Like an endangered species, preventive medicine and chronic disease management—the US primary care system—face extinction. With nearly 30% of American adults lacking a source of care and 28 percent reporting delaying or not getting care due to cost, the consequences are far-reaching.  The focus on chronic disease prevention and addressing its root causes demands greater attention, as the health of the system—and the people it serves—depends on it. If we are frustrated about something, this is worth the outrage.

It has been almost impossible for elected officials, who too often look for singular villains, to grasp the extent of this system-wide dysfunction. This crisis extends beyond consumer comfort with technology or the cost of medicines. Primary care medicine—the basis for health delivery—is marginalized as an honored medical discipline. Somehow, we opt for a national health system prioritizing sick care over healthcare.

Primary care providers are grappling with burnout and inadequate compensation compared to their specialist counterparts, and the system often prioritizes paperwork over quality of care. Economics drives health delivery and access, and it’s simply not working to the advantage of consumers and primary care physicians.  

Finger-pointing and Senate HELP Committee photo ops cannot solve this nation’s care crisis. What’s needed is a fundamental shift in our approach to illness, prevention, and access—one that addresses the root causes of our failing primary care system and ensures that quality healthcare is accessible to all Americans, regardless of zip code or digital literacy. That will reduce our total health costs.

Obesity and Heart Disease: A Multigenerational Threat

America’s waistline is changing—we are adding notches to the nation’s belts. Obesity rates among younger Americans are climbing, creating an abundance of chronic diseases that once seemed confined to older generations. Alarmingly, heart disease, which had been in decline for decades, is creeping back up.

The invention of new weight-loss drugs like GLP-1 receptor agonists helps many struggling with chronic weight issues and mitigates some health risks. Yet, these drugs are not a complete answer to the challenge. They do not adequately address the underlying risks—heart disease, diabetes, and other chronic conditions—that require ongoing, consistent engagement with health professionals. Without this, even those who benefit from these medications – looking trim – may still end up battling old health challenges.

The persistent challenge of obesity across various age groups in the US, which hovers at +/- 40 percent, reinforces worrisome trends that impact people by age, race and region. A rate stable at 40 percent is not something to celebrate – it requires action. It’s a tipping point for illness.

Prediabetes: A Perfect Public Health Storm

Prediabetes is the nation’s silent epidemic. Close to 90 million adults—more than 1 in 3 Americans—have it, and 90% don’t know they do. Left unchecked, some 20 percent of these people “graduate” to Type 2 diabetes and other complications annually. The rise in obesity among younger populations only exacerbates this issue, setting the stage for an earlier onset of chronic diseases that worsen over time.

Prediabetes demands a dedicated behavior-focused treatment plan. Without significant lifestyle changes, individuals are on a fast track to diabetes and its life-altering complications. And yet, the primary care system—our first line of defense—is buckling under pressure, unable to provide the consistent support patients need. It’s not just the use of medications – it’s understanding that obesity is a multi-system condition and a unique disease that transcends more belt notches.

The Limitations of GLP-1 Drugs:

GLP-1 drugs do reduce weight and lower the risk of diabetes and heart disease. But they are not a substitute for comprehensive care. The underlying dangers—poor cardiovascular health, insulin resistance, and other metabolic issues—don’t disappear with weight loss alone. Without engagement with allied health professionals trained to address the complexities of obesity to monitor and address these risks, consumers will face new challenges despite these drugs’ initial success in losing pounds.

We live in what Katherine Saunders, MD, DABOM, a Weill Cornell Medicine’s Comprehensive Weight Control Center and co-founder of FlyteHealth, calls the “Obese-a-genetic” era.  Her efforts at FlyteHealth leverage the latest in science, technology, patient support, and a range of medications to individually tailor weight treatment based on a person’s unique biology alongside the complexity of obesity treatment:

“Overweight and obesity are misunderstood medical conditions that are more complex than calories in and calories out. The advice many patients receive—to eat less and exercise more—often fails to address the problem.”

Saunders and her colleagues are at the cutting edge of results-oriented care, but she is among the handful who have dedicated their careers to this pressing clinical discipline.

Walk-In Clinics are about Convenience

Convenience of care is essential to people’s well-being. Entrepreneurial internists have recognized this, creating “pop-up” vaccination and care centers to bring services closer to those in need and better work/life balance. But convenience alone isn’t enough. Urgent care clinics underscore one of the nation’s most pressing public health threats—the erosion of primary care—has reached a retail-like inflection point.

Walk-in clinics and telehealth check-ins are helpful but do not offer dedicated follow-up. They are geared to address the consumer’s immediate need and are not structured for the longitudinal engagement for the hard-to-tackle considerations that call for comprehensive support.

We are stuck between a system that focuses on its self-preservation and what is in our and national long-term interests – protecting our most important asset – our health.

The Rise of the Make American Health Again Movement

Primary care physicians, the cornerstone of preventive health, are becoming extinct as a medical profession species. The reasons are many: medical school debt driving doctors to higher-paying specialties, they are paid by the number of patients seen daily burnout, and the rise of retail clinics offering quick, transactional care.

While these clinics improve access, their focus is not on a long-term patient-physician relationship. This shift leaves a dangerous gap in the medical safety net, particularly for chronic conditions like obesity, prediabetes, and heart disease. Without a trusted health provider to guide them, patients are left to navigate their health journeys solo—often with devastating consequences.

Many are aghast at Robert F. Kennedy Jr.’s nomination to the Department of Health and Human Services as Secretary of the nation’s key organization setting national health policy. This justified anxiety centers on his stated positions on vaccines and his off-hand comments dismissing the importance of medicines in preventing more serious illnesses. However, his thoughts about America’s poor health report card grades deserve attention regardless of the outcome of the Senate confirmation hearings.

His Make America Healthy Again movement has an approach that deserves consideration: the need to tackle the chronic disease epidemic, which has become the leading cause of death in the US and, later, drives massive costs in hospitalization.

“There are some things that RFK Jr. gets right,” says Resolve to Save Lives CEO Dr. Tom Frieden, who was appointed Director of the Centers for Disease Control and Prevention during the Obama Administration. “We do have a chronic disease crisis in this country, but we need to avoid simplistic solutions and stick with the science.” Frieden made his comments in an NPR interview on the RFK Jr. nomination.

We need (much) more than medications and pop-up clinics to address America’s growing health crises. The health ecosystem must be reimagined to center around people’s health outcomes – not a one-size-fits-all approach to keeping them well. We must foster long-term patient-provider relationships, ensure easy access to understandable health data, emphasize nutrition and physical education in schools, and make care accessible to people across racial and generational lines.

As the ticking time bombs of obesity, prediabetes, and heart disease continue to warn, the urgency for change cannot be overstated. The frustration over the current complexity of access underscores what happens when we prioritize the system over prevention. Access to care isn’t just a convenience—it’s a matter of survival. To prevent the collapse of this fragile house of cards, we must act decisively and collaboratively to build a health system that sustains us all.

The post Conceptually, the “Make America Healthy Again Movement” Needs a Nod appeared first on Medika Life.

The answer, at least the expectation of the commanding officer, was fairly simple, if not obvious. And a good ice-breaker to start the discussion. But the young pilot’s response caught his CO completely off guard. The pilot reacted, as pilots often do, with a simple and emphatic word: no.  At that moment, the tone of the conversation changed rather dramatically, and the officer looked quizzically at his inexperienced student and asked why. His answer was both factual and based on science versus speculation or military optimism. “With our current engine specifications of lift and drag, higher speeds would require the engines to be too big. And, at that size, the resulting aerodynamics would not allow a significant increase in airspeed.” Of course, the answer didn’t incorporate the jet engine which was the real game-changer and not yet available to either the military or commercial aviation.  But that innovation was just around the corner.

