Category: Patient Engagement

Did You Forget Something???

Check this out. What you will see is a “pull through” strategy being employed by Biogen to increase the sales of its Alzheimer’s drug, Aduhelm. Take an unvalidated quiz to see if your concerns about having Alzheimer’s are, well, valid. Whatever your score, the online quiz is programmed to tell you to speak with your physician about cognitive screening. OR. You can enter your zip code and be turfed to a specialist who can do fun things like a spinal tap to determine if you have a buildup of amyloid plaque. 

Bottom Line. Pull throughs like this are not new to the pharmaceutical industry. Raising physician consciousness of an underdiagnosed disease is probably a good thing in most cases. Ditto raising patient consciousness through DTC. BUT. How about here?

My two cents worth is that using an unvalidated quiz to get patients to believe that even the most casual forgetting is Alzheimer’s is iffy. Throw in the optics of trying to get new patients to take a drug that maybe works and maybe doesn’t, but in any event costs the health care system over $50,000 per year per patient, and Biogen has certainly given muck raking journalists something to feast on! 

Synthesizing a Patient Journey

Check this out. What you will see is a description of the “LEAP” program, assembled by Alexion to permit their team members to get a more in-depth feeling for the 4.8 years and 7.3 specialists journey that the average patient with a rare disease traverses to get to an accurate diagnosis. Key moments, e.g. the point at which symptoms begin, are explored, and the roles of the various key players in the journey are investigated. 

In this piece, Alexion reports out the benefits they see from using this approach, some anticipated, others not so much.

Desired/anticipated results include the development of more empathetic thinking about patients on the part of their team members.

Unanticipated advantages include the opportunity for team members to learn to work with other Alexion professionals, in many cases people they had never even met. 

Bottom Line. As corporate “social responsibility” programs become increasingly popular among pharmaceutical companies, I am betting that we will see many more programs like this being launched by health care companies.

And I think that is a good thing!  A very good thing!!!

Are Physical Exams Obsolete?

Sometimes! Check this out. What you will see is a post by our friend, The Country Doctor, who argues that such examinations are often conducted without a good reason.  and perfunctory. As evidence, he offers the successful journey that most physicians made into telemedicine during the COVID-19 pandemic, successfully treating patients without laying eyes or hands on them. 

BUT. The conversations I have been having with physicians for my ongoing On Doctors’ MindsSM project have clearly indicated to me that many of them feel otherwise. For them, telemedicine was a necessary, temporary adaptation to permit their practices to go on rather than being put under, in terms of both patient care and finances, by the coronavirus.  Now that offices have reopened to personal visits, telemedicine is being relegated to extremely limited use, if any. Doctors report that they need to observe their patients to get the full picture of what is going on. Specialists in fields from cardiology to neurology have specific evaluations that they want to make, and they have to be done in person.

But is the same thing true for PCPs in a “routine” office visit? A brief story. When my wife and I moved to Hilton Head Island almost a decade ago, we promptly joined the concierge practice of what we were told (and it is true!) was the best Internist in Beaufort County. On my wife’s first visit, the physician laid her hands on my wife’s throat and “felt something.” Scroll forward and her cancerous thyroid was summarily removed. A good “routine” physical exam? Damn straight!

Bottom Line. I get the Country Doctor’s point.  Sometimes physical exams look a lot like “going through the motions” for no reason whatsoever.  BUT. To catch the unanticipated, as well as to build patient relationships, they are probably about as far from obsolete as they could possibly be!!!

The “Difficult” Patient

A simple thought for the day. Check this out. What you will see is a brief but fascinating little piece. The point? With 15-60% of patients being considered by their physicians to be “difficult,” the underlying problem just might not be one of psychiatric pathology in the patient. Maybe the problem needs to be reconceived as resulting from a damaged interaction between the patient and the “health care delivery” she has encountered.

Bottom Line. It always amazes me how often “reconceiving” a problem can be a powerful first step towards its resolution.  

Patient Engagement

An easy one today. Just a focus on two words. Patient Engagement. And a moment of pondering what the term actually means.

Check this out. What you will see is a brief but important piece that eloquently describes what patient engagement is, how important it is and obstacles to obtaining its full power.

At the most elementary level, we see patient engagement reflected in patient comprehension. Tough to be engaged in your treatment if you don’t know what the heck is going on.

And then there are the encouragement components of patient engagement, working with patients to engender a spirit of optimism, hope and cooperation.

At a higher level there is shared decision making. Physician and patient working together to decide on the best course of therapy. Some doctors embrace it, others feel that it threatens their role. And focus groups reveal that patients are often in denial, not even wanting to have their physicians talk about the costs of medical care, let alone get them involved in decision making. Patient disengagement in spades.

Bottom Line. If you haven’t done so already, check out the publication date for this piece. 2013. Has “patient engagement” changed a lot since then? In definition? In practice?  

Think about it! I’m thinking yes. And no!

Filling The Cavity Between Dentistry And Medicine

Check this out.  What you will see is a brief but important report on a residency program designed to train dentists to intervene in a limited array of primary care medical issues. Why not? As they give dental exams to patients, issues like oral cancer, eating disorders, substance and child abuse, etc. can be readily detected IF the practitioners are trained in what to look for and what questions to ask the patient.  

Bottom Line. It will be interesting to see the extent to which dentists opt to enroll in an “oral physician” residency program. Given the way insurance billing works, this is not a great way for dentists to learn to make extra money. BUT. What a great way to learn to more holistically serve the patient, especially the underserved patient who is lucky to get to see one practitioner, any practitioner, during the course of a year.

