Author Archives: Katerina Jackson
Compelling lecture on clinical decision making and diagnostic error
This post was written by e-Patient Dave on March 20, 2011 and appeared on www.e-patients-net.
I think if we want to improve this aspect of medicine, it’s essential to understand the evidence presented here. It documents some of the major challenges in diagnosis, which suggest that we shouldn’t expect clinicians to be perfect and clinicians shouldn’t expect us to think they are.
The lecturer is Pat Croskerry, Professor in Emergency Medicine at Dalhousie University, Halifax, Nova Scotia. Levy’s post says:
Croskerry’s exposition compares intuitive versus rational (or analytic) decision-making. Intuitive decision-making is used more often. It is fast, compelling, requires minimal cognitive effort, addictive, and mainly serves us well. It can also be catastrophic in that it leads to diagnostic anchoring that is not based on true underlying factors.
He says we should explicitly teach decision making skills in medical training. I’ll add: if we all recognize the difficulty of perfect decisions, we can work together to improve the odds – with more participation, less blaming, and overall better outcomes. And, I hope, less unwarranted stress for clinicians who are doing the best they can.
The Healthcare IT Puzzle: Something is missing… “Oh yes, the patient!”
What does “patient-centric” really means? – that was one of the questions addressed during the interactive Roundtable organized by the Institute of Federal Health Care and Lifetime Health Diary in Washington, D.C. on March 4.While it’s now generally agreed that the patient should have access to his/her own health records and control them, it seems as though our healthcare system is not designed with the patient in mind. Not only does it ignore the patient as a stand-alone and the most responsible decision-maker in the healthcare value chain, it also fails to provide ways for collaborative decision-making by all parties involved in the care of an individual. How do we change and redesign the system so the patient is in the middle? How do we address gender and race differences when delivering care to make it more specific to each group? How do we make delivery of care more adequate when treating chronic illness patients, undeserved communities members (Latino, HIV/AIDS, mental health, etc.)? Finally, how do we initiate a behavior change in the patients?
All these questions were addressed and discussed last Friday by a very diverse group of participants where everyone came with his/her own personal story to share about the inability of obtaining the health records in the most critical moment in life (e-Patient Dave and Regina Holliday), frustrating birth experience where the “care team” does not corroborate decisions made by the patient (Lygeia Ricciardi), lack of transparency in the healthcare and inadequate care delivery to diabetes patients (Amy Tenderich), and other touching stories once again proving that changes in the healthcare system should be made “right now and right here”.
I think because we had such a diverse group of people with different backgrounds (government, patient advocates, enterprise, academia) but evenly passionate about healthcare transformation, the Roundtable turned into a very insightful and productive event. I think one of the most exciting and memorable moments for me was when Regina Holliday offered to re-configure the room. Yes, we all were talking about a need for a behavior change, yet, no one except for Regina realized that the change should be made “right now and right here”. And this is where an official government room with neatly set tables and chairs turned into an informal discussion where everyone could easily face each other without having any barrier and obstacles. As Ted Eytan mentioned in his blog “The patient in the room changes everything. Everything”.
Viva la Patient!
Please visit Flickr to view more picture and videos from the event.
“The Biggest Wasted Resource in Health Care? You.” via ABC News
Here is a great new post by Roni Zeiger (Google Health) on ABCNews.com. A very encouraging and inspiring piece from the doctor who actually welcomes the “third person” in a care room – the internet. An informed patient is an armed patient. Do your homework, prepare questions for the doctor, realize the importance of your kids health data and your own, take charge of it and increase the chances of getting the right decisions from your healthcare professional.
However, only being a smart consumer of health information benefits all the parties involved in the care, and truly empowers the patient. “Consuming” all the health information online via Twitter, Social Networks, Online Patient Groups and Health portals can be quite overwhelming. Moreover, reading without filtering does not lead to an empowerment; instead, it harms the recipient.
The video below brings up some excellent statistics as well as an example of how misleading, low-quality health information can reach almost 1 million people (and potentially harm us) in a few hours after posting powered by the social networks such as Twitter
Redesigning Medical Data
We all know information is a powerful tool, particularly when it is displayed in a way that informs, educates, engages and eventually leads to behavior change. We all know when crafting a Power Point Presentation we need to keep in mind our audience and tailor it accordingly to their needs if we want appeal to them and convince them. Techniques we are using for information presentation have become second nature and utilize the latest software developments…However, when it comes to health and medical information we rely on old-fashioned and outdated ways to display and share the information, ways that neither inform or educate and most often are time consuming for both the patient and health professionals.
