Cast & Curious

Tag: Medicine

  • Social networks and physician bloggers:Why some physicians blog and some others don’t

    In the recent years we’ve seen the rise of physician bloggers and physicians in social networks like Facebook, Tweeter, Multiply, online medical community like Recomed , Linked In or such online conferencing tools like Skype. While what constitute “sociable” data (those that can be shared or not shared on these networks) remains gray and debatable, this rising trend will continue for quite sometime at least in the first world countries I believe.

    Still, some physicians (especially in developing countries) isn’t taking advantage of these social networks and online health care tools to develop their practice and improve patient care. Obviously there are distinct advantage and disadvantages for physicians getting involve on these social networks. The recent suggestion of charging patients for online consults is gaining some discussion. While such non-conventional patient-doctor interaction evokes strong debates on ethical issues, it is putting affront alternative ways of improving health care delivery and efficiency. This is a clear indication that some physicians are opening their minds to “non-conventional” patient-physician interaction to improve health care delivery and practice. Its only a matter of time before ethical issues is resolved and guidelines set forth.

    What about the other physicians who don’t blog or join these social networks? What are the main reasons they don’t capitalize on these social networking sites?On these online health care tools? In third world countries like the Philippines, where technology is generally 10 years behind. Ironically, this is not limited to the more senior generation of physicians. Nowadays, I am not surprised when one colleague whispers the question  “what is an e-mail” or mumble “social networking are for teenagers”. Surprising, but I’m not entirely surprised.

    Here are some of what I gather as the reasons for this lackluster jump into blogging, online health care tools and social networking.

    As I pointed earlier,  in the Philippines, our technology is  generally 10 years behind that of first world counterpart.  Technology adaptation in medicine for developed countries is usually 3 years behind. Thus we know how developing countries delayed  “jump” into these online tools. If ever we have this kind of technology, it is usually limited to private tertiary hospitals in big cities who can afford to provide their staff with a suitable online tools to improve hospital services. Even in such centers, health care technology is limited to improving health care delivery inside the institution rather than collaboration with the online health care community . What interest me though is this.Majority of physicians in this country own a PC, a laptop, top of the line cellphones phones and an internet connection, but only a few capitalize on online health care tools!

    The next most common reason is that physicians are almost always busy attending to their practice and for that matter their patients. Some don’t bother to read mails, journals or online medical feeds much more write something to this effect. Others, believe online networking  tools isn’t useful to them they’d rather spend time in their clinics and on their patients. If you noticed however, that most physicians have leisure time activities, like outings, sports, etc on a regular basis which means time can be allocated if one wants to. Which brings me to the next reason.

    Social networking and online health care tools are not a priority to most physicians. There’s no clear cut benefits and advantages to them and hence the “wait and see attitude“. We physicians are always relying on personal experiences for technology adaptation. Look at what happened to cellphone and sms messaging. Philippines is the world’s texting capital. Slowly physicians adapted to this too. Now it’s common for Filipino physicians to use sms messaging to schedule patients, communicate information and what others.

    Basically that will be the path of social networking to health care professionals in this country. As soon as we experience the clear advantage and use of social networking and online tools, the jump will happen. Until then, we only hope some physicians gain interest and try to advantage of these available tools. Then we will see technology adaptation just like what we saw with the sms invasion.

  • An over the counter, “drug store diagnosis” and drug dispensing

    I usually go to drugstores incognito to buy my own anti allergy meds. During these incognito trips to pharmacies and drugstores, I get to witness interactions between customers and pharmacy attendants without them knowing I’m a medical professional. Most conversations are totally harmless but on few occasions, I hear conversations that could probably bedevils me.

    Here’s one of the sales lady – buyer overheard conversations:

    Customer: “Miss ano maganda gamot sa trankaso?”(Miss , what drug can you recommend for flu?)

    Saleslady:” (Name of brand X drug), trangkaso man kaha.” (_________, you got flu, right?)
    Customer:” Three times a day na sya ano?”( Three times a day?)
    Saleslady:“Yes”.

    While the saleslady was getting the drug…..

    Customer: “Unsa, maayo nga antibiotic para sa trangkaso?”(Miss , what antibiotic can you recommend for flu?)
    Saleslady: “Konsulta sa mo sa duktor nay.” (Consult a doctor first)
    Customer: “Cge, katong Decolgen na lang ako-a, tatlo ka buok. Ug isa ka Eskinol kanang medium bottle)” (I’ll get three tablets of Decolgen and one Eskinol medium sized bottle.)

