Feb 28 2014
Design

Proceed with Caution

My last blog entry posed a question that has yet to be explored: should patients be obligated to share themselves with their doctors via social media? That is, might physicians be able to use social media to learn more about their patients?

 

To answer this question, I present a scenario:

 

Susie, a twenty-three year old female, enters the ER with severe iron-deficiency anemia and a shockingly low hemoglobin count. She needs to be transfused right away, but Susie quickly and firmly refuses the transfusion because the idea of having someone else’s blood “freaks her out.” She stays in the hospital for three days when Dr. Smith notices a fresh wound on Susie’s left thigh that is becoming infected. Susie swears that it showed up on its own, but the wound looks like the result of self-mutilation.

 

Dr. Smith becomes increasingly worried that Susie’s low hemoglobin count is due to self-phlebotomy and that, because of her dramatic refusal of transfusion and her unclear and changing symptoms, she may have Münchausen syndrome.

 

Dr. Smith decides that, because Susie is being uncooperative and irrational, she will look at Susie’s Facebook page to retrieve honest information. After work, Dr. Smith scrolls through Susie’s pictures and sees photo after photo of blood bags, IVs, and hospitals, as well as statuses bragging about how many times she’s visited the ER that year.

med

 

In an attempt to uncover more information, Dr. Smith reads through Susie’s Twitter feed. Almost every tweet mentions a new diagnosis or medical problem.

tweet

Is it ethical for Dr. Smith to look at Susie’s Facebook page and Twitter feed to search for information that would confirm her hypothesis? What if the discovered information would alter the course of Susie’s treatment? Would the information retrieved from the social media sites go into Susie’s EMR? Would Susie ever find out?

 

Social media is taking medicine to new heights, but it’s leaving us with many unanswered questions as well. Platforms like Facebook and Twitter are opening new avenues of communication between patients and physicians, but in doing so, may cause breaches of patient autonomy and confidentiality.

 

The positive repercussions of using social media in medicine are many, but be warned: we must proceed with caution.

 

 

 

 

Feb 28 2014
Design

Taking the Pulse of Social Media

Doctors are becoming more than a white coat and a stethoscope. They are becoming bloggers and photographers; rappers and painters; designers and musicians. Quite simply, doctors are becoming people. Real, true people.

 

To what do we owe this drastic change of public image?

For the most part, we can attribute it to social media.

fb

We all know that physicians are beginning to utilize social media platforms—such as Twitter, Facebook, Instagram, and LinkedIn—as avenues for effective communication with patients. They are realizing that, by breaking down communicative barriers, they are able to engage patients in a new way.

 

The way I see it, there are five reasons why physicians should embrace social media:

  1. It lets you meet the patients where they are.
  2. It increases physician transparency in the medical community.
  3. It makes for engaging interactions with colleagues, and therefore helps spread important health information.
  4. It’s a way to create and curate medical narratives.
  5. It’s not mandated (for the most part).

 

But, as social media plays a bigger and bigger role in the lives of patients, physicians very well may be obligated to share themselves with patients via social media. It allows patients to get to know their doctors outside the four walls of the hospital and, therefore, keeps them better informed. As we know, informed medical decision-making is a prerequisite for all effective medicine.

 

Social media may be used as an avenue for storytelling—something that, conveniently, is the foundation of our Artificial Hearts group problem. Cardiologists have made use of social media in a rather unique way: as a tool for education of clinicians, physicians, nurses, and medical students. Rather than embracing patient-driven social media, the field of cardiology is embracing physician-driven social media.

 

Blogs and social networks dedicated exclusively to cardiology are allowing physicians to distribute, share, and comment on medical content such as images, scientific abstracts, and summaries of clinical trials. One such network is CardioSource.org, founded by the American College of Cardiology

ACC

CardioSource.org is an organizational website that has a private social network for users in which issues important to cardiology are discussed. The blog’s content is majority member-sourced, and the members and readers both are predominantly heart-centered medical professionals. In this way, the platform fosters a vivid culture of conversation, curiosity, and compassion.

 

The ACC has recently expanded CardioSource to LinkedIn, Facebook, and Twitter, and hopes to continue growing for decades to come.

