Sandy Pentland Discusses Wearable Tech and Medicine

credit: World Economic Forum

credit: World Economic Forum

Silicon Valley is clamoring to enter the medical, wearable tech niche.  Every tech company from Apple to Google is trying to solve our health crises with some kind of tracker, some simple, some sophisticated.

Sandy Pentland, PhD., of the MIT Media Lab has been tracking individuals by smart phones and other devices for years. He has gleaned a theory of “Social Physics” that can track and predict behavior and even foresee disease and illness. We had the chance to talk with him about his intriguing research and how physicians can apply it to their patients today.

~ Video Introductions by Ayesha Khalid, MD, MBA, Enterologist

Social Physics and Obesity: In the healthcare world, we have a hard time motivating our patients to follow the plans and pathways we create as doctors. If we can find the right incentives to get people to change their behavior and keep it that way- bingo! Huge win!

Pentland addresses this in a pilot health program. Participants received incentives whenever a person they partnered with worked out.   This buddy system was eight times more effective per dollar than normal financial incentives. More importantly, they kept up the social network and exercise guidelines after the experiment concluded.

 

Social Physics and Genetics: The power of social physics and thinking about the spread of ideas can be very powerful in health care. Disease groups such as depression may be haphazardly grouped based on an accidental clustering of symptoms. Pentland discusses why therapeutics work so differently on individual diseases within a category. One recent project adds a behavioral and phenotypic component to genetics data and starts to tease out the different types of diabetes, or depression.

 

 

Social Physics and mental health: Imagine a world, where soldiers who have PTSD provide their psychiatrist with daily updates via their smart phones. Physicians don’t have to wait weeks for a check-up to see how medication is doing, but can simply check an app to look for tell-tale signs. Changes in behavior, both major and nuanced are tracked relaying a patient’s progression.

 

Social Physics vs Social Media: Recent media discussed the inaccuracy of “Google flu,” an online tracking algorithm that predicts the movement of the flu virus based on people searching for information. Pentland discusses the difference between aggregated data point from individual tracking vs keyword tracking through social media and search.

 

 

Conclusion  

Human beings are highly social and communal in our sharing with one another, a trait signified by the importance of language and sociocultural imprinting. We know that Western healthcare does not pay attention to the power of social dynamics, our external environment, and the role it plays in our own wellbeing. Would it not be interesting if we could measure that in some way and help it to understand the power of the relationship of our genetic makeup with our disease manifestation?

Bios:

Sandy Pentland has been a professor with the MIT Media Lab for nearly 30 years. He is also the co-founder of several companies including ginger.io and Thasos Group. He is the author of two books, Social Physics and Honest Signals.

Ayesha Khalid is a sinus surgeon with an MBA from the MIT Sloan School of Management. Ayesha is interested in the re-design of the health care system with a patient-centered focus, specifically in the area of clinical trials and rare diseases. She is a co-organizer at Hacking Medicine, an interdisciplinary group at MIT that seeks to spark change in healthcare. She also serves as the Young Physician Chair for all ear, nose and throat physicians in the United States.

 

Sermo Announces Eight New Hubs

BiPolar disorder

We are pleased to announce the creation of eight new Hubs, or online information libraries, in several specialty areas.

The new content pages will pull content from around the web and from within the Sermo community to one centralized location.  Each Hub will include topic-specific posts, videos, new research, and polls as well as areas for physicians to discuss the latest updates.

If you are a physician, please join us at our newest Hubs, they are:

  • Infectious Diseases
  • Depression
  • Bipolar Disorder
  • Dermatology
  • Pain Medicine
  • Asthma
  • Rheumatoid Arthritis
  • Pain Medicine

One of the strengths of our community, is the number of doctors who are contributing to the Hubs.  There are over 40 ambassadors who regularly write fresh, thought-provoking posts aimed at improving patient outcomes and sparking debate among fellow physicians.

