Medscape Expanding to Kindle Fire Market

The Medscape app has been one of the most used medical apps in the mobile market. Since it began, the app has expanded to include a number of devices, such as the iPhone, iPad, Blackberry, and Android. Now, that expansion has moved into the Kindle Fire market.

Utilizing the same features that can be found on the iPhone app, Kindle Fire users can access drug references, daily medical news, continuing medical education courses, drug interaction information, disease/condition references, proper medical procedures/protocols, MEDLINE articles, professional directories, and other special features.

This move for inclusion shows that the Kindle Fire market is growing and should be utilized for mobile technology in the future. The population is integrating mobile devices into their daily lives already, especially those in the medical industry, and instant access to information is beneficial for both the health professional and the patient.

Internal Medicine Not Growing

After two years of increase, the number of US medical students entering internal medicine has leveled off. This is according to a new report by the 2012 National Resident Matching Program. This is concerning, considering the high need for internal medicine focus, especially within general care. Only 20-25% of the 2,941 students who matched in internal medicine are expected to go into general care. Just 14 years ago that percentage was closer to 54%. The future does not look bright for this area of medicine.

 "We remain concerned about the need to significantly increase the nation's internal medicine and primary care physician workforce to meet the needs of an aging population requiring care for chronic and complex illnesses." ~ Virginia L. Hood, MBBS, MPH, FACP (President of the American College of Physicians)

With changes in the medical system, creating a higher number of new patients entering the marketplace once healthcare reform comes into full effect, the need for physicians in internal and primary care remains a high priority. Medical schools must work to increase these areas, focusing more attention on the benefits of these career choices as well as promoting advantages for these areas of medicine.

Medically Illiterate

Gaining medical knowledge is a challenge for medical students around the globe. Even more challenging is breaking down complex medical information so that it is understood by patients and made more difficult when patients' literary skills are not at a proficient level. This is a subject that was recently looked into by the AMA on their site.

According to a 2003 study by the US Department of Education, 90% of adults in this country do not have proficiency in the acquisition and understanding of medical information. Added to this, 33% are at either a basic or below basic level, which means they struggle with filling out medical forms or complying with simple testing instructions. This puts their health at risk, causing an increase in negative health outcomes because of treatment or medication errors as a result of not understanding instructions (written and oral). And it's not just a matter of increasing education among these individuals in order to counteract the problem, since up to 75% fail to tell their doctors of their limitations.

“Health literacy is about mutual communication. It is when patients or anyone on the receiving end of health communication and anyone on the giving end truly understand one another.” ~ Helen Osborne, Boston Health Literacy Consultant

What can be done to help patients in these situations? Initiate one-on-one communication so that patients can ask questions and go over information that they may be confused about. Ask them to repeat back the instructions so any errors can be corrected immediately. Also, increase the use of visual communication techniques rather than relying solely on written instruction and review all written information to make sure it is at a sixth grade level or below. Making the questions too complex will increase the rate of errors. By making strides to cut down on health illiteracy, physicians can make sure patients are receiving the best care possible and assure that they have a better health outcome once they are out of the office. 

Balancing Patient Care With Patient Cost

Medical students are taught how to properly care for patients. They are given knowledge on how to diagnose, what tests should be performed for medical scenarios, and how to proceed in treatment. However, they must also learn the hard truth of cost. Sometimes, the best option is not the one that can be chosen.

The patient care system has become costly for the medical industry. Charges for testing and treatment has risen, sometimes to the point that a patients' coverage (or lack of coverage) cannot support the best option for their case. This is what physicians must learn to balance; choosing the best option for care that the patient can actually afford. The itemization of costs is often difficult, since physicians may not know how much each test will cost, only a rough estimate of "expensive." It's important to have that information beforehand in order to make the best selection.

While it would be wonderful if physicians could treat patients without keeping money in mind, it's not possible. However, they cannot spend all their time worrying about costs either. Physicians must focus on their patient's health and what would be best for them. If a less expensive treatment wouldn't be beneficial, or the time spent debating less expensive options would put the patient's life in danger, limitations of payment should not be an overarching issue. It's a delicate balance between the two and physicians-in-training must learn it well. Their entire career will be faced with these types of choices.

Empathy Learned, But Not Retained

Medical students are taught many subjects in school in order to become better physicians when they embark on their careers. One subject they learn is how to be empathetic with their patients. Showing empathy helps in the patient/physician relationship by emphasizing that the medical professional cares about patient outcome. However, a recent article shows how these skills might not be retained for long.

"[W]e found there was a decline in empathy in medical students as they progress through medical school, and that decline is particularly noticeable the third year of medical school...If you want to sustain empathy, you need to reinforce it." ~ Mohammadreza Hojat, PhD, Research Professor of Psychiatry and Human Behavior (Thomas Jefferson University Jefferson Medical College)

Students were shown to gain empathy skills immediately after learning scenarios, but as these interactions became less common during the progression of medical school the skills dull as well. Medical schools must include empathy skills training throughout students' education in order to reinforce those skills and prepare for actual patient interaction. Empathy has been shown to aid in positive patient outcomes, so it is an essential skill that all physicians should learn and utilize in their practice.

