Wednesday, November 30, 2011

Females Outnumbering Males In Medicine

A recent article in the British Medical Journal suggests that by 2017 female physicians will outnumber males in the UK. While some have called into question a trend that will push males to the minority, it isn't necessarily a bad move to bridge the gender gap and achieve equality.

In areas such as pediatrics, general practice, and palliative care, females are already dominating, while surgery and cardiology remain a male arena. While females are entering medical schools at increased rates, they have been limited from high level jobs. But males have actually started moving away from entering the medical field, instead seeking more steady employment in financially viable fields. This gap of applicants is set to be filled by women, thus hopefully opening up those top jobs.

And a female-dominated medical field might actually be more beneficial for patients. Looking at complaints filed against doctors, the National Clinical Assessment Service reports that women are less likely to be the subject of discipline. Within an eight year period, only 79 female physicians were banned from patient interaction as opposed to 490 male physicians. By increasing the number of females in practice, disciplinary actions could go down and patient safety could increase.

Monday, November 28, 2011

Pairing With Patients

Medical students must learn how to treat the ailments of patients in order to become successful physicians. In the midst of this training, they are often told to separate themselves from the situation so that they don't become personally involved with their patients. This helps them remain objective and not weighed down with emotion when choosing treatment options. However, it's important that medical students and physicians don't become so separated that they forget to see the treatment relationship from the other side. That's what the new Patient and Family Care Experience Program seeks to do.

This program takes 16 first-year medical students and pairs them with patients or families of patients in the Saskatoon Health Region. The goal is to give medical student access to real-world feedback on what patients and their families have experienced so that they can refocus their attention on proper patient/physician dialogue. There are also benefits from the patient perspective, as they will be able to provide real feedback and take an active role in shaping the future of healthcare.

“I know there is a lot of work to be done with the young students, patients and health care, but I truly believe we can affect the future through this program.” ~ Gloria Brilla, Patient

It is through this collaboration that changes can be made in the way healthcare is presented. Medical students learning these basics of patient feedback early in their careers can utilize the information in order to provide a different level of care as opposed to their predecessors. It is through a community effort that changes can be made and healthcare can be reformed.

Monday, November 21, 2011

Happy Thanksgiving!

November is coming to a fast close and the week will be topped off by Thanksgiving. For the holiday, the Medical Student Learning blog will be on hiatus. We will resume posting on November 28th.

Happy Thanksgiving!

Friday, November 18, 2011

LGBT Issues Neglected In Medicine

Physicians have to be educated about a number of issues, as well as prepared to treat patients from a variety of different backgrounds. Their training in medical school seeks to prepare them for the real-life issues they'll come up against when they embark on their careers. However, it seems that certain patients, namely LGBT individuals, are being neglected by medical schools in properly training their students on the unique issues that they may deal with.

The New York Times had a recent article about how medical schools neglect LGBT issues when training their students. They used the example of a transgender patient who felt so uncomfortable disclosing her status that the surgeon did not discover it until he prepared her for surgery. This also highlights the fact that the surgeon did not properly assess the patient prior to surgery in order to discover her transgender status. This communication breakdown could have had more dire results, but it is not an uncommon occurrence. LGBT patients are often uncomfortable revealing their status, whether that be from fear or a perceived uncomfortableness from their physicians to talk about these issues. From the physicians' perspective, this lack of willingness to explore the topic could be rooted in the fact they were not properly trained in medical school.

“These patients need to feel that they can tell their doctor they are gay and that their doctor will accept them. This is about being a good doctor, because a trusting relationship is not just about a patient’s physical or even mental well-being. It’s about learning who that patient is.” ~ Dr. Mitchell R. Lunn, Internal Medicine Resident (Brigham and Women’s Hospital)

A study recently published in JAMA showed results from a survey sent to 176 Deans of medical schools in the US and Canada. The study showed that while LGBT issues were being brought up within the curriculum in many schools, only an average of five hours was devoted to it. Some schools reported that they didn't deal with LGBT health at all (6.8% pre-clinical, 33.3% clinical). With so little time devoted to the unique issues that may come up with LGBT patients, medical schools are producing physicians who are ill-equipped to have the conversations they need to have with their patients.

Not only do LGBT patients fear coming out to their physicians, they are also more prone to chronic illness and have a higher rate of isolation. The fear of discrimination may prevent them from seeking healthcare and they may also be prone to substance abuse, suicide, or domestic violence. Physicians must learn how to approach the conversation with these patients, if they actually do come to the office, and help to cut down on the fear that exists among patients who do not make frequent medical visits. Until the communication gap is rectified, LGBT patients will still be under-served and physicians will still be lacking the knowledge they need in order to turn the statistics around.

