The Latest Update on Face Masks

In "A Visual Guide to Face Masks: What Works, What Doesn't," posted 9/17/20 on Medscape.com, author John Watson reviews the latest data on the most commonly used masks and their benefits and limitations in protecting against coronavirus.

Bottom line: "not all masks are created equal."

You can read the full article here.

Be safe.

New App Helps Patients Prepare For Appointments With Healthcare Providers

Asking the right questions is the best way to maximize time with your doctor by focusing her or him on your specific needs, which in turn leads to optimum care and outcomes.

The Question Builder app is the latest in a series of campaigns developed by the Agency for Healthcare Research and Quality (AHRQ) that are designed to enhance patient-provider communication and support shared decision making.

Available for free on iTunes and Google Play, the app:

• Guides you through a list of questions that can be customized 
• Enables you to append photos, e.g., insurance cards, pill bottles, visible symptoms, etc.
• Provides access to consumer education materials and videos

Here's a brief video on how to use the app.

Other Resources Available From AHRQ:

Questions to Ask Your Doctor

Patient and Provider Videos

New App Offers Roadmap for Dealing With a Devastating Diagnosis

AfterShock provides concise information and resources to help newly diagnosed patients and their loved ones navigate the fear and confusion that often follow a serious diagnosis.

Jessie Gruman

The app is based on the book AfterShock by Jessie Gruman—Founder and President of the Center for Advancing Health—who was a tenacious advocate for patient engagement and empowerment. Her wisdom and passion informed by her own battle against five cancer diagnoses over a 40-year period. 

The recommendations in AfterShock are based in part on her experiences and on more than 200 interviews with patients, family members, nurses, doctors, and hospital administrators. Woven throughout the content are stories of people who like Ms. Gruman faced the challenges of their diagnoses and learned how to cope and take care of themselves. 

The app is a condensed version of the book. Sections include:

• Getting Through the Shock
• Learning About Your Diagnosis
• Learning About Treatment Options
• Telling Others
• Finding Good Doctors and Hospitals
• Getting a Second Opinion
• Making Your Appointments
• Finding a Little Relief

Ms. Gruman, who passed away in July, was remembered by many colleagues and friends as a "pioneer," "champion," and "hero" in helping people understand their role and responsibility in participating in their care. She leaves a rich legacy.

AfterShock is available for free downloading in Apple's App Store. It is currently compatible with iPhone, iPad and iPod Touch. The app is optimized for iPhone 5.

Meddik Helps You Create Your Own Health Network

"Many of the issues that exist within healthcare can be solved simply by increasing communication channels." Tim Soo, Cofounder, Meddik

Meddik is a new site that gives you the opportunity to create—anonymously—a personal health network of people who share health challenges similar to yours. You can browse advice, questions, and stories while sharing as much or as little information as you choose.

You may be wondering how Meddik is different from sites like Patients Like Me, Cure Together and other condition-focused online forums.

The major difference is that Meddik is the first to combine user-submitted content with a design that tags a users' specified interests and then uses those tags to create networks of people with similar profiles. When users sign in, discussion threads, articles and resources generated by others in their network come up. Content is moderated by users—up-voting and down-voting determines rank and helps ensure accuracy and relevancy. 

More and more patients and caregivers are connecting online in order to supplement professional medical advice, according a recent study conducted by Pew Research Center. In "Peer-to-Peer Healthcare," a report based on the study, author Susannah Fox quotes a woman who is caring for her husband:

“We have found that we get helpful info from both doctors and other patients/caregivers. Other patients/caregivers are almost more helpful when it comes to this disease because as a group they have more info than any one individual doctor has. We have gotten info from other patients/caregivers that we've then told the oncologist about so he could look into it. Sometimes we feel like we're educating our doctor more than he is educating us.”

The statement not only supports the value of peer-to-peer learning but also validates the potential of Meddik's mission "to tap into the power of the masses...ultimately accelerating the pace of innovation."

Meddik, which was launched in July of this year by cofounders Tim Soo and Benjamin Shyong, is in the early stages of development and actively recruiting users. Take a few minutes to explore the site and, if so inclined, drop a question, story, or pearl of wisdom and watch the ripple effects of people helping people.

