Narrative Medicine: Every Patient Has a Story |

Every patient has a story that goes beyond the symptoms they bring into the doctor’s office.

Those stories can illuminate how a person became ill, the tipping point that compelled them to seek help, and, perhaps most importantly, the social challenges they face in getting better. Stories can offer the kind of contextual richness that promotes and nourishes empathy, prompting a provider to switch from asking “How can I treat this disease?” to “How can I help my patient?” The difference may seem subtle at first, but knowing how to get patients to share their stories can be transformative in improving patient care, say proponents of this approach called “narrative medicine.”

Another classification for this is Social Determinants of Health (SDOH)

Social determinants of health

These include underlying communitywide social, economic, political, cultural, and physical conditions people experience when they are born and as they grow, live, work and age. These experiences shape individual material and psychosocial circumstances as well as biological and behavioral factors. The term commonly refers to defined communities or regions, which are typically defined by geography. All patients experience social determinants of health.  

Structural determinants

These include the climate, socioeconomic-political context—for example, societal norms and macroeconomic, social, and health policies—and the structural mechanisms that shape social hierarchy and gradients, including economics income, access to food, power, class, racism, sexism, and exclusion. It commonly refers to cities, states, nations, or the world and typically is defined by political jurisdictions, cultural boundaries, or economic relationships. 

Community Health

A multisector, multidisciplinary collaborative enterprise that uses public health science, evidence-based strategies, and other approaches to engage and work with communities in a culturally appropriate manner to optimize the health, quality of life, and social determinants of health for all people who live, work or are otherwise active in defined communities.

Public Health

Public Health is often determined by factors outside the health care system and is committed to addressing the social determinants of health to improve health outcomes for all Americans.

Narrative Medicine: Every Patient Has a Story | AAMC

    

Prior Authorization Angst, Another Reason for Doctor burnout.

Consult this handy glossary to better grasp the frustrating cost-control practice and learn how the AMA is leading the charge to fix prior auth.

Listen to this Article

Any patient who has been to their physician in the past decade has heard, (We'll have to get authorization for a referral, treatment, or medical equipment.  The time involved or this is not insignificant and adds expense for additional personnel. Some medical practices may employ one or two full-time employees to perform this task.

Amongst other tasks contributing to physician burnout is the electronic health record.   

What is the leading cause of physician burnout?

The healthcare environment—with its packed work days, demanding pace, time pressures, and emotional intensity—can put physicians and other clinicians at high risk for burnout. Burnout is a long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment.

8 prior authorization terms that drive every doctor crazy | American Medical Association:  

Among physician specialties, the biggest declines were seen within internal medicine, family practice, and emergency medicine fields. (Getty)

Nearly 334,000 physicians, nurse practitioners, physician assistants, and other clinicians left the workforce in 2021 due to retirement, burnout, and pandemic-related stressors, according to new data.

Physicians experienced the largest loss, with 117,000 professionals leaving the workforce in 2021, followed by nurse practitioners, with 53,295 departures, and physician assistants, with 22,704 departures. About 22,000 physical therapists also left the healthcare workforce and 15,500 licensed clinical social workers, according to a report from commercial intelligence company Definitive Healthcare.

Among physician specialties, the biggest declines were seen within internal medicine, family practice, and emergency medicine fields. "Like clinicians and registered nurses, providers in these three specialties frequently worked on the frontlines during the pandemic, risking exposure and facing many of the same pressures and stressors as described earlier," the report authors wrote.

In 2021, 15,000 internal medicine doctors left the workforce, followed by 13,015 providers who left family practice and 10,874 who left clinical psychology.

Definitive Healthcare's report leverages data from more than 2 million physicians and nurses, 9,200 hospitals and IDNs, and 128,000 physician groups.

Among high levels of burnout, many healthcare providers are nearing retirement age, the report noted.

 According to Definitive Healthcare data, many physicians across several healthcare specialties are on the verge of retirement or will be near that age soon. Research from the American Association of Medical Colleges (AAMC) found that nearly 45% of doctors are older than age 55, and more than 40% of active physicians will be 65 or older in the next ten years. The average age of a nurse is 57, the report said.

