Differing opinions about Telemedicine

Differing opinions about Telemedicine
Updated: Sep 2, 2008 07:23 PM EDT

Includes video...

"...Patients pay $99.95 to access MDWebLive. The fee includes a camera, headset, and the first online doctor's visit. After that, it's $40 up front per consultation. Some insurance companies reimburse for the service.

It is convenient, but it's also controversial.

Dr. Bernd Wollschlaeger, the president of the Dade County Medical Association, said patients must have a traditional face-to-face relationship with their doctors before using telemedicine.

"You see the physician first, establish patient-physician relationship, do a complete physical exam," Wollschlaeger said. "You can utilize the online consultation as an adjunct in your relationship, but not as a substitute for your relationship...."

At least the importance of a doctor-patient relationship is acknowledged!

Questions cancer patients should ask

Questions Patients Should Ask
By JANE E. BRODY, Published: August 19, 2008

Patients armed with clear-cut facts are often able to make wiser choices about their care. Yet doctors are often reluctant to broach these matters.

In their review in The Journal of the American Medical Association of the role of chemotherapy at the end of life, Dr. Thomas J. Smith and Dr. Sarah Elizabeth Harrington listed these questions to ask — of professionals and of yourself — when considering chemotherapy that is unlikely to cure the cancer but may extend the length and quality of life.

Six Ways to Be a Better Patient

Six Ways to Be a Better Patient By Tara Parker-Pope, Published: August 12, 2008, NYT

To improve doctor-patient communication, patients need to follow a few rules of their own.

Last week, the Well blog featured “Six Rules Doctors Need to Know.” So what about patients?
Dr. Robert Lamberts, the August, Ga., physician who wrote the original rules in his blog, Musings of a Distractible Mind, says it was easy to criticize his own profession, but it’s tough to turn the spotlight on patients. That said, patients are half of the doctor-patient relationship, and they need a few rules of their own. Here are his six rules for patients.

...Any comment...

Doctor and Patient, Now at Odds

Doctor and Patient, Now at Odds.
By TARA PARKER-POPE
Published: July 29, 2008
"A growing chorus of discontent suggests that the once-revered doctor-patient relationship is on the rocks.
The relationship is the cornerstone of the medical system — nobody can be helped if doctors and patients aren’t getting along. But increasingly, research and anecdotal reports suggest that many patients don’t trust doctors.

About one in four patients feel that their physicians sometimes expose them to unnecessary risk, according to data from a Johns Hopkins study published this year in the journal Medicine. And two recent studies show that whether patients trust a doctor strongly influences whether they take their medication."

Is the trust gone? Comments?

Hurried Doctor Visits May Leave Patients Feeling Forgetful

ScienceDaily (June 25, 2008) — Have you ever been whisked through a doctor's visit, and afterward were unable to remember what the doctor said? A University of Rochester Medical Center study disclosed that doctors don't often take the steps necessary to help patients recall medical instructions.

The study, published online in this month's Journal of General Internal Medicine, investigated how frequently physicians repeat themselves, write down information, summarize instructions or take other steps to help patients remember the doctor's advice. The results suggest that doctors do not use these tools effectively or consistently. In fact, not one of the 49 doctors who took part in the study summarized their treatment recommendations.

"It's common for patients to forget half of what they're told in a medical visit," said the study's lead author, Jordan Silberman, a second-year University of Rochester medical student. "Obviously, this is cause for concern. As noted by the British researcher Philip Ley, 'if the patient cannot remember what he is supposed to do, he is extremely unlikely to do it.' No matter how effective a treatment is, it can be rendered useless by poor recall."

Researchers sent unannounced standardized patients (actors trained for this study) into primary care physician practices across Rochester, N.Y., with hidden recording devices. The actors complained of typical heartburn symptoms. Researchers then coded the recordings to determine how often doctors reinforced their instructions in some way.

Only about a third of the physicians wrote down instructions for patients. About half of the physicians repeated their recommendations, but some only repeated about 10 percent of the information.

Very few of the doctors made sure the patient understood by asking him or her to repeat it back to the doctor -- a technique cited in research literature as one of the best ways to help patients recall medical advice. For example, Silberman said, the doctor might say, "We've talked about a lot of things today and I want to make sure you understand everything. Can you explain to me what you're going to do when you get home?"

