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La Nueva Relación Médico Paciente / The New Patient Physician Relationship
En esta página cuelgo todo lo que me parece interesante sobre nuevas tecnologías, redes sociales online y otras tendencias emergentes que están cambiando la relación médico paciente. Cuando pongo solo una parte de un artículo, indico que hay más texto con (...). Las negritas indican lo más relevante. Mis comentarios aparecen como CE: ------------------ In this page I post everything that I consider interesting about new technologies, online social networks and other emerging trends that are changing the patient physician relationship. When a curated article is cropped, I indicate that there is more text with (...). Bold indicates what is most relevant. My comments are under CE: 
A digital tool that prompts users to share their daily thoughts is helping to strengthen links between therapists and clients...
(...) "Buddy helped me communicate better with my therapist, and it helped me to spot patterns and see what I was doing or not doing," says Sarah, 36. "Buddy really felt like a friend checking up on me at the end of the day. Sometimes it was the only contact I would have throughout the day. It's something that helped point me in the direction of change, and which I then felt better able to act on."
The digital tool linking therapists and people with mental health problems has been piloted in four London boroughs since early last year. In Lambeth, Southwark, Lewisham and Croydon Buddy was made available to a range of different users, including people with depression and anxiety disorders and military veterans with mental health difficulties. It is now being rolled out in mental health services in north-east Essex, Pennine and the Five Boroughs' Partnership, in north-west England.(...)
"A six-month evaluation of the tool by researchers at South London and Maudsley trust last year found a 40% increase in satisfaction with therapy. Around 30% of respondents reported improvements in wellbeing, and there was a compliance rate of 76% in responding to text messages. The number of DNAs also fell by 7%." (...)
CE: Good example of mobile technology as a 'booster' for a health interaction. Integration and expansion of therapeutical capabilities with technology is a worthy goal. Via Juli Garzo 
Los pacientes de La Asunción de Tolosa accederán 'online' a su ...Noticias de Gipuzkoa... (...) El desarrollo de esta iniciativa se enmarca en el proyecto Hospital sin papeles que la Clínica de La Asunción puso en marcha en 2003 y con el que se quiere avanzar hacia un sistema que aproveche los beneficios de la era 2.0 para optimizar al máximo la relación médico-paciente, agilizando los actos administrativos y eliminando tiempos muertos. CE: ¿Optimizar al máximo? Otra expresión de voluntarismo 2.0 sin fundamentos... 
(...) "Vosotros, los profesionales de la salud, además de las mismas herramientas poseéis el conocimiento que os permite discriminar esos contenidos poco fiables de los que si son de calidad. Se me antoja que si mi médico o enfermera, aquellos a los que confío el cuidado de mi salud, me "recetasen" la visita a ésta infografía me libraría de más de un susto y mal trago innecesario por culpa del desconocimiento." (...) CE: Indeed. First presented at Digital Pharma Europe, Barcelona, 31st March 2009....
CE: Good insights on doctors-only Social Networks... from 3 years ago! No analysis as towards the role of the patient, or the consequences for the patient... but makes for interesting research questions. Via Lionel Reichardt / le Pharmageek Presentation delivered at eyeforpharma eMarketing Europe & Mobile 2012, Barcelona. What are the game changers for pharmaceutical digital marketing and communications? Understanding the impact of a socialised world and mapping the social web, mobile and ubiquitous connectivity, the quantified self and health applications, big data and the impact on measuring, predicting and tracking health.
How can games rock the health and pharma world? What is a game? Motivational design, games for health, immersive gaming and narrative based simulation, the virtual world and how we can harness gamers for science.