As an example, the Infectious Diseases Hubs has had recent conversations on Ebola, EV-D68, the upcoming flu season, and HIV/AIDS.  Our Depression Hub currently has an active conversation about the incidence of over-diagnosis for bipolar disorder.

Our newest Hubs join other ongoing information centers for a total of 13:

 

  • Multiple Sclerosis
  • Oncology
  • Diabetes
  • Cardiology
  • Obesity

If you are an M.D. or D.O., please join our community and explore our latest Hubs, polls and posts.  There is a conversation just waiting for your input.

 

The Despicable Patient and Name Calling

click to enlarge

click to enlarge

~ by Maxwell M. Krem, MD, PhD

How does a physician deal with a despicable patient—not just a difficult patient, but an individual whose maladaptive behavior reaches the extremes of physical and verbal abuse, persistent sexual harassment, and even danger to medical staff or the patient’s family members? The answers lie on two levels, professional and personal.

Professionally, techniques such as boundary- and limit-setting, an empathetic demeanor, obtaining additional staff for security and chaperoning purposes, careful monitoring and documentation of clinical encounters, and reasonable attempts to develop a therapeutic alliance are likely to help the physician navigate encounters with even the most behaviorally challenging patients.

However, on a personal level, the answers are less clear. How does one face regular exposure to some of the ugliest facets of human behavior and maintain sanity? Many, if not most, physicians employ defense mechanisms, and humor is high on the list. In the humor category some unofficial acronyms have emerged, some of which are not intended to be derogatory but are clearly inappropriate for professional settings or patient encounters. Examples include FLK (funny-looking kid) and LOL (little old lady).

A recent Slate article by Columbia University psychiatrist Anne Skomorowsky looks at one of those acronyms, exploring the author’s experiences with it and exposing it to the general public. The abbreviation: SHPOS, standing for “subhuman piece of shit.” The author discusses the acronym as one commonly used by physicians for patients they despise or who behave disgracefully. She describes encounters with patients who displayed severely dysfunctional behavior, such as harassing medical staff or endangering themselves, staff, and family members; she discussed her own intense reactions to those patients, as well as the misogynistic components to the behavior. Dr. Skomorowsky additionally explains that the term has been in use since at least the early 1980s and is “known to physicians everywhere.” She concludes that “[n]o one is proud to call another person subhuman.”

Dr. Skomorowsky is certainly correct that the despicable patient does exist. A recent discussion of her article on Sermo confirms that physicians from nearly all specialties have had similar encounters. Maladaptive, misogynistic, abusive, infuriating, assaultive, and dangerous behavior is not confined to the psychiatry ward, and it cannot be tolerated in a therapeutic setting. SHPOS may reflect “the clash of various narcissistic needs between the resident and his difficult patient,” in the words of Strauss (South Med J 1983; 76: 981-984). SHPOS also goes too far, is not in common usage and carries overtones of arrogance and lack of sympathy by the medical profession.

Why is SHPOS an unjustifiable acronym? Despicable behavior is an element of the human condition. The behavioral range of our species is vast and ranges from the most noble to the most base. The “SHPOS” is as human, and as “subhuman,” as are we in the white coats. Though physicians, professionally and often personally, aim for the noble end of the human behavioral spectrum, members of our profession have committed terrible acts against mankind, their patients, or their families. We are not above reproach and must not rejoice in a false sense of superiority. Superiority is at the heart of the abbreviation SHPOS, which labels the wrongdoer as something less than human; his behavior is explained by his inferiority. When confronted with what seems to be a SHPOS, we are looking at one of our own kind.

The Slate article brought back a memory from the very beginning of my medical education. Stephen Lefrak, MD, Professor of Medicine at Washington University School of Medicine, delivered the address at the White Coat Ceremony on my first day as a medical student. He recounted a story from early in his own training, during which he assisted a Jewish surgeon and Holocaust survivor in a procedure to save the life of a patient. As the procedure was getting underway, Lefrak noticed that the patient was tattooed with swastikas and other neo-Nazi insignias. He asked his colleague whether that patient deserved their efforts. The Holocaust survivor’s response was that to give any less than their best effort would be sinking to the patient’s level.

