Cast & Curious

Category: Learning and Development

  • Should Physicians mind their “Webside Manners”?

    Approximately 87% of US adults are online. Of these, a huge 72% seek health information online. Trust for physicians remains high though as 70% of these adults would seek a healthcare professional’s help  for major medical conditions.

    Contrast this trend with how many of physicians are taking advantage of information technology to provide healthcare information online or even clinical care from a distance.  A measly 3% of physicians engages patients online. Even if one in three US physicians use or is planning to use telemedicine, the actual usage of telemedicine by patients is lower though at about 9-15%.

    What these statistics are saying is this: patients are going online for health information but our healthcare system is slow to adapt. The advantages of Telehealth and telemedicine especially for the archipelagic Philippines is pretty obvious but so are the staggering challenges.

    How about Social Media?

    Telemedicine is broadly defined as providing clinical care from a distance, using telecommunication and information technologies. Strictly speaking, social media isn’t part of telemedicine yet. Dr. Joseph Kim pointed out though that there’s a small (albeit increasing) percentage of doctors who use social media to provide health information and professional networking.

    Extending Bedside Manners

    The traditional physician-patient interaction in the clinical setting is governed by a set of attributes, behaviour or communication skills called “bedside manners”. Studies have shown that bedside manners ultimately affect delivery of care. The entry of information technology into actual patient-physician interaction clearly changes too the clinical setting. Perhaps this is an opportune moment for examining how effective a physician’s manners are in the light of information technology or maybe, we need to expand our concept of manners.

    Webside Manners

    The concept of webside manners came with the advent of telemedicine. While “bedside manners” pertains to how a healthcare professional interacts and communicates with a patient in a face to face encounter, webside manners probably refers to how the healthcare professional interacts or communicates with a patient over a medium (of information technology) to provide clinical care.

    So lets talk about “webside manners” this Saturday November 26, 2016 at 9PM Manila time and determine whether it should be (or it should be not) part of our bedside manners:

    • T1. Does Telemedicine have a role in clinical care? How about Social Media?Why or why not?
    • T2. Should our bedside manners need extending, to include webside manners with the advent of information technologies like telemedicine or social media?
    • T3. What webside manners do you think are most needed?

     

    Don’t forget to include hashtag #healthxph when joining the chat on Saturday at 9PM Manila time. See you!

    Image: https://commons.wikimedia.org/wiki/File:Telemedicine_Consult.jpg

    Resources:

    http://www.pewinternet.org/data-trend/internet-use/latest-stats/
    http://www.pewinternet.org/2013/01/15/health-online-2013/

    https://en.wikipedia.org/wiki/Telemedicine
    https://www.accessrx.com/blog/current-health-news/how-many-family-doctors-are-using-telemedicine/
    http://www.mobihealthnews.com/45682/survey-9-percent-of-consumers-have-used-a-telehealth-service

  • Disruptions in Health: Healthcare information technology in a limited resource community

    How could information technology improve healthcare in a limited resource community? 

    This is one of the questions asked in one of the health information technology appreciation talk I gave recently.

    When care is complex, expensive, and inconvenient, many afflictions simply go untreated.

    Health information technology is a broad concept that encompasses an array of technologies to store, share, and analyze health information.  In primary care, examples of health IT include the following:

    • Clinical decision support.
    • Computerized disease registries. (e.g. Trauma registries)
    • Computerized provider order entry.(CPOE)
    • Consumer health IT applications. (e.g. wearables)
    • Electronic medical record systems (EMRs, EHRs, and PHRs).
    • Electronic prescribing.
    • Telehealth

    HIT ultimately aims to help healthcare providers provide excellent care to their patient.  HIT does this by improving point of care areas along the patient – provider flow, from the time patient goes in the hospital to the time he/she went out and up to their home. (see figure below)

    cds flow
    Conventional flow of patient /point of care in a hospital setting

    Some of these HITs (EMR, CPOE)  have been shown to reduce medical errors by up to 80%, prescription errors by up to 55%. While HIT has the potential to reduce utilization of healthcare, investing in HIT is not cheap so far. The main challenges are investing cost and resources.

    The real hope is in disruptive innovations in health that uses these information technologies to bring down healthcare cost but improve quality of care.

    Disruptive innovation, a term of art coined by Clayton Christensen, describes a process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves up market, eventually displacing established competitors. – See more at: http://www.claytonchristensen.com/key-concepts/#sthash.iNDhe9BG.dpuf

    Areas like telemedicine and consumer health products are just beginning to pick up trend. But cost and quality of care metrics has yet to be validated to yield a significant disruption.

