MSL Blog

Medical students learn many traits that will help them become successful in their careers. One such trait is the ability to communicate effectively and efficiently with their patients. A recent blog post in Dr. Wong's blog highlights this often-overlooked skill and gives some suggestions on how to incorporate it effectively into an office visit.

1. Greet Patients By Name: By looking into the patient's eyes and greeting them by name, you are making a connection with that person, as well as putting them at ease. This will open the lines of communication.

2. Ask Why They Are At The Office: Let the patient describe their ailment and symptoms without interruption for two minutes so that you can get a clearer picture of what's wrong. That way you can ask the right follow-up questions.

3. Follow Up With Questions Related To Their Explanation: By connecting your questions with the explanation they just gave, you are showing that you've listened to your patient and are continuing that discussion. The exchange of information should be more like a discussion than a monologue.

If you show your patients that you are listening to their concerns and taking them under consideration, you are helping to ensure an open and honest discussion. This will move you closer to a correct diagnosis and support a healthy and happy team effort between physician and patient.

Three years ago, changes to the MCAT were proposed. This would have been the first change in structure in over 20 years. As of this week, these changes have been approved by the AAMC and will come into effect in 2015. The restructure was done to more fully reflect the current medical system and all the knowledge medical students would need as they embark onto their careers.

Certain sections were removed, while others were added to test in new areas. There will no longer be a writing test component of the MCAT, as that was not deemed worthwhile for overall knowledge. Instead, there will be a new section titled "Psychological, Social, and Biological Foundations of Behavior" which will test in areas of psychology, sociology, and biology. These areas are essential for medical students to understand when engaging with patients in practice.

“Being a good doctor is about more than scientific knowledge. It also requires an understanding of people. By balancing the MCAT exam’s focus on the natural sciences with a new section on the psychological, social, and biological foundations of behavior, the new exam will better prepare students to build strong knowledge of the socio-cultural and behavioral determinants of health.” ~ Darrell G. Kirch, M.D., AAMC President and CEO

Additionally, there will be a new "Critical Analysis and Reasoning Skills" section. Students will be presented passages which they will have to extract information from. This will test their abilities of analysis, evaluation, and application of information. Two natural science sections have also been added, including topics in the areas of biology, organic chemistry, biochemistry, and physics. These areas will test students' skills to use scientific inquiry and reasoning in order to solve problems. This will show that they are ready to embrace the requirements necessary for medical school.

In total, the overall testing time has been increased by an hour, from 5.5 to 6.5 hours, but this is in line with former versions of the test, so it should not be a problem for students. It will be interesting to see if the revised test shows a more complete picture of students' abilities and gives better selection for medical schools.

Social media has become a large component of life for much of the population, physicians included. However, it's always a tricky line to walk between being professional and being open. Principles for use were often requested, but it was not until this week that the AMA came out with a non-binding policy to guide the use of social media within the healthcare community.

1. Physicians should be cognizant of standards of patient privacy and confidentiality that must be maintained in all environments, including online, and must refrain from posting identifiable patient information online.

This should be self-evident, but the guiding principle is to respect doctor/patient confidentiality. Medical professionals should not talk about cases with information that could be traced back to a specific patient.


2. When using the Internet for social networking, physicians should use privacy settings to safeguard personal information and content to the extent possible, but should realize that privacy settings are not absolute and that once on the Internet, content is likely there permanently. Thus, physicians should routinely monitor their own Internet presence to ensure that the personal and professional information on their own sites and, to the extent possible, content posted about them by others, is accurate and appropriate.

While medical professionals should strive to keep their personal information separate from their professional information, even locking down the private information does not guarantee that only a limited audience will see it. Medical professionals should be aware that the image they put out online can be damaging if patients see it.


3. If they interact with patients on the Internet, physicians must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just, as they would in any other context.

Physicians should never over-step their boundaries of a professional relationship with their patients. It is not a good idea to "friend" patients or enter into discussions that they would not otherwise contribute to in a professional environment.


4. To maintain appropriate professional boundaries physicians should consider separating personal and professional content online.

