A new report, to be published in the Medical Education journal, has revealed that the medical profession may be placing patient trust in danger. In a survey of 200 medical students across three UK and Australian medical schools, respondents were asked about patient consent. Of those that indicated that they had been ordered to perform rectal, genital, and breast exams on patients who were unconscious, incapacitated, or otherwise unable to give their consent, 82% did as they were told.
“I was in theatre, the patient was under a spinal [anaesthetic] as well and there was a screen up and they just had a queue of medical students doing a rectal examination. He wasn’t consented but because.. you’re in that situation, you don’t have the confidence to say ‘‘no’’ you just do it.” ~ Medical Student Questioned During Survey
This situation reveals a very serious problem in the medical arena. First of all, the breach of trust with patients is quite shocking. While incapacitated, patients trust medical professionals to keep their wishes in mind and not perform any procedures that they had not previously agreed to. However, with these findings, that trust is misplaced. If patients cannot trust those taking care of them, they may grow fearful of what could happen and lessen their exposure to the medical field altogether.
Secondly, the fact that medical students are being ordered to perform these actions by their superiors means that they are learning by these examples. Students fear repercussions from refusal, so they do what's ordered even if they do not personally agree. Also, when being shown that everyone around them does the same, subsequent orders to perform procedures without consent may be done with less qualms of ethics.
The report is sure to create a stir in the medical community. Patients must be able to trust their provider, as the patient/physician relationship is built upon this. In turn, students must be able to trust their superiors to teach them the ethical and proper treatment of patients. Without trust, the entire medical industry is in danger.
Monday, January 31, 2011
Friday, January 28, 2011
Medical School Training: Too Focused On Inpatient Care?
Medical students are trained in many areas of medicine, in an attempt to fully prepare them as they embark on their careers. However, according to a recent article by Johns Hopkins University, physicians-in-training may be better able to handle inpatient issues than outpatient ones.
"When I graduated from residency here, I knew much more about how to ventilate a patient on a machine than how to control somebody's blood sugar -- and that's a problem." ~ Dr. Stephen Sisson, Associate Professor of Medicine (Johns Hopkins University)
While inpatient skills are invaluable, these situations only compromise 10% of patient encounters. This emphasizes a real need to re-evaluate the way medical school training is handled. If physicians are unable to perform actions associated with primary care, they are unable to fully treat their patients.
One large area of need is chronic disease. Chronic care issues affect a large number of patients and this number will likely increase as the population ages. Medical professionals need to be able to handle these cases with as much knowledge as possible. By being able to treat patients through outpatient means, the cost of healthcare will ultimately be lower than if they are forced into inpatient care.
As we look at the future of medicine, changes are definitely warranted. By restructuring the way medical students are trained, we can assure a better outcome for their patients.
"When I graduated from residency here, I knew much more about how to ventilate a patient on a machine than how to control somebody's blood sugar -- and that's a problem." ~ Dr. Stephen Sisson, Associate Professor of Medicine (Johns Hopkins University)
While inpatient skills are invaluable, these situations only compromise 10% of patient encounters. This emphasizes a real need to re-evaluate the way medical school training is handled. If physicians are unable to perform actions associated with primary care, they are unable to fully treat their patients.
One large area of need is chronic disease. Chronic care issues affect a large number of patients and this number will likely increase as the population ages. Medical professionals need to be able to handle these cases with as much knowledge as possible. By being able to treat patients through outpatient means, the cost of healthcare will ultimately be lower than if they are forced into inpatient care.
As we look at the future of medicine, changes are definitely warranted. By restructuring the way medical students are trained, we can assure a better outcome for their patients.
Thursday, January 27, 2011
EMRs Alone Cannot Improve Healthcare
Electronic medical records are the future. That's what the federal government is hoping, as they invested $19 billion towards expanding health information technology and the integration of EMRs into healthcare. It seems evident that having a collective database of information would go far towards providing strengthened patient care as the exchange of information can assure that every health provider who treats the patient would have a wealth of history upon which to order treatment. However, the medical system cannot rely on new technology alone to spur change. A new study published in the Archives of Internal Medicine has shown that the integration of EMRs into some healthcare systems have not necessarily improved care.
