Critical Medical Information Available In Hand

In another step to make modern medicine look like something from the Starship Enterprise, medical PDA software enables healthcare providers and other professionals quick access to knowledge on more than 3,300 drugs, more than 1,200 diseases and hundreds of diagnostic tests.

This system puts this critical information in the professional's hand right when he or she needs it. This software, available for a year at $149, would seem to be a critically important tool for health pros in the field, such as medical first-responders and trauma teams. Having quick access to this kind of comprehensive information could speed treatment options and prove the life-or-death decision-maker for a critically ill patient.

Aside from necessity, the medical PDA software also provides a level of convenience for physicians and other providers in an office setting. A provider can answer a patient's question easily and more quickly, with less distraction, for instance.

Epocrates, the company, says its software is already used by 500,000 health care professionals today. Click on the link above to learn more and to find out what free software comes with the Epocrates system.

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Researcher Argues Most Physicians Aren't Prepared to Deal With Obesity Epidemic

The soaring obesity rates across the globe have been called the most critical challenge to public health of the 21st century. A university researcher argues that most physicians are not adequately prepared to deal with this obesity epidemic.


In an article published in Canadian Family Physician, University of Alberta researcher Tim Caulfield examines the vital role physicians play in managing and identifying obesity and highlights the obstacles these physicians must overcome when treating obese patients. Caulfield, who is the Canada Research Chair in Health Law at the U of A and professor and research director in public health sciences, is recognized as one of the foremost experts in health law research in Canada.

In North America, physicians have a legal obligation to provide their patients with a reasonable standard of care, says Caulfield. By law, overweight and obese patients are entitled to the same level of care as the general public; however, there are reasons to believe this patient population is not, in some circumstances, receiving optimal care and advice.

Available data indicates that many physicians do not have the skills and knowledge to address obesity. According to Caulfield, this could contribute to substandard care in the way obesity is handled and in the way obese patients are treated.

"Family physicians play a crucial role in identifying and managing obesity," says Caulfield. "As the rates of obesity become more prevalent, we need to recognize and become aware of the issues that can reduce liability and improve the care of these patients."

Caulfield notes that earlier studies have found that most physicians (83 percent) were less likely to perform physical examinations on reluctant obese patients, and 17 percent admitted reluctance to perform pelvic exams on obese patients. One study found that one-fourth of physicians think that they are not at all or only slightly competent recommending treatment for obese patients.


As obesity rises, Caulfield notes, so will the number of malpractice suits. "By identifying the legal issues that may come with treating these patients, it will become easier for family physicians to address weight management."

Steps should be taken, according to Caulfield, to ensure family physicians have the skills, tools and resources necessary to satisfy their legal duties and to optimize their role in managing this complex public health concern.

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Video: What's Up Robodoc?

Robots have not yet replaced doctors. But one physician has found way to use a videoconferencing robot to check on his patients when he is miles away.

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Coaching For Doctor Office Visits Helps Patients Ask Right Questions

Asking more questions during a visit to the doctor might help patients get care that is more satisfactory, but many patients are not sure where to start.

A new review of 33 studies found that giving patients question checklists or providing in-office coaching can help them ask more questions of their health care provider and get more information that is useful — often extending the length of the consultation as well.

“For outcomes like satisfaction, the patient’s response is likely to cover the whole experience in the clinic — coaching and consultation — and thus the patients will feel like they got a better deal than usual as they had a nice time with the coach,” says lead review author Paul Kinnersley.

The review appears in The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

When interventions took place immediately before a consultation, they resulted in a small but significant increase in the duration of the office visit. Interventions that occurred some time before the consultation had no effect.

In general, interventions produced small increases in patient satisfaction, plus a possible reduction in patient anxiety before and after visits. Coaching had a slightly larger benefit in patient satisfaction than providing question checklists.