Lack of time may be the biggest obstacle for doctors, researchers believe. The next step is to develop a new approach to improve patient recall that can be applied in today's busy practices, and then to study the techniques in the context of what is feasible for doctors.

The Agency for Healthcare Research and Quality funded the study, which was conducted at the Rochester Center to Improve Communication in Health Care, part of the URMC Department of Family Medicine. Co-authors include: Aleksey Tentler, a recent URMC graduate, Rajeev Ramgopal, a research coordinator at the VA Pittsburgh Healthcare System, and Ronald Epstein, M.D., URMC professor of Family Medicine and Psychiatry.

Wolters Kluwer Health and Johns Hopkins Bloomberg School of Public Health Launch "The Patient"

Wolters Kluwer Health and Johns Hopkins Bloomberg School of Public Health Launch "The Patient"

"First Journal Dedicated to Using Scientific Methods for Patient-Centric Research
Baltimore, MD (May 6, 2008) – The Johns Hopkins Bloomberg School of Public Health and Wolters Kluwer Health, a division of Wolters Kluwer, today published the premiere issue of The Patient: Patient-Centered Outcomes Research, an international forum devoted to publishing research on patient-centered medicine.
The first academic journal in medicine to present solely the patient's perspective, The Patient addresses the growing concern that modern medicine has failed to adequately satisfy the needs of its most important stakeholder, the patient. In an era of managed care and cost-containment, current trends in medicine are being driven primarily by the needs and wants of healthcare payors. Even in academic medicine, new therapies are often studied in terms of their risks and benefits, measures that are chosen by physicians and researchers, often without the involvement of patients. The new journal will publish research to help advance a medical environment where patients are not just subjects but part of the scientific process."

Complicated medical lingo can confuse patients: researchers

Complicated medical lingo can confuse patients: researchers
Last Updated: Thursday, April 24, 2008 | 4:59 PM ET CBC News

"Using complicated medical jargon can be confusing, anxiety inducing and potentially dangerous for patients, a new study found.

The research, the focus of this week's editorial in the Lancet, finds that when doctors speak to their patients using the terminology they learned in medical school, patients can fail to identify what it is that's being said, be confused about their diagnosis or incorrectly interpret their condition.

According to health experts, the confusion can happen very easily."

How to deal with the digitally empowered patient

How to deal with the digitally empowered patient

From the site:

ORTHOPEDICS TODAY 2008; 28:30
April 2008

In November I wrote an article for the Time magazine Web site about an encounter with a demanding and computer-search savvy patient named Susan that touched off a small firestorm in the blogosphere. At least 20 well-read blog sites ran pieces about it with vigorous reader-response on both sides, either pro-patient or pro-doctor. The New York Times blog site alone has more than 300 write-ins, many emotional. At the end of January, CNN still had an article concerning this on the front page of its Web site.

For this Orthopedics Today Round Table discussion, I have gathered together a panel of orthopedic surgeons to discuss how patient empowerment by the Internet as well as other factors such as new commercialization efforts, regulation and the liability threat in medicine is changing their current practice and what they see as their future.

Scott V. Haig, MD
Moderator

Radio: White Coat, Black Art

White Coat, Black Art Radio series from the CBC
From the site:
"Dr. Brian Goldman takes listeners through the swinging doors of hospitals and doctors' offices, behind the curtain where the gurney lies.

It's a biting, original and provocative show that will demystify the world of medicine.

We'll explore the tension between hope and reality: between what patients want, and what doctors can deliver. Doctors, nurses and other healthcare professionals will explain how the system works, and why, with a refreshing and unprecedented level of honesty."

CMA unveils website for patient-doctor communication

CMA unveils website for patient-doctor communication
From the CBC:
A secure website for patients to interact with their family doctors was launched Tusday by the Canadian Medical Association.

CMA president Dr. Brian Day said the Mydoctor.ca portal will empower patients to take a more active role in their health care.

"The patient will be in control. I believe in empowering patients. I believe in a patient-focused system where the patient and the consumer is No. 1," Day said.

The new online tool, unveiled Tuesday at a news conference in Vancouver, focuses on tracking tools for three key areas: asthma, high blood pressure and obesity.

