Memorable Healthcare from 2015

The New York Times pulled together a list of memorable stories from 2015 (Medical and Health News that Stuck with us here)
– The discovery that Ebola is not cured nor over
– The ongoing war against epidemics and debilitating and now potential treatable diseases
– Anxiety and stress increasing (or is it increasingly diagnosed) and little progress in treatment
– The ongoing Drug Nuclear arms race of blockbuster (and unaffordable) prices for new drugs
– valuing time with the clinician for discussion of end of life care
– the sorry state of mental health in this country pales into insignificance with the chain therapy in Africa
– Despite real progress in treating Type 1 Diabetes unnecessary limitations are still being placed on children

Its been an interesting year and we have made much (rapid) progress. These stories are just the tip of iceberg and next year expect many more and heres hoping for some real change to a broken healthcare system

Memorable Healthcare from 2015 was originally published on Dr Nick van Terheyden, MD

Notable Medical Advances

Jerome Groopman’s highlights of medical advances form 2015: source
Coming at the bottom of his list but what continues to amaze me is the Placebo effect – well known in its effectiveness when offered without explanation but more surprisingly is that it is still effective even when the patient knows he is being given a placebo!
Other highlights include a new approach to cancer treatment that blocks its growth, the incredible insights emerging from our continued expansion of knowledge on the human genome (a different approach to cholesterol management)

We live in exciting times of innovation and medicine is benefiting greatly from advances in our understanding and science behind disease and the workings of our world and bodies

Notable Medical Advances was originally published on Dr Nick van Terheyden, MD

Healthy Living Starts with You

Human capital – the stock of knowledge, habits, social and personality attributes embodied in the ability to perform labor so as to produce economic value.

When reading the above definition of human capital, a particular word jumps out… habits. I am passionate about habits because poor lifestyle choices—or bad habits—are the number one driver of today’s health crisis. Chronic illnesses—such as heart disease, stroke, asthma, diabetes, and obesity—are responsible for 7 of 10 deaths each year, and treatment of chronic diseases accounts for 86% of U.S. healthcare costs. However, while they are among the most common and costly of health problems, chronic diseases are also the most preventable and manageable, because they often result from choices we make in our daily lives. To conquer chronic illness, we have to change our bad habits. And that’s not easy.

If I had to prescribe one medication to cure bad habits, it would be patient engagement. When we are effective at engaging patients to participate in their care, they begin to take more responsibility for their own health and adopt healthier habits. Effective engagement of chronic disease patients can lead to reductions in hospital visits, decreased morbidity and mortality and improvements in treatment adherence and quality of life.

To truly influence positive behavior changes, health goals must fit meaningfully in patients’ everyday lives. People must be surrounded by opportunities to embrace healthy lifestyles, and that requires the involvement of the entire community – care providers, governments, businesses, and of course, the people living there.

It’s no surprise that 7 of the top 10 Future-Ready cities overlap with the American Fitness Index’s list of healthiest U.S. cities. These developed cities are arguably some of the most connected and most educated, and they have infrastructure that supports recreational activity. But health is not only an outcome of development, it is a prerequisite for it, and never before have communities had such an incredible tool to engage people in making healthy lifestyle changes… technology.

Just as technology is giving providers more ways to care for and engage their patients in more places, it’s also providing the means for governments to reach constituents, businesses to tailor wellness programs for their workforce, and people to take charge of their own health.

Care providers

Technology gives caregivers unprecedented opportunity to engage patients and provide excellent care, anywhere, while also giving both patients and doctors a valuable feedback loop. Telehealth, remote biometric monitoring, and technology-assisted health coaching are powerful tools in the fight to improve chronic care outcomes because they provide in-the-moment support to patients struggling with diet, exercise habits, and medication routines.

For example, an FDA-cleared mobile app that delivers real-time motivational messages, behavioral coaching and educational content right to the mobile devices of patients with Type II diabetes has demonstrated significant drops in their A1C levels.

Even simple text message programs can make a difference. Text2Breathe, a program of the Children’s National Medical Center, sends care information and reminders to parents of children with asthma and has helped help reduce emergency room visits.

State and local government

State and local government agencies have immense power to use technology to spearhead healthy lifestyle and disease prevention programs. For example, in response to Philadelphia’s high rates of chronic disease, city officials recently launched PhillyPowered, a multi-media campaign designed to encourage Philadelphians to become more physically active. The campaign features a mobile-friendly website, which lists free or low-cost places to get fit in the city, provides educational information, and includes a social media component that enables Philadelphians to share tips on how to fit exercise into their busy lives.

