Focusing On LGBT Health

In medical school, students are taught how to treat different disorders, how to relate to patients, and how to properly diagnose ailments. However, focus must also be on how different populations have different risk factors and individualized health needs which must be addressed. That's an idea that the University of Missouri's School of Medicine is focusing on.

Community, family, and other factors affect individual health. In the LGBT community, patients have a higher risk of suicide and substance abuse, as well as higher incidence of HIV in black MSMs and breast cancer / obesity among lesbians. In light of this, and the different contributing factors that may affect individual health, medical professionals need to be aware of how to approach these differences. The University of Missouri is trying to make sure their students are fully equipped with this knowledge.

 "From my personal standpoint as a family physician, I am not able to optimally provide care to patients if I don't know them and about them as individuals, if I don't know the supportive people in their lives, the resources they have in their lives and if I don't know lifestyle issues that might impact their health care. Race, ethnicity and religion are some traditional ways of looking at diversity, but sexual orientation and gender identity are components of an individual's culture that really impacts their health." ~ Debra Howenstine, Assistant Professor of Family and Community Medicine (University of Missouri)

Students must be trained on how to identify and treat for different populations. The education of LGBT medicine has not been prominent in the past, but pushes are being made to change that. Physicians should be equipped to ask questions, learning more about their patient's overall health, and how to answer questions that may come up on their specific risk factors. By working together and supporting each patient's health needs, treatment outcomes can improve.

Do EMRs Decrease Malpractice?

The move from paper medical records to electronic has been happening at a steady pace. Physicians can type in their findings and not have to rely on handwritten notes, often shared between offices and medical professionals. There is always the chance that these notes may be misinterpreted and improperly transcribed because of handwriting, but the use of EMRs can help lessen that. As a result, the number of malpractice cases may decrease, too. That's what a recent study looked into.

In 2005 and 2007, 275 Massachusetts physicians were surveyed about their malpractice cases. The study found that 12% had malpractice clams against them and 49 of those claims filed prior to the adoption of EMRs, while only 2 occurred afterword. This means that, according to the study's findings, after EMR use is put into practice, physicians were 84% less likely to have malpractice claims filed against them. Other factors may have been in play, but the presence of EMRs were noted. The benefits of EMR technology makes it easier for physicians to record accurate notes, which can be shared and understood by multiple health professionals without reliance on paper and pen recordings. It is a change in the medical field which, in the long-term, is sure to ease the treatment path for everyone involved.

FDA Regulations On Mobile Apps

The use of mobile apps is growing. Many medical applications have been released to help patients and physicians become educated, monitor health, or communicate with others. However, governmental regulations for these apps has been slow to catch up, mainly because of how quickly the releases are occurring. A recent article looked into this issue and the need for approvals to be streamlined.

At present count, there are 40,000 medical apps available and this number is growing. However, it's hard to determine which apps are giving proper medical advice and which can be harmful. Without the presence of governmental regulations, users are left on their own to determine which app is best. The FDA has started to cover the gap, releasing preliminary regulations, but the approval process is costly and slow. With waiting periods of 6-20 months, the process simply cannot keep up with the ever-changing technology that is happening in app development.

"The FDA's current regulatory process was created when the floppy disk was around...We're seeing mobile apps updated and created on a daily basis. The life cycle is dramatically different." ~ Joel White, Executive Director (Health IT Now Coalition)

However, some sort of regulations are necessary to protect the public health. With app developers making medical claims that are unfounded or untested, how can consumers know what to trust? The FDA is pushing for a final list of guidelines so that they can clearly state how to gain approval, and hopefully do so in a timely manner. Already some app developers have gained FDA approval, which goes far in helping those apps to stand out as being more trustworthy. The need for clear guidelines and fast turnaround is present. The FDA just has to make sure it can keep up.

The Spread of Medical Information

The use of electronic medical records is growing. However, concerns about patient safety need to be addressed, as the protection of their medical information should be at the forefront of EMR use. Recently, Bloomberg touched upon Dr. Latanya Sweeney's research on this topic. In 2010, she created an infographic to highlight how widespread electronic medical record information could go and to emphasize the need to protect patient privacy.