References

Medical School vs Doing a Start-Up. Accessed at http://www.timsoo.com/2012/08/06/medical-school-vs-doing-a-start-up/

Meddik is using its recently-raised $750K in Seed funds to build a ‘health network’ based on whole health profiles. Accessed at http://startupbeat.com/2012/06/08/meddik-is-using-its-recently-raised-750k-in-seed-funds-to-build-a-health-network-based-on-whole-health-profiles/

Meddik's Bet: Peers beat search on health questions. Accessed at http://gigaom.com/2012/05/23/meddiks-bet-peers-beat-search-on-health-questions/

Peer-to-Peer Healthcare by Susannah Fox. Accessed at http://pewinternet.org/Reports/2011/P2PHealthcare.aspx

Choosing Wisely™

Your doctor recently ordered a medical test or course of treatment for you because (choose all that apply):

Photo Credit: Ambro

1. She is practicing evidence-based medicine, i.e., the test or treatment has been proven effective in diagnosing/treating your condition
2. She is afraid she will be sued for malpractice if she misses something
3. She hasn't spent enough time with you
4. She is participating in quality measure reporting
5. All of the above

Answer: It depends...


According to an article by Brenda E. Sirovich, MD, MS, Steven Woloshin, MD, MS, and Lisa M. Schwartz, MD, MS, published last year in Archives of Internal Medicine, 42 percent of U.S. primary care physicians believe that patients in their own practices are receiving too much care; only 6 percent said they were receiving too little. Factors cited for aggressive testing and treatment included: fear of malpractice (76 percent); clinical performance measures (52 percent), and inadequate time spent with patients (40 percent). Sixty two percent said diagnostic testing would be reduced if not for financial incentives to specialists (39 percent for primary care physicians).

The cost of these unnecessary, and sometimes harmful, tests and treatments are estimated to be a third of the $2.6 trillion Americans spend on healthcare each year.

Last week, a new campaign that Dr. Donald Berwick—former Administrator of Centers for Medicare and Medicaid and longtime champion of patient safety—called "a game changer" was launched by nine prominent physician groups. The groups have each identified five specific tests or procedures that are commonly used but not always necessary. 

Choosing Wisely™ Five Things Physicians and Patients Should Question which is led by the American Board of Internal Medicine Foundation with Consumer Reports, includes such recommendations as:

• Don't order sinus computer tomography (CT) or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis (American Academy of Allergy, Asthma & Immunology)
• For pharmacological treatment of patients with gastroesophageal reflux disease (GERD), long-term acid suppression therapy (proton pump inhibitors or histamine2 receptor antagonists) should be titrated to the lowest effective dose needed to achieve therapeutic goals (American Gastroenterological Association)
• Don't do imaging for low back pain within the first six weeks, unless red flags are present (American Academy of Family Physicians)
• Don't perform stress cardiac imaging or advanced non-invasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present (American College of Cardiology)
• Don’t obtain preoperative chest radiography in the absence of a clinical suspicion for intrathoracic pathology (American College of Physicians)

Full lists with rationales can be found on the Choosing Wisely™ website. Several more physician specialty groups are preparing lists that will be released in the fall of 2012.

While many in healthcare have praised the initiative, others worry that the recommendations may be adopted too broadly, restricting choice and putting patients at risk.

A press release for the campaign describes the lists as evidence-based recommendations that are meant to encourage discussion among physicians and patients and to guide decisions about the most appropriate care based on individual situations.

So the next time your doctor recommends a test or treatment, ask questions, talk through the options and together make the best decision for you.