Patients using the system can call up their personal profile online and enter information about their conditions. That information is forwarded to their doctors' offices and then the physician monitors and assesses it.

More conditions, such as diabetes, will be added as time goes on.

When the Disease Eludes a Diagnosis

By BARRON H. LERNER, M.D.
NYT Published: March 25, 2008
Why do doctors and patients often approach the diagnosis of disease so differently?

"...Part of the answer lies in the concept of triage — the notion, originated in wartime, of caring for the sickest and most salvageable patients first. Once they were saved, attention could be turned to less drastic cases.

A similar strategy has evolved in emergency rooms, where physicians are trained to “rule in” or “rule out” severe conditions. Thus, doctors immediately consider heart attacks or pulmonary embolisms for patients with chest pain, and intestinal rupture for those with abdominal pain.

But what happens when these conditions are ruled out? In such cases, doctors proceed to search for less dire (and, it must be said, more mundane) diagnoses. The trouble is that at this stage, some physicians, busy with other patients and duties, lose interest."

Mansbridge with Richard Smith, former editor, BMJ

RICHARD SMITH
Former editor, British Medical Journal
One-on-one with Peter Mansbridge (video, 30 minutes)
Saturday, March 22, 2008
"...It seems every week there's a new medical study in the headlines, followed weeks later by other studies that seem to contradict the first findings.

What are we supposed to believe? And are journalists being vigilant enough in what they choose to report?

It's a delicate question but this week's guest has some tough answers to consider."

Practicing Patients

Practicing Patients
By THOMAS GOETZ
Published: March 23, 2008
PatientsLikeMe, an Internet start-up, creates information-rich communities for the chronically ill. Is it the next step forward in medical science — or just a MySpace for the afflicted?

"...There are a little more than 7,000 Todd Smalls at PatientsLikeMe, congregating around diseases like Parkinson’s, multiple sclerosis (M.S.) and AIDS, all of them contributing their experiences and tweaking their treatments. At first glance, the Web site looks like just any other online community, a kind of MySpace for the afflicted. Members have user names, post pictures of themselves and post updates and encouragements. As such, it’s related to the chat rooms and online communities that have inhabited the Internet for more than a decade.

But PatientsLikeMe seeks to go a mile deeper than health-information sites like WebMD or online support groups like Daily Strength. The members of PatientsLikeMe don’t just share their experiences anecdotally; they quantify them, breaking down their symptoms and treatments into hard data. They note what hurts, where and for how long. They list their drugs and dosages and score how well they alleviate their symptoms. All this gets compiled over time, aggregated and crunched into tidy bar graphs and progress curves by the software behind the site. And it’s all open for comparison and analysis. By telling so much, the members of PatientsLikeMe are creating a rich database of disease treatment and patient experience..."

The difficult doctor?

The difficult doctor? Characteristics of physicians who report frustration with patients: an analysis of survey data

BMC Health Services Research 2006, 6:128

Background
Literature on difficult doctor-patient relationships has focused on the "difficult patient." Our objective was to determine physician and practice characteristics associated with greater physician-reported frustration with patients.

Methods
We conducted a secondary analysis of the Physicians Worklife Survey, which surveyed a random national sample of physicians. Participants were 1391 family medicine, general internal medicine, and medicine subspecialty physicians. The survey assessed physician and practice characteristics, including stress, depression and anxiety symptoms, practice setting, work hours, case-mix, and control over administrative and clinical practice. Physicians estimated the percentage of their patients who were "generally frustrating to deal with." We categorized physicians by quartile of reported frustrating patients and compared characteristics of physicians in the top quartile to those in the other three quartiles. We used logistic regression to model physician characteristics associated with greater frustration.

'Bothering’ Your Doctor

'Bothering’ Your Doctor
NYT March 17, 2008, 2:23 pm
By Tara Parker-Pope

Does the medical system try to prevent you from “bothering” your doctor?
That’s a question Sacramento physician Dr. Faith Fitzgerald mulled recently as she attempted to notify another physician about a health crisis involving one of his patients. She chronicles her futile effort to phone a fellow doctor in an essay that appeared in last months’ Annals of Internal Medicine.