Years later, a young medical student was called into his attending’s office.  This time, the discussion was regarding his application for a residency program at a prestigious medical center. The conversation followed a similar path as the young pilot, as they both chatted about the evolution and transformation of medicine today and into the future.  The discussion turned from the clinical to the philosophical, as the student spoke of his father’s dissatisfaction with his current job as a primary care physician. The future seemed a bit uncertain for both father and son.

Then the question from the attending came.  “Do you feel that the physician of today, you and me, will become obsolete?”

The medical student was on guard, as this was an important interview.  So, it’s no surprise that he heard zebra hoofbeats in the distance. But still his response was swift, resolute, and almost pilot-like—he said yes. But there was more to come. He spoke eloquently of his father and how the joy of medical practice had deteriorated into a system where pre-authorization became a misplaced journey of hope for both the clinician and patient. He explained how holding a hand was replaced by holding a mouse and peering at a keyboard and screen. And he opined on how his father would come home late at night, exhausted and burned out from a system that seemed to priortize dollars over heartbeats.

His point was clear.  That physician of today is obsolete.  The role is inconsistent with the human needs and desires expressed by patients, caregivers, clinicians and all those who provide that simple four-letter word: care. But he continued about his personal expectations for tomorrow. He clearly didn’t want to become that type of physician and suffer the consequences of an oppressive system. It had little place for him or his father. 

His voice became elevated and optimistic as he presented his generation’s future and reclaiming the joy of medicine.  His vision wasn’t a compromise, but a perspective on how technology can redefine roles, share the cognitive burden, and even enhance his human capabilities such as hearing, touch, and sight. 

Just like the jet engine, advances in technology that he grew up with, can help define his humanity and redefine medical practice.  He tempered his perspective with the reality that this is no simple task or path.  And in many instances, it’s already been declared DOA by those types who still flew in the old “prop jobs” of yesterday.  He concluded with the simple observation that change, and change for the better, is at hand.  And his job, as a new intern, would certainly be to hold the hand of his patient. But sometimes, he concluded, technology might be holding his other hand.

Author’s note:  The young pilot in this story is my father, John T. Nosta who was a Naval Aviator in World War II. He later went on to become a successful electrical engineer.  His vision was both practical and forward-thinking.  And sometimes, he liked to fly very fast.  The year 2022 is the 100^th anniversary of his birth.

The post The Parable Of The Pilot And The Medical Student appeared first on Medika Life.

This research paper is a very confusing read, even for someone who is quite familiar with this kind of research. Yet what is said in the paper is crucial to the case being made by Jean Twenge (and Jon Haidt) that government intervention is urgently needed to curb the harms of social media to the mental health of teens. I’ll use the abstract of the paper to discuss how to find flaws in a research study that is intended to influence public health policy.

Parents and school teachers and administrators cannot be expected to interpret original research studies on their own. But they might learn from discussions like this one to be more skeptical of experts who claim their advice is based on social science, but who make emotional appeals and rely on anecdotes to rouse their readership into action.

The ratio of emotional story-telling to actual scientific evidence is very high in stories in the popular press expressing alarm about the damaging effects of teen girls’ use of social media on their mental health.

There is an excess of hype and drama about this topic, even in op-eds in the New York Times. When in doubt, be skeptical of social scientists who try too hard to convince you that they are correct and that other experts have just not noticed something that is obvious to them.

In a widely discussed article, Jean Twenge says that she has been studying generational trends in mental health for over 25 years and that she never before found such a dramatic change in mental health as she saw around 2012.

Have Smartphones Destroyed a Generation? More comfortable online than out partying, post-Millennials are safer, physically, than adolescents have ever been.

Around 2012, I noticed abrupt shifts in teen behaviors and emotional states. The gentle slopes of the line graphs became steep mountains and sheer cliffs, and many of the distinctive characteristics of the Millennial generation began to disappear. In all my analyses of generational data — some reaching back to the 1930s — I had never seen anything like it.

Twenge has advice for parents and teachers:

If you were going to give advice for a happy adolescence based on this survey, it would be straightforward: Put down the phone, turn off the laptop, and do something — anything — that does not involve a screen.

Twenge commands special authority because her views are said to be derived from the best available evidence.

However, most of the key research that Twenge and her fellow advocate Jonathan Haidt cite was not conducted by either of them. I suspect that many of the authors of these studies they cite would disagree with Twenge and Haidt’s interpretation of their work, some vigorously so. That situation makes one centerpiece study led that was led by Twenge particularly important.

The key research article by Twenge and her colleagues is here.

Increases in Depressive Symptoms, Suicide-Related Outcomes, and Suicide Rates Among U.S…In two nationally representative surveys of U.S. adolescents in grades 8 through 12 ( N = 506,820) and national..

The article is unfortunately paywalled, but here is its abstract. We can do a lot with it.

In two nationally representative surveys of U.S. adolescents in grades 8 through 12 (N = 506,820) and national statistics on suicide deaths for those ages 13 to 18, adolescents’ depressive symptoms, suicide-related outcomes, and suicide rates increased between 2010 and 2015, especially among females. Adolescents who spent more time on new media (including social media and electronic devices such as smartphones) were more likely to report mental health issues, and adolescents who spent more time on nonscreen activities (in-person social interaction, sports/exercise, homework, print media, and attending religious services) were less likely. Since 2010, iGen adolescents have spent more time on new media screen activities and less time on nonscreen activities, which may account for the increases in depression and suicide. In contrast, cyclical economic factors such as unemployment and the Dow Jones Index were not linked to depressive symptoms or suicide rates when matched by year.

The editors at a top psychology journal, Clinical Psychological Science, and the reviewers the editors picked were obviously impressed enough to recommend the article and its abstract be published in the form that we now see.

I noticed lots of things that made me suspicious because I have higher standards for talking about risks to health than most psychologists do.

• I received excellent training in my Ph.D. studies as a research-oriented clinical psychologist. I received my doctorate in 1975 but then began working in situations where medical scientists and public health officials demanded stricter standards than what was required of psychologists trying to get published in a respectable psychology journal. Lives depended on what a different kind of expert decided about risks from the often limited and flawed data that was available to them.

The COVID pandemic and the quick decisions that had to be made about what advice could be given concerning vaccination, social distancing and lockdowns put this kind of expertise on display. The world-class experts giving briefings on the best of cable news were good at policing each other to avoid exaggerating what was known and to admit they did not know. “We don’t know yet” was often the best answer, as frustrating as it was.

For a start, I expect more information from an abstract than this one provided. The authors did not follow standard advice on what to include in an abstract. I’ll have a future story documenting how abstracts attached to paywalled articles like the one we are discussing here can actually kill people, aside from spreading misconceptions.

Rather than doing their own research to collect new data, these authors relied on existing survey data sets collected for other purposes. This leaves lots of questions about they did this that the authors do not address in a transparent way.

How did the authors integrate this data from different sources in one study? Relying on someone else’s data is attractive and may at first seem expedient, but effectively and validly doing requires a lot of difficult decision-making.

Inevitably, the original researchers did not ask the right survey questions for new research. What questions in the surveys best fit the new issues researchers wanted to address? How could the new researchers verify that their selection from already collected data was most valid and relevant to their issues?

Twenge and her co-authors imply in the abstract that they had been able somehow to integrate the survey questions with information from the national statistics on deaths by suicide. I knew that was bunk. Ethics committees overseeing the protection of human subjects insist the data be anonymized so that identification and matching of people across data sets becomes virtually impossible.

Then, there is the problem of the small number of suicides in this relatively low-risk group. Let’s stop here and apply some numbers I revealed last time.