"We’ve shown that electronic health records and clinical decision support don’t by themselves improve quality. If we want improved quality, we have to look at the whole range of issues that affect quality of care and not put all of our hopes on a single technology.” ~ Randall Stafford, MD, PhD (Associate Professor of Medicine, Stanford Prevention Research Center)
Some reasons behind the lack of improvement may be tied to training. The EMR systems are new and often complicated. However, training on use is often limited or lacking. This leads to physicians not using the systems to their full capacity and not taking full advantage of how EMRs could benefit care. Additionally, concentration on EMRs alone will not result in improvement if surrounding education is not present. Physicians must be capable of treating their patients, communicating about their care as well as committing to follow-up. Additionally, outside factors such as patient access to care can negatively affect outcomes.
Technology can go far in advancing medical care, but without physician education and training, the tools cannot provide benefit. It is a team effort of provider and technology, working together to provide the best care possible.
"We’ve shown that electronic health records and clinical decision support don’t by themselves improve quality. If we want improved quality, we have to look at the whole range of issues that affect quality of care and not put all of our hopes on a single technology.” ~ Randall Stafford, MD, PhD (Associate Professor of Medicine, Stanford Prevention Research Center)
Some reasons behind the lack of improvement may be tied to training. The EMR systems are new and often complicated. However, training on use is often limited or lacking. This leads to physicians not using the systems to their full capacity and not taking full advantage of how EMRs could benefit care. Additionally, concentration on EMRs alone will not result in improvement if surrounding education is not present. Physicians must be capable of treating their patients, communicating about their care as well as committing to follow-up. Additionally, outside factors such as patient access to care can negatively affect outcomes.
Technology can go far in advancing medical care, but without physician education and training, the tools cannot provide benefit. It is a team effort of provider and technology, working together to provide the best care possible.
Wednesday, January 26, 2011
Doctors Need To Be More Empathetic
While physicians get training in how to properly assess patients, conduct examinations, and review test results, one area they may be lacking in is the empathy they show towards their patients. According to recent surveys conducted by Duke University and the University of Toronto, when patients give emotional cues to their healthcare providers, 90% of the time the medical professional fails to respond. It is a professional detachment that may actually be learned in medical school.
Physicians cannot afford to become emotionally invested in their patients while giving a diagnosis and a plan for care. To succumb to the emotions themselves means that their judgement may be compromised or that the patient starts to see them as a friend rather than a health professional. However, this emotional detachment may also give the wrong impression and make patients think that their healthcare provider does not listen nor care about their well-being.
“It is perfectly OK for the doctor to remain detached, but it is not OK to talk detached. Acknowledging what a patient is feeling is not the same as feeling it yourself.” ~ Robert Buckman, MD, PhD
The lack of emotional acknowledgement might actually take more time to complete the patient / physician exchange since patients will likely bring up the point again and again, seeking a response. Instead, physicians can engage the patient on the matter and relevant health data can be obtained. Additionally, the exchange will build trust between the patient and doctor, thus allowing the patient to more fully commit to the treatment plan suggested.
This emphasizes the point that empathy should not be ignored within medical training. Whether it's maintaining the empathy that medical students already have or teaching them to become more empathetic, it's important that the future of healthcare not let these opportunities be lost.
Physicians cannot afford to become emotionally invested in their patients while giving a diagnosis and a plan for care. To succumb to the emotions themselves means that their judgement may be compromised or that the patient starts to see them as a friend rather than a health professional. However, this emotional detachment may also give the wrong impression and make patients think that their healthcare provider does not listen nor care about their well-being.
“It is perfectly OK for the doctor to remain detached, but it is not OK to talk detached. Acknowledging what a patient is feeling is not the same as feeling it yourself.” ~ Robert Buckman, MD, PhD
The lack of emotional acknowledgement might actually take more time to complete the patient / physician exchange since patients will likely bring up the point again and again, seeking a response. Instead, physicians can engage the patient on the matter and relevant health data can be obtained. Additionally, the exchange will build trust between the patient and doctor, thus allowing the patient to more fully commit to the treatment plan suggested.
This emphasizes the point that empathy should not be ignored within medical training. Whether it's maintaining the empathy that medical students already have or teaching them to become more empathetic, it's important that the future of healthcare not let these opportunities be lost.
Tuesday, January 25, 2011
The Loss of the Physical Exam
With the expansion of technology in medicine, one consequence may be the loss of the physical exam. Physicians have begun to rely more on test results to make their diagnosis rather than performing a hands-on exam. Recent articles by Mind the Gap and Daily Breeze touched upon this trend, pointing out the faults of moving away from physical contact between patients and physicians.
