Epocrates Changing Focus

In the past, Epocrates has focused its attention on improving EHR technology. However, the company has decided to pull back from that arena to instead increase focus on mobile technology. This means that the company will be transitioning their current EHR members to another platform and commit company resources to expansion of the mobile branch. The reason for this change is the fact that Epocrates does not feel that it is a leader in the EHR area of technology and does not want to sacrifice its lead in the mobile areana.

"[W]e are already late to the game in an already crowded marketplace...[and]...our EHR efforts have hindered our ability to aggressively pursue opportunities more closely aligned with our core capabilities. As a result, we are exploring strategic alternatives for our EHR offering.” ~ Peter Brandt, Interim President and CEO (Epocrates)

The company recognizes the potential for success in the mobile technology market and wants to utilize their resources to achieve that. Medicine is integrating mobile apps and other mobile resources at an increased rate, so to be able to offer cutting-edge information access to physicians will allow Epocrates to remain at the head of the field. In a market that added over 1500 new medical apps in 2011, Epocrates remains the most used. It's important that they retain that lead.

Will this change negatively affect their user base? Or will it once again prove that Epocrates is leading the way in mobile medical technology?

PCPs Needed

The medical industry is preparing for the influx of new patients set to enter the marketplace in 2014 with the passage of the Patient Protection and Affordable Care Act. Coupled with this increased patient population is the need for increased physicians, especially PCPs. However, the rate of increase for this medical area is not keeping up with the future demand. This is due to the fact that many medical students don't even consider non-specialty medicine as an option.

To help counteract this problem, medical schools are increasing the sizes of their classes and new medical schools are opening across the country. This increased pool of potential healthcare providers will hopefully increase the number of PCPs as well. However, this is not a guarantee. Medical students often choose specialized care rather than primary care because the former has larger paychecks. When students are embarking on their careers with high student loan debts, this difference in pay is important. Additionally, the patient/physician interaction that one gets in specialty care is often perceived as being better, allowing physicians to spend more time with their interesting cases, rather than being rushed through 15 minute interviews for repetitively normal casework. The lure of the exciting side of medicine may sway students towards specialty care.

The medical field must counteract the misconception that primary care is not as appealing as other areas of medicine. Emphasis should be placed on the fact that PCPs are the first-line of care and can develop more personal connections with their patients than those who practice in specialty care. By focusing on the human aspects and the non-monetary rewards that can be experienced, perhaps PCP numbers can rise to meet the coming demand.

Alcohol Addiction Among Physicians

Addiction is a large problem in our country and is especially worrisome among the medical professional population. Being under the influence of alcohol or drugs puts the patient at risk because of physician impairment. Recently a new study looked at the issue of alcohol addiction among surgeons in the United States and the statistics show a noted problem.

In a survey of 25,000 surgeons, medical professionals were asked about their lifestyle, mood, and work in order to gain insight into how each influenced their career. Of the 7,197 who completed the questions, 15% (1,112) met the AUDIT criteria for alcohol dependence or abuse. Surgeons who met the criteria were often found to be depressed or burned out, thus increasing their likelihood to drink. In light of these combined factors, steps must be taken to decrease this number significantly. Additionally, the small number of respondents might reflect a larger problem, since addicted surgeons may not have wanted to disclose their issues within the survey.

"Nonresponse bias is particularly salient when the topic is considered sensitive and the respondents would prefer to not discuss such matters. Surgeons who drink more heavily are potentially less likely to respond, which might underestimate the prevalence of alcohol abuse." ~ Study Authors

While the study did not show a connection to patient endangerment in the cases of surgeons who met AUDIT criteria, there is always the possibility. Confronting the stigma that goes along with addiction will help more physicians be open to getting help, thereby decreasing the number of addicted professionals who are in the medical industry. Patient lives are important and all medical professionals should be able to provide the best care possible, including being unimpaired at all times. Medicine is a team effort, so make sure all the team members are at the top of their game.

Students Teaching Teachers

Medical students rely on their professors to train them in all the areas they'll need before embarking on their medical careers. However, a group of medical students at Yale want to be involved in shaping their education. The MedEd Interest Group is the first of its kind at Yale, targeted towards helping bring together medical students who wish to develop better teaching skills in a combined effort of improving medical education.