That ethos is what makes medicine special—a calling—and provides the glue of the doctor-patient relationship. Medical care is nonjudgmental. To be repulsed by despicable behavior is only natural, but to denigrate patients behind their backs erodes the central compassionate culture of the medical profession. The vast majority of doctors do not engage in the denigration of patients. A poll on Sermo (with more than 2500 responses at the time of writing) revealed that 90% of physicians had never heard the acronym SHPOS. We may occasionally have (justified) unspeakable thoughts in response to despicable behavior, but perhaps that is how those thoughts should remain. As one physician on Sermo said, “but when you let it out your lips, others hear you. It makes you look bad.” To call the offender subhuman is a facile defense mechanism, but for our good fortune we do not walk in his shoes. To call him a SHPOS is to be judgmental and be drawn into despicable behavior ourselves.

credit: Seattle Cancer Care Alliance

credit: Seattle Cancer Care Alliance

Bio:

Dr. Maxwell M. Krem, MD, PhD, is a medical oncologist who sees patients with hematologic malignancies at the VA Puget Sound Health Care System. His primary specialty is bone marrow transplantation.

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How Long Does Your Doctor Really Spend With You?

how a doctor spends his time

click to enlarge

by Linda M. Girgis, MD, Family Practitioner

I often hear patients complain their doctor barely spends time with them at their appointments. Many feel rushed in and out, dumped on the curb, their wallets lighter by a co-pay. But, the truth is far from assembly line medicine. Patients rarely stop to consider the time we spend outside the exam room on their behalf, and it is hours a day.

Prescriptions eat up hours

Pharmacies often call us when a patient’s insurance rejects a prescribed medication. Instead of letting our patients battle it out with their insurance companies, we do the task ourselves. We spend time trying to find equally effective alternatives that may be on their insurers formularies. If not, then we are condemned to do the dreaded prior-authorization. The whole process can take up to half an hour of just being on hold waiting to speak to a living person. Or it can mean filling out prior authorization paperwork required by a particular insurance company. The patient just sees the prescription waiting for them at the pharmacy and not the work that went into getting it into their hands.

Diagnostic testing causes headaches

Authorizations for diagnostic testing can take hours, sometimes days, occasionally months. It includes a phone call to the insurance company, or a case management company as many now use.  These calls can take 30-45 minutes of hold time to reach the responsible party.  Office notes need to be faxed over for review. Often, the decision is made for a one-on-one peer consultation before approvals are granted. This means the doctor has to have a phone discussion with the medical director of the insurance company. Usually, this is a 15-minute call but can be longer.

When I’m fighting insurance companies, I can’t be in the exam room. These days the majority of my time is stolen by people with checklists following up on the work I do.  They never see a patient or understand the nuances of a case. Doctors simply cannot examine patients and do these tasks at the same time. Every day, there are more and more regulations requiring us to do more paperwork and record more metrics.

EMRs and my former personal time

Doctors do not have the leisure to go home at the end of the day and just put our feet up and relax. Many days, I take my laptop home to work on patient charts after hours. To ensure we’re using our chart software in a meaningful way, the government dictates what information is important (even if we don’t agree).  We are often filling in data points that are useful to the government for tracking purposes, but not to our individual patients. While we may spend 15 minutes with a patient in the exam room, recording that visit often takes longer. So, while most people go home and put their jobs down for the day, many of us are spending more time with patient charts.

On Call Is Still A Way Of Life

Doctors must be available 24/7 for patient care. Many of us take call hours and are available all night for calls and emergencies. We often sleep with phones next to us in case we’re needed, regularly jolted  by a 4 am call.  While this is not time in the exam room, this is time available to our patients to provide them better care. Yes, I’ve even taken a call at 3 am on Christmas morning, my children dreaming of Santa and presents.