When it comes to redesigning health and medical data, I would like to refer to Thomas Goetz talk during TED Conference back in October. While I may not agree with some points, overall I do believe Goetz outlines an interesting and timely solution which may lead to patient’s behavior change, and eventually improve health outcomes…
An informed patient is an armed patient.
Did you know that… Health 2.0 NYC Meetup recap
Did you know that since 2006 health category searches have been outpacing overall internet search growth by almost 4 times? Did you also know that Americans conduct over 651 Million health related searches a month? – Well, me neither until I got a chance to view a presentation by John Mangano from ComScore during the Health 2.0 NYC meetup last Thursday. (A BIG THANK YOU to Alex Fair for organizing this monthly meetup event, having great presenters (always exciting to see new companies joining the industry) and keeping it always interesting).
Not that I was surprised to see the figures, yet, it was quite interesting to find out that Americans prefer online search resource to family/friends opinions and advices when it comes to healthcare.
Below I included few pictures with slides presented by John about physician and patient behavior online
I just wonder though if 80% of Americans refer to online search when it comes to health, why does the adoption of PHRs remain so low (~7%)? (taking in account availability and variety (cloud-based, mobile apps, with/without automatic uploads, alert, etc.) of these tools
Health should not be a burdensome task on our daily “to-do list”
A year ago I knew nothing about our healthcare (besides few facts such as having to co-pay $5 every time I visit my dentist and having to wait for my appointment for at least 1 hour before I see a nurse for 5 minutes and my physician for another 3 minutes). But look at me now: I read healthcare and HIT news daily (not that I understand 100% everything. Well… in my defense, our Healthcare system is too complicated and disconnected that it makes it difficult to digest all the current news), with the same frequency I visit patient advocate blogs, I twit recent news, I tell my friends about PHRs and EHRs (not that they understand what I am talking about. As other 93% of our population they are too busy with a daily routine, and thinking of taking another responsibility such as engaging in their own health makes them feel overwhelmed), I attend monthly Health 2.0 Meetups in NYC where tech savvy and passionate about healthcare people discuss current issues, present demos of new patient-centric tools and connect to each other; I also attended Health 2.0 Conference in SF in October (where I had a pleasure to meet even more people passionate about healthcare transformation, and where I got to see demos of even more patient-centric tools).
However, this is my experience. I probably would not be engaged in healthcare and my own health unless I gotten evolved in the company where I am at now. Look at my friends – they still do not understand what I am doing and why do they need having their health records available to them all the time wherever they are. (Yes, they like to use a few iPhone apps which help them track fitness and diet progress though). They just do not get it! And looking at the current statistics most of our population does not get it either (e.g. only 7% currently use PHRs).
What it tells me is this is a time to finally start rolling out campaigns directed on the patients (I purposely do not use “consumers”) to bring awareness, education, engagement and, finally empowerment. Health is local - so let’s start educate and talk to people at where they are at now, talk to them in their “language”, show the demos of available patient-centric tools to them, let people know that no doctors will help them to be healthier unless they make a decision themselves to do so. Health should not be a burdensome task on our daily “to-do list”. It should rather be an enjoyable part of our daily lives (taking in account all these cool HIT gadgets available our there, and, yes, people actually like cool gadgets – we just need to be aware of them) reducing the stress, time and money spent on the doctors, preventing preventable diseases and helping us create healthy, engaged and conscious population.
Health 2.0 in San Francisco. Quick update
A very quick update from Health 2.0 in San Francisco before I post a full recap of the conference tomorrow.
It was an eye-opening event with smart, dedicated, passionate participants who are all about changing healthcare, its delivery and finding ways to provide right information in a timely manner for each and everyone.