References

Choosing Wisely by Christine K. Cassel, M.D. and James A. Guest, J.D. Journal of the American Medical Association, published online April 4, 2012.
Accessed at http://jama.ama-assn.org/content/early/2012/03/30/jama.2012.476.full

Doctor Panels Recommend Fewer Tests for Patients by Roni Caryn Rabin. The New York Times, April 4, 2012. Accessed at http://www.nytimes.com/2012/04/04/health/doctor-panels-urge-fewer-routine-tests.html

Physicians Wade Into Efforts To Curb Unnecessary Treatments by Julie Appleby. Kaiser Health News, April 4, 2012. Accessed at http://www.kaiserhealthnews.org/stories/2012/april/04/physicians-unnecessary-treatments.aspx

U.S. Physician Groups Identify Commonly Used Tests or Procedures They Say Are Often Not Necessary. Press release, April 4, 2012. Accessed at http://www.prnewswire.com/news-releases/us-physician-groups-identify-commonly-used-tests-or-procedures-they-say-are-often-not-necessary-146046345.html

What Is Your Patient Safety IQ?

It's been more than ten years since the Institute of Medicine published To Err Is Human, their much publicized report that estimated as many as 98,000 Americans die each year from preventable medical errors. Since then, according to recent article in the journal Quality and Safety in Health Care, "efforts to improve patient safety have proliferated but progress toward improvement has been frustratingly slow" 

The authors—who are safety experts from some of the most prestigious healthcare organizations in the country: Harvard Medical School, Institute for Healthcare Improvement, Agency for Healthcare Research and Quality, National Patient Safety Foundation, Consumers Union, Kaiser Foundation, Vanderbilt University Medical Center—propose five concepts for transformation of care:

• Transparency—free, uninhibited sharing of information about hazards, errors and adverse events
• Integrated care platform—evidence-based, patient-centered care across all venues: inpatient, outpatient, and residential
• Consumer engagement—"Nothing About Me Without Me"
• Joy and meaning in work—caregivers cannot meet challenges unless they feel valued 
• Medical education reform—greater emphasis on information management, basic concepts of human interaction, patient safety, etc. 

Their vision for consumer engagement is encouraging:

"We envisage patients as essential and respected partners in their own care and in the design and execution of all aspects of healthcare. In this new world of healthcare:

Organizations publicly and consistently affirm the centrality of patient- and family-centered care. They seek out patients, listen to them, hear their stories, are open and honest with them, and take action with them.

The family is respected as part of the care team—never visitors—in every area of the hospital, including the emergency department and the intensive care unit.

Patients share fully in decision-making and are guided on how to self-manage, partner with their clinicians and develop their own care plans. They are spoken to in a way they can understand and are empowered to be in control of their care."

Feeling inspired? Test your knowledge of patient safety by participating in a brief survey and as a bonus you will be entered in a drawing for one of 20 copies of You the Smart Patient or the just published The Smart Parent's Guide to Getting Your Kids Through Illnesses, Accidents, Checkups: http://www.surveymonkey.com/s/Patient_IQ_Quiz

The answers provide links to the Joint Commission's Speak Up series of brief, easy-to-read brochures about how you can protect yourself and your family against healthcare errors by taking an active, informed role in your care. Brochures are available in English and Spanish. 


Access pdfs of the full series at http://www.jointcommission.org/PatientSafety/SpeakUp/


Reference


Leape L, Berwick D, Clancy C, et al. Transforming healthcare: a safety imperative. Qual Saf Health Care 2009;18:424-428. Accessed 3/18/10 at http://qshc.bmj.com/content/18/6/424.htm

Questions Are the Answer

A series of amusing TV public service announcements for "Questions Are the Answer" from the Agency for Healthcare Research and Quality (AHRQ) makes the point very well: in most business transactions we are curious and full of questions—except it seems in the doctor's office.

http://www.ahrq.gov/questionsaretheanswer/level2col_1.asp?nav=2colNav00&content=09_0_videos

Why are we so timid? We are after all paying a fee for a service. Aren't our bodies more important than a cell phone contract or what we order in a restaurant? Whether our discomfort is caused by our fear of appearing uninformed, our fear of actually being informed, or our doctor's manner and/or body language, a lot of us seem to find it difficult to talk with our healthcare providers. 

Well it's time that we, as Cher so memorably said, "Snap out of it!"