For example, at the Hilton Head Island Volunteers in Medicine Clinic, where I serve on the Board of Directors, there is a tight connection between our physician volunteers and our dental program. For our 10,000 patients, all of whom are uninsured or underinsured and underserved, having the medical clinic and the dental program under one roof lets us do a far more efficient job of working to eliminate health care disparity. 

The special training provided by the residency program described in this article would obviously go a long way toward enhancing this efficiency. 

Doctors And Politics

Check this out.  What you will see is the asking, and the purported answering, of the question as to whether physicians should discuss politics with their patients. We can make this quick. The line of reasoning espoused here is that since “social determinants” of healthcare are now considered the prime factors in the determination of a patient’s health, and since many of these determinants are the direct or indirect results of “political decisions,” it is well within the purview, or maybe even the professional responsibility, of a physician to discuss politics with patients in the exam room.  

Bottom Line. Yeah, I get that. But to put it mildly, I have a couple of problems with this line of reasoning. Three to be more exact. First, we all know that, especially in these pandemic times, there are many pressures on a physician’s time spent with each patient. How much of this precious time should be spent “chatting” about politics? I’m going with not much.

Second, what is the desired outcome of such a conversation? Converting the patient to the physician’s own political ideology? Given the oft discussed differential in the power bases of the physician and the patient, this seems to me to be a little Machiavellian. Maybe even unethical.

Finally, I don’t know about you, but at this point I am so sick and tired of “talking politics” that the last thing I need is somebody making the case that such conversations should take place in one more venue, especially one long thought to be sacrosanct and impermeable to such discussions.

What do you think?

Building Blocks Of Therapeutic Relationships

Check this out.  What you will see are ten excellent recommendations for making a patient feel, as I discussed in a previous post, “cared for” rather than just “treated.” It’s been a long time since the office of the Primary Care Physician looked like that pictured above. Hovering over the doctor’s office today are interlopers like the computer and insurance companies, that make the establishment of a meaningful therapeutic relationship all the more difficult and all the more important. Look across these ten recommendations and you will see a common theme. Quite simply, that common theme is that physicians need to work with patients to manage their time together, and to let patients know that they are doing so. Use body language to convey that the doctor is paying attention. Listen and respond. Set an agenda for the visit that is responsive to a patient’s actual, current needs. Etc.  

Bottom Line. As I sit back and ponder this blogging physician’s post, I see something very important happening here. While the post is focused on making the patient feel good about the office visit, I am also thinking that following these ten guidelines might well also have a positive effect on the physician doing so. Physicians, like their patients, are bedeviled by computers and insurance companies intruding in their offices. I’m betting that a doctor who follows the ten steps outlined here will be significantly less likely to “burn out.” Since a major symptom of burn out is disengaging with patients, reengaging with patients could, in and of itself, have a positive impact on a physician’s psychological well-being.   


Performing A Procedure Without Patient Consent

Check this out. What you will see is a continuation of yesterday’s riff on our Consent Culture and Bodily Autonomy. Yesterday’s bottom line was that in order to avoid traumatic surprise to the patient, physicians should make it a point to inform the patient about what needs to be done, and then wait for the green light. 

But today’s version is a little different. The question before the house today is whether a physician who has patient consent to do one diagnostic procedure can do another one that the first procedure revealed to be necessary. The kicker is that the patient is sedated while this decision is being made. What is the ethical thing to do? Proceed, since the second procedure is a related one, or hold off until all the paperwork is signed, meaning that the patient will need to be sedated again.

This Gastroenterologist proceeded, and found the problem the patient had authorized him to look for, although not where he was authorized to look. All’s well that ends well, although it should be noted that the medical malpractice attorneys would doubtless have had a field day if something had gone wrong during the second procedure.  

Bottom Line. SO. Yesterday’s guideline of “Always inform the patient and get permission in advance” clearly has some limitations. And that’s the way things work in medicine.  

And in life!

Sharing A Screen With A Patient

Check this out. What you will see is the kind of endearing brilliance that I always encounter when I read the “A Country Doctor Writes” blog.  

In this post, the good Doctor cleverly tames several issues that other bloggers have had me wrestle with over the past year. How? Simply by sharing his thought process as he greets a new patient into his practice.

It starts when he greets the patient. Here, the Doctor introduces himself by “first and last name.” He cleverly notes that he only calls himself “Doctor” when introducing himself to children, or when entering a crisis situation that might require the extra clout of that title. Wow! How many blog posts have I read over the last year, penned by doctors who are indignant when a patient calls them by their first name?

The next part is absolutely brilliant. Because his laptop was slow to load that morning and he didn’t want to fall behind schedule, he didn’t have the chance to do his usual EMR briefing before entering the treatment room. Instead, he entered the room lap top in hand, and had the patient look over his shoulder as he reviewed the various salient screens. Wow again!!! How many blogs and articles have been written by disgruntled doctors AND patients, concerned about the percentage  of time during a visit that the doctor spends looking at the screen rather than at the patient. By flipping the screen around so that the patient can see it, the computer becomes a communications tool rather than an obstacle.  

Bottom Line. Bingo! Think about this one for a second. Picture a shared screen technology, easily rigged in 2019, that would permit the patient to hold an iPad that showed exactly what the doctor was looking at. Consider how that would enhance the value of, and probably improve the efficiency of, the patient visit!

Yeah, I know. We would then enter the line of discussion as to whether patients should actually be able to see what their doctors have written about them. I’ve read lots of blogs and articles on that one too.

My answer? Sure they should! And not just at home on their computers, but while they are sharing time and space and screens with their physicians, and thus able to discuss and ask questions!!!