 

http://www.cardiosource.org/acc.aspx

 

 

 

 

 

Feb 28 2014
3 Comments
e-patient, Technology

Quantify Yourself

As Socrates once said, “to be is to do.”

As an aspiring physician, I’ll soon enter a clinical environment that’s more data-driven and technology-oriented than ever before. More patients are using mobile applications to track their health data. More providers are incorporating patient-generated big data into clinical decision-making. More devices are becoming integrated into the Internet of Things, a connected contextual framework with the power to drive personalized, predictive healthcare.

In class, we’ve discussed how e-patients can use self-tracking to build awareness and control over their health status. In our design setting, we’ve examined how intensive care physicians have to consolidate vast quantities of data into a cohesive patient narrative and a plan of care. But there’s discussing and observing, and then there’s doing. I decided to take it a step further. I wanted to situate myself in the patient’s, or provider’s perspective, using self-tracking to inform and inspire my own health behaviors.

Over the past 30 days, I’ve used Azumio’s Argus to construct a digital timeline of my lived experiences. Every morning, I log my sleep, heart rate, and blood pressure. As I walk across campus, I measure my steps and calorie consumption. When I sit down for a meal, I take a snapshot of my plate. With each meal, I record how many glasses of soda and/or water I’ve had. When I hit the Rec Center, I record my exercise by type and duration. If it’s a weeknight study session, I count how many cups of coffee or tea it takes to power through it. If it’s a weekend, as I hit the bars, I save how many bottles of beer or glasses of wine I’ve had. And at night, I check my pulse and blood pressure again right before my head hits the pillow.

Now, the critical question: what have I learned?

Commitment. Between Week 1 and Week 4, my “compliance” fell from 96% to 63%. It takes a committed, conscious effort to record every meal, every vital sign, every exercise, every minute of the day. I hold a new-found respect for the diabetic patient who has to monitor his blood sugar, manage his appointments, and mind his meals; it’s a process that’s both distracting and exhausting.

Awareness. As much as the constant inputs were a challenge, they empowered me to become cognizant of my daily behaviors. Did I really eat pizza and chips for lunch that often? I went that long without drinking water? Do I really spend so much of my day in a sedentary state? To record empowers us to know, and to know inspires us to act. I wonder if, as we move towards ‘ambient-tracking’ devices, we’ll lose this sense of awareness and agency.

Application. So often I found myself asking, what really matters? Argus would frequently warn me that I hadn’t drank water in three hours, or congratulate me for walking 10,000 steps that day. Did these things necessarily make me a healthier person? As we realize our ability to quantify everything, it’s important for us to isolate signals amidst noise. It’s necessary that we identify the parameters that matter for health versus those that don’t. It’s vital that we appropriately calibrate the thresholds of behavior that justify a congratulatory or cautionary alert. Data for data’s sake is useless; the next step is to make that data actionable.

If you haven’t quantified yourself yet, it’s a must. Data is a ubiquitous element of our modern lives. When we quantify ourselves, we can critically evaluate our daily experiences from a birds-eye vantage point. We can channel those insights into knowledge and action to enrich our lives. And, as future physicians, we can learn what it means to gather data, make sense of data, and use data to drive clinical decisions.

Feb 28 2014
Communication, Culture, e-patient, Humanities, Humanity, Medicine

A Technocultural Medical Revolution

ePatients are often lauded for their effective use of technology.  They use technology as a means to take measurements, research information, and create communities.  While their use of technology is often the focus of attention, their culture is often neglected.  Ferguson and Frydman (2004) address both of these points in their seminal article about ePatients and argue, “We are witnessing the most important technocultural medical revolution of the past century.”

The culture of the ePatient movement definitely needs attention.  By changing the dynamics of the physician-patient relationship, ePatients are effectively changing the culture of how laypersons interact with physicians.  Carman (2013) proposes that there is a continuum of engagement for patients in direct care.  Currently, most patients fall under the category of consultation; that is, they receive information about a diagnosis.  ePatients argue that they should have greater engagement.

Patients may get more involved by sharing their preferences in a treatment plan, thereby taking into account their individual culture, background, and spirituality.  On the most engaged end of the spectrum, patients have partnership and shared leadership with the physician.  Carman (2013) imagines that with this level of engagement, “treatment decisions are made based on patients’ preferences, medical evidence, and clinical judgment.”