I've written before about the importance of asking questions (see 8/14/09 posting, Another Reason to Ask Your Doctor Questions) and so I won't repeat the basics here. Although one point is worth reinforcing: the ability to gather information, think about how the information pertains to your individual circumstances, and then using the information to evaluate your options and make decisions is fundamental to gaining greater control over your health and your life. 

Because the circumstances of our health may change over time (think decision re treatment of a cold vs. a diagnosis of cancer) we all need a little help now and then. The AHRQ has an excellent feature on their site that will guide you through creating a list of questions for a variety of situations, e.g., a new medication or diagnosis, recommendation for a medical test or surgery, choosing a clinician, hospital, health plan, or long-term care. Once you've built your list, you can print a copy to take with you to your next doctor's appointment.

See https://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/index.html

Remember, practice builds confidence. And when it comes to your own body, another favorite line from Moonstruck comes to mind, "You have such a head for knowing!" 

How to Be a Smart Healthcare Consumer

FACT: The quality of healthcare in this country varies—a lot—according to the Agency for Healthcare Research and Quality

What You Can Do About It

• Take control of your health. As a starting point, ask your doctor these three questions and make sure you understand the answers:

1. What is wrong with me?
2. What do I have to do?
3. Why is it important for me to do this?

• If necessary, enlist family members, friends, and/or coworkers to help you get informed about your condition and especially selecting your healthcare providers
• If you (or a loved one) are in the hospital, ask for a social worker or patient advocate. If you are more comfortable talking in a language other than in English, ask for a translator. Most hospitals and health plans will provide these services
•  Create your own Personal Health Record with family/personal health history, medications/dosage, blood type, etc.

Resource for Creating a Personal Health Record (PHR)

The American Health Information Management Association (AHIMA) is a non-profit professional association dedicated to the effective management of personal health information needed to deliver quality healthcare to the public. For information and free PHR forms: http://www.myphr.com/

FACT: WHO you receive your treatment from determines the quality of care you receive.

What You Can Do About It

Because there is no complete database of information on how well individual physicians perform, there is really not one best way to find the right doctor for you…the best approach is to use several approaches:

• Talk with family, friends, and social and business contacts who may have had a similar health condition
• Network to get names from other doctors, nurses and allied health professionals
• Check Best Doctors lists for your city or nearby metropolitan area
• Double and triple check recommendations to assess and confirm a physician’s credentials:

• Is he/she board certified, i.e., completed advanced study and passed a rigorous test in his or her specialty? (use links below to find information about an individual physician)
• Does he/she have admitting privileges at an accredited hospital?
• Has she/he published articles or participated in clinical trials related to your disease or condition? This may be important if you have a rare disease or condition
• Does she/he have a good reputation among peers?

• Visit several doctors before deciding
• Ask about level of experience in treating your condition—this is very important and you are entitled to know this—especially if it involves new technology or surgical procedures
• Observe how the office staff treats you and how the office is managed
• Ask if the office is equipped with electronic medical records (EMRs) and if the physician uses e-mail with patients. EMRs have been shown to reduce medical errors
• Look for consistency in what you read, hear, feel

Resources

Agency for Healthcare Research and Quality publication Your Guide to Choosing Quality Healthcare is available at no cost by calling 1-800-358-9295 or by visiting their website at www.ahrq.org

Your State Department of Health or State Medical Board is responsible for investigating complaints about physicians and monitors physicians who have been placed on probation. A full listing of US state and local health departments can be found at:

http://www.apha.org/about/Public+Health+Links/LinksStateandLocalHealthDepartments.htm

FACT: WHERE you receive treatment determines the quality of care you receive.