Any potential risk factors the authors can find in these pre-existing survey questions must pass the test of predicting relatively infrequent events with some percision. The abstract suggests the authors may have succeeded (“which may account for the increases in depression and suicide), but that would be statistically improbable, given the basic rate of death by suicide and any conceivable fluctuation in the study period of this article.

For 2017, we have about 420 suicides to explain among 20.5 million girls. I wish the authors luck in using whatever fancy statistics they can muster to predict which girls will die by suicide with the risk factors they can pull from other people’s data. Chances are no one died by suicide or only a chance handful from participants in the survey data they acquired. Neither Twenge and her co-authors or readers can tell.

Not being able to identify which of the teens completing the survey died by suicide means the authors will be left making speculative statements beyond what their data allow.

The authors used the term “iGen adolescents” in the abstract to describe the teens they studied. That fits with Jean Twente’s best-selling books, but I was skeptical about such a sweeping term being able to capture much of the similarities and differences in an increasingly diverse and divided America in the association of use of social media and mental health.

Was any similarity of teens falling in this age range more important than the vast range of differences? Consider one white teen having alcoholics or Trump supporters for parents versus another teen having teetotaler Hindu parents who insisted that their teen study hard enough to go to medical school and become a physician? White teens with two Ivy League faculty as parents versus a Black teen raised by a single grandmother who dropped out of high school and does not have internet? Versus a Black teen raised by a single grandmother who dropped out of high school, but the great of the story is the teen’s mother was an innocent victim of random gun violence and the grandmother insists the teen fulfill the mother’s dream and go to college, no excuses accepted?

I could generate thousands of these kinds of contrasts, and some would be quite absurd.

The final conclusion where I seem to be headed is that a generational label like iGen or Generation Z cannot capture much of variations among teens — or across an individual teen’s transition into adulthood and afterward.

“iGen” [Don’t you like the cool choice of labels so that you automatically think of having “iPhones” as what 25 million American teen girls have in common?] might serve to highlight some things teens that might be missed that teens have in common. Surely it misses a lot of things teens don’t have in common, whether they are from radically different backgrounds or with nearly identical demographics but just different in the place of social media in their lives.

The authors end their abstract with straight-faced reassurance that they controlled for “cyclical economic factors such as unemployment and the Dow Jones Index,” matched by year. I can just imagine some badass experts at conferences I have attended who would lie in wait for a speaker to say such a silly thing.

Academics who think their research saves lives can be real a*holes when dealing with other academics whose research they think will never save any lives.

Imagine the response of experts accustomed to identifying health risks from correlations found in survey or surveillance data. Unprepared for what they would hear, some would have spilled coffee on their fancy suits and chocked on the stale Danish from the free conference breakfast as they scrambled to correct the speaker, not allowing anyone to discuss what else the presenter had to say.

I can imagine the string of cliched criticism that could be unleashed.

“Of course, you know that correlation does not equal causality.”

“You can’t do magic with statical controls of correlations when all you have is somebody else’s survey data they collected for some other purposes.”

“What a dumb choice! Are you a psychologist who does not understand regression analysis or do you have books to sell at the conference? Will your next slide tell us where to find your Tedtalk?

Maybe the badass expert would be in an uncharacteristically charitable mood and simply explain:

“I appreciate your effort to find support for a hypothesis that excites you.You should realize that you are relying on statistical controls to settle some issues of causality that are not readily solved. If you were to rely on such controls, you are first making the assumption that you have isolated all the variables that could possibly explain away your findings. I don’t think these crude economic indicators begin to do that. Secondly, you are assuming that these variables are measured without error. I don’t think an economist would say these two variables perfectly measure year to year differences in the economy affecting either teen’s use of social media or dying by suicide.”

One final cynical a*hole comment before we move on —

“If we had used your approach to statistical analysis, we would have concluded at the early days of mystery in the HIV/AIDS epidemic that someone using poppers to enhance orgasm during casual sex or simply having too many Judy Garland LPs in their vinyl collection was a modifiable risk factor.”

Frightened and humiliated, the psychologist trying to finish their talk would miss a very serious and useful message that was being disguised here.

Not knowing what you are doing with bad data and a computer program can lead to all kinds of compelling, but spurious correlations to get worked up about, some more plausible for a while than the modifiable risk factor you are listening for in very noisy data.

So, just what did Twenge and colleagues do with “two nationally representative surveys of U.S. adolescents in grades 8 through 12 (N = 506,820) and national statistics on suicide deaths for those ages 13 to 18, adolescents’ depressive symptoms, suicide-related outcomes, and suicide rates increased between 2010 and 2015?”

That is a true mystery that is never clarified in this abstract. I was stumped at first. I gave the authors the benefit of a doubt and thought maybe they did some kind of prospective analysis, looking ahead and predicting later things that happened to individuals from their earlier responses on surveys.

I had to get a copy of the paywalled article. The overall design of the study was still difficult to decipher from the methods section, where it should have been laid out in detail and given a name, like case-control or cohort study.

I eventually figured out that the authors did not have two “nationally representative surveys of U.S. adolescents.” They had over two dozen cross-sectional retrospective studies (a one-time survey asking about the past year) with nonoverlapping samples and important differences in the questions that were asked. No questions at all about social media in the survey for some years (!).

This dog’s breakfast of a design for this study will be the topic of my next article about this study, as we dig deeper into what can reasonably be claimed from this study and what cannot — if we stick to principles of best science, not just good story-telling.

The post A Stunningly Bad Study Claims Social Media Devastates Teen Girls’ Mental Health appeared first on Medika Life.

When it comes to buying a household appliance, car, or home, consumers study their options carefully. The customer is conditioned to consider all options when making these major purchases; benefits and costs are mapped out clearly by manufacturers and reality checked by consumer product journalists and other customers who have purchased similar products. 

But what happens when people are confronting cancer, diabetes, or heart disease treatment or prevention? Then, they’re not so sure in their decisions as they confront a lack of authoritative information and a web of conflicting studies and recommendations.

Talya Miron- Shatz, PhD, an expert in medical decision making, and author of a new book titled “Your Life Depends on It: What You Can Do to Make Better Choices About Your Health,” takes a new approach to why physicians and patients need to abandon old behavior patterns that no longer work and learn to help each other make better collaborative choices. 

Dr. Miron-Shatz maintains that consumers must learn to express what they want and become part of the decision-making process as a partner or informed participant.

It’s an intriguing idea whose time, very frankly, is overdue. Doctors can no longer assume treatment decisions are all “their call.” Dr. Miron-Shatz maintains that both doctors and patients must explore what will work best toward the desired outcome and, as an outgrowth of this exploration, health system leaders must recognize that their processes for approvals, prior authorizations, and formulary baffle patients and cloud their understanding of potential outcomes and must change.

The System Rules Itself — Not Patient Input or Outcomes

We make a mistake if we assume that patient care is the system’s priority. When the decision pathway is murky and the consumer’s voice is absent, the system jockeys to make sure “house rules” win. Consumers not only need clarity of information, but they also need to build up their ability to make informed choices. As Dr. Miron-Shatz writes:

“We all make health and medical choices every single day. We choose to take a vitamin supplement, go for a run despite a sore tendon, forgo birth control pills, or have chemotherapy after cancer surgery. The more important these decisions are, the more vulnerable we are, and the tougher choosing becomes. This is why we need to build up skills to deal with these choices.”

It’s a simple yet powerful concept. For years, we in the healthcare ecosystem have heard the seemingly sensible call to “invite patients to the table.” Epidemiologist and decentralized clinical trials leader Craig Lipset, himself a patient with a rare disease, recognizes that assumption is flawed. “It’s their table in the first place,” Lipset says. “Too many fear ‘I don’t know’ as a sign of weakness, rather than a signal of confidence and honesty.” 