(Graphic Credit: Dr. Latanya Sweeney)

Looking at this graphic, one might be surprised where medical information goes without patient or physician knowledge. Employers, the government, pharmaceutical companies, and more could have legal access to patient records and patients may be unaware. Even when no clear identifying information is present, it's still possible to piece together the clues and figure out which patient the health information came from. Currently, there are not defined tracking standards to prevent or monitor this access.

Technological advances are outpacing guidelines, so more understanding and contemplation about new rules is warranted. Information access by third parties has doubled in the last ten years and the information includes more personally identifiable details. Dr. Sweeney is delving deeper into her research through TheDataMap.com, using contributed data to build a better understanding of where data goes and how to control the flow in a more responsible manner. Technology is meant to improve patient health, as well as the face of medicine in general, but it must be done with patient safety in mind.

Using Apps To Change Behavior

The idea that mobile apps can change behavior is nothing new. Allowing patients to track their health issues and choices can help them become aware of patterns and inspire changes. This was an issue recently addressed in Technology Review, which took a closer look at a food app and its impact on future health.

The article looked at an app called The Eatery, which allowed users to take pictures of their food and upload them for other users. Not only could participants follow those who shared their culinary interests, they could also rate the health factor of each others' food choices. Through the use of this data, patterns were discovered about why food choices were made and when the choices were the healthiest. Peer pressure and the time of day had a significant impact on how healthy or unhealthy a person's meal was. If a person delayed their lunch until later in the day, or waited until they were too hungry, they were more likely to make bad food choices.

The data collected from this app is being used to create a new one, which is meant to promote healthier eating habits. If an app could push users to eat earlier in the day or make suggestions of alternative choices, their overall health might improve. By utilizing the current tools, health behavior can be changed and the future of the country's population can be centered in better eating habits.

Mobile Health No Replacement For Physicians

With the growth of mobile health applications, patients are able to look up symptoms, read the latest medical research, and become better informed about their own health. However, these tools should not be used as a replacement for actual physicians. A recent article by Dr. David Lee Scher looks into that issue. He gives five good reasons why, despite mobile technology gaining favor, it will never replace actual physician care.

• Not Everyone Will Use Mobile Health Apps: The numbers are growing, but not there are still people who don't have smart phones, will never use a computer, and might not even know what an app is. They are not going to be refused care simply because they haven't kept up with current technology.
• Apps Are Tools, Not Replacements: When medical apps were designed, they were never built with the intention of replacing physicians in patient care. Instead, they are a tool to help in the diagnosis and education of patients. Apps add to the wealth of medical knowledge available, but they cannot substitute for actual care.
• Apps Can Give Data, But They Cannot Provide Care: Data that is provided through an app is just that, data. Physicians are the ones who are required to review this data and come up with a diagnosis, taking into account the entire patient and not just lab findings. This human interaction cannot be traded for a computer print-out. 
• Each Case Is Different: Two patients may present with the same symptoms, but that doesn't mean they have the same diagnosis. Apps can give a standardized overview of what might be the problem, but they can never take into account each person's specific needs. Physicians are able to decipher what lab findings actually mean by treating the entire person, not just their individualized symptoms.
• Self-Diagnosis Is Not The Answer: Though medical apps can provide a starting place for patients to narrow down what their diagnosis might be, it can never fully replace a physician's diagnosis. Often patients will misdiagnose themselves based on what they've put together through research. They are often not trained to accurately decipher what the combination of symptoms might mean. For that, a doctor's visit is warranted.

Mobile technology has helped our population make great strides, but it is not a substitute for accurate medical diagnosis. While patients can become more aware of their own health through currently available tools, they will never be their own doctor.

Reliance On Web Information

Online medical information is becoming more readily available for patients. With just a few keystrokes, one can touch base with other patients experiencing the same illness, get the latest research findings, or search symptoms to get an idea of what illness they might have. In a 2011 Pew study, health information searches ranked as the third highest web use in the United States, with 80% of internet users having sought online health information.