Team-Based Training

The move towards more team-based care has grown over the years. Instead of treating patients singularly, now physicians are working in teams to create a more well-rounded patient experience. Being referred to a specialist, follow-up care with their PCP, and any other health coverage they may need is collectively treated between the medical group. Medical students must learn this type of treatment mindset while in training, so more medical schools are moving towards that learning scenario, such as the Medical University of South Carolina.

"The idea is that they learn, for all health care providers, what the scope of practice is and what the responsibilities are, so that they can really reach out and use other professionals to the best of their ability." ~ Amy Blue, PhD, Family Medicine Professor (Medical University of South Carolina)

Many physicians tend to work in single practice and, when their patient is referred elsewhere, they are no longer involved in that aspect of their care. In team-based treatment, the team of medical professionals are all responsible for the patient. This supportive environment ensures that the patient is receiving the best care possible, as well as having all the treatment professionals aware of each step of care so they can contribute accordingly. Healthcare providers can focus on their strengths and rely on a team rather than having to pass along a patient once their needs exceed the physician's abilities. Team-based care is a positive outcome for both patient and physicians and the trend is growing.

Patient-Centered Healthcare

Mobile technology not only allows physicians to have easy access to medical information, it also allows patients to take a more active part in their own care. A new report from Float Mobile Learning shows how this trend could be beneficial in the future.

The study looked at mobile technology use among patients and physicians. They found that medical and healthcare apps were the third fastest-growing category among Android and iPhone markets. With 320 million mobile phones in use in the United States, and 80% of physicians reporting that they use smartphones and medical apps, the market is open for potential.

Additionally, patients can already use their mobile devices to monitor their own health, and this is important for physicians, as 88% of them report a desire for their patients to have the ability to monitor their health at home. This would lessen the burden on healthcare professionals because changes in health could be detected early. It is also believed that this constant monitoring would decrease the 1 billion annual visits to healthcare providers because routine testing could be done outside an office environment.

Phones aren't the only potential market for healthcare information. The use of tablets have opened the door for more extensive mobile technology and physicians are 250% more likely to own a tablet than the general public. There are also other tools that can integrate with mobile devices or expand their use. Nike Plus has become popular a personal fitness monitor, allowing consumers to monitor their health progress as they exercise. Both the iHealthBPM and iStetoscope can turn mobile devices into medical devices through the use of the app. These examples, as well as a number of others, show that the future of mobile technology in medicine has great potential. The market must keep up with the demand being placed on it by these consumers. If it does so, the benefit to healthcare will be enormous.

iPad Use Heightens Patient Care

The medical industry's use of mobile technology has been long discussed. Physicians, both in practice and in school, are adopting more technology to help them in their patient care. Now, a new study underlines the positive impact these devices would have on medicine.

The study involved 115 medical residents at the University of Chicago Medicine. In November 2010, they were given iPads to use for various tasks: showing test results to their patients, accessing patient records in order to make diagnoses, contacting other departments to follow-up on test results, and also accessing medical journals to heighten their own understanding of medicine and current research. These residents were allowed to use the devices for a few months and then asked to complete a survey on their opinions. The results showed that the iPad had a positive impact on their patient/physician relationship.

• 90% used the iPad for their clinical duties on a consistent basis

• 78% felt the iPad increased their work efficiency

• 68% said the iPad helped to eliminate delays during patient care

The rate of ordering tests for patients also increased (5% more before morning rounds, 8% more before end of shift). Tests were often ordered within two hours of patient admittance rather than waiting until the end of shift. This can be attributed to the fact that the technology to do so was readily available, so physicians didn't have to take extra time to fill out forms and get them filed or make a phone call. Instead, they could make a note electronically and the orders would be automatically sent to those responsible. This increased efficiency shows how much of a positive impact mobile technology can have on medicine.

Selective Communication

Communication between patients and physicians is key. We have talked at length about the subject on this blog and it has been covered in other articles. However, the extent of transparency in that relationship is variable, depending on the participants. This is an area that the NY Times recently looked into.

While prior surveys have highlighted patients' desires to be told the complete and honest truth, even if the news is not good, some physicians are still of the mindset that withholding certain information might be more beneficial. Does a patient really have to know that they were admitted to a regular ward simply because there was no room left in the ICU? Would it do them more harm than good to know some medical decisions are made because of ability to pay? And what if your patient doesn't want to know everything? When presented with too much information, they may become hesitant to make a decision. Is more information necessarily the best in these situations?

The approach to transparency must be done with mindfulness. Patients must be able to trust their physicians to give them the information they need. It may be hard, but progress towards a more open and honest relationship between patients and physicians will help make the medical process smoother. Communication skills are necessary to learn for medical students to become successful physicians and is essential for the patient/physician relationship to succeed.