Though a response of “I don’t know” from a physician to a patient’s question may not inspire confidence, a provider’s willingness to explore questions with the patient — working as a team — is the foundation for a patient-physician relationship that is a positive force for inspired and trusting care and likely better outcomes.

Time for Shared Decision Making

It’s this working partnership that Dr. Miron-Shatz believes to be foundational for systemic change. However, with payers often making the care decisions, it often seems that the system serves itself. The patient is an afterthought with little influence in the conversation — at best a “junior partner” in their own care decisions. 

Payers often reject medical technologies for reimbursement as “investigational.” They cut physical therapy short, either because “it’s working” or “it’s not working.” Doctors are forced to battle the system, until, exhausted, they follow the path of least resistance. Physicians and patients need to hone their shared decision-making abilities in order to align and direct their combined voice toward better care choices.

Dr. Miron-Shatz knows this must happen. Consumer-patients need to have a larger say in the direction of their care, and they need allies to help them make smart decisions. Sy Syms, the menswear mogul and health philanthropist who founded the SYMS clothing chain in New York City, coined the expression, “An educated consumer is our best customer.” 

It’s a concept that transcends its advertising tagline as it applies to just about every interaction a consumer, even a health consumer, may find themselves in. Consumers entering the health system as patients should remember it, and physicians should listen to their charges. Perhaps the will and needs of the educated (health) consumer can be the foundation of a new alliance that helps healers, too often swimming upstream against the flow of the system, to be better partners and advocates for their patients.

Healthcare professionals that master the patient-care decision-making partnership draw upon emotional intelligence to communicate effectively, empathize with their patients’ struggles, and call upon medical knowledge and research to be better providers. 

But, most physicians are not sufficiently trained to speak with patients and are overwhelmed with the expectations of the system struggling to digitize and integrate technologies to ease their administrative burden. It’s a recipe for making decisions in isolation.

Physicians are Dedicated to Patient Advocacy

Allyson Ocean, MD, a medical oncologist and Associate Professor of Clinical Medicine at Weill Cornell Medicine, is among the founders of a pancreatic cancer health professional and patient advocacy community called Let’s Win for Pancreatic Cancer, that encourages shared decision making, says she is on the phone with insurance companies nearly every day trying to make sure her patients can get the treatment they need, and get it paid for.

“My best advice to work around the system of whether or not drugs or tests can be covered for cancer is to make sure you have an advocate in your field working for you,” says Dr. Allyson Ocean. “The frustrating part for me is that sometimes we even have to educate the insurance companies and say, ‘There’s a reason why I want to use this medicine.’”

In medical school, doctors do not learn how to navigate the medical system. They expect to help patients, to tackle disease — but not how to collaborate to tackle obstacles thrown up by the very system in which they’re preparing to work. Dr. Miron-Shatz, a “medical decision-making scientist,” has researched how doctors, consumers, and health systems need to learn how to collaborate and make better medical choices. 

Her new book is the long-needed guide for physicians, patients, and payers that will help them better navigate today’s care realities and rising consumer expectations. Dr. Miron-Shatz recognizes that what is essential to innovation’s success is having a knowledgeable and engaged customer — the consumer voice — as part of the decision-making conversation. She sums up the challenge facing caregivers and patients in this fragmented health ecosystem:

“Making better health and medical choices is neither intuitive nor easy, especially in the face of a life-threatening decision or despite medical jargon and confusing probabilities. Expecting us to handle these flawlessly is unrealistic and ignores issues of cultural background, a whole slew of cognitive barriers, lack of professional training in how to convey medical information, time constraints, and health-system deficiencies.”

Consumers and providers are at a disadvantage. Patients often feel that medicine employs a secret language requiring a skilled translator, and the range of treatment protocols and care options appear to change constantly. The outlook is daunting; to better make informed decisions, Dr. Miron-Shatz prescribes collaboration. 

That’s the key from her point of view, and ensuring patients sit at the head of the medical decision-making table must become the norm. It’s central to better, informed choices that drive care delivery, and will also influence future drug development and regulatory processes. Our lives depend on it.

[Special thanks to Dr. Elinor D. Bashe and John Bianchi for their contributions and input.]

The post A Reference Manual Toward Better Care for Patients and Physicians in 2021 appeared first on Medika Life.

The average American is blissfully unaware of this world, even though it directly affects them, often in hugely personal ways. Your most intimate details, like medical records, may be available for sale online and there’s nothing you can do to prevent it.

When the hack, referred to as a Ransomware Attack, hits closer to home, it becomes public knowledge. Take for instance the attack in early May on American gasoline supplier Colonial Pipeline, which crippled many cities. Americans were soon queuing for gas, hoarding supplies, as gas stations across the US closed or ran out of gas. 

The hackers had taken control of the systems operating the supply of gasoline via pipelines that criss-cross America. This was personal and the American public felt the effects first hand. Ransomeware was all over the news.

What most Americans don’t realize, however, is just how common these attacks are. It’s the perfect digital crime. Take over some company’s system, shut it down remotely from a place of safety, and then demand payment from the company. Once the company pays — the ransom — their systems are unlocked and they can resume business.

Bizarrely, the hacker’s “code of ethics” for want of a better term, seems to hold true. Once payment is made, the systems are released. Payment is a simple matter, digital currencies like Bitcoin make tracking the money all but impossible. 

It could be argued that without access to digital currencies, these hackers would be unable to extort money from their victims without leaving a clear trail for authorities to pursue.

Aside from the obvious inconvenience and potential dangers to essential energy supplies and other critical systems, there is another hugely unreported consequence of these hacks. The bleeding of personally identifying data. That’s your info and mine, all of it fair game. Don’t forget, these hackers are inside the systems they compromise, they have sufficient access to lock down the system.

It would be hugely naive to imagine they simply leave it there. While companies run around trying to secure loans to pay off ransom demands, the hackers are merrily downloading every shred of data they can strip from the systems.

That’s where the real value lies. Your information or data, which is spread throughout numerous systems across the US. This data is worth real hard cash on the dark web, especially certain types of personal data, like your healthcare information. From recent reports, it would appear no systems within the US are immune.

Your Data, Healthcare, and the silent war

Most ransomware attacks never see the public light of day. They’re kept quiet and settled away from the prying eyes of the media and the public. For very good reasons. Investors don’t like companies that appear vulnerable and companies would rather not spend the next six months explaining to their customers that their data was compromised.

Healthcare is particularly vulnerable. It’s a sector favored by hackers. Easy access to poorly protected systems, rich data pickings, and a culture of “keeping it on the QT’ among medical institutions, hospitals, and healthcare systems make this sector almost irresistible. 1 in 3 companies or institutions within healthcare get hit, according to a recent whitepaper from IT Security firm Sophos. Here are the key takeaways from the paper. 

• 34% of healthcare organizations were hit by ransomware in the last year.
• 65% that were hit by ransomware in the last year said the cybercriminals succeeded in encrypting their data in the most significant attack. 
• 44% of those whose data was encrypted used backups to restore data. 
• 34% of those whose data was encrypted paid the ransom to get their data back in the most significant ransomware attack. 
• However, on average, only 69% of the encrypted data was restored after the ransom was paid. 
• 89% of healthcare organizations have a malware incident recovery plan. 
• The average bill for rectifying a ransomware attack, considering downtime, people time, device cost, network cost, lost opportunity, ransom paid etc. was US$1.27 million. While this is a huge sum, it’s also the lowest among all sectors surveyed.

Scripps is an excellent example in case. Scripps began notifying more than 147,000 individuals in early June this year that their protected health information was exposed during a malware attack. They now face 4 class-action lawsuits.

