Looking for summaries of the best current evidence for healthcare decision making? Cochrane Evidence may have a report on a topic of interest
Cochrane reviews are systematic reviews of primary research of human health care. They are systematic because they review ALL the available journal articles to answer a specific question.. Each systematic review can take up to 2 years and includes at least 2 people.
An example of a question would be
Can antibiotics help in alleviating the symptoms of a sore throat?
Cochrane Reviews do not answer every healthcare question, but they currently have several thousand reviews answering specific questions.
Cochrane Evidence has plain language summaries of the above reviews.
““Cochrane summarizes the findings so people making important decisions – you, your doctor, the people who write medical guidelines – can use unbiased information to make difficult choices without having to first read every study out there…”
Sifting the evidence, The Guardian, 14 September 2016
Guide to Clinical Preventive Services 2014: Recommendations of the U.S. Preventive Services Task Force
Guide to Clinical Preventive Services 2014: Recommendations of the U.S. Preventive Services Task Force (ePub) – Available for download at this site.
Source: U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality (via USGPO)
The Guide to Clinical Preventive Services presents abridged U.S. Preventive Services Task Force (USPSTF) recommendations on screening, counseling, and preventive medications for use in primary care practice. The 2014 Guide continues the precedent set by earlier editions in providing the Task Force recommendations in a form that provides on-the-job clinical decision support for clinicians. The Guide is organized and cross referenced so that clinicians can search for recommendations alphabetically by topic and by patient category (adult or child/adolescent).
Related Resource
Choosing Wisely is an initiative of the ABIM Foundation that promotes patient-physician conversations about unnecessary medical tests and procedures.
Patient Engagement: Overused Sound Bite or Transformative Opportunity? ‹ Reader — WordPress.com
Patient Engagement: Overused Sound Bite or Transformative Opportunity?
From the 31 March 2015 post at The C Health Blog
Criteria for Stage 3 of meaningful use of EHRs were released recently and there is lots of controversy, as would have been predicted. One set of recommendations that is raising eyebrows is around patient engagement.
The recommendations include three measures of engagement, and providers would have to report on all three of them, but successfully meet thresholds on two.
- Following on the Stage 2 measure of getting patients to view, download, and transmit their personal health data, the Office of the National Coordinator (ONC) has proposed an increase from five to 25 percent.
- The second measure requires that more than 35 percent of all patients seen by the provider or discharged from the hospital receive a secure message using the electronic health record’s (EHR) electronic messaging function or in response to a secure message sent by the patient (or the patient’s authorized representative).
- The third measure calls for more than 15 percent of patients to contribute patient-generated health data or data from a non-clinical setting, to the EHR.
This is all a mouthful, and it’s striking and a bit misguided from two perspectives. First, this requires health care providers to present material to or interact with patients electronically in the name of patient engagement. But it is really mostly about shoveling uninspiring material at our patients that is redolent of highly technical jargon with minimal context, with the belief that it is somehow good for patients to be engaged in this way. The intent is admirable, but the execution flawed. In addition, it is not surprising that many providers have had challenges meeting the Stage 2 requirement that five percent of patients download their medical records. It seems akin to saying that this week’s book club selection is the text for advanced graduate study of quantum mechanics — and then wondering why no one shows up for the meeting.
Some define engagement in terms of how many times consumers or patients interact with informational websites or portals. Both insurers and providers do this. Once again, there is puzzlement over why consumers would choose to spend more time on sites such as BuzzFeed, Facebook and Yahoo, rather than intently study their health benefits or review their lab tests.
At Partners HealthCare Connected Health, our first generation interest in engagement came when we saw, reproducibly, that people who interact with connected health programs have consistently better health outcomes.
This brings up two salient points: The first is how finely we can measure engagement using connected health.
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[Reblog] THE BATTLE OF INTERPRETING RESEARCH RESULTS TO SPECIFIC AUDIENCES
From the 28 April 2015 post at Nordic EBM
Evidence-based medicine has been called “cookbook medicine” by some of its more vocal critics. This implies that evil faceless organisations like Cochrane aim to turn all healthcare workers into mindless automatons who blindly follow dictums derived solely from scientific evidence. I hope it doesn’t surprise many in that this has never been the aim of Cochrane, or EBM in general, nor will it ever be. EBM, or EBP if you prefer the term ‘practice’ rather than the more vague ‘medicine’, is a belief system that rests on three pillars (cf. five in Islam). The EBM pillars are: 1) best available scientific evidence (i.e. the purview of Cochrane and yours truly), 2) clinical experience and 3) patient preferences and values. So, the main gist is that evidence doesn’t matter – no matter how scientific – if we don’t have a clinician at hand to interpret it for the benefit of a particular patient equipped with a particular set of values. For example, in a situation where two very similar patients have the same condition, one might wish to achieve speedy return to work whereas the other might rather avoid pain at all cost. The clinician would then use his or her judgment to identify the best course of treatment for both based on experience and what us science types have to offer. However, let us now leave the two pillars of clinical experience and patient preferences to be explored in future posts so that we can chew the first a bit more.
Now, the evidence bit in EBM is often understood to mean results of systematic reviews(a fancy type of research). Inasmuch as they offer an abstracted truth devoid of context (see my earlier post on mathematical ghosts) they still need to be interpreted for use in particular circumstances. This doesn’t always have to be done for every single patient by every single clinician separately. Think of the usefulness of reinventing the wheel for every drive. Often the thinking behind the interpretation and application of evidence can be written down and made use of by many. On a population level this means drafting guidelines. However, it is important to note that when scientific evidence is freely available one does not need to wait for formal committees to grow their beards long enough to formulate official guidelines. Especially when even supposedly professional guideline developers can do a really poor job (see previous post by Margot Joosen). In fact, all informed people and communities should participate in making sense of and advocating for the use of research to back up health decisions. In the end it affects the quality of care they receive.
[Reblog] Beware your doctor’s knee-jerk reflex: 3 questions to ask
From the 3 September 2014 post at KevinMD.com
In summary
1. Always ask “why?” This seems obvious, but even in this modern era, many patients take it as an article of faith that a doctor’s recommendation is thoughtful and well informed. It may well be; but on any given occasion, it could also be a knee-jerk — born of prevailing tendencies, distractions, and want of time. The question “why” is easily addressed by those who have already thought it over; and is a necessary reality check for those of us who have not.
2. Always ask “what else?” In the case of the fluoroquinolone syndrome, it’s bad enough when a fluoroquinolone was a genuinely thoughtful, warranted choice. It’s downright tragic when a much-less-potentially-toxic, narrow spectrum antibiotic would have served at least as well. “What else?” is a reminder that there is generally more than one way to test or treat, and the one we want is the BEST of them: most likely to help, least likely to hurt. It prods our providers to do the extra work of getting us there when we remind them we want to know the options, and comparison shop them.
3. Always ask “then what?” This would certainly defend against a screening colonoscopy in an 85 year old with congestive heart failure. If I have this test, then what? The answer would have to be: We can find potential cancer early, and fix it now so it doesn’t cause you trouble in ten years. That would invite all concerned to revisit the relevance of that “help” ten years in the future of someone exceedingly unlikely to live that long.
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[Reblog] My Doctor Just Gave Me His Cell Phone Number … | The Health Care Blog
My Doctor Just Gave Me His Cell Phone Number … | The Health Care Blog.
From the 17 February 2015 post
That’s right…it really happened.
At the conclusion of a recent doctor visit, he gave me his cell phone number saying, “Call me anytime if you need anything or have questions.”
In disbelief, I wondered if this was a generational thing – and whether physicians in their late thirties had now ‘gone digital’.
My only other data point was our family pediatrician, who is also in her late thirties. Our experience with her dates back nearly seven years when my wife and I were expecting twins. A few pediatricians we met with mentioned their willingness to correspond with patients’ families via email as a convenience to parents. The pediatrician we ultimately selected wasn’t connected with patients outside of the office at that time, but now will exchange emails.
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[Reblog] The high cost of free check-ups
Bill Branson (Photographer)
http://commons.wikimedia.org/wiki/File:Doctor_consults_with_patient_(7).jpg
From the 14 February 2014 post at The Health Care Blog
A predictable irony of the never-ending Affordable Care Act (ACA) debate is that the one provision that the Republicans should be attacking — free “checkups” for everyone — is one of the few provisions they aren’t attacking. Why should they attack them? Simple — checkups, on balance, are worthless. Why provide a 100 percent subsidy for a worthless good? Where is the GOP when you need it?
How worthless are checkups? Dr. Ezekiel Emanuel — one of the architects of the ACA and its “free” checkup centerpiece — recently recommended not getting them. As if “free” is not cheap enough, the ACA also pushes ubiquitous corporate wellness programs, which often pay employees to get checkups — or fine them if they don’t. This policy establishes a de facto negative price for millions of workers, making checkups the only worthless service on earth that one could get paid to utilize.
Those economics of a “negative price” trump Dr. Emanuel’s advice, and have made preventive care the fastest-growing component of employer health spending. Though hard statistics on checkups themselves are elusive, Dr. Emanuel estimates about 45-millon adult checkups are conducted each year, the equivalent of roughly 8 percent of America’s PCPs doing nothing but checkups, a curious use of their time when experts say the country could soon face a shortage of PCPs.
Shortage or not, subsidies and incentives might make economic sense if checkups improved health. However, when generally healthy adults go to the doctor for no reason, just the opposite is true: the Journal of the American Medical Association (JAMA) supports Dr. Emanuel assertion that annual checkups for asymptomatic adults are at best worthless, saying that additional checkups are “not associated with lower rates of mortality” but “may be associated with more diagnoses and more drug treatment.”
…
The solution to this orgy of overscreening and overdoctoring is remarkably simple: remove the ACA provision that makes annual checkups automatically immune from deductibles and copays; if they are going to be free at all, it should only be every few years. The proposal could still allow employers to override this provision — and even to attach money (incentives and penalties) to checkups — if they are willing to summarize the above-cited clinical findings for their employees.
If the only way they can continue the subsidy is by summarizing the literature, corporate human resources departments would predictably and immediately curtail this expensive corporate medical campaign. That would free up PCP time to work with patients who actually need medical care, while reducing counterproductive and costly healthcare utilization by those who do not.
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[Press release] Patients dismissing ‘trivial’ symptoms could delay cancer diagnosis
One of our neighbors died 5 years ago. She hid her symptoms from her family. Wondering if she would be alive today if she would have been proactive.
[Press release] Patients dismissing ‘trivial’ symptoms could delay cancer diagnosis
26 January 2015, Cancer Research UKPeople who dismiss their symptoms as trivial or worry about wasting the doctor’s time may decide against going to their GP with red-flag cancer warning symptoms, according to a Cancer Research UK study* published in the British Journal of General Practice (link is external)today.
“Many of the people we interviewed had red flag symptoms but felt that these were trivial and didn’t need medical attention, particularly if they were painless or intermittent.” – Dr Katriina Whitaker
Others might decide not to get possible cancer symptoms checked out because they fear a cancer diagnosis, they adopt a stiff upper lip, they lack confidence in the healthcare system, or they think their problem is down to ageing.
Researchers in London and Hull** looked at how people who experience possible cancer symptoms decide whether or not to seek medical help. They sent out a health survey that was completed by more than 1,700 people, aged 50 and over, from three London GP practices.
The survey specifically did not mention cancer, but incorporated a list of 17 symptoms including 10 cancer ‘alarm’ warning signs, such as persistent cough or hoarseness, unexplained lump, persistent change in bowel or bladder habits, and a sore that does not heal.***
More than 900 people reported having at least one alarm symptom during the past three months. Researchers carried out in-depth interviews with almost 50 of them, almost half (45 per cent) of whom had not seen their GP about their symptoms. ****
One woman with persistent abdominal pain did not go for a recommended test. She said: “At times I thought it was bad … but when it kind of fades away, you know, it doesn’t seem worth pursuing really.” A man, who experienced a persistent change in bladder habits, said: “You’ve just got to get on with it. And if you go to the doctor too much, it’s seen as a sign of weakness or that you are not strong enough to manage things on your own.”
Dr Katriina Whitaker, a senior research fellow at University College London during the study, said: “Many of the people we interviewed had red flag symptoms but felt that these were trivial and didn’t need medical attention, particularly if they were painless or intermittent.
“Others felt that they shouldn’t make a fuss or waste valuable NHS resources. The stiff-upper-lip stoicism of some who decided not to go to their doctor was alarming because they put up with often debilitating symptoms. Some people made the decision to get symptoms checked out after seeing a cancer awareness campaign or being encouraged to do so by family or friends – this seemed to almost legitimise their symptoms as important.”
Reasons people gave for deciding to seek help included symptoms not going away, instinct that something was not right, and awareness or fear that they might have cancer. A man with an unexplained throat lump said: “But always at the back of your mind you’ve always got the fear of cancer …….. well it’s best to check just in case.” However, fear also made some people decide not to check out symptoms, or if symptoms did persist some people began to think they were normal for them.
Some people waited for another reason to visit their GP and mentioned the cancer alarm symptom then. Others said they would rather use an emergency route, such as going straight to A and E, than wait to see a specialist after being referred by their GP.
Dr Richard Roope, Cancer Research UK’s GP expert, said: “The advice we give is: if in doubt, check it out – this would not be wasting your GP’s time. Often your symptoms won’t be caused by cancer, but if they are, the quicker the diagnosis, the better the outcome. Seeking prompt advice from your GP about symptoms, either on the phone or during an appointment, could be a life-saver, whatever your age. And the good news is that more than half of all patients diagnosed with cancer now survive for more than 10 years.”