As mentioned above, medical professionals should maintain a separate private profile that is limited to just friends and family, while allowing others to access a more limited public profile. Patients finding more personal information about their physicians could damage the professionalism that physicians strive to maintain.


5. When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities.

While physicians should self-regulate their information, they also should regulate the information of their colleagues. If something is seen as inappropriate, first contact the poster to deal with it. If the colleague does not abide by proper action, going to a higher official is warranted.


6. Physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers (particularly for physicians-in-training and medical students), and can undermine public trust in the medical profession.

As mentioned above, patients and the public can access a tremendous amount of information online. If inappropriate content is found related to a physician, the professional respect could be damaged, not only for the physician but the medical field in general. Physicians should be conscious of what they are posting and in what context.

By abiding by these suggested guidelines, medical professionals can assure that they are able to take part in social media without damaging their professional image. There are many advantages to using social media, but always be aware of the disadvantages that could come from improper use.

Addiction is a large problem around the globe. Patients are often treated for drug or alcohol abuse, given treatment in order to release themselves from the physical and mental symptoms that addiction bring. However, medical professionals are not immune either. A recent article looks at anesthesiologists who are battling their own addictions.

Trained medical professionals are often better able to hide their addiction from family and coworkers. They know how to inject without being caught and how to dose themselves so that they don't lose coherency. Anesthesiologists especially are of concern. Even though they only account for 3% of all medical professionals in the industry, 20-30% of all addicted physicians are anesthesiologists. This discrepancy warrants the need for more attention paid to the profession, especially in terms of how their addiction puts their patients in danger.

If an anesthesiologist is under the influence while treating patients, they are likely to make grave medical errors. Additionally, they often acquire their fixes by diverting a portion of medical meant for patients, so treatment is already put into jeopardy even if the physician isn't under the immediate influence of drugs at the time. Patients are given stronger medication, when it's seen that their current charted dosage isn't working, but the reality is that they were getting diluted levels of pain medication and are thereby put in danger of an overdose at higher levels.

“These drugs can take somebody who is at the top of their game, and bring them down very hard and very fast. It’s a story that a lot of people aren’t talking about.” ~ Dr. Ethan Bryson, Associate Professor (Department of Anesthesia and Psychiatry, Mount Sinai School of Medicine)

It is important that treatment for these addicted medical professionals is sought immediately, so that they will not continue to put others' lives in danger. However, fear of professional repercussions often lead addicts to keep their secret. Changes in communication must be made so that addicted medical professionals are not blacklisted for seeking the treatment that they need. Until the door is open to them to start on the path to recovery, patients' lives will continue to remain at risk. No one is immune to the negative outcomes of addiction, not even those professionals who have sworn to treat and keep safe those around them.

Patients trust their doctors to provide them high quality care, as well as look after their best interests. This trust is built upon assurance that their doctors are telling them everything they need to know. However, that may not be the case. According to a 2009 survey recently published in Health Affairs, in which 1800 physicians in the US were interviewed, 11% admitted to lying to their patients within the last year.

The reasons for these untruths vary. More than half (55%) have given their patients a more positive prognosis than their test results support. This may be done in order to put their patients in a positive mindset for treatment, thereby unconsciously aiding their recovery, or simply emphasizing a best case scenario. That doesn't mean that physicians are always lying for the benefit of their patients, though. Nearly 20% who admitted lying did so because they had committed a medical error and did not want their patients to sue for malpractice. In these cases, the lies might have seriously harmed patient outcome because of lack of disclosure.

What do these findings mean for the medical profession? It certainly warrants a change in behavior. If patients cannot trust their physician to give them an honest answer, their health may be in jeopardy. The healthcare relationship is built on trust and being a team through the process of treatment and recovery. When one of the team players is keeping secrets, it does not bode well for the outcome.

The demand for physicians is rising as more patients are set to enter the medical marketplace in the coming years. Current healthcare workers are being stretched for time and some patients may feel they're not getting the best care they can. However, patients have the option of paying more for personalized care. Is this a worthwhile choice for the future of medicine?

