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How to Teach Doctors Empathy
"Being a good doctor requires an understanding of people, not just science."
Studies have linked empathy to greater patient satisfaction, and better outcomes
HEALTH TRAIN EXPRESS Mission: To promulgate health education across the internet: Follow or subscribe to Health Train Express as well as Digital Health Space for all the updates for health policy, reform, public health issues. Health Train Express is published several times a week.Subscribe and receive an email alert each time it is published. Health Train Express has been published since 2006.
Friday, March 20, 2015
Wednesday, March 18, 2015
Tuesday, March 17, 2015
Geriatric Crisis in Process
WHEN SUSAN BLOCK, a professor of psychiatry and medicine, started practicing medicine more than three decades ago, there was no formal field of palliative care. Today, it is an established specialty with a growing presence in the U.S. healthcare system. The number of hospital-based programs nearly tripled between 2000 and 2010, and most large hospitals now have palliative-care teams, according to the Center to Advance Palliative Care, a national organization aimed at expanding these services. Still, Americans living in certain geographic regions (for example, where small hospitals are the norm) have limited access to this comfort-centered approach to serious illness.
We all can see how the relative numbers of people over the age of 65 has expanded in the past three decades. This is not only due to aging of the baby boomer demographic, but also due to great strides in treating chronic disease and the recognition of life style and nutrition upon the aging process. Will we live longer ? Perhaps not, but the goal actually is to live a good quality of life, then die quickly.
Everyone wishes to live healthier and longer live , hence the overwhelming menu of snake oil medicine, herbs and substances which has become a multi-billion dollar business.
Statistics reveal that for the aged infirm options are becoming narrower due to the lag in providing suitable living arrangements for many.
Palliative care emerged with the hospice movement of the 1960s, but it wasn’t until 2006, after a strategic campaign led by Block and other advocates, that hospice and palliative medicine became a defined medical specialty. The move marked “a critical step in achieving legitimacy and a seat at the table in American medicine,” says Block, chair of the psychosocial oncology and palliative care department at Dana-Farber Cancer Institute and Brigham and Women’s Hospital. “It has raised the stature of the field.
There are now nearly 100 hospice and palliative-medicine fellowship programs around the country; Harvard’s fellowships in palliative care educate about a dozen doctors, nurse practitioners, and social workers annually.
Palliative care is associated with higher quality of life and lower costs through fewer and shorter hospital stays, less intensive treatments, and more hospice use, so it’s an attractive option in the context of healthcare reform. But experts worry about the future. There’s already a serious national shortage of hospice and palliative-medicine physicians (one study estimates a gap of at least 6,000), and demand will likely grow as baby boomers age, the number of Americans with chronic conditions (such as heart disease, diabetes, cancer, and dementia) soars, and more providers in community settings, like outpatient clinics, aim to offer palliative care as well. The global demand is rising, too; according to the World Health Organization and Worldwide Palliative Care Alliance, only one in 10 people who need these specialized services receives them—and most palliative care is provided in high-income countries.
In addition to the lag in numbers of professionals there also is a deficit in bed capacity for the aged infirm. At the moment we are caught in the effort to reduce hospital admissions, length of stay, leaving many to find suitable respite.
Medicare does not provide long term insurance. Long term insurance must be acquired elsewhere. Hospice care is for the terminally ill, who have assigned medicare medical benefits toward hospice care.
Most patients do not have long term insurance due to costs. And there are no provisions for long term care in the affordable care act, thus far.
How will the void be filled. I am interested in your comments.
Most patients do not have long term insurance due to costs. And there are no provisions for long term care in the affordable care act, thus far.
How will the void be filled. I am interested in your comments.
