e-patient | Medical Futures Lab

Mar 22 2014

Communication, e-patient, Electronic Medical Record, Health

Medical Data Fingerprints

Cancer and cancer treatment leaves a trail of digital data. I’ve been thinking about this digital trail today, and the different forms it took for me during my diagnosis and chemotherapy.

MyMDAnderson

Patient Report on myMDAnderson

This is my personal MD Anderson portal. Though I never bothered to check on my documents very often, they are are available online, like pictures in a scrapbook. Looking back on them now, I’m intrigued by sheer the volume of the data MD Anderson collects on me. There are patient reports for every meeting and consultation, notes on every interaction.

During my first echocardiogram, the technician applied gel on my chest and asked an innocent question: “so, you’re an Ecology and Evolutionary Biology major?” I was instantly taken aback. I had never seen the man in my life or mentioned my major. But everything I told my oncologist had been stored for future reference, even the information I considered mundane. I often think about this interaction when we talk about how doctor-patient interactions should improve. The question about my major was unsettling to me rather than indicative of warmth and caring. It implied a greater, almost sinister, system of knowledge that I had not considered before then. Though the question was intended to be intimate, it “revealed the trick” and made the interaction seem alien and forced.

Texts

Cellphone picture taken while prepping for a CT scan.

I sent many messages, both in text and photograph form, in the earlier stages of diagnosis. They weren’t really to alert my friends and family to my progress, and they weren’t really to stave off anticipation and fear with regards to treatment, at least not consciously. I just had an obsessive desire to share the new events and experiences that were occasionally humorous, as in the case of the apple-flavored barium swallow, or the nurse who assured me that the radioactive glucose used during PET scans was “just a bit of sugar water, like they give to hummingbirds.” It turned out that image texts were the most immediate and easy way for me to convey information, and what I usually used. The trail of texts did die off towards the end of my treatment, however. I was tired. I felt I had less to say. This is in line with what I’ve heard from many current and former patients: when you’re feeling sick, you don’t want to interact with technology and others.

Google Searches

This one is less obvious, but still there and very important. I was constantly researching my diagnosis, symptoms, side effects of chemo and biotherapy. These will influence my future search results in ways I may not necessarily anticipate now.

Many communication problems in medicine require tailoring the solution to the individual patients. Some may want warm and caring doctors, others want their physicians clinical and direct. Some may engage eagerly with apps, while others have trouble mustering the motivation to get out of bed. These sorts of digital trails provide several unique perspectives: the medical and physiological angle, the relationship angle, the personal and introspective angle. How can we harness and combine these perspectives to create better solutions? And how can we respect privacy and patient concerns while we do so?

Mar 17 2014

1 Comment

Communication, e-patient, Health, Humanity, Medicine, Technology

Can Telehealth and Integrative Medicine Coexist?

Telehealth advocates the use of electronic services to support patient care, education, and monitoring. Proponents of telehealth acclaim its potential to reduce healthcare costs and to increase patient satisfaction. Implementing telehealth, however, would require deconstructing the traditional healthcare encounter. Patients and physicians would have to redefine their expectations for one another, and some argue that telehealth belittles the patient-physician relationship.

Photo Credit: firsthealth.org

Nevertheless, there are clear advantages for telehealth. Telehealth can serve as a means of supporting traditional healthcare. When distance separates participants, patients can use electronics to directly contact their physicians. They can receive direct clinical service miles away from the doctor’s office via virtual visits. If the patient’s health records, medical images, and medication lists are already compiled online, such virtual visits can serve as a timely and efficient way to improve patient care.

Additionally, telehealth allows the early detection of irregular or unfavorable body rhythms. For instance, early detection of irregular heart and brain rhythms could prevent potential heart attacks and seizures. In this respect, telehealth plays a role in preventive medicine and contributes to better health outcomes.

Schwamm (2014) gave an example that cellphone cameras could be used to photograph rashes and skin lesions. This would allow dermatologists to diagnose and treat their patients without having to physically meet. While this form of treatment is fast and efficient, it seems to be in stark contrast with integrative medicine.