    Here’s another.

    Customer:”Miss anong maganda na bitamina para sa matatanda?” (What’s vitamin can you recommend for adults?)
    Saleslady:“Para sa unsa?Ugat o bukog?”( For what?Nerves or bones?)
    Customer: “Sakit man yung likod ko kasi. Yung para sa ugat. Bigyan mo ako ng pito” (I have backpain, I need the one for nerves.Give me seven pieces.)

    I was shaking my head in disbelief. If this is happening in one major drug dispensing store, I could only sigh for whats happening in other smaller drug stores somewhere else!

    I cannot simply point finger on any one health stake holder as the cause of this drug dispensing dyseducation (for lack of a better term), but I’m pretty sure we all contribute.

    That’s why it is imperative that pharmacists (or their salespersons) are not allowed to prescribe drugs or give health information that are beyond their knowledge base. In Medicine, a bad information is no worse than no information at all. And it kills, mind you. That’s why accountability for providing health care is a must, otherwise these type of interactions just go unabated.

  • Philippines: Enroute to Mc Allen Health Care System

    It came as a no surprise. The never ending  finger pointing of who or what did “jacked” up the high cost of health care in the US suddenly found an ominous target. Health care providers particularly physicians, may have been partly responsible for the high cost of health care in the US. One such article that suggest this was written by Atul Gawande and posted on New Yorker Annals of Medicine: The Cost Conundrum.

    Atul wrote his “musings’ on two health care systems (Mc Allen in Texas and Mayo Clinic)  that exist in the US which showed a stark contrastsin their health care cost and outcomes. Health care authorities wonder why such an average income city like McAllen, wield one of the highest health care costs (second only to Chicago, considered to be a high income, high cost of living area) yet their cities health care outcomes are no better than other cities in the US utilizing a lower cost of health care. Surprisingly, a well known top notch health care institution like the Mayo Clinic deliver a better than average health care outcomes with health care utilization cost that is lower than most health institutions in the US!

    So why the physicians are partly the reasons for this? The writer ponted some not so obvious reasons. Not a few physicians order” “unnecessary” diagnostics to increase diagnostic accuracy and partly to protect themselves from malpractice suits or litigation. Another reason is rising unnecessary clinic visits, specialist referrals, entrepreneurial marketing endeavors that walk on thin borders of ethical compromise, physician s education or training and so many things. The fee based business- like private practice also creates pressure on objective decision making of physicians, propelling a market physician practice. There were so many things pointed out and none has yet set a clear local and national health policy to clear this out.

    This article became a must read for Obama and his White House staff.

    I think the Philippines can also learn from these insights. While we preoccupy much of our debates over two spectrum of health care delivery (poor vs rich ) present in the cities, we do not exactly know the vast number of “in between” that reside in the rural areas.The Mc Allen phenomena is not unique to Texas. While those in the tertiary centers of health (e.g. Manila, Cebu, Davao) presumably get better access to quality health care system, the fee based system we have limits this quality health care to those who can afford it. Of greater concern are those poor Filipinos in the rural areas, where not only that they don’t have access to better quality healthcare, they’ll have to shell out more than their counterparts in the centers to obtain same quality health care. Why is that? I don’t have answers to this. Our health insurance system? It only magnified a few these apparent disparity.

    One example I can point out is the coverage Philhealth (PHIC) for illnessess claimed by its insured constituents. Assuming the same illness, the same level of care is provided for by the health care professional or instituion, reimbursements is still dependent on the “level of hospital” (primary vs. secondary vs. tertiary) where the patient was admitted to. Since it is rare to see tertiaries in rural areas, claim coverage is lesser (~30-40% for some, although practically no one knew except PHIC). Ergo, the patient pays more because less is covered by his insurance. It may sound superflous but yeah, will an appendectomy performed really differ between a secondary or tertiary center? Bottomline is not who pays for the patient. The patient pays more for the same level of care provided. I am not yet talking of why the health care provider should be paid less..

    The recent drives for an evidence based medicine and the attempts by expert panels to reduce diagnostics procedures to meaningful ones is laudable. The only two great limitations to these are the source of the evidence, which is mostly foreign and the availability of such diagnostic or treatment procedures in the rural areas. Thus in the rural areas, the best evidence often translates to what is available. The GP has no choice but to revert back to his personal expertise which is most often borne out on the availability of facilities and logistics. They dont have any choice.

