Category Archives: Communication

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

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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

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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?

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.

The Opportunity of a Lifetime

Since the advent of the internet the global economy has been evolving and adapting dramatically to keep up with increasing technological innovation in a shrinking world.  A recent article published in The Economist discusses the reasons for the current boom in digital startups and not only its economical but cultural repercussions.

Much like the Cambrian Explosion which led to the vast proliferation of life on Earth, the current explosion in internet startups has created a variety of services and products that penetrate a multitude of markets and user bases. Cheap technologies and ubiquitous online services and resources are the main reasons for this boom in the internet business. These startups also benefit from being able to move overseas with ease and access a larger audience due to the extensive reach of the internet around the world.

The author of the article compares this current boom with that of the dotcom era in that most of the newly released products and services are simply iterations of existing ones. This leads to a high rate of failure much like what many dotcom businesses faced in the late 90’s. However, the author does point out that today’s boom has much more solid foundations with more dependable platforms and better tools. This leads us to believe that this current economic episode will continue for years to come.

This article also delves into the cultural implications of this phenomenon. Since the recession millennials have preferred less conventional jobs and have looked to be more entrepreneurial than the previous generation of young professionals. The growing business of internet startups is very attractive considering the relatively low startup costs to enter the industry. There is also huge potential to make it big due to the abundance of other programs and services offered online and free of charge that can be used to distribute products and market them globally.

Since the article does not argue how to improve and sustain this boom in economic growth I offer my suggestions here. This explosion in digital startups would be even more fruitful if there were fewer regulations on access to internet tools and databases. Why not let loose the reins of this economic dynamo and sustain this boom to see where it takes us and how much good it can do in the spaces of health and government? Especially when one considers the growth in mobile technologies over the years the possibilities for benefit in these industries is limitless. However, in order to ensure real improvements to current systems true visionaries not hype filled get-rich-quick firms are needed. If visionaries are squeezed out of the market by spammers and hollow products consumers will lose interest and abandon the industry. The bubble will burst much like the dotcom bubble of the late 90’s, allowing many rewarding opportunities to drift into afterthought.

Presidents, Physicians, and Public Dialogue

http://www.youtube.com/watch?v=6wGN-lbd7Ss

If you haven’t yet seen President Obama’s interview with actor-comedian Zach Galifianakis, you’re missing out.

President Obama makes a clever pitch to the Young Invincibles—uninsured millennials in their 20s—to sign up for health insurance under the Affordable Care Act. It’s sharp. It’s fresh. And it works.

For physicians in the Digital Age, President Obama’s interview offers valuable insight.

Be accessible. There’s no jargon or formality to President Obama’s pitch. He understands his audience, and brings both content and tone to its level. For health communicators, it’s essential to be mindful of where the audience comes from and form-fit the message accordingly. Public conversation, especially something on as massive of a scale as social media, isn’t something that health providers are trained to do. But if we are to inform popular opinion and create public dialogue, it’s something we’ll have to learn.

Be visible. How often do we catch people talking about what’s playing on C-SPAN? Never. A politician press conference? Rarely. News commentary talk shows? Sometimes. The president’s comedic interview? It’s everywhere. The President drew some criticism for informality, but he made headlines, sent a message, and inspired conversation. Similarly, health communication has to transcend academic journals and medical conferences to go where the patients are: online. Even the best professional, peer-reviewed content can’t generate dialogue or spark disruption if there’s no audience for it.

Be innovative. This may be the Oval Office’s first use of viral video for political outreach, but it certainly won’t be the last. As digital communication expands to new collaborative platforms, “the medium is the message” becomes increasingly relevant. Academic blogging and tweeting is an excellent start, but as new avenues for dialogue emerge, look for opportunities to reach different audiences, share different messages, and try different strategies for engagement.

As the Web turns 25 this year, it’s hard to overlook the transformative impact it’s had on the way we connect, communicate, and collaborate as a society. What’s been less dynamic is our willingness to embrace new forms of media to reach new levels of engagement. Boldness in public communication is something that needs to be wired into medicine at all levels, from medical training to clinical practice to institutional leadership. If the President isn’t above it, then heck, neither are we.

Through the Looking Google Glass

As I was scanning my twitter feed this last week I came across an article discussing one of Google’s newest technology accessories, Google Glass.  Google glass is essentially a lightweight pair of eyeglasses that works like a headset equipped with camera, GPS, Bluetooth, microphone, and viewfinder. This technology allows the wearer to connect to smartphones, allowing them to search for and access information online and to use the camera, GPS, etc. all hands-free.

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Google Glass: What It Does

 

With all this information less than a click away and viewable without having to carry a physical device I wondered, what possibilities could this technology have in the world of medicine?

I decided to look at how Google Glass was currently being used in the medical field. I found that this technology provides a means to change the ways the doctors work and communicate both with each other and with patients.

In class we’ve discussed how the internet has come to change how information is spread throughout the medical community, from simple avenues like the increased access to information to more creative paths like the live tweeting of surgeries for the public to access. Technologies like Google Glass make these information sharing “innovations” of today look small in comparison.

A perfect example of this can be seen in an article that discusses a surgery performed by Dr. Pedro Guillen earlier this year. Dr. Guillen was able to perform a highly complex surgery while wearing Google Glass, allowing the surgery to be streamed around the world in real-time. This feature allowed him to serve as an interactive teaching tool to university students and physicians all over the world, opening non-traditional avenues to improve medical education around the globe. The technology, as reviewed by Guillen, also revolutionized the way he performed surgery. The split-screen display allowed him to maximize access to valuable information such as images of the knee, notes, or past surgery videos without having to lift his eyes from the table. While all of these features were impressive one that stood out the most was in the off chance that an error occurred, Dr. Guillen possessed the ability to rewind the tape to review the surgery while standing at the table. This feature can serve to drastically change the way we approach and view medical error in the future.

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Video of Dr. Guillen’s Surgery

I also found an account of how Google Glass is working to improve doctor-patient interaction. One company, IOS Health Systems, has developed a native EHR app that can be used with Google Glass. This means that doctors could access patient information such as medical history, vitals, etc. and display it into the heads-up display while talking to the patient. This opens the possibility for doctors to reduce reference to a stationary screen and engage in more direct conversation with the patient, working to improve the doctor-patient interaction.

As I reviewed the literature I marveled at the possible impacts that technology like Google Glass could have on the practice of medicine and considered the role that Google Glass could play in our design setting. In the cardiovascular ICU physicians are required to both consolidate and communicate vast quantities of data into a simple and informative patient narrative and plan of care. In the current system often hand copy detailed data from the patient EHR onto sheets of paper. This practice, while necessary within the system, has created a sort of presentation “crutch,” where fellows will focus and rely on the data that they have spent so much time collecting rather than giving a cohesive patient narrative. Technology like Google Glass can work to eliminate this crutch. By allowing for the information to be readily available and accessible, physicians can focus more on preparing a patient narrative and care plan for presentation during rounds.

While Google Glass offers many positive aspects for the world of medicine it also holds many cautionary aspects. With the adoption of any new technology there come many unanswered questions. How will the ability to stream in real-time at any moment change privacy?  Will the knowledge that your doctor is viewing information that you cant see change the way that doctors and patients interact? The positive impacts that utilizing revolutionary technology in medicine can have are great, but as always we must move carefully as we move towards the future.

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