“Coaching is a more intensive intervention and may have some therapeutic impact,” says Kinnersley, co-director of the Communications Skills Unit at Cardiff University in Wales.
At the very least, coaching helps patients voice and rehearse their concerns.

“Patients need to have the courage and confidence to ask questions,” says Sherrie Kaplan, co-director of the Center for Health Policy at the University of California, Irvine. “Many patients don’t want to look stupid. Studies have shown that even doctors find that when they are patients, they don’t want to ask questions that will make them look stupid.”

The review also looked at the value of refresher courses in communication skills for doctors.
Doctors can underestimate their patients’ information needs for a variety of reasons, according to the review authors. When treating patients with serious or life-threatening illnesses, doctors might be reluctant to dispense information that they feel could be harmful or disturbing.

Alternatively, they sometimes focus so hard on confirming a diagnosis that they do not take the time to encourage patient involvement in constructing more individualized treatment approaches.

“Doctors are prepared to ask questions, to formulate what’s wrong, find it and fix it,” Kaplan says. “In studies we’ve done, the patient will talk for about 30 seconds before the doctor interrupts with more questions and takes over.” Kaplan was not involved with the Cochrane review.

According to Kinnersley, doctors do benefit from refresher courses in communication, even if they are not always eager to go.

“Pretty much every medical school will teach communication skills and assess them before qualification, but we still have evidence that patients are dissatisfied with doctors’ communication skills,” Kinnersley says. “I think the problem is that after qualification, doctors learn a lot more clinical knowledge and they get more enveloped by medical culture. Thus, their communication skills often deteriorate. They focus on curing the patient rather than caring for them.”

The review found small increases in consultation time when doctors received training, but found no significant increase in patient satisfaction. Ultimately, the review recommended more studies to compare methods of intervention, intervention timing and the possible benefits of additional training for health care providers.

The review studies covered a variety of settings and diagnoses, including primary care, cancer, diabetes, women’s issues, heart problems, peptic ulcers and mental illness. It is possible that the more serious the illness, the greater the level of anxiety might be and the more intimidated a patient will feel about asking questions, Kinnersley suggests.

“If patients are anxious or the answer to a question might be frightening, you’re going to need more encouragement to ask questions,” he says.

For Kaplan, the key to getting the most out of any doctor visit and reducing anxiety is preparation. She compares preparing for a doctor visit to studying for a test.

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Overcrowded Hospitals May Risk Adverse Events on Busiest Days

Hospitals that operate at or over their capacity may be at increased risk of adverse events that injure patients, according to a study led by investigators from Massachusetts General Hospital (MGH) and Brigham and Woman's Hospital (BWH). The report in the May issue of the journal Medical Care suggests that efforts to meet two primary challenges facing hospitals today – reducing costs and improving patient safety – may work against each other.

"While financial and political pressures to make health care more efficient are leading to increased hospital occupancy and greater patient turnover, patients and policymakers are quite rightly demanding that health delivery systems be made safer," says Joel Weissman, of the MGH Institute of Health Policy, the report's lead author. "Our study suggests that pushing efficiency efforts to their limits could be a double-edged sword that may jeopardize patient safety."

In order to examine their hypothesis that increased workload could raise the likelihood of adverse events, the investigators examined data from four hospitals in two states – two large urban teaching hospitals and two suburban teaching hospitals – over the 12 months from October 2000 through September 2001. To compile patient care information they reviewed patient charts and billing records on almost 25,000 patients, selecting 6,841 for comprehensive review, and analyzed that data against information on hospital workloads and staffing patterns, with a focus on variations within each hospital.

From the nearly 7,000 records receiving detailed review, 1,530 adverse events – defined as preventable injuries not resulting from patients' underlying medical condition – were identified. The most common such events were wound infections and adverse drug events. At three of the four hospitals, the rate of adverse events did not appear to increase at times of peak workload. But at the fourth – a major urban teaching hospital with consistently high occupancy rates, exceeding 100 percent for more than three months – workload increases and higher patient-to-nurse ratios were associated with more adverse events.