There are many problems with the move towards "test-centered medicine." By not performing an examination, the physician has to cast the net wider for diagnosis. This leads to ordering many tests that may be unnecessary, driving health costs up and causing the patient to undergo risks from tests they may not even need.
This is not to say that technology should be excluded entirely. By utilizing testing, physicians have the potential to more quickly and accurately begin needed treatment. However, it should not be an either / or situation where physicians feel they have to choose between technology and hands-on care.
"I think technology has helped our diagnostic accuracy. But if you would get a retired physician who was trained 30 years ago with one of our new graduates these days, the retired physician will have much better physical examination skills than our newer trainees." ~Dr. Camelia Davtyan (Clinical Professor-General Internal Medicine, UCLA)
By using the tools of technology as an accompaniment, rather than placing total reliance on it, physicians can have a more well-rounded diagnostic experience and more accurately treat their patients for the ailments they are facing. Just as medicine is a team effort between healthcare providers, it is also a team effort between physicians and technology.
There are many problems with the move towards "test-centered medicine." By not performing an examination, the physician has to cast the net wider for diagnosis. This leads to ordering many tests that may be unnecessary, driving health costs up and causing the patient to undergo risks from tests they may not even need.
This is not to say that technology should be excluded entirely. By utilizing testing, physicians have the potential to more quickly and accurately begin needed treatment. However, it should not be an either / or situation where physicians feel they have to choose between technology and hands-on care.
"I think technology has helped our diagnostic accuracy. But if you would get a retired physician who was trained 30 years ago with one of our new graduates these days, the retired physician will have much better physical examination skills than our newer trainees." ~Dr. Camelia Davtyan (Clinical Professor-General Internal Medicine, UCLA)
By using the tools of technology as an accompaniment, rather than placing total reliance on it, physicians can have a more well-rounded diagnostic experience and more accurately treat their patients for the ailments they are facing. Just as medicine is a team effort between healthcare providers, it is also a team effort between physicians and technology.
Monday, January 24, 2011
Anatomy Apps
With the popularity of the Google Body Browser, anatomy education is beginning to be expanded to the wider public. Integration into mobile technology is also important, as medical education has moved towards the mobile arena. But weeding through the app market is often difficult with the high number of choices. As a starting point, we've gathered five paid apps that are available for the iPhone/iTouch that are worth a look.
Pocket Anatomy: This app contains 30,000 keywords for learning, as well as 9 layers of musculoskeletal content. You can self-test on the material and make notes as you navigate.
AnatomyLab: While other apps use artistic renderings for anatomy education, this app uses actual cadaver images to teach about body dissection.
eHuman (Cranial Nerves): eHuman teaches about the 12 cranial nerves, as well as the foramen at the skull base. Images are pulled from CT scans to get a more realistic representation for learning.
Blausen Human Atlas: This app contains a searchable medical glossary that can be used in conjunction with 3D medical animations to enhance learning.
3D4Medical Skeletal System Plus: Learning about the skeletal system is made easier with this app, which features fully-labeled representations of bones and ligaments in both English and Latin. You can take quizzes in the app to solidify the education that you've received.
Pocket Anatomy: This app contains 30,000 keywords for learning, as well as 9 layers of musculoskeletal content. You can self-test on the material and make notes as you navigate.
AnatomyLab: While other apps use artistic renderings for anatomy education, this app uses actual cadaver images to teach about body dissection.
eHuman (Cranial Nerves): eHuman teaches about the 12 cranial nerves, as well as the foramen at the skull base. Images are pulled from CT scans to get a more realistic representation for learning.
Blausen Human Atlas: This app contains a searchable medical glossary that can be used in conjunction with 3D medical animations to enhance learning.
3D4Medical Skeletal System Plus: Learning about the skeletal system is made easier with this app, which features fully-labeled representations of bones and ligaments in both English and Latin. You can take quizzes in the app to solidify the education that you've received.
Friday, January 21, 2011
Artificial Life Expanding Their Mobile Health Market
Artificial Life is adding to its medical apps library. The company was founded in 1994 and has developed games and apps for multiple mobile platforms. Its first venture into medical apps came with GluCoMo™ for diabetes monitoring and they are now expanding into the area of neurodermatitis with the NeuroDerMo app.
The NeuroDerMo app will supply information, health reminders, as well as increasing patient/provider communication on neurodermatitis, a skin disorder that affects 6% of the population worldwide. The disorder also causes secondary problems, in terms of mental health, when dealing with the symptoms associated. With the NeuroDerMo app, patients can constantly keep their healthcare professional up-to-date on any changes they notice with their condition. The app also supports a web portal that fosters social engagement between users.