CE: I'll be on the lookout for more material on Gamification; I still can't picture a "game" in which physicians and their patients can interact and keep it professional. Via Alex Butler 
(...) Las principales causas de este aumento de las reclamaciones tienen un importante reflejo en la crisis económica y el cambio en la relación entre el médico y el paciente, así podemos distinguir varios factores: - Aumento de la presión asistencial y la crisis actual: los recortes en la sanidad pública por un lado, o la bajada de precios generalizada en los honorarios fijados por las entidades aseguradoras de salud, han provocado que los profesionales sanitarios se vean en la obligación de tener que atender a un mayor numero de pacientes en el menor tiempo posible y con menores recursos. (...) - Enriquecimiento injusto del paciente: (...) Los pacientes, en ocasiones, no asumen la materialización de los riesgos y aprovechan los cauces legales para obtener una satisfacción económica en una mal entendida medicina del resultado. - El cambio de la relación sanitaria: hemos pasado, de una posición médico-paciente, a entender al médico como proveedor y al paciente como consumidor. (...) - El 'efecto llamada': parece que solo se reproducen los casos de negligencias médicas en los que los pacientes reciben unas suculentas indemnizaciones o porque tienen una relevancia mediática importante. Estas noticias generan una conciencia colectiva y un efecto contagio, que hacen pensar a los pacientes que tienen derecho a reclamar una indemnización en similares circunstancias, pensando que cualquier resultado lesivo es consecuencia de una negligencia sin tener en cuenta que la medicina no es una ciencia exacta ni el cuerpo humano reacciona igual a todos los tratamientos. - El 'Dr. Google': vivimos en la era de la información, teniendo acceso a numerosos canales para poder buscar información especializada en el ámbito médico. En muchas ocasiones esta información extraída de los portales web, hace que los pacientes cuestionen la información facilitada por los propios médicos, oponiendo su propia impresión diagnóstica o incluso variando el tratamiento prescrito. (...) CE: No solo el 'Dr. Google' como causa de aumento de reclamaciones/demandas tiene que ver con Internet. El paciente como consumidor se relaciona también con la ilusión que tienen los usuarios de poder relacionarse con el sistema de salud a través de internet como lo hacen con otros servicios. El efecto contagio en casos de negligencia que aparecen en los medios podría magnificarse con la dinámica de las redes sociales. 
Las redes sociales, expresión instrumental de la web 2.0, está modificando nuestra forma de relación. (...) "He estado buscando en la red, por inquietud personal y de cierto grupo, sobre comunicación en redes sociales. Hay muchísima información técnica sobre la evolución de las herramienats y sus aplicaciones; muchísima información desde el punto de vista antropológico, psicológico, desde la publicidad y el marketing. Y todo esto.. ¿Cómo va a afectar a nuestra relación de conversación con nuestros pacientes? "Es cierto que en cierto sentido va a tener ventajas objetivas, de las que ya algunos intentamos disfrutar, para la transmisión de conocimientos. De esta forma podemos recomendar espacios de obtención de información, aprendizaje y entrenamiento de conocimientos y aptitudes para nuestros pacientes. Posiblemente un vídeo sobre un tema concreto sea mucho más eficaz que la información que pueda proporcionar en la consulta y el paciente va a poder acceder a ella de forma repetida cuando lo necesite y en el momento que considere apropiado. Pero no solamente transmitimos conocimiento. Somos transmisores de emociones cuando reimos con nuestros pacientes, les acompañamos en el llanto o sostenemos solidariamente su mano. A las redes sociales les falta piel. Han desarrollado la vista y el oído. Les falta el gusto el tacto y el olfato que posiblemente nunca lleguen a tener. Pero no nos podemos quedar al margen. No podemos ser simples espectadores, porque ser espectador tiene sus peligros." (...) CE: Refleja la misma preocupación que este sitio. ¿Cómo están cambiando las TICs la comunicación y por lo tanto la relación entre pacientes y médicos? También me gusta el llamado a no ser meros espectadores. 
Las redes sociales han crecido de forma exponencial en los últimos años, incrementándose su uso entre los profesionales sanitarios. Conscientes de esta realidad, la Consejería de Salud promueve –a través del apartado Participa de Red Salud Andalucía- la elaboración cooperativa de la Guía de estilo de los profesionales del Sistema Sanitario Público de Andalucía (...)
"En este post, hemos traducido y adaptado un artículo titulado How Medical Doctors and Students Should Use Social Media: a Review to Propose Practical Recommendations en el que se han revisado las principales guías publicadas sobre el uso de las redes sociales por parte de los profesionales sanitarios, con un doble objetivo: recopilar las recomendaciones más relevantes y proponer una serie de consejos prácticos basados en la comparación del contenido de dichas guías, a fin de encontrar los puntos comunes ylas diferencias (...)
