctor and doctors who can’t afford to let patients do that.”.

The problem with transformative technologies in medicine

by ROB LAMBERTS, MD(KevinMD.com post, 17 July 2012)

Eric Topol wrote a post on The Health Care Blog where he looks to a future enabled by emerging technology: “Just as the little mobile wireless devices radically transformed our day-to-day lives, so will such devices have a seismic impact on the future of health care. It’s already taking off at a pace that parallels the explosion of another unanticipated digital force — social networks….

…

large number, if not the majority, of ear infections are undiagnosed and clear on their own at home without intervention.  Now add to this a technology which gives us the ability to see all of those undiagnosed ear infections, and we have to muster even more willpower to resist the urge to treat them all.  This is the same problem as we have encountered with PSA testing: be careful gathering data you don’t know how to handle.

But even without considering this important objection to improved data-gathering, there is another problem which stands in the way of this type of technology: reimbursement.  It sounds great to enable people to avoid visits to the doctor’s office by having tools that previously were only accessible at an office visit.  It sounds like a very good way to save money and wasted time spent in waiting rooms with outdated magazines.  But this technology presumes that doctors will be willing to act on this information without seeing the patient in the office.  It presumes we will be willing to offer free care.  If the time I spend sifting through patient-collected data rises exponentially, the payment I get for that time cannot remain at the present level: zero.

If our goal (as it should be) is to spend less money on unnecessary care, we will get to it much faster if we somehow give proper incentive.  Our encounter-based payment system stands in the way of any progress in this area.  The only way most of us get paid is to see people and deal with problems.  This makes doctors reluctant to offer any care outside of this setting, and puts undue pressure on intervention (to justify the encounter to the payors).  Until our system puts more value on avoiding unnecessary treatment and keeping people well we will be stuck in this struggle between patients who want to avoid seeing the doctor and doctors who can’t afford to let patients do that….

Related articles

• Will Information Technology Squeeze Physicians Out Of Their Central Role In Health Care? (the healthcareblog.com, July 11, 2012)

  “Turns out that while most of us (90%) would like be able to make a doctor’s appointment and check lab results online….85% of us also still want the option of be able to talk to our physician face-to-face.  These are the finding from a recent 2012 study conducted by Accenture.”"

What is significant about the finding cited above is that patients at least get it.  They understand the value of a having a relationship with a knowledgeable physician or similar health care provider.  In spite of, and for some, because of the plethora of health information outlets on the web people want to know that they always have access to your family doc when the chips are down.”

“Here’s what I mean…based upon some 20+ years working in health care:

From the get go…going back to Hippocrates…health and health care delivery has been about the relationships between people starting with the  physician-patient.relationship.

The most important diagnostic tool a physician has at their disposal is not a smart phone…but their ability to talk with and observe  patients verbal and non-verbal behavior.

 “Talk” is not only how physicians diagnose problems and recommend the appropriate treatments…talk is also how patients are able to engage in the health care.  Perhaps the most overlooked aspect of talk (and touch) during the medical exam is the therapeutic benefits patients derive from being able to express heart-felt fears and concerns to someone who hopefully cares.”

• Now Your Smartphone Can Be Used To Diagnose Ear Infections At Home (singularityhub.com)
• Now Your Smartphone Can Be Used To Diagnose Ear Infections At Home (forbes.com)
• Back to the Future: Predicting the Future of Healthcare (Part I) (drchrono.com)
• Three mobile tools that could transform how cardiovascular disease is managed (medcitynews.com)
• Company developing #mhealth ECG device for iPhone, ipad raises $10.5M (medcitynews.com)
• Dr Topol to med students: “When I was in medical school, the term “digital” was reserved for the rectal examination” (casesblog.blogspot.com)

Choosing Wisely – Conversation starters for office visits on choosing health care

From Choosing Wisely – a Web site that aims to “aims to promote conversations between physicians and patients by helping patients choose care that is:

Supported by evidence
Not duplicative of other tests or procedures already received
Free from harm
Truly necessary

 

Nine United States specialty societies representing 374,000 physicians developed lists of “Five Things Physicians and Patients Should Question” in recognition of the importance of physician and patient conversations to improve care and eliminate unnecessary tests and procedures.