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[Reblog] Do drug seekers in the ER make you burst out in song? It did here.
Do drug seekers in the ER make you burst out in song? It did here.. From the 19 January 2015 post at KevinMD.com
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[Article] BBC News – Do doctors understand test results?
BBC News – Do doctors understand test results?.
From the 6 July 2014 article
In 1992, shortly after Gerd Gigerenzer moved to Chicago, he took his six-year-old daughter to the dentist. She didn’t have toothache, but he thought it was about time she got acquainted with the routine of sitting in the big reclining chair and being prodded with pointy objects.
The clinic had other ideas. “The dentist wanted to X-ray her,” Gigerenzer recalls. “I told first the nurse, and then him, that she had no pains and I wanted him to do a clinical examination, not an X-ray.”
These words went down as well as a gulp of dental mouthwash. The dentist argued that he might miss something if he didn’t perform an X-ray, and Gigerenzer would be responsible.
But the advice of the US Food and Drug Administration is not to use X-rays to screen for problems before a regular examination. Gigerenzer asked him: “Could you please tell me what’s known about the potential harms of dental X-rays for children? For instance, thyroid and brain cancer? Or give me a reference so I can check the evidence?”
Gerd Gigerenzer
The dentist stared at him blankly……
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[Reblog] The Problem of Pain: When Best Medical Advice Doesn’t Equal Patient Satisfaction
From the 4 April 2014 post by Karen Sibert, MD at The Health Care Blog
The problem of pain, from the viewpoint of British novelist and theologian C. S. Lewis, is how to reconcile the reality of suffering with belief in a just and benevolent God.The American physician’s problem with pain is less cosmic and more concrete. For physicians today in nearly every specialty, the problem of pain is how to treat it responsibly, stay on the good side of the Drug Enforcement Administration (DEA), and still score high marks in patient satisfaction surveys.
If a physician recommends conservative treatment measures for pain–such as ibuprofen and physical therapy–the patient may be unhappy with the treatment plan. If the physician prescribes controlled drugs too readily, he or she may come under fire for irresponsible prescription practices that addict patients to powerful pain medications such as Vicodin and OxyContin.
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Ethics: A Patient’s Right to Not Know
Ethics: A Patient’s Right to Not Know.
Excerpt
Writing in Science, the chair of the Presidential Commission for the Study of Bioethical Issues notes it is increasingly common for physicians and medical researchers to discover a disease that was not the original target of a medical test or screening.
Amy Guttman Ph.D. notes these surprise clinical test results are called incidental and secondary findings. Guttman explains the surprise discovery of an unexpected illness from screening and similar tests is called an ‘incidental’ finding. Guttman adds when clinicians deliberately seek to discover a second or third disease in addition to the primary target, these results are called ‘secondary’ findings.
Guttman, who is the president of the University of Pennsylvania, writes (and we quote): ‘Improved technologies are making incidental and secondary findings increasingly common. They are becoming a growing certainty in clinical practice as well as in the distinct contexts of research and direct-to-consumer testing’ (end of quote). For example, Guttman notes an array of unexpected clinical findings may be generated by new CT scans intended to detect lung cancer in heavy smokers. The increased screening will occur because of recent recommendations from the U.S. Preventive Services Task Force, which we discussed in last week’s podcast.
Guttman writes before CT scans or other medical tests, clinicians should alert patients about the possibility of surprise findings regardless whether screening deliberately seeks (or accidentally finds) new, unexpected illnesses.
Guttman notes while some persons will ask a physician to tell them about whatever clinical tests discover, some patients do not want to learn about incidental or secondary findings.
As a result, the Presidential Bioethics Commission recommends physicians and medical practitioners need to know a patient’s health priorities and tolerance to manage surprising results prior to clinical testing. Guttman writes (and we quote) ‘A patient who does not wish to learn about information related to the primary purpose of the test should not undergo the test. If a patient wishes to opt out of receiving incidental or secondary findings that are clinically significant and actionable, then clinicians should exercise their discretion whether to proceed with testing’ (end of quote).
Guttman notes health care providers should explain both the risks and rewards of finding unexpected illnesses that can occur from a new generation of sophisticated clinical tests, such as human genome screenings. While false positive findings are among the risks, Guttman explains the rewards include the detection of diseases and illness that could be clinically actionable.
In terms of biomedical ethics, Guttman concludes (and we quote):’ In keeping with shared decision-making, clinicians live up to their highest calling when they discuss how they will handle incidental findings with their patients’ (end of quote). While the Presidential Bioethics Commission provides more specific recommendations in their report, their overall intent is to improve patient-provider disclosure and communication as well as help patients anticipate the possibility of unexpected findings from routine testing.
The Commission’s report is available at bioethics.gov.
Meanwhile, a link to a website that explains some of the ethical issues associated with patient and provider health decision making (from Beth Israel Medical Center) is available in the ‘specific conditions’ section of MedlinePlus.gov’s medical ethics health topic page.
Similarly, a link to a website that explains some of the ethical issues associated with patient and provider treatment decisions (also from Beth Israel Medical Center) can be found in the ‘specific conditions’ section of MedlinePlus.gov’s medical ethics health topic page.
MedlinePlus.gov’s medical ethics health topic page also provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. You can sign up to receive updates about medical ethics as they become available on MedlinePlus.gov.
To find MedlinePlus.gov’s medical ethics health topic page type ‘medical ethics’ in the search box on MedlinePlus.gov’s home page. Then, click on ‘medical ethics (National Library of Medicine).’ MedlinePlus.gov additionally contains a health topic page on talking with your doctor, which provides tips to enhance provider and patient communication.
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[News item] British hospital to become first in Europe to use Skype for consultations
From the 21 March 2014 Daily Telegraph article
A hospital in Staffordshire is set to become the first in Europe where doctors consult with their patients via Skype
A hospital is set to become the first in Europe to tackle waiting times by getting overworked doctors to consult with their patients via Skype.
Managers at the University Hospital of North Staffordshire claim using the online video calling service could reduce outpatient appointments by up to 35 per cent.
They argue that using Skype will help free up consultants’ time and car parking spaces – while also helping patients who are unable to take time off work.
If approved, they would become the first UK hospital to use Skype to consult with patients.
The proposals, by Staffordshire’s biggest hospital, also include doctors treating patients via email consultations……..
…
“The key issue for doctors will be to recognise when this mode of consultation is not sufficient to properly assess the patient and address the problem, and to arrange a face-to-face consultation instead.”
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Skype (Photo credit: Wikipedia)
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Order or Download Your Free Patient Packet – Tips on How to Talk with your Health Care Provider
Order or Download Your Free Patient Packet | NCCAM
From the Web page
Order or Download Your Free Patient Packet
As part of the Time To Talk campaign, NCCAM has developed a packet of helpful materials to help you begin a dialogue with your health care providers. Order your packet online or call 1-888-644-6226 and use reference code D393.
Each packet contains:
Backgrounder: The backgrounder provides information about the importance of health care providers and their patients talking about complementary health practices.Download PDF
TELL tip sheet: This sheet provides tips for talking with health care providers.Download PDF
Patient wallet card: This card will help to keep track of all medications, including dietary supplements and other complementary health products, and will be a handy reference during visits to your health care provider.Download PDF
Get the Facts: Are You Considering Complementary and Alternative Medicine? This fact sheet will assist you in your decision making about using CAM.Download PDF
Order your packet online or call 1-888-644-6226 and use reference code D393.
Related Resources
- Patient involvement (including questions to ask your doctor) from US AHRQ (Association for Healthcare Research and Quality)
- Diagnosis and Treatment (including Quick Tips When Talking with your Doctor) from US AHRQ
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[Press release] Taking statins to lower cholesterol? New guidelines
From the 4 February 2014 Mayo Clinic Press Release
ROCHESTER, Minn. — Feb. 4, 2014 — Clinicians and patients should use shared decision-making to select individualized treatments based on the new guidelines to prevent cardiovascular disease, according to a commentary by three Mayo Clinic physicians published in this week’s Journal of the American Medical Association.
Journalists: Sound bites with Dr. Montori are available in the downloads.
Shared decision-making is a collaborative process that allows patients and their clinicians to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences.
In 2013, the American College of Cardiology and the American Heart Association issued new cholesterol guidelines, replacing previous guidelines that had been in place for more than a decade. The new guidelines recommend that caregivers prescribe statins to healthy patients if their 10-year cardiovascular risk is 7.5 percent or higher.
“The new cholesterol guidelines are a major improvement from the old ones, which lacked scientific rigor,” says primary author Victor Montori, M.D., Mayo Clinic endocrinologist and lead researcher in the Knowledge and Evaluation Research Unit. “The new guidelines are based upon calculating a patient’s 10-year cardiovascular risk and prescribing proven cholesterol-lowering drugs — statins — if that risk is high.”
However, Dr. Montori cautions that the risk threshold established by the guideline panel is somewhat arbitrary. Instead he recommends that patients and their clinicians use a decision-making tool to discuss the risks and benefits of treatment with statins.
“Rather than routinely prescribing statins to the millions of adults who have at least a 7.5 percent risk of having a heart attack or stroke within 10 years, there is an opportunity for clinicians and patients to discuss the potential benefits, harm and burdens of statins in order to arrive at a choice that reflects the existing research and the values and context of each patient,” he says.
“We’re creating a much more sophisticated, patient-centered practice of medicine in which we move the decision-making from the scientist to the patient who is going to experience the consequences of these treatments and the burdens of these interventions,” Dr. Montori explains. “Decision-making tools can democratize this approach and put it in the hands of millions of Americans who have their own goals front and center in the decision-making process.”
Additional authors of the commentary include Henry Ting, M.D., and Juan Pablo Brito Campana, M.B.B.S., both of Mayo Clinic.
[Reblog] Are you a victim of patient profiling?
Very controversial, this posting has 113 comments as of Feb 4, 2014.
Two (or more! ) sides to this.
On a personal level, my medical record very boldly on the first page states two conditions
— Anxiety/Depression (have not needed medication for these conditions in 5 years)
— High Cholesterol ( have disputed the doctor on this, based on how I have read the scientific literature)
So, yes…I feel profiled!
Yet, the doctor is doing the best he can. He can only see patients for 15 minutes. His electronic records are
basically, well, dictated by the group he is in.
On another note, just as I am not defined by my job or resume…
I am also not defined by my medical record!
From the 4 February 2014 Kevin MD article by Pamela Wible, MD
Ever felt misjudged by a doctor? Or treated unfairly by a clinic or hospital? You may be a victim of patient profiling.
Patient profiling is the practice of regarding particular patients as more likely to have certain behaviors or illnesses based on their appearance, race, gender, financial status, or other observable characteristics. Profiling disproportionately impacts patients with chronic pain, mental illness, the uninsured, and patients of color. Like racial profiling by police, patient profiling by physicians is more common than you think.
We rely on doctors to first do no harm–to safeguard our health–but profiling patients often leads to improper medical care, and distrust of physicians and the health care system, with potential lifelong consequences.
For the first time, people share their stories:
I was once denied pain meds after a fall off a 10-foot porch by the same doc who gave my pretty female friend pain meds after getting two stitches in her finger. I felt like my appearance had something to do with it.” ~ Jay Snider
Read the entire article (with 113+ comments) here
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Things Physicians and Patients Should Question – With Lists From Choosing Wisely
Things Physicians and Patients Should Question | Choosing Wisely.
Ever wonder if a medical test or procedure was right for you?
Maybe you read about it, hear it on the news, or came across it on the Internet.
Here’s Web site that just might help in discussions with your health care provider.
Choosing Wisely® 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
In response to this challenge, national organizations representing medical specialists have been asked to “choose wisely” by identifying five tests or procedures commonly used in their field, whose necessity should be questioned and discussed. The resulting lists of “Five Things Physicians and Patients Should Question” will spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments.
This concept was originally conceived and piloted by the National Physicians Alliance, which, through an ABIM Foundation Putting the Charter into Practice grant, created a set of three lists of specific steps physicians in internal medicine, family medicine and pediatrics could take in their practices to promote the more effective use of health care resources. These lists were first published inArchives of Internal Medicine.
Recognizing that patients need better information about what care they truly need to have these conversations with their physicians, Consumer Reports is developing patient-friendly materials and is working with consumer groups to disseminate them widely.
Choosing Wisely recommendations should not be used to establish coverage decisions or exclusions. Rather, they are meant to spur conversation about what is appropriate and necessary treatment. As each patient situation is unique, physicians and patients should use the recommendations as guidelines to determine an appropriate treatment plan together.
From the List at Choosing Wisely, by the ABIM Foundation
United States specialty societies representing more than 500,000 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.
Choosing Wisely recommendations should not be used to establish coverage decisions or exclusions. Rather, they are meant to spur conversation about what is appropriate and necessary treatment. As each patient situation is unique, physicians and patients should use the recommendations as guidelines to determine an appropriate treatment plan together.
In collaboration with the societies, Consumer Reports has created resources for consumers and physicians to engage in these important conversations about the overuse of medical tests and procedures that provide little benefit and in some cases harm.