For certain patients, exposed information included names, addresses, birthdates, health insurance data, medical record numbers, patient account numbers, and treatment details. Less than 2.5 percent of individuals’ Social Security numbers and/or driver’s license numbers were involved, according to the health system.

The list of attacks is growing exponentially.

• 500,000 patient files were potentially stolen in a ransomware attack on Iowa clinics.
• 334,000 Ohio Medicaid providers’ data were breached in a vendor hack

Keep in mind that only a small percentage of these attacks are ever made public and the data above should serve as a fair warning to all healthcare organizations. No one is immune and even smaller organizations are targeted.

Protecting yourself

Clearly, we cannot exist in a modern society without sharing our most private details with companies on a daily basis. There is a huge amount of trust involved, and where many Americans now simply take this relationship for granted, assuming companies will protect their information, ransomware exploits have exposed clear flaws in companies’ approaches to protecting our privacy.

We cannot affect or restrict the data we share without compromising, for instance in a healthcare setting, our quality of care and service. In these instances, the onus falls squarely on the shoulders of the service providers to protect our data and they are failing. 

Our only recourse in this instance is to lobby our congressmen and women. Changes need to be urgently brought to bear on the holders of personal data, fines imposed for lack of proper security, and audited processes put in place to ensure our data is safe.

This is going to prove challenging, particularly when not even the federal government’s systems appear immune to attack. Perhaps it is time to apply Bitcoin-style encryption to our data and fight fire with fire.

The post Held for Ransom. A New Pandemic is Sweeping American Healthcare appeared first on Medika Life.

The purpose of the article is to explore the benefits of performing a therapist-client or coach-coachee survey. Next, I look at why defining private practice goals allows a pathway to measure assessment feedback against. I look at a potential set of criteria to define the client assessment. Finally, the article investigates what available applications exist in the market today to solicit, gather and make sense of the data. We have a lot to unpack; let’s get started. 

The Background

At this moment, I see an absence of therapists and coaches requesting performance assessments from their clients — unless the practitioner takes matters into their own hands. Let’s examine the challenge through a personal example. 

All students who study Gestalt Psychotherapy must accumulate 50 hours of therapy with a more experienced Gestalt practitioner before the end of Year 3. Through this process, the therapist-in-training gains client hours towards becoming certified while I, the client, can witness firsthand the use of Gestalt in action. The therapist-in-training must write detailed notes regarding their client experience and submit the forms to the Gestalt faculty for review through their mentorship program. All of this sounds great. Except I see one fundamental flaw. 

Where is the voice of the client providing feedback on their experience with the therapist? How will the therapist know if they are truly supporting the needs of their clients?

The current method allows the Gestalt therapist to provide their inherent bias on the quality of the interaction with the client rather than allowing a holistic client-therapist-program feedback loop. When writing this article, I am engaging with Gestalt faculty on this critical question and will update the notes section once I have answers. 

Define Your Goals For Private Practice 

I believe in the importance of goal setting, even when establishing a psychotherapy or coaching practice. Knowing your goals will allow you to measure against them and to adjust and pivot based on client feedback. Examples of goals statements may include:

• I desire to work with people who possess a burning passion for change.
• My client base will remain small and focused, allowing for five people at a given time. 
• I will strive to be present and available at all times during client conversations.

While the above statements are not concrete, the qualitative nature will allow me to measure whether change over some time will occur for clients, what it is like to have a small base of people to work with, and whether others perceive my ability to be present. For those of you who are already seeing clients, do you have goals? Are your original goals the same as they are today? 

Criteria To Assess Client Impact

Like so many before me, in the Fall of 2021, I will find myself a part of the Gestalt student clinic and work with clients in the earlier stages of their psychotherapy learning career. The difference is — I’m from the corporate world and understand the value of data and analytics; in particular, my fascination lies in how data tells a story. Based on my personal experience, the following questions emerge:

• How can I utilize qualitative data from my clients to gauge overall performance? 
• How can I engage with clients in a friendly, engaging way to solicit feedback while avoiding a cold, factual approach?
• How often should I extend outreach to clients? What is the healthy balance to obtain just enough feedback promptly?
• Based on the data, where are opportunities to pivot?
• How can I evolve my practice to ensure I am at my best in every interaction? 

Through this lens, the following sample assessment criteria are under consideration and applied to therapists and coaches. 

•  In what ways can the therapist-client relationship be strengthened? 
• Trust is the foundation upon which the therapist and client perform the work. Are there ways to further develop and strengthen trust in our sessions? 
• Do you have an interest in exploring other ways to collaborate during therapy sessions? And if so, what activities do you gravitate towards?
• In our initial sessions, we established a Design Alliance. Are there areas we need to refine to improve our mutual approach? 
• How likely are you to recommend psychotherapy services to a friend or family member?

Once the assessment criteria are more formalized and data gathered, my objective is to ensure the results are transparent on my website. Honesty and integrity are building blocks of private practice, and I believe this behavior has a powerful appeal for others seeking therapeutic or coaching services. 

Applications To Obtain Client Feedback

Online surveys and options to request client feedback are plentiful. The following list is courtesy of Zapier and amended for this article: 

• SurveyPlanet for beginners.
• Typeform creates visually appealing surveys.
• SurveyMonkey for creating surveys on a phone or tablet.
• LimeSurvey for self-hosted surveys.
• QuickTapSurvey for offline surveys.
• YesInsights for one-click surveys.
• Surveybot for chatbot surveys on Facebook.
• SmartSurvey for collaborating on survey questions.
• SurveyGizmo for optimizing your surveys.
• Constant Contact includes helpful survey builders.

To Conclude

The article explores the importance of possessing clear goals to operate a therapy or coaching practice. Over time, collecting qualitative data from clients will demonstrate the quality of therapeutic sessions and showcase areas where I excel and others where I need to pivot and improve. If any readers have direct experience gathering client data in your therapy or coaching practice, please reach out; I will love to learn best practices as I get closer to opening a private clinic. 

The post How Do Therapists And Coaches Know If They’re Impacting Clients? appeared first on Medika Life.

“The cost of a thing is the amount of what I will call life which is required to be exchanged for it, immediately or in the long run.” – Henry David Thoreau

Have you ever changed your mind? Your patients do it all the time. Furthermore, they do it throughout their plan of care. You may have nailed the initial visit by asking all the right questions, developing well-reasoned goals, and fostering the beginning of a magical patient-therapist relationship, only to have it all come crashing down in a couple of weeks because the patient changed their mind on everything.

Sometimes this is the result of you being so awesome at your job and Exceeding Expectations that they develop new expectations they previously thought were unattainable. If you keep striving for the original goals and never discuss the updates with the patients, you will find their frustration mounting and frequently stating “it’s fine” when it is clearly not fine (in case you were wondering, it’s never fine when someone uses that phrase…ever).

Patient and therapist expectations often differ

Now, this does not mean we should strive for mediocrity to protect ourselves from setting up a patient with unreasonable expectations. Instead, this highlights the importance of continually seeking to understand your patient throughout the plan of care. This is different from constantly asking them their status with negative framing. Frequent use of “how does that feel?” or “how are you feeling today?” routinely fosters hyper-focus on any unpleasant sensations or difficulties. Instead, ask them about their perceived progress, highlight the areas they have improved upon, and revisit their goals.

You may find hidden frustrations around the perceived lack of progress despite your assessment that the patient is on track. The patient may expect the same rapidity of improvement while you expect more of a leveling off in the next couple weeks or perhaps even a temporary small step back with the increasing difficulty of exercises. You will find greater trust and engagement if there is alignment on the plan of care of expected outcomes. This is only scratching the surface of patient expectations and their drivers.

