Does Technology Improve Healthcare or Access?

This article (1) stirs my mind. By itself, it is food for thought about the future of American healthcare and the future of those unable to access advanced technology because of insurance coverage.

In the US healthcare arena, Medicare is the gold standard. Being the largest payer, as well as the Government, Medicare dictates what is covered and what is not.

Commercial insurers either try to meet Medicare standards or exceed them, to compete in providing health coverage to employers.

Access to advanced technology that is changing healthcare, allowing it to be delivered anywhere, is not available to everyone with insurance.

The elderly who are on Medicare have the worst coverage, with most of this advanced technology that is beneficial to them not covered. No coverage means no access. Medicare sets the standard for coverage of healthcare services.

Others who do not benefit from advanced technology that is transforming medicine, moving it to the communities where outcomes are determined, are Black & Brown communities. Impoverished neighborhoods in urban areas.

Only recently did Medicare lift the limitation on telemedicine to include care in patient homes. Still Most Black & Brown communities do not receive such access to telemedicine, where transportation limitations can make doctor office visits a hardship.

The above is an example of structural racism. In addition, Black & Brown community hospitals are under-staffed and the staff poorly screened. As well as not offering many technologies available in rural hospitals, such as telemedicine in the home. Other limitations include Black & Brown communities still lacking smart phones, which could deliver such services.

[ What is the penetration rate of smart phones in Black communities? Anyone know?]

Doctors are leaving impoverished, homeless, mentally ill and Black & Brown communities behind. Without access to immediate life saving measures these communities are dying off. Infant mortality rates for Black women, despite income, are similar to that of a developing nation. Infant mortality is a standard indicator of health.

We need doctors to advocate policies that benefit patients and not drug and medical device companies. Doctors also need to stop letting insurance companies dictate patient care.

Please do share your thoughts.

New Rules For Our Health’s Digital Future

http://techcrunch.com/2016/01/02/new-rules-for-our-healths-digital-future/?ncid=tcdaily

Second Part in Series on How Doctors Kill Patients

Part One: FFT: Are White doctors misdiagnosing Black patients? https://failuretolisten.com/2015/12/29/fft-are-white-doctors-misdiagnosing-black-patients/

Physicians Guide Patients Choice

Physicians Guide Patient’s Choice of Treatment

Doctor Priorities vs. Patient Priorities

The link to Doctor Priorities vs. Patient Priorities, DANIELLE OFRI, M.D uniquely frames contrasting views of illness between patients and physicians. At the same time, she reminds that patients determine their care and physicians guide toward roads of health. Finally, our outcomes measures are lacking by putting research parameters first.

A diabetic patient educated about his disease yet noncompliant with alarmingly elevated blood sugars headed for disaster without treatment but refusing. Similar to most physicians Dr Ofri does not bludgeon the patient nor refer him for psychotherapy She takes times with multiple visits to understand her patient’s illness, contextually within the scope of his life as opposed to limiting her understanding of his illness to her priorities as a physician. For example, limiting her understanding to diabetes and its complications and not the impact of dietary changes or treatment options on a patient’s lifestyle.

A physician’s job is to help patients and do no harm. Patients have the right to refuse treatment; exception being impairment of decision-making capacities. Physicians guide but it the patient’s choice of treatment. A right to refuse treatment exists and cannot be dismissed unless the patient or guardian’s decision-making capacity is impaired. Impairment is subjectively and always objectively evaluated and documented prior to removing that right. Modern day medicine has forgotten these seemingly trivial standards but crucial in protecting patients as well as providing effective medical care.

Dissimilar to Boston Children’s Hospital–most physicians find alternative non-adversarial resolutions for disputes over treatment (btw, these disputes happens often) Treatment plans developed in collaboration with patients are the most effective paths of engagement and trust, the pre-requisite to patient compliance and the road to health.

Parent-Ectomy a term coined by Boston Children’s Hospital seizure of Justina Pelletier and other children from parents with the full support of the Department Children and Families in MA. Parent-Ectomy Success derives from labels. Labelled patients are not only ignored and denied standard medical care but often find themselves stuck fighting POWERFUL systems with deep pockets without funds or representation.

Defamatory labels concocted by hospitals who have total control of the patients medical records (information input) prime the system and other systems to pre-judge patients and discriminate. Discrimination compromises medical care, results in misdiagnosis and missed diagnosis. Discrimination triggered by buzz words in the medical records hinder attempts at recourse by patients. Legal firms complicit in this organized maze of crime through policies that make their services inaccessible and unaffordable.

Glaring evidence refuting such labels cannot match POWERFULLY organized systems composed of concealed partnerships. Systems of no accountability, multitudinous sources of funding and MONEY, lucrative business partnerships offer complex armors of secret powers cloaked by judges, government agencies and law enforcement — fertile breeding ground for corruption and its lack of transparency.

Dr. Ofri poetically describes the art of medicine. Respecting patient’s wishes, honoring the oath to do no harm and, as a result, finding common focus that offers future opportunities for change on the path to health.

Great article!

Should Physicians Interact with Patients on Social Media?