Physicians leaving the workforce of patient care

Retirement age, disability, burnout, including pandemic stress, new non-clinical role, loss of license due to malfeasance, malpractice.

Plan B

Plan B is about mixing boxes, not stacking them. Instead of a sequence of education, work and retirement, the approach means blending the three during your life and creating a portfolio career. In addition, if your interest is some kind of alternative career using your skills as an experienced physician, then you need to plan sufficiently ahead of time, with areas of overlap and transition, instead of just jumping off the cliff once you decide to shove the white coat.

Truveta releases live dashboard with healthcare data from 25 health system partners

The age of AI is here,  and how it will improve your health.  The data is collected after personal information is removed from it.

Health data startup Truveta has released a real-time searchable dashboard featuring deidentified medical records from more than 70 million patients from its 25 health system partners.

Truveta Studio has data covering 16 percent of the healthcare system that researchers can use to study patient care and outcomes by condition, drug or medical device. The data, integrated via artificial intelligence-powered natural language processing, is updated daily.

"For researchers, this is really exciting," said Ari Robicsek, MD, chief medical analytics officer and senior vice president of research at Renton, Wash.-based Providence, in a Nov. 2 Truveta news release.

The data spans a patient's longitudinal history, covering diagnoses, vital signs, lab tests, clinical notes, procedures, medications and vaccinations. Gaps are filled with insurance claim information, while daily mortality and social drivers of health data is imported from LexisNexis.

"Researchers often spend countless hours attempting to stratify and define the patient populations they are seeking to study before they can even begin their analysis," stated Eric Eskioglu, MD, executive vice president and chief medical and scientific officer at Winston-Salem, N.C.-based Novant Health. "Truveta not only ensures consistency and transparency across different clinical concepts and outcomes, but also fundamentally lower the cost and increase the speed of research, enabling scientists to get to insights faster for saving more lives."

Truveta's health system partners include:

• Advocate Aurora Health (Downers Grove, Ill., and Milwaukee)
• AdventHealth (Altamonte Springs, Fla.)
• Baptist Health (Jacksonville, Fla.)
• Baylor Scott & White Health (Dallas)
• Bon Secours Mercy Health (Cincinnati)
• Centura Health (Centennial, Colo.)
• CommonSpirit Health (Chicago)
• Hawaii Pacific Health (Honolulu)
• Henry Ford Health (Detroit)
• HonorHealth (Scottsdale, Ariz.)
• MedStar Health (Columbia, Md.)
• Memorial Hermann Health System (Houston)
• MetroHealth (Cleveland)
• Novant Health (Winston-Salem, N.C.)
• Northwell Health (New Hyde Park, N.Y.)
• Ochsner Health (New Orleans)
• Providence (Renton, Wash.)
• Saint Luke’s Health System (Kansas City, Mo.) 
• Sentara Healthcare (Norfolk, Va.)
• Tenet Healthcare (Dallas)
• Texas Health Resources (Arlington)
• Trinity Health (Livonia, Mich.)
• UnityPoint Health (Des Moines, Iowa)
• Virtua Health (Marlton, N.J.)
• WellSpan Health (York, Pa.)

Truveta releases live dashboard with healthcare data from 25 health system partners

The Effects of the Use of Patient-Accessible Electronic Health Record Portals on Cancer Survivors’ Health Outcomes: Cross-sectional Survey Study

From the Journal of Medical Internet Research

Located in Toronto Canada JMIR provides online access to many medical journals. Articles can be submitted directly to JMIR for review and/or publication.  It is linked to many prestigious medical journals such as the NEJM

JMIR Research Department

Background:

In the past decade, patient-accessible electronic health record (PAEHR) systems have emerged as an important tool for health management both at the hospital level and individual level. However, little is known about the effects of PAEHR portals on the survivorship of patients with chronic health conditions (eg, cancer).

Objective:

This study aims to investigate the effects of the use of PAEHR portals on cancer survivors’ health outcomes and to examine the mediation pathways through patient-centered communication (PCC) and health self-efficacy.