Photo Credit: mc.vanderbilt.edu

Growing in favor since the 1990s, integrative medicine emphasizes a holistic approach to medicine with a focus on health and the physician-patient relationship. With this method of telehealth, the physician-patient relationship is almost nonexistent, and patients are reduced to their skin problems. Furthermore, diagnosis via photograph is hardly holistic; rashes and skin lesions may be signs of a multitude of health problems. It is unlikely that only the dermis is affected, and it would be erroneous to assume that the organ systems of the body work independently.

In Engel (1977)’s seminal article, he claimed the need for a new medical model—namely, the biopsychosocial model. This model posits that biological, psychological, and social factors all play a significant role in the context of disease and illness. Integrative medicine relies on this model because it focuses on the whole body. Therefore, it seems to be opponent to this localized method of diagnosis.

Photo Credit: theemotionmachine.com

While telehealth has its greatest benefits in early detection, it still has some outstanding limitations. In accordance with the biopsychosocial model, the physician also plays a role in helping the patient cope with stress and vulnerability. On a standardized stress scale, finding out that you are HIV+ scores a 99/100. Given current technological advances, it is possible to get tested for HIV without ever having to actually see a doctor; however, this is a questionable idea. Beyond biomedical treatment, the physician also provides intimate psychological and social support.

Currently, telehealth and integrative medicine can coexist; however, telehealth has its limitations. While it should complement and add value to existing medical care, it should not substitute healthcare completely.

Mar 06 2014

Communication, e-patient, Health, Medicine, Technology

There Are No Dumb Questions

“There are no dumb questions.” We’ve all heard this before, and as a result, we ask questions for all sorts of reasons. We ask questions because we want to know the answer or because we want to prompt someone else to get to the answer. We ask questions to impress our professors or classmates, to stand alone rhetorically, and to fill awkward silences. We ask questions constantly to other people, to anyone who’s listening, and even to ourselves (don’t pretend you don’t talk to yourself too).

So, why is it that we suddenly clam up in front of our doctors?

Many patients suffer from “white-coat silence,” or “a reluctance to vocalize questions to physicians.” At first this might sound ridiculous. Isn’t that your doctor’s job? To be the medical expert who answers your questions? Why wouldn’t you talk to him/her? While for many people this might seem obvious, for others, the doctor’s office is a strange, scary place where it’s a lot safer to just listen and let the doctor tell you what to do.

However, communication is key to successful patient-doctor interactions. In fact, a study found that the most powerful predictor of positive physician communication is good patient communication, which—surprise, surprise—includes the tendency of patients to ask questions. By asking a question, patients catalyze a cycle of patient-doctor communication in which they provide an opportunity for physicians to share information and give support. Not only does this increase a patient’s knowledge about their own health, but it also makes them feel more comfortable in the clinical setting, making for a better patient-doctor relationship.

So, why don’t patients talk to their doctors?

Intimidation, anxiety, and even impatience are just a few reasons. However, a study published in 2007 found that low health literacy is one of the most influential factors negatively affecting patient communication. Patients with low health literacy ask fewer questions, are less likely to use medical terminology, and ask less meaningful questions (e.g. “What is the name of that medicine?” rather than “Will I be in danger if I increase my dosage?”). Conversations with your doctor are much less beneficial if you don’t know what to say. With such a short amount of time per visit, low-literacy results in missed opportunities for patients to become more engaged and informed about their own health during their doctor’s appointment. Sometimes, patients who are aware of their low health literacy are too embarrassed to ask questions at all.

So, how is this being addressed?

The Agency for Healthcare Research and Quality (AHRQ) released a toolkit for improving health literacy. One of the guidelines was to “Encourage Questions.” Patients with low health literacy can benefit more from their visits if they know what questions to ask. By empowering these patients to see the benefits of speaking up, they can slowly learn that there are no dumb questions and learn to effectively communicate with their doctors. Over time, this increased communication can lead to the gathering of more health information, improved health literacy, better communication, and ultimately better health outcomes.

So, what can we do about this?

AHRQ also published a question guide that can be utilized by all patients, as everyone can stand to benefit from communicating with their doctor. Any MMAL group involved in patient-doctor interactions should keep patient-initiated solutions as an important consideration. Patient involvement indicates to the doctor that the patient is interested and engaged in their own health. It also helps battle the ‘intimidation’ factor in white-coat silence by empowering patients and giving them some authority. In developing our media solutions, the ‘not-dumb’ question we should ask is “How will this help catalyze patient-doctor communication?” because active patients make for happy doctors, which leads to better patient care.

Judson, T. J., Detsky, A. S., & Press, M. J. (2013). Encouraging patients to ask questions: How to overcome “white-coat silence”. Journal of the American Medical Association, 309(22), 2325–2326

Street RL Jr, Gordon H, Haidet P. Physicians’ communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor? Soc Sci Med. 2007;65 (3):586–598.

Katz MG , Jacobson TA , Veledar E , Kripalani S . Patient literacy and question-asking behavior during the medical encounter: a mixed-methods analysis . J Gen Intern Med . 2007 Jun;22(6):782–786 Epub 2007 Apr 12.

Feb 28 2014

Communication, Culture, e-patient, Health, Story, Technology

Self Help App for Anxiety

SAM App Review

Recommended by: http://it-is-a-3-patch-problem.tumblr.com/post/57732674295/thought-this-may-be-useful-for-a-few-people-on

Feb 28 2014

Art, Communication, Design, e-patient

Conveying information (Feat. The best infographic ever)

First things first—doesn’t anyone else find it funny that there are 10 13 new posts here in the past couple days? No, just me? Ok…

How is everyone today? I’m a bit miffed writing this, because I’m not scoring as well as I would like in this class, according to my critique and dossier grade (pre-med problems, am I right?). No biggie, I can do better next time, but I’ve got to solve a very important problem first. In our presentation, we gave a lot of information—probably too much as we went a good 2 or 3 minutes over time. Having this information is great, but the problem seems to be that we couldn’t convey it effectively. My introductory linguistics professor described it well: language is used to take an idea in one’s head and vibrate some air with some flaps in our body in such a way that another person in the vicinity can have the same idea. We could not accomplish this pseudo-telekinesis, so we didn’t do as well as we wanted.

I can guess what you’re thinking though: “Wah-wah. That’s not a real problem. How does this apply to me?” Well, I figure that if we cannot get an idea across accurately to doctors, professors, and others sufficiently, what chance do we have of getting the same (or other) ideas across to the patients that we aim to empower?

There are a couple of things we could do, actually. For one, we can work on basic presentation style, so that the information we give is more engaging for an audience. We can also make analogies. When you simplify an idea by comparing it to other things (e.g. the heart to a pump) people can get a better sense of what something truly means and can figure out implied effects or solutions of that thing.

However, one new trend that is becoming more and more used is called an inforgraphic. For those of you who don’t know what that is, it’s basically some type of image that conveys information, usually in a fun and easily digestible manner. If you want a few examples, here’s like 80 of them. Info graphics are useful because people only really read a portion of the information they encounter, according to Dr. Paul Lester in his paper “Syntactic Theory of Visual Communication” . People following instructions with infographics are much better at following them than without and adding pictograms to medicine labels increased patient compliance significantly (around 25%). And honestly, infographics are just fun. People like them—a lot. If you want to know more about why we like infographics, check out this one. I know I put up a lot of links, but you seriously should check it out.

No, seriously. Look at it. It’s pretty great. I’ll wait.

Anyway, I feel that both in our next presentation and in our solution, it would be a great idea to create some visual representation of our information. I’ve been looking up infographics and how they work so we can harness their powers for good, but honestly, this information is pretty useful for us all.

Medical Futures Lab

Category Archives: e-patient

Medical Data Fingerprints

Can Telehealth and Integrative Medicine Coexist?

There Are No Dumb Questions

Self Help App for Anxiety

Conveying information (Feat. The best infographic ever)

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