By paying a fee ranging from $1500 to $15000 annually, patients taking part in concierge care can be assured that they'll get quick, personalized care from their physician. Appointment times are set up almost immediately, direct communication is assured, extensive physical exams are provided, and a wealth of other wellness programs are open to those who choose the services. Additionally, even though the concierge fee doesn't cover  specialist or hospital care, physicians are known to follow patients through their care and be present during procedures that they are not performing themselves.

All this sounds like a great opportunity for patients looking for that "something extra" but it also allows for exclusion based on ability to pay. Those who cannot afford concierge care may be getting less extensive care than their counterparts or may be excluded from treatment access by certain physicians because they are dedicating more time to their concierge patients.

In the end, is concierge care harming the medical industry or helping it? Should patients get preferential care because they can pay more? Or is this just another way to guarantee that medical care received is at the highest level possible?

The rate of prescription adherence is always a problem in medicine. Physicians give paper prescriptions to their patients, but it doesn't guarantee that the patient will take it to the pharmacy or that they'll pick the medication up when it's ready. How can these rates be improved? According to a recent Information Week article, the answer may be e-prescribing.

A study conducted on paper prescribing showed that 73.2% were taken to the pharmacy, but only 69.5% were picked up. Compared to these rates, for prescriptions sent electronically, 81.8% were delivered and 76.5% were picked up. That means that patients are more apt to receive their medication if physicians ease the process through electronic prescribing. However, currently only 40% of physicians take part in this mode of prescribing.

"Improved medication adherence results in lower downstream medical costs." ~ Seth Joseph, Leader Researcher 

A higher rate of prescriptions being obtained from the pharmacy means that patients are more apt to take their medication. Higher rates of medication usage means better long-term health. In fact, current estimates are that if physicians take part in electronic prescribing, the higher rate of patient pick-up could reduce long-term health expenses by $240 billion. With all these benefits from a more streamlined process, it seems evident that electronic prescribing is worth looking into.

Patient safety should be a top priority for all caregivers and is especially important when patients are in the hospital. A recent article delved into the issue and calls for healthcare workers to increase their devotion to patient safety.
Ten years ago, the Institute of Medicine estimated that around 100,000 people were dying annually in hospitals from preventable issues. Those shocking numbers should have pushed for changes, but sadly the situation has gotten worse. The rate of deaths among Medicare patients has raised to 180,000 annually, marking faulty hospital care as the third leading cause of death in the United States. This indicates a strong need to change the statistics.
One suggestion is to have caregivers rely on checklists. This would allow standards of care to be present, as well as assuring that proper procedures were being taken by all healthcare workers. Improper care through shift changes, as well as mistakes during surgery, could be decreased if a visual representation of completed procedures had to be gone through. This was the theory Atul Gawande, a surgeon in Boston, was working on when he came up with a medical checklist with members of the World Health Organization. The checklist was sent to eight international hospitals in 2008 and all saw a drop in medical mistakes. Complications from surgery dropped 36% and hospital deaths decreased by 47%.
With these results, it seems obvious that health checklists would go a long way in decreasing health complications among hospitalized patients. The key is to convince hospital staff to abide by the checklists and actually fill them out. While procedures may become so common that they can be completed from memory, it's important to have the physical list to go through in case something is missed. Convincing healthcare workers of this necessity may be hard, but it's important for the safety of healthcare. Patients want to feel safe when they enter the hospital, so caregivers should do all they can to assure that.

Smoking, drinking, and being overweight are all negative health factors which physicians warn against, but what if the physicians themselves are taking part in these same behaviors? That's what a recent study delved into; specifically the negative impact overweight doctors have on treating patients for weight issues.

Surveying 498 PCPs, the study found that 38% were overweight and 15% fell within the obese category based on BMI. While this is a problem itself, what was more concerning was how their weight impacted their diagnosis of overweight patients. If the physician thought that their own weight was less than the patient, that prompted a diagnosis of obesity in 93% of cases. However, that diagnosis dropped to 7% when the physician thought that the patient was actually smaller than them. Such a dramatic drop leads one to believe that physicians comparing themselves to their patients would lead to a false sense of good health.

