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]

Doctors Minus The Bedside Manner

The New York Times has put up an article concerning the increasing rudeness of doctors towards patients. This post goes along with the earlier one on concierge medicine and the effects of increasing patient loads for future doctors. The article states how neglectful and rude doctors are becoming more common in the United States. Also, it seems that most of these unsympathetic doctors do not even recognize the problems they are causing for their patients.
The cases in the article seem mighty extreme such as one doctor chastising a woman for being sexually active and not married. Another, where a doctor says to an overweight woman, "I could wire your jaws shut so tight that you can't move your jaws to talk, and if you can't talk you can't eat." Though these are pretty crazy (and hopefully rare) cases, it does seem from the explanations in the articles that doctors today have to carry a more time consuming role at the office. The article proposes some solutions for current doctors:

At the Rochester Independent Practice Association in New York, with 3,000 doctors, patients are surveyed, and their satisfaction scores can account for 20 percent of a doctor's pay. At Tufts Health Plan, 3,000 to 4,000 doctors had all or part of their bonuses withheld last year because their patients did not rate them highly, said Richard Lynch, the plan's vice president of network contracting.

In California, said Dr. Ronald Bangasser, the past president of the California Medical Association, eight major health insurers have a new program in which they divide $30 million among 35,000 physicians depending on how their patients rate them. "It could be $3,000, $4,000 or $5,000 per physician," Dr. Bangasser said. "That would get their attention."

As for doctors in training, it seems that many residency programs are teaching doctors how to be "nice" and they are also reviewed by a fake patient's feedback. Something as simple as teaching doctors to nod and say, "uh huh," made a dramatic difference.

There is one last thing to be noted from the article that is HUGE for future doctors and how they will be practicing medicine. The article highlights the increasing use of physician's assistants in hospitals and offices. The medical system seems to be going in the direction of separating out the work over different tiers, with the doctors overseeing the final findings of physician's assistants and nurses. Patients and I think a lot of pre-med students are dismayed by this, but it seems to be where this overly strained field is headed.

Summer Medical Education Program Has Changed

The Summer Medical Education Program (SMEP) provided by AAMC is no longer available in the form it once was. It has now changed to SMDEP. The program still has a lot of similarities to the old one, but to some people's dismay or happiness it only accepts freshmen and sophomores now. I feel that they should have had a transitional period for a couple of years to let some of the older kids that did not know about the change, get an opportunity too. According to the website some of offerings are:

• Academic enrichment in the basic sciences (organic chemistry, physics, biology, pre-calculus/calculus) and key elective courses (writing, oral presentations, current topics in health)
• Learning-skills seminars, including study skills and methods of individual and group learning
• Limited clinical exposure through small-group clinical rotations and full-group clinician seminars
• Career development, including the exploration of the medical and dental professions and an individualized education plan to identify other appropriate summer experiences
• A financial-planning workshop

Looks like a solid setup, plus it's free. That includes tuition, meals and even housing. The app will be open in December and is due on March 1, 2006. The program uses rolling admissions, so apply as soon as possible.

Forgot to Introduce Myself

My name is Nirav Patel. I currently attend the University of Arizona.I am the creator of this blog and also the main writer for it. My goal for this blog is a simple one, to provide a blog for pre-medical students that is informative and useful. This means that I hope it will include study tips from real professors, news on the ever changing state of medicine that will affect future doctors, and anything else that is possibly relevant to a pre-med student. We here at PreM.D. are always open to suggestions. Everyone is able to contribute and we would love help from all areas.

Hello from Varun

My name is Varun Rajendran. I will be an occasional writer for this blog. I hope to bring new ideas and thoughts to here and this is my first entry. I attend the University of Texas at Austin.

Medicine for the Rich?

The New York Times has posted an interesting article on boutique or concierge doctors. A concierge doctor is basically one that sees fewer patients in exchange for much higher fees. Some of these fees surmount to 10,000 dollars a year or even higher. The doctors do and explain everything to the patients for as long as it takes. Some will even make house calls. Other doctors have even chosen to include “scholarships” for patients that cannot afford the extrememly high fees (the exact number of patients that receive these I am assuming is low).

To me this basically amounts to greed and only greed. There is enough of a disparity between the rich and the poor in the country. All concierge doctors will do is widen the gap that is already present. When did “regular medicine” in this country turn into the equivalent of buying a KIA? In my opinion, a doctor should offer equal treatment to everyone that he or she sees. With a doctor shortage in this country already present the last thing needed doctors taking less patients. What is going to happen if one day 50% of medical students become concierge doctors? How will people who cannot afford treatment get proper medical care? There should not be a luxury model on medicine. Giving patients the right attention, calling them with results, and checking up on them should not be an extra charge, it should be a duty. Every patient has the right to all those things and shouldn’t have to save up so that they can get good medical care. The doctors in the article complain of having too large a number of patients. Why not reduce the number patients? The doctors see more patients to make more money. Doctors deserve a good salary for the work that they do, but there is a line where one will eventually cross from being a caregiver to a businessman. That is the line I believe these boutique doctors have not only crossed, but ran miles past. This is an article that everyone pre-med student should take a close look at.