Tag Archives: optimizing patient care

Patient Engagement and Improving Outcomes: Tweeting for Success

Patient engagement is critical to success–particularly in treating chronic medical conditions such as heart disease, diabetes and asthma.  In this era of healthcare reform and cost-containment we must now, more than ever, rely on patient participation in their own care.  Studies have shown that when patients play an active role in the management of their disease, hospitalization rates and complications are minimized.  Examples of “engagement” include daily recording of blood pressure and heart rate, blood sugar logs, daily exercise logs, and the like.  Engagement requires that patients not only partner with their physicians during office visits but take individual responsibility for their own healthcare—showing up three times a year as a passive participant in the office visit is not nearly enough.

This week in the Wall Street Journal, author Laura Landro explores the issues surrounding patient participation in management of chronic illnesses.  In her piece, Ms Landro uses chronic kidney disease as an example of how patient engagement and strict adherence to a physician’s recommendations can make a difference in outcomes.  Exercise, dietary changes and monitoring of blood pressure can make a significant impact on kidney disease and, in many cases, slow progressing to kidney failure for many years.  However, this type of intervention only works when the patient and physician are “partnered”.  With increasing workloads and more clerical demands, physicians are not able to reach out to patients as often as they would like between formal visits.  Through patient engagement, however, we have the potential to bridge the gap between visits.  As Ms Landro points out, one of the biggest challenges is in “getting the word out” to patients.  Most patients lack disease specific education and are not sure how to go about “at home” management.  Moreover, with increasing patient volumes and less time available to spend with each patient in the office, many physicians are not able to adequately educate patients during a quarterly office visit.

What is the solution?  How can we educate more patients effectively?

For me, the answer is simple.  Let’s use the tools we have that are easily accessible to most patients. Today, more than 60% of all Americans own a smartphone or other “connected” mobile device.  Most households have at least one computer.  While today’s children are “born” understanding and interacting with the computer and mobile world, older Americans are also becoming more tech savvy.  Social media and the virtual world lend itself perfectly to helping support patients as they engage in the co-management of their own diseases.  Virtual health coaching and support can be the way in which we support patients between “real time” office visits in the future.   Applications for smart phones such as Lift can be an essential part of engagement and ultimately may become part of routine patient care activities.

1. Twitter:  Twitter can be a great way to conduct “disease-specific” chats–engage patients virtually with regularly scheduled group events identified by a specific hashtag.  A physician or other healthcare provider can serve as a moderator for the chat.  This is a great forum for support groups, educational events and information exchange.  As a legal side note, this is NOT an acceptable forum to provide specific medical advice or patient care.  It is more about support, engagement and education.  For patients it is a wonderful way to “check in” and track their progress in a supportive non threatening environment.  For instance, a twitter chat amongst patients with kidney disease may involve an exchange of healthy recipes.  By connecting with others (and likely a healthcare professional who is moderating the chat) the patient is supported and remains engaged during the time between real live office visits.

2. Blogging:  Regular blogging can provide a wonderful resource for patients and their families.  Disease specific blogs may provide nutritional advice, exercise tips, and help disseminate important information about drugs and disease.  Blogging can help educate and inform patients–as Ms Landro correctly points out in the WSJ education is a major reason that patients sometimes fail to engage.  Thru regular posts (by physicians, nutritionists, exercise physiologists, etc) a broad range of topics can be covered and the patient is provided with the tools they will need to succeed.

3. Facebook posts:  Maintaining a “Disease-Specific” Facebook page for patients is another outlet for successfully educating patients and disseminating information between office visits.  These pages can be a great place to post pictures of interesting recipes or provide information on new therapies for a particular disease.  As with Twitter, clinicians must take care to provide information only and NOT use it as a platform for discussing privileged medical information or for providing treatment.

4. Prescribing Apps:  As I have discussed before in previous blogs, applications for mobile devices are likely to play a major role in disease management in the future.  There are already numerous applications available for tracking blood pressure or blood sugars.  These applications are a wonderful way to store data and share the data with physicians during a live quarterly visit to the clinic.  The physician is better able to track progress and the engaged patient is able to see real change.  In fact, Lift has developed an app that is specifically designed to help patients achieve health related goals and is in the midst of a large diet tracking and comparison project called the quantified diet.

