Grand Rounds Vol. 7, No. 27 is up at Family Medicine Rocks

Please visit Dr. Mike Sevilla's brand new website, Family Medicine Rocks, for this week's edition of Get Better Health Grand Rounds.  Dr. Sevilla's website may be new but he's veteran Grand Rounds host.  This week's edition features a wide range of topics from the healthcare blogosphere including my recent post on the use of social media by physicians.  Enjoy!

A Personal Perspective On End Of Life Care

Amy Berman, an RN and program officer at the John A. Hartford Foundation, recently wrote a very personal and moving post on The Health Care Blog about her journey through the healthcare system after having been diagnosed with Stage IV inflammatory breast cancer.  Despite the fact that the cancer had metastasized to her spine and her cancer was not curable, one of the oncologists she consulted recommended an aggressive course of chemotherapy, radiation, a mastectomy, followed by more aggressive chemotherapy.When she asked if she would get better, he said "you might live longer, but there are no guarantees."  He never once asked what her care goals might be. 

Are Your Patients Listening To You?

At the TEDMED conference in October, 2010, Thomas Goetz, an editor at Wired Magazine, observed that patients are not following through with the health information that is given to them:  they don't take their medications and they don't follow their doctor's advice.  A recent study published by the New England Healthcare Institute (NEHI) supports this observation.  Only one half of people surveyed by NEHI said they take their medications as prescribed.  NEHI estimates that poor medication compliance can add as much as $290 billion each year to total medical spending.  High tech solutions like cell phone reminders and chirping pill bottles are being considered as solutions; however, we shouldn't overlook more important and potentially more effective low tech solutions such as improved communication between clinicians and patients.

Research conducted by pharmaceutical companies about medication non-adherence has revealed the following:

• Patients are primarily concerned about side effects, the need for the medication and the cost
• Compliance is hardest for patients who are being treated for diseases whose symptoms are not obvious, such as cardiovascular disease
• When asked directly about medication adherence, patients overestimated their level of compliance

These findings suggest that clinicians can encourage adherence by focusing their conversations on specific patient concerns and explaining the positive impact of compliant behavior on a patient's disease.  Eric MacLaughlin and his colleagues at Texas Tech University also found that more reliable information about medication adherence was gained by using open-ended, indirect questions such as, "Can you tell me how you take your medications?"  In fact, the Texas Tech researchers determined that this may be the best way to gain information from elderly patients, a group particularly vulnerable to poor medication adherence.

I agree with the conclusions reached by MacLaughlin and his colleagues that, "medication adherence demands a relationship between a patient or caregiver and prescriber that values open honest discussion about medications."

What strategies are you using to discuss medication adherence with your patients?

No need to fear the Ides of March!

Diabetes Mine is this week's host of Get Better Health Grand Rounds, Vol. 7, No. 25, the weekly roundup of healthcare blogs.  Please visit the site for an informative update on what's happening in the world of healthcare.

A special thanks to our host who included my post on making time for patients.  Enjoy!

Offline Vs. Online Patient Conversations

A survey by the Pew Internet and American Life Project found that 8 out of 10 internet users search for health information.  In response, Software Advice blogger Houston Neal suggested, "Doctors have an opportunity and obligation to join us in sharing information online."  Sounds good, but ideally effective online interaction should begin with offline conversations.  If doctors don't understand which patients are searching and why, they will not be able to engage effectively online.

Grand Rounds Vol. 7, No. 24 up at Dr. Pullen!

Dr. Pullen, a family physician from Washington state, is this week's host and judge of Get Better Health's Grand Rounds, Vol. 7 No. 24.  Please visit Dr. Pullen's blog for an excellent summary (and rating) of news from the healthcare blogosphere--including my submission on personalized medicine.

What Do Hospital Patients Have In Common With Airline Passengers?

Delta Airlines recently announced it is sending its 11,000 ticket agents back to school for a refresher course in customer service.  "No one cared or apologized" was a recurring comment among Delta's passengers last year.  Hospital patients, like airline passengers, often feel shortchanged.