Category Archives: Design

Modeling the Path to Engaged Patients as a Metabolic Pathway

Guest posting by Sharon Syau


During the first semester of biochemistry, my classmates and I learned the details of the Kreb’s cycle—a process responsible for turning half a sugar molecule into cellular energy, or ATP.  Honestly, I was feeling pretty good when the semester wrapped up.

Then the second semester came around, and I found out (much to my dismay, since break had allowed my hard-earned Kreb’s cycle knowledge to slip away) that every other macromolecule seemed to feed into or come out of some other molecule in the main loop of the Kreb’s cycle.  For an idea of what the pathways are like, click here; for a dramatized version of my reaction, click here.

I bring this up because thinking about the interconnectedness of the body’s metabolic pathways is very much like thinking about patient engagement.

Modeling Path

In trying to map the elements that influence patient engagement, I found that the big ideas we had identified were connected, and that the levels of elements like trust or assurance could regulate the amount or quality of communication between the patient and the doctor.  At the same time, however, assurance itself relies on both communication (assurance needs to be communicated) and some existing trust (assurance from an untrustworthy someone is not assuring at all), so we find ourselves with a chicken-or-the-egg problem.

Using metabolic pathways as a framework, though, gets us away from looking for single starting point for our problem.  To break down sugar, we need not just the glucose, but a host of other enzymes and molecules as well.  In a similar vein, my group and I have come to realize over the course of the semester that all of these elements—trust, assurance, and communication—need to be present to help increase a patient’s voice during a patient-doctor interaction, and that each of them modulates the others.

While I’ve modeled patient engagement as a pathway that requires several coexisting elements and careful regulation, what I’ve really drawn is something very similar to the Kreb’s cycle from the first half of biochem.  My diagram outlines the big ideas that my teammates and I have identified, but it does so largely from the patient’s perspective.

If my diagram is the Kreb’s cycle, then we can think of the healthcare system as the organism.  Nurses, physician assistants, hospital administrators, insurance companies, pharmaceutical companies, and government agencies all have a stake in the way healthcare works.  Each of these stakeholders feeds into patient care at some point, but each is also a distinct pathway, subject to other methods of regulation.

Though this complexity is daunting, it isn’t impossible to map, understand, and eventually change.  Just as modern medicine has developed drugs that tinker with our physiologies, so too can we, with enough research, optimize the way healthcare works.

The Shifting Medical Field

Guest posting by Andrew Ta

It’s often said the medical field has yet to receive innovation or be affected by the same winds of change that have blown through other industries. However, to say such a statement requires ignorance of the reality that the medical field is so immensely large and multi-faceted, and that each part of it changes without regards to each other. There’s medical training & physician shortages, global health & big data, and changing patient habits & an influx of individual technologies (Internet of Things, anyone?). Each of these things are lumbering from old standards towards new, innovative ideals, and those willing to take a moment to look at the big picture of all the aforementioned parts will be amazed, if not a bit apprehensive.

It begins in the medical school, as curriculums that haven’t shifted in decades undergo dramatic changes. Most still follow traditions set by Abraham Flexner in the early 20th century, but his 2+2 model fails to address and teach the patient-centeredness expected of doctors today. The Flexner model states that students spend two years studying from the books, followed by two years of shadowing professionals. Although the academics and hard sciences remain important (although perhaps less so given the rise of easily-accessibly and searchable information along with how there’s just so much more info to know), new emphasis must be placed on soft skills like communication, for the discussion between a patient and their physician comprises a significant part of what patients take away from the medical industry. Doctors must convey everything from good practices and habits to delivery of unfortunate, sometimes tragic, information. Also important is the ability to critically think and react to changes that will inevitably happen to the medical field. We know that doctors not trained as such will resist change in their older years; we should take steps now to avoid that and ensure we have a spry healthcare system willing to adapt.

That isn’t everything that medical schools much change, however.  In today’s hospitals, doctors no longer work alone; they have a team of professionals at their side, whether it be nurses, physician assistants, social workers, or otherwise. Doctors must be able to work with those individuals, and although improving communication training will help with that, more explicit steps taken should be taken. Medical schools admit students based on supposedly holistic standards and their leadership and personability, but do they work to improve those traits in those they admit? Medical schools should push more inter-professional training and team-based exercises into their curriculum to better accomplish those goals.

