Archive for the ‘getting good healthcare’ Category

From Salon: Doctors need to be aware of widespread health misinformation on the Web, because patients are going to find it.  Although the article is pitched as “Internet information is good for patients and doctors”, the misinformation aspect it its major point.

And a good point.  This is a basic tenet among the people who study end users of software and web applications, who do user-centered design, human-computer interaction, usability studies, etc:  You have to design your approach for what people are going to do.  Designing (whether it be software/web applications or any kind of information delivery) for what you think they ought to do is an approach destined for failure.

And you can’t stop the Internet.  It spreads information, and misinformation, like nothing else.

(On the other hand, calling doctors who don’t get this – like the article does – ow.  Good way to piss people off.  Doctors are end users of information, too, and starting off your approach with an insult, maybe not so effective.)

Checklists are often simple and straightforward, and very short checklists can carry the unfortunate implication that the person using the checklist can’t remember to do simple things. But sometimes they can’t. Or don’t. The NY Times has an article discussing the rewards – in lives saved – of medical professionals using checklists, sometimes very simple one, to ensure that they don’t forget – or skip out on (do you wash your hands every single time you go to the bathroom?) – important steps under pressure, particularly those that may not seem as important as others.

The practice of medicine gets a little more scientific here , and rewards clinical intuition a little less, by reducing the human element involved in medicine. I’d bet you money that most patients would think that a doctor who uses a checklist is less competent than one that doesn’t, because they’re following delineated steps set up by someone else.

And that’s the dilemma: you can get the best healthcare available, or you can get healthcare that feels intuitively right.

If we keep going, healthcare may wind up being executed by health professionals but determined by information professionals. Good news for us science of info people…although I could just be expecting this potential from based on personal bias…
Using checklists (NYT article).

A book review with a lot of commentary.

Most doctors do not like decision aids. They rob them of much of their power and prestige. Why go through medical school and accrue a six-figure debt if you’re simply going to use a computer to make diagnoses? [….] It is no secret many doctors despise evidence-based medicine. It is impersonal “cookbook medicine.” It is “dehumanizing,” treating people like statistics. Patients do not like it either. They think less of doctors’ abilities who rely on such aids.

The problem is that it is usually in patients’ best interest to be treated like a “statistic.”

And he talks about why.

It’s unfortunate that getting good healthcare can be at odds with doctors and patients thinking about things in normal human ways.  It does take the humanity out of it; it’s not “normal”.  But seriously: is it worth it to have an intuitively comfortable visit, and make your doctor feel better, at the cost of your getting better healthcare?

Here’s an article on a review of 33 studies of strategies such as question prompt sheets, pre-session “coaching sessions”, and watching videos. The review found that some strategies were “somewhat effective”, i.e., nothing seemed made more than a small improvement, but it did make an improvement. The lead author, Paul Kinnersly of Cardiff University, suggests that people think about a doctor’s appointment ahead of time, write down their concerns, and consider bringing a family member to help ask questions and to remember the answers.

It seems there’s also room for targeted strategies; I mean, doctors, like people who are not doctors, vary in how you can best communicate with them.

One thing we suggest to people at CrazyBoards, a support forum for mentally ill people, when they are having trouble communicating something serious (and/or complicated) to their doctor, is to print out the post they talked about it all in, and bring that in to their doctor. If the immediate interpersonal pressure of the social interaction is what’s making it extra hard (or the problem is having to say it aloud, or to interrupt the doctor, or to say their piece without being interrupted, or something similar) thinking it all out ahead of time, writing it down, and asking them to read what you’ve written may help.