“All doctors are educators, since they teach their patients on health and diseases. Doctors also teach residents and students, focusing even more on the link between education and medicine.” ~ Chung Sang Tse, Medical Student and MedEd Organizer

The group is hoping to create curriculum for a two-week intensive summer elective, as well as develop mentor relationships between current faculty and students so that education can be more of a team effort. At present, MedEd has 60 students and 35 faculty scheduled to attend its official launch on Tuesday. The need for more educational training among the medical professional field has been recognized and hopes are that this group will help bridge that gap in skills.

By helping the student become the teacher in this instance, Yale is helping to foster a life-long learning technique. Being involved in one's education will increase the desire to succeed and the interest in the subjects being presented. It will help provide a stronger base for future career success.

Be Open To Communication

Medical students learn many traits that will help them become successful in their careers. One such trait is the ability to communicate effectively and efficiently with their patients. A recent blog post in Dr. Wong's blog highlights this often-overlooked skill and gives some suggestions on how to incorporate it effectively into an office visit.

1. Greet Patients By Name: By looking into the patient's eyes and greeting them by name, you are making a connection with that person, as well as putting them at ease. This will open the lines of communication.

2. Ask Why They Are At The Office: Let the patient describe their ailment and symptoms without interruption for two minutes so that you can get a clearer picture of what's wrong. That way you can ask the right follow-up questions.

3. Follow Up With Questions Related To Their Explanation: By connecting your questions with the explanation they just gave, you are showing that you've listened to your patient and are continuing that discussion. The exchange of information should be more like a discussion than a monologue.

If you show your patients that you are listening to their concerns and taking them under consideration, you are helping to ensure an open and honest discussion. This will move you closer to a correct diagnosis and support a healthy and happy team effort between physician and patient.

MCAT Changes Approved

Three years ago, changes to the MCAT were proposed. This would have been the first change in structure in over 20 years. As of this week, these changes have been approved by the AAMC and will come into effect in 2015. The restructure was done to more fully reflect the current medical system and all the knowledge medical students would need as they embark onto their careers.

Certain sections were removed, while others were added to test in new areas. There will no longer be a writing test component of the MCAT, as that was not deemed worthwhile for overall knowledge. Instead, there will be a new section titled "Psychological, Social, and Biological Foundations of Behavior" which will test in areas of psychology, sociology, and biology. These areas are essential for medical students to understand when engaging with patients in practice.

“Being a good doctor is about more than scientific knowledge. It also requires an understanding of people. By balancing the MCAT exam’s focus on the natural sciences with a new section on the psychological, social, and biological foundations of behavior, the new exam will better prepare students to build strong knowledge of the socio-cultural and behavioral determinants of health.” ~ Darrell G. Kirch, M.D., AAMC President and CEO

Additionally, there will be a new "Critical Analysis and Reasoning Skills" section. Students will be presented passages which they will have to extract information from. This will test their abilities of analysis, evaluation, and application of information. Two natural science sections have also been added, including topics in the areas of biology, organic chemistry, biochemistry, and physics. These areas will test students' skills to use scientific inquiry and reasoning in order to solve problems. This will show that they are ready to embrace the requirements necessary for medical school.

In total, the overall testing time has been increased by an hour, from 5.5 to 6.5 hours, but this is in line with former versions of the test, so it should not be a problem for students. It will be interesting to see if the revised test shows a more complete picture of students' abilities and gives better selection for medical schools.

AMA Publishes Principles For Social Media

Social media has become a large component of life for much of the population, physicians included. However, it's always a tricky line to walk between being professional and being open. Principles for use were often requested, but it was not until this week that the AMA came out with a non-binding policy to guide the use of social media within the healthcare community.

1. Physicians should be cognizant of standards of patient privacy and confidentiality that must be maintained in all environments, including online, and must refrain from posting identifiable patient information online.

This should be self-evident, but the guiding principle is to respect doctor/patient confidentiality. Medical professionals should not talk about cases with information that could be traced back to a specific patient.