"1.- El uso de las redes sociales por parte de los profesionales sanitarios abre nuevas vías de comunicación con los pacientes, el público general y los colegas, pero como herramienta profesional hay que tener en cuenta diferentes aspectos que garanticen la seguridad, utilidad y su uso ético y legal.
2.- Se deben utilizar medios para garantizar en todo momento la privacidad, pero teniendo en cuenta que no toda la información debe ser protegida y cómo es ésta de accesible.
3.- En relación a la información sobre pacientes, deben respetarse los estándares de privacidad y confidencialidad establecidos, de tal forma que no puedan ser identificados agregando toda la información disponible enla Red. Porotra parte, deben respetarse los contenidos y la información sometidos a derechos de autor. (...)
CE: El documento da 10 recomendaciones en total, todas bastante razonables, pero más bien restrictivas. Es posible que recomendaciones que se desprendan de la legislación estadounidense (y no del código de ética de colegios o asociaciones médicas), no sean necesariamente las mejores para otros países. Las reglas para el uso de redes sociales debieran obedecer al entorno local, pero aquí lo transfronterizo de internet se vuelve un desafío mayúsculo. Via Juli Garzo, CTIC-FCS-UC 
“Generation C” has recently been defined by Nielsen as adults between 18 and 34 years old, who are entrenched in digital technologies. They are indeed the Connected Generation and use technology by choice in all facets of life. It is part of their fabric. Those entering the field of medicine would logically desire and expect to carry that over to their professional lives. (...)
"Young physicians will spearhead the use of mHealth technologies for a few reasons. The BYOD (bring your own device) to the healthcare workplace with use of these devices is greater among young physicians. They are more engaged in social media than older physicians. Mobile health technologies are discussed more in social and online media (utilized more by younger physicians) than mainstream media. (...)
"While medicine changes slowly with regards to adoption of new treatments and technology, younger physicians today are taking more initiative in affecting positive changes in the arena. I look forward to having them become champions of technology which will be more efficient and less complex tools to engage, diagnose, and treat their patients."
CE: No specific mention as how this last statement might work out, especially considering last posts in this 'Scoop' re: health literacy... Considering most patients with chronic disorders are older, and have less access to IT in general, this might become the beggining of a further increase in a generational gap and a monumental digital divide in healthcare access. Will young physicians and health professionals drive adoption in their older colleagues? And what of their patients? Via Juli Garzo Health literacy is basic reading and numerical skills that allow a person to function in the health care environment.
"Health literacy is basic reading and numerical skills that allow a person to function in the health care environment. Even though most adults read at an eighth-grade level, and 20 percent of the population reads at or below a fifth-grade level, most health care materials are written at a 10th-grade level. Older patients are particularly affected because their reading and comprehension abilities are influenced by their cognition and their vision and hearing status. Inadequate health literacy can result in difficulty accessing health care, following instructions from a physician, and taking medication properly. Patients with inadequate health literacy are more likely to be hospitalized than patients with adequate skills. Patients understand medical information better when spoken to slowly, simple words are used, and a restricted amount of information is presented. For optimal comprehension and compliance, patient education material should be written at a sixth-grade or lower reading level, preferably including pictures and illustrations. All patients prefer reading medical information written in clear and concise language. Physicians should be alert to this problem because most patients are unwilling to admit that they have literacy problems."
(...)
"When giving information verbally, talking too quickly reduces the chance that patients will understand what is being said. It is important for physicians to take time to ask their patients to repeat the instructions or otherwise demonstrate their understanding(Table 3).21 Physicians seldom check to see if patients understand what happened during these visits. (...). Patients who have the most difficulty comprehending health material are the least likely to have access to the Internet or know how to use it."
CE: This information is frequently brought up by sceptics when talking about using the Internet or other ICTs in low-health-literacy environments. Indeed, most solutions today are created by people skileed in information retrieval, and are not adapted to use with low-literacy patients or users.
However, one could still argue that: 1.) Using the internet as educational 'leverage' with a subgroup of patients might allow more time to dedicate to others, with a total net effect. 2.) There are tools that can be designed specifically to the low-literacy level users (altough it will require more research, development, extensive testing, etc.).