Patient engagement is critical to the management of chronic diseases under our new healthcare system.  Physicians have less time to devote to patient care due to paperwork, documentation mandates and higher volumes.  In order to maintain a high level of care and clinical success, we must also rely on patients to take individual responsibility for their own healthcare issues.  In the past, engagement between visits has been difficult to accomplish due to the lack of resources available for communication and interaction with patients.  Now, with the proliferation of mobile technologies and the use of social media outlets patients can be engaged daily–if they will accept the responsibility of co-managing their own disease in concert with their physician.  With widespread engagement, I expect to see outcomes improve and patient lives changed for the better.  #Engage now!  (in 140 characters or less!)

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Practice Makes Perfect: Muscle Memory and “Brain Training” to Improve Patient Care

Certainly, when learning to play an instrument or perform a particular pose in yoga class, repetition and practice is important in order to succeed and ultimately to improve.  Athletes train their muscles to remember particular movements so that when in competition, they can perform at very high levels without even giving a thought to mechanics.   Similarly, a concert pianist or violinist are able to guide their hands along the keyboard or strings even under the pressures of playing at Carnegie Hall.  A recent article in the Wall Street Journal by Doug Lemov discussed the utility of rehearsing activities commonly performed at a particular job in order to free up the brain for other more complex tasks.  As the author suggests, there are limitless applications for this type of “brain-training” in business, medicine and other technically challenging professions.  

In medicine, the old adage of “see one, do one, teach one”  has been the standard for educating young medical students and physicians.  Much hands on experience is gained during the years of training in our current system.  As Mr Lemov describes in his WSJ article, practicing one task until it is nearly automatic allows us to devote more of our brainpower to other more complex tasks.  Practicing skills allows us to not only improve at a particular movement but more importantly helps us respond to a particular situation quickly, calmly and automatically.  This can be a life saving proposition in the practice of medicine, particularly in emergencies.  I suspect in medicine, we could improve upon the old adage and adapt it to “see one, do many, teach several” in order to apply these principles more fully.  

A recent article in the New York Times  described “brain training” techniques that are being marketed to children between the ages of 11 and 21.  Unlike traditional tutoring, these classes focus on brain exercises such as number recall, sequence memorization, and visual manipulation tasks in the face of distractions.  Similar to practicing repetitive mechanical tasks until they become second nature, “brain training” is designed to help students focus on complex mental tasks in the face of significant auditory and visual distractions.  The theory behind the process is that through the performance of mental exercises, we are able to sharpen and brighten the brain’s skills–similar to how a professional golfer may perfect his or her golf swing.  

I believe that the practice of medicine may very well benefit from incorporating these types of mechanical and cognitive practice sessions into physician education.  Today, medical centers are beginning to use simulators to train surgery residents to perform procedures.  Physicians in training should begin by utilizing simulators to develop muscle memory –then move to assisting and performing actual surgical procedures in order to perfect their skills.  Certainly, simulators do not replace the experience gained in the operating room but can improve safety and expose trainees to more opportunities to learn.  Additionally, physician-patient interactions could be simulated and practiced using actors as patients. Many medical schools are already using simulated patients to evaluate competency in patient interactions.    In my medical school training at Wake Forest University I benefited greatly from interacting with simulated patients.  Not only did I learn how to perform a history and physical exam  I was also given direct feedback from the patient–I learned the importance of making eye contact, expressing emotion and forming a connection with the patient in a short exam room interaction.   By putting even more emphasis on “practicing” these interpersonal interactions, physicians in training will be more prepared to handle complex situations such as delivery of bad news, angry families or other challenging patient interactions.  Most importantly, through a combination of both physical and mental “practice” we are able to perform at very high levels in very chaotic situations and environments such as the trauma suite in the Emergency Room or in the Operating Room.  

Practice makes perfect in sports, music and in medicine.  As medicine becomes more complex and more advanced technologies are made available, it is essential that physicians are able to become proficient and able to treat patients under pressure.  Moreover, the doctor-patient relationship is critical to success.  Physicians must constantly work to improve our ability to connect with patients.  Although practice may not always make us perfect,  practice will make us better physicians and ultimately help to improve patient outcomes.