But even in both these cases of weight notation, the instances of weight loss discussion was less than diagnosis, which means physicians are identifying patients as overweight in some cases, but not discussing ways to correct the issue. Time limits are no excuse for not pursuing good health practices with patients. 
Physicians have a responsibility to provide an example for their patients when it comes to good health. When their physician is exhibiting the same health concerns as they are, patients will be less likely to change their own behavior. Physicians taking care of themselves as a "do what I do" mentality will help give patients encouragement to pursue good health standards. And when weight is an issue, it's important that physicians talk about this with their patients. Health is a team effort, so physicians must make sure they are becoming an active part of that process.

Ingrained in the American consciousness is the traffic light symbolism. Red means stop, yellow means caution, and green means go. Now, that same mentality is being brought to food, according to a recent study from the American Journal of Public Health.

Within a large hospital cafeteria, foods and drinks were labeled with red, yellow, or green depending on their health value. Signs encouraged customers to choose green items more and red items less, with yellow items being a choice only some of the time. After three months, the results were striking. Green-labeled beverages saw their sales increase by 9.6% and red-labeled beverage sales were down 16.5%. Overall, red-labeled sales were down 9.2% and green-labeled sales were up 4.5%. This shows a direct correlation between ingrained color symbolism and behavior.

"We believe this intervention was so successful because it was simple and easy to understand quickly.  The labeling did not require any special skills and could be easily interpreted when a customer was in a rush." ~ Anne Thorndike, Study Leader

The concept of unconscious choice was also expanded in terms of product placement. Healthier, green-labeled choices were placed at eye-level and unhealthy, red-labeled choices were placed either above or below the eye-line. This encouraged customers to choose the better alternatives at an increased rate. Red-labeled items saw their sales decrease another 4.9% and green-labeled food items saw their sales increase another 4%.

Collectively, these study results show that simple labeling may help customers choose healthy when out to eat. If the same color concepts could be applied to menus and other food areas, consumers would be better informed for the choices they're making without having to understand complex food labels.

Electronic health records are gaining popularity among the more electronically-inclined physician population. So, too, are personal health records. But providing access doesn't necessarily translate to use, according to a recent article on FierceEMR.

"PHR access alone failed to activate patients, improve outcomes, increase satisfaction with care or change the frequency within which patients use medical services." ~ Researchers in JAMIA

Citing a study in the Journal of American Medical Informatics Association, hypertension patients were given PHRs which interconnected to their EHRs. Studies have found that use of PHRs help to decrease blood pressure and improve patient outcomes in the area of hypertension. Despite this, only 26% of patients noted frequent use of their PHR. Not surprisingly, those that had a higher rate of use were described as being more tech-savvy, and therefore more comfortable with evolving technology. How can physicians bridge the gap of use?

It's important that healthcare providers train patients on how to use their PHR, as well as being available for any questions that may come up during use. If patients know that they can ask for help, without being looked upon as a burden, they may perhaps take a larger role in their healthcare. While a 100% use rate may be impossible, there is always the possibility of raising the rate of use to 50% or more. Physicians should always strive to help their patients achieve positive outcomes in whatever way that is possible.

The need for increased knowledge in the area of LGBT health has been identified on multiple occasions, but finding physicians who can provide for these health issues is difficult. In a recent article by the Globe, the LGBT population was shown to have higher rates of substance abuse and mental disorders, as well as being at risk for:
Gay Men: At higher risk for contracting STDs.
Lesbians/Bisexual Women: Increased risk to be overweight.
Transgender Population: At higher risk to have cardiovascular disease.
It's important that physicians identify their LGBT patients so that they can consult on these increased health risks. However, the burden for care does not fall solely on the physicians. Many patients may feel uncomfortable disclosing their sexual orientation for fear of judgement, so they keep that information private and put themselves at a disadvantage for care.
“In order to understand and address LGBT health disparities, we as health care providers need to better understand who our LGBT patients are." ~ Dr. Stephen Boswell, President of Fenway Health
It's important that physicians address sexual orientation when evaluating their patients. To do this, they have to put their patients at ease and assure that no judgement will come from the disclosure of information and that it will be kept private, along with the rest of their medical records. If patients feel safe to disclose sensitive personal information, they will be more likely to do so and that can lead to better care.