Specialty Society Lists of Five Things Physicians and Patients Should Question (for physicians):
- AMDA – Dedicated to Long Term Care Medicine
- American Academy of Allergy, Asthma & Immunology
- American Academy of Dermatology
- American Academy of Family Physicians
- American Academy of Hospice and Palliative Medicine
- American Academy of Neurology
and more!Download a pdf of all specialty society lists
Patient-Friendly Resources from Specialty Societies and Consumer Reports:
- Allergy tests: When you need them and when you don’t
- Antibiotics: When children need them for respiratory illness
- Bone-density tests: When you need them…
- Cancer care at the end of life: When to choose supportive care
- Chest X-rays before surgery: When you need them…
- Choosing pain relievers with kidney disease/heart problems
- Chronic kidney disease: Making hard choices
- Colonoscopy: When you need it…
and more!
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Health Care Consumerism: Patients Still Lack Agency at the Point of Care | Health care and the digital revolution
From the 27 January 2013 post at Health care and the digital revolution — A graduate student’s take on health care going digital – Claudia Paz
Something we have been hearing a lot of lately is how this is the moment for the healthcare consumer (see, Bloomberg Review video, MedCity Article, Forbes article on trends to be excited about). Basically, people are noting that EMR’s and patient portals, the proliferation of health and wellness related mobile apps, and greater transparency across the system, will all lead to a new age of health care where patients have the information and tools to savvily navigate a streamlined healthcare delivery system oiled by customer reviews, online tools, and digital gadgets. Think Yelp and MenuPages meets healthcare.
While all of the trends listed above are exciting leaps forward, not enough attention is being paid to the patient’s needs at the point of care. Research on patient activation andshared or participatory decision making all points to the following:
Empowered patients who actively participate in decisions about their health and treatment options are more likely to be compliant with their medications, make less risky and more cost effective decisions, and are more confident in the management of their health outcomes.
For the purposes of this blog, I am focusing on the concept of a patient as an active participant at the point of care. From my own personal experience, it seems that “doctor knows best” remains the dominant paradigm. Instead of having a conversation about treatment options, the pros and cons of alternatives, variations in costs and side affects, I am more often than not prescribed a medication or treatment option and sent about my day. If I feel like knowing more about the medication (that I have already agreed to take), I usually conduct research after the appointment.
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[KevinMD Reblog] The one little question that could save your life
A patient having his blood pressure taken by a physician. (Photo credit: Wikipedia)
By VAL JONES, MD | PHYSICIAN | at the 12 November 2013 KevinMD.com blog
I realize that my blog has been littered with depressing musings on healthcare lately, and so I thought I’d offer up one very positive and “actionable” suggestion for all you patients out there. In the midst of a broken system where your doctor is being pressured to spend more time with a computer than listening and examining you, where health insurance rates and co-pays are sky-rocketing, and where 1 in 5 patients have the wrong diagnosis… There is one “magic” question that you should be asking your physician(s):
“What else could this be?”
This very simple question about your condition/complaint can be extremely enlightening. Physicians are trained to develop extensive “differential diagnoses” (a list of all possible explanations for a set of signs and symptoms) but rarely have time to think past possibilities 1 through 3. That’s one of the reasons why so many patients have the wrong diagnosis – which is both costly in terms of medical bills, time, and pain and suffering.
There is a risk in asking this question – you don’t want to be over-tested for conditions that you are unlikely to have, of course. But I maintain that the cost/risk of living with the wrong diagnosis far exceeds the risk of additional testing to confirm the correct diagnosis. So my advice to patients is to keep this very important question in mind when you see your doctor for a new concern.
Related articles
- Better tests needed to improve patient care, public health (medicalnewstoday.com)
- Mistakes even good doctors make (consumerreports.org)
- Hypochondriacs Rejoice: WebMD is Beefing Up Its Real-Life Doctor Support (betabeat.com)
- Admit when you fall short: The power of “I don’t know” (kevinmd.com)
[Reblog] Forms do not keep patients out of hospitals
A patient having his blood pressure taken by a physician. (Photo credit: Wikipedia)
From the 21 October 2013 KevinMD.com article by Kathy Neider, Physician
Over one year ago my office implemented an EHR (electronic health record). I’ve not done a note on paper since.
Last week, a Transition of Care (TOC) document was placed on my desk with a sticky note stating: “Dr. Nieder please fill out this form so we can bill a 99496 for your visit with Mrs. Jones yesterday.”
I pick up two sheets of paper with multiple questions including:
- discharge Medications: (list)
- present Medications: (list)
- diagnostic tests reviewed/disposition (list)
- disease/illness education (discussion documentation)
- home health/community services discussion/referrals: (list)
- establishment or re-establishment of referral orders for community resources: (list)
- discussion with other health care providers: (list)
- assessment and support of treatment regimen adherence: (discussion documentation)
- appointments coordinated with: (list)
- education for self-management, independent living and activities of daily living: (discussion documentation)
Please remember, I am now on an EHR. So I am expected to document electronically first then manually fill out forms. I have no discharge summary yet from the hospital. The medications when she left the hospital state “resume pre-admission meds.” In order for me to list what tests she had I log in to the hospital portal and look them all up. Some of them have been scanned into my EHR, some not. She had a straight forward admission for a small bowel obstruction. She declined to keep the surgeon’s appointment as she was told there was nothing he could do for her.
A TOC visit is paid at a higher rate than other visits if the patient does not return to the hospital in the following 30 days. Hence, we hold the billing until that time. My understanding of the purpose of this new code is to improve coordination of care as a patient transitions from the hospital to home. Coordination would imply that there are other individuals involved and thus there is improved communication between us.
However my staff and I bear the brunt of gathering information (which is what we normally do anyway, so I guess it’s nice because now we get paid for it).
At what point will it become incumbent upon the hospital to send me the necessary information for treating the patient now that he/she is home again? How does it follow that improving care means the primary care doctor fills out even more forms, ultimately reducing the time spent with the patient?
The form will not keep the patient out of the hospital. Communication can keep the patient out of the hospital. True coordination of care might keep the patient out of the hospital. More busy work for the patient’s primary care doctor will not. Since the order of the day is using hospitalists, it is imperative that we improve our communication systems at the time of discharge and before the patient is seen again in the primary care office. Systems must stop thinking that one more form is going to save the patient. Especially another form on my back.
Kathy Nieder is a family physician who blogs at Family Practice 2.0.
Related articles
- How Can Reinventing Patient Experience Decrease Readmissions? (healthcareitstrategy.com)
- St. Elizabeth Hospital Helps Meet HIMSS Stage 7 Requirements, Improves Patient Care with Hosted Electronic Patient … (prweb.com)
- Electronic Health Records Benefits: An ePatient Story (healthcarereimagined.wordpress.com)
- Managing Unsolicited Health Information in the Electronic Health Record – AHIMA (healthcarereimagined.wordpress.com)
- Meaningful Use, Meaningful Results (medcitynews.com)
Patients Not Included * [Inclusion of Patients at a Medical Conference]
From the 25 October 2013 blog item By LESLIE KERNISAN, MD at The HealthCare Blog
few weeks ago, I went for the first time to Stanford’s Medicine X conference. It’s billed as a conference that brings a “broad, academic approach to understanding emerging technologies with the potential to improve health and advance the practice of medicine.”
Well, I went, I saw, and I even briefly presented (in aworkshop on using patient-generated data).
And I am now writing to tell you about the most important innovations that I learned about at Medicine X (MedX).
They were not the new digital health technologies, even though we heard about many interesting new tools, systems, and apps at the conference, and I do believe that leveraging technology will result in remarkable changes in healthcare.
Nor were they related to social media, ehealth, or telehealth, even though all of these are rapidly growing and evolving, and will surely play important roles in the healthcare landscape of the future.
No. The most remarkable innovations at MedX related to the conference itself, which was unlike any other academic conference I’ve been to. Specifically, the most important innovations were:
- Patients present to tell their stories, both on stage and in more casual conversational settings such as meals.
- Patient participation in brainstorming healthcare solutions and in presenting new technologies. MedX also has an ePatient Advisors group to help with the overall conference planning.
These innovations, along with frequent use of storytelling techniques, video, and music, packed a powerful punch. It all kept me feeling engaged and inspired during the event, and left me wishing that more academic conferences were like this.
These innovations point the way to much better academic conferences. Here’s why:
The power of patient presence
I wasn’t surprised to see lots of patients at Medicine X, because I knew that the conference has an e-patient scholars program, and that many patients would be presenting. I also knew that the director of MedX, Dr. Larry Chu, is a member of theSociety of Participatory Medicine. (Disclosure: I’ve been a member of SPM since last December.)
I was, on the other hand, surprised by how powerful it was to have patients on stage telling their stories.
How could it make such a difference? I am, after all, a practicing physician who spends a lot of time thinking about the healthcare experience of older adults and their caregivers.
But it did make a difference. I found myself feeling more empathetic, and focused on the patient and family perspective. And I felt more inspired to do better as a physician and as a healthcare problem-solver.
In short, having patients tell their stories helped me engage with the conference presentations in a more attentive and meaningful way.
…
Read the entire blog item here
Related articles
- Real patient engagement depends on defining it correctly (kevinmd.com)
- Reducing medical errors will require better reporting tools, engaged patients and – you guessed it – culture change (medcitynews.com)
[Reblog] In Medicine, More May Not Be Better
From the 23 October 2013 item at The Health Care Blog
…..
Physicians love being liked. They also love doing their jobs well. With other incentives, such as monetary returns, dwindling, the elation we get from satisfying a patient as well as providing them good care is what still makes being a doctor special. But is keeping patients satisfied and delivering high-quality care the same thing? And more important, can patients tell if they are getting good care?
Policymakers certainly think so. In fact, under the Affordable Care Act, Medicare, and Medicaid hospital reimbursements are now being tied to patient satisfaction numbers.
But the association between patient satisfaction and the quality of care is far from straightforward, and its validity as a measure of quality is unclear.
In fact, a study published in April and conducted by surgeons at the Johns Hopkins School of Medicine showed that patient satisfaction was not related to the quality of surgical care. And a 2006 study found that patients’ perception of their care had no relationship to the actual technical quality of care they received. Furthermore, a 2012 UC Davis study found that patients with higher satisfaction scores are likely to have more physician visits, longer hospital stays and higher mortality. All this data may indicate that patients are equating more care with better care.
Although patients and their physicians generally have similar goals, that is not always the case. As a resident, who is not paid on a per-service basis, I have no incentive to order extra testing or additional procedures for my patients if they’re not warranted. But one study found that physicians who are paid on a fee-for-service basis and therefore have an incentive to deliver services — needed or not — are more likely to deliver these services (such as an MRI for routine back pain).
On top of that, as another study found, they also are more liked by their patients. It is no wonder then that the number of patients with back pain, one of the most common reasons for physician visits, are increasingly being overmanaged with MRIs and narcotic pain medications.
Consumer satisfaction is a metric that has been used extensively in other industries, and its increasing integration in healthcare may represent a desire to model medicine on industries that lead in efficiency, such as the technology, automobile or airline industries. But healthcare remains fundamentally different.
Consider Medicare’s initiative to have hospitals publicly report their patient outcomes and satisfaction data and have consumers compare them a la computers or SUVs. Of the 13 teaching hospitals within five miles of my apartment, the relationship between the quality of care and patient satisfaction was unclear. Within these hospitals, hospital mortality outcomes did not correlate with satisfaction ratings.
I’m a physician and I had difficulty making sense of the data, so how can we expect everyday people to use them in a meaningful way? Would they prefer a place where they or their relatives are likely to live longer, have a lower risk of readmission and have fewer infections, or a place where their pain would be better managed, their nurses more responsive and their bathrooms cleaner? Although ideally hospitals would score highly in both sets of measures, data suggest that is not necessarily always the case.
Patient visits can sometimes be like family dinners. They are probably not the best occasions to talk about Dad’s smoking habit or Mom’s Xanax addiction. But to maintain shared decision-making, clear and honest communication is vital. And in critical situations, most data suggests that patients want their physicians to be upfront about bleak issues such as life expectancy.
Yet a 2012 study by investigators in the Dana-Farber Cancer Institute found that patients who were better informed about the grim nature of their cancer and the goals of their treatment were less satisfied with their physicians. Such findings put a physician in a quandary: a more informed patient or a more satisfied one?
Emphasizing patient satisfaction and offering incentives to hospitals and physicians to keep their patients satisfied are laudable. But trying to transform patient satisfaction into a catch-all quality metric may not be the right approach. What is really needed is for physicians to take the time to help patients identify the things they need, not just what they want.
….
A patient having his blood pressure taken by a physician. (Photo credit: Wikipedia)
Related articles
- ‘Common courtesy’ lacking among doctors-in-training (eurekalert.org)
- Study finds little correlation between patient satisfaction scores, quality of care in hospitals (medcitynews.com)
- Are Patient Views about Antibiotics Related to Clinician Perceptions, Management and Outcome? A Multi-Country Study in Outpatients with Acute Cough (plosone.org)
- Patient Satisfaction? In a Jail? (jailmedicine.com)
- Patient experience more of a priority for hospitals (chronicle.augusta.com)
- It’s Not You, Doctors Are Just Rude (healthland.time.com)
- Hospitals face whole new world under health law (usatoday.com)
[Repost] Parents Want E-Mail Consults With Doctors, but Don’t Want to Pay for Them
From the 21 October 2013 ScienceDaily report
Most parents would love to get an e-mail response from their kids’ health care provider for a minor illness rather than making an office visit, but about half say that online consultation should be free, according to a new University of Michigan C.S. Mott Children’s Hospital National Poll on Children’s Health.
