Choosing Treatment Based On Recipient

A recent study among physicians showed that the treatment choices they made was dependent on who the recipient was. The physicians were presented with scenarios whereby they had to choose between two treatments, one which carried a higher mortality rate but lower complication rate and another which carried a lower mortality rate but higher complication rate. They were asked which procedure they'd recommend for their patients and which procedure they'd choose if they themselves had the illness.

Interestingly, the choice of treatments was not the same. Physicians were more likely to choose higher mortality/lower complications for their own cases, but lower mortality/higher complications for their patients. What would lead to these choices? Perhaps a professional separation from the affected person. If the person being treated is a loved one or the physicians themselves, they are less likely to want to cause harm, even if it means a higher risk of death. When there's professional distance, such as with patients, the higher assurance of treatment success outweighs the harm that it may cause through complications.

What does this mean? It illustrates the reason that physicians should not treat themselves or loved ones, because their professionalism will be clouded by personal feelings. Additionally, it calls into question the ability to balance empathy and professional distance. While physicians must be able to connect with their patients on a personal level, they also must not let their personal feelings affect the treatment they suggest since it may not be the best choice in terms of outcome success. It's important that patients are given the best treatment possible, especially if the alternative has the possibility to cause more harm in the long-term.

Are Americans Getting Too Much Healthcare?

According to recent reports, the amount of healthcare that Americans get may be excessive. This seems like it's in direct opposition to the reality of many Americans not being able to afford any type of care. However, it seems that the insurance industry may be partially responsible for this discrepancy not only in lack of care, but overabundance.

A survey conducted among 627 physicians shows that 50% admit that patients were often given too much care, in terms of tests ordered and medications prescribed. Additionally, more than 25% admitted being too aggressive in their practice. With little time to devote to individual patients, and a fear that something may be missed, the reliance on testing is heavy. Additionally, since the insurance industry will often reimburse for all tests ordered, there's no dissuasion from this reliance.

“I’m not saying that physicians do tests in order to make money — there is a potential to be a real cynic here — but I think that the reimbursement model for most healthcare encourages utilization in a variety of ways. It’s a time for us to reflect about what incentives we have built into our healthcare system, and what directions they are taking us in.” ~ Dr. Brenda Sirovich (VA Medical Center, White River Junction, Vermont)

It's important that physicians learn to talk to their patients and rely on their own diagnostic skills rather than extensive testing. Unnecessary testing could cause patients to have additional symptoms, through stress, and prescribing unnecessary medications could have negative effects on overall patient improvement. We must reset the balance so that physicians are treating patients, not cycling through as many cases a day as they can.

Doctors Embracing Social Media

The rate at which physicians are embracing social media is growing rapidly. As soon as usage data comes out, it's already out of date as more and more medical professionals utilize the tools that new technology has afforded them. The trend is steadily going upwards.

Between February and May 2010, Dr. Gabriel Bosslet, MD collected data on how many physicians were using social media. His number, which was published in reports this year, put the number at 41.6%. Reports from Frost Sullivan between April and May 2011 put that number at 84%. And just last month, 90% of physicians were said to use at least one social media site personally according to QuantiaMD (67% professionally). What does this mean for technology?

Well, considering the rates of the regular population who use social media is still somewhere around 65%, it means that harnessing social media to target the medical field can be very productive. Physicians can use the platforms as a way to reach out to the patient population and teach about general medical topics. Ethics may prevent many physicians from engaging their own patients directly, they can still serve as teachers to help others learn more abut a specific medical area. Medical professionals can also trade information with their peers in order to strengthen their own practice. Closed communities, as well as Twitter and other more public communities, can serve as discussion avenues and learning opportunities.

However medical professionals decide to use social media, it's clear that they are not shying away from the technology. It will be interesting to see how social media shapes the future of medicine through its community-based understanding. The potential is large for a change in the way the industry approaches learning and patient care.

More Information, Better Decisions

The more informed a person can be, the better able they are to make decisions. This is very applicable in medicine, as patients should be aware of all aspects of their potential care before making a decision on which to pursue. This ideal was explored in a recent AMedNews article.

A study, whose results were published in the September 12th edition of the Archives of Internal Medicine, surveyed 3,000 participants. They were asked their opinions on the FDA's approval of drugs on the market. 25% of those responding thought the FDA only approved drugs that didn't carry serious side effects and 39% thought the FDA only approved drugs that were "extremely effective." These misconceptions possibly come from the fact that patients aren't fully informed about the success versus interaction rates that drugs actually have.

Short, simple explanations can help patients learn about the medications they're considering and decide which is the best option for them. The study looked at the difference these explanations would have on patient choice. When supplied with a 23-word explanation, "12% more people correctly chose a drug that reduced myocardial infarctions over one known to improve only cholesterol levels."

It is not only patients that need to be better informed. Physicians are not getting the full details on the medications available, so they aren't able to make well-founded decisions when choosing which medications to prescribe. The high marketing of certain drugs may seep into the public conscience and thus increase the rate at which they're prescribed. However, these medications may not be as effective as others among patients, especially considering individual health needs, so physicians should take into consideration not what sells the most, but what is best for their patients.

By increasing consumer and physician awareness in terms of medications, the healthcare relationship can become better informed and better suited to make the right decision for patient health. It's important that all professionals involved share what they know and what they do not in terms of medication efficacy.

White Coat Ceremony

The White Coat Ceremony is a rite of passage for many medical students. This is the event where they put on their first white medical coat, marking their turn from preclinical to clinical study. Students are praised for their achievements and sets them on the path towards being fully trained physicians. This tradition formalized in 1993 at the Columbia University College of Physicians and Surgeons and has been utilized in an increasing number of colleges and universities around the globe.

