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Improve Health Literacy

Medical students often learn the technical descriptions of diseases, symptoms, test results, etc. However, using these same terms with patients does not translate as well. A recent Huffington Post article looked at the issue of health literacy among patients and how physicians could improve upon the understanding patients have about their cases.

"Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." A large part of this literacy is dependent upon successful communication between physicians and patients. When a physician uses medical terms that are not understood by the patient, it's not always the case that the patient will point that out. Instead, physicians may continue on with the false assumption that all the information they provided was obtained successfully.

What can physicians do to make sure patients have the knowledge they need to make good health decisions? First of all, cut down on the medical jargon. Utilizing technical terms in medical school may be appropriate, but patients often do not have that same level of education. They have not been to medical school, so they require a more straightforward explanation of their health issues and the decisions they must make. It's important that physicians also learn to ask patients if they have any questions about what they've just learned. Patients may keep silent for fear of looking less than intelligent, but opening up for questions might spur them into seeking the clarification they need.

From a patient's perspective, they can utilize different ways of approaching a physician for the clarification they need. One suggestion is the Ask Me 3 program, which is meant to promote understanding between patients and physicians. Patients should ask and receive answers, in plain terminology, to these three questions:

1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?

By utilizing the answers from these questions, patients can get a better understanding of their current health and the issues they are facing. Also, repeat back the information given because then physicians can clear up any misunderstandings rather than there being a remaining communication gap. Medicine is a team effort, so make sure all participants are on the same page.

Follow-Through

Medical students often run through multiple cases during their education, often getting only a brief glimpse at the patient's life before they move on to another department for training. However, studies have shown that allowing students a chance to follow-through with patients and remain on their case for their entire 3rd year experience was more beneficial than when they went through traditional training.

Piloted through the Harvard Medical School, students in this training follow a range of patients from admission to outpatient care. This allows them to get a more in-depth experience with each patient, as well as track their outcomes over time. The students get to know the patients as people rather than solely by the disease they're presenting with. The same principle is true of PCPs who can take the time to get to know their patients on a more personal level, allowing them to see a more well-rounded picture of who the patient is and what needs they might have rather than treating towards each presenting symptom as it comes along.

By building these skills and abilities early on, students can get a better feel for well-rounded patient care. Establishing these types of relationships can have a positive impact on their approach to medicine in their future careers. By seeing patients through from admission to outpatient care, they can get a better handle on patient progress over time and utilize that knowledge on their subsequent cases. It creates a positive outcome for all involved.

Multi-Talented Med Students

It used to be that medical students would seek out their MD and be off to practice. However, now students are seeking multiple degrees so that they can be multifaceted when it comes to taking care of patients. American Medical News recently looked at this trend.

Many medical schools across the country offer the ability to get a dual degree. Students could couple their medical training with degrees in Public Health, Journalism, Law, or other areas. Though this idea isn't new, the recent push in popularity may have something to do with the changing medical marketplace. Students are now, more than ever, tasked with being a more well-rounded physician in a competitive market.

“Our reason for providing dual-degree programs stems from the realization that the standard medical school curriculum will not adequately prepare all students for medicine as it will be practiced over the next 30 years. There will be sweeping changes in delivery of medical care, medical care policy, and the relationship between the medical care establishment and government.” ~ Joseph P. Grande, MD, PhD, Associate Dean for Academic Affairs (Mayo Medical School)

By seeking dual degrees, students have the opportunity to approach medical topics from different perspectives, which gives the future physician insight that they might not have otherwise. Students seeking dual degrees must invest more time and money than their single degree counterparts, but in the end it will increase the positive returns they have on their investment. Overall, this will provide a better outcome for patients as well, since their physician will be more well-rounded and able to utilize multiple skill sets in treating them. Students should keep in mind their future goals when approaching training. Will one degree be enough?

Patients Don't Speak Up

When patients go through treatment, physicians are hopeful that they have the best experience possible, with no complications. If they do, however, one would expect the physician would be notified so that corrections can be made. That might not be the case in reality, as mentioned in a recent EmpoHER story.