…
The full report is available online at: http://mottnpch.org/reports-surveys/email-consultation-co-pay-or-no-pay
Related articles
- Parents want e-mail consults with doctors, but don’t want to pay for them (medicalxpress.com)
- Parents want e-mail consults with doctors, but don’t want to pay for them (eurekalert.org)
NLM Director’s Comments Transcript Caregiver Assistance & Better Communication: 09/30/2013
Greetings from the National Library of Medicine and MedlinePlus.gov
Regards to all our listeners!
I’m Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.
Here is what’s new this week in MedlinePlus.
The extent of caregivers’ assistance to patients — and suggested strategies for physicians to assist caregivers — are detailed in an interesting commentary recently published in the Journal of the American Medical Association.
The commentary’s author (who is a professor at Harvard Medical School) explains about 42 million Americans are caregivers and they assist patients for an average of 20 hours a week. Muriel Gillick M.D. reports the majority of caregivers are middle-aged women caring for aging parents.
Dr. Gillick notes caregivers often assist patients with daily living activities, such as shopping, cooking, bathing, and dressing. However, Dr. Gillick writes (and we quote) “Nearly half of all caregivers report responsibility for complex medical tasks that often are the province of a professional nurse or trained technician’ (end of quote).
Dr. Gillick finds caregivers report they are responsible for clinical activities including: diet adherence, wound care, treating pressure ulcers, providing medications and intravenous fluids, as well as operating medical equipment.
Dr. Gillick notes the recipients of caregiving are likely to be seniors in the last stages of their life. In the year before death, Dr. Gillick explains only 17 percent of Americans are without a disability while about 22 percent have a persistent severe disability. She reports the largest groups of caregiver-dependent adults include seniors who are frail or have advanced dementia. Dr. Gillick notes about 28 percent of Americans are frail and 14 percent have advanced dementia in their last year of life.
Dr. Gillick adds patients who are frail or have dementia often cannot participate in the management of their care, which necessitates a caregiver’s involvement. Dr. Gillick writes (and we quote): ‘If (end of life) medical care is to be patient centered, reflecting the values (patients) no longer have the cognitive capacity to articulate, clinicians must rely on surrogates to guide them. Yet, few programs caring for patients with dementia (or frailty) regularly incorporate caregivers in every phase of care’ (end of quote).
To improve assistance to caregivers, Dr. Gillick suggests physicians need to better explain a patient’s underlying health condition as well as work with caregivers to prioritize a patient’s health care goals.
Dr. Gillick adds caregivers should be encouraged to provide input about a patient’s surroundings as well as more fully participate in health care planning in a partnership with attending physicians.
Dr. Gillick notes caregivers are especially helpful in creating a continuity of patient care within different settings. She writes (and we quote): ‘In the complex US health care system, in which patients are cared for in the home, the physician’s office, the hospital, and the skilled nursing facility, the most carefully thought-out plan of care will prove useless unless its details can be transmitted across sites’ (end of quote).
Dr. Gillick concludes physicians as well as health care organizations need to provide more educational support to help caregivers.
Meanwhile, MedlinePlus.gov’s caregivers health topic page provides comprehensive information about caregiving’s medical and emotional challenges. For example, a helpful website from the American Academy of Family Physicians (available in the ‘start here’ section) helps caregivers maintain their health and wellness.
A similar website that addresses overcoming caregiver burnout (from the American Heart Association) can be found in the ‘coping’ section of MedlinePlus.gov’s caregivers health topic page.
In addition, there are special sections loaded with tips to provide caregiving to seniors as well as women and children within MedlinePlus.gov’s caregivers health topic page.
MedlinePlus.gov’s caregivers health topic page also provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about caregiving as they become available on MedlinePlus.gov.
To find MedlinePlus.gov’s caregivers health topic page, type ‘caregiver’ in the search box on MedlinePlus.gov’s home page. Then, click on ‘caregivers (National Library of Medicine).’ MedlinePlus.gov additionally features health topic pages on Alzheimer’s caregivers, child care, and home care services.
It is helpful to see JAMA address some caregiving issues. Let’s hope other medical journals will help educate caregivers and encourage more physician-caregiver communication.
Before I go, this reminder… MedlinePlus.gov is authoritative. It’s free. We do not accept advertising …and is written to help you.
To find MedlinePlus.gov, just type in ‘MedlinePlus.gov’ in any web browser, such as Firefox, Safari, Netscape, Chrome or Explorer. To find Mobile MedlinePlus.gov, just type ‘Mobile MedlinePlus’ in the same web browsers.
We encourage you to use MedlinePlus and please recommend it to your friends. MedlinePlus is available in English and Spanish. Some medical information is available in 43 other languages.
Your comments about this or any of our podcasts are always welcome. We welcome suggestions about future topics too!
Please email Dr. Lindberg anytime at: NLMDirector@nlm.nih.gov
That’s NLMDirector (one word) @nlm.nih.gov
A written transcript of recent podcasts is available by typing ‘Director’s comments’ in the search box on MedlinePlus.gov’s home page.
The National Library of Medicine is one of 27 institutes and centers within the National Institutes of Health. The National Institutes of Health is part of the U.S. Department of Health and Human Services.
A disclaimer — the information presented in this program should not replace the medical advice of your physician. You should not use this information to diagnose or treat any disease without first consulting with your physician or other health care provider.
It was nice to be with you. I look forward to meeting you here next week.
George W. Bush’s angioplasty: Did he receive the best care? (With Lively Discussion on Pros/Cons of Medical Screening)
Polygon Medical Animation – Angioplasty Procedure (Photo credit: Polygon Medical Animation)
From the 19 August 2013 Kevin MD article by ALBERT FUCHS, MD
…..
The press coverage of Bush’s angioplasty had frequent questions about the necessity of the angioplasty and the cost of such a procedure. That is precisely not the point, and gives the public the incorrect idea that angioplasties are expensive and beneficial luxuries. BMWs, after all, are unnecessary and expensive, but very nice. And if a VIP gets something unnecessary and expensive, shouldn’t I want one too? The point of the evidence about angioplasties is that in most patients they have no benefit. Focusing on “necessity” misses that point.
It is entirely possible that Bush’s care was flawless. One possibility was that his stress test was extremely abnormal. Such very abnormal tests were excluded from the COURAGE trial, and we have no definitive evidence whether medications or stenting is best in those cases.
The important thing for the public to understand is that VIPs sometimes get terrible care. I’ve personally seen that myself. Physicians often over-test and over-treat celebrities, wrongly thinking that this will protect them from blame for any adverse outcome later. It’s much easier to tell a prominent patient that we will fix your problem with a high-tech and very expensive solution, rather than taking the time to educate the patient that we should start a few very old and very inexpensive medicines which have been proven to save lives. Paradoxically, we’re frequently much more comfortable doing the right thing for patients who will not draw public attention.
……
The comments section was very interesting and lively.
Pap testing was one topic. An excerpt
For those women interested, in my opinion, the best screening program in the world for cervical cancer is the new Dutch program. They’ll scrap their 7 pap test program, 5 yearly from 30 to 60, and offer instead 5 hrHPV primary tests at ages 30,35,40,50 and 60 and ONLY the roughly 5% of women who are HPV+ and at risk will be offered a 5 yearly pap test. (until they clear the virus) This will save more lives and take most women out of pap testing and harms way. (damage to the cervix can mean miscarriages, premature babies, c-sections etc.)
Those HPV- and no longer sexually active or confidently monogamous might choose to stop all further testing. Dutch women are already using a HPV self-test option/device, the Delphi Screener. (also, available in Singapore and elsewhere)
I’ve also, declined breast screening even though that cancer is far more common. Weighing up the risks and actual benefits, it doesn’t get over the line for me. (The Nordic Cochrane Institute brochure on breast screening and Professor Michael Baum’s informative articles and lecture helped me make an informed decision to decline testing)Speaking generally:
We need to stop telling women what to do and start respecting informed consent. Give women real information on risk and ACTUAL benefit, respect them as competent adults/individuals and offer evidence-based testing that focuses on what’s best for them AND, leave the final decision to women, to accept or decline screening as they see fit.
Related Resources (just a few from many!)
- Cochrane Reviews (require subscription, available at many academic/health science libraries…however free summaries are here)
systematic reviews of primary research in human health care and health policy, and are internationally recognised as the highest standard in evidence-based health care. They investigate the effects of interventions for prevention, treatment and rehabilitation. They also assess the accuracy of a diagnostic test for a given condition in a specific patient group and setting. They are published online in The Cochrane Library.
Example of a free summary
Screening for breast cancer with mammography (2013) –[scroll down for link to abstract]
- AHRQ-Patient Involvement
- Evaluating Health Information (with links)
- Research papers summarized for us all (links to resources)
- Evidence based practice (LibGuide with links to tutorials, databases, web resources and more)
- Crunching Numbers: What Cancer Screening Statistics Really Tell Us (National Cancer Institute)
- AHRQ-For Professionals-Prevention and Chronic Care
- Evidence Based Decision Making
- US Preventive Services Task Force
- What Not to Do in Primary Care: Overuse of Preventive Services (
Microsoft PowerPoint version – 1.12 MB )
Michael LeFevre, University of Missouri-Columbia
- What Not to Do in Primary Care: Overuse of Preventive Services (
- US Preventive Services Task Force
- Evidence Based Decision Making
Related articles
- UDoTest, HPV Virus Home Screening Kit, Launches In South Africa; Doctor Says It’s ‘More Effective Than A Pap Smear’ (medicaldaily.com)
- Many Docs Don’t Follow HPV/Pap Test Guidelines (nlm.nih.gov)
- Women may not need pap smears every two years according to University of NSW research (abc.net.au)
- Outdated practice of annual cervical-cancer screenings may cause more harm than good (eurekalert.org)
- Why Some Parents Are Refusing HPV Vaccine For Their Children (shotofprevention.com)
- On Self-Advocacy and Paying It Forward (draemadden.wordpress.com)
Self-diagnosis on Google, other websites the first line of medical care for more than half of Canadians: poll
Related Resources
- Evaluating Health Information (jflahiff.wordpress.com)
- Evaluating Health Information [with links] (MedlinePlus)
Millions of consumers get health information from magazines, TV or the Internet. Some of the information is reliable and up to date; some is not. How can you tell the good from the bad?
First, consider the source. If you use the Web, look for an “about us” page. Check to see who runs the site: Is it a branch of the government, a university, a health organization, a hospital or a business? Focus on quality. Does the site have an editorial board? Is the information reviewed before it is posted? Be skeptical. Things that sound too good to be true often are. You want current, unbiased information based on research.
Related articles
- Calling Dr. Google: Poll finds more than half of Canadians use web to self-diagnose (calgaryherald.com)
- Study: More Caregivers Seeking Health Information Online (money.usnews.com)
Facebook medical advice isn’t what’s best for your child
From the 29 July 2013 KevinMD.com article
COURTNEY SCHMIDT, PHARMD | SOCIAL MEDIA | JULY 29, 2013
It happens about once a week. As I scroll through Facebook and peruse the latest happenings, I notice that someone (usually a mom of small children, like me) has posed a question to their Facebook friends about some type of health dilemma.
“Little Sally is cutting teeth, and she’s miserable. What can I give her to make her feel better?”
“Johnny has such a bad cough, and he can barely breathe. Anyone used Vick’s Vaporub on a baby before?”
“Took Sam for his 4-month checkup today. Dr. says I should wait to start giving him baby food until 6 months, but I feel like he’s ready. Any moms have some advice?”
I’ve seen each of these health concerns voiced on Facebook along with many others. Various friends weigh in with their tidbits of advice or personal experience, and usually the mom will choose from those options and then report back about how that advice worked.
Here’s the problem: all health information isn’t created equal.
And crowdsourcing for medical advice isn’t likely to result in the best outcome for your child.
Although the Facebook community recommended several products for Sally’s mom to try to ease teething pain, they were likely unaware that many of these products are no longer recommended for infants because of serious health risks associated with their use.
While Johnny’s mom’s Facebook friends offered enthusiastic support for rubbing Vick’s VapoRub on his chest, feet, and even putting it under his nose, they didn’t know that this product can be harmful to children under two years of age.
Read the entire article here (which includes great Web sites for child health/medical information)
Related resources
- Caring for Your Baby and Young Child, 5th Edition: Birth to Age 5. Author: The American Academy of Pediatrics
- My Child Is Sick! Expert Advice for Managing Common Illnesses and Injuries. Author: Barton D. Schmitt, MD, FAAP
- Healthychildren.org
- Familydoctor.org includes health information for the whole family
- KidsHealth provides information about health, behavior, and development from before birth through the teen years.
How To Make The Most Out Of Your Doctor
Written by a nurse.
Admittedly everyone have the same feeling when they are compelled by physiologic abnormality to visit the doctor. Anxiety is the leading cause of why people delay seeing a doctor, they would tend to rationalize their illness until it interferes with their day to day living. Anxiety is a common feeling especially if you have no idea of what your illness is, could it be life threatening or just a minor glitch? One should not be afraid to visit the doctor it is their job to diagnose our illness and provide us with medical interventions to maintain the homeostasis of our body. Some people when visiting the doctor don’t know what to do or what to say, some would even freeze as if that they are being interrogated. The doctor can’t help you unless you are willing to help the doctor! Yes, he may relay on laboratory findings but it will…
View original post 687 more words
Medicare Drug Program Fails to Monitor Prescribers, Putting Seniors and Disabled at Risk
Excerpt from
ProPublica, May 11, 2013, 9:06 p.m., by Tracy Weber, Charles Ornstein and Jennifer LaFleur
….An analysis of four years of Medicare prescription records shows that some doctors and other health professionals across the country prescribe large quantities of drugs that are potentially harmful, disorienting or addictive. Federal officials have done little to detect or deter these hazardous prescribing patterns.