Searches for general health research included:

• 29% Food Safety / Recalls
• 24% Drug Safety / Recalls
• 19% Pregnancy / Childbirth

Searches for symptom-specific health research included:

• 66% Specific Disease / Issue
• 56% Medical Treatment / Procedures
• 44% Doctors / Health Professionals

This accessibility of health information might also come at a cost, though, as reliable information isn't always easy to find. Rumors, misinformation, and potentially dangerous advice abounds in the online environment. This can lead to patients suffering from cyberchondria, a fear that manifests through online searches and believing their symptoms translate into a serious disease.

What can patients do, aside from ignoring all online medical information and simply going to their doctor? The most accurate information can often be found on government or news websites. Reliance on the findings there will be a good start for patients seeking to become better informed. And patients should be wary of sites that are out-dated as well. If the research is more than five years old, it's likely not as reliable as current findings, so patients should avoid basing their medical decisions solely on them. And most importantly, patients should go see their doctor for all their medical concerns. Health information online is meant to be an extension of becoming educated about personal health, not a final diagnosis.

Lead By Example

During office visits, physicians may recommend their patients eat a healthy diet or exercise more often. They also advise at-risk patients to quit unhealthy activities such as smoking or drinking. This is great advice, but it should also be followed by the physicians themselves. Often, the doctor is in a "do as I say, not as I do" mindset and this does not set a good example for the patients. This is an issue that was recently covered by The Atlantic in a June 12th article.

Patients look to their physicians as role models in terms of health. If they see that their doctor is overweight, smoking, or taking part in other unhealthy activities, how likely will it be that the patient will take their advice? A change in attitude must take place in order to put the healthcare industry back on track. Physicians must commit themselves to following the same advice they're giving.

 "If we can't make changes in our own lives, how can we expect patients to do the same? So much of health care spending and disease burden in society is due to things that could largely be prevented by stopping smoking, losing weight, exercising 30 minutes a day, and reducing stress." ~ Shiv Gaglani, Medical Student

An initial step has begin through The Patient Promise, a campaign begun by two John Hopkins medical students. They seek physicians who are willing to sign and make the commitment to follow the same healthy lifestyle choices they expect of their patients. Signatures are publicly known so that patients can check to see if their physician is on board and, if not, ask them to sign up. The team effort of medicine requires that physicians be just as committed to their own health as they are the health of their patients. Together, a positive change can take place.

Connecting To Physicians

Telemedicine has become more popular as the use of mobile devices has increased. Through this avenue, patients can connect to medical professionals, receiving answers to their questions no matter where they are.  One company that is focusing on this is Consult A Doctor. Already popular in the telemedicine marketplace through phone and email consultations, the company is seeking to move into the mobile market through a new app release.

Their proposed app, iDr 24/7, will provide instant access between patients and physicians through the mobile interface. Utilizing a cloud-based platform, the app will identify physicians who are available and connect them with patients who have questions or need care. The service will be available to those who already have access to Consult A Doctor 24/7 through their current healthcare and is set to expand later in the year to include more groups.

Some features of the app include:

• My Message Center: To send messages to physicians directly from the iPhone

• My Consult Center: To instantly connect to a physician or get priority scheduling

• My Health Center: To receive medical information on a variety of topics

The current medical market has wide potential for expansion in terms of how and where patients are treated. Considering current estimates say that 90% of American adults have mobile phones, this is a great target audience for telemedicine. Barriers of money and geography no longer have to limit patients to how much care they receive. Instead, the world can be opened to them and medical avenues can once again be available.

Doctors Should Test Less, But They Still Won't

There is an overabundance of testing in our medical system. Patients are put through extensive trials in order to garner results which physicians can then use to diagnose. However, perhaps many of these tests are not necessary and are simply costing the insurance industry money they shouldn't have to spend.

In a recent article in the Psychology of Medicine blog, Psychology professor Gary B. Rollman looked at the issue of over-testing and how to change the mindset of physicians in order to ensure unneeded tests would be eliminated. Findings show that less testing is warranted for patients, since routine screening does not need to be ordered for those at less risk, but will physicians follow these suggestions? Probably not. And it's not because they want to take advantage of the system, but perhaps more out of reliance on trusting their own instincts.