These lists represent specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation. Each list provides information on when tests and procedures may be appropriate, as well as the methodology used in its creation.

What tests and procedures should patients and physicians talk about? Read the lists:
[Links at
http://choosingwisely.org/?page_id=13
]
American Academy of Allergy, Asthma & Immunology
American Academy of Family Physicians
American College of Cardiology
American College of Physicians
American College of Radiology
American Gastroenterological Association
American Society of Clinical Oncology
American Society of Nephrology
American Society of Nuclear Cardiology

Related articles

• 5 Things Doctors And Patients Should Question (boston.cbslocal.com)
• Six Common Medical Procedures You Probably Don’t Need (businessinsider.com)
• Medical societies list unneeded tests to reduce healthcare costs (medcitynews.com)
• Physician Groups Call for Fewer Medical Tests (cherished79.wordpress.com)
• Physician Groups Call for Fewer Medical Tests (news.health.com)
• U.S. doctors advised to reduce routine tests, treatments (ctv.ca)
• Which Medical Tests Are Really Needed? (connecticut.cbslocal.com)
• Choosing Wisely, Continued… (rjwh617dotcom.wordpress.com)
• US doctors urge fewer tests‚ less costly treatments (thehimalayantimes.com)
• Doctor Panels recommend fewer tests for Patients (maryannebachia.wordpress.com)

Why doctors should screen for poverty

From the 4 April 2012 blog post by NAHEED DOSANI, MD AND JEREMY PETCH at KevinMD.com

…Bloch points to a growing body of research evidence showing the impact of financial struggle on the risk of a variety of diseases (this research is largely Canadian, so US statistics will differ, though the themes are likely similar):

Cardiovascular disease: there is a 17% higher rate of circulatory conditions among the lowest income quintile versus the average
Diabetes: prevalence among the lowest income quintile is more than double the rate in the highest income quintile
Mental Illness: the suicide-attempt rate of those living on social assistance is 18 times higher than higher-income individuals
Cancer: low-income women are less likely to access screening interventions like mammograms or Pap Smears
Development: infant mortality is 60% higher in the lowest income quintile neighborhoods
Regardless of this compelling evidence, why is there a need to screen for poverty? “Simply because we don’t know which patients live in poverty and if we don’t ask, we won’t find out,” says Dr. Bloch.  Since the recession of 2008, many hard-working people have been squeezed out of the middle class.  A November 2011 report by Wider Opportunities for Women entitled, “Living Below the Line,” highlighted the fact that nearly half of Americans struggle to make ends meet. …

 

Complementary Health Practices Information from NCAAM

NCAAM (National Center for Complementary and Alternative Medicine) recently published these pages/articlers

• Director’s Page – It’s Time to Talk (March 13, 2012)
  Time to Talk is a recently launched NCAAM series which encourages folks to discuss complementary health practices with their health care providers

  The director notes the following

  • We know that nearly 40 percent of Americans use some kind of complementary health practice. But we also know that most patients do not proactively disclose use of complementary health practices to their health care providers. Likewise, most providers don’t initiate the discussion with their patients. As a physician, I strongly believe that patients and their health care providers need to talk openly about all of their health care practices to ensure safe, coordinated care. Talking not only allows fully integrated care, but it also minimizes risks of interactions with a patient’s conventional treatments.