What really stroke me during the event is a positive energy, entrepreneurial spirit and desire to find sustainable solutions to current problems. Hamish and myself very much enjoyed every session and panel starting on Wednesday with Patient 2.0 session (and its fantastic speakers – patient advocates – such as Regina Holliday, Gilles Frydman, Amy Tenderich, ePatient Dave de Bronkart and others) and finishing up late Friday with Investor Panel where Esther Dyson, Don Casey and others talked about current and future state of Health 2.0. and the path of investments in that area.
Come back tomorrow for a 2-day Conference recap!
How a true passion can bring a sustainable difference
Hi Everyone,
I am thrilled to introduce you our guest blogger, a very inspiring social entrepreneur Aga Nazaruk, a director at Ignite Consultants based in Dunedin, New Zealand. Over the next few days and weeks as it progresses she will be covering a new Project: A Healthy Community Enabled by Information -a partnership between Ignite Consultants and Lifetime Health Diary Ltd and a number of community groups. You’ll be truly amazed (because I am!) what a real change a few people can make by embarking on a collaborative project and working towards a mutual goal!
I met Aga back in Spring of 2010 and was literally stunned to see how much power, energy and passion for driving social innovation into communities, training and inspiring leaders and building partnerships between businesses, the not-for-profit sector and academia for the growth of a sustainable society this petite girl possesses. She reminds me of this powerful storm coming onto the shore, sweeping off the dust and old litter, and bringing a fresh air, fresh prospective and a real change onto the ground.
Aga, welcome aboard! Looking forward to your great posts.
Time to take control of the situation…”e-patient advocates”
Every now and then I come across patient’s stories describing terrifying experience with our healthcare system, and stories on how this experience motivated them to become e-patients – engaged, empowered and educated. I am talking about people such as e-patient Dave , Trisha Torrey, Regina Holliday, and many more: people who experienced unfairness of a healthcare delivery, who were treated for something what was not there, people who struggled for their loved ones in order to obtain an appropriate care. Some – failed, unfortunately, others – succeeded. But no matter of the outcomes, they all became active “patient advocates” who are trying (successfully) to empower thousands of others, who are struggling to receive adequate care, obtain their records, who are getting in those “holes” of our health system where infinite medical errors and oversights occur during diagnosis (e.g. 1 out of 4 times the diagnosis will be wrong according to the report of the Agency for Healthcare Research and Quality), or treatment (medication side effects, drug interaction), or hospital admission/discharge, or during handoff process which occurs 4,000 times a day! Yes, seems like there are more opportunities for the mistakes than for accurate decisions…
And health professionals should not be blamed for this either. There are many stories out there where the nurses, or physicians, or surgeons saved thousands of patients’ life, and cured incurable.
What should be radically changed though is our inefficient healthcare system, not suitable for chronic patients, for people with disabilities, for retired employees, etc.; well.. Honestly it is not suitable for anyone, with its myriads of disparate silos, lack of standardized process in the hospitals, nursing homes, clinics, etc., lack of communication between patients and the doctors, doctors and nurses, primary and secondary care, and so on so forth.
However, what keeps me optimistic about our healthcare system, and gives me some hope it can be changed soon, can become more patient-centered is these “patient advocates” who through themselves out there and do what has to be done. Thus, recently, I came across the post by Elizabeth Cohen (CNN) and terrifying story about her baby-girl, which shows how lack of communication between health professionals within a single institution could take a life of a new-born baby, and how important it is for the caregiver (in this case – a mother) to take a charge of the situation and fix it before something bad happens.
So, the question is how long will it take for us, patients, (and, will it happen at all! or do we want it?) to start finally relying on our healthcare system without worrying much about following up on and checking every step made by our health professionals during the time we are seeking for health care?
“Smart pill”? “Smart Contact Lenses”? Age of Sci-Fi…
This week I stumble upon two new developments. Both impressed me so much that I could not help myself but to share it with you: contact lenses that monitor your health and “smart pill” that is once in your stomach reports to the computer/cell phone it was taken.
Both developments involve nanotechnology and are in an experimental mode yet, and it may be a long way before you actually start wearing those contact lenses that monitor health and display information on the body temperature, glucose level, inflammation, infection or fatigue, and swallowing your morning pill. However, the fact we have dedicated researchers working on these kind of projects who combine Health IT, science and nanotechnology, gives me a hope that we are still capable of coming up with a true innovation in that area besides just developing new software, “innovative” social networks, etc.