Institute of Medicine in the United States currently studying the ethical and social implications of mithochondrial replacement therapy
Following the approval of legislation to license clinics to perform mitochondrial replacement therapy in the United Kingdom, United States may now be following suit. The US Food and Drug Administration (FDA) requested the Institute of Medicine (IOM) to produce a “consensus report regarding the ethical and social policy issues related to genetic modification of eggs and zygotes to prevent transmission of mitochondrial disease”. Subsequently, IOM set up a committee which plans to meet approximately five times over the course of the study. The first committee met in January 2015, the second is expected to be in March 2015, which will include a 2 day public workshop in addition to a closed committee session. The third committee will meet in May 2015, which will include a public comment session with two closed committee meetings, during which the committee will draft and finalise the final report. OrphaNews will provide readers with information on the proceedings of these meeting as they become available. You can also receive updates from the IOM website .
Mitochondrial DNA
Human DNA is found in the chromosomes of cell, and inside mitochondria in the cytoplasm. Mitochondria are the power generator of the cell providing the intermediary metabolites for cellular metabolism. The presence of DNA defects in this organelle can cause serious disease. The defects are inheritable. The key difference in inheritability of mitochondrial DNA is that the mitochondrial DNA is transmitted by the female in her ovum cytoplasm.
The List of Mitochondrial Disease
Audio report - William Gahl MD
This will be the first time mitochondrial DNA therapy is attempted. Previous DNA therapy has been focused on nuclear DNA diseases, such as Cystic Fibrosis,
Nuclear DNA Disease
Health Problems with Mitochondrial Disorders
Hospital Evaluations by Social Media: A Comparative Analysis of Facebook Ratings among Performance Outliers.
BACKGROUND
An increasing number of hospitals and health systems utilize social media to allow users to provide feedback and ratings. The correlation between ratings on social media and more conventional hospital quality metrics remains largely unclear, raising concern that healthcare consumers may make decisions on inaccurate or inappropriate information regarding quality.
OBJECTIVES
The purpose of this study was to examine the extent to which hospitals utilize social media and whether user-generated metrics on Facebook(®) correlate with a Hospital Compare(®) metric, specifically 30-day all cause unplanned hospital readmission rates.
This was a retrospective cross-sectional study conducted among all U.S. hospitals performing outside the confidence interval for the national average on 30-day hospital readmission rates as reported on Hospital Compare. Participants were 315 hospitals performing better than U.S. national rate on 30-day readmissions and 364 hospitals performing worse than the U.S. national rate.
MAIN MEASURES
The study analyzed ratings of hospitals on Facebook's five-star rating scale, 30-day readmission rates, and hospital characteristics including beds, teaching status, urban vs. rural location, and ownership type.
KEY RESULTS
Hospitals performing better than the national average on 30-day readmissions were more likely to use Facebook than lower-performing hospitals (93.3 % vs. 83.5 %; p < 0.01). The average rating for hospitals with low readmission rates (4.15?±?0.31) was higher than that for hospitals with higher readmission rates (4.05?±?0.41, p < 0.01). Major teaching hospitals were 14.3 times more likely to be in the high readmission rate group. A one-star increase in Facebook rating was associated with increased odds of the hospital belonging to the low readmission rate group by a factor of 5.0 (CI: 2.6-10.3, p < ?0.01), when controlling for hospital characteristics and Facebook-related variables.
CONCLUSIONS
Hospitals with lower rates of 30-day hospital-wide unplanned readmissions have higher ratings on Facebook than hospitals with higher readmission rates. These findings add strength to the concept that aggregate measures of patient satisfaction on social media correlate with more traditionally accepted measures of hospital quality.
Author Opinion
The results of this study are not surprising. Popular publication reviews are often based upon public opinion on discharge as well as statistical metrics for excellence. Facebook uses similar metrics in it's reviews of hospitals.
Upcoming Topics:
Medical Students' Views and Knowledge of the Affordable Care Act: A Survey of Eight U.S. Medical Schools.
The future for the Affordable Care Act may well live in the minds of the current generation of medical students and trainees and not the electorate or political party. In reality the future of medicine is in their destiny.
Journal of General Internal Medicine: March 10, 2015
BACKGROUND
It is not known whether medical students support the Affordable Care Act (ACA) or possess the knowledge or will to engage in its implementation as part of their professional obligations.
PARTICIPANTS
All 5,340 medical students enrolled at eight geographically diverse U.S. medical schools (overall response rate 52 % [2,761/5,340]).
