healthcare technology

Obtaining informed consent is one of the most important things that a surgeon does.

I’d argue that obtaining informed consent is one of the most important things that a surgeon does — akin to the last stitch of an aortic anastomosis, the life-saving jolt of electricity to jumpstart a fibrillating heart, or the first pass of a scalpel during an emergent laparotomy.

Informed consent defines 21st-century medicine, contrasting sharply to the days of paternalistic care. Informed consent, when done properly, puts decision making into the hands of our patients. It can serve as a checkpoint to discuss goals of care and what constitutes a meaningful life for a particular patient.

It’s time we teach our trainees how to obtain informed consent the proper way. We need to slow down, pull up a chair, and look people in the eyes. We need to truly know our patients — how they understand their diagnoses, how they interface with medicine, their socioeconomic status, and education level. We must address goals of care with clear “if-then” statements.

When I teach younger residents how to obtain informed consent I often harp on a concept I learned in my undergraduate psychology class called theory of mind. Theory of mind is defined as “being able to infer the full range of mental states (beliefs, desires, intentions, imagination, emotions, etc.) that cause action.” In my opinion, theory of mind is an integral part of the consenting process that allows us to reverse roles, to see the world how our patients see it.

Halfway through obtaining informed consent from my patient, my attending steps in. He snags a stool from the corner of the room. He sits directly in front of the sick man.  He talks about what life will be like for him as a new amputee.

He emphasizes the importance of diabetes control and smoking cessation. We may do everything we can and the man still may die. Would he want to live if it meant he could never go home again? He conveys the gravity of the current situation in a way that is pitch perfect.  This, I think to myself, is how it’s done.

For surgeon trainees, just like making our first cut, informed consent is a skill learned by example and should be done under the watchful eye of our mentors. It’s time to pay it forward. Next time you are the chief resident, the senior attending, or anywhere in between, take a trainee with you and teach him or her how to obtain informed consent the right way. Do away with the notions of “efficiency” and speed. Your patients and your pupils will be eternally grateful.

Google is changing the way it displays search queries to pull medical facts directly into its results.

The medical information is being added to the company’s Knowledge Graph, which underpins Google’s instant search results and powers Google’s Now personal assistant and app. It will allow health questions to be answered directly, without a user having to click.

Google already does this with dictionary definitions, schedules for big sporting events and Wikipedia extracts for famous people. Knowledge Graph is essentially a built-in encyclopaedia, which pulls in facts, data and illustrations from various sources.

One in 20 searches on Google are health-related, according to the company. “We’ll show you typical symptoms and treatments, as well as details on how common the condition is – whether it’s critical, if it’s contagious, what ages it affects, and more,” said Prem Ramaswami, a product manager for Google’s search.

Google Translate has only 57.7% accuracy when used for medical phrase translations and should not be trusted for important medical communications.

However, it still remains the most easily available and free initial mode of communication between a doctor and patient when language is a barrier.

Although caution is needed when life saving or legal communications are necessary, it can be a useful adjunct to human translation services when these are not available.

Read the research paper below which formed the above conclusion.

Communication is the cornerstone of medicine, without which we cannot interact with our patients. The General Medical Council’s Good Medical Practice states that “Doctors must listen to patients, take account of their views, and respond honestly to their questions. However, we still often interact with patients who do not speak the local language.

In the United Kingdom most hospitals have access to translation services, but they are expensive and often cumbersome. A complex and nuanced medical, ethical, and treatment discussion with patients whose knowledge of the local language is inadequate remains challenging. Indeed, even in a native language there is an element of translation from medical to lay terminology.

We recently treated a very sick child in our paediatric intensive care unit. The parents did not speak English, and there were no human translators available. Reluctantly we resorted to a web based translation tool. We were uncertain whether Google Translate was accurately translating our complex medical phrases. Fortunately our patient recovered, and a human translator later reassured us that we had conveyed information accurately.

We aimed to evaluate the accuracy and usefulness of Google Translate in translating common English medical statements.

Ten medical phrases were evaluated in 26 languages (8 Western European, 5 Eastern European, 11 Asian, and 2 African), giving 260 translated phrases. Of the total translations, 150 (57.7%) were correct while 110 (42.3%) were wrong. African languages scored lowest (45% correct), followed by Asian languages (46%), Eastern European next with 62%, and Western European languages were most accurate at 74%. The medical phrase that was best translated across all languages was “Your husband has the opportunity to donate his organs” (88.5%), while “Your child has been fitting” was translated accurately in only 7.7% (table⇓). Swahili scored lowest with only 10% correct, while Portuguese scored highest at 90%.

Current controversy surrounding health domains is rooted in the Internet’s growing importance as a health information source. In 2013, the International Telecommunication Union estimated that 38.8% (2.7 billion) of the world’s population used the Internet. Many of these users are seeking important health information online. In the United States, surveys report 72% of online adults accessed the Internet to find health information primarily on the subjects of diseases and treatments . Other regions, including the European Union and emerging markets, have also shown marked increases in online health information seeking and self-diagnosing behavior.

The importance of establishing an inclusive yet reliable presence for health information online is critical to future global health outcomes given the growing importance of the health Internet. However, .health and many other health-related gTLDs are now on sale to private sector entities that largely permit open and unrestricted use. Yet, the globalized nature of the Internet, the public health need for privacy, security, and quality health information, and the rapid expansion of online health technologies demonstrate a critical need to ensure proper governance of future health domains. Focusing on the public good can be a first and crucial step to ensure an accurate, reliable, and evidence-based online presence for health for this generation and the next.