 

• This month’s Time to Talk includes these tips

1. List the complementary health practices you use on your patient history form. When completing the patient history form, be sure to include everything you use—from acupuncture to zinc.  It’s important to give health care providers a full picture of what you do to manage your health.
2. At each visit, be sure to tell your providers about what complementary health approaches you are using. Don’t forget to include over-the-counter and prescription medicines, as well as dietary and herbal supplements. Make a list in advance, or download and print this wallet card and take it with you. Some complementary health approaches can have an effect on conventional medicine, so your provider needs to know.
3. If you are considering a new complementary health practice, ask questions. Ask your health care providers about its safety, effectiveness, and possible interactions with medications (both prescription and nonprescription).

Don’t wait for your providers to ask about any complementary health practice you are using. Be proactive. Start the conversation.

• NCCAM TiwtterChate – Join us for monthly Twitter Chats that cover a variety of health topics and complementary approaches. Each month, a different topic will be selected. An expert in scientific and health issues will be available to answer your questions. Most chats will occur on the last Thursday of each month at 1 p.m. ET. Dates, times, and topics may change, and will be announced on this page and through Twitter and Facebook.

  Find us on Twitter: @NCCAM. To participate, use the hashtag: #nccamchat.

  Upcoming Chats

  March 30, 2012 Time to Talk

  Time to Talk Campaign—an educational campaign to encourage patients and their health care providers to openly discuss the use of complementary health practices.

  April 26, 2012 Asthma and Complementary Approaches

  May 31, 2012 Yoga

 

 

 

Related articles

• Is it Time to Talk? (lynnawiensmd.com)
• The Holistic Nurse: What’s So Awful About the Placebo Effect? (makingsofanurse.com)

What Doctors Are Telling Us Even When They’re Not Talking

Image via Wikipedia

Am thinking…how does one be compassionate to a doctor who lacks good communication skills?
And how does one draw out needed information from the same doctor when one is in a confused state of mind?
Maybe a communication and or/ life skills class in high school should be required that includes body language?

From the 9 February 2012 New York Times article

…For nearly two decades, teaching good communication skills has beenmandatory for medical schools because of research showing that good patient-doctor communication can lead to improved patient satisfaction and better health care outcomes. To this end, medical educators have developed a host of communication courses and workshops that combine lectures, self-assessments, video recordings and “standardized patients,” or actors in the role of patients.

More recently, many schools have broadened their courses to include “cultural competency,” or the ability to communicate with those from different racial, ethnic and social backgrounds. Studies have shown that while a patient’s race and ethnicity can be linked to sharply different treatment courses and quality, better communication between doctors and patients of different backgrounds can reduce the disparities.

Despite these tremendous efforts, there is one area of communication to which few schools have devoted significant time or resources: body language and facial expressions.

 In this recent study, for example, a group of medical sociologists analyzed the interactions between 30 primary care doctors and more than 200 patients over age 65 and found that white physicians tended to treat older patients similarly, regardless of race. Black physicians, on the other hand, often gave white patients contradictory signals, mixing positive nonverbal behaviors, like prolonged smiling or eye contact, with negative ones, like creating physical barriers by crossing the arms or legs….

Related articles

• What Doctors Are Telling Us Even When They’re Not Talking (well.blogs.nytimes.com)
• Doctors may paint overly rosy prognosis (cbc.ca)
• Study Finds Doctors Not Always Honest With Patients (dfw.cbslocal.com)
• Study finds doctors aren’t always honest with patients (mercurynews.com)
• 1 in 10 Doctors Admit Lying in the Past Year (livescience.com)
• Many doctors in survey admit they have lied to their patients (seattletimes.nwsource.com)
• Study finds MDs not always honest with patients (seattletimes.nwsource.com)
• Skills in medicine (slideshare.net)
• Doctors’ Honesty Put to the Test (webmd.com)
• Some physicians do not agree with, uphold standards on communication with patients (Eureka News Alert)

  A significant minority of physicians responding to a national survey disagreed with or admitted not upholding accepted standards of professionalism for open and honest communication with patients. In the February issue of Health Affairs, investigators from the Mongan Institute for Health Policy at Massachusetts General Hospital (MGH) report that, among other findings, one fifth of respondents indicated they had not fully disclosed a medical error out of concern for malpractice lawsuits and about one tenth admitted telling a patient something that was not true during the preceding year….