The company's former venture into the medical field came with the GluCoMo™ app to monitor diabetes health. With information on the disorder, as well as support for social engagement between users, the app fosters the exchange of knowledge. Additionally, the app seeks to foster communication between patients and healthcare providers through constant monitoring and reporting so that changes in patient health can be quickly noted and dealt with.
The move towards health apps increasing communication between patients and physicians has made healthcare a more team-effort. The mobile apps have allowed patients to take a more active role in their care, as well as allowing healthcare professionals a more immediate monitoring of patients without having to make time for multiple office visits. The future of healthcare has definitely gone mobile.
Thursday, January 20, 2011
Patients Are Googling
Today, on his blog, Dr. Kevin Pho looked at the issue of patients self-diagnosing prior to coming to the doctor's office. The issue is no longer concerning trying to get patients to not do so, but rather about how to give patients valid information in their searches.
Health professionals may look with disdain upon patients who feel the need to research their symptoms prior to medical visits. At times, the patient may feel that they've adequately diagnosed themselves and simply need the health professional to confirm the diagnosis and prescribe the requested medication. This causes problems in healthcare, since some patients are taking control away from their physicians and see them as someone who should simply follow their requests rather than take control of their care. They are also often basing their self-diagnoses on incorrect information.
A simple reaction would be to convince patients to not research on their own. However, this is neither beneficial nor feasible. Current research by Pew Internet and American Life Project show that 61% of patients seek health information online. This rate will likely increase. The easy access to information makes it unfair to expect patients to simply rely on just the physicians' knowledge.
So, instead, physicians should work more towards ensuring that the information being accessed is medically correct. There are a number of reputable sites which can be accessed and it is important that physicians highlight these for their patients so that they can get the best information available during their searches. By showing that physicians do not look down upon patients who seek to be better-informed, the future of healthcare can indeed be a team effort.
Health professionals may look with disdain upon patients who feel the need to research their symptoms prior to medical visits. At times, the patient may feel that they've adequately diagnosed themselves and simply need the health professional to confirm the diagnosis and prescribe the requested medication. This causes problems in healthcare, since some patients are taking control away from their physicians and see them as someone who should simply follow their requests rather than take control of their care. They are also often basing their self-diagnoses on incorrect information.
A simple reaction would be to convince patients to not research on their own. However, this is neither beneficial nor feasible. Current research by Pew Internet and American Life Project show that 61% of patients seek health information online. This rate will likely increase. The easy access to information makes it unfair to expect patients to simply rely on just the physicians' knowledge.
So, instead, physicians should work more towards ensuring that the information being accessed is medically correct. There are a number of reputable sites which can be accessed and it is important that physicians highlight these for their patients so that they can get the best information available during their searches. By showing that physicians do not look down upon patients who seek to be better-informed, the future of healthcare can indeed be a team effort.
Wednesday, January 19, 2011
The Future of Trauma Medicine
With recent tragedies in the news putting more emphasis on trauma medicine, it is important that the U.S. public understand the need for treatment professionals, as well as the possible problems that this area of medicine now faces. Today, the Huffington Post looked at this problem in depth.
With 116 million patients being seen in the ER every year, 23% of those are seen for traumatic injuries. Among people 45 or younger, trauma remains the leading cause of death. In studies, it's been found that 25% of these deaths can be avoided if the patient is given care quickly. This signifies a real need to have adequate health professionals to deal with traumatic injury in hopes that more lives can be saved. However, with less than 10% of hospitals staffed with trauma centers, there is a wide gap between need and care.
Trauma care is expensive, which may be a large contributing factor to the existing gap. With costs to society ranging from 400-600 billion dollars, it's the second most costly health issue in the United States. These costs do not mean that trauma centers get reimbursed, however. While trauma centers are required to give care, there is no requirement that the patient must pay. This causes a lack of funding support for centers that are already overcrowded and eventually this leads to the center being closed down because it cannot financially continue. Closure of trauma centers put more people in danger because they would have to travel further for care. Currently, 45 million Americans live outside a one hour range of trauma centers, and this number continues to grow. Attention should be focused on the industry itself and try to improve the financial support that trauma centers receive, as well as how payments are processed.