Via callooh, Mariano Fernandez 
When I wrote an iHealthBeat Perspective two years ago, social media in health care was just getting started. (...) Two years ago, the e-Patient movement was just getting on its feet. Now it, too, is receiving national attention in the media and blogs. The Society of Participatory Medicine and its associated journal have grown, as has their influence. The group has appeared at multiple conferences, as well as in videos on the Office of the National Coordinator for Health IT's website advocating the importance of electronic health records for patients. (...) Hospitals and health systems have moved beyond initial experiments with social media to integrating these tools into their marketing and patient engagement efforts. Facebook is becoming a key tool in patient engagement with encouragement from hospitals to post patient stories or notes of gratitude that are almost universally positive. (...) Many hospitals also have launched blogs -- some provide general content, some are written by specific physicians and others are disease-specific. (...) Then there is "Seattle Mama Doc," a blog written by Seattle Children's Hospital pediatrician Wendy Sue Swanson, which is incredibly popular -- way beyond her patients and the confines of the Northwest. (...) The Next Two Years (...) Online communities will become more integrated with health care delivery so that they will be "prescribed" by physicians, as will mobile apps that have been vetted. The app world has widely expanded how social media can impact care; with public-private partnerships and online community-provider partnerships, the future holds much promise. (...) CE: Insightful, with a good synthesis of past and current trends and a pondered outlook into the future. Useful for social media strategizing. 
Pacientes 2.0 interesante :o http://t.co/YuaEkqhI http://t.co/RIa2dN4e... (...) Por más experiencias que tenga un médico que trata una enfermedad, no podrá haber vivido tantas como las que expone la comunidad de enfermos que publican información en los portales diseñados para esto. Un médico, por bueno que sea, puede ser superado por la comunidad de Internet al tratar el mismo tema. Existe el caso de un portal que, en respuesta a un estudio que afirmaba que el litio les sirve a enfermos con ALS -la enfermedad de Lou Gehrig-, hizo una evaluación de la información colocada en él por personas con esta enfermedad y concluyó que esto no era cierto. El portal llegó a esta conclusión seis meses antes que estudios clínicos convencionales sobre el uso de litio para enfermos de ALS, que determinaron exactamente lo mismo que el sitio web. Los médicos están asombrados y asustados con este nuevo uso de la tecnología de Web 2.0. Como es obvio, los usuarios deben tener las precauciones necesarias para el uso de la información consignada en estos sitios, en especial cuando puede aplicarse al tratamiento de sus enfermedades. Hay que considerar no solo que la información no es la mejor para cada caso, sino también que los pacientes no están preparados para asimilarla y comprenderla. (...) |
"The increased use of social media by physicians, combined with the ease of finding information online, can blur personal and work identities, posing new considerations for physician professionalism in the information age. A professional approach is imperative in this digital age in order to maintain confidentiality, honesty, and trust in the medical profession. Although the ability of physicians to use online social networks, blogs, and media sites for personal and professional reasons should be preserved, a proactive approach is recommended that includes actively managing one's online presence and making informed choices about disclosure. The development of a “dual-citizenship” approach to online social media that separates public and private personae would allow physicians to both leverage networks for professional connections and maintain privacy in other aspects. Although social media posts by physicians enable direct communication with readers, all posts should be considered public and special consideration for patient privacy is necessary." CE: Having two accounts on social media outlets is a difficult proposition for many doctors, being even MORE time consuming. A hard sell, but maybe the only possibility to be a responsible "digital" doctor. 
Physicians who use social networks to share clinical experiences risk violating patient privacy. A niche industry of private social network providers has cropped up to address the desire to communicate. (...)"Another ethics conundrum that has come into being with the rise of social networking is whether physicians should peruse their patients' pages on social networking sites. "For example, a doctor who gave a patient a prescription for medicine that could have an adverse affect when mixed with alcohol might decide to check out the patient's Facebook page to see if the individual is telling the truth about his drinking habits, Crotty said. "Is that a breach of privacy? Or is it fair game because it's public information?" he said. "There are so many questions that we don't know the answer to." (...) CE: Definitely read at least pp 1-2; includes a good example of an extreme case where an emergency prompted a healthcare provider to - legitimally? -use the info on the patient's Facebook page to make a diagnosis. Andrew Lansley introduces the Information Strategy... "This information strategy from the Department of Health sets a ten-year framework for transforming information for the NHS, public health and social care. One of the key commitments is that you will be able to view your GP record online by 2015." CE: Bold policy proposal; I'll be looking forward to the reactions from medical associations about this claim. 