A recent survey asked cancer patients about their treatment experience. It found that although many mentioned having problems during treatment, they never told their healthcare providers about them. Despite issues with complications during surgery, treatment delays, and communication problems between the physician and the patient, survey respondents said that they kept silent about their complaints. Why? The reasons are variable, but one reason might be that patients were so grateful to have any treatment that they overlooked the bumps along the road to recovery.

"Sometimes there's a situation where they're really still thankful for the care that they got, and so they don't want to hurt anybody by saying, 'Everything was great, except...' Or they don't want to do harm to their relationship (with their doctor)." ~ Kathleen Mazor (Meyers Primary Care Institute and the University of Massachusetts Medical School)

This lack of feedback to the physician means that not only are they unaware of the immediate issues that need correcting, they are unaware for future situations so that it doesn't happen again. Additionally, patients may be upset over something they perceived their doctor did wrong, but which was actually a normal outcome of treatment. Without a conversation between patient and physician, these issues are never dealt with. It is important that patients feel comfortable enough to express their concerns and complaints within a treatment setting. Medicine is a team effort, so make sure all members of your team are on the same page.

Over-Testing the Physician

Medical students have to prepare themselves for multiple exams in order to proceed through their medical school training. However, once they graduate and enter the job market, the testing does not end. The push of the American Board of Internal Medicine to have all physicians re-certified year after year may not necessarily improve patient care, as noted by Dr. Alieta Eck in a recent article.

Physicians must meet certain requirements to maintain their certification. Many times this means taking continuing education courses and passing exams to show that they've learned the topics. Though the education received is meant to benefit patient care, the time spent preparing for and taking these courses means time away from patients. But does the constant push to re-certify actually create better physicians?

"[L]ess than 5% of doctors feel that [re-certification] makes them better able to care for patients."

Additionally, the requirements for re-certification is not imposed on all physicians. Older doctors are grandfathered in so that they don't have to meet the requirements, but they are not worse at their practices than those who must get re-certified every year. So, the evidence doesn't seem to be present to support re-certification as a method of improved care. 

What does this mean in the long term? Perhaps a re-evaluation of certification requirements is needed. When more patients are going to be entering the medical marketplace, physicians must be able to maintain their practices with the latest information while also remaining available for the patients. A new balance of time must be sought because patient care can only be improved when the physician is around to treat them.

Practicing Interview Skills

Medical students must prepare in multiple areas in order to be ready to practice. One such area is the ability to properly conduct interviews with patients. By using conversation techniques, physicians can gather information about patient health that might not be evident through written data. However, it's a skill that takes time to learn. One way medical schools have been training their students in this valuable area is through standardized patient encounters.

Through the use of SPs, medical students can practice their skills for proper interviews, test their abilities in real-world situations, and get feedback on both their performances and how to improve. Standardized Patients are actors who present medical scenarios as if they were real patients. The physician-in-training then goes through the steps of diagnosing their case. The scenarios are also put into real-time constraints so that the medical students can understand how quickly they must go through a patient visit in order to keep up with the demands of the practice.

Clinical Tools has employed SP scenarios into its modules to teach proper interview techniques as well. Chat-based or live SPs can provide a more instant type of training scenario since it's putting learned skills into practice. The medical student can see where their strengths and weaknesses are through patient encounters and continue to improve. The SP training is also a good learning experience in preparation for the USMLE Step 2 exams, since they require an SP component. All these training opportunities means that the medical student is a stronger physician when they embark on their careers.

Pain Education Lacking

With the constant pull of increasing medical topics and decreasing time, many subjects are often either only briefly touched upon or not touched on at all in medical school. One such subject is pain education, which the Journal of Pain recently touched upon in their study of 117 medical schools in the US and Canada.

Even though chronic pain is an issue for 116 million adults in the US, medical schools often only teach the subject within a more generalized medical course instead of having a stand-alone course in the curriculum. In the study, only 3.8% of medical schools listed a required pain course and only 16.3% had an optional pain course that could be taken as an elective. Sadly, during the four years students spend at medical school, they often spend less than 5 hours total becoming educated about pain topics. This leaves them under-prepared when they move to practice and have to treat patients who report issues with chronic pain.

