Archive for Health care social media
Are flurrying over on the Mighty Casey blog. It’s a report on my experience at the ePharma Summit in New York this week. Click here, read it, and share your thoughts?
Res ipsa loquitor:

Hang on to your hats – this one might wade into controversy.
As I write this (3:30pm EST on January 1, 2013), I’m listening to a conversation on NPR about the Emancipation Proclamation, which was signed into law by Abraham Lincoln 150 years ago today. I’m also reflecting on a couple of movies I’ve seen in the last 45 days: Lincoln (over Thanksgiving weekend) and Django Unchained (on Christmas Day).
Is it time for an emancipation proclamation for patients? Or should we just saddle up and have a shootout at the plantation … um, hospital instead?
Too many healthcare transactions are still conducted over the patient’s supine form. Doctors, hospitals, and other entities in the “provider” column horse-trade with health insurers, including Medicare, in the “payer” column. That means that the patient winds up shackled. No say in how much something costs, no real voice (yet) in what happens next, little interest on the part of the two trading entities in clueing us in to what’s happening.
Some of my connections in the participatory medicine/e-patients movement use a driver-rider metaphor for transforming healthcare, with the patient moving from passenger to driver in healthcare. It’s a less controversial/confrontational metaphor than referring to patients as chattel on the medical plantation. However, I’m sticking with that plantation metaphor for the moment, because too many in the provider and payer camps are still viewing patients as meat puppets, not as full participants.
Does healthcare need an emancipation proclamation? Yes. Here’s where the metaphor shifts: let’s not wait for someone to proclaim us (patients) emancipated. Let’s break our own chains, and be our own liberators.
Let’s demand that the providers and the payers give us an equal seat at the table, and then let’s …
LEARN EVERYTHING WE CAN TO BE PRODUCTIVE CONTRIBUTORS TO THE HEALTHCARE SYSTEM.
That last statement is the core of what will emancipate healthcare: patients, providers, payers, caregivers, everyone. Shared decision making – along with “patient-centered”, that’s the new hot phrase in healthcare – can only exist if all parties are able to participate in sharing the decision-making. We must learn how to understand the language of medicine, including research statistics (by the way, many doctors aren’t great at that, either). We must learn to apply critical reasoning to what we see/hear/read in the media about risks and trends in health and disease. We need to work on getting a seat at the research table to give a hard shove in the direction of making clinical research less ivory-tower and more boots-on-the-ground.
Some recommended reading for those who’d like to emancipate themselves:
Society for Participatory Medicine blog
ePatient Dave
Susannah Fox
Dr. Ted Eytan
and our movement’s own Rosa Parks (or, dare I say it, our own Django?):
Regina Holliday
Let’s liberate ourselves, shall we?
I had the opportunity to be a guest on This Week in Oncology’s weekly web radio show with Dr. Richard Just and Gregg Masters.
Enjoy!
Inspired by this, I wrote the following.
The first list is from the linked post, the second is my take. In the wake of recent #epicfail blogging by rheumatologists, I’m semi-amazed that this “how to terminate” thing got posted, although I’m only semi-amazed …
Grounds for Terminating the Physician–Patient Relationship
A successful physician–patient relationship must be based on mutual trust and effective communication. When these elements break down, it is likely in both parties’ interests to terminate the relationship. Common reasons for terminating the physician–patient relationship include:
- The patient fails to pay his/her bills.
- The patient continually cancels or misses appointments.
- The patient is rude, disruptive, uses improper language, exhibits violent behavior, or threatens the safety of the office staff or other patients.
- The office staff is uncomfortable working with or communicating with the patient.
- The patient is dissatisfied with the care he/she received from the physician.
- The patient requires more highly specialized services than the physician can provide.
- There is a conflict of interest between the patient and the physician (e.g., the physician’s religious beliefs preclude him/her from providing certain treatment options, or the physician has a personal or financial interest in the treatment option).
- The patient is habitually uncooperative and refuses to comply with the treatment plan.
- The patient fails to complete a series of treatments.
- The patient is unreasonably demanding.
- The patient did not provide an honest medical history or was misleading in the information he/she provided, thereby compromising the efficacy of treatment.
- The patient develops a personal interest in the physician. Examples include excessive contact with the physician, demanding the physician’s time in the absence of a legitimate or urgent medical need, or becoming angry or unreasonable when the physician is unavailable.
- The physician develops a personal interest in the patient. Examples include consultations that involved discussion of information not relevant to the patient’s treatment (e.g., details about the physician’s personal life), the physician becomes attracted to the patient, or the physician acted in a manner that would be deemed inappropriate by his/her colleagues.
- The patient filed a complaint or initiated a legal proceeding against the physician.
Grounds for Terminating the Physician–Patient Relationship (Patient Version)
A successful physician–patient relationship must be based on mutual trust and effective communication. When these elements break down, it is likely in both parties’ interests to terminate the relationship. Common reasons for terminating the physician–patient relationship include:
- The physician consistently fails to disclose the cost of treatment.
- The physician habitually leaves the patient lounging, in a gown, in a cold exam room, for thirty minutes or longer. Every damn time.
- The office staff behaves like a military guard in East Berlin in 1964: officious, unpleasant, and armed with strange weapons, including the ability to deny the patient access to her records.
- The office staff entertains itself by running the patient around in circles when trying to schedule appointments, get test results, renew prescriptions, or get phone access to clinical staff.
- The patient, after months/years of treatment, still feels like hammered whale shit.
- The patient requires more highly specialized services than the physician can provide. Like, say, kindness. Or actual help.
- There is a conflict of interest between the patient and the physician (e.g,, the physician is a paternalistic fuckweasel, and enjoys offering the patient hope, only to snatch it back because that treatment isn’t covered by the patient’s insurance).
- The patient is habitually uncooperative and refuses to comply with the treatment plan, reportedly because after months/years, IT STILL ISN’T WORKING.
- The patient fails to complete a series of treatments. Because that series keeps getting longer, changing, try-this, try-that, world without end, amen.
- The physician thinks the patient is unreasonably demanding. (“Bitch wants to be pain-free. As if.”)
- The physician believes that the patient did not provide an honest medical history or was misleading in the information he/she provided, thereby compromising the efficacy of treatment. (“Lying, drug-seeking bitch. For realz.”)
- The physician thinks that the patient has a personal interest in the physician. Delusions include perceived “excessive contact with the physician” (patient solely attempting to get an appointment sooner than 12 weeks out), demanding the physician’s time in the absence of a legitimate or urgent medical need (“because we all know bitch wants to be pain free”), or becoming angry or unreasonable when the physician is unavailable (“because bitch is still on that damn pain-free bus!”).
- The patient filed a complaint or initiated a legal proceeding against the physician, because bitch just wanted to be pain free but discovered she’d been given a medication that caused random side effects like anal bleeding and liver failure.