  …

  Five questions on the survey specifically addressed attitudes related to communication – including whether physicians should fully inform patients of the risks and benefits of their treatments, disclose all significant medical errors to patients and always keep patient information confidential – and four addressed what respondents had actually done in the preceding year. The survey was sent to 3,500 U.S. physicians – 500 each in internal medicine, family practice, pediatrics, cardiology, general surgery, psychiatry and anesthesia – and almost 1,900 surveys were completed and returned.

  The overhelming majority of respondents agreed that physicians should completely inform patients about risks and benefits, never disclose confidential information and never tell a patient something untrue. While 66 percent agreed that all significant medical errors should be disclosed to affected patients, one third did not completely agree. Also, about one third did not agree that financial relationships with drug and device companies should always be disclosed. When asked about their own behavior in the preceding year, almost 20 percent admitted not fully disclosing a medical error for fear of being sued,[my emphasis] 28 percent admitted revealing a patient’s health information to an unauthorized person, and 11 percent responded that they had told a patient or the parent of a child something that was not true.

10 (strongly suggested yet humorous) commandments for physicians when prescribing treatments

Unnecessary reliance on screening tests and the underuse of personalized medicine are two major concerns I have with the present practice of medicine. Hence the selection of this article for a blog item.

Mayo’s Dr. Victor Montori and his team argue that medical intervention success is best be measured in holistic terms as death, quality of life, and ability to function. This is in direct opposition to current industry and professional guideline standards which emphasizes narrow (and often misleading) outcomes as blood pressure reduction, lipid levels, and glucose levels.

The team’s analysis with “10 commandments” for physicians is published in the 28 December 2011 article The idolatry of the Surrogate. The article, unfortunately, is only available through paid subscription through the BMJ (British Medical Journal – Helping Doctors Make Better Decisions).***
The commandments basically encourage physicians to be careful with statistical results from clinical trials, information from industry experts, and to treat and respect the patient as individual with treatment related statistics as guides.

On a related note, I am very impressed with folks who empower themselves in treatment decisions by keeping up with biomedical breakthroughs, new treatments, and new ways of looking at diseases. I have posted related blogs as ePatients: The hackers of the healthcare world and Meet e-patient Dave – a voice of patient engagement.

Here is the abstract of the article
Easier to measure surrogate outcomes are often used instead of patient important outcomes such as death, quality of life, or functional capacity when assessing treatments. John Yudkin, Kasia Lipska, and Victor Montori argue that our obsession with surrogates is damaging patient care
Diabetes care is largely driven by surrogates. The US Institute of Medicine defines surrogates as “biomarker[s] intended to substitute for a clinical endpoint [and] expected to predict clinical benefit (or harm . . .) based on epidemiologic, therapeutic, pathophysiologic, or other scientific evidence.”1 In diabetes, concentrations of glycated haemoglobin (HbA1c) are used as a surrogate marker for outcomes that are important to patients, such as blindness or amputation. Other surrogates such as blood pressure, lipids, albumin excretion rates, and C reactive protein have been used to predict outcomes of cardiovascular disease and to guide clinical practice in people with or without diabetes. Much of the evidence for clinical interventions is based on their effect on surrogate outcomes rather than those that matter to patients such as quality of life or avoidance of vision loss or renal failure. Moreover, because these “hard” end points generally show much smaller responses to interventions than surrogate markers, many of the widely accepted strategies for diabetes may be based on artificially inflated expectations.
Recent studies have challenged the assumption that reliance on surrogates can accurately predict the effect of treatment on hard outcomes. There are the oral hypoglycaemic drugs that reduce HbA1c but increase the risk of cardiovascular events,2 antihypertensive drugs that do not reduce the risk of stroke,3 and drugs that improve cholesterol profiles but do not reduce cardiovascular events.4 Explanations for such phenomena include unwanted effects of the drug or an incomplete understanding of the pathophysiology of the disease.5 But why have …

Below are listed the the ten commandments**** with definitions and paraphrasing. I have forgotten much more than I have remembered from a college statistics class 30+ years ago! The “explanations” are a result of finding quality information on the Internet.

