Mar 21 2014
Design

Room to Create

This semester, as we’ve investigated strategies to improve inter-professional communication and care coordination in intensive care unit (ICU) rounds, I’ve been surprised by two things:

  1. Everyone’s seen the problem. This isn’t a situation where astute perception revealed systemic undercurrents; anyone who’s participated in rounds is intimately familiar with its inefficiencies. Everyone understands this, but nobody has definitively addressed it.
  2. Everyone’s thought about solutions. Whenever we’ve discussed rounds with a patient or provider, it’s profound how much they’ve given this thought. Anyone can readily suggest areas for impact, or even specific methods for improvement. Why hasn’t intuition translated to innovation?

It’s attention – or more specifically, the scarcity of it. Nobody recognizes the opportunities for creative destruction in healthcare better than the people who spend each day in the trenches of clinical medicine. But after patient care, administrative hurdles, research responsibilities, teaching duties, continuing education, and something that might resemble a personal life, providers have neither the interest nor the capacity to cultivate an innovative spirit.

Which leads me to ask: what might healthcare look like if we gave providers the time and space for disruptive thinking?

What if medical teams borrowed from Dropbox’s Hack Week? What if health institutions, as Google did, allowed every provider 20% of their time for creative ventures? What might the likes of the inventive energies and constructive cultures that created GMail, AdSense, and Google News do for healthcare? A different approach to ICU rounds? A re-designed EMR interface? A stronger capacity to screen for, and address, the social determinants of poor health? The opportunities are limitless.

And thus, for healthcare providers, students, patients, entrepreneurs, everyone, I offer these thoughts:

  1. What would you do if 20% of your professional time was protected for creativity and inspiration?
  2. In what ways does your work atmosphere cultivate innovative vision, and how could it better meet that goal?
  3. Beyond limits to time and attention, what are other functional obstacles to innovation in health settings, and how can we mitigate them?
Mar 18 2014
Design

The far-reaching effects of clinical trial conversations

When I was first diagnosed with Hodgkin’s Lymphoma, my oncologist sat down with me to discuss treatment options.

There were two options for standard of care, she told me. I could get six cycles of chemotherapy, or four cycles of chemotherapy followed by radiation. I could also enroll in a late-phase clinical trial, which was testing the long-term results of rituximab biotherapy on Hodgkin’s patients with cancer cells that fit a certain profile.

Rituximab had already been approved for other lymphomas, and a published study showed improved results when this biotherapy was combined with chemotherapy. It also was fairly risk-free. Although various adverse effects do occur with rituximab, the most common is an allergic reaction, which they give Benadryl for during treatment.

I decided not go on this clinical trial because of concerns about the control group. However, rituximab intrigued me. I found the previous studies convincing, even though the prices for the drug were astronomical – more than $6,000 per dose, and I would need more than one dose. So I called up my insurance company, and they agreed to review my case.

They ended up paying for my treatment with rituximab, which makes good business sense. If I don’t relapse, my insurance doesn’t have to pay for the hassle. However, this is the key point: I would have never known about a vital drug if my oncologist had not mentioned a clinical trial. 

What else can we learn from my anecdote?

  • Conversations about clinical trials indicate a high quality of care. My oncologist gave me several options, one of which represented the cutting edge of cancer research.
  • Patient education and engagement matters. I had to be my own advocate to the insurance company, and it was precisely because I was educated and pushed that I was able to get the best treatment possible.

 

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 15 2014
Communication, Culture, Technology

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.

Mar 12 2014
Communication, Culture Video

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.

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