Would the patient classify your treatment as valuable?

Brain imaging shows that when someone perceives they were ripped off; they have activity in regions associated with disgust and pain. Conversely, when people perceive they received a good deal, it is a pleasurable event. How does this apply to physical therapy? Simple, we provide a service in exchange for money, time, and effort.

While we may want to avoid the financial piece of PT, it is a primary influencer of every treatment session, especially if the cost of care stretches the patient financially. The cost and value of a service are relative to each patient. A $25 copay may be expensive and challenging for one patient while a $300 payment (prior to meeting their deductible) may not faze another. I am not saying the quality of our care should be influenced by this perceived value, as we should provide the best quality possible each session, but we must understand patient expectations may shift with the relative cost. The patient may expect to be cured in one visit if they perceive the cost to be high. You want to know if you are fighting an uphill battle from the onset.

Negative emotions often outweigh positive ones

When assessing a patient’s expectations of care, we need to consider their current emotional state as well. Negative emotions and negative feedback often have more impact than positive ones, and negative information is processed more thoroughly than positive ones. The self is more motivated to avoid negative self-definitions than to pursue positive ones. Negative impressions and negative stereotypes are quicker to form and more resistant to disconfirmation than positive ones. In a nutshell, negative emotions are typically stronger the positive emotions.

While this is not universal to all people and all situations, we have likely experienced this during patient care and witnessed patient perseveration on the negative information they received (e.g. their MRI report). The information a patient receives prior to starting PT (e.g. imaging report, the media, their referring physician) and the information a patient receives in PT (how weak they are, poor mobility, crappy squat mechanics) can weigh them down and reshape expectations. There are many ways a patient can decide to cope and respond to this information. One of these strategies is loss aversion.

“I knew I shouldn’t have done that”

Could of, should of, would of…I heard this phrase often as a kid. My father would say it after my incessant complaining about some boneheaded move. Instead of focusing on the past, we need to learn from it and focus on the current situation and future investments. This is easier said than done. As Richard Feynman said,

“A rational decision-maker is interested only in the future consequences of current investments. Justifying earlier mistakes is not among the Econ’s concerns.” We can all benefit by channeling our inner economist.

Frustration can mount rapidly when reviewing an undesirable outcome and knowing you were responsible. Often the frustration is greater for the outcomes we are able to control versus the ones we cannot. This phenomenon is referred to as loss aversion. When directly compared or weighted against each other, losses loom larger than gains. It is important to define a “loss” and a “gain” as those can be subjective.

We have to define success to measure it

Outcomes better than the reference point are gains, while outcomes worse than the reference point are losses. Reference points are key for most assessments. For example, our assessment of a test grade substantially changes once we know what the grading scale is (i.e. an “A” being 90-100% vs. 94-100%). In treatment, the reference point may be predicted improvement in FOTO outcome measures or the MCID of a pain scale.

Daniel Kahneman wrote that “Loss aversion implies only that choices are strongly biased in favor of the reference situation (generally biased to favor small rather than large changes).” So, how does this apply to patient care? It can lead to very reserved expectations as a means of psychological protection. Instead of using an outcome tool’s MCIDs or patient goals, we use the status quo, or current medical condition, as the reference point. If the patient improved at all, we deem the treatment a success rather than needing to meet a specific level of improvement.

The more challenging the goal, the easier it is for us to fail to achieve it. It is easier to justify not achieving a goal by failing to act than by trying and failing. Loss aversion is a powerful conservative force that favors minimal changes from the status quo in the lives of patients and clinicians. People expect to have stronger emotional reactions (including regret) to an outcome that is produced by action than to the same outcome when it is produced by inaction. Going back to patients, this can impact their willingness to fully invest in PT, especially if they have experienced failed treatment before. It is easier to justify failure when we don’t make the effort.

How to combat loss aversion and hesitancy

One method to address loss aversion is broad framing, which is approaching a situation with a ‘big picture’ lens as opposed to looking at each event in isolation. For example, loss aversion typically homes in on a single reference point, such as returning to the soccer field. Broad framing would highlight all of the progress made and frame setbacks as opportunities and lessons for future development. Conversely, loss aversion and narrow framing is a lethal combination. While loss aversion and negative emotions can significantly dampen expectations, there are instances where a lack of expectation ‘control’ can negatively impact the assessment of the true benefit or harm of intervention.

Patients often over-estimate treatment benefits and underestimate treatment harm. This can lead to rash decisions (such as pursuing a risky intervention or prematurely ending a plan of care).^[1] Many studies have demonstrated individuals work significantly harder to achieve a goal compared to exceeding one. One is success vs. failure (achieving the goal) while the other is a cherry on top (exceeding the goal). This can impact the desire of a patient to resume PT once they achieve a primary goal, despite your knowledge they can achieve even greater outcomes or vice versa. On the flip side, a clinician may lack interest in a case if they perceive the patient has achieved sufficient improvement.

When trying to determine a patient’s expectations of PT, it can be helpful to understand how they developed those expectations and what information may assist or hinder the development and refinement of new expectations. Let’s take a look at four categories of expectations.

Predicted Expectations

The first is Predicted expectations, which are what the individual believes will occur. Many studies have highlighted a link between expectation and clinical outcomes for individuals experiencing musculoskeletal pain.^[2] Predicted expectations, both positive and negative, have a direct relationship with musculoskeletal pain. These expectations will be heavily influenced by the information the patient receives – such as from their referring physician or social media – prior to starting physical therapy.

Ideal Expectations

The second is Ideal expectations, which refer to a patient’s desire and hope. Essentially, they are what an individual wants to occur, while predicted are what an individual thinks will occur. Many patients will not share these as they believe they are not attainable and will lead to disappointment. I recommended asking. If they are attainable, and you help the patient achieve them, you will have an advocate for life

Normative Expectations

Normative expectations are what the patient believes should occur. While little is known of impact normative expectations have on clinical outcomes, it does appear to play a role in patient satisfaction (or dissatisfaction if you fail to meet it). These are heavily influenced by the value proposition. If the commute time is long, the cost of care is high, or you come highly recommended, the patient will likely expect rapid, superior outcomes.

Unformed Expectations

Lastly, we have Unformed expectations. These are the expectations an individual is unaware of or is unwilling or unable to express. This could be to a lack of previous experience or education necessary to form an expectation, or it could be the result of an activity being habitual and the patient hasn’t taken the time to develop an expectation.

Addressing expectations in the clinic

It is important to remember that expectations can change, even if you do everything right. For example, you may exceed a patient’s expectations and achieve one-month goals in only two weeks.

Great!

Then the law of unintended consequences strikes. Know the patient will expect the same rapidity of improvement the rest of the plan of care. This is why constant communication and reviewing of goals is necessary. Not just on progress note days but instead every session.

Everyone will have unique tweaks to their methodology for developing rapport with patients and assessing their expectations. Additionally, it is important to recognize your own expectations. Patients can be quite perceptive, and our body language often betrays our words. Studies have shown that when our verbal information, visual cues, and body language do not match, it sows distrust in the patient-therapist relationship.^[3] Like motivational interviewing, understanding and assessing patient expectations is a skill to develop. It can have significant impacts on the compliance with a plan of care and the outcomes a patient achieves.