CONCLUSIONS
The majority of students in our sample support the ACA. Support was highest among students who anticipate a medical specialty, self-identify as political moderates or liberals, and have an above-average knowledge score. Support of the ACA by future physicians suggests that they are willing to engage with health care reform measures that increase access to care.
KEY RESULTS
The majority of respondents indicated an understanding of (75.3 %) and support for (62.8 %) the ACA and a professional obligation to assist with its implementation (56.1 %). The mean knowledge score from nine knowledge-based questions was 6.9?±?1.3. Students anticipating a surgical specialty or procedural specialty compared to those anticipating a medical specialty were less likely to support the legislation (OR?=?0.6 [0.4-0.7], OR?=?0.4 [0.3-0.6], respectively), less likely to indicate a professional obligation to implement the ACA (OR?=?0.7 [0.6-0.9], OR?=?0.7 [0.5-0.96], respectively), and more likely to have negative expectations (OR?=?1.9 [1.5-2.6], OR?=?2.3 [1.6-3.5], respectively). Moderates, liberals, and those with an above-average knowledge score were more likely to indicate support for the ACA (OR?=?5.7 [4.1-7.9], OR?=?35.1 [25.4-48.5], OR?=?1.7 [1.4-2.1], respectively) and a professional obligation toward its implementation (OR?=?1.9 [1.4-2.5], OR?=?4.7 [3.6-6.0], OR?=?1.2 [1.02-1.5], respectively).
Author's Opinion
Judging from the survey result the majority of trainees support the ACA and will work with the new system. This is not surprising. Young physicians are altruistic and by and large are not driven by monetary aspects. of health care. Few are knowledgable about the inner workings of the payment system until they enter practice. It would be interesting to survery physicians in age groups centering around their length in practice. Perhaps the quote, "Old dogs do not learn new tricks" would be appropriate.
Journal of General Internal Medicine: March 10, 2015
BACKGROUND
It is not known whether medical students support the Affordable Care Act (ACA) or possess the knowledge or will to engage in its implementation as part of their professional obligations.
PARTICIPANTS
All 5,340 medical students enrolled at eight geographically diverse U.S. medical schools (overall response rate 52 % [2,761/5,340]).
CONCLUSIONS
The majority of students in our sample support the ACA. Support was highest among students who anticipate a medical specialty, self-identify as political moderates or liberals, and have an above-average knowledge score. Support of the ACA by future physicians suggests that they are willing to engage with health care reform measures that increase access to care.
KEY RESULTS
The majority of respondents indicated an understanding of (75.3 %) and support for (62.8 %) the ACA and a professional obligation to assist with its implementation (56.1 %). The mean knowledge score from nine knowledge-based questions was 6.9?±?1.3. Students anticipating a surgical specialty or procedural specialty compared to those anticipating a medical specialty were less likely to support the legislation (OR?=?0.6 [0.4-0.7], OR?=?0.4 [0.3-0.6], respectively), less likely to indicate a professional obligation to implement the ACA (OR?=?0.7 [0.6-0.9], OR?=?0.7 [0.5-0.96], respectively), and more likely to have negative expectations (OR?=?1.9 [1.5-2.6], OR?=?2.3 [1.6-3.5], respectively). Moderates, liberals, and those with an above-average knowledge score were more likely to indicate support for the ACA (OR?=?5.7 [4.1-7.9], OR?=?35.1 [25.4-48.5], OR?=?1.7 [1.4-2.1], respectively) and a professional obligation toward its implementation (OR?=?1.9 [1.4-2.5], OR?=?4.7 [3.6-6.0], OR?=?1.2 [1.02-1.5], respectively).
Author's Opinion
Judging from the survey result the majority of trainees support the ACA and will work with the new system. This is not surprising. Young physicians are altruistic and by and large are not driven by monetary aspects. of health care. Few are knowledgable about the inner workings of the payment system until they enter practice. It would be interesting to survery physicians in age groups centering around their length in practice. Perhaps the quote, "Old dogs do not learn new tricks" would be appropriate.
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