(For a great “translation” with less math, please go to the blog posting …Get Your Doctor to Treat You Right)

The New Therapeutics: Ten Commandments

•     Thou shalt treat according to level of risk rather than level of risk factor.

Level of risk - these levels are experienced by everyone, not just those having the disease being treated
[good summary of risk levels (minimal, less than minimal, greater than minimal) ]

Risk factor -anything that makes it more likely you will get a disease, either something you do (smoking)or something you have no control over (as being over 50 makes it more likely you will get colon cancer.  People should be given treatments based on the risks associated with the treatment on anyone,not  individual factors (age, blood pressure, other conditions)

• Thou shalt exercise caution when adding drugs to existing polypharmacy.



Polypharmacy - (poly is Greek for many) Whenever a person is taking a drug, any additional drugs may interact and cause bad reactions, including death.

• Thou shalt consider benefits of drugs as proven only by hard endpoint studies.


Endpoint study – research study involving humans where the outcomes (results) directly address the question. For example, if a drug was tested on how it reduced heart disease, the hard endpoint would be the reduction of heart disease.  However, hard endpoint studies are usually not accomplished in short periods of time, because it takes time for diseases to develop.  This paragraph sums up endpoint workarounds well.
From Deciphering Media stories on Diet (Harvard.edu)
4. Did the study look at real disease endpoints, like heart disease or osteoporosis? Chronic diseases,
like heart disease and osteoporosis, often take many decades to develop. To get around waiting that
long, researchers will sometimes look at markers for these diseases, like narrowing of the arteries or
bone density. These markers, though, don’t always develop into the disease.

•     Thou shalt not bow down to surrogate endpoints, for these are but graven images.



Surrogate endpoint – a substitute endpoint in a clinical trial. It is not the item being measured directly (as  heart disease), but an item related to what is being studied (as blood pressure). During the study these substitutes will be used to check on the health of the people in the clinical trial, the usefulness of the drug being treated, and if there are any complications. Surrogate endpoints are substitutes for (true) clinical endpoints (as survival for 5 years after the treatment).  Surrogate endpoints don’t always guarantee a clinical endpoint (just because blood pressure goes down, heart disease may not be treated). However studies with good endpoints are expensive (require testing on many people) are take long periods of time.
[Adapted from an eHow article with good references]

•      Thou shalt not worship Treatment Targets, for these are but the creations of Committees.

Correlation doesn’t always meant causality!A treatment target is a goal of a treatment intervention.  An example would be to reduce a specific protein in order to prevent a specific cancer (Potential New Treatment Target for Retinoblastoma, 13 January 2012 Medscape article) .  The “cause/effect” relationship between something measurable (as a protein) and a disease may not truly exist.  It is also possible that the  presence of the protein and the onset of a disease may be due to other factors in a web of events.

• Thou shalt apply a pinch of salt to Relative Risk Reductions, regardless of P values, for the population of their provenance may bear little relationship to thy daily clientele.

Relative Risk - The number of times more likely (RR > 1) or less likely (RR < 1) an event is to happen in one group compared with another. [From the BMJ glossary]
 P value – a number used to show how a variable (as a drug treatment) has a different result thano variable (no treatments). So, a high P value would seem to point to an effective drug treatment.

• Thou shalt honour the Numbers Needed to Treat, for therein rest the clues to patient-relevant information and to treatment costs.

The Numbers Needed to Treat (NNT) tells how many patients need a specific treatment in order to prevent an additional bad outcome (as a heart attack or stroke). So if a drug has an NNT of 10, 10 people have to be treated with the drug in order to prevent one additional bad outcome.
For example, if a drug is found to reduce the risk of a bad outcome from 50% to 40%, the absolute risk .1 (the difference). And the NNT is the inverse of the absolute  or 10.  [From Numbers Needed to Treat (Patient.co.UK)

•  Thou shalt not see detailmen, nor covet an Educational Symposium in a luxury setting.