"While we looked at only four hospitals, which limits the ability to generalize these findings, the hospital where we found a relationship between working conditions and adverse events was disproportionately crowded for much of the study period," says study co-author Eran Bendavid, MD. "That suggests hospitals operating at the high end of their capacity may need to examine safety systems with an eye towards coping with periods of high stress."

Formerly with the MGH Institute of Health Policy, Bendavid is now at the Center for Health Policy at Stanford University.

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Learning From Both Ends of The Stethoscope

A systematic review of studies published over the past four decades has confirmed that good doctor-patient communication makes a difference not only in patient satisfaction but in patient outcomes including resolution of chronic headaches, changes in emotional states, lower blood sugar values in diabetics, improved blood pressure readings in hypertensives, and other important health indicators.

The review, published by researchers from the Indiana University School of Medicine and the Regenstrief Institute, Inc. and colleagues from the US Centers for Disease Control and Emory University, appears in the April 2007 issue of Medical Care, a journal of the American Public Health Association.

“In looking at these 36 studies we learned many things. For example, research on non-adherence to doctor’s instructions has focused on bad or poor behavior by patients rather than on the clarity of the physician’s instructions or whether the physician actually checked to see if his or her instructions were understood by the patient. The physician assumed that the patient understands and thus will comply. But is this a logical assumption? We don’t assume that when a pilot and an air traffic controller converse that they have understood each until there is an affirmation of understanding. That acknowledgement is lacking in most patient-physician encounters,” says Richard Frankel, IU School of Medicine professor of medicine and Regenstrief Institute research scientist, senior author of the study.

Frankel is a sociologist who studies ways to improve the doctor-patient relationship. He is currently investigating how behavioral changes by both doctors and patients impact medical care.

“From previous work, including a well regarded 1999 study from the University of Washington, we know that doctors ask patients whether they understand what was discussed during a medical appointment only about 1.5 percent of the time,” Frankel says. “It is extremely important that a patient be given the opportunity and probably even encouraged to ask questions. Doctors should be trained to routinely check for understanding to ensure that there is neither miscommunication nor mismatch between what the patient wants and what doctors assume the patient wants.”

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New Report Portrays Patient Safety, Health Care Quality Performance of U.S. Hospitals

Hospitals across the United States have significantly improved the quality of care provided for patients suffering from heart attacks, heart failure, or pneumonia over the past four years, according to a new report from the Joint Commission. The Joint Commission is a non-government organization that accredits US hospitals.

The report details the performance of accredited hospitals against standardized national performance measures and the Joint Commission's National Patient Safety Goals.

"Improving America's Hospitals: A Report on Quality and Safety" also shows, however, that the effectiveness with which hospitals carry out safe practices and provide patients proven treatments for common clinical conditions varies by state.

These variations spotlight clear opportunities for hospitals to strengthen their efforts in delivering safe, effective care. For example, the Joint Commission report found that almost all heart attack patients are receiving the life-saving benefits of aspirin when they arrive at the hospital, yet many heart failure patients do not receive specific discharge instructions about their condition and necessary follow-up care when they leave the hospital. Hospital performance in complying with National Patient Safety Goal requirements has also been variable. Most hospitals do well in using objective methods to identify patients before undertaking treatments, but many are finding it challengingto put processes in place to avoid medication mix-ups.

The Joint Commission is issuing this detailed report as part of itsongoing efforts to stimulate continuous quality and safety improvement andto empower consumers with information that will make them more activeparticipants in their health care. This report, which is the first of whatis to become an annual report, covers the time period from 2002 through 2005.

"The real and potential improvements in patient safety and health care quality identified in this report underscore the value of ongoing measurement of hospital performance against standards and performance measures," says Dennis O'Leary, M.D., president, the Joint Commission."This is the kind of information that will truly create informed consumers who can ask good questions about their care and even become involved in hospital performance improvement processes."


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