“The more we come to know about what’s being taught in pain, the more glaringly obvious the gap between theory and practice becomes.” ~ Beth B. Murinson, MS, MD, PhD, Associate Professor and Director of Pain  Education (Department of Neurology, Johns Hopkins School of Medicine)

What must be done is a re-evaluation of medical subjects and a re-configuration of medical school curriculum overall. Within medical areas that are more prevalent in the general population, more time must be spent focusing on them in medical school. Students must gain hands-on training in order to be better prepared how to handle these subjects when they go into practice. Pain treatment can only improve when education sets the groundwork for success.

Mobile Technology in Medicine

The integration of mobile technology in medicine is ongoing and growing. In 2011 alone, the market for mobile health reached $718 million in the United States. With this wide potential for advancement, there are a number of areas where medicine can be improved by mobile technology.

Increase Patient Access To Their Health Information: At present, health information can be confusing or inaccessible to patients. However, with the introduction of mobile technology, patients can use a variety of apps or websites to look at their health records and test results, or constantly monitor their ongoing health. This will improve their overall health by catching issues early, as well as helping them to become more involved in their own health.

Increase Adherence And Understanding Of Post-Treatment: After patients are released from the hospital, there are a number of areas of after-care that they must adhere to. Unfortunately, this treatment is often misunderstood or ignored because of lack of understanding. With the use of mobile technology, the hospital and patient can access health information to ensure that post-treatment outcome is positive.

Increase Compliance To Medication Treatment: As with post-treatment after hospital stays, prescriptions for medication are often not followed correctly because of patients not understanding proper procedures. With the use of mobile technology, patients can instantly access information on their medicine, as well as proper dosing, and have their questions answered about compliance.

Increase Positive Outcomes For Overall Population: Mobile technology can aggregate medical information for the population as a whole so that healthcare providers can see trends and areas of issue. Being able to see these trends will help healthcare providers work on improving them, thus cutting down on negative health outcomes. Mobile technology can also show where health problems might be emerging in certain areas, so physicians can circumvent the problems before they become more serious.

Mobile technology is a viable area for healthcare. By utilizing the new tools available to them, physicians can work towards a better health outcome for all involved. The patient/physician relationship is an important one, and so too is the technology/physician relationship.

Negative Mindset

Medical schools are hoping to bring in more students, more potential doctors who can enter the medical marketplace and fulfill the growing need for physicians as the patient pool increases. They are especially in need of PCPs, as they are the first line in most treatment encounters. However, those who are trying to become PCPs aren't going into their careers with idealistic views. That's what a recent survey of medical students looked into.

Surveys were distributed to medical students at the University of Michigan Medical School, Warren Alpert Medical School, and Michigan State University College of Human Medicine. Of the 1,533 that were sent out, 64.1% were filled out and returned to be evaluated. The findings of these surveys was surprising. Interest in becoming a PCP was at an average of 15% (1st year--11.2%, 2nd year--10.8%, 3rd year--18%, 4th year--21%). These are positive numbers, since more PCPs are needed, so a continued interest in the career path is worthwhile. 

But even with this interest, students aren't seeing this chosen career as an overall positive experience. The survey found that students believed patients' ability to pay limited the positive influence physicians could have upon their health and that physicians were often tasked with too much paperwork and not enough time to have an overall positive impact on patient outcome. However, having the opportunity to actually participate in primary care lessened these negative feelings and students recognized the heightened ability to have a good patient/physician relationship.

What can we learn from these findings? For one, students need the opportunity to have hands-on training to correct negative assumptions and stereotypes of medicine. Secondly, medical schools need to continue to foster the positive impact that PCPs have on the overall health of the country. By promoting PCP training, medical schools can ensure that the country's need for primary care will be met.

Co-Existing Medical Issues

Mental health and substance abuse issues often go hand-in-hand. Physicians must be able to treat both as a collective diagnosis, rather than individually, because the issues of one disorder will often contribute to the other. Additionally, these issues may exist at a higher rate among certain populations, which should also be taken into consideration when treating. This is a topic that The Times of India reported on in their own country, but the issues are relevant globally.