EMRs May Not Save Money

The use of electronic medical records is increasing within the medical industry. The hope is that, with shared information, patients can receive better care and be subject to less redundancy in testing. However, the testing rates might actually be higher since EMRs came into use. That's the topic that a recent EmaxHealth article looked into.

In a 2008 survey of 28,741 patient records from the offices of 1,187 physicians, the rate of additional imaging testing was between 40-70%. Lab testing was also increased among those who utilized electronic patient records. While this may seem counterproductive, it is also an inevitable side effect of the digitizing of medicine. Without the need to go through long forms and paperwork, physicians are more likely to order more tests with the click of a button.

So, how can EMR usage increase without also increasing the orders for unnecessary tests? First of all, physicians should learn to rely on prior findings when necessary. If indications are that a prior result may have been false, then a re-test is warranted, but many times it's an unneeded expense. Additionally, insurance companies should be more adamant on limiting the amount of re-tests that can be funded. If a patient has had the same test run a certain number of times and the result is always the same, then further orders for that test during the calendar year shouldn't be reimbursed to the physician. The medical industry must learn to work together, rather than being individual caregivers. Just as the patient/physician relationship is a team effort, so too is the physician/physician one. By having everyone work together, the overall outcome of patient health will be more beneficial.

Is Truth Gender-Based?

Patients expect their physicians to be honest with them. However, if a patient has a female physician, they might be getting the truth more often. That's the finding of a recent study, which surveyed 1891 physicians about their truthfulness towards to their patients. Ten percent reported lying to their patients at least once in the prior year, but when broken down by gender female physicians were overall more honest than their male colleagues. However, that doesn't mean that female physicians are always completely honest. Here are some findings among survey respondents of both genders:

• 55% told at least one patient in the past year that their prognosis was more positive than it actually was

• 33% didn't find disclosure of drug/medical device company relationships to be relevant to their patients

• 25% had shared patient health information without the patient's consent

• 20% covered up a medical mistake because they didn't want to be sued

• 10% had outright lied about something in a conversation with a patient or, in cases of children, their guardian

It is important that physicians understand the implications of their actions. By not being honest with their patients, they are harming the patient/physician trust relationship and may be doing harm to not only their patients, but the reputation of medicine in general. Patients value truthfulness, even when it is not the best news. Male or female, all physicians should tell their patients the truth.

Mobile Healthcare Still Limited By Current Technology

The healthcare industry is starting to embrace the wide range of mobile technology tools. However, the lengths that physicians want to integrate these tools into their current practice may exceed the currently-available technology. That's pushing mobile technology to strive to be better, more wide-ranging, and more adaptive to future needs. That's the subject of a recent iDatix article.

Spyglass Consulting Group asked physicians about their opinions on tablet and mobile technology. The results were supportive of innovation, but also wary of the current limitations. Here are some findings of their survey:

• 98% have utilized current mobile technology to help in both their jobs and their personal time

• 80% believe the iPad has a future in the medical industry, but it currently has too many limitations to be fully integrated

• 75% are wary of integrating current mobile technology into medical practice because of security and reliability concerns

The use of mobile technology has grown dramatically over the past six years. In 2010, 94% of physicians reported as having used it in their professional and personal lives, while only 59% reported the same in 2006. These rates exceed the increase in the overall population, too, which signifies that the medical industry is welcoming of new technology and willing to push the boundaries of currently-available tools in order to request expanded use. It's beneficial for all involved. Technology just has to keep up.

Lying For The Good Of The Patient?

Doctors take an oath to "first do no harm" during patient care. In an earlier post, we highlighted that this should include not lying to patients. But perhaps the reasons behind this deceit is for the patient's best interest? The NY Times looks into this matter and shows how truthful physicians may feel that a little white lie is the best course of action.

The article chronicles Dr. Pauline Chen's dilemma when confronted with a liver transplant case. Dr. Chen was responsible for telling the patient's parents that their son may not make it. His health was in such a delicate state that, even if they found a viable organ, he may not be healthy enough for the short journey to the OR. No one wants to hear that their child might die, so even though the patient lived the parents still seemed to hold some anger towards the physician who told them the worst case scenario. But is one approach better than another?

Had the physician given the best case scenario, as is often the case among physicians who admit to lying, and the patient passed away, would the parents be angry for the false hope? Studies have asked patients their opinions on hope versus honesty and most patients prefer their doctor be honest with them. This will give them a realistic overview of their case and what might happen, even if it's not a positive outcome.

“Patients need the truth so they can best make decisions for themselves.” ~ Dr. Lisa I. Iezzoni, Professor of Medicine (Harvard Medical School)

Direct and honest patient/physician dialogue is beneficial to all involved because the patient can trust that their physician isn't giving them false hope and the physician can remain objective in their patient care. If the best case scenario comes true, then the patient is able to reap those benefits. But in some cases, the worst case scenario becomes a reality. Patients have to be prepared for the possibility, even if it means the physician is tasked with giving them the bad news.