News Blog

Medicine in the 'Middle of Nowhere'
Friday, March 23, 2018

by Kristy Thomas, MS, PA-C


I've dealt with many frontier emergencies throughout my career -- some of them life-saving, but nothing quite eclipses the experience of being the only medical provider to coordinate care for a man carrying his severed arm. In that moment I was reminded that as a rural health physician assistant (PA), I must be prepared to make quick life-or-death decisions for whomever walks in the door.
Now working as a primary care PA at a remote health clinic in rural New Mexico, I see injuries that can be just as jarring as the man holding his own limb. From hard-working community members with ranching and bull-riding trauma injuries to the elderly battling diabetes and children with infectious diseases, each patient interaction comes with unique and sometimes unexpected challenges.
My clinic -- the most remote within its network of clinics -- is situated in a town of about 1,600 people, predominantly Hispanic, about 3 miles north of the Mexican border (I use Spanish to converse with roughly 90% of my patients). It's an outpatient setting that relies on resources from hospitals to coordinate ambulance services or summon Life Flight helicopters for medical emergencies. This system operates similar to other rural clinics and hospitals -- allowing remote providers to address holistic patient needs and work largely autonomously.

More:https://www.medpagetoday.com/primarycare/generalprimarycare/71847?utm_source=Sailthru&utm_medium=email&utm_campaign=PopMed_032218&utm_term=Pop Medicine
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Microsoft, Alphabet, Apple bet big on health with 300+ patents since 2013
Wednesday, March 21, 2018

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1 in 4 patients used virtual health services last year: 6 things to know
Monday, March 12, 2018

Healthcare consumers are increasingly turning to virtual health services, with 25 percent of patients reporting they received virtual care services in the previous year, up from 21 percent one year prior, according to a survey released by Accenture.
As part of its 2018 Consumer Survey on Digital Health report, Accenture surveyed 2,301 U.S. consumers ages 18 and older to evaluate their attitudes toward healthcare technology, modernization and service innovation.
Here are six things to know about the survey.
1. Of the patients who accessed care virtually, 74 percent said they were satisfied with the experience.
2. Nearly half (47 percent) of all patients surveyed said they would prefer a more immediate, virtual appointment over a delayed, in-person appointment.
3. Almost 75 percent of healthcare consumers said they would use virtual care for an after-hours appointment.
4. Around two-thirds said they would use virtual care for a follow-up appointment after seeing a physician or other healthcare professional in person.
5. Over half (54 percent) of consumers said they believe virtual care reduces patients' medical costs.
6. Forty-three percent said they like the timely care virtual technology provides.
Gohere to download the complete report.https://www.beckershospitalreview.com/telehealth/1-in-4-patients-used-virtual-health-services-last-year-6-things-to-know.html
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Look how far we've come: 93% of hospitals enable online access to health data in 2017, up from 27% in 2012
Monday, March 12, 2018

More and more patients are going online to access their health data, according to a Trend Watch report by the American Hospital Association.
The health IT issue brief highlights data from a 2016 AHA Annual Survey Information Technology Supplement it administered to community hospitals between November 2016 to April 2017.
Here are five things to know.
1. Almost every hospital and health system (93 percent) enable patients to view their health record online, up from 27 percent in 2012.
2. More organizations are allowing patients to pay their bills online, with 78 percent of hospitals and health systems featuring the service in 2017, compared to 51 percent in 2012. Features like requesting prescription refills online, scheduling appointments online and securely messaging providers have also expanded over the last five years.
3. Larger hospitals with at least 100 beds are more likely to offer comprehensive online access to health data, with 91 percent of hospitals with 300 beds or more enabling patients to download information from their health records, compared to 79 percent of hospitals with fewer than 100 beds.
4. Large hospitals with at least 300 beds are more likely to allow patients to submit their own generated data (53 percent), compared to hospitals with 100-299 beds (43 percent) and hospitals with fewer than 100 beds (30 percent).
5. "More sophisticated systems allow patients to obtain healthcare services through an online patient portal, conduct activities such as requesting prescription refills, schedule appointments, pay bills and securely message their healthcare providers," the report reads. "These activities support a patient-centered healthcare system in which patients are partners with their healthcare providers and share in decision making."

