Medical Futures Lab

Guest posting by Emile Gleeson

All of our readings about e-patients and patient engagement over the last month or so as well as the team presentations last Thursday have caused to me reflect a lot on my own recent experience as a surgical patient at Baylor/St. Luke’s Hospital. Just a few months ago, in December 2014, I received surgery to shorten my left anterior talofibular ligament (ATFL) and remove some excess scar tissue in the surrounding area. This surgery was necessary because, as a dancer, I snapped my ATFL in high school and didn’t stop dancing long enough to let it heal properly. As a result, my ligament inappropriately lengthened itself during the healing process and a large amount of scar tissue formed in the area. Eventually the pain had gotten so bad that I couldn’t walk without being in extreme pain (I was in a walking boot for three months pre-surgery, and even then I still had a lot of pain). As a pre-medical student, I was probably a prime example of an engaged patient, as I was always very aware of what exactly my medical issue was and what my best chances were of fixing it, and I had a great overall experience with my surgery. However, I think that my surgeon’s availability and willingness to answer questions both pre- and post-surgery was what really gave me this great experience.

When I first met with my surgeon, a few months before my actual surgery, he was able to email me a full report describing my condition and the exact surgical plan that he wanted to use to fix it. While many patients may have simply glossed over this email, or figured that they wouldn’t be able to understand the medical terminology, I took the time to really understand the entire procedure, looking up unfamiliar terms when necessary. As a result, I was extremely prepared for exactly what my post-surgical recovery would be like, and I was able to plan accordingly (For example, I scheduled my surgery right before winter break started so that I wouldn’t need to push myself to begin walking sooner than recommended in order to go to classes). Additionally, I thoroughly read through all of the post-surgery paperwork that I was provided with, and followed all instructions carefully, since, as a pre-medical student, I knew the importance of a good post-surgical recovery. This engagement of mine certainly played a big role in my successful (at least so far…) recovery, however, I still believe that my surgeon’s availability and willingness to explain everything on a level that I would understand is really what made the biggest difference in my experience. During both my pre- and post-surgery times, my surgeon made himself available for questions through email, which allowed me to clarify anything that I didn’t quite understand, and allowed me to work together with him to choose the best date for my surgery. Despite the prevalence of the “pre-surgical blackhole” which was mentioned in one of the other teams’ presentations on Thursday, I didn’t feel as though I was ever disconnected from my surgeon during this time. Perhaps if more doctors made themselves available to their patients in this way, more people would have positive surgical experiences such as mine.

Guest posting by Alisa Momin

The wearable technology market has been criticized repeatedly for failing to cater to patients who actually need to monitor their health on a regular basis in order to keep up good health and a decent quality of life. Instead, the industry is producing flashy technology for everyday people without chronic conditions or any real need use to track their sleep cycles or steps for about two minutes, before inevitably tossing them aside after the originality wears off. How many of us have tried tracking the amount of steps we take per day, or logging the amount of calories we digest and burn? How long did these practices last? Probably not long.

How do we fix this problem and make this kind of technology widespread and long lasting in the healthcare industry, where it has so much potential? By proving to people that wearables can actually help people detect chronic conditions, illnesses, or diseases before they have the chance to do much harm, we can overcome the lack of interest in wearables. We can also thereby move toward patients and consumers that actually have a need for this tech—especially aging patients with several chronic conditions. This is exactly what is happening now.

Recent news in healthcare is disproving the apparent uselessness of the current wearable technology market. The Scripps Translational Science Institute has received a grant from the USAID for its program that uses Sotera Wireless’ ViSi Mobile System to continuously monitor the blood pressure, pulse rate, ECG, breathing rate, temperature, etc. of Ebola patients through a wearable sensor. Ultimately, this would help in identifying warning signs of Ebola early on, before the virus has the opportunity to spread. Doctors’ chances to miss changes in health status will be significantly reduced, as they would receive the data collected regularly. This project, called STAMP2, could monitor up to 500 patients, with the potential to grow even further.

Why is this important? I believe this could be a new approach for this industry that opens up the usability of wearables on a global scale. If physicians become more aware of the widespread use of wearables, especially in preventing health concerns even as devastating as an Ebola outbreak, they will become more invested in applying this technology to their own aging patients in order to prevent or detect chronic conditions earlier. Patients tend to trust their doctors—44.2% have said their doctors’ recommendations would be an incentive to use a fitness tracking device. Hopefully, as wearables start to show that they are useful in healthcare, they will have the opportunity to impact more patients in the future.

http://www.wired.com/2014/11/where-fitness-trackers-fail/

http://mobihealthnews.com/40564/scripps-wins-usaid-grant-to-monitor-ebola-patients-with-medical-wearables/

http://technologyadvice.com/medical/blog/study-wearable-technology-preventative-healthcare/

Guest posting by Jesal Shah

Going forward, as identified by many in the first critique session, the most challenging task in our campaign to increase HIV screening by physicians will be the aspect of changing doctor behavior. Most health education efforts are usually patient-centered; moreover, a majority of recent attempts to change doctor and hospital practices have involved top-down, reimbursement and incentive-based mechanisms rooted in economics. This includes remuneration forms, such as salary, capitation, fee-for-service and diagnosis-related groups, as well as reinforcement schemes, like pay-for-performance or financial penalties. However, these strategies are beyond our limited institutional know-how and power.

Increasing physician testing of HIV will be particularly challenging, because screening benefits are not immediate. It’s as Dr. Atul Gawande, a prominent surgeon, health policy expert and author, puts it, “an invisible problem”. In his piece, “Slow Ideas”, Dr. Gawande contrasts the difference between the widespread adoptions of anesthesia, which provided visible benefits and eased doctor’s workflow, and the slow implementation of antiseptic protocols and technologies, which had less immediate returns and required greater doctor effort. Evidence for a certain practice in itself is not enough to build acceptance in the medical community.^1,2 While there are very few high quality studies examining physician behavior change models/strategies, the status quo dissemination through publication, pamphlets or guidelines has been shown to be largely ineffective.^2,3 These methods are extremely passive and distant; efforts, which are active and interactive, have been demonstrated to be more successful. These include in-person educational outreach or academic detailing. There has also been evidence supporting the utility of reminders or audit-then-feedback approaches. Overall, there are other innovative individual piloted techniques, such as Dr. Vivian Lee’s tactic to capitalize on the intrinsic competitive nature of physicians or Dr. Gawande’s mentorship network, which uses persistent human connection to promote behavior change. However, the most important message ingrained in literature is that multifaceted interventions tackling various barriers is better than a single campaign.^2,3 This echoes the suggestions of many at the critique session, including our problem owner. Physician behavior change is an insurmountable barrier when approached narrowly, but in combination, many of the above techniques and others, can hopefully facilitate a change in HIV screening practices.

Sources:

1. Gawande, Atul. “Slow Ideas.” The New Yorker. The New Yorker, 29 July 2013. Web. 14 Feb. 2015.
2. Grimshaw, J. M., M. P. Eccles, A. E. Walker, and R. E. Thomas. “Changing Physicians’ Behavior: What Works and Thoughts on Getting More Things to Work.” Journal of Continued Education of Health Professionals 22.4 (2002): 237-43. PubMed. Web. 14 Feb. 2015.
3. Smith, W. R. “Evidence for the Effectiveness of Techniques to Change Physician Behavior.” Chest 118 (2000): 8-17. PubMed. Web. 14 Feb. 2015.