    Information technology that has potential in improving quality of care
    Information technology that has potential in improving quality of care

    So going back to the question earlier, I’m a believer that somehow a disruptive innovation would breakthrough with these sets of HIT and  improve delivery of healthcare in low resource communities.

    I’m inviting all health stakeholders- MDs, Nurses, allied med professions, policy makers, health institutions, research groups, pharma and medical devices to a tweetchat this Saturday May 14, 2016 9PM Manila time.

    Lets crowdsource ideas from HIT thought leaders and healthcare community what would these potential disruptions and innovations that will impact low resource communities.

    • T1. What health information technology you use now to provide quality care and why?
    • T2. What specific disruptive information technology do you think would improve delivery of care at a lower cost  in limited resource community (like PH)? How?
    • T3. What is the main challenge to this disruptive technology? Research? Policy?Education?

    Don’t forget to use #HealthXPh. Se you all!

    Readings:

    https://www.healthit.gov/patients-families/basics-health-it

    https://hbr.org/2000/09/will-disruptive-innovations-cure-health-care

    Disruptive Innovations That Will Change Your Life in Health Care

    http://www.forbes.com/sites/ashoka/2013/04/23/disruptive-innovation-a-prescription-for-better-health-care/#f7dfd447c442

    http://mobihealthnews.com/31470/revisiting-how-christensens-disruption-innovation-in-healthcare-means-decentralization

  • Book Review: Comprehensive Hip & Knee Textbook 1st Edition

    The Comprehensive Hip and Knee Textbook 1st Edition by the ASEAN Arthroplasty Association and The Hip and Knee Society is a comprehensive textbook for arthroplasty surgeons and healthcare professionals managing hip and knee patients in the ASEAN region.

    Contributed by select experts on arthroplasty from ASEAN region, the book essentially lays out theoretical concepts and tips for routine practice in primary hip and knee arthroplasty.

    The book is written with the ASEAN hip and knee arthroplasty surgeons in mind. The editorial board took great lengths in selecting regional experts and healthcare professionals in the field of hip and knee arthroplasty. The contributing authors and editors also tapped on the time tested experience of these surgeons, combined that with currently accepted treatment guidelines to treat hip and knee problems peculiar to the ASEAN region.

    The table of contents is chronologically arranged- from patient selection to post op management, to guide surgeons as he goes to the process of treating a hip and knee patient. These include the various approaches, implant selection, pre op and intraop techniques, to postoperative rehabilitation and management of potential complications.

    The content is written formally with citations to recently published researches to back up concepts laid out in the book. It however, maintained a more spontaneous, lively narrative akin to a surgeon managing a hip or knee patient and at the same time, teaching surgeons  technical pearls in hip and knee surgery. What’s more exciting is the book’s anchor on current literature, citing accepted treatment protocols but adapting time tested regional experience to address hip and knee surgery problems in the ASEAN region.

    Another thing I liked about this book is the clarity and simplicity to which key concepts are expounded. The chronological progression of concepts, techniques, pearls and management peculiarities makes it easier for the reader to follow the flow of thoughts through the chapters of the book. The authors clearly spent time simplifying concepts to make it really understandable even to the newest surgeon in practice.

    Notable also is the book’s detailed and orderly presentation of techniques. Picture plates of diagnostics, pre op and actual surgeries brought the presentation alive. Since arthroplasty is a very visual field of practice, the reader will gain much by studying the picture plates

    Index is arranged alphabetically with word appearances paged chronologically so it will be easy to find similar concepts appearing in the different chapters of the book.

    All in all this is a well written, collated, well presented textbook for ASEAN hip and knee surgeons. It succeeded in compiling hip and knee arthroplasty concepts from well known experts in the region. It also succeeded in elucidating current treatment protocols , combining that with the ASEAN experience, to create a hip and knee textbook tailored made for the ASEAN hip and knee surgeons and their patients!

    The Comprehensive Hip and Knee Textbook 1st Edition was edited by Aree Tanavalee, Christopher Scott Mow, Azlina Amir Abbas, Gregorio Marcelo Santos Azores, Nicolaas Cyrillus budhiparama and Ngai nung Lo. It was produced by the ASEAN Arthroplasty Association and The Hip and Knee Society. It was first published in Thailand in 2013 by Holistic Publishing co, Ltd. The copyright belongs to The Thai Hip& Knee Society.