https://www.beckershospitalreview.com/ehrs/look-how-far-we-ve-come-93-of-hospitals-enable-online-access-to-health-data-in-2017-up-from-27-in-2012.html
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Consumers hungry for more digital healthcare interaction
Monday, March 12, 2018

Rising demand for digital interaction between consumers and doctors is paving the way for nontraditional players to upend the healthcare industry, according to a new survey.

More than half of the nearly 2,500 consumers surveyed are comfortable contacting their physician digitally and already use available technology, according to a new survey from the consultancy Ernst & Young. The main motivators are that virtual data-sharing will reduce wait times and lower costs.

Both consumers and physicians are hungry for more connected experiences that reframe how and where care is delivered, Jacques Mulder, U.S. health leader for Ernst & Young, said in a statement.

"This … is another indicator that health is entering an era of convergence," he said.

Thirty-six percent of consumers are interested in at-home diagnostic testing, 33% are open to using a smartphone to share data and 21% would do video consultations.

There's widespread agreement among physicians that digital technology will improve care. Two-thirds of the about 350 physicians surveyed said that it would reduce the burden on the healthcare system and its associated costs, and 64% think it would help reduce doctor and nurse burnout.

The survey marks gradual improvement in the industry's embrace of digital technology. Notably, only a quarter of consumers are interested in granting physicians access to their lifestyle habits, unless it comes with added incentives.

But despite hesitation in sharing dietary and exercise information, 26% indicated that the ability to receive tailored diet and exercise plans would boost engagement, which is much lower among the 45-and-older demographic.

http://www.modernhealthcare.com/article/20180306/NEWS/180309946

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A patient’s expertise is often undervalued
Monday, March 12, 2018

Thanks to a surprising and devastating diagnosis, I know more than most physicians about what it’s like to live with the brain cancer known as glioblastoma, everything from self-titrating my anti-epileptic medications to making sure the right ICD-10 code appears on my MRI referrals. As much as I’d rather not have this expertise, I’ve learned that it is extremely valuable for medical students, physicians, people with brain cancer, pharmaceutical companies, and others. I’ve also learned that it is undervalued.
Since I was diagnosed 20 months ago with glioblastoma — a disease I share with Sen. John McCain and about 18,000 other Americans — I’ve tried to learn all I can about the disease, its treatment, and how best to live with it. In doing that, I’ve become an expert patient, what some call an e-patient, following in the footsteps of pioneering e-Patient Dave.

I and other e-patients have a lot to offer in at least three separate areas:

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Unnecessary testing wastes money and can lead to further testing
Monday, March 12, 2018

Unnecessary testing wastes money and can lead to further testing. Why does it occur?
Almost 60% of medical personnel surveyed at a large academic medical center believed that hospitalized patients should have daily laboratory testing.
Of 1,580 attending physicians, fellows, residents, physician assistants, nurse practitioners, and nurses sent surveys, 837 (53%) responded; 393 (47%) were RNs, and 80% of those nurses felt that daily laboratory testing should be done on all patients.
Nurses strongly felt that patient safety and protection against malpractice litigation were enhanced by daily laboratory testing.