Clearly, this is a step away from current physician-patient interactions.  With higher levels of engagement, patients are expected to be health literate.  They are considered equals with the physicians and can elect their own treatment plans.

But is this change in culture possible?  People around the globe unanimously regard physicians to be the most respected professions, and there are multiple reasons for this.  Medical professionals have a direct impact on the lives of everyday people.  They are present when people feel the most vulnerable, and they serve as their confidants.  Physicians tend to have higher levels of education and higher income, and they have great responsibilities and expectations.

Photo Credit: illustrationsource.com

In cultures that have a predominant social hierarchy, the idea of being an ePatient seems almost frightening.  For many East Asian countries, some patients would not dare correct their physicians.  It would be disrespectful, impolite, and indicative of lesser social status.  It would disregard power dynamics, and the patients would be overstepping long entrenched boundaries.  It is, therefore, unsurprising that the ePatient movement has its roots in the Western world.

Additionally, in the ePatient-physician relationship, it is critical to distinguish the difference between health literacy and medical education.  While patients may understand the biological processes behind their illness, physicians have had at least seven more years of education in medicine whether in medical school or in residency.

Photo Credit: healthydebate.ca

In this technocultural medical revolution, there must be balance.  Mutual respect is key.  There must be an acknowledgement that the physician has greater expertise, but physicians cannot regard themselves as superior.  It is true that the physician cannot fully understand what the patient is experiencing, but the physician can at least practice empathy.

In any case, we must be aware of these cultural phenomena if the ePatient movement is to be globally ubiquitous.

Photo Credit: growingolder.org

Feb 28 2014
Communication, Design, e-patient, Electronic Medical Record, Health, Prototyping, Technology

Ping. Have It Your Way.

Ping.  That must be my daily reminder.  How am I feeling now in terms of arousal and valence?  Well, I just had my weekly meeting with my research advisor.  He was really getting into the nitty-gritty and suggested that I should have been farther along with my project.  I don’t even like this project.  I wish I could just get it over with… Anyway, probably low valence.  It was a pretty negative experience.  Also high arousal… He really stresses me out, and I could feel my blood pressure rising.

Photo Credit: mzstatic.com

One of the greatest benefits of mood tracking is increased self-awareness.  Mood tracking apps like Moodscope and Mobile Therapy remind users to take a step back and to reevaluate their life choices.  They can reflect on what is bringing them happiness and what is bringing them down.  By connecting their moods with other factors happening in their lives, users can develop a greater understanding of themselves with respect to their environment.

The beauty of mood trackers is that they also provide spatial and temporal information.  Users can link their moods to their immediate spatial surroundings and to the time of recording.  By randomly sending pings throughout the week, these apps can help users determine where and when they tend to feel upset or happy.

Additionally, mood trackers do not only take in information, they can also offer advice.  Mobile Therapy offers therapeutic exercises, including breathing visualization and muscle relaxation.  It also offers strategies to quit smoking, treat anxiety, and detect relapses in psychotic disorders.  Ideally, these mood tracking apps could personalize therapeutic exercises to a user’s specific input.  You could “have it your way” by inputting end goals, such as cultivating happiness or controlling the relaxation response.

Photo Credit: play.google.com

With most mood trackers, it is also possible to add information through texting—users can share paragraphs of information if they feel inclined to do so.  Therapists and physicians could use these self-reflections to see how their patients are doing over time.  Appointments with health professionals are short, and they are not necessarily indicative of how the patient normally acts.  Some patients may experience white coat syndrome, so there is an additional benefit of having records of patients outside of the doctor’s office.

In the future, perhaps these apps could notify the patient’s physician directly.  Jon Cousins describes the benefits of connecting his data to those close to him: “We leave traces of ourselves with our numbers, like insects putting down a trail of pheromones, and in times of crisis, these signals can lead us to others who share our concerns and care enough to help.”

If physicians have access to their patients’ personal information, they can individualize their treatments.  While there would be a lot of information to handle, this issue could be alleviated with efficient organization and clean programming.  It is possible to automatically assemble the relevant information in a visually aesthetic way, and these apps track not only the physical health of users, but also their mental and psychosocial health.

← Older posts
Newer posts →
Follow

Get every new post delivered to your Inbox

Join other followers: