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  • A doctor friend – let’s call her Anne – was teaching three smart medical students who were told to diagnose a woman complaining of nonspecific pain and anxiety. After 20 minutes of questions, the students wrote seven pages of notes and recommended two drugs: a painkiller and an antidepressant. Anne considered the students’ analysis and agreed that it was based on sound medical evidence. But something told her there was more to the story. She sat beside the patient, asked general questions and listened carefully. After a few minutes, the woman broke down in tears and told her about a personal tragedy involving a family member. After some comforting, the woman’s tears, shoulder pain and anxiety went away. Anne’s dose of empathy cured the woman, without the need of resorting to drugs. This is an important consideration, given that even relatively mild painkillers may contribute to the opioid crisis as some patients subsequently seek stronger and stronger drugs. The high value now placed on good empathic communication in medicine is relatively new. Until the 1970s, the doctor-patient relationship was often paternalistic. An anxious patient was less likely to be given a shoulder to cry on and more likely to be given a prescription for Valium (“mother’s little helper”). In the best enactment of the paternalistic doctor, the fictional surgeon Sir Lancelot Spratt, in the 1969-70 British TV series Doctors in the House, tells a patient who has become distressed at being diagnosed with a serious tumour: “This is nothing whatsoever to do with you.” Colleagues tell me that the scene is an accurate depiction of how things were. At that time, there was little if any communication skills training. Many doctors believed it was an innate skill that could not be taught. The 1980s saw a change, with the General Medical Council (which...
  • Author: Jeroen Tas Over the past two decades many everyday experiences have turned digital. I remember when my team at Citibank launched Internet banking in the mid-nineties. People thought we were wasting our time, as “nobody would trust the Internet with their financial data”. But almost all of us now bank digitally and even cash is being replaced with the tap of the phone, while payments can be made seamlessly around the globe. Healthcare is moving in the same direction, albeit slowly. As described in my blog two years ago, the future of a hospital is not brick and mortar. Instead, care will be provided in “meshed up” digital and physical networks that provide 24/7 access, improve patient outcomes and provide personalized patient and staff experiences, while simultaneously optimizing operations. Healthcare will find its way into the fabric of communities in different forms and shapes, bringing neighbours, friends and family into care teams. Those providers who are leaders in specialized care, for instance in specific cancer types, cardiovascular or neuro diseases, will increasingly make their expertise available globally. Like internet banking, which took time to really take off, we’re at an inflection point where digital models are getting close to scale. The merger of CVS and Aetna in the US is a sign of the times, providing a one-stop shop for primary care, diagnostics and pharmacy, combined with a virtual consumer experience. People are increasingly seeking care closer to home, without having to travel and wait hours to see a doctor, and in a more comfortable, consumer-friendly environment. They want to get personalized health content and tools on their phones, just like their other consumer experiences. Even complex, minimally invasive procedures, like inserting a stent in an artery, are now increasingly performed in “office-based labs” that are located in communities close to where people...
  • Hospital Acquired Infections (HAIs) or nosocomial infections are complex to treat and are a growing global burden. HAIs affect about one in 25 patients in the US and situation is worse in resource-poor nations. A prevalence survey conducted under WHO in 55 hospitals of 14 countries showed that ~8.7% of in-patients had HAIs. At any time, over 1.4 million people worldwide suffer from infectious complications acquired in hospital. HAIs contributes to increased economic burden, negatively affecting quality of life and deaths. 1,2 As per the existing methodologies direct observation is the gold standard to monitor compliance and to prevent or reduce HAIs. Frequent surveys, interviews and inspections are the other commonest methods implemented as prevention of HAIs. Indirect monitoring involves automated monitoring systems (video monitoring , real time location systems) monitoring hand hygiene product consumption). Hospitals with sophisticated information systems are in a position to streamline surveillance process through computer-based algorithms that identifies patients at highest risk of HAI.3 4 Computerized surveillance helps in better implementation of preventive strategies, but lower infection rates have not been proven conclusively. Conventional training methodologies have not proved to be significantly impactful in knowledge retention and message recall. A newer approach called Gamification is a positive and effective method to change behaviour. It can engage, motivate and influence people. It is a concept that has unknowingly been applied for years though the term was widely used only after 2010. A ‘serious game’ is defined as an ‘interactive computer application, with or without significant hardware component, that has a challenging goal, is fun to play and engaging, incorporates some scoring mechanism, and supplies the user with skills, knowledge or attitudes useful in reality. A hand hygiene improvement campaign in Edinburgh Royal Infirmary (Scotland, UK) using the SureWash gesture recognition system (SureWash, IRL) which concluded that...