Of note is that more than half of those who returned completed surveys said they thought attendings would be uncomfortable with less testing, and 37% said they ordered unnecessary tests to satisfy attendings. However, the category of respondents who least felt daily tests were needed was attending physicians at 28%, and 84% of attending physicians said they would be comfortable if their patients had fewer laboratory tests.
Unnecessary lab testing on their units was observed by 60% of respondents, but only 37% said they had requested unnecessary testing themselves. Perhaps the unnecessary tests had been ordered by people who did not respond to the survey, or the tests were ordering themselves.
The authors of the JAMA Internal Medicine study, done at Memorial Sloan Kettering Cancer Center in New York, concluded that although nurses did not order laboratory testing themselves, they might have some effect on the frequency of lab tests being done.

https://www.kevinmd.com/blog/2018/03/unnecessary-testing-wastes-money-can-lead-testing.html




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Unnecessary testing wastes money and can lead to further testing
Monday, March 12, 2018

Unnecessary testing wastes money and can lead to further testing. Why does it occur?
Almost 60% of medical personnel surveyed at a large academic medical center believed that hospitalized patients should have daily laboratory testing.

Of 1,580 attending physicians, fellows, residents, physician assistants, nurse practitioners, and nurses sent surveys, 837 (53%) responded; 393 (47%) were RNs, and 80% of those nurses felt that daily laboratory testing should be done on all patients.
Nurses strongly felt that patient safety and protection against malpractice litigation were enhanced by daily laboratory testing.


Of note is that more than half of those who returned completed surveys said they thought attendings would be uncomfortable with less testing, and 37% said they ordered unnecessary tests to satisfy attendings. However, the category of respondents who least felt daily tests were needed was attending physicians at 28%, and 84% of attending physicians said they would be comfortable if their patients had fewer laboratory tests.
Unnecessary lab testing on their units was observed by 60% of respondents, but only 37% said they had requested unnecessary testing themselves. Perhaps the unnecessary tests had been ordered by people who did not respond to the survey, or the tests were ordering themselves.
The authors of the JAMA Internal Medicine study, done at Memorial Sloan Kettering Cancer Center in New York, concluded that although nurses did not order laboratory testing themselves, they might have some effect on the frequency of lab tests being done.
Another recent survey published in Hospital Medicine asked internal medicine and general surgery residents at the Hospital of the University of Pennsylvania why they ordered unnecessary tests as defined by the authors.

https://www.kevinmd.com/blog/2018/03/unnecessary-testing-wastes-money-can-lead-testing.html
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Are patients using social media to attack physicians?
Monday, March 12, 2018

I have a colleague who is a pediatrician in private practice in the suburbs. He has a great practice and loves his patients. One day, he walked in 15 minutes late to a 7:00 a.m. meeting we both attend. “Moms are calling early today.” Parents in his practice have learned to bypass their elaborate phone triage system. They have learned that if you press “1” for emergency, an actual doctor will call you back within 15 minutes, regardless of whether an actual emergency exists. When I asked what can be done to curb such behavior, he shrugged and replied, “We’ve tried a few things, but then we just get slammed on Facebook … and that’s bad for the practice.”
Another physician friend provided factual and evidence-based testimony as an expert witness during a legal proceeding. When the proceedings did not go in favor of the plaintiff, they took it upon themselves to post slanderous comments about this physician (not their own personal physician, mind you) on various online forums, including comment sections on advocacy group websites.

https://www.kevinmd.com/blog/2018/03/are-patients-using-social-media-to-attack-physicians.html
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Online ratings have me scared for the future of medicine
Monday, March 12, 2018

When did patient satisfaction become more important than appropriate medical care? Medicine has been turned into a service with bonuses related to the patient’s satisfaction score. There is a complete disregard for the appropriate medical care if the patient is dissatisfied with what they’re told. Doctors are so afraid of losing satisfaction scores and getting sued that inappropriate medical care has become the norm. The opioid epidemic is just one example of this. Other examples include unnecessary testing when a good physical exam and history suffice.
While I agree that there should be a rapport between patient and provider, telling a patient what they don’t want to hear is bound to cause dissatisfaction. You will never please everybody no matter what kind of provider you are not what you do for your patients. So what is best?

https://www.kevinmd.com/blog/2018/03/online-ratings-scared-future-medicine.html
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