Just a short time ago physicians and scientists had primarily one readily available search engine, sponsored by the National Library of Medicine and the NIH. (...) "At times physicians and patients use the same search engines, and I always want to source another reference that a patient would not have access to. After all they reimburse me to add some value to the visit about their illness that they would not already have access. My own opinion is reflected aptly by this opinion, “And while 90 percent of the physicians said that more access to online medical information and resources improved the quality of care at their organization, a fifth said that patients' online health research has "been detrimental, leading to misinformation and incorrect self-diagnosis." In fact, more than half (53 percent) of those surveyed ranked "patient misinformation" as the top barrier to good doctor-patient communication, trumped only by lack of time with patients (78 percent).” Notably, the survey revealed that physicians get their online health information from some of the same sources as patients with search engines, such as Google and Yahoo, ranking second only to medical journals as resources used by physicians. (...) CE: Worthwhile to read it whole. Good insights and observations about search and/or social. Doctor patient relationship issues are addressed throughout the story. 
We've discussed previously how medical societies, healthcare practitioners and life science product developers are increasingly concerned about reducing costs of healthcare product development and delivery – both for the developing company and the... (...) An ideal information system should track product (or service) quality, total patient outcome and the cost of treatment for the entire time a patient is sick. In addition, this information system should monitor and discover behaviors that can prevent illness from happening, or check up remotely on a healthy healthcare consumer (such as a pregnant woman). This will require a “democratization” of IT; a design of systems that anybody can use and that contain metrics that are shared among platforms: As Paul Sonnier observed in his latest post, customers are becoming more aware, more informed, and more demanding of healthcare. And they’re getting their information with better IT, using smart phones, tablets and the Internet to get the information they want and need. They’re not waiting for their physicians or life science companies to deliver it. (...) CE: So if such system is indeed 'democratic', doctors will have access to this info and they will 'track' their patients in new ways, as well as have a more thorough understanding of were costs are incurred. Big implications for reimbursement; huge for patients (as consumers) empowerment. 
HealthTap is an app available on iOS, Android, and the web that lets people ask medical questions of real doctors and get quick answers in return.
(...)
A Pew study on the relationship between the internet and healthcare revealed that 59% of Americans (including the author) have searched for health information online. The obvious issue here is the matter of trust -- how credible is the information that you find?
(...)
CE: Massive. DO read the complete story for the nuances on liability and participation barriers for MDs and patients out of US.
Via Alex Butler 
"(...) 65 percent of those seeking medical information online saying they trust the information they see. Among consumers seeking medical information online, 63 percent claim to have never misdiagnosed themselves using online information. The survey’s authors surmise easier access to online medical information may have a positive impact on the doctor-patient relationship, with two-thirds, 67 percent, of Americans that seek medical information online stating that this has made them better informed as patients. Forty-eight percent of consumers say they turn to the internet to find answers to medical questions in order to be more informed about a medical condition before a doctor’s visit. Even with all of these consumers seeking medical information online, the survey said only four percent report having experienced “cyberchondria” – which is a term that describes when people become convinced that they have an illness or condition they don’t actually have based on information they read on the Internet. (...) "...among Americans who would rely on the Internet to diagnose an illness, more than three-quarters (77 percent) say they would then discuss the information with their doctor to verify a diagnosis. Twenty-nine percent of those who go online for medical information, including 38 percent of those between the ages of 18 and 34, cite “accessibility” as the reason they would turn to the Internet versus visiting a doctor to diagnose or treat an illness." CE: Having some international comparison would be great; the consumerism and market dynamics of the US healthcare system might drive some of these figures. This is relevant info to those concerned about 'Dr. Google' replacing doctors; it will most probably derive towards a second, or even a "zero" (pre-visit) opinion. CE: Down to earth recommendations, useful and practical. Doesn't touch on 'deep' issues discussed in this channel, but there are lessons that clinicians and health organizations might use to be more effective communicators in Twitter. Via Andrew Spong, Lionel Reichardt / le Pharmageek 
Just telling doctors to stay away from patients on social media is a lazy approach, and both doctors and patients will be worse off for it. CE: Opinion piece, with good links to stories about the mishaps of doctors and hospitals in social media. I agree with the statement that staying away of social media because of perceived risks is a 'losing strategy'. 
Mayo Clinic has launched a patient mobile app. "In a phone interview, Dr. Sidna Tulledge-Scheitel, associate dean of e-health and medical director of Institutional Business Solutions, said that the new Mayo Clinic Patient app is “unique” compared to what Mayo has in the App Store in that it is free and centered around the patient. "The app aims to connect with patients from the time they are simply seeking for information about Mayo, to their first visit to any of the three campuses and finally when they become an established patient at Mayo. (...) "Scheitel of Mayo said that the app is meant to empower patients and “aligns with Mayo’s mission of trying to make our services accessible and affordable.” (...) CE: But which patients will it empower? Appartently the app has gotten great reviews; I'm not so sure it is the first app of its kind, but it will be surely the most visible. Will download it and comment... as soon as it is available for Android. :-) 
"Hace un tiempo los pacientes empezaron a usar el teléfono, así que la Sanidad implantó la atención telefónica porque era una forma de facilitar el contacto. Ahora el paciente está en Internet". El subdirector del Departamento de Salud de Sant Joan, en Alicante, Miguel Ángel Mañez cree que el salto a las redes sociales y el mundo 2.0 es un paso congruente. Las organizaciones sanitarias y muchos profesionales están adentrándose en Internet y las redes sociales o, mejor dicho, en el amplio terrotorio de lo 2.0: desde los blog a la Wikipedia..." (...) "El doctor Manuel Bayona, gerente de Atención Primaria y vocal de SEDAP, recalca que se deben aprovechar las ventajas de las redes sociales para mejorar la comunicación entre los profesionales sanitarios y la ciudadanía. En ese camino, Bayona encuentra varias claves: la actitud ante el paciente, cuyo cambio significa que el médico deja de afrontar su trabajo desde la perspectiva tradicional médico-paciente y se aproxima a un modelo más igualitario, "más de tú a tú"; la accesibilidad del sistema, y que se garantice la seguridad e intimidad de las personas. "Los médicos no podemos seguir atendiendo como en el siglo XIX, con el maletín. Tampoco basta ya únicamente con la consulta". (...) En el distrito sanitario que dirige Bayona, el Costa del Sol (Málaga), ha empezado a usarse una plataforma web denominada Espacio Salud 2.0 que pone en contacto a médicos y pacientes. "Los usuarios solicitan en la recepción del centro de salud su clave y nombre de usuario, además de firmar un consentimiento". Así se garantiza la confidencialidad, un aspecto siempre polémico en Internet y las redes sociales, y especialmente sensible en el ámbito sanitario. (...) CE: Artículo que requiere registro para el acceso, pero vale la pena por amplitud de los temas que trata. Recomendado. 
Perspective from The New England Journal of Medicine — Patients and Doctors — The Evolution of a Relationship. (...) The relationship between patients and doctors in the clinical realm has historically been framed in terms of benevolent paternalism. Until about 1960, most codes of medical ethics relied heavily on the Hippocratic tradition, framing the obligations of physicians solely in terms of promoting the welfare of the patient, while remaining silent about patients' rights. The past several decades have seen tectonic societal shifts that have resulted in increasing empowerment of individuals against the authority of government and institutions, creating a surge of rights-based movements, with patients' rights emerging as a societal demand alongside women's rights, minority groups' rights, consumers' rights, and others.
(...) CE: I don't agree with the argument, but it contextualizes the role of the Internet and readily available information as sources of empowerment within societal changes and trends. Important. 
For some reason, even as Americans’ mistrust of bedrock social institutions grows, they’ve retained their faith in physicians. (...) Medical professionals haven’t just relied on long-standing respect; they have also evolved with the times. In the past generation, the practice of medicine has undergone a sea change—from the old-school approach in which the doctor knew everything, made decisions, and told the patient little, to a new model that emphasizes patient understanding and choice. Medical schools added compulsory courses on communication and ethics, and the medical-licensing exam now includes an entire segment on doctor-patient interaction.
(...) CE: This is part of a series on Trust in institutions; the role of the Internet as a source of information and empowerment for patients is just a part of a more complex story... |
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