It can be really difficult for us to hear bad news, especially when the bad news is about something serious like our health.
In some of our recent research about the conversation between doctors and patients with chronic conditions, we asked patients to share how their doctor communicated the diagnosis to them, and how they as the patient felt hearing the news.
We found that, even though patients are often upset when finding out they have a condition like Multiple Sclerosis, there are things that the doctor does or doesn’t do that can positively or negatively impact the patient moving forward.
First, we found that patients want and need the whole truth about their condition. Doctors may sometimes think they’re helping by watering down the information or not talking too much about details of the condition, when in reality the patients need this information to gain clarity, familiarity, and to successfully move forward to starting treatment.
We also found that, while it’s very important for the doctors to give the patients a detailed and complete diagnosis, doctors should also make sure to leave enough time during the conversation to talk about treatment options. If the patient hears just that they’ve been diagnosed with Leukemia but doesn’t hear what treatment options are available, they could be left without much confidence or hope in being able to treat their condition.
Lastly, we found that the first few sentences of the conversation communicating bad news, like a diagnosis, matter a lot. In several instances patients described how the doctor didn’t communicate the beginning of the diagnosis well, saying things like “you have an aggressive cancer” or “I’m so sorry”. In these cases, the patient tended to not hear and really process the rest of the conversation. Things like poor word choice or the wrong demeanor can impact patients negatively in a way that lasts far beyond the diagnosis.
No patient wants to hear bad news. But when bad news needs to be communicated, it helps the patient immensely when they hear the whole truth, all about their treatment options, and are met with words and demeanor that give them as much confidence and hope as possible.(Read full post)
I don’t go to the grocery store that often. At work, we have a group called Expedite Group who will do our shopping for us. This not only saves me time, but probably money, too, because I’m not able to just pick up extras that look “interesting” or “tasty.” I also don’t have to worry about falling victim to purchasing extra snacks and junk food as a result of hunger. I have friends who tell me this happens to them all the time, and apparently they’re not alone. An ABC News report investigated this exact topic and found that hungry shoppers not only purchase higher calorie and less diet-friendly foods, but as a result they eat worse all week. So one day of hungry shopping dooms you for seven days.
OK. So if you must physically go to the store, the solution is to just make sure to have a good snack or meal before shopping. If you do this, then you’re good. You won’t mess up your new diet or overspend. Sadly, no.
According to a new study in the journal Obesity, even if you go to the grocery store on a full stomach, shopping after a night of poor sleep can also have deleterious effects on your food choices. Not only are people hungrier when they get less sleep, but it’s long been known that decision-making, in all aspects of life, is affected by sleep deprivation.
In this fast-paced society we live in, five to six hours of sleep is sadly normally for many. So many of us are walking around sleep-deprived. Groups like Expedite Group are wonderful solutions for companies looking to improve work-life balance for employees. They take the burden of grocery shopping, returns, and other errands off the plates of employees to help them focus on work and family life. But this new obesity research shows that helping to improve work-life balance shouldn’t be their only hook for prospective clients. While hiring someone else to do your food shopping is certainly not the only way to stay on track with food choices and health management, it may be a start.(Read full post)
Take Two Apps and Call Me in the Morning
It may not be too long in our future when part of a prescription from our physicians may include and app (or two). This is the exciting idea of medically prescribed apps. Some futurists predict that doctors will prescribe FDA-approved apps to treat patients. So far, the FDA has maintained that it will only vet apps that perform device-like functions, such as making diagnostic determinations or treating ailments. The FDA has yet to release its full guidance on the regulation of mobile apps and will not go after the many available downloads that make untested medicinal claims until its rules are in place.
WellDoc is one of the pioneers in the prescription-app field. Its DiabetesManager system collects biometrics about a patient’s diet, blood sugar levels and medication regimen through manual input or from wireless devices. It then gives advice to a patient and sends clinical recommendations to the doctor. The Food and Drug Administration gave the system 510(k) clearance to operate as a medical device in 2010.
Happtique (health app boutique) is a company that operates a mobile app prescribing solution for healthcare called mRx. Happtique has recently launched a pilot that will test whether the company’s solution will encourage doctors to prescribe mobile software for patient use. mRx consists of Apple and Android smartphone and tablet compatible apps that focus on cardiology, rheumatology, endocrinology, orthopaedics, physical therapy and fitness training. The mRX system gives patients more structured guidance when it comes to selecting and using health apps and empowers them with tools to help them take a more active role in their care. And similar to traditional prescription, mRx will track how many times an app is prescribed as well as how many times patients click the “fill” button once the prescription is sent.
If the mRx trial is successful, it will help demonstrate that mHealth technology will be viewed as legitimate, powerful healthcare tools, not just fun programs to install on a phone or tablet.
From a behavioral point of view, the WellDoc and mRx systems can help encourage a dialogue between physicians and patients about available healthcare technology tools. These conversations will not only give patients additional resources, but will also encourage them to consider incorporating apps and other healthcare technology into their health management. In addition to increased health care provider connectedness, these systems also help achieve behavioral change and continued adherence through sustained influence over the patient’s multiple chronic states and enhanced patient self-determination.
