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.

In order to properly study anatomical structures, medical schools have had to either enlist living models or acquire cadavers for dissection. The issue is that these are both in short supply, which means medical students aren't getting the full education that they need. However, a new computer tool from Ireland may get around this problem.

Funded by the Royal College of Surgeons Ireland (RCSI) and the Science Foundation Ireland, the program presents 3-D images of anatomical structures from the surface to the interior. Students must wear 3-D goggles in order to fully interact with the images.

"[S]urface anatomy is the basis of clinical examination and students must learn where to listen to the heart, the markings of the liver, the sites of incisions and the movements of joints – in short the site of everything from the outside in." ~ Clive Lee, Department of Anatomy Professor (RCSI)

Professors, artists, and designers all came together to create a fully-functional 3-D experience for medical students. The program will be invaluable for schools that are limited in their acquisition of anatomy models. Currently, the program is set to be integrated into medical school curriculum in Kuala Lumpur, Bahrain, and Dublin. It opens the door for wider learning opportunities and could possibly spread to more geographical areas in the near future.

The MCAT might be changing. According to the Association of American Medical Colleges, social sciences may be added in order to create a more well-rounded student. However, two writing sections would have to be cut to make room for these changes.

The AAMC has proposed that the 2015 version of the test include new sections on psychology and sociology. This would foster students that have a fuller knowledge of both humanities and the sciences, which would in turn bring in more students who have non-traditional degrees outside pre-med and science. Additionally, a wider background in the humanities can improve students' bedside manner as they will be equipped with the skills necessary to provide better care.

“There’s a lot more to medicine than just the symptoms and what science tells you. Organic chemistry has nothing to do with patient interaction. Patients need emotional care, too.” ~ Holly Bui, President (University of Minnesota’s Pre-Med American Medical Student Association)

However, in order to add the new sections, other areas have to be cut. The AAMC proposes that two essay sections go on the chopping block. While this might make some sense, making the test more standardized and easier to grade, it would also mean that students may lose valuable writing abilities as they enter into the medical field. Physicians don't need to be able to write novels, but they need to be able to express themselves and their ideas clearly when making notes and marking diagnoses.

While the changes have not yet been approved, colleges are taking note of the possibility. Curriculum might need to be realigned, as well as expansion of pre-med educational paths. But while seeking to achieve a more well-rounded physician, the AAMC should remember that all aspects of educational ability are important.

Earlier this school year, the UA College of Medicine distributed iPads to their new students in order to cut down on the amount of printed materials they would have to deal with. By having their syllabi and required books in digital format, there would be less financial burden on both the college and the student. Now, at the mid-year break, a look back shows that the program was a success.

“I thought it was pretty useful. It’s different from what we used in undergrad. With all the apps that came out that people are designing there are a lot of cool quiz and flash-card programs that you can use that integrate really well with it.” ~ Andy Chuu, UA College of Medicine Student

There's also the potential to expand its use in education, as well as streamlining the learning process for the student. By getting these students comfortable with iPad technology, they will be more likely to utilize them in their later careers. Already physicians are integrating iPads into their practice by using the devices for research, as well as accessing patient records and providing communication contact between the patient and physicians. The medical field is changing and it's important that medical students keep up with these changes. iPad use in the curriculum is just one way to do so.

Before patients are released from care, physicians or nurses often go over their discharge orders so that the patients can continue their treatment after they leave the hospital/medical office. However, just because patients have said they understand the instructions doesn't mean they necessarily do.
A recent article on PennLive by the Body and Mind Staff highlights the lack of health literacy among the population. Physicians know how to perform the necessary treatment because they are trained and do the same actions day after day. However, patients are not professionally trained and therefore may not understand instructions or my misinterpret them, which may cause more harm.
“A lot of people just do not understand what they hear from a physician or nurse. It crosses all levels of ages, races, income and education backgrounds.” ~ Barbara Terry, Vice President of Mission Effectiveness, Chief Diversity Officer, Interim Chief Development Officer (PinnacleHealth System)
By going over the discharge instructions and then having the patient repeat the information, or performing the actions necessary, medical professionals can correct misinterpretations or go over any questions they may have in succeeding with continuing treatment. Additionally, try to confront any cultural myths that patients may believe, since this may create a noncompliance with treatment, even if they know what they must do. Always make sure that patients are comfortable to ask questions, since their understanding will foster their treatment success. 