The lack of physicians also plays a large role in the problem. There is a looming doctor shortage, but it's already a problem in trauma centers. The requirements for trauma specialists, including a decade of training and need to be on-call for increased hours, has put the future of this health area in danger. It's important that medical schools focus their attention on trauma medicine and in training more students to pursue the specialty. Otherwise, the future of medicine could be dire.
Tuesday, January 18, 2011
Shadowing Nurses
While doctors are often seen as the face of medicine, the health professional that is often on the front lines is the nurse. The balance of care between doctors, nurses, and patients is vitally important since they each have to rely on one another for the best possible care. The University of Vermont recognizes the importance of this relationship and they are seeking to strengthen it through medical school training.
Through the Professionalism, Communication, and Reflection (PCR) course, first year medical students shadow a nurse for two hours during shift. This opportunity is meant to teach doctors-in-training about the importance of nurses and how good communication between nurses and doctors is vital for patient care. The program also changes preconceived notions that medical students may already have about nursing.
"They know the patients very well – more than I thought they would – so in the future, I think it is important to consider their input in patient care." ~ Maramawit Wubeshet, medical student
Doctors, patients, and nurses create what has been described as a triangle of care. Nurses are often the health professional in most contact with patients. However, they must seek approval for treatment through the doctors. Because of this balance, it's important that the lines of communication are kept open and that a good relationship is built between the three participants. By utilizing the opportunity to teach medical students early on about this relationship, the future of healthcare can be more team-oriented and the care of patients can be strengthened even more.
Through the Professionalism, Communication, and Reflection (PCR) course, first year medical students shadow a nurse for two hours during shift. This opportunity is meant to teach doctors-in-training about the importance of nurses and how good communication between nurses and doctors is vital for patient care. The program also changes preconceived notions that medical students may already have about nursing.
"They know the patients very well – more than I thought they would – so in the future, I think it is important to consider their input in patient care." ~ Maramawit Wubeshet, medical student
Doctors, patients, and nurses create what has been described as a triangle of care. Nurses are often the health professional in most contact with patients. However, they must seek approval for treatment through the doctors. Because of this balance, it's important that the lines of communication are kept open and that a good relationship is built between the three participants. By utilizing the opportunity to teach medical students early on about this relationship, the future of healthcare can be more team-oriented and the care of patients can be strengthened even more.
Friday, January 14, 2011
The iTouch Revolution
The distribution of iTouches has continued throughout medical schools, allowing for a wider range of educational tools for students. UCLA nursing students were given the devices in December at their white coat ceremony. With these iTouches, they have the ability to use apps to prepare them for upcoming exams through the "NCLEX Review" app, translate patient language between English and Spanish with the "Medical Spanish" app, and running patient diagnostics through the "Nursing Central" app.
“Taking care of patients is a tremendous responsibility. While we still encourage the traditional methods of diagnosis, there is an overwhelming amount of medical information available. Providing each student with new technology for use at the bedside can only improve patient safety and the delivery of care. … Anything that improves health care ultimately helps patients.” ~ Courtney Lyder, Dean (UCLA Nursing School)
Some schools have even gone so far as to integrate the technology more directly into their curriculum offerings. The University of Michigan Medical School has been doing their Dr. iPod program for over a year. Through this program, students can instantly access lectures for review. This allows for better preparation for exams, as well as allowing students to catch-up with their missed classes.
The integration of mobile technology into medical education has expanded the possibilities available. By utilizing the changing educational tools, educators can better prepare students for their future careers. This will allow for a stronger pool of medical professionals as they embark on their practices.
“Taking care of patients is a tremendous responsibility. While we still encourage the traditional methods of diagnosis, there is an overwhelming amount of medical information available. Providing each student with new technology for use at the bedside can only improve patient safety and the delivery of care. … Anything that improves health care ultimately helps patients.” ~ Courtney Lyder, Dean (UCLA Nursing School)
Some schools have even gone so far as to integrate the technology more directly into their curriculum offerings. The University of Michigan Medical School has been doing their Dr. iPod program for over a year. Through this program, students can instantly access lectures for review. This allows for better preparation for exams, as well as allowing students to catch-up with their missed classes.
The integration of mobile technology into medical education has expanded the possibilities available. By utilizing the changing educational tools, educators can better prepare students for their future careers. This will allow for a stronger pool of medical professionals as they embark on their practices.
Thursday, January 13, 2011
Dental Anywhere App
With the push towards integrating mobile technology into medicine, the focus of media has been on PCPs. However, other medical arenas have gotten into mobile healthcare as well. One such field is dentistry and the Dental Anywhere application.