    The cheaper medicine law is in place after so much hoopla but so far, the effect seem anemic. The Cheaper Medicine law should have lessen the grip of pharmaceuticals on drug prices, but that doesn’t seem to be the case yet. Or will it ever be?

    Yes, the fee based health care system suck, but that’s what our system ‘revert” to with a government does not (for lack of balls perhaps) prioritize healthcare subsidies? We doctors could probably reduce our health care utilization cost if we wanted to. We were trained to do just that in training. We were taught that our patients come first and our physician business last. But while such patient-doctor relationship may seem so simplistic and altruistic, it is not bipartisan. Pressures created by external factors on this relationship surely influence the dirsection to which this relationship is consumated. The rising health care cost is just one of them.

    I’d say Filipinos will have to move heaven and earth to adopt a health care system akin to UK, porportedly the best in the world. Resitance to such change is not only unique to the pharma industries but to some physicians also. Even if it takes time for you to be seen/operated on by a specialist in UK/US, at least you get to be seen. Here in the Philippines, the chances of you getting seen/ operated by a specialist is largely proportional to your paying capacity.

  • If you’re young and wealthy, you probably own an iPhone

    That is if you believe the latest study published by Forrester Research ( private Marketing Analyst) among the 32,228 adults in the US last 2008. Take a look at their graphs below:

    or this,

    Rightly so perhaps. With the initial offering of iPhone(Apple) last 2008 skyrocketing to almost that which cannot be afforded by the “average” middle income citizens, I guess this come as a no surprise. Also with the thousand usable apps that brings in ease and usability on productivity, perhaps iphone will really beat the hell out of its other competitors in the market.

    This study will probably be more “skewed” to the right among its Filipino users, as IPhone prices here in the Philippines are only affordable to the savvier, wealthier crop of professionals.

    Let’s see what happens with the iPhone price cuts that Apple is offering these days.

  • The (high) cost of hospitalization in the Philippines

    I’m not talking about top quality health care that is available to those who can afford. I’m not even compounding the issue with other factors such as health insurance system and access to medical care. Not even the extensive use of public health facilities by the poorest 30% of the Filipino population.

    I’m talking about this patient’s words

    Doc, di nalang ako magpapaadmit sa ospital kahit kelangan. Di ko po kaya ang gastusin” (Doc, I don’t want to be admitted in the hospital  even if its needed. I can’t afford the expense)-Indang

    Her words not only rang the current “cost” of being a “poor” sick here in the Philippines but of frustration and disgust for having been a victim of a doubly whammy – that of being a poor and getting sick here in the Philippines.

    The findings of a study to assess the three year implementation of Health Sector Reform Agenda
    narrates a littany of negative factors that promotes this double whammy among the poorest of this country. One i could highlight is this:

    The average hospital bill is three times the average monthly income. Costs are so prohibitive so that a 10 percent increase in the price of private hospital services will reduce utilization by as much as 30 percent.

    Not only sounded true but also alarming. Compared to the Mayo Clinic which is among the highest-quality, lowest-cost health-care systems in America, ours pales on its reach and delivery. Philippine General hospital tries to deliver such high quality low cost health care system also but even such healthcare system hurdles not a few logistics problems.

    Here’s one good thing the guys at Mayo clinic are doing:

    …Mayo recognized that the first thing it needed to do was eliminate the financial barriers. It pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors’ goal in patient care couldn’t be increasing their income. Mayo promoted leaders who focussed first on what was best for patients, and then on how to make this financially possible. No one there actually intends to do fewer expensive scans and procedures than is done elsewhere in the country. The aim is to raise quality and to help doctors and other staff members work as a team. But, almost by happenstance, the result has been lower costs. “When doctors put their heads together in a room, when they share expertise, you get more thinking and less testing,”

    I’d like to think this should be another thrust among health care reforms (among a plethora of other issues) be implemented. Maybe we should look at our health cost utilization and unnecessary diagnostic costs. Put patient first and then work on to minimize health financial expenses. Maybe its not who pays or how are we paid as physicians and how we can maximize health expenses. Lowering cost of expense is second only to quality life of patients.

    What do you think?
    (Photo taken from the Daily Herald, here)