What You Can Do About It

• Check that the hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations 
• Consult your State Health Department to make sure hospital is highly rated, in general, and specifically for treating your condition. Look for high volume, i.e., large numbers of patients with your condition have been successfully treated 
• Consult U.S. News & World Report annual issue on Best Hospitals

Resources for Learning About a Hospital and/or Health Plan

Joint Commission provides information about how well hospitals perform procedures and surgeries at http://www.QualityCheck.Org/consumer/searchQCR.aspx

Agency for Healthcare Research and Quality publication Your Guide to Choosing Quality Healthcare is available at no cost by calling 1-800-358-9295 or by visiting their website at www.ahrq.org

The National Committee for Quality Assurance (www.ncqa.org) publishes report cards with more than 50 criteria for hundreds of health plans. Report cards are available on line or by calling 1-800-839-6487

The U.S. Department of Health and Human Services has a website called Hospital Compare (www.hospitalcompare.hhs.gov) with information about how well hospitals care for adult patients. This year, in order to qualify for full Medicare reimbursement, hospitals will be required by the federal government to participate in a national patient satisfaction survey program. Results will be posted on the hospital compare website.

U.S. News & World Report Annual Best Hospitals and Best Health Plans Lists are available at www.usnews.com/usnews/health/rankings.htm

FACT: WHAT you don’t know can harm you

What You Can Do About It

• Get informed
• Ask questions
• Listen to your body and to your doctor

Resources for Finding Trusted Information

See the full list of top 100 websites at the Consumer and Patient Health Information Section of the Medical Library Association at http://caphis.mlanet.org/consumer/index.html

A sampling:

MedlinePlus http://www.medlineplus.gov

Recommended as the first website any health consumer should visit on the Internet.

MedlinePlus offers over 18,000 links to accurate and current medical information on the Internet that has been evaluated by the National Library of Medicine. It includes drug information, an illustrated medical dictionary, the latest health news, directories of doctors, dentists and hospitals, surgery videos, and interactive health tutorials. Brief information is available in the Medical Encyclopedia with more in depth information in over 750 health topics. The GoLocal initiative adds links to local resources in over 18 states with hospital information available in the other states.

healthfinder

http://www.healthfinder.gov/

Developed by the U.S. Department of Health and Human Services, this site links to carefully selected information and Web sites from over 1,500 health-related organizations. There’s a wonderful children’s interface with age-appropriate health information. Their Drug Interaction Checker, Online Checkups, and health newsletters in Spanish and English provide useful additional features.

NOAH: New York Online Access to Health

http://www.noah-health.org

Bi-lingual in Spanish and English, NOAH provides links to high quality consumer health information that is accurate, timely, relevant and unbiased. Arranged both alphabetically and by body site, it includes a search feature to guide you to a specific topic.

PATIENT ADVOCACY & SUPPORT GROUPS

American Cancer Society: www.cancer.org

1-800-ACS-2345

National Cancer Institute: www.cancer.gov

1-800-4CANCER

American Diabetes Association: www.diabetes.org

1-800-DIABETES

American Heart Association: www.americanheart.org

1-800-AHA-USA1

American Stroke Association: www.strokeassociation.org

1-888-4STROKE

American Lung Association: www.lungusa.org

1-800-548-8252

National Aging Services Network: www.eldercare.gov

1-800-677-1116 

National Alliance on Mental Health: http://www.nami.org/

1-800-950-NAMI

National Center on Caregiving: www.caregiver.org

1-800-445-8106

How Not to Be a Bothersome Patient

This will be brief because I cannot imagine that any of my readers could be "bothersome" in any way. Nevertheless, I thought it might be interesting to look at the patient-doctor visit from the physician's perspective.

As patients, we are sometimes so focused on the reason that brought us to our doctor's office that we forget that there is a human being behind the white coat. Although much has been written about patients' complaints of arrogant and uncaring doctors, little has been published about patient behaviors that are also considered "counterproductive."

To learn more about these behaviors, Dr. Randolph Evans, Clinical Professor of Neurology at Weill Medical College of Cornell University, and his associates, conducted a pilot survey of neurologists attending the Texas Neurological Society Winter Conference a few years ago.

Based on completed surveys by 80 neurologists, the top five bothersome behaviors are:

• No show for appointment
• Verbally abusive to staff
• Poor compliance with medications and treatment
• Late for appointment
• Do not know the medications they are taking

Obviously, not understanding and following treatment recommendations are potentially very harmful to your health. And being late for appointments has a ripple effect that results in long wait times for the rest of us. But beyond that, building a good relationship with your doctor may be as simple as adopting the Boy Scout Motto and Oath as guides: Be prepared. Tell the truth. Be helpful, courteous and kind. Keep your body fit and clean.