The spread of mobile technology is growing. Medical professionals everywhere are learning the ease and accessibility of integrating mobile resources into their practice. However, there are still some that have not sought these new technological advancements for their own careers. In a recent blog article on KevinMD.com, Dr. David Lee Scher lists 5 Reasons Why Physicians Will Love Mobile Health.
1. Engaging The Patient: Physicians are often pressed for time and must encourage the patient, in what little time they have in the office, to take control of their own health. Weight loss, borderline test results, and negative health consequences for patients' habits are often thrown out and the patient expected to make the change on their own. However, many do not do so, whether because they need support during the process or they just have no time to do so on their own. However, with mobile technology, physicians can keep in contact with their patients, offer encouragement, and provide mobile apps to offer support as their patients go through making changes that will benefit their overall health.
2. Keeping Tabs On The Patient: As mentioned earlier, time is a precious commodity in doctors' offices. Many patient/physician encounters are kept to 15 minutes and during that time physicians must deal with immediate health concerns rather than long-term changes. And they often don't see their patients frequently. Visits three to twelve months apart cannot support long-term health changes. However, with the use of mobile technology, physicians can remain in more constant contact with their patients, as well as monitor health changes in order to deal with small issues before they become larger. 
3. Take It With You: It seems self-explanatory, but mobile technology is mobile. Physicians don't have to be in one physical location to receive information, they can use their mobile devices to access patient information, as well as medical articles and the latest developments in their fields, at a moment's notice. This freedom can allow for better efficiency and perhaps better patient outcomes since physicians are able to work wherever, whenever.
4. It Means More When You're Here: With the increased interactions with patients while out of the office, when there is face-to-face patient/physician interaction, it can be more efficient since the physicians already has the wealth of background information and doesn't need to waste time gathering it. That means physicians can take time to treat the whole patient, not just individual symptoms. This can reform medicine and have more positive patient outcomes.
5. Physicians and Patients Are A Team: Limited time in the office may mean patients rely too much on internet searches to self-diagnose their problems. This puts physicians at a disadvantage because they then have to work to correct these misconceptions. Additionally, the limited time in the office does not allow the patient/physician relationship to flourish, so patients and physicians may be getting negative first impressions of each other, which affect their treatment efforts. By integrating mobile technology into practice physicians can provide correct, current health information for inquiring patients and the patient/physician team can have conversations and a relationship that is built off of trust rather than quick impressions.
Mobile technology is a great contribution to the medical marketplace. Physicians can become better providers through instant access and frequent patient interactions. By integrating the new technology into medical practices, patients and physicians can both benefit. Medicine is changing, but it's changing for the better.

A recent article in the British Medical Journal suggests that by 2017 female physicians will outnumber males in the UK. While some have called into question a trend that will push males to the minority, it isn't necessarily a bad move to bridge the gender gap and achieve equality.

In areas such as pediatrics, general practice, and palliative care, females are already dominating, while surgery and cardiology remain a male arena. While females are entering medical schools at increased rates, they have been limited from high level jobs. But males have actually started moving away from entering the medical field, instead seeking more steady employment in financially viable fields. This gap of applicants is set to be filled by women, thus hopefully opening up those top jobs.

And a female-dominated medical field might actually be more beneficial for patients. Looking at complaints filed against doctors, the National Clinical Assessment Service reports that women are less likely to be the subject of discipline. Within an eight year period, only 79 female physicians were banned from patient interaction as opposed to 490 male physicians. By increasing the number of females in practice, disciplinary actions could go down and patient safety could increase.

Medical students must learn how to treat the ailments of patients in order to become successful physicians. In the midst of this training, they are often told to separate themselves from the situation so that they don't become personally involved with their patients. This helps them remain objective and not weighed down with emotion when choosing treatment options. However, it's important that medical students and physicians don't become so separated that they forget to see the treatment relationship from the other side. That's what the new Patient and Family Care Experience Program seeks to do.

This program takes 16 first-year medical students and pairs them with patients or families of patients in the Saskatoon Health Region. The goal is to give medical student access to real-world feedback on what patients and their families have experienced so that they can refocus their attention on proper patient/physician dialogue. There are also benefits from the patient perspective, as they will be able to provide real feedback and take an active role in shaping the future of healthcare.

“I know there is a lot of work to be done with the young students, patients and health care, but I truly believe we can affect the future through this program.” ~ Gloria Brilla, Patient

It is through this collaboration that changes can be made in the way healthcare is presented. Medical students learning these basics of patient feedback early in their careers can utilize the information in order to provide a different level of care as opposed to their predecessors. It is through a community effort that changes can be made and healthcare can be reformed.