Medicine is going mobile. We've seen the indications, as more medical professionals are relying on mobile devices and more patients are accessing medical information through apps and online. Medill Reports recently had an article that delves into the changing face of medicine.

As the article points out, by the end of this year 80% of doctors are estimated to own a smartphone. That means increased access to information and increased use of apps. Medical professionals can readily look up information relevant to a diagnosis they are considering, access patient records, or be in contact with their office when not physically there.

“As time goes by, more and more resources are becoming available in a mobile optimized format.” ~ Mark Berendsen, Electronic Service Librarian 

The use of mobile devices can be beneficial not only in more populated areas, but those areas that don't have ready access to larger hospitals. Using an example from the Philippines where healthcare workers take cell phone photos of patient amputation and send them for consultation from Philippines General Hospital, the same type of long-distance consultation can happen in rural areas. Healthcare workers as well as patients in rural areas can take photographs of their presenting physical symptoms to be reviewed by treatment professionals in larger hospitals. This will allow rural patients to receive the same health benefits as their counterparts in larger cities.

Mobile healthcare is on the rise and has the potential to provide increased health benefits to patients and physicians alike. It's important that the medical industry embrace the new tools available in order to create a world where healthcare is truly a team effort.

Substance abuse is a large problem in the US population and one that physicians will have to treat in their careers. However, it's not just substance abuse that is the issue. According to a recent report by the Center for Substance Abuse Treatment (CSAT), 50-75% of those seeking treatment also have a mental health disorder. This means that it's important for physicians to deal with a dual diagnosis and how to best treat both co-currently.

However, medical schools may not be adequately preparing physicians for this reality. 5.6 million adults in this country have co-occurring mental and substance abuse issues. Of these, only 112,000 (2%) are receiving dual treatment. Physicians must understand that treating one disorder or both separately is not the best approach. Each disorder influences the other, so it's important that treatment follow a combined regimen. It is not merely a substance abuse issue or a mental health issue, but a third disorder that must be treated accordingly.

By increasing the education on dual diagnosis and how to best treat those who have combined mental health and substance abuse issues, patient outcomes can become more successful. Healthcare is a team effort, so physicians must make sure they're best prepared to be a part of that team.

Physicians are often taught to bring up the topic of smoking cessation with all their patients who smoke. The medical professionals are advised to only pursue the topic with those who express a willingness to quit. However, a new study shows that Willingness To Quit shouldn't be the only push for physicians to help their patients become smoke-free.

The study indicates that, while official guidelines in the US state a willingness to quit must be expressed before cessation assistance is offered, 40-60% of additional smokers could seek out cessation if their doctors would just push for it. However, with physicians' time already stretched, instituting a new cessation approach for all patients might not be feasible. Additionally, physicians may feel uncomfortable pursuing cessation counseling with patients who have not indicated a willingness to stop smoking.

Even among those who have shown a willingness to quit, the success rate is low. The CDC states that 68.8% of current smokers want to stop, yet only 52.4% have tried in the past year, and only 6.2% have been successful. This seems to indicate a need for increased cessation counseling, but can physicians do it? The health of the patient is in the physician's hands. Together, they can set on a positive health journey and perhaps at the end smoking will be a distant memory.

Binge drinking in America has gotten worse. On Tuesday, the CDC said that 80,000 annual deaths are a result of excessive alcohol, stemming from alcohol-related violence, car crashes, and other linked reasons. This makes it the third leading cause of preventable death in the US.

“Binge drinking is defined as consuming four or more drinks on an occasion for women and five or more drinks on an occasion for men.” ~ Ursula Bauer, Director (National Center for Chronic Disease Prevention and Health Promotion)

With this definition of binge drinking, 17% of Americans fall under the category and average about 8 drinks per session. What's perhaps surprising is the income gap of those Americans who binge drink. While it's more common in households that make more than $75,000 per year, those that drink more in one session fall below the $25,000 annual income level. What does this indicate? It may indicate a more social aspect of binge drinking for lower income levels or an increased accessibility to alcohol for those in the higher income bracket. Additionally, 18-34 year olds binge drink more commonly, but those 65 or above do so more frequently.