Methods:

Data for this study were derived from the Health Information National Trends Survey 

(HINTS 5, Cycle 4) collected from February 2020 to June 2020. This study only involved respondents who reported having been diagnosed with cancer (N=626). Descriptive analyses were performed, and the mediation models were tested using Model 6 from the SPSS macro PROCESS. Statistically significant relationships among PAEHR portal use, PCC, health self-efficacy, and physical and psychological health were examined using bootstrapping procedures. In this study, we referred to the regression coefficients generated by min-max normalization as percentage coefficients (bp). The 95% bootstrapped CIs were used with 10,000 resamplings.

Results:

No positive direct associations between PAEHR portal use and cancer survivors’ health outcomes were found. The results supported the indirect relationship between PAEHR portal use and cancer survivors’ psychological health via (1) PCC (bp=0.029; β=.023, 95% CI .009-.054), and (2) PCC and health self-efficacy in sequence (bp=0.006; β=.005, 95% CI .002-.014). Besides, the indirect association between PAEHR portal use and cancer survivors’ physical health (bp=0.006; β=.004, 95% CI .002-.018) via sequential mediators of PCC and health self-efficacy was also statistically acknowledged.

Conclusions:

This study offers empirical evidence about the significant role of PAEHR portals in delivering PCC, improving health self-efficacy, and ultimately contributing to cancer survivors’ physical and psychological health.

J Med Internet Res 2022;24(10):e39614

Ref:   doi:10.2196/39614

Journal of Medical Internet Research - The Effects of the Use of Patient-Accessible Electronic Health Record Portals on Cancer Survivors’ Health Outcomes: Cross-sectional Survey Study: 

The Federal Telehealth Extension and Evaluation Act: What You Need to Know |

We’re still feeling the impacts of coronavirus, especially in older and more vulnerable populations, which is why these telehealth services must be extended.”

- U.S. Senator Catherine Cortez Masto

On February 7, 2022, Senators Catherine Cortez Masto (D-NV) and Todd Young (R-IN) introduced the Telemedicine Extension and Evaluation Act, important bipartisan legislation to ensure predictable patient access to telehealth following the end of the public health emergency, allow more time to gather data around virtual care utilization and efficacy, and avoid a sudden drop-off in access to care (known as the telehealth cliff).

What is the Telehealth Extension and Evaluation Act?

The Telehealth Extension and Evaluation Act would establish a two-year extension for certain COVID-19 emergency telehealth waivers. The legislation aims to extend the waivers of the geographic and site restrictions and allow Medicare beneficiaries to access telehealth even when at home; allow controlled substances to be prescribed via an initial telehealth encounter under the Ryan Haight Act; and extend Medicare payment flexibilities for Rural Health Centers (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs). To address Medicare program integrity concerns, the bill also introduces in-person restrictions on telehealth orders for certain high-cost durable medical equipment (DME) and laboratory tests. It also contains language that might serve to restrict the use of “incident to” billing for telehealth services.

“The waivers were a key part in allowing healthcare providers to meet patients where they live, and we risk reversing the great progress we have seen if we go back to the way things were prior to the pandemic.”

(- René Quashie, Vice President, Policy and Regulatory Affairs, Digital Health, Consumer Technology Association)

Key Takeaways for the Telehealth Industry

Here are the key takeaways on how the new legislation may affect the telehealth industry.

1. General Extension of Medicare Payment for Telehealth Services

Under the CARES Act, Congress gave CMS authority to waive certain limitations on Medicare coverage and payment for telehealth services furnished to Medicare beneficiaries, clearing the way for Medicare beneficiaries to receive care in their homes. If passed into law, the Telehealth Extension and Evaluation Act would extend certain Medicare telehealth payment waivers on originating site and geographic location limitations, expand the list of permissible telehealth providers, and broaden the availably of audio-only telehealth services for Medicare beneficiaries for two years after the public health emergency ends. Read our prior coverage here and here.----

Prior to 2020, there was a reticence to adopting telehealth. Although technology had outpaced the use of telehealth there was also a reluctance on the part of physicians to utilize this resource.  Reimbursement regulations were also restrictive preventing patients and physicians from utilizing telehealth. 