Detailmen are pharmacy representatives who present doctors with their company's drug information with the aim of persuading the doctor to presribe their drugs. These representatives often sponsor educational talks (often "focusing" on conditions rather than drugs) at physician meetings. These "luxury settings" may included free buffets and hospitality rooms. [From Influencing Doctors :How Pharmaceutical Companies Use Enticement to 'Educate' Physicians (ABC News)]

•    Thou shalt share decisions on treatment options with the patient in the light of estimates of the individual’s likely risks and benefits.

•  Honour the elderly patient, for although this is where the greatest levels of risk reside, so do the greatest hazards of many treatments.

*** Click here for suggestions on how to get this article for free or at low cost.
In past blogs I have posted items on initiatives for the wider sharing of scientific articles to the public with subsidies, open access, etc.
****Richard Lehman’s Journal Review – 3 January 2012

amednews: Why patients are turning less to media and friends for health information :: Dec. 26, 2011 … American Medical News

 

Image via Wikipedia

amednews: Why patients are turning less to media and friends for health information :: Dec. 26, 2011 … American Medical News

Excerpts from the 26 December 2011 news item of the American Medical Association (AMA)

Consumers’ access to physicians and the quality of information available are affecting their level of interest in seeking outside guidance on their conditions.

By PAMELA LEWIS DOLAN, amednews staff. Posted Dec. 26, 2011.

 

As patient visits to physicians have declined, so has their interest in finding information relating to their health.

The waning interest in information-seeking as patient visits fall is what the Center for Studying Health System Change called a “surprising” conclusion to a survey of 17,000 patients released in November. Visits to physicians dropped 4% between 2007 and 2010. Meanwhile, the percentage of American adults seeking information about a personal health concern in the previous 12 months decreased from 55.5% to 50% in the same period, it said.

Analysts said there probably are multiple reasons for that. The trend could reflect that when patients are less able to see a physician, they are less likely to be engaged in their health. It could be that with physician visits down, patients have more time to spend with their doctor, meaning they have less of a need for outside sources of information.

And they said the decline could reflect that so much information is available — and so much of it conflicting — that some overwhelmed patients may be opting out altogether from researching their health.

For physicians, analysts said, the implication of the study is that when patients come into their offices, they are going to rely on them more than ever for help in managing their health.

1 in 5 patients has delayed or canceled a doctor visit, medical test or procedure in the past year.

The sources of information the center studied were the Internet, print media, television and radio, and friends and relatives. Internet was the only source that went up, to 32.6% from 31.1%. But center researcher Ha T. Tu wrote that the growth failed to keep pace with a strong rise in residential broadband Internet access, which went up from 47% to 66% between 2007 and 2010….

Read the entire news article

Related articles

• How much guidance do patients want with their medical decisions? (jflahiff.wordpress.com)
• Epatients: The hackers of the healthcare world [O'Reilly Radar] (jflahiff.wordpress.com)

Epatients: The hackers of the healthcare world [O'Reilly Radar]

[While I have some major concerns about this video, since it was at the blog item, I decided to add it anyway.

In my humble opinion the background music is too gloomy, the use of some declatatory statements seem to false imply "all", and it seems to foster an "us" versus "them" mentality that in the long term may be unhelpful...

Still, it does emphasize that people can be empowered through reputable information and interacting with other like-minded and similarly educated folks]

A quick reference for becoming an empowered patient

Excerpts from the blog item by Fred Trotter at O’Reilly Radar- Insights, Analysis, and Research about Emerging Technologies

 help build open source software tools that patients can use to have greater control and influence over their own healthcare (like the Direct Project and Your Doctors Advice). As as result, I’ve become quite familiar with other tools that do the same sorts of things. There is a community of patients who are deeply interested in the ways in which they can become more engaged and how they can specifically use technology to achieve this. This community calls themselves epatients. The epatient community asked me to write a short collection of resources for “becoming an epatient.”