Binge drinking carries social and health risks, which could be prevented with proper education and intervention. Younger drinkers often binge when they drink, highlighting a need to educate on proper levels of alcohol consumption. When drinking to excess, people are put at risk for STDs, cancer, and liver/brain/heart damage, as well as put infants at risk for SIDS.

It's important that healthcare professionals discuss alcohol use with their patients and work towards decreasing, or perhaps eliminating, consumption. The positive health benefits from decreased alcohol use will be long-lasting and help solidify a positive health journey for patients and physicians.

Anatomy labs are very important to medical student training. However, often bodies are either in short supply or incomplete for all organs. But developing technology is making this education easier through the use of 3D technology.

The New York University School of Medicine is incorporating a new 3D anatomy program into their medical curriculum. The technology was developed by BioDigital Systems and provides a 3D rendering of the human body. Students can section body parts, doing a full-scale examination without the need for actual donated tissue. The virtual bodies are also complete, so there's no chance that a donated body might be missing an organ that might have been removed.

“We want to become a scalable model...a Google Earth for the human body.” ~ John J. Qualter (BioDigital Systems)

While still in the early stages, the program has gotten good feedback from some students. Users have noted the expanded ability of the program to reset, return the body to its starting status so that students can practice their skills again and again. However, others still value the ability to dissect real bodies, since the tactile sensation is important to learning. So, while the new technology won't necessarily completely replace the traditional anatomy lab, it can provide a good compliment for learning, as well as providing skills training to those students who might not have access to full anatomy labs.

The Medical Student Learning blog will be on hiatus until January 9th as the Clinical Tools, Inc. staff takes time to spend with friends and family during this holiday season.

All continuing medical education programs are still available so that you can get training during your time off. Please visit our company website for a complete listing of educational training.

See you in 2012!

The iPhone has been used for many things in the medical community. Doctors can stay in touch with their office and their patients. Patients can access medical apps to help them learn about healthy living. And now the iPhone can be used as a medical monitoring device as well.

The FDA has just approved a glucose monitor that can be plugged into the iPhone, a first of its kind. Using the meter, patients can take a blood sample and then plug the meter into the iPhone to see instant results. By coupling the use with the free "Diabetes Manager" app, patients can track historical readings, monitor insulin, and see when glucose varies too widely.

This meter joins a former FDA-approved device, a blood pressure cuff, as integrative technology to be used with an iPhone. Researchers are also looking into how the device's use can be expanded for diagnostics. Since the touchscreen is so sensitive, analysis of blood, urine, and saliva could be possible.

Mobile technology is joining with medical technology to give patients control of their own health. By utilizing these advancements, both patients and physicians can work towards better health outcomes.

The value of good communication skills has been focused on in medical schools across the globe. However, has this change in focus sacrificed other critical skills in the medical school curriculum? Some students may think so.

Recent reports from the UK show that new physicians entering the field don't feel comfortable dealing with seriously ill patients. This is rooted in the fact that they believe they haven't been given the basic skills to deal with such situations. Because of the wealth of information necessary to learn, and the reduced time that medical schools can devote to everything, some skills training may have been lessened. Among them, says new physicians, are proper prescribing and acute care.

"One of the reasons that junior doctors might feel more prepared in some of the other domains is the emphasis on communication and teamworking . It is very difficult to keep the same level of emphasis on other things when new things are added in." ~ Dr. Sam Smith

This lack of comfort and ability has detrimental effects for patients. During the weekends or times when senior physicians aren't as readily available, new physicians are often left to cover acute cases on their own. Without the skills necessary to adequately deal with these patients, nor the access to more experienced physicians, patients are more likely to experience negative side effects, or even death.

This situation indicates a real need for change. Medical schools must learn to balance all the curriculum necessary to produce well-versed, confident physicians. And changing schedule requirements, which limit the time a physician can practice continuously in a week, must be taken into account to assure that senior physicians are always on hand to help less-experienced providers. By learning together, and gaining the skills necessary, new physicians can be assured that they are providing the best care possible to their patients.