The passing of the Affordable Care Act accelerated the changes in the medical field and made healthcare much more accessible to those that had previously been neglected. With that, however, there was an influx of new patients with countless complications, all at the same time as a host of other changes to the medical field, including change insurances and payment models. The medical system was already overworked, and it will undoubtedly get worse before it gets better; hopefully the different changes synergize well.

Even as the ACA changes occur, startups are hoping to exploit new technologies to tap into the lucrative patient market. Those startups and telehealth companies can work with or against the existing industries. Will they partner with hospitals (like SeamlessMD attempted to), or will they remain a separate alternative (like Doctors on Demand and Grand Rounds)?

Other surprise trends have appeared as well, made possible by today’s changing values and technologies. There’s a growing movement for patients to receive treatment at home, rather than in a hospital.  In the hopes of improved quality of life and reduce costs, hospitals are experimenting with the possibility of offering hospital-level care to patients who live in their own homes, their family and familiar belongs at their side. Besides the practical benefits of avoiding the hospital (such as skipping out on the hospital superbugs the media likes to monger), there’s the possibility that these new approaches signify the next medical frontier.



Cassella, Carol W. “Keep Patients Healthy, and Doctors Sane.” The New York Times. The New York Times, 15 Apr. 2015. Web. 30 Apr. 2015. <>.

Khullar, Dhruv. “Doctors and Nurses, Not Learning Together.” The New York Times. New York Times, 30 Apr. 2015. Web. 30 Apr. 2015. <>.

Lamas, Daniela J., M.D. “Admitted to Your Bedroom: Some Hospitals Try Treating Patients at Home.” The New York Times. New York Times, 27 Apr. 2015. Web. 30 Apr. 2015. <>.

Rovner, Julie. “Medical Schools Reboot For 21st Century.” NPR. NPR, 9 Apr. 2015. Web. 30 Apr. 2015. <>.


Do Annual Checkups Need a Reevaluation?

Guest posting by Andrew Ta


Annual checkups undoubtedly improve patient outcomes, but with today’s new technologies, is the status quo regarding them no longer the best solution? With companies like Doctors on Demand and telehealth solutions everywhere you look, there are more avenues than ever to get the care you need, when you need it. The archaic model of a yearly checkup should change to accommodate those realities, and such changes should strive to capture the individual personalization endemic in other industries. I’ve constructed an infographic that helps capture the benefits and drawbacks of the current annual checkup system, as well as what both patients and physicians can work towards for better care and a more efficient healthcare system.



Aschwanden, Christie. “Annual Physical Exam Is Probably Unnecessary If You’re Generally Healthy.” Washington Post. The Washington Post, 8 Feb. 2013.

Boyer, Tim. “Why an Annual Physical Exam May Shorten Your Lifespan.” EmaxHealth. EmaxHealth, 24 Jan. 2014.

Weintraub, Karen. “Ask Well: Do I Need an Annual Physical?” The New York Times, 17 Apr. 2015.


A Few Tips That Will Transform You Into an Empowered Patient

Guest posting by Sonali Mahendran


Throughout our project, Improving Communication with CHD Families, our team centered our focus on the communicators, the medical personnel, which includes doctors, nurses, and social workers. We decided that it’s important for communicators to make it more convenient and easier for parents to get involved in their child’s care. I also think that it’s significant for parents to do their part to become more engaged in their child’s care, as well.

So, I’ve created an infographic that compiles some of the most important tips to become an engaged patient, whether it includes CHD parents or the broader group, patients. Some of these tips have been shared by other empowered patients on US News Health.

Few Tips That Will Transform


The Physician Shortage and What We Can Do About It

Guest posting by Andrew Ta


Whispers of a physician shortage abound, but I have yet to see any real discussion about it, nor have I heard anything regarding possible solutions or mitigation strategies. Just how many physicians will we need as the baby boomer generation enters a phase of life that typically requires increased doctor visits and specialized care? A report released by the Association of American Medical Colleges on March 3 of this year helped quantify the issue. The study, described as the first comprehensive national analysis that accounts for demographic and recent changes to how care is delivered and payment is sorted, predicts a significant shortage of thousands of both primary care and surgical physicians. The report outlines possible solutions and advocates for increased funding for medical education, but I believe it to be best paired with other articles (sourced in the infographic) that further seek to make healthcare and doctors more efficient both through better medical education as well as a greater focus on preventive care. These sentiments jive with recent statements from US Surgeon General Vivek H. Murthy.
Infograph doc shortage

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