Doctors shouldn’t buddy up with patients on Facebook or Twitter, hospitals warn

Hospitals, worried about lack of professionalism and inadvertent leaking of confidential data, are warning doctors not to set up relationships with patients on Facebook and Twitter.

The AMA recommendation: “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.”(1)

Should Physicians Interact with Patients on Social Media?

As I read the article, Doctors warned not to use social media with patients I reflected on how far I had strayed from the so-called professionalism in medicine. Five years ago, I empathetically agreed, maintaining a professional “wall” between physician and patients. Fast forward to today and I am ambivalent about the AMA recommendations.

It is certainly a safe recommendation and a traditional stance, but what of the rapidly changing interconnected globalized world of medicine? Are physicians being left behind the digital age of interconnectivity? Or are physicians using technology to further insulate themselves from patients?

Few newly trained physicians know how to do physical exams and instead rely solely on technology. Most lack the ability to take good histories. Time but also inability to communicate have made complete histories obsolete. Obolete histories mean patient’s voices are not necessary, and their stories are becoming the fictional subjective interpretations of medical providers rather than the voice or words of patients.

Another thing, if X-rays and labs are normal—and they usually are—highly trained physicians– not having done histories or physicals– concoct histories and physicals to suit desired diagnoses, without regard to patients’ history or findings on physical exam. Incentives are strong motivators for certain diagnoses where patients are given diagnosis for the purposes of experimentation or starting new drugs.

Finally, Some providers go as far as to dismiss patient complaints when patients disagree. These providers refer “uncooperative” patients to psychiatry, from which there is no sane return. I am especially disappointed with Emergency Departments where patients are bullied and defamed by both first responders and ED staff, setting the tone for further abuse of staff and misdiagnoses.

It is disappointing to hear the AMA take the same old stance that is not working.

Let’s be creative! Simply state that online conversations are not private, and physicians will not discuss personal medical information on social media–patients will understand.

Social media offers opportunities for Physicians to educate, interact, and get to know the communities they serve. Many physicians already see a role for social media in chronic illnesses, cancer, depression and rare diseases.

Patient online communities are rapidly growing meantime physicians are discouraged from joining these communities. Most physicians join online physician communities where knowledge is exchanged about diseases, but not about how to deliver compassionate or quality care or how best to cool the flaring embers of an irate patient or how to avoid conflicts of interest.

Currently, the wall between patients and physicians is thick and filled with mistrust. Social media offers opportunities for physicians to build trust with patients, to remove the god-like facade, and tear down unnecessary barriers that lead to poor patient-physician relationships, medical errors, and discriminatory care–all contributing to the astronomical costs of health care. Finally, social media offers the opportunity for physicians to understand the multi-cultural nature of their patients, such an understanding could be key to reducing unnecessary tests, medical errors and misdiagnosis.

The AMA should have programs that teach physicians how to interact safely online rather than a stance that ignores progress in the surrounding world. Providers need tools to improve embattled and severed patient-physician relationships.

What a wonderful surprise had the old ways of the AMA embraced the future, by showing the adaptability of medicine. However, the AMA responded cautiously and missed scalable and repeatable opportunities to engage patients, repair broken relationships with patients and improve health literacy within communities by tapping myriad of resources offered through social media.

Interesting, AMAs concern around confidentiality, given patient data is widely available to government agencies, research institutions and third parties who not bounded by HIPAA.

Many physician already interact with patients online. I find it convenient to email my physician. What are your thoughts?

1. Doctors warned not to use social media with patients

2. Doctors, Patients & Social Media

Watch Out! Thi…

Watch Out! There is a New Culture of Hospitals and Hospital Employees–A Culture of Corruption and Cruelty.

Doctors with Crystal Balls

Do they belong together? Doctors and Crystal Balls

Doctors with Crystal Balls

by Angela Grant

It is terrible to be a patient and not be heard. Terrible to be in need, and that need ignored. Apathy seems to rhyme with this culture of domineering minds. Men of medicine who lack skills of listening miss the story, miss the diagnosis. Still clueless, they dismiss you. If only those doctors saw the hidden gem: the art and science in the words of the history and physical findings.

Now I am left to float wandering aimlessly about because listening, even purchased, is never in vogue particularly when god almighty gave doctors crystal balls. Use it, use it now, tell me why I feel so ill; can’t move my foot at will. Waited I did, patiently for this important exam… I saw the male resident who knew immediately. Oh yes, and his senile, attending in the role of supervisor came in for a ride. The resident had the latest technology crystal ball plus an attending and training from the best of them all. To my chagrin, his faulty ball, customized for clueless idiots with malicious gall, dismissed my symptoms as unreal despite the physical findings: my inability to move a foot, an important finding. When did medicine rely on crystal balls and unsupervised residents to make ‘the calls’?

Almost as if I have to learn to communicate anew, to make doctors understand the mind and the body can be one. A problem in the mind or body can cause pathology. Why did this problem occur? They did not help instead attempted to create another. My real problem: Oh… it’s not your field; pass it on for another to add-on. Incomplete diagnoses, only speculations, data based on the average. Have you not figured out that I, like most, am not the average? Why so many die from common treatable problems? Millions, ignored, whilst you doctors with crystal balls create mental hysteria.

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