When you think about it, these apps are no different from physicians prescribing a diet, a support group or any other resource. In fact, these apps will enable physicians to be more creative with the ways they engage their patients and provide the best care to them.(Read full post)
More than one-third of US adults are obese, and this number is only predicted to increase over time. And with obesity, there’s often an increase in the number of preventable health problems, like diabetes, heart disease, and stroke, to name just a few. According to a recent article, online weight loss programs have proven results to help combat this public health problem in the United States.
It comes as no surprise to me that the online, interactive programs that offer chat rooms and individualized capabilities are showing more success with weight loss than pamphlets and other hard copy materials often provided to patients by doctors and counselors. While this study does indicate that in-person weight loss programs are also highly effective, the fact of the matter is that patients may not have the time or money to invest in these kinds of in-person programs. Additionally, healthcare professionals often have limited time with their patients, making it difficult to have a real impact on weight loss in the short time they spend together.
Online weight loss programs pay attention to the drivers and barriers of behavior change – support, motivation, and goal setting, among others – that are specific to weight loss. They allow patients to personalize their experience to ensure it meets the individual goals each person has for him or herself, and help patients overcome the inevitable road blocks along the way. And, online programs are available day and night for patients to access and interact with, providing a constant, long term resource.
As a behaviorist at MicroMass, understanding what patients need to motivate positive change is near and dear to my heart. The science is out there proving that static materials are just not cutting it when it comes to sustainable behavior change. It takes more than a pamphlet; but rather, a true understanding of what is holding patients back, what will drive them to action, and a personalized plan to create the desired change.(Read full post)
I sit a lot. I try to get exercise after work, but for the most part, my weekdays involve a lot of sitting. I drive to work, I sit at a desk, I drive home, I watch TV. You get the idea. I do walk around during the work day when I can, but I don’t make a conscious effort to do so…until today. Today I stood at a table for an hour reading articles that I normally would have read sitting at my desk.
Why, you might ask?
According to an analysis by Gretchen Reynolds in a recent NYT article, breaking up long hours of sitting is really important. Tell me something I don’t know, you might be thinking. I know. This isn’t news to me, either.
I’ve read numerous articles about what people call “work walking” to burn calories and get exercise while doing what most of us do sitting. A treadmill at work just isn’t feasible for me, but standing up while working is. According to Reynolds, “….when volunteers stood all day – nothing else; no walking or jogging; just standing – they burned hundreds more calories than when they sat for the same period of time.” This is feasible. I can stand more.
I also need to monitor how much television I watch. I never considered myself a couch potato, but a recent Australian study showed that watching even an hour of television can cut 22 minutes away from someone’s life. So in just a month, my weekly hour of Law and Order:SVU will cut my life short by an hour and a half. That means just one year of SVU will shorten my life by 18 hours! And I’ve been watching this for years. On top of that, SVU is not my only guilty pleasure when it comes to television shows.
Despite these statistics, I’m not yet willing to give up my shows, and sitting is really the best way to enjoy them. But, I am willing to try out some new office techniques. In fact, I’m standing as I write this.(Read full post)
Using frightening images that depict the consequences of this habit to encourage quitting is probably not enough in all cases. After all, these images aren’t revealing new information. I do agree that one piece of influencing behavior change is to heighten individuals’ perceived susceptibility of developing complications from smoking, and also increase the perceived severityof these consequences. But, like I said before, most people know the consequences. They’ve seen the images before, they’ve been told by their peers that smoking can ultimately kill, yet they still choose to light up. In this case, influencing behavior change isn’t as simple as just using these warning labels, although it’s definitely an important piece.
Behavioral science tells us that information alone isn’t enough to influence behavior change. People need to be motivated to master the behavioral skills needed to change. While these labels all provide the 1-800-QUIT-NOW contact information, many won’t take advantage of this service if they lack motivation. Officials need to uncover the insights that will help them successfully motivate smokers to want to quit. Using exercise as a comparison, most people know that exercise helps maintain good health and helps to stave off certain diseases. But many people still don’t exercise. They often lack motivation to work out. In addition, they need tangible steps to help them not only get into a good routine, but also the confidence and skills to maintain this healthy behavior. It’s no different with smoking.
These images are a great step in helping to reinforce the negative consequences of smoking and making them more apparent and top of mind, but just as much effort needs to be put toward helping people want to build the skills they need to quit.
For more information, or to see the new images, visit the FDA’s website at: http://www.fda.gov/TobaccoProducts/Labeling/CigaretteWarningLabels/default.htm.(Read full post)
Visiting a different country is a great opportunity to discover your own cultural baggage.
Whenever you travel abroad, there’s the opportunity for culture shock. In its mild form, a little culture shock is a good thing: it helps you appreciate the differences between your culture and the culture you are visiting.