Searches through hundreds of millions of records turned up physicians such as the Miami psychiatrist who has given hundreds of elderly dementia patients the same antipsychotic, despite the government’s most serious “black box” warning that it increases the risk of death. He believes he has no other options….
…..
The data, obtained under the Freedom of Information Act, makes public for the first time the prescribing practices and identities of doctors and other health-care providers. The information does not include patient names or the reasons why doctors prescribed particular drugs, so reporters interviewed the physicians to learn their rationales.
…
Medicare has access to reams of data about its patients, their diagnoses and the medical services they received. It could analyze all of this information to determine whether patients are being prescribed appropriate drugs for their conditions.
But officials at the Centers for Medicare and Medicaid Services say the job of monitoring prescribing falls to the private health plans that administer the program, not the government. Congress never intended for CMS to second-guess doctors – and didn’t give it that authority, officials said.
“CMS’s payments don’t go to physicians, don’t go to pharmacies. They go to plans, which is how our oversight framework has been established,” Jonathan Blum, the agency’s director of Medicare, said in an interview. The philosophy “really has been to defer to physicians” about whether a drug is medically necessary, he said.
Asked repeatedly to cite which provision in the law limits their oversight of prescribers, CMS officials could not do so.
The Office of the Inspector General of the Department of Health and Human Serviceshas repeatedly criticized CMS for its failure to police the program, known as Part D. In report after report, the inspector general has advised CMS officials to be more vigilant. Yet the agency has rejected several key recommendations as unnecessary or overreaching.
Other experts in prescription drug monitoring also said Medicare should use its data to identify troubling prescribing patterns and take steps to investigate or restrict unsafe practitioners. That’s what state Medicaid programs for the poor routinely do.
“For Medicare to just turn a blind eye and refuse to look at data in front of them . . . it’s just beyond comprehension,” said John Eadie, director of the Prescription Drug Monitoring Program Center of Excellence at Brandeis University.
“They’re putting their patients at risk.”
….
The Part D records detail 1.1 billion claims in 2010 alone, including prescriptions and refills dispensed. ProPublica has created an online tool, Prescriber Checkup, to allow anyone to search for individual providers and see which drugs they prescribe.
…
Typically in Medicare, the government is responsible for contracting with doctors, reviewing claims for treatment and paying the bills.
But Part D is different: Patients get their drugs through stand-alone drug plans, which cover only drugs, or through Medicare HMOs that also cover medical services.
Medicare pays private insurers a set amount per enrollee to run the program and pay for the drugs. All the insurance plans are supposed to alert pharmacies to potentially harmful drug interactions, query doctors who prescribe high levels of narcotics to individual patients and be on the lookout for fraud, among other things.
……
Potential for Fraud
Since Part D was launched, the HHS inspector general and the Government Accountability Office have grown increasingly worried that it lacks adequate oversight.
Several reports have found that Part D is vulnerable to fraud. Insurers have paid for prescriptions from doctors who were barred by Medicare. Separately, in 2007 alone, the program covered $1.2 billion worth of drugs prescribed by providers whose identities were unknown to insurers or Medicare, according to a June 2010 report.
The inspector general even found fault with the contractors Medicare hired to dig out fraud: The contractors generated few of their own investigations, relying on outside complaints for direction.
Although many reports focus on fraud, analysts also have found that the program was vulnerable to inappropriate prescribing that put patients’ lives in danger.
A May 2011 report said Medicare has not ensured that Part D paid only for drugs prescribed for FDA-approved and widely accepted off-label indications as federal law requires. About half of the 1.4 million antipsychotic prescriptions made to nursing home patients in the first six months of 2007 “were not used for medically accepted indications,” the report said.
“There’s certainly room for improvement,” Robert Vito, a regional inspector general who has directed many of the reports, said in an interview.
Medicare should, for example, require that prescriptions include a patient’s diagnosis as a way to monitor how Part D drugs were being used, his agency said.
But Medicare officials told the inspector general that neither state boards of pharmacy nor private industry requires this practice, so neither would they.
CMS also has rejected proposals to require insurers to report suspicious prescribing to its fraud contractor. Such sharing is now voluntary.
Medicare’s safeguards lag well behind those of many state Medicaid programs.
Louisiana requires that doctors include diagnosis codes when they write prescriptions for painkillers and antipsychotics. Similar checks have proved effective in other states. Florida found that antipsychotics given to children younger than 6 dropped when specialists reviewed prescriptions.
Even some of Medicare’s top prescribers think the program should do more to research unusual or suspicious prescribing patterns.
Indiana physician Daniel J. Hurley led the country with more than 160,000 prescriptions under Part D in 2010, ProPublica’s analysis shows. In an interview, he said nursing home pharmacies had credited him with prescriptions by other health professionals in his practice, a quirk Medicare should want to address.
It’s unclear how often this might happen, and some nursing home doctors do write lots of prescriptions on their own. Medicare said it recently addressed this issue, but according to Medicare’s own numbers, Hurley’s prescriptions have dropped only slightly.
“Why wouldn’t they call us up and ask us?” Hurley said. “If you hustled, you couldn’t come anywhere near that number, nor should you.”
Related articles
- Doctors’ Extreme Prescribing – Footprints of Medicare Fraud? (aarp.org)
- Top Medicare Official: ‘We Can and Should Do More’ to Oversee Drug Plan (gantdaily.com)
- A Rap Sheet For Medicare’s Prescription Drug Program (propublica.org)
- Inspector General Faults Medicare for Not Tracking ‘Extreme’ Prescribers (stateofglobe.com)
- Medicare Has Been Paying for Prescriptions Written by … Art Therapists (newser.com)
- Top Medicare Prescribers Rake In Speaking Fees From Drugmakers (wnyc.org)
- Over 700 US doctors suspected of harmful excessive prescription practices – report (rt.com)
[Reblog]Let Patients Help: A New Book Authored by e-Patient Dave deBronkart | ScienceRoll
Let Patients Help: A New Book Authored by e-Patient Dave deBronkart | ScienceRoll.
From the 20 March 2013 post at Science Roll
Posted by Dr. Bertalan Meskó in e-patient, Health 2.0, My Bookshelf, Web 2.0.
trackbackI was very glad to see the new book authored by e-Patient Dave deBronkart, whose thoughts I describe to medical students as a part of the official curriculum at Semmelweis Medical School, just became available.
Medical professionals must let patients help and become equal partners in the treatment! A must-read book!
Concise reasons, tips & methods for making patient engagement effective.
Third book by e-Patient Dave, cancer beater, blogger, internationally known keynote speaker and advocate for patient engagement; co-founder and past co-chair of the Society for Participatory Medicine. Profile:http://www.ePatientDave.com/about-dave
Related articles
- Let Patients Help: A New Book Authored by e-Patient Dave deBronkart (scienceroll.com)
- Project HealthDesign’s new video series: Conversations with e-PatientDave (projecthealthdesign.typepad.com)
- Part 1: Value of social media in healthcare is already outlined – just not realized (himss.org)
- The Multidimensional Role of Social Media in Healthcare (gumption.typepad.com)
- First Post: A Video About Patients Involvement in Their Own Healthcare (healthitoutlook.wordpress.com)
- The 7 Habits of Highly Patient Centric Providers (forbes.com)
- I’m an e-patient: equipped, enabled, empowered, engaged (worldofdtcmarketing.com)
Behind the fetish of vitamin B12 shots
From the 3 February 2013 post at KevinMD.com
…
The treatment of B12 deficiency, as has been established from studies done in the 1960s, is ORAL B12. That’s right. Pills. Injections of B12 are not necessary—oral supplements work well, even in pernicious anemia. They’re cheap and they work. I suppose a very rare patient, say one who has surgically lost most of their gut, could require injections. But the vast majority of people with genuine B12 deficiency can get all of the B12 they need through eating foods or swallowing supplements. No needles needed.
So why this fetish with injections? From the patient’s point of view, shots feel more like something important is going on. Placebos need rituals—with acupuncture, for instance, the elaborate ritual creates an illusion of effectiveness. And from the doctor’s point of view, injections reinforce dependence on the physician, creating visits and cash flow.
So: people seem to think they feel better with injections, and the doctor makes a little cash, and everyone’s happy. So what’s the harm in that?
I think it’s wrong to knowingly dispense placebos, even harmless ones. We doctors like to criticize the chiropractors and homeopaths. We point fingers. They’re the quacks. We’d better take a close look at what we’re doing, first. Our placebos are sometimes far more dangerous than theirs.
More importantly, people should be able to expect more from physicians…
The High Cost of Not Listening to Patients.
This article reminds me of my days as a medical librarian.
If I did not carefully listen to a patron (customer) or ask the right questions, I gave the person the wrong information!
Minutes spent in listening and asking focused questions often saved an hour (or more!) of fruitless searching.
So, when I talk with a health care practitioner, I am mindful to give as much relevant information as possible to so the proper diagnosis and treatment can be given!
It is also necessary that we all do whatever we can so that health care practitioners are given the time they need to listen to patients.
Ultimately this will result in lower health care costs overall.
From the 18 January 2013 post at The Health Care Blog
Before we can understand the high cost of not listening, we need to examine in detail the diagnostic process. I am limiting my discussion to patients with chronic or recurring symptoms lasting several months. I am not discussing acute illnesses. They fall into completely different category.
At the front line of medical care, at the first contact between a patient and a doctor, the patient describes physical symptom. Whatever the real underlying cause, a physical symptom is the required ticket to see a physician. The physician, on first contact, has no idea what the underlying nature of the patient’s chronic complaint really is. At the risk of oversimplifying, there are five broad categories of the causes for complaints.
These are:
1. There is a definable medical disease in one or more organs.
2. There is no definable medical disease but the patient is in contact with an unknown toxic substance causing the symptom (inhaled, ingested, or from skin contact).
3. The patient is in a stressful or toxic relationship at home or work producing physical symptoms or even a definable medical disease. (“What the mind cannot process is relegated to the body.” Dr. William Mundy, psychiatrist, personal communication. )
4. The patient or a companion is inflicting harm. Here, there are several categories:…
…
5. There is no definable medical disease but the patient has assumed a chronic illness role in life with multiple symptoms (i.e. hypochondriasis).
Psychosomatic Illness
6. There is a sixth category; patients with psychosomatic disorders. Time and space does not permit a full discussion of this important and very common set of disorders. I suspect they represent more than fifty percent of patients seeking primary medical care. The book“The Divided Mind” explains and defines these disorders and the successful treatment applied to thousands of patients at NYU by Dr. Sorno and his colleagues. At present the medical profession denies the existence of this category. The epidemic emergence of pain clinics comes from lack of knowledge about psychosomatic disorders and their proper treatment.
Of course, the patient can have any of these, and also be suffering from a definable medical disease.
But my experience in primary care over the past 55 years — combined with studies in the medical literature —suggest that between 30 and 40 percent of first contact primary care visits are stress related or are psychological in nature (#3 and #6 in above list).
It should be obvious that the only way to sort out these causes of symptoms requires very careful listening to the narrative of the patient’s life. Some of these causes can be determined only by listening…..
Patients who self track their data: Curb your enthusiasm
From the 17 January 2013 article by KEEGAN DUCHICELA, MD at KevinMD.com
…
1. There’s not strong data to support self-tracking. We can make some inferences about how self-tracking would work in a clinical setting by looking at the studies done on telemonitoring, which also generates a large volume of attribute-rich data. Some studies have shown benefit in outcomes, especially for diseases like diabetes, COPD, and hypertension. However, hard measures like mortality have not been improved by telemonitoring devices. Data on hospitalization and ED visits, especially in the elderly, have been mixed. People (especially the engineers who created these wonderful devices and apps) love to think that more data points are better. But to date, we just don’t have a robust set of well controlled studies telling us what self-tracking is useful for, what devices or apps to use, how to interpret the data, or how to integrate it into medical care.
2. Physicians may not want the data. Imagine that a 45-year old man who had just started exercising after years of inactivity gives their doctor all of their heart rate measurements from the past month. All 5000 measurements. There’s no way their physician is going to want to touch that data. Buried inside those data points will be erroneous and clinically meaningless measurements which, without review and context, will be fodder for trial lawyers when something bad happens. It’s data overload to the Nth degree, because let’s face it … anything can be tracked. Once data gets put into the medical record, it’s assumed the physician has reviewed the data and acted on it accordingly. No one wants something in the patient’s chart that not only has limited medical use but carries substantial legal risk.
Finally, we need to pay physicians to analyze and counsel about the data, similar to how we pay for EKG interpretation or reading an x-ray. Fee-for-service still rules the roost, and nothing gets done unless someone pays for it…
Simple intervention helps doctors communicate better when prescribing medications (5 basic facts to convey)
English: medications (Photo credit: Wikipedia)
The EurkAlert article is here.
If the prescribing health care practitioner forgets, here they are
- the medication’s name
- its purpose
- the directions for its use
- the duration of use
- the potential side effects
Related articles
- Doctors Prescribe, Pharmacists Dispense, Patients Suffer (medicine.com.my)
- Better care from doctors who are culturally aware (eurekalert.org)
- Pharmacists to prescribe medication (stuff.co.nz)
[Article Summary] 1 In 3 Americans Uses Internet To Help With Diagnoses

From the 15th January 2013 article at Medical News Today
A nationwide survey ***of US adults finds that 1 in 3 of Americans say they have used the internet to help them diagnose a medical condition, either for themselves or someone else. But, when asked who they turned to for help with a serious health issue, either online or offline, the majority said they turned to a doctor or other health professional…
…when these “online diagnosers” were asked who they turned to for information, care or support the last time they had a serious health problem, either online or offline:
- 70% said they got it from a health professional,
- 60% turned to family and friends, and
- 24% said they got it from others with the same condition.