Portland University, in conjunction with the Oregon Department of Transportation, is piloting a smartphone app called ORcycle

designed to collect data and feedback about bicycle routes, infrastructure and accidents in order to improve infrastructure suitability for bicycling in Oregon.

Businesses suffer from the impact of chronic illness through absenteeism and retention problems, yet they are uniquely positioned to promote healthy lifestyles for workers and their families. Employers can work with their health plans to identify need for wellness programs and services such as preventive screenings, tailored to lowering both health risks and costs.

 

 

Companies are increasingly integrating technology into their wellness programs. For example, Dell’s Well at Dell program includes a virtual wellness portal that imports numbers from onsite health screenings and provides employees with an action plan, educational information, and email and text reminders to stay on track. Some companies are adopting wearable technology as part of their wellness programs to incent employees to get fit. It is worth noting that data security and privacy is paramount to protect employee health information and need to be designed in as part of all of these initiatives to maintain the trust that is essential for an effective healthcare system.

Technology today gives communities in all geographies the means to invest in the health of human capital and very real opportunities to shape the future of healthcare… now.

 

This article previously appeared on Future Ready Economies site

Healthy Living Starts with You was originally published on DrNic1

Doctors and Patients – Who Knows Best

The Power of Knowledge

Life has changed and access to information is no longer the definition of value – we have seen these changes in the past as far back as 1494 when the printing press was introduced making books and knowledge more widely available:

And proceeds through newspapers, the steam engine, photography and the death of painting, the telegraph, movies and the death of theaters, the telephone, phonograph, radio, television, computers and the internet and if anything the speed of change is accelerating. So too in medicine have things changed with a shift away from paternalistic experts to wide knowledge access and cooperative systems of healthcare delivery.

The Sorry State of Medicine

But the physician is still a key part of healthcare delivery and for many in the profession there is a sense of despondency and even despair with profession and their ability to deliver the care they aspire to deliver each and every day.  This recent piece in the Wall Street Journal Why Doctors Are Sick of Their Profession captured the spirit – only 6% of doctors surveyed describe their morale as positive and that’s not just bad for the doctors – its bad for patients too.

The sad part is we chose medicine because we thought it was worthwhile and noble, but from what I have seen in my short career, it is a charade

Running out of Time – Walking Gallery Jacket

Physician suicide remains high with doctors the most likely to commit suicide with a rate of 1.87 times that of the average population (the US alone loses ~400 physicians to suicide per year) and their “success” measured as a completion rate is far higher than the general population (x 1.4 – 5.5).

 

As this piece The Painful Truth: Physicians Are Not Invincible highlighted (South Med J. 2000;93(10) ):

Physicians fulfill a special role within our society. While they are given many privileges and rewards, they also carry serious responsibilities. Physicians are expected to be healers, available to others whenever a crisis occurs or a medical need arises. They are expected to have unfailing expertise and competence, to be compassionate and concerned, and to provide universally successful care in a cost-effective manner. Such idealized expectations emanate from patients, from families, from society (including payers and regulatory and accreditation agencies), and from within the profession of medicine itself. Self-imposed expectations inhere in the institutions of medicine — medical colleges, clinics, hospitals, professional associations, and collegial relationships — and are internalized by students of medicine as they are socialized to become practicing professionals. These expectations become a part of how physicians define themselves.

So when I came across a picture of this mug:

I posted it to my social media feed with a commentary

Great reminder for #RSNA15 of the value of clinicians in #healthcare pic.twitter.com/Mew9Rkg836

— Nick van Terheyden (@drnic1) November 30, 2015

I wanted to highlight that clinicians are still an essential part of the healthcare system and their contributions are valued. This mug captured a strength of feeling that caught me by surprise.

It is available for purchase from a British eBay store and has been subject to several posts including this one from ePatient Dave – here and here and plenty of likes, dislikes, tweets, and even some fairly hefty criticism including one comment about starting a holy war.

Doctors Under Siege

I know many of my colleagues feel besieged. The system has drained every last ounce of empathy and compassion out of many with overhead requirements that detract from direct patient care and turn highly qualified, talented and well intentioned clinicians into data entry clerks and automatons. I have always believed and still do that every clinician gets up in the morning with all the best intentions to deliver high quality, compassionate car. There may be a small percentage of individuals who do not but  if they exist are a tiny minority.

