What doctors are telling us, even when they’re not talking
This article by Dr. Pauline Chen highlights some of the important issues surrounding non-verbal communication between doctors and patients.
Non-verbal cues such as facial expressions and body language are deeply ingrained and very difficult for a person to change. I often get told that I have an expressive face (for example, when I'm annoyed or confused it's usually pretty obvious to those nearby), and even though I suppose I have to trust those around me when they tell me that, I still secretly think I must have a poker face.
And that gets at the complexity of this issue - many people don't realize the kinds of non-verbal communication they put forth. And patients, who can be in painful, confusing or vulnerable situations, often rely on body language and facial expressions for cues to understand what a doctor is really telling them. Dr. Chen reports in the article that not much research has been done on this aspect of the patient-doctor relationship, but I suspect that will change very soon (particularly given the issues surrounding gender, race and cultural competency discussed). But even then, I struggle with ways this could be integrated into medical school communication curricula. Perhaps a discussion about it will increase self-awareness of non-verbal language cues, and that is a good place to start.
Physician communication portal
A new clinical communication platform aims to improve health by connecting physicians and nurses. PerfectServe platform connects over 20,000 physicians and 50 hospitals. The platform is processing over 35 million communication transactions per year between physicians and nurses. This communication tools allows health systems to streamline clinician communication and possibly remove communication breakdowns which result in patient safety being negatively affected.
The system allows physicians to stay in contact and share data quick and easy. Nurses spend less time tracking physicians which improves patient care. The system provides convenient access to the portal through smart phone apps and tablets access. The system has many advantages in the clinical setting and can expend to provide additional services.
The importance of social and environmental factors to health
A brief essay on the importance of the patient-doctor relationship by Ricky Choi, MD posted on Kevin MD. Although he doesn't frame it that way, I feel that this is partially about the value of taking time with patients to do a thorough H&P, investing in a real conversation, and asking probing questions. I had a similar experience recently, where I was having a prolonged allergic reaction of which I couldn't pinpoint the origin. My doctor (whom I like very much and trust implicitly) spent at least 30 minutes with me, asking about pets, carpets, soap and cleaning products, my work environment, the plants in my backyard, and more. When we together were unable to determine a likely cause, he sent me for allergy testing which resulted in me learning that I had developed an allergy to cats (unfortunate, as I live with four!)
But the main point of this essay is also very important - the social and environmental factors related to our health are often overlooked or underrated. Maybe we all just need to go to doctors like House, MD - I'm always amazed and more than a little amused when the young physicians on that program are shown rooting around in people's closets and under their bathroom sinks for clues to mystery illnesses. As if! Although, he is really rather awful at the patient-doctor relationship thing, so perhaps that's not such a great idea after all.
Surgeon assessment
The da Vinci robort is a devise that scales down a surgeons hand movement in order to allow him to perform operations using tiny incisions. This innovation allows for less tissue damage and a much quicker recovery period for patients. There are over 200,000 being used for surgical procedures today.
The newest innovation to the da Vinci Robot is the MScore which assesses the robot to more reliably predict whether new surgeons are ready to operate on patients. MScore compares the skills of novice surgeon to that of an experiences surgeon. This is a great tool for surgeon’s own assessment and continuing growth and skill.
Patient-centered care and cultural conflict
I just finished this fascinating article on cultural conflicts that can exist between patients and physicians. The case presented is simple and realistic, and the commentary provided very thought-provoking. The author touches on a wide array of cultural topics such as autonomy, privacy, and differing cultural standards, along with a thorough dissection of a variety of pre-conceived notions that both patients and physicians may bring to the clinical setting. The article ends with a rational suggestion on how cultural conflicts can still result in quality, patient-centered care, and includes a good justification for when and how to yield to a patient's wishes when they are in conflict with the physician's beliefs.
"Patient-centered medical care is not only a rejection of “my way or the highway” thinking; it is also a commitment to meeting patients on their own terms and respecting their values. We need to enhance our focus on commonality, rather than on difference, especially as the United States becomes more diverse. Providers must avoid thinking in “us versus them” terms—not only because “us versus them” is a false dichotomy but also because such thinking decreases the resolve to meet patients where they are."
Friday round-up
Federal investigators have released a new report stating that only about 1 in every 7 hospital errors are reported. Adverse events ranging from infections to excessive bleeding to even death are supposed to be reported through systems present at almost every hospital in the US. The systems often allow for anonymous reporting, in order to encourage hospital staff to cooperate. However, as it states in the article: "organizations that inspect and accredit hospitals generally "do not scrutinize" how hospitals keep track of medical errors and other adverse events". And if the accrediting bodies do not scrutinize the process (and results thereof), there isn't much incentive for staff to report. It also states in the article that no new federal regulations regarding this are expected.