References
Hoffmann TC, Del Mar C. Patients’ expectations of the benefits and harms of treatments, screening, and tests: a systematic review. JAMA Intern Med 2015;175(2):274-86. doi: 10.1001/jamainternmed.2014.6016 [published Online First: 2014/12/23]

Bialosky JE, Bishop MD, Cleland JA. Individual expectation: an overlooked, but pertinent, factor in the treatment of individuals experiencing musculoskeletal pain. Phys Ther 2010;90(9):1345-55. doi: 10.2522/ptj.20090306 [published Online First: 2010/07/02]

Daniali H, Flaten MA. A Qualitative Systematic Review of Effects of Provider Characteristics and Nonverbal Behavior on Pain, and Placebo and Nocebo Effects. Front Psychiatry 2019;10:242. doi: 10.3389/fpsyt.2019.00242 [published Online First: 2019/05/01]

The post Are you meeting the expectations of your patients? appeared first on Medika Life.

Date of Release:  Sept. 18, 2020

NEW YORK, /PRNewswire/ — Castle Connolly Private Health Partners (CCPHP) and Medical Economics teamed up to offer a possible lifeline to private practice physicians around the country. The two organizations hosted a webinar for over 300 physicians across the nation on Wednesday, August 26^th which featured two top concierge physicians sharing their experiences navigating private practice in this day and age.

Dr. Kim Parks of Synergy Private Health, in Massachusetts and Dr. Paul Knoepflmacher of New York City, both CCPHP Partners, shared their stories in a candid discussion with Dr. Dean McElwain, President, COO and Co-Founder of Castle Connolly Private Health Partners. They discussed the challenges facing private practices even before the “COVID Era,” their thought processes in deciding to convert their practices to a concierge model, the conversion process as well as navigating the pandemic as a concierge physician.

The discussion was a true glimpse into the process of transitioning a practice and how it can be a great solution to the issues facing private practices. Many are struggling, MGMA reports that 97% of private practices have been affected financially by the pandemic. Even before March of 2020, many practices were dealing with decreasing reimbursements, increased administrative duties, physician burnout, and a revolving door of patients with increasingly complex needs that can’t be addressed in a 7-minute visit.

So many doctors are considering selling their practice to a large hospital system, however, that can come with another set of challenges such as being held to a certain number of RPU’s and less autonomy when it comes to running the practice on the day to day. Other physicians are contemplating early retirement leaving their patients to scramble and find another physician amidst a pandemic. Dr. Parks and Dr. Knoepflmacher explained exactly how transitioning to a membership model saved their private practices. To watch the full webinar and learn more, follow this link: Webinar

CONTACT: Lisa Wielgomas, 212-367-1950 ext. 1003, lwielgomas@ccphp.net

SOURCE Castle Connolly Private Health Partners, LLC

The post Private Practice: Solution Mode to Survival Mode appeared first on Medika Life.

One patient may view success as meeting their goal of running a 5K pain-free in under 25 minutes. Anything less is a failure. Another patient may view success as simply finishing the race, even if walking breaks were required.

We don’t all live by the Ricky Bobby mantra of “If you ain’t first, you’re last.” How does everyone else in healthcare measure success?

If you ask a researcher, success may be exceeding the minimally clinically important difference (MCID) or achieving a greater level of change relative to a control (with acceptable p-values and confidence intervals of course).

If you ask Medicare, success is determined when a patient is “functional” (because that isn’t muddy at all…). If you ask a therapist, it may be 0/10 pain, full range of motion, 0% on the Oswestry Disability Index, or a beautiful single leg pistol squat with absolutely no compensation, pain, or difficulty.

But what if the patient doesn’t care about any of those things. How do we juggle the markers of “success” for all relevant stakeholders?

There is not a simple one size fits all answer. What I will try to untangle are the factors that influence how satisfied a patient is with physical therapy.

Why does this matter? Patient satisfaction has a substantial impact on both current and future performance. How a patient perceives their care can dictate the success of interventions, their compliance with care, how they speak about their providers in public, and potentially future reimbursement.

So, patient satisfaction is kind of a big deal.

THE DOMAINS OF PATIENT SATISFACTION

Patient satisfaction questionnaires target many different domains. At PT Solutions, the practice I work for, we ask patients their satisfaction with the treatment they received, the information provided about their condition, their input on goal settings, access to the physical therapy facility, and the availability of convenient appointments. I then receive a scorecard containing all individual scores and the overall satisfaction — an average of the five questions.

This provides us a substantial amount of information and allows us to tease out potential issues and highlight areas of strength.

Quick note, patient satisfaction scores are only valuable if we act on the data. Treating data as a “fun fact” is essentially useless and does not allow us to grow as clinicians. Of course, the data must be accurate.

Ulterior motives and biases can impact the answers patients provide and when the clinician provides the surveys. For example, if a clinician asks a patient how satisfied they are with face to face, they are more likely to receive a positive report. Most people do not like confrontation. This is different for outcome measures.

Outcome measures are designed to highlight functional areas of difficulty. These are best completed with the clinician present. Incorporating Patient-Reported Outcome Measures (PROM) throughout a plan of care has the potential to promote shared decision making between patients, their families, and clinicians.

PROM assessment heightens the provider’s awareness of patients’ health concerns and facilitates communication regarding available medical evidence for optimal treatment options. Geroge et al found patients who were satisfied with symptoms reported higher physical function, lower pain intensity, and less symptom bothersomeness (great word chosen by the authors) at six months.

The two strongest absolute and unique predictors of patient satisfaction with symptoms at six months were whether treatment expectations were met and change in symptom bothersomeness.

Patient satisfaction is most associated with items that reflected a high-quality interaction with the therapist — such as time, adequate explanations, and instructions to patients.

Environmental factors such as clinic location, parking, time spent waiting for the therapist, and type of equipment used are not strongly correlated with overall satisfaction with care.

HOW DO WE GET ACCURATE SATISFACTION DATA?

Clinicians work on their craft daily. They take courses, read the research, engage in clinical conversations, and reflect on past treatments to improve their care. All of these strategies certainly improve the care provided to patients, but they don’t guarantee satisfaction, and outcome scores will improve.

There is an art to administering outcome and satisfaction measures. Here are the strategies I have learned over the past few years as the National Director of Quality and Research for PT Solutions.

A quick caveat, this is not meant to artificially inflate your scores. Furthermore, the goal of obtaining outcomes and satisfaction scores is not simply to inflate the ego and display your awesomeness to everyone.

The purpose is to objectively assess your quality of care and make the necessary adjustments. You may apply guideline adherent care and have mastered your exercise prescription and manual therapy techniques, but if the patients are unhappy and prematurely ending the plan of care then the quality is not high.

Strategy #1: Obtain timely scores.

Patient evaluation worsens as the gap between encounter and completing the measure increases. Our memories become less clear as time passes. I would argue the most important indicator of whether your outcome data is accurate is the ‘days between status and discharge’.

This number represents how many days you treated a patient after obtaining their final outcome measure. The larger the number, the more days you treated and helped a patient without obtaining credit for the improvement. Additionally, patients (and clinicians) have poor long-term memory for our subjective experiences.

The longer a patient goes without a survey, the more they are guessing at how they previously felt.

Clinicians have to decide whether in-person or email surveys will provide more value. They both have benefits and drawbacks. In-person provides more immediate ratings and a larger volume of data, while emails rely on the patient open and answering the survey. However, a patient may feel less pressured to convey disappointment over email.

Strategy #2: Complete the specific actions from the outcome tool on the day a survey is administered.

If a questionnaire asks how difficult it is to walk a quarter-mile, then have the patient walk a quarter mile on the treadmill the day they complete the questionnaire.

Again, this limits the guesswork and provides a more updated assessment.

Strategy #3: Prep the patient but do not hover or bias them.

This strategy falls under ‘obtaining accurate scores’ not ‘maximizing your score, even if it is artificial’. If you hover over a patient during the survey, your body language or the way you ask a question (or your mere presence) may cause scores to be artificially high.

Patients are reluctant to disclose negative attitudes toward a health care provider because of a sense of dependency on patient-provider communication. This doesn’t benefit anyone. Instead, fully explain the survey and be available for questions.