The National Institute for Research in Tuberculosis conducted a survey was initially meant to show which behaviors among MSMs make them more prone to HIV. Their findings on mental and substance abuse issues among this population was very enlightening. They found that more than 50% of the MSM population that was surveyed were prone to having depression and 28% had a high level of alcohol use. These issues were present because of the contributing negative factors that exist within the Indian MSM population. Many have low self-esteem, no family support, and are prone to bearing disapproval from their country's society as a whole. With these heavy burdens weighing them down, they often turn to substance abuse or are apt to show signs of mental health issues as a result.

What does this teach us about medicine? That we cannot treat within a vacuum. Physicians must take into account a patient's social background, as well as their medical background. If they have mental health issues coupled with substance abuse issues, they are likely contributory to one another. Is there a reason they have these disorders? Is their home life a factor? By delving further into a patient's history, physicians can not only treat the surface problems, but also the reasons behind them. That will help ensure a positive health outcome for the patient, as well as a positive patient/physician relationship. It's a team effort, so learn more about your patient.

Focus On The Patient, Not The Computer

Medicine and mobile technology has become very integrated. Physicians will often be seen carrying around their smartphones or iPads, checking on patient records or researching symptoms to make a proper diagnosis. They will often bring their devices into the room while interacting with patients. That's when the issue of decreased human interaction comes up. If the physician is focusing on their devices, they're not focusing on the patient. Sci-Tech Today looked at the issue in a recent article.

When physicians' attention is focused on their devices, they become distracted and might miss certain symptoms their patients are exhibiting. Through personal interaction, physicians can learn about their patients, what complaints they might not have written down, and other clues that don't necessarily show up on test results. This information aids in the overall ability to properly diagnose and treat patients. While it's a valid component to care, helping physicians to look up test results and other research to support a diagnosis, using mobile devices when with a patient can be seen as disrespectful because the physician is virtually ignoring the person they're supposed to be helping.

Some Suggestions To Integrate Technology and Personal Touch:

Face The Patient: Physicians should never sit with their back to the patient or in a posture that looks like they're ignoring the patient. Engage patients in face-to-face interaction. This is a conversation, a team effort to help the patient get properly treated. The patient doesn't want to be ignored. This is their time for personal interaction, so physicians should make the effort to supply that.

Put Away The Device When It's Not Needed: Often, people will rely on their mobile devices even when they don't need them. A quick check of email or a brief check-in when a text alert comes up isn't necessary when other, more pressing matters are at hand. If the device isn't helping the physician to treat or research the case in front of them, the device should be put away.

When A Physician Must Use Their Device, They Should Excuse Themselves: If a physician must look up a symptom or test result while the patient is in the room, they should make clear their intentions before doing so. It's all about treating the patient with respect. When a physician is focused on their device, the patient doesn't know if they're doing something to help their case or if the patient is simply ignoring them.

Mobile technology is helping medicine improve in countless areas. However, physicians shouldn't lose sight of what their careers are all about--the patient. Put the patient first and put the iPad away.

Digital Distraction

It seems like everyone has a mobile device now. Whether it's a smartphone, an iPad, or another digital tool, we are able to instantly access information or remain in communication with whoever we want throughout the day. This is beneficial for medical professionals especially because they can check guidelines or be alerted for changes in patient health. However, the constant use of mobile devices might also prove to be a negative aspect of our changing society.

A recent article at Healthcare Technology Online looks at what distractions mobile devices cause. Because many physicians are using their own devices at work, they are blurring the lines of their professional and personal lives. They may be entering orders for patient care, or looking up information on cases, when personal communication comes through and distracts them from their tasks. They may forget to finish what they were researching or ordering, putting patient outcome in danger.

What are some solutions to this problem? Well, one would be to cut out all mobile device use in a medical setting. While it might help the problem of distraction, it would also eliminate the positive impact mobile device use has on patient treatment. An alternative is to issue job-related mobile devices that could only be used for medically-relevant tasks, no personal use. This would help assure, if physicians abide by the rules, that they are focused on the patient and medically-related tasks instead of the email from their friend or an invite to a social event.

Whatever decision is made concerning mobile devices in a medical setting, one thing is clear. Distraction can be detrimental for patient care. First do no harm, and stop checking Facebook during rounds.