The app is available for the major mobile platforms: Droid, Blackberry, and iPhone. The application allows integration into a dental practice to give patients' more control over their care, as well as increase communication between patient and provider. Dental offices can send their patients appointment reminders, GPS-aided directions to the office, and emergency care instructions when necessary. The latter is especially important because patients can identify problems and get advice on what steps to take towards treatment, which can help eliminate unnecessary after-hours visits or speed the notification of care when the situation calls for it. The app also allows for out-of-town care, with notification of the nearest dental office.
Mobile health technology is expanding and has allowed for increased patient control of their cases. By utilizing the advancements available, as well as pushing forward with more possibilities, healthcare is ensuring a stronger system for patient care.
The app is available for the major mobile platforms: Droid, Blackberry, and iPhone. The application allows integration into a dental practice to give patients' more control over their care, as well as increase communication between patient and provider. Dental offices can send their patients appointment reminders, GPS-aided directions to the office, and emergency care instructions when necessary. The latter is especially important because patients can identify problems and get advice on what steps to take towards treatment, which can help eliminate unnecessary after-hours visits or speed the notification of care when the situation calls for it. The app also allows for out-of-town care, with notification of the nearest dental office.
Mobile health technology is expanding and has allowed for increased patient control of their cases. By utilizing the advancements available, as well as pushing forward with more possibilities, healthcare is ensuring a stronger system for patient care.
Tuesday, January 11, 2011
Technologically-Advanced Patient Rooms
The move towards technology integration in medicine is now moving more fully into the hospital room. A recent article by the Columbia Daily Tribune covered the changes that are set to take place at University Hospital by way of “smart rooms.” These rooms allow healthcare professionals to have quicker access to patient files when interacting with those in their care.
Some highlights of the “smart room” at University Hospital is acknowledgment of the healthcare professional when in the room, through scanning of their electronically-enhanced identification. By instantly recognizing when a health professional is entering, the patient's file is instantly pulled up so that the provider can review and make necessary changes. When the system verifies the provider has left the room, the files are shut down, thus preventing a breach of patient privacy.
Outside the room, the system can alert as to which health provider is currently in the room, as well as any patient information that might be relevant, such as their allergies, their diet restrictions, and any other contributing health warnings. This is in conjunction with the electronic patient identification bracelets that are already in use, which makes sure medication is assigned to the correct patient.
These technologically-advanced patient rooms have already been proven elsewhere and the expansion into medical facilities is inevitable. By utilizing the advancements that technology provides, medicine can become better suited to the needs of patients, as well as empowering the healthcare providers to give the best care possible.
Some highlights of the “smart room” at University Hospital is acknowledgment of the healthcare professional when in the room, through scanning of their electronically-enhanced identification. By instantly recognizing when a health professional is entering, the patient's file is instantly pulled up so that the provider can review and make necessary changes. When the system verifies the provider has left the room, the files are shut down, thus preventing a breach of patient privacy.
Outside the room, the system can alert as to which health provider is currently in the room, as well as any patient information that might be relevant, such as their allergies, their diet restrictions, and any other contributing health warnings. This is in conjunction with the electronic patient identification bracelets that are already in use, which makes sure medication is assigned to the correct patient.
These technologically-advanced patient rooms have already been proven elsewhere and the expansion into medical facilities is inevitable. By utilizing the advancements that technology provides, medicine can become better suited to the needs of patients, as well as empowering the healthcare providers to give the best care possible.
Monday, January 10, 2011
FIU Seeking To Provide Community Healthcare
A recent article spoke of a new model of education at Florida International University's College of Medicine in Miami. They are bringing medicine to a community level by having students assigned to families and neighborhoods. By doing this, the students can follow health changes on a more individualized basis and learn how to make a more widespread impact in health.
“We've adopted those neighborhoods, and we never leave. Clearly, we have a commitment to those neighborhoods to be there and to work with households and with the community to address the socio-determinants of health care.” ~ Dr. John Rock, Founding Dean of Florida International University's College of Medicine in Miami
Refocusing medical care towards a community audience can go far in making a change in health. By looking at what socio-economic factors lead to health outcomes, physicians can go further in providing individualized care that will have a greater positive impact. In conjunction with that healthcare, positive attempts towards change can be tried in order to ultimately improve socio-economic situations in the community. Students learn that health issues may be connected to a wider problem rather than what they merely see during the 15 minute patient visit. The collective support system that community health care foster can lead to notable changes in wider population health.