There is debate on whether this ceremony promotes good ideas or a sense of elitism that sets the physician too far apart from the patient he/she is treating. This is a physical act of receiving commendation of a transition from student to caregiver, thus separating oneself from the rest of society. However, does this act place a pressure on the student to perform to the best of his/her ability or does it create a feeling that they know more than their patients and thus should be listened to without fault?

It is also argued that the ceremony, which some hope would imbue a sense of compassion, does not. The act of putting on a white coat cannot connect a medical student/doctor with their patient. The ideals that are taught in medical school about patient interactions can remain with a practicing physician, but it's dependent on the person. Over time, in their careers, they may become more cynical or simply ignore the ideals of good patient interactions. The action of putting on the white coat for the first time can inspire hope, but it cannot change the person unless they take the teachings to heart.

Medical Student Health

Healthcare costs continue to make care cost-prohibitive for individuals. What's surprising is that some of these individuals are students who are training to become health professionals themselves. A recent study by Cambridge Health Alliance collected information from 115 medical schools in the United States. They looked at health insurance options for medical students with substance abuse or mental health issues. Their findings were disheartening.

73% of medical schools required the students to pay a portion of healthcare costs when receiving substance abuse or mental health treatment. And in 5% of cases, the medical school would cover none of the costs for such treatment. With already-stretched budgets, if a student does not have outside coverage or can utilize the mental health services provided by the college, they may have to forego care because they cannot afford the co-pays. This leads to larger issues in personal health and can have detrimental effects on learning and living.

Even without the prohibition of cost, medical students may not want to utilize services because of the stigma attached to such treatment diagnoses. Additionally, those treating the students are often the same people who are teaching medical classes, so there's the issue of the professor knowing problems that are technically confidential and having that negatively affect teaching situations.

Positive changes in these situations are being looked at by the Department of Health and Human Services. They would like to put in place restrictions on benefit caps, less cost-sharing by the student, and more free preventative care so that the student doesn't have to bear the financial burden. This is one step towards changing the situation where students are not receiving the care they need when dealing with mental heath and substance abuse issues.

Use of Smartphones Increasing

Physicians are increasing their use of smartphones in the course of treatment. Medical professionals can use apps, as well as mobile access, in order to gain information necessary to diagnose and treat patients. A new article by Web Digital Life reveals that this accessibility will be increasing even more for physicians in Pennsylvania. AmeriHealth Mercy will be starting a 6-month trial wherein 167 PCPs can use their smartphones to e-prescribe and access medical information that is patient-specific. 

"Mobile technology will allow physicians to have the latest clinical and medication information about patients covered by AmeriHealth Mercy, which will support doctor-patient engagement, a model that has been proven to improve patient care and reduce healthcare costs." ~ Jay Feldstein, Regional President for Northern Division (AmeriHealth Mercy)

The delivery of patient information will be done through NaviNet Mobile Connect, which will integrate with the individual medical offices' systems and provide real-time information to the physicians at no cost. NaviNet has experience in EMR technology and has received both OMC-ATCB and CCHIT certification in 2011 for its NaviNet EMR, as well as ONC-ATCB and CCHIT certification for its NaviNet Prescribe tool.

Hopefully, with proven success in this trial, the use can expand to a larger audience. Allowing physicians instant, real-time access to patient information would do well to increasing the level of care patients can receive within an industry where physicians are often hard-pressed for time.

Smartphones for Physicians

The use of smartphones among physicians is widespread. Manhattan Research did a survey recently that showed 82% of physicians used smartphones. This highlights a great potential market for medical apps and other inclusive tools which the medial industry can use to integrate smartphones with patient care. In fact, physicians are already taking advantage of these mobile tools by bringing them into the treatment room.

“I’ll tell my patient how often they need to get a particular cancer exam, but then look it up on my phone to double-check. Guidelines are always changing, but my phone is always updating. It’s an unrealistic expectation that a doctor can keep up on everything. I just want to be accurate and use the best information out there." ~ Dr. Trevor Satterfield, Physician (St. Luke’s Magic Valley Medical Center)

There are three particular medical apps that physicians have shown positive use for: Epocrates, Diagnosaurus DDx, and 5-Minute Clinical Consult. The three apps allow physicians to identify medication, calculate medical formulas, and choose possible diagnoses by presented symptoms. These are just a few potential areas where smartphone apps can provide useful information for physicians within the treatment environment. Mobile technology is growing and it's important that physicians, both new and experienced, take advantage of all the potential that it holds.

PCPs Declining

The amount of primary care providers have continually been a point of concern. While the importance of such providers remains high, the number of those entering practice are decreasing. JAMA did a study in 2009 to look at the distribution of practices among graduating medical students. They found that only 2% of those graduating were going into primary care.

The draw of specialty care has taken students away from the prospect of being a PCP. This is partially because of the increased loan burden these students are under, coupled with the higher pay rate to become a specialist rather than primary care provider. This is problematic because the number of available PCPs invariably go down. However, just because there are less providers available doesn't mean there are less patients in need of care. In fact, the opposite is true.

There are 56 million people in the US who do not have adequate access to PCPs and more than 1.3 million have trouble finding a new PCP when they need one. And those that are practicing must take more patients to cover the gap, as well as cover their own costs for medical reimbursement from Medicare and other insurance providers. It's becoming a cycle that does not show a good outcome unless changes are made.

It's important that medical schools promote the importance of primary care. The pay scale is just one factor in choosing a career path. Medical schools have the opportunity to highlight the factors that makes primary care not only a vital part of the medical process, but also one of the best medical careers that can be chosen. It's vital to the future health of the United States.