FROM THEORY TO PRACTICE

Ok, your NVBs are top-notch, you are providing evidence-based care, and you are a master at collecting the data appropriately, what can go wrong? In many cases, it will be smooth sailing to world-class outcomes and satisfaction, but there are a few remaining barriers.

The malalignment of therapist and patient goals can be detrimental to satisfaction. It is imperative you are both on the same page with the goals and the methods for obtaining them. This is where motivational interviewing comes into play as this alignment may take weeks to obtain.

Another barrier is understanding what the patient values. They lack the knowledge to assess accurately the technical competence of health care personnel and therefore may only judge satisfaction on outcomes.

Others, however, may care far more about the ‘experience’ and weigh NVBs and the interaction with employees much higher. It is important to recognize these differences and assess them all.

A final thought on this topic is the impact the scores can have on our treatment choices. It can be tempting to provide whatever treatment a patient wants, regardless of the efficacy, to simply satisfy them. This can be a major driver of continued use of treatment with poor efficacy and limits both our progression as a profession and the long-term outcomes of a patient.

Patient satisfaction and outcome measures are by no means the pinnacle of assessment tools. However, they do carry immense value and can help guide improvement for the benefit of our patients and ourselves.

The post How Do We Define Success In Healthcare? appeared first on Medika Life.

We have preferences for the manner in which we learn and communicate. Introverts prefer one-on-one conversations with low stimulation and ample time to critically assess. Extroverts prefer high stimulus environments and frequent interaction.

As an introvert myself, I am capable of working and interacting in an extrovert habitat, but my performance and enjoyment will suffer. The same holds true for patient preferences. If we try to engage and inform each of them with the same methodology, we will accomplish the objective, but the effectiveness will be poor in many cases.

The following subtypes are described in more detail in Your Medical Mind: How to Decide What is Right for You by Jerome Groopman and Pamela Hartzband. They write through the lens of a physician while I will take a physical therapy approach.

Understanding these tendencies and preferences of your patients can help you better tailor a message and understand the patient’s point of view and values.

I’m a believer vs. nothing does or ever will work (believer vs. doubter)

The eternal optimist versus the pessimist is not a new concept nor will the debate about the value of each ever resolve. The comparisons extend well beyond patient subtypes.

Optimists tell themselves that bad events are temporary and maintain a positive outlook. They are often viewed as opportunists who find the silver lining in any situation.

Conversely, pessimists tell themselves that bad events will last a long time and focus on the negatives of a situation. A pessimist will often describe themselves as a realist and keep expectations low.

In his book Barking up the Wrong Tree: The Surprising Science Behind Why Everything You Know About Success Is (Mostly) Wrong, Eric Barker explains:

Optimists told themselves a story that may not have been true, but it kept them going, often allowing them to beat the odds. Psychologist Shelley Taylor says that “a healthy mind tells itself flattering lies.” The pessimists were more accurate and realistic, and they ended up depressed. The truth can hurt.

Yes, blind optimism can lead to unrealistic expectations, so there is a balance to be had. How does this apply to physical therapy patients?

Believers are the eternal optimist, always believing a treatment option exists for them. They are more prone to trust most recommendations from the clinician. Conversely, the doubter is the skeptic, challenging the efficacy of the recommendation, and wanting to know all the facts. Knowing which one patients lean towards changes your education strategies.

The doubter will be resistant to treatments they are unfamiliar with or do not conform to their expectations, making them more likely to self-discharge at the beginning of a plan of care. On the flip side, we have more wiggle room with the believer, but therapists need to be wary of how this can affect their treatment decisions.

Unconditional trust in our treatments can lead to shooting from the hip and investing less effort into the treatment. The doubter creates vigilance while the believer can foster laziness.

Can’t Stop, Won’t Stop vs. Nah, I’m good (maximalist vs. minimalist)

The maximalist lives by the mantra more are better. This is the patient who wants every treatment you can possibly throw at them. The tricky part is knowing what the “treatment” is and where it is coming from.

A maximalist may be completely reliant on a provider and lack any self-efficacy, seeking every potential treatment for a condition, or a maximalist may live in the gym 3 hours a day and have a gym bag full of all the latest and greatest supplements. Maximalists rarely see the harm in treatments — or at least don’t put much stock into them — only the potential benefits.

The minimalist, meanwhile, cares about the minimum dose needed for a response. They are more apt to use the “wait and see” approach. They are more likely to ghost at the first sign of improvement.

Once they believe they can handle the treatment on their own, they no longer seek care. It can be an abrupt transition. Minimalists will question treatment decisions more frequently and keep treatment plans short, not wanting to commit to more care than may be needed.

Clinicians will likely need to reign in the maximalist and build appropriate self-efficacy. The maximalist will be all ears, but they will also be eager to jump into treatment. Clinicians must ensure the patient is fully aware of all potential risks and benefits.

The opposite will be true for the minimalist. They will require more convincing. Some clinicians will challenge their inner Barney Stinson and boldly claim “challenge accepted” while others will become frustrated at the patient’s lack of trust in their recommendations.

At the end of the day, the treatment goals are the patient’s decision. Our job is to help achieve it in a manner that aligns with their beliefs and preferences.

The latest and greatest vs. tried a true (technology vs. nature)

Technology-oriented patients want the latest and greatest treatment. They are not impressed by experience unless it directly translates to more effective use of new treatments. If a clinician expresses he has perfected a 20-years-old technique and refuses to use the new intervention the patient learned about after consulting Dr. Google, session over.

When speaking to a patient with a technology orientation, the statistics on risk factors and information about a lack of clinical trials for a new technique falls on deaf ears. They want innovation.

Conversely, someone with a naturalistic orientation believes the body can heal itself when provided the proper environment; no fancy technology needed. They seek to harness the mind-body connection and avoid invasive procedures. They are more apt to rely on herbal remedies, lifestyle modifications, and meditation.

In many ways, this can be ideal for clinicians, however, expectations need to be held in check. No herbal supplement will reattach a ruptured Achilles tendon. Meditation does not hypertrophy muscle.

A patient with a naturalistic orientation may also choose interventions outside the clinic that impedes progress in the plan of care. Ever see someone in the middle of a juice cleanse? Your pain and function scores are going to be a little skewed.

Being aware of a patient’s lifestyle and home interventions can help guide the plan of care and in-clinic treatment decisions. Technology oriented patients may even seek to replace physical therapy with the $300 Theragun.

Clinicians will need to highlight their use of the latest evidence, even if exercise and education are not “technology.”

One size does not fit all

While recognizing these categories are beneficial for tailoring patient communication, it is important to note that patients do not neatly fit into a single category; they lie along a spectrum.

Clinicians will often see a blend within a patient. For example, someone may be a minimalist doubter with a naturalism oriented. They will want the hard facts to justify treatment and prefer to allow the body to recover on its own.

Conversely, you may have a maximalist believer with a technology orientation. This patient will always believe a treatment solution exists for him and he continually seeks the newest treatment to try, often self-experimenting.

Knowing your patients’ beliefs and mindset will allow you to better refine your treatments. Groopman and Hartzband describe this process as “judgment-based medicine.” They wrote the following:

We are often asked who is the “best doctor” to treat a particular condition. One criterion is a physician’s knowledge about your condition and its treatments, his or her command of the scientific data, so-called evidence-based medicine. But we believe the best doctors go one step further and practice “judgment-based medicine,” meaning they consider the available evidence and then assess how it applies to the individual patient.

The heterogeneity of patients will always lend to challenges with translating research to clinical practice, but through refined assessments of patient beliefs and expectations, we can improve our chances of success.

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