Friday, January 7, 2011
Substance Abuse Treatment Still A Problem
The issue of substance abuse remains a large problem in the United States. However, the training that medical students receive in school may not adequately prepare them to deal with this issue. A new study, published in the Annals of Internal Medicine's January 3rd issue, takes a closer look at this problem.
Annually, alcohol and drug abuse costs $300 billion, and leads to 100,000 U.S. deaths. An SBIRT study showed that patients were positive for heavy drug/alcohol use in 23% of cases. However, the concentration of care currently centers around treatment programs. This may seem logical, but the numbers indicate that compared to 2.5 million presenting in treatment programs, there are over 20 million presenting in primary care and other situations. This means that PCPs must become more highly trained in how to screen and treat these patients.
The problem is very clear when examining the results of a study done among PCPs. When they were presented a patient who had early alcohol abuse, 94% failed to diagnose. By not being able to properly diagnose substance abuse, PCPs cannot adequately treat presenting illnesses and may put their patients in danger of worsening conditions. This underlines a definite gap between patient need and treatment.
The authors of the article have outlined five recommendations that will improve the outcomes of the situation. Most importantly is the need for increased resident training in all areas of addiction. By making addiction education just as important as chronic health topics covered in medical school, students can be aware of the implications of abuse. Additionally, medical school faculty should have a specialized background in addiction, just as they are required to have in other topics, so that they can provide the best education possible for their students. Going along with that, there is a need for academic infrastructure in the area of addiction, as none currently exists. Finally, substance abuse screening and management must be more fully integrated into routine care. Substance abuse treatment is a team-based effort that must be achieved with the help of physicians, nurses, and others for continuing care. By focusing more attention on substance abuse identification and treatment, physicians can better treat their patients and help prevent worsening problems that may arise from addiction.
Thursday, January 6, 2011
Increased Need For Physicians In Geriatrics
2011 marks the beginning of many things; life, love, careers. This year also marks the beginning of the baby boomer generation reaching the age of 65. And when the last portion of the boomer population reaches retirement age in 2015, adults over the age of 65 will number 18% of the population.
This growing population also marks an increased need for physicians in geriatrics. Currently in the United States, there are only 7,000 geriatricians when current need sits somewhere around 20,000. In the immediate future, that need will increase to 35,000. Clearly, the demand is outpacing the available supply.
The lack of physicians is also compromising the health of older Americans. According to Richard Allman, director of the University of Alabama at Birmingham's Division of Gerontology, Geriatrics and Palliative Care, while 15% of the aged population need geriatric care, only 5% are getting it.
What is the reason for the low number of geriatricians? Perhaps is comes down to the bottom line of money. Physicians get paid for the number of patients they see, but because they are reimbursed at such a low rate, they have to try and cycle through a high number of patients everyday. With older patients, who take a longer amount of time, physicians might not meet their payline. Couple this with the fact that geriatrics is unlike other medical professions, as geriatricians looks at the effects of the illness as the main focus, rather than the illness itself.
"In geriatrics, you take the broadest approach and you don't ask what's the disease, you ask what's the effect of the disease on the individual, how they are functioning and how they are feeling. And you let the diseases come along for the ride." ~ Adam Duxbury, Geriatrician
The current healthcare system tends to focus on younger and middle ages, while the older population is left lacking. With the influx of baby boomers entering this age bracket, changes must be made. This is not a population that easily takes no for an answer; nor should they have to.
Wednesday, January 5, 2011
Doctors Telling Partial Truths
A main thrust of medicine is treatment. When a patient is ill, the health professional is responsible for finding a worthwhile treatment regimen that will cure the problem. However, doctors may be pushing for certain treatment decisions while downplaying any negative repercussions that may arise. John M Grohol, PSYD at Psych Central came up with some possible reasons why this may occur.
Medicine is a once-removed situation. The doctor cannot have personally experienced every illness they're presented with, so instead they must rely on their training of what the proper steps would be in each situation. Based on this reliance, the possible negative side effects of the choice can be presented, but only in general terms. To correct this issue, the side effects that each person may experience should instead be personalized so that the patient can make a more informed decision for their own care and how these symptoms will affect their own life.