  • Surgical practice has evolved over the centuries, more so in past 2 decades. However, continuing surgical education practices remain antique. Strongly dependent on hands-on-training, surgeons limitations of travel and time dedication, affects access to learning. Newer technologies for adaptive and immersive learning, including virtual reality and augmented reality has evolved over the past 5 years. It’s use might help to improve reach and quality of professional surgical education.  But some key questions to be answered are access to technology, adaptability and behaviour change. As an experiment, one year skill development program, Diploma in Minimal Access Surgery, with 80% of learning happening online and 20% offline was introduced for the first time in India to train surgeons on minimal access surgery. Online included the use of smart learning management system with AI, virtual reality, augmented reality, real time app based logbook, live surgery streaming and scheduled mentor interactions. Offline training included over the shoulder learning, hands-on and interactive class room learning over one week. Program enrolled 70 students in the first batch. In total 67/70 accessed the course (Ongoing). Over the period of 8 months, 34 video modules, 8 live interactions, including surgery streaming and one in person session with faculty, were conducted. Course received 100% attendance, with 3 or less reminders. A survey conducted at half time, to evaluate the effectiveness and net promoter,  73% responded (49/67). Average rating for the course stood at 4.35/5. Majority felt ‘Live Surgeries’ and ‘Virtual Contact Sessions’ were the most helpful ones. Ninetysix percent (96%: 47/49) said they either ‘agree/strongly agree’ that faculty provided all the necessary information during live surgeries and video lectures. When asked about ‘How likely are you to recommend the course to your peers?’, 47/49 rated either =or>7/10, and 26 responded 10/10. Providing the course a net promoter score of...
  • “Computers are a mixed blessing, because the ease with which they can make data widely available poses new risks to individual privacy. Compared to paper-based medical records, electronic information is more easily manipulated and linked…. [and] also raises the specter of a huge national database of identifiable, comprehensive health information”…..  Rybowski (1998)  Telemedicine came into existence in the latter half of 90’s, mainly focusing upon patient data storage. Quite obviously it is linked to the growth of information technology across other sectors. However, the boundaries got stretched in the early Y2K period, when the online education trend was picking up. Also online training and certifications for physicians was the new trend. One of the first training programs I remember to be delivered online was on one of most difficult and important procedures, Cardio Pulmonary Resuscitation. That’s around the time legal barriers for telemedicine started kicking in. Legal barriers or rather laws around telemedicine got beefed up only recently also, this is when the actual online physician consultations or tele-radiology began. Tele-medicine or eHealth has for sure increased the access, adherence, and availability of healthcare services, but along with it raised many questions in the minds of healthcare providers, payers, enablers, and recipients. Is storing patient data electronically, ‘on the cloud’, as safe as it is perceived or projected to be? Are the online training or certifications for physicians the same as live or in person training? Are online physician consultations provided by qualified doctors? Is an online consultation equivalent to an in person visit to physician clinic? Does my insurance cover an online consultation? Can a physician practicing in a different country provide a tele-consult to a patient in a different country, without legal implications? Legal considerations remain as a major obstacle in successful implementation of tele-medicine across the globe....