COVID 19 changed that. The emergency CARES ACT provided for the use of telehealth and required reimbursement by CMS and private insurers.  

The telehealth provision of the ACT is set to expire on December 31, 2022.  A bill is now in progress to extend this benefit for one or two years or make it permanent.

The Federal Telehealth Extension and Evaluation Act: What You Need to Know | Blogs | Health Care Law Today | Foley & Lardner LLP

Everything They Don’t Tell You About Taking Care of Aging Parents | by Adeline Dimond | Oct, 2022 | Medium

Get ready to fight, and don’t expect people to understand.

In addition to the emotional toll and time involved, there are few who can help. If you have enough money you can buy eldercare. But it ain't cheap.   Long-term care insurance is available but read the policy and benefits page carefully. 

2. Long-term care insurance might be bullshit.

When I recently wrote about the difficulty of taking care of my parents, including the stress of watching their savings dwindle, a lot of commenters wrote “I have long-term care insurance, so I’ll be fine.” Yeah, not so fast.

My parents also have long-term care insurance. They have (or had) exactly $938,000 in coverage. Their insurance only covers costs associated with an assisted living facility or a skilled nursing facility. It does not cover in-home care.

This is because halfway into paying premiums, the long-term care insurance company suddenly raised their rates. My father couldn’t afford the new premiums, but the long-term care insurance company continued to offer a cheaper option, one that only covered care if he entered a facility. Left with no real choice, he switched to the cheaper plan.

Some of the challenges:

1. Financial institutions will refuse to honor power-of-attorney documents.

Yes, this is likely illegal. But large financial institutions know that in order to be held accountable for failing to honor POA documents, the attorney-in-fact would need to sue them. Otherwise, there are no consequences for them at all. But suing a financial institution takes money and grit, which they are betting that the attorney-in-fact does not have.

Review the POA language very carefully.

In my case, my father’s POA documents listed my mother as his attorney-in-fact in the first instance, and me as a successor POA if my mother was “unable or unwilling to act.” My mother’s POA was the same, listing my father as the first POA. Financial institutions seized on this, asking me to “prove” that my parents were “unwilling or unable to act” on each other’s behalf.

Open a bank account with your parents.

I could have avoided all the above POA pitfalls if I simply were a signatory to my parent's bank accounts. Of course, not everyone has the type of relationship with their parents that allows for this; I definitely didn’t. But if you can swing this, being able to immediately access their funds at a moment’s notice is worth the uncomfortable conversations this might require. Parents hate giving up control.  I don't know why they would want to maintain control when they are dying or dead.  Some parents cannot get over  "I know what is best for you."

Go ahead and get the passwords to your parents’ accounts, and pretend to be them.

Eventually, in some cases, after it became clear that the financial institutions were going to block access to my parents’ accounts despite the perfectly executed POA documents, before spending my energy drafting more scary letters, I just got my parents’ passwords (and the answers to the security questions), logged on to their accounts, and pretended to be them.

I was warned by one financial institution that “they don’t allow this,” but I just didn’t care anymore. I have my parents’ authorization to access their accounts, and that’s enough for me.

https://adelinedimond.medium.com/everything-they-dont-tell-you-about-taking-care-of-aging-parents-de64e5bb47a7

Everything They Don’t Tell You About Taking Care of Aging Parents | by Adeline Dimond | Oct, 2022 | Medium

APIC urges members to disregard new CDC masking guidelines

Infection preventionists should continue to enforce universal masking for healthcare workers who come in contact with patients, says APIC.

The recent relaxation of masking guidelines for healthcare professionals by the Centers for Disease Control and Prevention (CDC) seems a bit premature to one professional organization,  The  Association for Professionals in Infection Control and Epidemiology (APIC) in a press release.

It is foolish to recommend a nationwide recommendation for a country of 350 million with a wide geographic area and diverse demographic. A more sensible approach is to make recommendations based on regional and local prevalence of Covid19.