When the survey asked online diagnosers if the information they found online had led them to think they needed to see a doctor, 46% said yes, while 38% said they could take care of it themselves and 11% said it was a case of both or something in between.
Related articles
- Internet Is First Stop for Many Ill People, Study Finds (mashable.com)
- 1 in 3 adults search online for medical diagnosis (cbc.ca)
- ‘Doctor Google’ Isn’t Replacing Actual Doctors Any Time Soon (betabeat.com)
***The full Pew Internet report Health Online 2013 may be found here
Are you a thrifty patient? How to get the care you need and save money
From the 2 January 2012 article by DAVIS LIU, MD at Kevin MD.com
It is increasingly becoming the year of the Thrifty Patient. People are paying for more medical care and are more responsible for the costs of getting that care via higher deductibles and co-pays. Patients don’t have a choice but to be involved in their care. Though the recent 2008 recession saw a decrease in overall medical and health care utilization as a sign of better informed patients, I believe that was simply because people deferred needed care in order to keep their jobs. With the economy getting better, more people will begin to seek care again. The question is how can they save money on medical and health care costs?…..
Related articles
- How and Where to Save Money on Health Care (dailyfinance.com)
- Better health care will reduce Medicare costs (mysanantonio.com)
- Spending More On Health Care Doesn’t Guarantee Better Treatment (thinkprogress.org)
The Empowered Patient Strikes Back (Book and Web site)
From the 21 December 2012 post at The Health Care Blog
…Julia Hallisy learned about patient safety the hard way. Hallisy’s daughter, Kate, was diagnosed with an aggressive eye cancer when she was five months old. Over the next decade, she went through radiation, chemo, reconstructive surgery, an operation to remove her right eye, a hospital-acquired infection that led to toxic-shock syndrome and an above-the-knee amputation…
…Hallisy decided to write a book that might help others. In 2008, I reviewed it on HealthBeat…
..
At the time I wrote: “Remarkably, The Empowered Patient is not an angry book. It is not maudlin. To her great credit, Hallisy manages to keep her tone matter-of-fact as she tells her reader what every patient and every patient’s advocate needs to know about how to stay safe in a hospital.”
Recently, Hallisy emailed to tell me know that the book has now become a non-profit foundation: The Empowered Patient Coalition.
Go to their website and you will find fact sheets, checklists, and publications including, A Hospital Guide for Patients and Families that you can download at no charge. I found the Hospital Guide eye-opening. I have read and written a fair amount about patient safety in hospitals, but it told me many things that I did not know…
[Great outline of doctor/nursing hierarchy]
[Questions Patients and Advocates Should Ask]
[What To Look For In Your Medical Record]
Related articles
- Oops! US Doctors Screw Up Surprisingly Often: Study (livescience.com)
- Patients as customers: surfing for hospital emergency departments with shorter wait times (blogs.vancouversun.com)
- My experience as an empowered patient (worldofdtcmarketing.com)
- How to Make Your Hospital Stay Safer and Cheaper: A Checklist (pbs.org)
- Hospitals Are Killing Us (lewrockwell.com)
Patient treatment preferences ‘often misdiagnosed’
From the 8 November 2012 article at BBC Health
Doctors are failing to really listen to patients’ views on how they want to be treated, suggests a study in the British Medical Journal.
The Dartmouth College research says working out a patient’s preferences is as important as an accurate medical diagnosis.
Involving patients in discussions about treatment could cut the cost of healthcare around the world, they say.
Doctors should follow a three-step approach to engaging patients.
The BMJ analysis, written by three healthcare experts from the Dartmouth Center for Health Care Delivery Science in New Hampshire, US, is based on a report written for the UK’s King’s Fund, a policy thinktank.
In it they argue that “preference misdiagnosis” – misinterpreting or ignoring the patient’s wishes – is a significant problem which is damaging to both doctors and patients.
The researchers say it can lead to, what they call, “silent” misdiagnoses – when doctors choose the wrong treatments because they fail to assess their patients’ preferences correctly.
These misdiagnoses are “silent” because they go largely unreported.
Priorities
While doctors are taught to concentrate on diagnosing the medical problem, the authors point to evidence which suggests doctors are not as good at setting out all the treatment options and finding out how the patient feels about them.
In one study they looked at, doctors believed that 71% of patients with breast cancer rate keeping their breast as a top priority, but the figure reported by patients was just 7%.
In another study of dementia, patients placed substantially less importance than doctors believed on the continuation of life with severely declining brain function.
Evidence also shows that patients often choose different treatments after they become better informed about the risks and benefits, say the authors….
….
“More than 100 years ago student doctors were told to ‘listen to the patient, he is telling you the diagnosis’.
“Today, the rise in treatment options makes this even more critical, not only to reach a correct medical diagnosis but also to understand fully patients’ preferences – and reduce the huge waste in time and money that comes from the delivery of services that patients often neither want nor need.”
Anna Dixon, director of policy at the King’s Fund, said the research supported the idea that patients should be helped to make decisions about their care.
“Not only does it find that this results in more appropriate treatment than currently achieved but, rather counter-intuitively, it results in dramatically lower intervention rates.”
Dr Vivienne Nathanson, head of science and ethics at the British Medical Association said good medicine was about doctors using their knowledge and expertise to help patients make informed choices.
“Good decisions about treatment reflect both a patient’s preferences, and the relevant medical evidence. Doctors try to help patients express their preferences and are aware that these sometimes differ from those of the ‘average’ patient.
“Exploring how the patient’s preferences and values relate to the decision to be made requires a relationship of trust between patient and doctor.”
Related articles
- Patient wishes ‘not listened to’ (bbc.co.uk)
- Doctors often miss patients’ treatment preferences (cbc.ca)
- Patient preferences often ignored in treatment decisions, warn experts (eurekalert.org)
- Doctors Often Misinterpret Patients’ Wishes, Study Says (newsday.com)
- A third of patients say their GPs are so rushed they are worried they will be misdiagnosed (thisismoney.co.uk)
The Future of Healthcare is Already at Your Fingertips [INFOGRAPHIC]
From the 8 August 2012 post at Mashable Lifestyle
The mobile healthcare industry has made significant strides within the healthcare provider community. Rock Health found 75% of small and medium size medical and dental offices will purchase tablets within the next year. And almost 40% of physicians use medical apps on a daily basis.
The digital healthcare field is also alleviating the costs of patientcare and increasing the scale at which doctors and nurses can help people. The healthcare industry is already strained, Ziegler says, and a shortage of primary care physicians in years to come will only exacerbate the problem. She says mobile apps can bridge that gap.
But patients have been slower to realize the impact apps could have, Ziegler says, potentially because the apps force people to take notice of their health.
“No one wants to actively track what they are always doing, so we really want to make the experience passive,” she told us, adding, they are working to make tech and apps that “provide incentives for people to manage health more efficiently.”
Consumers are also generally unaware of how quickly the space of mobile health is growing, David Tao, Chief Research Officer at Greatist, tells Mashable. He says once consumers realize the vast industry already accessible, more consumers will begin utilizing the products.
“Mobile health isn’t a replacement for healthcare, it’s a supplement,” Tao says. “These companies aren’t replacing doctors’ keen eye or experience, but the apps are just bettering communication between doctor and patient.”
Related Resources
- Health and Wellness Information and Tracking Apps (Flahiff’s Health/Medical Resources site)
- Health and Fitness Tracking Apps (Flahiff’s Health/Medical Resource site)
- And these may be helpful when selecting health apps
- How to Choose A Better Health App (by LEXANDER V. PROKHOROV, MD, PHD at KevinMD.com on August 8, 2011) contains advice in the following areas
- Set realistic expectations
- Avoid apps that promise too much
- Research the developers
- Choose apps that use techniques you’ve heard of
- See what other users say
- Test apps before committing
- iMedical apps has mobile medical app reviews and commentary by medical professionals. Most apps are about apps geared toward professionals and are not free.
- The iMedical app forum now includes a medical librarian corner, with some patient/consumer apps
- Evaluating Health/Medical Information
- The Penn State Medical Center Library has a great guide to evaluate health information on the Internet.
- The tips include
- Remember, anyone can publish information on the internet!
- If something sounds too good to be true, it probably is.
- If the Web site is primarily about selling a product, the information may be worth checking from another source.
- Look for who is publishing the information and their education, credentials, and if they are connected with a trusted coporation, university or agency.
- Check to see how current the information is.
- Check for accuracy. Does the Web site refer to specific studies or organizations?
- The Family Caregiver Alliance has a Web page entitled Evaluating Medical Research Findings and Clinical Trials Topics include
- General Guidelines for Evaluating Medical Research
- Getting Information from the Web
- Talking with your Health Care Provider
- Additional Resources
- Consumer’s Guide to Taking Charge of Health Information (Harvard Center for Risk Analysis)
- How to Evaluate Health Information on the Internet (US National Cancer Institute)9iiu9
- Quackwatch (a private corporation operated by Stephen Barrett, MD)
- And a Rumor Control site of Note (in addition to Quackwatch)
- National Council Against Health Fraud National Council Against Health Fraud is a nonprofit health agency fousing on health misinformation, fruad, and quackery as public health problems. Links to publications, position papers and more.
Related articles
- Phones, tablets may become most popular tech devices for docs since the stethoscope (infographic) (medcitynews.com)
- Does smartphone = smart healthcare? (docmate.com.au)
- Mobile health apps: a new opportunity for healthcare marketers (worldofdtcmarketing.com)
- More Consumers Get Health Info On Mobile Devices (informationweek.com)
- INFOGRAPHIC: Smartphone = smarter healthcare? (mobile-ent.biz)
- How Smartphones Are Facilitating Better Health Care (thinkprogress.org)
- U.S. HealthWorks Adopts iTriage App to Connect with Patients (prweb.com)
- Who Do You Trust When it Comes to Healthcare Information? [INFOGRAPHIC] (mashable.com)
- How Smartphones Are Changing Health Care (iphonesavior.com)
Preparing for your doctor’s visit: 10 things to always bring
Wow, am I the last person on earth sans smartphone?
From the 23 October 2012 article by Leana Win, MD at KevinMD.com
Most patients I see are surprised to find out that there’s something they should have brought to their doctor’s visit. Granted, I’m an emergency physician, and many of my patients come to me in emergency situations that they can’t plan for. However, most people have some heads-up for going to their doctor. Certainly if you’re going to your annual check-up or a routine appointment, you should bring these items with you.
Keep this checklist readily accessible; even if you’re going to the hospital for an emergency appointment, aim to take the following 10 items with you:
1. A medical card. It would be ideal for every doctor to have a full list of your medical history, but our country is not even close to having a nationally accessible medical record system. To make sure your doctor has your information available, carry a card with you. You can find many cards that easily downloadable on the Internet where you list your medical problems, surgeries, doctor’s names, insurance, and allergies. Especially if you are seeing a coverage doctor or visiting the E.R., he or she may not have your medical record. This makes sure that your doctor can see your most critical medical information.
2. Changes to your medical record. If you have had recent test results since you last saw your doctor, bring these with you. Even if it was your doctor that you’re going to see who sent you to get the test, bringing the results will make sure that they are discussed during the visit.
3. Your medications.
[Read the entire article at http://www.kevinmd.com/blog/2012/10/preparing-doctors-visit-10-bring.html]
8. A family member or a friend. Having someone with you will give you support and company during the appointment. As importantly, they can help remind you of your questions and concerns, and is another measure to help ensure your doctor answers all the questions that you have.
9. A smartphone. Everyone seems to have some kind of smartphone device: an iPhone, a Blackberry, an iPad. There will downtime when you’re waiting. Use this time to look up what your doctor has told you. The smartphone also keeps you busy if your wait is particularly long!
10. Some snacks. Often, there are limited food options are the doctor’s office, and you may be waiting for some time. Unless you’re told not to eat, or have a complaint that you’re not sure how it will go, having something on hand can help make you feel better.
I hope this list is useful for you as you prepare for your next doctor’s visit.
Related articles
- 5 Ways to Make the Most of Your Doctor’s Visit (sprighealth.com)
- Doctors open their notes to patients – and patients like what they see (washingtonpost.com)
- Think big about mobile health — going beyond medical records (blogs.computerworld.com)
- Benefits of online medical records outweigh the risks (larrysworld.com)
- Why electronic medical records are good for patients (whatsupatupstate.wordpress.com)
- Find out whether your medical record accurate (kevinmd.com)
Digital medicine: Patients are stuck in the precarious middle
Health Applications for Android Tablets (Photo credit: IntelFreePress)
From the 15 October 2012 post by JOHN SCHUMANN, MD at KevinMD.com
The use of computers in everyday medical practice has finally reached the tipping point.
The HITECH Act, part of the 2009 federal stimulus bill, has been the final kick in the pants that U.S. health care has long needed to make the conversion to digital. The act states that, by employing electronic health records (EHRs) in a fashion known as meaningful use, doctors are individually eligible for Medicare subsidies of $44,000, paid out over five years. Before now, only early adopters and deep-pocketed institutions like hospitals and large medical groups could afford the investment to convert to EHRs.
