e-Patient Dave

Power to the Patient!

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Larry Weed, 1975: “The patient must have a copy of his own record”

This week I’ve had two new blog posts published on other blogs. This one’s close to my heart.

Dr. Larry Weed, who died in June, was a legendary physician, way way WAY ahead of his time in his vision for computers in healthcare, but also for his clear vision that if it’s your health, you need to be actively involved in managing it. AthenaHealth, a medical records system vendor, commissioned me to write a post about him, and it went live yesterday.

I had found a copy of his amazing 1975 book Your Health Care and How To Manage It, and found some astounding things in it. Please go read the post and see the quotes.

Bringing method to medical practice

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Essential e-patient training: the uncertainty of all information

Pexels.com – Creative Commons CC0 license

Below is a long comment I posted Wednesday on my neighbor @KevinMD’s blog. (Most of his widely read blog is articles he’s found elsewhere; he’s cross-posted some of mine.)

The post I replied to is a thoughtful submission by two grad students (one business school, one med school).  Their thoughts are valid but as you’ll see, the issue isn’t apps – this is part of a broader issue that every engaged patient (you!) should understand. Here’s my reply.

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See my cousin @McCullohMD on a special ABC 20/20 Weds night

Wednesday night (Sept 13) at 10pm ET, a special edition of ABC 20/20 will air, promoting a new series called “Good Doctors.” I’m thrilled to learn that my cousin Chris McCulloh, a third year surgical resident, will be featured.

I’d be thrilled to have anyone I know on such a highly visible show, but the extraordinary thing about Chris is that he almost didn’t enter medical school because a few months earlier he fell at home and end up with a spinal cord injury, paralyzing him below the waist.

Well, not only did he enter medical school, he’s a surgery resident now, planning to specialize in pediatric surgery! You’ll see he’s got a “standing wheelchair” and a whole lot of unstoppable e-patient baked in. Check it out! Watch! Be inspired like me! Links:

https://twitter.com/McCullohMD/status/907642507571462144

 

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Rice bytes: best way I’ve seen to understand giga, mega, peta and such

I love anything that makes it easier for people to know what’s going on. Case in point: this tweet yesterday from Twitter friend David Grayson @Sasanof, from the IBM Watson Summit in New Zealand.

You can use this to understand enormous sums of money, too:

$1 = one grain of rice
$1000 = cup of rice
$1 million = 8 bags of rice
$1 billion = 3 trailer trucks of rice
$1 trillion = 2 ocean freighters (3,000 truckloads)
$3 trillion (the US healthcare budget) = 6 ships (9,000 truckloads)

When someone says a health improvement project will save (or cost us) $100 million a year, it’s a lot, but think:

  • The proposed amount is like 800 bags of rice.
  • The US health budget is 9,000 truckloads of rice

Puts it in perspective.

Thanks to @Green_Goddess, Caroline Taylor, CMO of IBM Global Markets, for the visualization, and to @Sasanof for tweeting it. Don’t I love how social media helps ideas spread??

Update next day:

One of my very early blog posts, on my old blog, was on this same subject. March 9, 2009: Comprehending the US healthcare budget. Here are the graphics from that one:

Here’s a million bucks’ worth of $100 bills. (That’s 100 packets of 100 $100 bills; each packet is 1/2″ thick.)

Here’s 100 times as much – a million hundred-dollar bills, $100 million:

Ten of those – a billion:

And a thousand of those – a trillion. Check out the little dude, who’s now in the bottom left corner:

And US healthcare is three times that size.

This helps me, for one, start to comprehend the magnitude of the problem. Something like that does not shrink willingly: lots of people would lose their jobs, including CEOs etc.  That’s why I liken US healthcare to “a tumor that doesn’t know how to stop growing and killing its host.”

Go back up and take a look at the size of one million in this picture. Urk.

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e-Patient request: family seeks highly engaged pediatric GI

Smiling pediatrician with toddler and parent
Stock photo from FreeGreatPicture.com

The latest in the occasional series of e‑patient requests, in which someone asks me to post their search for information. No guarantees; sometimes we connect with answers, sometimes not.

I know nothing about the issues – I’m just forwarding the request. Please share on social media and/or forward this to anyone who might have suggestions. On social media, use the hashtag #PedsGI, to tap into that network. 

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WikiProject Medicine: med students join in producing high quality Wikipedia articles.

I’m taking the extraordinary step of rerunning, verbatim, an entire post from the e-patient blog in 2014 about this important development. Why? Because tomorrow an update is coming, and to fully appreciate the news, you need the background.

Looking back on this, I see it sums up tons of different issues that have turned out to be important to a key question about how best to do healthcare: how do we know which information is reliable, and how can we improve how we get there?  The answer is clearly not to only listen to the medical literature, which, it turns out, has important delays and quality problems. To understand that radical statement, read the links in this long post.

Screen capture of The Atlantic headline
Headline from The Atlantic’s article last October

Peter Frishauf, member of the editorial board of our journal, has brought what is to me the most exciting news for participatory medicine since the OpenNotes project. Importantly, this news may have broader implications – because it addresses one of the core challenges of patient engagement: the quality and freshness of medical articles.

Last fall [2013], UCSF School of Medicine professor Amin Azzam started a course for fourth year medical students to become Wikipedia editors and apply their skills to Wikipedia articles that were important to them and were poor quality. It got big-name media attention (NY Times, The Atlantic), and it should – because as we’ve often written, one of the core challenges e-patients face (and doctors face!) is finding up to date, reliable information.

This is not a trivial question – you can’t just rely on the peer review process, because it too has flaws, and good luck ever getting mistakes fixed. The biggest example is the ongoing vaccine controversy caused by a massive failure of peer review in the top-tier journal Lancet, but there are many others. Another shortfall is what our movement’s founder “Doc Tom” Ferguson called “the lethal lag time” – the years of delay between a result being discovered and the time it reaches doctors.

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