The “e” in epatient is intentionally obscure. The initial assumption is that the “e” stands for “electronic,” as it does in “email.” But in fact, the “e” stands for “engaged” or “empowered.” Nonetheless, reference to email is intentional: The epatient community recognizes that leveraging data is a critical part of empowering a person who happens to be sick. Patients must be “electronic” to become fully “engaged.” I think of epatients as the healthcare equivalent of makers and hackers. More importantly, they are the people I have in mind when I write software….

…

Let’s go over some simple concepts that the rest of my epatient advice and resources are based on:

• Your doctors are probably not managing your healthcare information. You should assume it is your responsibility. Otherwise, the people involved in your treatment process will often presume that this information simply does not exist.
• Other patients, with similar conditions to yours, can have better information about your health problem than your doctors have.
• Like the highway system, the healthcare system is generally beneficial, but there are dangers, and you need to learn to avoid them.

And here are two things you should keep in mind:

• Whenever I say “patient,” I actually mean “the patient/caregiver team.” Often, the patient will not have the energy to do what is necessary to be fully engaged. It is critical that when the patient cannot be an epatient, that at least the patient’s team be an epatient proxy.
• In regard to the “better information” I mentioned above, I don’t mean that your doctor is typically wrong and another patient is typically right about your diagnosis or treatment options. While that does happen on occasion, it is not the norm. Another patient’s information is “better” because your doctor typically does not have the visceral experience of being a patient. Your doctor doesn’t understand which lotion can make all of the difference or what position might let you get some sleep after a rough procedure. There is simply no substitute for experience. Sometimes that experience can make your life a little easier, and sometimes it can help you get the right treatments that literally will save your life. (This is the gist of epatient Dave deBronkart’s story.)

Read the entire blog item (including descriptions and links to epatient communities)

Related articles

• The slow integration of community into health care (The Health Care Blog)

For a long time now patients have been meeting in online (and offline) communities, sharing experience, advice and more recently data and measurements. And the health care system–which knows that communities improve health–has done virtually nothing–other than some doctors having doctors answer questions on MedHelp. That is just starting to change. Last year Geisinger did a small trial with dLife that showed improvement in diabetics outcomes. More recently Aetna inked partnerships withMindBloom and OneRecovery, two communities focused on spirituality and addiction, and today Diabetic Connect (part of Alliance Health) announced a deeper integration with the Joslin Diabetes Center. It’s been a while, but the heart of Health 2.0 (communities) are starting to move towards the mainstream.

• Are you an ePatient? (enbloommedia.com)
• The Rise of the e-Patient: Slideshow  (ScienceRoll)

  “It’s always good to see the trends about the growing number and importance of e-patients. Lee Rainie, director of the Pew Internet Project, presented this wonderful overview of the Project’s health findings at Providence St. Joseph Medical Center in Burbank, CA, on January 12.”

• Why patients are turning less to media and friends for health information  (jflahiff.wordpress.com)
• Can differential diagnosis be crowdsourced to Facebook Friends?(medgadget)
• ePatient Connections: A Patient Checks In. (sixuntilme.com)
• From E-patient Hackers to Health Games on Mobiles (scienceroll.com)
• The end of social – O’Reilly Radar (queuniversidade2.wordpress.com)
• Meet e-patient Dave – a voice of patient engagement (and related resources) (jflahiff.wordpress.com)
• 2020 Vision: The ePatient Evolution Over the Next 10 Years (prweb.com)
• ePatients Come Together to Brainstorm and Share (brassandivory.org)
• 6 P’s Of Social Health (socialmediaclub.org)
• The Rise of the ePatient – presentation by Pew Internet Project (casesblog.blogspot.com)