  • February 28, 2019

    Diagnosis and Management of Dementia

    This 8-week mentor led online course along with virtual contact sessions (1 Day Interactive Workshop & Assessment) covers all the important aspects of understanding the broad concepts of dementia, identifying the common types of dementia, behavioural issues in dementia, basic principles of dementia management along with bed side teaching sessions which assists in appropriate diagnosis of a dementia patient On completion of the course, learner should be able to: Understand the broad concepts of dementia and its burden in society Identify common causes of dementia Acquire basic principles of dementia management Recognise when to refer a dementia patient to specialist services Create awareness about healthy aging and dementia in the community

Recent Posts

  • Researchers at the Technion–Israel Institute of Technology have developed a glue gun to put the human body back together when it has been seriously injured. The pins and stitches currently used to treat serious injuries come with drawbacks: They can be painful, they leave scars, they require high skill from the doctor, and they sometimes have to be removed after the tissues heal. Suture on the intestine, lungs or blood vessels often leak and therefore require a sealant. The medical glue that the researchers have developed is a “two in one,” said Prof. Boaz Mizrahi, head of the Biomaterials Laboratory of the Technion. It replaces both stitches and the sealant, and is good for both external and internal injuries, he said. All sorts of medical glues are already being used in dermatology, surgery, and other areas. Israeli startup Nanomedic Technologies Ltd., for example, has developed a medical device that it says can dress burns and other wounds with nano materials that mimic human tissue and peel off once the skin below is regenerated. Still, the glues currently in use to replace sutures and staples are limited by their mechanical properties and toxicity, the researchers said. Because they are very toxic, they can be utilized only on the surface of the skin. In addition, hardening of the glue may make the organ less flexible or the adhesion may not be sufficiently strong. With these limitations in mind, researchers have been on the hunt for a glue that is suitable for different tissues, nontoxic, and flexible after hardening. Such a glue would also need to decompose in the body after the tissue is fused together. Mizrahi worked together with doctoral student Alona Shagan and came up with what they say is a “very strong, nontoxic tissue adhesive that remains flexible even after solidification.” Their study...
  • Pinnacle Ventures has launched a pharmacogenomics programme to enable genetic testing to drive personalised prescribing decisions. The innovation arm of Pinnacle Midlands Health Network, a not-for-profit primary health care management company in New Zealand, is also working on embedding biomarker information into electronic health records and linking it to a clinical-decision support prescribing tool that can help prescribers by providing direct access to international pathways and guidelines. Pharmacogenetics involves prescriptions being tailored to a person’s genetic make-up, as people metabolise drugs in different ways, which can have a significant impact on a drug’s effectiveness. Ventures plans to do about 5,000 pharmacogenetic tests over the next 12 months, says chief executive John Macaskill-Smith. Some will be self-funded because individuals are struggling with their medications and others will be fully funded by Ventures, targeting specific groups within the Midlands population. Macaskill-Smith says it is a simple test that covers 65–70 per cent of medications frequently prescribed in New Zealand. “The New Zealand health system is under strain but using testing like this you could reduce the trial and error of prescribing and prevent adverse reactions to medications,” he said. Ethnicity plays a big part in how a person metabolises drugs, but the clinical trials that prescribing information are based on very rarely involve Māori or Pasifika test subjects. Macaskill-Smith said Ventures is partnering with key kiwi groups, Auckland University and Otago University medical schools and Callaghan Innovation to support research and develop a better understanding of how unique New Zealand populations respond to different medications. People who have a pharmacogenetic test can choose to consent to contributing their non-identifiable demographic information to researchers. Embedding the biomarker information into EHRs ensures a patient’s results are used for both current and future prescribing decisions, he said. Macaskill-Smith says a lot of direct-to-consumer online genetic-testing tools involve people...
  • Surgery students spend so much time on screens that they have lost the ability to perform simple tasks such as stitching and sewing up patients, a professor has warned. Roger Kneebone, a professor of surgical education at Imperial College, London, says the focus on academic knowledge has come at the expense of craftsmanship. “It is important and an increasingly urgent issue,” Kneebone told the BBC. “It is a concern of mine and my scientific colleagues that whereas in the past you could make the assumption that students would leave school able to do certain practical things – cutting things out, making things – that is no longer the case.” The professor, who teaches surgery to medical students, believes that this is down to an increase in technology which takes away the experience of handling materials and developing skills. ”An obvious example is of a surgeon needing some dexterity and skill in sewing or stitching,” he explained. ”A lot of things are reduced to swiping on a two-dimensional flat screen” Kneebone adds that a growing number of students are becoming “less competent and less confident” in using their hands, resulting in young professionals who “have very high exam grades but lack tactile general knowledge”. The professor will be speaking on Tuesday at the V&A Museum of Childhood in east London, at the launch of a report, published by the Edge Foundation, calling for more creativity in the curriculum. The report warns that entries to creative subjects have fallen by 20 per cent since 2010, including a 57 per cent fall in design and technology GCSE. Tristram Hunt, director of the Victoria and Albert Museum, who will be speaking alongside Professor Kneebone added: “Creativity is not just for artists. “Subjects like design and technology, music, art and drama are vitally important for...