Mount Sinai Health Cards

According to an article by CNET, Mt. Sinai Medical Center will introduce smart cards that will keep an entire patient’s history. This history includes, "current medications, conditions, allergies and lab results.” The patients, who hold the cards, will also be able to access their information through a special reader and code. Telecommunications giant, Siemens, seems to also be fronting the bill for this whole project. I would guess that this is because if the system works, hospitals around the country will be asking for it with checkbooks open. I think that this might actually work because it is on such a large scale. For it to really be successful, I think it would need to be interoperable with any new system that some other hospital uses, even if the system is not from Siemens. I doubt any hospital wants to deal with systems crashing because of a lack of compatibility or some monopoly on health cards by Siemens. If there is an open standard, then this will change health care around the country. Combined with this and a bunch of other technologies like telemedicine gaining ground, any new doctor in the next 5-10 years will be part of a gigantic revolution in medicine.

Here is a link of a sample card.

Patient Smart Cards get Boost at N.Y. Hospitals [CNET]

Telemedicine Here it Comes

Telemedicine has been slow in its adoption and development in the United States, but it seems Britain has begun to really use it.

Using the system to manage chronic respiratory diseases, doctors in Carlisle have managed to reduce hospital stays for some patients from 10 days to 5.5 days.

The project involves giving telemedicine monitors to patients, thus allowing them to measure their own temperature, heart rate, breathing rate, electrocardiogram and blood pressure. These results are sent via a phone line to a secure server, where they are saved as an electronic patient record, which can then be accessed by doctors or nurses.

The system can monitor diseases such as chronic obstructive pulmonary disease, which currently costs the United Kingdom's National Health Service about $1.44 billion (818 million pounds) per year.

Although the system is costly, I would imagine that the savings of having to keep a patient for less time and also the reduced rate of readmission would far outnumber the $1.44 billion. The article goes on to say that the system is fairly easy to use, and how most patients do not mind the new technology (94% acceptance rate). I think and hope that this will eventually pick up more and more steam in the United States, perhaps in the next five years. It could dramatically change how rural healthcare and the increasing geriatric patient load could be approached. In my opinion, every doctor out there and every future doctor will be using telemedicine at some point soon.

Telemedicine slashes hospital stays [CNET]

Oncology and Communication Education

This post is in relation to the earlier one about doctors and bedside manner.

The New York Times has done a really good story on oncologists, and the delivery of the hardest message to give a patient, telling someone they are dying. The article reports that an oncologist will give bad news to a patient countless times in their career and little even have training for it.

According to one estimate, over the course of a career an oncologist will break bad news to patients about 20,000 times, from the first shocking facts of the diagnosis to the news that death is near.

Despite all the practice, it is the rare doctor who is any good at these discussions. And while some medical schools now offer basic communication courses, more sophisticated training for specialists is uncommon. One recent survey found that less than a third of oncology training programs attempted any form of communication training; only about 5 percent of practicing oncologists have had any.

"The general feeling has been that these are not teachable skills - that either you have it or you don't," said Dr. Anthony Back, an oncologist at the Fred Hutchinson Cancer Research Center in Seattle.

Also, the article states that even experienced doctors have trouble when giving bad news to patients, even when that patient is an actor.

But even they, when they first come face to face with an actor playing a cancer patient, routinely lapse into the awkward, defensive "medspeak" patients know so well. They mumble about "abnormal laboratory findings," "concerning small shadows," "evidence of some lesions in the bones."

Medicine is finally putting more and more of an emphasis on not just the science of it, but also the art of it. Good bedside manner and learning how to give bad news to a patient are all part of this. Medicine has changed so much over the last 50 years, but the basics have not. It seems medical schools and fellowship training programs, are now getting back to the basics.

Doctors Learn How to Say What No One Wants to Hear [NY Times]