We selected the career because we care. We selected the career because we want to offer support and compassion to our fellow human beings. We get our reward from these actions and there is no replacing the privilege of the trust that is placed in our hands in a personal and intimate relationship with our patients.

To get into medical school required an incredible climb up an academic mountain that was littered with others who did not make it. The experience tends to reinforce the sense of importance and verges on narcissism for some as the course and hurdles demand a level of self confidence in our own skills and knowledge. It is little wonder that what emerges from the medical school sausage machine can appear devoid of compassion, over confidant and unwelcoming of other opinions. It is any wonder that there is any compassion left by the time a doctor emerges with his degree and board certification – and that’s before he steps into a the healthcare quagmire and finds himself unprepared for healthcare as it is delivered today.

But many patients and patient advocates perceived this negatively and as an affront to their place in participatory care. The perception from patients appeared negative and there were multiple reports of patients who had been blocked when bringing information to their doctor and Dave even cites the sad instance in the UK  of the 19 year old girl who had fibrolamellar hepatocellular carcinoma (a rare cancer that with ~200 cases diagnosed worldwide annually) that was treated and then returned. Despite her pleadings to the contrary the Hospital and clinical team refused to believe her and told her to “stop googling”

There were even a few physicians who saw this mug negatively – as Bryan Vartabedian a pediatrician at Baylor  said:

This mug reflects a dated mentality https://t.co/cUeELJOtUZ — Bryan Vartabedian (@Doctor_V) December 1, 2015

and he posted this piece “Doctors and the Google Threat“. I don’t disagree with him that information access brings huge value and makes healthcare more accessible to a wider population but the systems in place don’t support the time aspect that this new sometimes unfiltered and unscientific data brings to many of the clinicians I talk to. One of the main challenges with this was captured by one friend who said:

You came in to see me with 9 minutes of reading material but I only have 7 minutes of time to care for you

And James Legan said:

@jimmie_vanagon @drnic1 @tugger723 Web is a blessing & curse tons of info but w/o med training more noise than meaning — Jim Maughan (@tugger723) December 1, 2015

And the deluge of information that arrives on everyone’s phone is replete with snake oil and pseudo science oftentimes amplified by celebrities who’s impact with their millions of followers can be incredibly damaging to individuals health.

Dave did take a constructive approach to the participation of patients

I personally am completely opposed to a patient going in and saying “I’ve decided I have condition X, and I want you to prescribe 42mg QID of medication Y.” I mean, have you ever seen the things medical students have to learn to get their license?? But I’m all in favor of a patient saying, “I have symptoms A and B, and from what I can tell from websites J and Q, that sounds like it could be M.” Explain your thinking, identify your source, and try to solve the diagnostic puzzle together: Collaborate.

While there are still doctors who see this as a challenge to the traditional model of care and the paternalistic distribution of knowledge and care, most do not.  I leave it with these two tweets that for me captured the underlying spirit I felt when I posted the original image:

@drnic1@tugger723 I like to google with my patients at the point of care with #ProjectedEHR a great place to meet on common ground– — James Legan MD (@jimmie_vanagon) December 1, 2015

and this one

@harshybar @drnic1 you’re absolutely right and I love when my #patients are informed and ask questions #imaging3 — Geraldine McGinty (@DrGMcGinty) December 1, 2015

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Everyone on the Same Side

Most physicians say the best part of their jobs is taking care of people – its the human moments, the taking care of people that make our jobs so satisfying. We are all on the same side – the structure of  the  system forces behavior that is not always ideal but despite this physicians do want participatory interactions – we love patients, especially ones that are engaged in their own health and care and we do not (and cannot) know everything.

You may well bring information to us that we are not aware of or have not read or heard about and we hope there will be enough time and opportunity to review this and help include scientific knowledge, no matter the source, in our review and guidance on the best course of treatment for you.

Doctors and Patients – Who Knows Best was originally published on DrNic1

The Incredible Progress in Medicine

Looking back at the history of medicine is fascinating (Victorian Medicine – from Fluke to Theory). Medicine was a combination of chance and quackery but over the course of the the last century has made incredible leaps. Science became an integral and training more formalized and increasingly specialized.

From Macbeth-like preparations of arsenic, iron or phosphorous to white coats and x-rays, the Victorian era witnessed a medical revolution

It is worth pausing and looking back to see the progress to date….likely small steps as we move forward at an incredible and accelerating pace this century

The Incredible Progress in Medicine was originally published on DrNic1