2. When using the Internet for social networking, physicians should use privacy settings to safeguard personal information and content to the extent possible, but should realize that privacy settings are not absolute and that once on the Internet, content is likely there permanently. Thus, physicians should routinely monitor their own Internet presence to ensure that the personal and professional information on their own sites and, to the extent possible, content posted about them by others, is accurate and appropriate.

While medical professionals should strive to keep their personal information separate from their professional information, even locking down the private information does not guarantee that only a limited audience will see it. Medical professionals should be aware that the image they put out online can be damaging if patients see it.


3. If they interact with patients on the Internet, physicians must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just, as they would in any other context.

Physicians should never over-step their boundaries of a professional relationship with their patients. It is not a good idea to "friend" patients or enter into discussions that they would not otherwise contribute to in a professional environment.


4. To maintain appropriate professional boundaries physicians should consider separating personal and professional content online.

As mentioned above, medical professionals should maintain a separate private profile that is limited to just friends and family, while allowing others to access a more limited public profile. Patients finding more personal information about their physicians could damage the professionalism that physicians strive to maintain.


5. When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities.

While physicians should self-regulate their information, they also should regulate the information of their colleagues. If something is seen as inappropriate, first contact the poster to deal with it. If the colleague does not abide by proper action, going to a higher official is warranted.


6. Physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers (particularly for physicians-in-training and medical students), and can undermine public trust in the medical profession.

As mentioned above, patients and the public can access a tremendous amount of information online. If inappropriate content is found related to a physician, the professional respect could be damaged, not only for the physician but the medical field in general. Physicians should be conscious of what they are posting and in what context.

By abiding by these suggested guidelines, medical professionals can assure that they are able to take part in social media without damaging their professional image. There are many advantages to using social media, but always be aware of the disadvantages that could come from improper use.

Addiction in the Medical Field

Addiction is a large problem around the globe. Patients are often treated for drug or alcohol abuse, given treatment in order to release themselves from the physical and mental symptoms that addiction bring. However, medical professionals are not immune either. A recent article looks at anesthesiologists who are battling their own addictions.

Trained medical professionals are often better able to hide their addiction from family and coworkers. They know how to inject without being caught and how to dose themselves so that they don't lose coherency. Anesthesiologists especially are of concern. Even though they only account for 3% of all medical professionals in the industry, 20-30% of all addicted physicians are anesthesiologists. This discrepancy warrants the need for more attention paid to the profession, especially in terms of how their addiction puts their patients in danger.

If an anesthesiologist is under the influence while treating patients, they are likely to make grave medical errors. Additionally, they often acquire their fixes by diverting a portion of medical meant for patients, so treatment is already put into jeopardy even if the physician isn't under the immediate influence of drugs at the time. Patients are given stronger medication, when it's seen that their current charted dosage isn't working, but the reality is that they were getting diluted levels of pain medication and are thereby put in danger of an overdose at higher levels.

“These drugs can take somebody who is at the top of their game, and bring them down very hard and very fast. It’s a story that a lot of people aren’t talking about.” ~ Dr. Ethan Bryson, Associate Professor (Department of Anesthesia and Psychiatry, Mount Sinai School of Medicine)

It is important that treatment for these addicted medical professionals is sought immediately, so that they will not continue to put others' lives in danger. However, fear of professional repercussions often lead addicts to keep their secret. Changes in communication must be made so that addicted medical professionals are not blacklisted for seeking the treatment that they need. Until the door is open to them to start on the path to recovery, patients' lives will continue to remain at risk. No one is immune to the negative outcomes of addiction, not even those professionals who have sworn to treat and keep safe those around them.

First Do No Harm...Including Lying

Patients trust their doctors to provide them high quality care, as well as look after their best interests. This trust is built upon assurance that their doctors are telling them everything they need to know. However, that may not be the case. According to a 2009 survey recently published in Health Affairs, in which 1800 physicians in the US were interviewed, 11% admitted to lying to their patients within the last year.

The reasons for these untruths vary. More than half (55%) have given their patients a more positive prognosis than their test results support. This may be done in order to put their patients in a positive mindset for treatment, thereby unconsciously aiding their recovery, or simply emphasizing a best case scenario. That doesn't mean that physicians are always lying for the benefit of their patients, though. Nearly 20% who admitted lying did so because they had committed a medical error and did not want their patients to sue for malpractice. In these cases, the lies might have seriously harmed patient outcome because of lack of disclosure.