A main issue may be the mindset of health professionals in general. As mentioned prior, patients expect their doctors to solve the problem being presented to them. And in turn, physicians will seek to treat the patient in some manner, even if there's no main treatment that is obvious. Doctors may also downplay what the negative effects will be with a treatment choice simply because they desire to solve the problem in some way. Instead, patients should be told honestly what the implications will be of every treatment choice presented. That way, patients can be more informed and involved in their treatment, as well as becoming a partner in their care rather than a sedentary participant.
Medicine is a once-removed situation. The doctor cannot have personally experienced every illness they're presented with, so instead they must rely on their training of what the proper steps would be in each situation. Based on this reliance, the possible negative side effects of the choice can be presented, but only in general terms. To correct this issue, the side effects that each person may experience should instead be personalized so that the patient can make a more informed decision for their own care and how these symptoms will affect their own life.
A main issue may be the mindset of health professionals in general. As mentioned prior, patients expect their doctors to solve the problem being presented to them. And in turn, physicians will seek to treat the patient in some manner, even if there's no main treatment that is obvious. Doctors may also downplay what the negative effects will be with a treatment choice simply because they desire to solve the problem in some way. Instead, patients should be told honestly what the implications will be of every treatment choice presented. That way, patients can be more informed and involved in their treatment, as well as becoming a partner in their care rather than a sedentary participant.
Tuesday, January 4, 2011
Physician Burn-Out A Concern
With the numerous demands placed on physicians, burn-out is a real concern. And rather than just having a solitary impact, physician burn-out can negatively affect the working environment as well as patient care. It is a problem that affects physicians at all career levels and can produce symptoms such as substance abuse, depression, disillusionment, anxiety, and broken social relationships. There is also the possibility of suicide, as the rate among doctors is higher than for other jobs.
In 1990, when the first study on burn-out was made, reports were that 60% of physicians may have been dealing with burn-out. Current studies put the number closer to 37-47% for academic faculty and 55-67% for private practice. And with this burn-out, there is a self-acknowledged negative impact on patient care. A study of residents in 2002 showed that 53% had given "suboptimal care" to patients at least once a month and possibly more. Increased stress compromises physicians' capability to be empathetic with patients, as well as skipping preventative care that could negatively affect patient outcomes.
With the coming healthcare reform and influx of new patients, the issue of burn-out has the potential to increase. Seeking out ways to decrease physician stress will help to ensure that these patients will receive the best care possible as the healthcare industry seeks to treat more of the population.
In 1990, when the first study on burn-out was made, reports were that 60% of physicians may have been dealing with burn-out. Current studies put the number closer to 37-47% for academic faculty and 55-67% for private practice. And with this burn-out, there is a self-acknowledged negative impact on patient care. A study of residents in 2002 showed that 53% had given "suboptimal care" to patients at least once a month and possibly more. Increased stress compromises physicians' capability to be empathetic with patients, as well as skipping preventative care that could negatively affect patient outcomes.
With the coming healthcare reform and influx of new patients, the issue of burn-out has the potential to increase. Seeking out ways to decrease physician stress will help to ensure that these patients will receive the best care possible as the healthcare industry seeks to treat more of the population.
Monday, January 3, 2011
iPad Medical Use To Increase In 2011
In October 2010, a survey was conducted of 950 members within the Healthcare Information and Management Systems Society (HIMSS). The findings show that the iPad is gaining momentum within the healthcare industry. Among the survey participants, 70% will deploy the iPad among their healthcare organizations in 2011.
What is pushing this increased use? Many have pointed to the medical apps potential of the device. 33% of survey respondents mentioned that applications such as visualization of lab results and medical imaging are priorities for use in their organization. Following this, 18% said that they have priorities centering around coding, claims, billing, and other general administration needs, which could be fostered by the iPad.
The important focus now becomes security, as more data will become accessible over mobile devices. It is important that patient data remains private and that security is not breached with the increased accessibility that the iPad can provide. However, with the move to make medicine more mobile, these issues should be adequately dealt with as we progress. 2011 is set to become the year of mobile health.
What is pushing this increased use? Many have pointed to the medical apps potential of the device. 33% of survey respondents mentioned that applications such as visualization of lab results and medical imaging are priorities for use in their organization. Following this, 18% said that they have priorities centering around coding, claims, billing, and other general administration needs, which could be fostered by the iPad.
The important focus now becomes security, as more data will become accessible over mobile devices. It is important that patient data remains private and that security is not breached with the increased accessibility that the iPad can provide. However, with the move to make medicine more mobile, these issues should be adequately dealt with as we progress. 2011 is set to become the year of mobile health.
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