In general, EHRs are secure digital repositories of patient information–doctors’ notes, lab and X-ray reports, and letters from specialist physicians. They are an electronic version of the paper chart. Newer, more advanced EHRs are integrated systems and allow doctors to order tests, generate bills, communicate with patients, and run analyses on aggregate patient data. In hospitals, nurses use EHRs to administer and record medication dosing and document other patient care activities.
Though medical practices have a high burden of proof to claim their bonus–the Department of Health and Human Services is still in the process of fully defining just what constitutes ‘meaningful use’–there is now conclusive evidence that the carrots are working. Recent data demonstrates that solo and two-doctor offices, which still comprise over half of all medical practices in the U.S., have seen the biggest jump in EHR adoption over the last six months. These small shops are reaching the conclusion that they must.. participate, as they risk being left behind technologically and financially…
..
No one describes this more elegantly than doctor and author Abraham Verghese, who has lamentedthe rise of the “iPatient.” For Verghese, the iPatient symbolizes the adoption of technology to a level that is eroding the foundational elements of the profession, like the physical examination. He decries trainees spending vastly more time at computer stations looking over their ‘virtual’ patient [the collection of progress notes plus lab and x-ray data, not an avatar] than giving face time to the sick person down the hall. Other commentators describe the sloppy habits of ” copy and paste” medicine, in which doctors (especially trainees) perpetuate the same patient histories from one hospital admission to the next without applying fresh thinking. [Human nature is no different among doctors: Where possible, we take the path of least resistance.]
Further, doctors and nurses are now tethered to computer appliances. To perform any basic hospital function (e.g. admission, lab test, x-ray, pill delivery, discharge), an order needs to be sent via the computer system. The good in this is that all doctors’ orders go through one standardized entry point: It eliminates issues with poor physician penmanship. However, the technology inhibits doctors and nurses from actually talking to one another…
…
There is hope, however. Bryan Vartabedian, a pediatric gastroenterologist and social media enthusiast in Texas, gives voice to the possibilities of doctor-patient collaboration using technology. In a blog post about his visit to an orthopedic surgeon for back problems, Vartabedian writes (italics mine):
…through the course of my visit he never touched me. We spent an extraordinary amount of time examining my MRI. Together in front of a large monitor we looked at every angle of my spine with me asking questions. I could see firsthand what had been keeping me up at night. I could understand why certain positions make me comfortable. What we drew from those images could never be determined with human hands. In my experience as a patient, I consider it one of my most thorough exams.
Vartabedian is describing a new paradigm, in which he plays the role of empowered patient and demands an explanation to his level of satisfaction. In the parable offered, the technology is the medium, not the message….
Related articles
- EHRs: Fewer errors and better care are the end game, not increased fraud (medcitynews.com)
- 4 reasons why doctors need to drive health care technology (kevinmd.com)
- Essentials of telehealth and telemedicine, top Do’s and Don’ts, mHealth and other health IT advice (healthcareguy.com)
- Electronic health records improve quality of patient care, study says (bizjournals.com)
- Five Reasons Americans Should Want Electronic Health Records (thehealthcareblog.com)
- Survey: Clinicians believe EHRs will have positive impact on health care (eurekalert.org)
- Should medical students learn how to use an EHR in medical school? (kevinmd.com)
- PCPs may be distracted by adapting to EHRs (bhgstat.wordpress.com)
- Why we need to go from e-patient to i-patient(insurance savvy patient) (jflahiff.wordpress.com)
- e-patient Dave de Bronkart was successfully treated for kidney cancer at a very late stage. He credits his recovery to using the Internet to find trusted medical information as well as to get advice from patients via support groups.
His video Let Patients Help outlines how and why patients should empower themselves.
Some video highlights
- Patients are presently the most underutilized part of the health team
- The e-patient movement is at least partly based on hippie ideals of self-reliance and self-care (think Whole Earth Catalog)
- e-patients are empowered, engaged, equipped and enabled through finding information to use in discussions regarding treatment options with their health care providers
- Support groups often are useful in providing information not available at other sites (as which doctors specialize in certain treatments)
- Patients not only need quality information, but also access to their raw medical data
Patients Feel More Control of Their Health When Doctors Share Notes
From the 1 October 2012 article at Science Daily
Patients with access to notes written by their doctors feel more in control of their care and report a better understanding of their medical issues, improved recall of their care plan and being more likely to take their medications as prescribed, a Beth Israel Deaconess Medical Center-led study has found…
…
“Open notes may both engage patients far more actively in their care and enhance safety when the patient reviews their records with a second set of eyes.”
“Perhaps most important clinically, a remarkable number of patients reported becoming more likely to take medications as prescribed,” adds Jan Walker, RN, MBA, co-first author and a Principal Associate in Medicine in the Division of General Medicine and Primary Care at BIDMC and Harvard Medical School. “And in contrast to the fears of many doctors, few patients reported being confused, worried or offended by what they read.”…
..
Of 5,391 patients who opened at least one note and returned surveys, between 77 and 87 percent reported open notes made them feel more in control of their care, with 60 to 78 percent reporting increased adherence to medications. Only 1 to 8 percent of patients reported worry, confusion or offense, three out of five felt they should be able to add comments to their doctors’ notes, and 86 percent agreed that availability of notes would influence their choice of providers in the future.
Among doctors, a maximum of 5 percent reported longer visits, and no more than 8 percent said they spent extra time addressing patients’ questions outside of visits. A maximum of 21 percent reported taking more time to write notes, while between 3 and 36 percent reported changing documentation content…
Walker suggests that so few patients were worried, confused or offended by the note because “fear or uncertainty of what’s in a doctor’s ‘black box’ may engender far more anxiety than what is actually written, and patients who are especially likely to react negatively to notes may self-select to not read them.”..
Related articles
- Patients Like Reading Their Doctors’ Notes (nlm.nih.gov)
- Patients Feel More Control Of Their Health When Doctors Share Notes (yubanet.com)
- Doctors open their notes to patients – and patients like what they see (washingtonpost.com)
- Giving patients more control: share doctor’s notes (enterprisenews.com)
- OpenNotes: Great News for Patient Engagement (thehealthcareblog.com)
- Patients to View Doctors’ Notes Online (blogs.lawyers.com)
- OpenNotes: The Results Are In (thehealthcareblog.com)
When Patients Don’t Take Their Medicine What Role Do Doctors Play in Promoting Prescription Adherence?
About 10 years an area health care provider told me she did a study on prescription adherence.
The results included a shocking low percentage of folks taking their prescriptions as prescribed.
She said that no journal would publish the results, because the rates of adherence were so low. (This seemed odd to me, this reasoning).
I’ve been prescribed a cholesterol lowering drug, for being a bit over the HDL threshold. I decided to stop taking it, because after all I have read, I don’t really believe in either the tests, the thresholds, and the efficacy of the drug. No, I haven’t discussed this with my prescribing physician, but I think I’m going to catch hell on the next annual exam. For the past 5 years (age 58) I’ve only seen the doctor about once a year, just for the annual wellness.
Analyses indicated that although physicians uniformly felt responsible for assessing and promoting adherence to prescriptions, only a minority of them asked detailed questions about adherence.
“Medicine left in the bottle can’t help.”
— Yoruba proverb
Lack of adherence to prescriptions (that is, patients failing to take medicine either as instructed or at all) afflicts medical care in the United States. Nonadherence affects up to 40 percent of older adults, especially those with chronic conditions, and is associated with poor outcomes, more hospitalizations, and higher mortality. The health care cost of nonadherence is estimated at $290 billion per year. Prior RAND research has shown that some nonadherence is cost-related and can be addressed through insurance benefit designs that keep copayments low.[1]
Physicians also play a key role in addressing nonadherence. Yet physician perspectives on their responsibility for nonadherence and strategies for promoting adherence are not well understood. A team from RAND; the University of California, Los Angeles; and the University of California, Davis, examined physicians’ views about their responsibility for medication adherence and explored how physicians and patients discuss nonadherence. The team conducted focus groups with physicians in New Jersey and Washington, D.C., and audiotaped primary care visits in Northern California doctors’ offices.
The results point to a contrast between what physicians believe and what they do:
- Although physicians uniformly felt responsible for assessing and promoting medication adherence, only a minority of them asked detailed questions about adherence.
- Although providers often checked which medications a patient was taking, they rarely explicitly assessed adherence to these medications.
- Many physicians expressed discomfort about intruding on patients’ privacy to detect nonadherence. In the office, they rarely asked about missed medication doses.
- Most cases of nonadherence detected during office visits were revealed through unprompted patient comments.
Physicians’ reluctance to intrude has important implications for the vast array of new information that is becoming available from pharmacy benefit plans, managed care plans, and other data repositories. In addition, the reluctance to inquire that the physicians described contrasts sharply with the physician role in the increasingly prominent concept of the medical home, where primary care doctors are envisioned as playing a central and active role in managing and coordinating care.
The authors conclude that addressing nonadherence will require a different approach than the one they observed in the study. Given the importance of patients’ shared responsibility, a new paradigm that clarifies joint provider-patient responsibility may be needed to better guide communication about medication adherence. In this context, developing new protocols to guide discussions of adherence is worth exploring.
Related articles
- Monitoring Your Drug Use and Compliance through the Internet, with Electronic Smart Pills (engineeringevil.com)
- Three Reasons Why Doctors Need To Spend More Time Talking and Listening To Their Patients (healthecommunications.wordpress.com)
- Are Your Physicians Prescribing Mobile Apps? (thehealthcaremarketer.wordpress.com)
- Half of Heart Patients Don’t Take Their Meds; Probably a System Related Cause (labsoftnews.typepad.com)
- Put patients to work during their wait time (kevinmd.com)
- Things Your Doctor Should Tell You About Antidepressants (madinamerica.com)
- ACMT Studies Enhancement of Prescription Drug Monitoring Programs (prweb.com)
- “No.. Not Yet”:Answering the Patient’s Request for “Off Label Use” of a Drug (bioethicsdiscussion.blogspot.com)
- What Your Doctor Is Not Telling You: Why generic is better than name-brand (mothermiser.com)
- Drug czar to push for prescription monitoring program in Missouri, the last holdout (kansascity.com)
[Partial Reblog] New series: Understanding and Guiding Medical Research
A patient having his blood pressure taken by a physician. (Photo credit: Wikipedia)
From the 1 September 2012 post at ePatient Dave
Some edits made, and new items added, late the same evening.
I’ve recently learned of some well-intentioned medical research that disturbs me so deeply that I think it’s time to get formal about teaching e-patients and their partners how to detect research that misses its target, even if it’s well intentioned.
Doing this responsibly requires a deep understanding of the purpose of research and its methods. So this is the start of a series in which I’ll lay out what I’ve learned so far, describe the problems and challenges and opportunities that I see, and invite dialog on where I’m wrong and your own experiences as patient or clinician or researcher.
If this succeeds we’ll have a new basis for considering questions of what to do and how to prioritize it, in this era of change in medicine – not just in research but in all of medicine, as we work on reducing our spend. My goal in the series will be to be as clear in my writing as I can, while being as verifiably accurate as I can, given that I’m no PhD or Pulitzer laureate. Critique and correction are welcome.
This first post is an introduction, with background reading.
Context: Patient Engagement
The context for this series is patient engagement: patients shifting from being “compliant” cars in a medical car wash to being responsible and engaged.
Empowered, engaged patients take responsibility for their health and their care. One aspect is being responsible for understanding, as best we can, the evidence that a recommended treatment is right for us. Sometimes it’s pretty simple, sometimes not; but the higher the stakes get, the more important it is.
With respect to research, there’s a big challenge: sometimes the published evidence sucks – even though it got through the peer review process and was approved by a big-name journal.
Of course not all evidence sucks. But if you’re considering whether to be cut open or eat chemicals (meds), you have a choice: trust blindly (“whatever you say, doc”) or take responsibility for understanding as much as you can.
As we’ll discuss, one big reason blind trust fails is that the evidence your doctor gets isn’t necessarily great, and most clinicians aren’t rigorously trained in how to scrutinize it. (They too are largely trained to trust the journal process.) So this is for them too.
Intended audiences
- Patients and caregivers – the people on the receiving end of the treatment; the ones who make the decision to accept treatment.
- Clinicians, for two reasons:
- In a participatory relationship, the patient and clinician need to be on the same page regarding the basis for decisions, or one will think the other’s crazy
- As I said, in my experience most clinicians haven’t been rigorously schooled in the weakness of the info they were taught to trust. (This isn’t an insult; see homework below.)
- Health policy people (government and non-profits), because they need to be firmly grounded in reality, or they can’t possibly make policies that work in reality (eh?)
- Insurance companies (commonly euphemized as “care plans” or just “the plans”), who decide what will get paid for. (I know some insurance companies don’t mind paying for stuff that doesn’t work; they basically get a commission on all spending. But others do care what works and what doesn’t – some even have staff who help patients understand the options! They need to be well informed too.)
- Others, I’m sure.
This will make some people unhappy.
It’s the unhappiness that comes from realizing the world isn’t what you thought it was. And the unhappiness that comes from realizing you have to adjust.
But ladies and germs, disconnects like that are what keep a dysfunction in place and make problems intractable. So, comfortable or not, let’s get on with it. The unhappiness I anticipate:
- Some clinicians don’t welcome questions from their patients. (Others do.) In my personal experience most of the ones who object don’t realize how weak the evidence is.