    To purchase a copy of the book in the Philippines, please contact Elizabeth Fullente, secretary Department of Orthopedics, UP-PGH. 

  • EBM Tools : Ten Ways of Improving Journal Clubs

    Our department has been conducting evidenced based journal clubs for its orthopedic staff since last year. We implemented a relatively standard, EBM style “format” of presentation that encourages thorough, analytical and critical thinking among our residents. This was also to prepare these residents for a better, EBM acceptable researches in the future. Indeed during the initial sessions of our journal club, we seem to have made a good impact.

    After attending our latest journal club however, a few reports were drifting back and there’s still room for improvements. I’m not dampening the efforts of some residents in preparing their presentations. I can see potential in their reports. But a resident (you know who you are) simply made it appear he has been in the dark ages of EBM. His report pales in comparison to a known, acceptable format for a lively, critical and learning-conducive journal club reporting.

    In this, many (if not all) of our consultant staff would agree. So I’m making some suggestions to improve some more our  journal club presentations. I know I may sound like a broken record but  consultants do feel sad when residents perform below their potentials .

    To help you out, here are these suggestions.

    1. Prepare ahead (weeks, not an hour!) of the journal club schedule. Think (or look back) for an case/problem/dilemma that affected you and your orthopedic training
    2. Problems in orthopedics can be broadly classified into whether it is a clinical,  diagnostic, therapeutic, technical or surgical dilemmas, outcomes etc. Identify where your case/problems falls and then read the appropriate EBM guidelines in critiquing journals for those. Use them as guides.
    3. Search for an appropriate journal. Appropriate means the journal relevance to your case/dilemma/problem/question. The journal should be able to make you decide for an appropriate EBM based action on your case/problem on hand.
    4. Read first these general guidelines (I will enumerate them below) before during and after you read your journal. This will definitely guide you on sifting out weeds on your journal!
    5. Make sure you can answer these questions and knew your journal by heart before even trying to write/prepare your presentation slides.
    6. Prepare a 10-15 minute presentation that could answer these same general guidelines. Stick to the basic presentation format, slide color presentation and brevity of words.
    7. Presentation should be concise, short but should answer all the relevant questions. Relevance should be at the first level. Cut those unrelated words and phrases and don’t mention or drag in concepts your not familiar with. This will save you (and us) a lot of time.
    8. Wait for questions at the end of your presentations. Answer questions with first level relevant answers. Yes or no (or I don’t know) answers are pretty much better than strings of unrelated phrases.
    9. Take note (or ask someone to do it for you)  of questions you haven’t answered. or suggestions for your improvement.That will actually gauge your proficiency and how well you prepared for this journal club.
    10. Try to answer those unanswered questions in number nine after the journal club by either, going through the journal again and searching for appropriate material to read (books,journals researches etc). Just don’t leave any questions hanging for you and your colleagues.

    I’m reprinting this outline from this journal and so all credits goes to the authors

    • DESCRIBE THE CASE OR PROBLEM THAT ATTRACTED YOU TO THIS PAPER
    • EXPLAIN HOW YOU CAME ACROSS THIS ARTICLE
    • DESCRIBE THE STUDYAND THE RESEARCH QUESTION
    • STATE THE IMPORTANCE/RELEVANCE/CONTEXT OF THIS QUESTION
    • DESCRIBE THE METHODS BY GIVING MORE DETAIL ON THE QUESTION COMPONENTS
    • STATE YOUR ANSWERS TO THE CRITICAL APPRAISAL QUESTIONS ON VALIDITY
    • SUMMARIZE THE PRIMARY RESULTS
    • DESCRIBE WHY YOU THINK THE RESULTS CAN ORCANNOT BE APPLIED TO YOUR PATIENTS/SITUATION
    • CONCLUDE WITH YOUR OWN DECISION ABOUT THE UTILITY OF THE STUDY IN YOUR PRACTICE—RESOLVE THE CASE OR QUESTION WITH WHICH YOU BEGAN
    • FINALLY, PREPARE A 1 PAGE SUMMARY OF THE OUTLINE ABOVE AS A HANDOUT

    You can also freely download the file and reproduce or distribute them. Hope these suggestions will all improve our journal clubs in the coming months! I, for one will be expecting more from the presenter.

    • Mark D Schwartz, Deborah Dowell, Jaclyn Aperi and Adina L Kalet. Improving journal club presentations, or, I can present that paper in under 10 minutes Evid. Based Med. 2007;12;66-68