Wednesday, November 16, 2011

Talking About Obesity

Currently, two-thirds of Americans are overweight, yet patients feel like their physicians aren't spending enough time with them discussing their weight issues. A recent article by NPR talked with both patients and physicians to see where the communication gap might be. It appears that patients feel like they're seeking out information from their doctors but not being given enough, while doctors feel like they're providing sufficient information to start their patients down the road to weight loss and common sense should come into play.

"It's as unreasonable to say I didn't quit smoking because my doctor didn't tell me to as it is to say I didn't lose weight because my doctor didn't tell me to. Everybody knows you shouldn't smoke, and everybody knows you should be at a healthy weight. It's not a mystery." ~ Dr. Cynthia Ferrier, Internist (GreenField Health)

Time is also an issue. Physicians are already stretched for time when they have patient interactions. Office visits are usually only about 8 minutes per patient, and in that time the physician must deal with the acute symptoms that brought the patient in. It's hard to also tack on preventative health discussions and weight loss counseling. Additionally, reimbursement for such counseling is not always guaranteed.

It's possible physicians can run the risk of scaring away their patients or shaming them into not returning for follow-up because of their lack of success in weight loss. But with continuing health problems because of rising weight, perhaps the best approach is the direct one. Patients need to be aware how dramatically their weight has a negative impact on their health. Physicians should also be supportive of their patients as they embark on weight loss. Improvement in patient health can only come when patients and physicians involve themselves in a team effort. Together, patient outcomes can improve and weight loss can be a realistic goal.

Monday, November 14, 2011

New App From the AMA

The American Medical Association is moving more towards mobile technology with the release of apps in the iTunes marketplace. Recently, this contribution included the My Medications app. This app has been developed with patients in mind, by verified health care professionals.

The My Medications app helps patients keep track of their medications by creating a list of dosage and frequency of use. The database includes both generic and brand name medications so that you can easily enter in your personal medication prescriptions. You can also enter your allergies and immunization history for easy access, as well as your medical providers. The health information you've noted can also be sent to those you determine: friends, family, and physicians. And best of all, there's no need to worry about information breaches, as all data is stored locally on your device rather than in an internet database.

To learn more about the app, you can read the AMA website as well as the splash page on iTunes. Currently, the app is priced at only 99 cents and can be installed on the iPhone, iPad, and the iTouch.

Friday, November 11, 2011

Doctors: Wash Your Hands

Physicians come into contact with many different contagions during their day: sick patients, bodily fluids, and contaminated surfaces. Therefore, it is very important that they follow sanitary guidelines so that they do not spread disease among those they come into contact with. However, many of them don't.

A recent report shows that only 40% of American healthcare workers in hospital settings follow proper guidelines for hand-washing. Even more worrisome is that they may be substituting wearing gloves for following correct sanitation protocol. A study of more than 7,000 patient/doctor interactions in English hospitals show that hand-washing rates decreased by 6.7% when workers wore gloves. A common assumption is that gloves protect the patient from germs, thereby eliminating the need of the physicians to wash their hands. However, this is simply not true. Germs can travel through the latex, thus infecting patients. Additionally, when the gloves are removed, fluids can spray back onto the physician's skin and remain there, continuing the cycle of infection to the next patient. 

“Gloves are often used when in contact with bodily fluids or the most infective patients, like MRSA patient. So in the patient group or the clinical situation where you’re more likely to pick up potentially spreadable germs, health care workers are actually less likely to clean their hands afterward.” ~ Dr. Sheldon Stone, Senior Lecturer  (Department of Medicine, Royal Free Campus of University College London Medical School)

Healthcare providers must follow proper hand-washing guidelines, disinfecting their hands before and after patient interaction, in order to cut down on the spread of disease. Additionally, any contact with contagions, such as contaminated surfaces or bodily fluids, should create an automatic response of disinfecting. Patients rely on their physician to bring them good health and cure their illnesses. They are not seeking to compound their problems even more by having their healthcare provider bringing them new diseases.

Wednesday, November 9, 2011

Booking A Doctor Online

The population is utilizing the convenience of online tools to make their lives easier. People can order their groceries online, book a flight, or check the weather in far-flung locations. And now the population can even schedule medical appointments online with ZocDoc.

The ZocDoc service allows patients to search for physicians online, sorting by where the office is located as well as what insurance the provider accepts. Additionally, information is provided about the doctor and there are real patient reviews so that the decision of which provider is best can be based on actual feedback.

ZocDoc has been made available in more metro areas at present. The coverage area includes Atlanta, Baltimore, Boston, Chicago, Dallas, Houston, Los Angeles, New York, Philadelphia, Phoenix, San Francisco, and Washington, DC. Possible expansion into other areas may occur in the future. Currently, the free online service is used by 700,000 patient monthly, 40% of which get an appointment with a physician in 24 hours. And the appointments are not confined to typical office hours. 36% of users of the ZocDoc service manage to get an appointment outside of the normal 8AM-5PM time period. Physicians who are listed with the service must pay a fee to be included, but many have found it to be money well-spent.

"Most of my patients are younger professionals who are technologically savvy. I just want to be technologically relevant to my patients. It's one more way to stay cutting-edge in this highly competitive field." ~ Dr. Brynne Anderson, Dentist (Chicago)

The company has been honored by Forbes and PC Magazine for its work and now offers an app for both Android and iPhone to go along with its website. Also on its site is a section to receive answers to health questions, supplied by actual physicians from a number of top institutions such as Mass General, Johns Hopkins, Harvard, Beth Israel, and more. With focus towards the future, ZocDoc is changing the way patients access medical care.

Monday, November 7, 2011

What Medical Students Worry About: Loss of Free Time

Medical students have many concerns as they first go through school and then embark on their careers. Merritt & Hawkins wanted to know what was weighing on the minds of the new generation of doctors, so they conducted a survey on that very question. The results were surprising.

48% of newly graduated residents said that their biggest concern was the possible loss of free time when they enter a practice. This is increased since a 2008 survey when 33% reported the same concern. The response far outweighed any other response, which is concerning since medical knowledge and ability to deal with resulting educational debt were further down the list.

12% worried about dealing with their high educational debts and valued the opportunity to have their loans forgiven.

7% were concerned that their medical knowledge was lacking in terms of real-world application.

2% felt unprepared to deal with patients when they graduated from medical school and ventured into practice.

It is interesting, and a bit perplexing, why the survey got these results. Additionally, when asked about the "must-haves" when entering practice, personal enrichment outweighed professional enhancement. Residents sought a good geographic location, dedicated time off, and good pay. Further down the list was the desire to have good medical facilities and equipment with which to practice. It calls into question if there is a shift in mindset for the new generation of physicians. Will the medical field lose its notoriety as a career based on self-sacrifice? One would hope not, but the future will tell.

Friday, November 4, 2011

Training for the USMLE

Medical students work towards success on the USMLE throughout their educational career. This is the important test that will decide their future, so doing well is a necessity. Now, students have another avenue of accessibility when it comes to preparation.

USMLE Weapon does not merely exist as a question bank, but instead a full-aspect platform that is meant to help students score higher on the USMLE. The development was done by a group of 15 University of Pittsburgh Medical School medical students who scored in the 99th percentile on their exams. They are focused on quality education for their fellow students and set out to provide a test preparation tool for them.

The platform provides testing for both Step 1 and Step 2 CK and allows for charting of test results so that students can see their improvement over time, as well as compare performance among peers. Questions are added on a frequent basis so that knowledge is always fresh and new. Tests can be paused and restarted later as well, so scheduling is no problem. In addition to a web platform, they have also released a mobile platform with which to access testing preparation on the go. USMLE Weapon is also planning on releasing apps in the future as well.

Educational tools are always helpful when preparing for testing and it's even more important when it comes to the USMLE. Medical students who are better prepared will find success when testing day comes.

Wednesday, November 2, 2011

Medical School Enrollment Is Increasing

Healthcare reform has promised that more patients will be entering the medical marketplace in the coming years. This means that the demand is higher than ever for medical students to become educated and enter the medical field. While the number of physicians is currently projected to be far below the need in the next 10 years, there is some hope.

According to the Association of American Medical Colleges, enrollment for first year medical school was up 3% over 2010 enrollment, making 19,200 total new students entering medical school in 2011 out of a total of 43,919 applying. This is also in conjunction with the overall increase that medical schools have seen since 2001, when the total new enrollees was only 16,365.

This is a positive sign, as more physicians will be needed as patient load increases. However, we should not remain satisfied with current levels. More students are needed, in order to be trained and enter the field, so medical schools must strengthen their recruitment efforts. Medicine is a worthwhile service career that can benefit everyone involved.