What do these findings mean for the medical profession? It certainly warrants a change in behavior. If patients cannot trust their physician to give them an honest answer, their health may be in jeopardy. The healthcare relationship is built on trust and being a team through the process of treatment and recovery. When one of the team players is keeping secrets, it does not bode well for the outcome.

Concierge Healthcare

The demand for physicians is rising as more patients are set to enter the medical marketplace in the coming years. Current healthcare workers are being stretched for time and some patients may feel they're not getting the best care they can. However, patients have the option of paying more for personalized care. Is this a worthwhile choice for the future of medicine?

By paying a fee ranging from $1500 to $15000 annually, patients taking part in concierge care can be assured that they'll get quick, personalized care from their physician. Appointment times are set up almost immediately, direct communication is assured, extensive physical exams are provided, and a wealth of other wellness programs are open to those who choose the services. Additionally, even though the concierge fee doesn't cover  specialist or hospital care, physicians are known to follow patients through their care and be present during procedures that they are not performing themselves.

All this sounds like a great opportunity for patients looking for that "something extra" but it also allows for exclusion based on ability to pay. Those who cannot afford concierge care may be getting less extensive care than their counterparts or may be excluded from treatment access by certain physicians because they are dedicating more time to their concierge patients.

In the end, is concierge care harming the medical industry or helping it? Should patients get preferential care because they can pay more? Or is this just another way to guarantee that medical care received is at the highest level possible?

E-Prescribing Works

The rate of prescription adherence is always a problem in medicine. Physicians give paper prescriptions to their patients, but it doesn't guarantee that the patient will take it to the pharmacy or that they'll pick the medication up when it's ready. How can these rates be improved? According to a recent Information Week article, the answer may be e-prescribing.

A study conducted on paper prescribing showed that 73.2% were taken to the pharmacy, but only 69.5% were picked up. Compared to these rates, for prescriptions sent electronically, 81.8% were delivered and 76.5% were picked up. That means that patients are more apt to receive their medication if physicians ease the process through electronic prescribing. However, currently only 40% of physicians take part in this mode of prescribing.

"Improved medication adherence results in lower downstream medical costs." ~ Seth Joseph, Leader Researcher 

A higher rate of prescriptions being obtained from the pharmacy means that patients are more apt to take their medication. Higher rates of medication usage means better long-term health. In fact, current estimates are that if physicians take part in electronic prescribing, the higher rate of patient pick-up could reduce long-term health expenses by $240 billion. With all these benefits from a more streamlined process, it seems evident that electronic prescribing is worth looking into.

Patent Safety A Top Priority

Patient safety should be a top priority for all caregivers and is especially important when patients are in the hospital. A recent article delved into the issue and calls for healthcare workers to increase their devotion to patient safety.

Ten years ago, the Institute of Medicine estimated that around 100,000 people were dying annually in hospitals from preventable issues. Those shocking numbers should have pushed for changes, but sadly the situation has gotten worse. The rate of deaths among Medicare patients has raised to 180,000 annually, marking faulty hospital care as the third leading cause of death in the United States. This indicates a strong need to change the statistics.

One suggestion is to have caregivers rely on checklists. This would allow standards of care to be present, as well as assuring that proper procedures were being taken by all healthcare workers. Improper care through shift changes, as well as mistakes during surgery, could be decreased if a visual representation of completed procedures had to be gone through. This was the theory Atul Gawande, a surgeon in Boston, was working on when he came up with a medical checklist with members of the World Health Organization. The checklist was sent to eight international hospitals in 2008 and all saw a drop in medical mistakes. Complications from surgery dropped 36% and hospital deaths decreased by 47%.

With these results, it seems obvious that health checklists would go a long way in decreasing health complications among hospitalized patients. The key is to convince hospital staff to abide by the checklists and actually fill them out. While procedures may become so common that they can be completed from memory, it's important to have the physical list to go through in case something is missed. Convincing healthcare workers of this necessity may be hard, but it's important for the safety of healthcare. Patients want to feel safe when they enter the hospital, so caregivers should do all they can to assure that.