- I hope they’ll remember what I learned in school: all science must be open to new information. (As SPM co-founder and ACOR founder Gilles Frydman said in 2010, “All knowledge is in constant beta.”)
- I know clinicians have many pressures including short appointments. This doesn’t have to be done by an MD; in my view of the future, every “medical home” will have coaches who can help assess published material.
- Some patients really don’t want to hear that the science they depend on – which has indeed produced miracles – has also produced crap sometimes. They especially don’t want to hear that clinicians – their clinicians, who they know are good people – aren’t perfect.
- In general, everyone wants certainty – doctors and patients alike – so it’s unsettling to know you can’t have it. (Even the best science has a chance of errors, and all science is subject to correction.)
Important: This is not a “we reject science” series.
- I love science. I personally am alive because of great medical research that created a harsh treatment delivered brilliantly by great clinicians at Beth Israel Deaconess in Boston. I love the training and clinical experience that made them able to save my life!
- It included great laparoscopic surgery and orthopedic surgery developed by great skilled scientists and delivered by skilled, adroit surgeons & teams. Hooray for science!
- But in the end, science knows that there is no certainty. They’re doing the best they can amid uncertainty. Heck, I myself live in uncertainty:
- The best evidence (which is not great) says there’s a 50% chance my cancer will return, which would likely kill me
- At diagnosis the evidence said I had 24 week median survival
- On the flip side, the treatment that did cure me usually doesn’t work.
Bottom line: There Is No Certainty.
The art of designing, conducting and reporting research includes dealing accurately with this issue.Whatever you read, there’s always a chance it’s wrong.
In my view, the ultimate responsible patient understands this, accepts the uncertainty (as best a human can), and responds by saying “Okay, what are the options? And what are the chances they’ll work?”
If you fully understand that much research is shaky and deserves questioning, you can skip to the end and wait for round 2. If not, read these past posts, because if you don’t realize there’s weakness, you have no reason to learn what comes next.
Here’s your homework.
Past posts establishing the need to be responsible for our decisions
These posts are from e-patients.net………
Click here for the rest of the post
Related articles
- Is there hope for clinicians in the digital age? (guardian.co.uk)
- Martine Ehrenclou and “The Take-Charge Patient” (digitaldoorway.blogspot.com)
- Regular patient/clinician interaction can help increase follow-up cancer screening (medicalxpress.com)
- Helping Patients Communicate More Effectively About their Health (thielst.typepad.com)
Apply folk wisdom to your family practice patients (How to turn unsolicited advice into positive communication!)12
Great article on communication/relationship skills.
It shows how to show you value advice on your own terms.
This reminds me of a scene in Gone With the Wind. Rhett takes baby Bonnie for a walk in her baby carriage. He passes two older women and asks for their advice on breaking the child’s habit of thumb sucking. Although the advice does not seem good, Rhett smiles and thanks them profusely. After Rhett departs, the women talk amongst themselves what a wonderful father Rhett is.
From the 12 August 2012 article at KevinMD.com
…
Late in my family practice residency – and very early in my parenting career – I had mentioned the persistent and sometimes uncomfortably intrusive suggestions offered by my mother and mother-in-law. One of our faculty, a seasoned pediatrician and parent, made the suggestion that I call both sets of grandparents regularly and ask for advice. He pointed out that their motivation (to be helpful and involved) was beyond reproach and that they probably had valuable insights to offer, if I could just reframe it to protect my own need to be autonomous and masterful. It worked like magic. The unsolicited advice nearly disappeared – and I learned a great deal from our conversations. The grandparents felt needed. I benefitted. And so did my kids.
Over the years, I have found it a valuable life strategy, and it comes up fairly frequently in practice:
- I tell all new parents at my first opportunity that they should each call their in-laws regularly to discuss parenting concerns and ask for suggestions, pointing out that the investment in making them feel like a valued contributor will pay huge dividends over time, and making sure that they realize that asking for advice will make it easier to ignore it.
- I suggest to parents that they play various versions of the “what if” game with their kids, getting the kids to help decide how best to set rules, reward success, and punish transgressions.
- I tell young adults starting a marriage (or other long term relationship – times have changed) that they should make a point of asking their partner’s opinion and advice often and sincerely, to build a comfortable platform of sharing.
- I suggest proactive questions and requests for feedback when I see people with job stresses.
- When patients are diagnosed with a serious illness for which others will be directing their care (cancer, degenerative neurologic disease), I tell them we are going to be proactive rather than reactive, and schedule regular appointments to discuss their progress and concerns. This makes sure that they understand I want to remain involved, and I avoid having to deal with crises and questions in a vacuum. (Since we often have a long term relationship, I also find that they need to have me tell them the same things the specialist has said to understand it and believe it.)
- When patients reach an age and health status where they are declining and vulnerable, I suggest that we schedule regular visits to talk about how things have gone and what problems we might expect, rather than waiting to things to go wrong.
Try it!
Doctors Overlook Chemical Illnesses, Study Finds
While I know folks who are prone to conditions triggered by chemical intolerances….am blessed that environmental chemicals don’t seem to affect me for whatever reason..
Am posting this especially for folks with chronic conditions of any kind. Please ask your health care provider if screening, testing,prevention of, and treating for chemical intolerances is right for you.
From the 10 July 2012 article at Science News Daily
Chemical intolerance contributes to the illnesses of 1 in 5 patients but the condition seldom figures in their diagnosis, according to clinical research directed by a UT Medicine San Antonio physician.
Clinical tools are available to identify chemical intolerance but health care practitioners may not be using them, lead author David Katerndahl, M.D., M.A., said. The study is in the July 9 issue of Annals of Family Medicine.UT Medicine is the clinical practice of the School of Medicine at The University of Texas Health Science Center San Antonio.
Avoidance of triggers
The study’s authors said physicians need to know how chemical intolerance affects certain people and understand that conventional therapies can be ineffective. Some patients would improve by avoiding certain chemicals, foods and even medical prescriptions, the authors said.
Patients with chemical intolerance go to the doctor more than others, are prone to having multi-system symptoms and are more apt to have to quit their job due to physical impairment, the authors said….
…Chemically intolerant individuals often have symptoms that affect multiple organ systems simultaneously, especially the nervous system. Symptoms commonly include fatigue, changes in mood, difficulty thinking and digestive problems.
Related articles
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14 Ways Social Media May Soon Change Your Doctor’s Visit
Although this article has a good deal of advertising and most links are to commercial sites, the content seems to be a good summary of possible futures of doctor visits. Overall it seems that social media can improve the doctor-patient relationship.
From 14 Ways Social Media May Soon Change Your Doctor’s Visits (May 15, 2012 article at The Sociable Blog)
In 2006, Pew Research Forum discovered that 80% of American adults used the Internet to research medical information. By 2011, data (separately) compiled by Frost and Sullivan and QuantiaMD showed between 87% to 90% of physicians used at least one social media site for personal reasons, with a further 67% to 75% opting for more professional postings. LinkedIn, Facebook, YouTube, Twitter, blogging, and the like stand poised to change the face of healthcare in the exact same manner it pretty much did for most other industries.
Medical professionals — not just doctors — have discovered some creative (and not-so-creative) ways to apply the technology to many different aspects of their field, meaning savvy, Internet-literate patients should stay on the lookout for what might lay ahead.
Related articles
- QUOTE: patient-doctor relationship and social media (scienceintelligence.wordpress.com)
- The Social Health Correction (33charts.com)
- How Healthcare Professionals Can Improve Patient Relationships (scrubnotes.com)
Researchers Learn About End-Of-Life Communication
From the 4 June 2011 article at Medical News Today
…Lead author Robert E. Gramling, M.D., Sc.D., associate professor of Family Medicine at URMC, and colleagues with a special interest in palliative care, made several key discoveries:
- In 93 percent of the conversations, prognosis was brought up and discussed by at least one person, with the palliative care team broaching the issue 65 percent of the time. Also, the prognosis information focused more often on quality of life rather than survival, and on the unique individual rather than the population in general. Researchers noted that prior studies support the link between open and honest discussions about prognosis to clinical benefits.
- Both patients/families and physicians/nurses on the palliative care team tended to frame prognosis with more pessimism than optimism. This was unexpected and different than the usual patterns of communication, where talk of a serious illness tends toward avoidance or unbalanced optimism, researchers said. However, emphasizing accuracy during the palliative care consultation usually leads to treatment decisions that match patient preferences.
- The substance and tone of the conversations varied, depending on whether the patient was present and actively participating. For example, prognosis conversations with family members alone were more pessimistic and contained more explicit information. It is possible, researchers said, this type of conversation takes place out of respect for the patient, who might be sicker in this scenario, or is someone who prefers to avoid information.
- The closer to death, the more likely the palliative care physician was to foretell or forecast events. This might seem logical – that doctors would guide patients and families in what to expect as death approached – but in reality this vulnerable and frightening time is when families often report a void in communication. The URMC data suggests that palliative care consultations respond to this need….
Related articles
- Listening in, researchers learn about end-of-life communication (eurekalert.org)
- Palliative Care in Australia (blogs.abc.net.au)
- Some Facts On Palliative Care (georgevanantwerp.com)
- A nurse practitioner-driven palliative care intervention improves cancer patients’ quality of life (eurekalert.org)
- Honest talk eases end-of-life choices (futurity.org)
- A nurse practitioner-driven palliative care intervention improves cancer patients’ quality of life (medicalxpress.com)
- Nurses urged to discuss death with heart patients (yorkshirepost.co.uk)
- Improving Palliative Care For Heart Failure Patients (medicalnewstoday.com)
Evidence Based Medicine not the Holy Grail??
And don’t miss the lively discussion at the end of the article..
When self-evident truth in medicine is systematically ignored (KevinMD.com article of June 3, 2012)
Some things in medicine are obvious. Despite the endless worship of ‘evidence-based’ medicine, and the constant barrage of studies on every conceivable topic, we do certain things because we know they just seem right. I take as evidence the fact that we daily try to save lives, devoting research time, untold gazillions of dollars and heroic clinical effort to our continued goal of staving off death. Why is this? Do we know that death is inherently worse than life? Well, since we can’t see beyond the grave, and can’t exactly engage in double-blind, placebo controlled studies about the after-life, the answer is “no.” But we assume that life is preferable to death, based on our feelings, our sense of the thing.
The same is true in our personal lives. No one can show me a scientific study that details why he or she married a particular person. No one can offer up a mole of affection for empiric analysis. And yet, we don’t doubt the existence of romance, or the reality of love.
And yet, medicine is filled with situations in which “self-evident truth” is systematically ignored, and those who believe in it intentionally and often viciously marginalized.
For example, after years of being told that physicians weren’t giving enough treatment for pain, and after years of clinicians saying, “yes we are, and too many people are addicted and abusing the system,” the data from CDC says that far too many are dying from prescription narcotics, far too many infants being born addicted, and far too many people, young and old, are using analgesics and other drugs not prescribed for them. To which many of us say, “duh!”
And then there’s the customer service model, the thing which causes clinicians to lose their jobs as satisfaction scores fall due to disgruntled patients (often upset over not receiving the drug they desired … see above paragraph). This is a darling of administrators. And it clearly has flaws…
Related articles
- Will Evidence-Based Medicine Become Reality? (georgevanantwerp.com)
- A Rough Guide to Evidence-Based Medicine (jdc325.wordpress.com)
- This is not what the doctor ordered (thehindu.com)
- “How do you feel about Evidence-Based Medicine?” (sciencebasedmedicine.org)
- Scientific evidence (sixpointnineme.wordpress.com)
- Evidence based medicine (slideshare.net)
- Faux Evidence-Based Behavioral Medicine at Its Worst (Part I) (psychologytoday.com)
- Healthcare, a New Car, or Paying for College (georgevanantwerp.com)
About
This blog presents a sampling of health and medical news and resources for all. Selected articles and resources will hopefully be of general interest but will also encourage further reading through posted references and other links. Currently I am focusing on public health, basic and applied research and very broadly on disease and healthy lifestyle topics.
Several times a month I will post items on international and global health issues. My Peace Corps Liberia experience (1980-81) has formed me as a global citizen in many ways and has challenged me to think of health and other topics in a more holistic manner.
Do you have an informational question in the health/medical area?
Email me at jmflahiff@yahoo.com
I will reply within 48 hours.
This blog is a companion site to my Health and Medical News and Resources Web site with…
- Great places to start (locating health information)
- Links to help from others (as health care providers and support groups)
- Interactive tools (as health calculators and apps)
- Select related news sites and blogs
My professional work experience and education includes over 15 years experience as a medical librarian and a Master’s in Library Science. In my most recent position I enjoyed contributing to our library’s blog, performing in depth literature searches, and collaborating with faculty, staff, students, and the general public.
While I will never be be able to keep up with the universe of current health/medical news, I subscribe to the following to glean entries for this blog.
- Science Daily – Your source for the latest research news
- MedlinePlus email updates from the US National Institutes of Health
- Partners in Information Access for the Public Health Workforce – a collaboration of U.S. government agencies, public health organizations and health sciences libraries
- US Agency for Healthcare Research and Quality (AHRQ) news now with updates on the agency’s efforts to “improve the quality, safety, efficiency, and effectiveness of health care for all Americans”
- Research Buzz, “news about search engines, digital archives, online museums, databases, and other Internet information collections since 1998”
- Scout Report, a “weekly publication offering a selection of new and newly discovered Internet resources of interest to researchers and educators”
- KevinMD.com -“Social Media’s leading physician voice”
- EurekAlert-Medicine and Health
Health and Medical News and Resources 
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