COVID TRACKER

APIC urges members to disregard new CDC masking guidelines: 

Long COVID Experts: U.S. Government Needs to Do More | Time

Long COVID Experts and Advocates Say the Government Is Ignoring 'the Greatest Mass-Disabling Event in Human History'

Video of Patient with Long Covid

Many of the symptoms are identical to "chronic fatigue syndrome: which was a "wastebasket" term used to identify a constellation of signs and symptoms present in patients with 'Long Covid'.

Long Covid is still a constellation of signs and symptoms that scientists are studying.  There is strong evidence that it is linked to the immune system and there may be a genetic link for those who develop 'Long Covid"

Some think it is related to the activation of the Epstein-Barr virus, once thought to result in "chronic fatigue syndrome".  Both Chronic Fatigue Syndrome and Long Covid are enigmatic.  However modern science is showing that Long Covid is a real entity proven by tests that were not available at the time of Chronic Fatigue Syndrome.

Covid19 has been around for only 3 years, a very short time, and over the next decade we will see what else develops. The immune system has a long memory.

Long COVID Experts: U.S. Government Needs to Do More | Time

Prosopagnosia (face blindness) Do you suffer from this? Brad Pitt has it

People who are diagnosed with prosopagnosia often fall into one of two categories: either they are born with it or they acquire it.

Prosopagnosia is not related to memory problems, vision loss, or learning disabilities, but it's sometimes associated with other developmental disorders, such as autism spectrum disorder, Turner syndrome, and Williams syndrome. However, estimations reveal that as many as one in every 50 people may struggle with some lifetime form of the disorder, and experts hypothesize that it may run in families.

According to Blum, research “suggests that congenital, or lifelong, prosopagnosia is less prevalent.”

According to Andrey Stojic, director of general neurology at the Cleveland Clinic, children born with the illness “don’t seem to have any visible structural abnormality” in the brain.

Notably, doctors don’t fully understand what causes congenital prosopagnosia because there aren’t any obvious brain lesions in persons who have it.

In contrast, people who develop prosopagnosia later in life may have brain abnormalities brought on by a trauma or head injury.

According to Bonakdarpour, individuals can also develop prosopagnosia while dealing with Alzheimer’s illness or following a stroke.

What therapies are available for prosopagnosia?

Borna Bonakdarpour, MD

Assistant Professor of Neurology (Behavioral Neurology

Prosopagnosia is now untreatable, according to Bonakdarpour. The problem can be treated, though.

People who have the syndrome frequently attempt to distinguish between people by focusing on physical characteristics like hair color, gait, or voice.

Usually, a set of tests that measure a person’s memory and face recognition help neurologists make the diagnosis.

As doctors frequently take care to ensure that a patient’s face blindness is not an indication of a more extensive degenerative neurological disorder, Blum adds, “it can be a drawn-out process.”

It’s noteworthy that many people with the illness, like Pitt, won’t get an official diagnosis.

Many of the difficulties he’s discussing and the issues he has are not unusual for people to go through them, according to Stojic.

He continued, “It may be relatively crippling for folks. “Others find it difficult to comprehend,”

Worldwide Directory of Pregnancy Help

Use the search tools below to locate a pregnancy help service provider in your area. Heartbeat International Affiliates will have a light red background in the search results. If you don't find the pregnancy help location you're looking for, it may be because some service providers choose not to have their locations made public for security reasons.

This post is offered as a service to women who are contemplating terminating a pregnancy.  It has no political affiliations.  It is offered as an educational resource and is advisory only.

Every day women take the first dose of the abortion pill and regret their decision. But, there is a way that they can reverse the effects of the abortion pill. There is an effective process called Abortion Pill Reversal. Contact us and we can talk with you about joining the Abortion Pill Rescue Network so that you can help these women take that last chance to choose life.

Join Abortion Pill Rescue Network 

Each month, hundreds of women call the Abortion Pill Reversal hotline seeking help after starting a chemical abortion. Each call is immediately connected to a knowledgeable and compassionate member of our team.

The hotline is staffed by trained nurses 24/7 who are available to answer questions and explain reversal. 

Worldwide Directory of Pregnancy Help

Listening to Black Californians: How the Health Care System Undermines Their Pursuit of Good Health - California Health Care Foundation

Don't dis me bro !

