Sunday, July 31, 2011

File This Under Random

I check out many health-related websites on a daily basis. I click on links from Twitter and Linked In and see the entrepreneurial ventures of fellow health care professionals. One of the things that irks me of late is the random stock image of health care "professionals" posted throughout websites (for example see below).


This woman has been featured on more websites that I can count. It's not that I doubt her professional credentials - she seems to at least have a legitimate Littman-type stethoscope and upgraded smoke finished clipboard. But is it that hard to post a picture of actual clinicians today? When we talk about patient-centered care, I believe patients deserve to see an actual image of their provider rather than the random clip-board touting, lab-coat wearing stock image that graces so many websites. I hope this woman is at least getting royalties from gracing so many sites! 

So please, if you have a website and are a healthcare professional or entity, please use your actual photo rather than the one above - it helps regarding credibility. Patients know much better than that. 

Wednesday, July 20, 2011

Preventative Health: Is it Really Preventative?

Lately, there has been increased emphasis on "preventative" care in the US now that there are some mandates under the Affordable Care Act. There is even the U.S. Preventative Services Task Force (USPSTF) which is a panel of private sector experts who recommend evidence based preventative screenings for certain conditions based on factors such as age and gender.

As a family nurse practitioner, I base a large part of my practice on wellness and prevention in addition to episodic (or "sick") care. I believe in "wholistic" care - that is, care of the whole person including mental and physical states. Though lately, I question whether if "preventative" is really the best moniker for this type of care. Prevention assumes that one can completely avoid health conditions by subscribing to certain recommendations, screenings and/or tests. Is it naive or even obnoxious to think that we can prevent disease and illness? I have seen many patients follow all the recommendations only to end up with some other life threatening malady. Of course, we cannot avoid all sickness and illness as there are inherent non-modifiable risk factors (such as age, gender and heredity) that hold the potential to affect one's health. 

I am not necessarily disputing any evidence or recommendations that have been introduced but the false sense that we have the ability to "prevent" an illness or disease from happening in the first place. This can lead to unrealistic expectations and negative backlash. Yes, we be able to detect an early cancer prior to it's spread or immunize individuals against certain infectious diseases. But prevent altogether? Sadly, I don't think so - in fact, I know so. 

That's why I am using the term pro-active health rather than prevention. There are actions that individuals can take to lower their risks from disease and illness and I believe that is taking a pro-active part in one's health. We do this in the hopes of longevity, wellness, disease avoidance and early detection (if illness is identified).

Perhaps I am more hung up on terminology in my new post doctoral reflective state. I believe in open and transparent communication with my patients and other members of the care team. I don't want to purport to my patients that we can cure and prevent all illness. We can however, instill evidence based methods to increase patient activation, patient engagement, and ownership of one's health and behaviors to take a pro-active approach and present realistic expectations based on the available data. 

I'm curious to know what you think. Am I too fixated on the words (and the resulting expectations from that title) or are we possibly setting patients up for let-down and failure if they do encounter illness after following all recommendations? Please feel free to comment below.

Tuesday, July 12, 2011

That's What I Call Access to Care!

I am a huge baseball fan and my favorite team is the NY Yankees. Star third baseman Alex Rodriguez was recently diagnosed with a slight meniscus tear of his right knee. He has played through some pain over the last few weeks and was given conservative treatment by the Yankee training staff up until the point that it didn't really improve. Check out this timeline of events:

Friday 7/8/2011 - MRI reveals meniscal tear. I presume the team physician recommends surgery.
Sunday 7/10/2011 - A Rod gets a second opinion on SUNDAY with Dr. Lee Kaplan of Miami.
Monday 7/11/2011 - A Rod has successful surgery and is expecting 4 - 6 weeks of rehabilitation.

That is what I call access to care! From MRI to second opinion to surgery was a cool 72 hours (I surmise that he also needed a pre-op clearance thrown in there as well).

Yes, he is arguably one of the greatest players to ever play the game and is also the highest paid player but it is amazing how anyone can get a second opinion with an Orthopedist on a Sunday and have elective surgery the next day!

When we talk of health disparities, this is a prime example of what is wrong with our system. No, I don't expect a consultation to surgery time period of 72 hours, I just wish I can get some of my patients to just see an Orthopedist in the same month.