Physicians have learned to rely on their own judgement. Their experiences and training have prepared them to make decisions on the best avenue of care and what tests might be beneficial in order to treat and diagnose. Despite having study results that say they shouldn't, doctors are more apt to keep performing in the way they always have because it's dependable. This type of thinking, while comfortable, does not do the patient any favors. Exposing them to testing that they don't need not only puts strain on their finances, but also their bodies. It's important that physicians realize they might not always be right and that changes may be needed in order to provide the best care possible.

Patient and Physician Interaction

The interaction between physicians and patients is very important. The way a physician approaches their patient, the conversational and listening skills they utilize, and the amount of effort they put into engaging the patient all makes up for either a positive or negative experience. Salon Magazine recently ran an article that took on this subject and the suggestions are worthwhile to remember for everyone who has patient interactions.

Give Patients Your Full Attention: Don't act like the patient is inconveniencing you by showing up in your office. It's important that you take the time to fully engage the patient, giving them your full attention for the time they're in your office. Even the simple act of making eye contact can help make the patient feel more at ease.

Treat The Person, Not The Symptoms: A patient may come in complaining of a sore knee or a rash or a host of other symptoms, but it's important that physicians don't just narrow their focus on that one problem. Treat the patient like a person, because they are. Listen to what their complaints are, try to understand how the symptoms come together to affect overall health, and treat the whole person. Their health issues are important to them and they should be important to you as well.

Don't Base Everything Off What's Written Down: Testing can go a long way in helping to understand and treat a patient's ailments, but it won't do the entire job. You must engage the patient, allowing them to tell you what they're feeling and what symptoms they've noticed. Discounting the long line of patient complaints just because the test came back negative is not doing anyone any good. Dig deeper and do more.

Don't Talk Down To Patients: Physicians went to medical school, they know technical terms for body parts and illnesses and can employ scientific language in conversation. Most patients, however, cannot do the same. They did not spend years in medical school, so they are likely not going to understand you if you use these types of terms to describe their case. And in many cases, they will not stop you to ask questions, fearful that they might look misinformed or be looked down upon for not understanding. Use direct, easy-to-understand language and engage the patient to repeat information back to you so that you can clear up any misconceptions. Perhaps even follow up with the patient after the shock of diagnosis has worn off. Making sure the patient understands what's going on with their health is vitally important.

Don't Let Money Rule A Diagnosis: Patients have varying levels of medical coverage available to them. Some may be fully insured and any treatment plan will work with their coverage, while others may only be covered for select procedures, and still others have no insurance at all. However, the ability to pay for treatment should never overrule what is best for that patient's outcome. If a more expensive procedure is needed, or a longer hospital stay, discuss with the patient before dismissing it as not possible. Don't make assumptions about money that will cost your patient their health.

By listening to your patient, engaging them and working with them as a member of the health team rather than a silent recipient, the overall outcome of their case will be more positive. Medicine is a team effort and the patient is the most important person on that team. Their health is your responsibility.

Social Media Rules

Many students currently entering medical school come from a generation where social media is an everyday part of their lives. They have become accustomed to sharing their thoughts and life events via Facebook, Twitter, and other social media outlets. However, when they enter into medicine, they must learn to balance social media openness with privacy. Telling students to just start abstaining from social media is not the answer, but what is? That's an issue that was looked at recently.

Instead of ruling against the use of any social media, many medical schools are putting guidelines into place to determine what should or should not be shared. Students must learn the power of their postings and understand that what they put online has a bearing on the image of not only them as individuals, but also their professional reputation and the reputation of the facilities they represent. In order to help make these guidelines clear, a framework of digital professionalism was developed by a group of educators. These were meant to aid in clarifying the proper use of social media for medical professionals.

(Image Credit: Janet Tworek; May 31, 2012)

These guidelines should be utilized and consulted throughout a medical professional's use of social media. It is important to appear professional at all times when interacting online, especially when dealing with matters that are sensitive. By maintaining a professional presence, students and physicians can still use social media without compromising their reputation.