Surprisingly, Black Californians care more about their health care than other Californians.  Contrary to what providers believe, it is not so !  

The real barrier is NO or little access to health care.

In Their Own Words: Black Californians on Racism and Health Care

California, home to the most culturally diverse population in the country and the fifth-largest Black population of any state, has a major opportunity to be a leader in health equity. But glaring racial and ethnic inequities pervade its health care system, from insufficient access to worse health outcomes to excess mortality.

Black residents have the shortest life expectancy (75 years) at birth of any racial/ethnic group, six years shorter than the state average. Black Californians have the highest death rates from breast, cervical, colorectal, lung, and prostate cancers. Black birthing people experience the highest rates of prenatal and postpartum depression, preterm births, low birthweight births, and pregnancy-related mortality. And Black infants have the highest mortality rates.

As part of its commitment to ending health inequities, CHCF commissioned Listening to Black Californians, a three-phase qualitative and quantitative study to understand the health and health care experiences of Black Californians. The research is being conducted by EVITARUS, a Black-owned public opinion research firm in Los Angeles. An advisory group composed of academics, policymakers, providers, and community advocates is guiding the study.

This report describes the results of Phase I of the Listening to Black Californians study. In this phase, EVITARUS conducted individual, hour-long interviews with 100 Black Californians from June to August 2021 to understand their views on health and well-being, their perceptions of discrimination and bias in the health care system, and their views on what a quality health care system looks like. Each story provided unique insights. Still, taken as a whole, the stories revealed many similarities in how Black Californians view health and how they experience health care.

Key findings include:

• Respondents held a holistic view of health and prioritized it in their everyday lives.
• Experiences with racism in health care were widespread and negatively impacted participants’ health.
• Participants envisioned high-quality health care as patient-centered and proactive.

The complete report is available under Document Downloads.

In Their Own Words: Black Californians on Racism and Health Care — Executive Summary (PDF) 

Listening to Black Californians: How the Health Care System Undermines Their Pursuit of Good Health - California Health Care Foundation

Findings suggest COVID-19 rebound not caused by impaired immune response | National Institutes of Health (NIH)

Findings from a small study of eight patients published in Clinical Infectious Diseases suggest that COVID-19 rebound is likely not caused by impaired immune responses. The study, led by scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, aimed to define the clinical course and the immunologic and virologic characteristics of COVID-19 rebound in patients who have taken nirmatrelvir/ritonavir (Paxlovid), an antiviral therapeutic developed by Pfizer, Inc. COVID-19 rebound is characterized by a recurrence of COVID-19 symptoms and/or a new positive viral test after having tested negative, according to the Centers for Disease Control and Prevention. According to the study authors, the results do not support the hypothesis that the five-day course of Paxlovid is too short for the body to develop a strong immune response to SARS-CoV-2, the virus that causes COVID-19.

The next question is do we need a 4th Omicron booster?  Where are the studies showing repeated infections in the 3rd booster group vs the 4th booster group?  The short time periods do not allow for the true degradation (if any) of the immune response to a 4th generation omicron booster.

The rush to re-vaccinate may be premature.  Hopefully, the development of a whole virus vaccine is in process.  There has been enough time to do so using conventional vaccine production.  We should not lose sight of the original rush to produce the vaccine using a relatively unproven new mRNA process. which has been shown to produce a more limited length of an immune response.

What do the new boosters contain?

A bit of the old and a bit of the new. Both the Pfizer-BioNTech collaboration and Moderna make their vaccines from messenger RNA (mRNA) coding for the spike protein of SARS-CoV-2. The new vaccines are bivalent. Half of the mRNA codes for the spike protein of the ancestral virus strain that emerged in Wuhan, China, in late 2019, which is also in the original shots; the other half codes for the spike protein in BA.1 or the one in BA.4 and BA.5, which have identical spikes. Because they contain a lower dose of mRNA, the shots are meant to be used as boosters only, and not in people who were never vaccinated.

Findings suggest COVID-19 rebound not caused by impaired immune response | National Institutes of Health (NIH)