The National Science Foundation has released the 14 winners of the "Digging into Data" challenge. The 14 winning projects all involve innovative ways to use data analysis and natural language processing (NLP) to enhance research in the humanities and social sciences. Those interested in large-scale data mining and investigation should read through the winning projects, as they all sound extremely interesting. I think my favorite might be the analysis of newspaper reporting on the 1918 flu pandemic (and not just because most of the PIs are from my alma mater!), in order to see how such reports affected public opinion and the idea of "authority" during the outbreak. I will be eagerly anticipating their results. The 14 winning research projects are sharing nearly $5 million in funds.
Dr. Matheson Harris has written a brief and clear tutorial for patients (with some help from the Chicago Tribune) on how to spot a good doctor (and a bad one!) and how to be a good, educated patient. I really like a lot of what is said here, and agree with the vast majority of it; though it might be a little harsh to tell patients not to go see a doctor who can't see them within a few days. I think it greatly depends on the type of doctor you're seeing, and what the appointment for. I make my dermatology appointments a year in advance because it is so hard to get an appointment at the practice (widely considered one of the best in the nation). And many women in the state of Pennsylvania can tell you about the difficulties in getting an OB-Gyn appointment due to the shortage of those specialists. But the gist of the advice and guidance here is very strong, and all patients should read and take it to heart.
The future of medicine: 2012 edition
Livescience.com has a list of five expected medical advances for the year 2012, and they are:
- the use of vaccines in cancer treatment (not just for prevention)
- better vaccines for malaria
- better air quality regulations
- cheaper life-saving drugs
- clearer consumer information regarding health insurance plans and the nutritional content of food
What I like about this list is that it is partially focused on prevention/pro-action and not just reactive health care (which is frequently more expensive and less efficient). All good things: giving consumers more (and more comprehensible!) information regarding the food they purchase and eat, cheaper medication (such as drugs for diabetes, rheumatoid arthritis and heart disease), clear summaries and comparisons of health care plans, a wider variety of cancer treatments (which may end up being less invasive and with fewer side effects), and better vaccines for life-threatening illnesses like malaria.
2012 may have a lot to look forward to!
Avoiding medical errors
Medical errors are unfortunately a big part of our health care. Medical errors do occur and sometimes are unavoidable, however there are things that patients can do to prevent or decrease errors. Taking steps and being persistent can help avoid being a statistic. Communication, monitoring, and being involved can help patients avoid errors from happening to them. Being engaged in one’s own treatment and having access to medical records is a great start to living a healthier life.
Technology to bridge language barriers
Barriers such as access to care, no health insurance, and language create big dents in our health system and keeps patients from receiving the treatment they need. The Howard County General Hospital unveiled a tool that will stream videos to provide live interpretation services to patients. This service will be instantaneous and will cater to 170 languages including Spanish, Korean, Mandarin Chinese, and even deaf communities. The tablets access networks of interpreters and goes as far as reading patients body language and other visual cues to assist in accurate interpretations. This is a great tool to remove health barriers which prevent patients from receiving proper care.
What a concept: human-friendly hospital rooms
Michael Graves designed this bedside table with patients in mind
I've always found it a little odd that patients (disabled, blind, chronically ill, etc.) aren't consulted when hospitals, rehab facilities and doctor's offices are designed. I actually wonder if they're considered at all. I've gone to dermatologist appointments in the winter in a brand-new state of the art building that is frankly, too cold to be in fully clothed. Rooms with walls made of glass, floors of icy tile, and soaring 15+ foot ceilings aren't the best place to have a full body scan. I can't imagine being a patient going through chemo or radiation and having to be in that building multiple times a week. While I think natural light and colorful artwork definitely helps overall health and healing in an aesthetic way, there are other things to consider (like having rugs in the rooms where barefoot patients are waiting for 40 minutes to see a doctor in the middle of winter).
Renowned architect Michael Graves gave a talk regarding hospital and exam room design at the 2011 TEDMED conference, where he highlighted a lot of these issues, and gave numerous ideas for improvement and change. This article and the video of the talk itself (also at the link) are worth visiting, because it gives the perspective of a patient who is also a designer - one, in fact, who has spent his life integrating form and function. He is one of few people in the position to be able to see both sides of this issue, and be the one to know how to fix it. Now paralyzed and wheelchair-bound from an extremely rare infection, Graves can look around and see where current hospital and rehab center design has gone wrong. It may be that he is the one to show how to keep the bright, colorful and sensory-pleasing elements of current modern architecture, and incorporate sensible, patient-friendly features as well.