Recently, I visited South Korea. Seoul, with its population of 10.4 million, struck me as far more clean, organized and efficient than any other large U.S. city I’ve visited. It certainly challenged my expectations that large cities are by definition a bit chaotic and unkempt.
One of the most discomforting aspects of the trip came when I looked around a crowded marketplace and realized something was quite different from life at home. It wasn’t that almost everyone I saw was Asian, or that I couldn’t understand the language being spoken around me. It was that everyone, aside from the occasional chubby grandparent, seemed to be of a normal weight.
There are most likely lots of reasons for the discrepancy in weight between Americans and South Koreans: diet, exercise, processed foods, etc., but the most obvious diet-related difference that I saw was portion size.
With the exception of some super-sized red bean dumplings that I bought from a street vendor, most of the portions in Seoul were modest by American standards.
In the US, when we belly up to the bar, were are usually poured a 12 oz. beer, while in South Korea, beer glasses only hold about 6 oz. And the office workers hurrying down the streets carry ‘tall’ Starbucks cups rather than the larger sizes that Americans favor. In fact, the ‘venti’ wasn’t even on the menu at the Starbucks I visited.
In a spectacular case of not seeing the forest for the trees, we have becomes so accustomed to seeing people who are overweight that it no longer registers.
Getting away from home focused my attention on what a huge behavior change challenge is before us.
As always, travel is good for a little perspective.(Read full post)
Most Americans are somewhat familiar with diabetes and high blood pressure. In fact, if you yourself don’t have high blood pressure or diabetes, chances are someone in your immediately family has at least one of these metabolic diseases. Nearly 8% of the US population (23.6 million children and adults) have diabetes and one in three adults has high blood pressure.
Fortunately, there are a number of medical treatment options that help people manage these metabolic diseases and keep potential complications at bay. And then there’s that other important aspect to treatment — lifestyle changes such as diet and exercise.
But did you know that there are psychological interventions that may also improve disease management and outcomes associated with diabetes and hypertension?
An article in the July issue of Cleveland Clinic Journal of Medicine provides a nice review of evidence-based psychophysiologic interventions that have been used in patients with diabetes and hypertension. Studies using techniques such as biofeedback and relaxation have demonstrated improved glucose and blood pressure levels.
There are several pieces of biologic evidence that may explain why these approaches work:
- Chronic stress affects the body systems, including the nervous and endocrine systems .
- Research has demonstrated that psychological states such as anger, hostility and anxiety may be associated with the development of high blood pressure.
- Anxiety, which activates the body’s stress response, impacts blood pressure and glucose levels even in healthy individuals. And the effects of anxiety in persons with metabolic syndrome are even greater.
- The quality and length of sleep affects metabolism.
- Specifically related to blood pressure, an important period of blood pressure reduction takes place at night during sleep.
So, aside from being interesting, what does this mean?
I think this type of evidence underscores the importance of a broad approach to disease management – an approach that takes into account those important mind-body connections. Not everyone is a candidate (nor is everyone interested) in biofeedback or relaxation therapy. But programs and interventions that offer patients and healthcare professionals access to information and tools that support positive lifestyle changes such as stress reduction and others, will only drive better health outcomes long term.
Being a nurse, I am a big proponent of medical treatment and I have seen firsthand the power of medicine. But I think true power and impact on health can be realized when our health system embraces, values, and incorporates complementary, evidence-based approaches.(Read full post)
Wireless technology used to track packaged items has made a big turn towards healthcare monitoring. New technologies that you wear will help doctor monitor your vital signs and your compliance to prescription medications.
One such device consists of a Band-Aid looking patch and microchips attached to your pills. When the microchips are activated by your stomach fluids, they will send a signal to the patch. When you get near your smart phone, the data collected by the patch will be uploaded over the Internet. If you give permission, this data can be shared with your doctor. The device is being pioneered by Proteus Biomedical, a company that started with their smart-pill system.
These kinds of devices will have a profound effect on health care. The near real-time data can help your doctor help you almost immediately if events in your life keep you from taking your medication as prescribed. This should benefit you in a couple of ways. First, if you have a chronic disease, like hypertension, it will enable you to take greater control of your condition and your health. Second, it will provide your doctor with more accurate information. All of this should help you avoid costly hospital stays – and that is money saved.
Many believe these kinds of extensions to current health care practices is the key to cutting costs. This is just the beginning of remote monitoring, especially for the most acute cases. If these devices can keep enough people from going to the hospital unnecessarily, hospitals can utilize their limited resources more effectively.
Proteus is one of many companies with wireless monitoring technologies. Coventis is developing CardioMems to address congestive heart failure conditions (watch the video below); Cambridge Consultants is developing PHT to tackle asthma; DexCom is developing SEVEN PLUS for diabetes; and Airstrips Technologies is developing Airstrip for obstetricians (watch the video below).
These medical devices are putting a whole new twist on wearable, wireless technology.(Read full post)