Patients might feel they are at war with us as they try to get more face-to-face time.  We feel we are in a war of paperwork and insurance bureaucracy to make sure our patients get the care they need.  All we ask is for patients to take a little time and think about what happens outside of the exam room.  That’s medicine too.  Maybe if we work together we can reform the system, tame the paper tigers and put us back where we belong, with our patients.

Bio

Linda Girgis, MD

credit: Linda Girgis, MD

Dr. Linda Girgis MD, FAAFP is a family physician in South River, New Jersey. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University, UMDNJ, and other institutions.  Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University.  She has appeared in US News and on NBC Nightly News.

Celebrity Medical Treatment: What happened to Joan Rivers?

doctor treating joan rivers

credit: Shutterstock

As Melissa Rivers prepares a lawsuit for damages against the clinic that performed her mother’s fatal surgery, a new report released yesterday details what went wrong with her procedure.

A 22-page report issued yesterday said the clinic where Joan Rivers received care made “major mistakes.” Violations include:

  • failure to recognize deteriorating vital signs
  • improper regulation of the dosage of Propofol
  • failure to obtain consent for each procedure
  • not cared for by authorized physicians
  • and perhaps most telling, a staff member taking a picture while sedated

The report clearly indicates that, at least for Ms. Rivers, she received celebrity treatment that might have cost her life. We asked our physicians about celebrity treatment, and they had a lot to say about it.

Do Celebrities Deserve Different Treatment?

Some physicians found deferential treatment to be against the idea of being a doctor. The goal is to give everyone the best medicine, period.   One anesthesiologist wrote, “I told the CEO of a Fortune 500 company that he’ll get my best effort, just like the homeless guy I took care of right before him.”

An oncologist echoed that sentiment strongly, “When VIPs in need of care enter my realm, I bend over backward not to cut corners. It is a superstition of mine based on a Palmer Slogan, “only the very rich can afford poor healthcare.” Every patient deserves the best efforts I can give them, and there is ALWAYS a cost to cutting corners for anyone.”

Some doctors acknowledged there are reasons to treat celebrities differently, but it’s more about the mechanics of practice management than patient treatment options. An Emergency Medicine doctor wrote, “We get a fair amount of celebrities where I work, some VERY famous. The majority get a room quickly and seen within minutes of arrival. It’s a perk of celebrity, but it also keeps the ER functional. The treatment is the same. I do have to say the vast majority of them have been very decent, patient, and cooperative.”

Some specialties lend themselves to a higher level of celebrity patients. One in particular is Otolaryngology: a doctor wrote, “It really isn’t as cut and dried as ‘treat every patient the same,’ because not every patient has the same needs. Would I treat my next-door neighbor’s voice problems the same as the Bono’s if he was in town for a concert and needed to perform tonight? I don’t think anyone would.”

VIP Syndrome

One cardiologist described what sometimes happens when doctors treat celebrities. “There is a name for this, the VIP syndrome. It is often doing either slightly more or slightly less often at the request of the famous. Alternatively, the physician tries to do more to make sure the procedure will be successful. Unfortunately, things tend to go wrong in these circumstances the most.”

Having famous parents can have an impact on your care as well, one pediatrician wrote, “I covered a practice with lots of household names. The parents brought their kids in and were perfectly normal. The only issue was they were constantly refusing immunizations. They were nice about it, however. It was time consuming to talk about why these immunizations are recommended, the risks of the diseases, etc. They also needed to sign a form they had refused immunizations.”

An otarologist summed up the pitfalls of celebrity and medicine. “By human nature, doctors are just as awe-struck by celebrities as anyone else. Many times celebrities are treated as royalty, and there are many celebrities that expect it—-and demand it. The problem when too many rules are bent to please the celebrity can be fatal. We don’t tell them how to perform and do their business—therefore the celebrity should not command what we do—-especially if you bend rules or push the envelope.”

What do you think about celebrity status and medical treatment? Are there times when treating celebrities differently makes sense such as a singer with a throat problem or a busy urban Emergency Room suddenly dealing with a celebrity? What controls should be in place to protect the famous? If you’re an M.D. or D.O. you can see the full conversation inside Sermo.