You can read the full article, which includes respondents’ comments, by clicking on the link below. One wise soul suggested that doing tandem surveys of doctors and patients might show "... certain physician behaviors create the problems they complain about, and certain patient behaviors foster the problems that they complain about." Something to ponder whichever side of the hyphen you're on.

Reference

A Survey of Neurologists on Bothersome Patient Behaviors by Randolph W. Evans, MD; Rochelle E. Evans; Richard I. Evans, PhD. Published 11/16/06. Accessed at http://www.medscape.com/viewarticle/546878

Another Reason to Ask Your Doctor Questions

Long before Dr. Jerome Groopman published his recent bestseller How Doctors Think, my very smart friend Barbara made the insightful comment that asking questions is not only useful for gaining information but it also helps focus the doctor on you and the specifics of your case.

Tens of thousands of Americans die each year as a result of preventable mistakes in medical treatment. Frequently, these mistakes result from failures in the system—for example, incomplete or inaccurate information about a patient’s medical history—which, in turn, lead to human error.

But sometimes the cause of medical error is information overload. Doctors and other providers have to struggle to keep up with a vast amount of complex information and, as a result, not all decisions are based on the most recent treatment guidelines. As Dr. Groopman explains, most misguided care results from “snap judgments,” “miscommunication,” and “the denial of uncertainty.”

If you want to ensure that you receive the very best care, you need to take responsibility and assume an active role in information exchange and decision-making with your doctor.

How To Make It All About You

• Be organized. Before your visit, think about what’s bothering you and make a list of questions. If you are seeing the doctor for the first time, or if there has been a change in your health status, bring along a list of your medications and dosages as well as relevant test results, films, descriptions and dates of past surgeries and/or procedures.

• Plan. Sometimes it helps to rehearse how you’re going to describe your concerns to your doctor. Keep it brief and to the point leaving out irrelevant detail. (He really doesn’t need to know all the day’s events leading up to your sprained ankle.) If you think you’ll need a longer appointment than usual, call ahead and let the office know so they can schedule the time.

• Share. Show your doctor your list of questions and concerns and make sure he or she understands which are the most important to you.

• Speak up. If you’re feeling rushed during a visit, simply ask the doctor if you can schedule another time to talk when he or she is feeling less pressured. Many of us are unaware of the vibe we give off when we are in a hurry and doctors are no different. Saying something lets him know how you feel and may make him slow down.

• Ask. According to the Partnership for Clear Health Communication at the National Patient Safety Foundation (NPFS), the three most important questions you can ask you doctor, nurse, and/or pharmacist are:

—What is my main problem?

—What do I need to do?

—Why is it important for me to do this?

• Ask again. If you don’t understand something, the NPFS advises saying “This is new to me. Will you please explain that to me one more time?” and asking for written instructions or information.

• Call for test results. Always do this. Recent research from Weill Cornell Medical College shows that doctors did not notify patients about abnormal test results in one out of every 14 cases of abnormal results. Do not assume that no news is good news. Take the initiative and call. It’s also a good idea to ask for a copy of the test results to be mailed to you.

While I am a strong believer in the power of the squeaky wheel, there are times when a little WD-40® can go a long way. Next installment…How not to be labeled a bothersome patient.

For more detailed lists of questions to ask your doctor about specific diseases and conditions, see resources below.

Resources

Talking With Your Doctor: http://www.nih.gov/clearcommunication/talktoyourdoctor.htm

Partnership for Clear Health Communication at the National Patient Safety Foundation: http://www.npsf.org/askme3/

Medline Plus: http://www.nlm.nih.gov/medlineplus/talkingwithyourdoctor.html

National Women’s Health Resource Center:

http://www.healthywomen.org/healthcenters/hearthealthcenter/communicatingwithyourdoctor

National Coalition for Cancer Survivorship Care Planning for Cancer Survivors:

http://www.canceradvocacy.org/resources/survivorship.html