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Communicating with patients: A Brave New World

Dr Jaita Mukherjee, Specialty Registrar in Rheumatology, Imperial College LondonDr Amrita Jesurasa, Specialty Registrar in Public Health, University of Sheffield

http://www.youtube.com/watch?v=jfheO9H8CD4

Introduction

Many sources of health ‘information’ accessible to patients

However the medical profession remains one of the most trusted professions

Main determinant of trust in doctors = interaction during consultations

Shift in the dynamic of the doctor-patient relationship

More widely, does the medical profession have a responsibility to mitigate the risks to patient safety of inaccurate information?

Resources

Traditional TV, radio, newspapers

Internet search engines / Wikipedia

Social media

‘Apps’

Trusted sources e.g. NHS Choices, Patient.co.uk, Royal Colleges, charities

Health Literacy

Limited health literacy associated with: Poor self-management skills and use of preventive services Late presentation and delayed diagnoses Understanding medical conditions Adherence and compliance Poorer health and greater mortality risk

Protect patient safety

Health inequalities

Evidence-based best practice

Testing Treatments

“ Sometimes this can be in the presentation of facts and figures, telling only part of the story, glossing over flaws, and ‘cherry picking’ the scientific evidence which shows one treatment in a particular light

We have an understandable desire for miracle cures, even though research is frequently about modest improvements, shavings of risk, and close judgement calls. In the media, all too often this can be thrown aside in a barrage of words like ‘cure’, ‘miracle’, ‘hope’, ‘breakthrough’, and ‘victim’. ”

Patient stories from Rheumatology Clinic

Case 1 Ms SF, 34 y old, mother of 2 children, teacher Newly diagnosed with rheumatoid arthritis (RA) after 3/12 of painful hands Keen to receive information about arthritis charities and meeting others who suffer

from the condition

Case 2 Mrs AR, 58 y old, cleaning lady Known diagnosis of RA, attends clinic with ongoing pain Brings tabloid newspaper cutting of headline reading: “Painkillers double the risk of

heart attacks”

Patient stories from GP/ Paediatric A&E

Case 3 Parents of 18-month old SJ, both university lecturers SJ has a fever and viral symptoms Parents aware that viruses not treated with antibiotics Reassured by assessment and explanation of viral illness

Case 4 Parent of 2-year old LM, travelling family LM presents with features of measles Neither LM nor siblings have received childhood immunisations

Social media and medical education

Prevalence of social media

Maintaining the trust of the public

Blurring boundaries

Keeping a pace of modern technology

Connect with: Professionals Patients

Social media and health promotion

Context: evolving doctor-patient relationship

Positives Social marketing technique Potential to improve health of historically underserved Widening ‘lay referral networks’

Negatives Inverse care law Widening the ‘digital divide’ Worsening health inequalities

Key Messages

1. Internet safety and literacy present enormous challenges, as basic health literacy is still a hurdle to overcome

2. The dynamics of the doctor-patient relationship are evolving

3. Doctors need to ensure more rigorous use of evidence and recognition of lay sources of information

4. Familiarity and confidence using social media may be necessary for doctors in the future

How do we achieve this?

1. Integrating digital health literacy and awareness of online safety into schooling and adult education

2. Widening understanding of lay sources of health information in UG and PG medicine

3. Increasing access to postgraduate level qualifications in clinical research for doctors

4. Enhancing the role of the BMJ, Lancet and other high profile medical journals in improving the health literacy of doctors

References

1. Agency for Healthcare Research and Qulaity [online]. Wolf MS, Cooper Bailey S. The Role of Health Literacy in Patient Safety. August 2012. Available from: http://webmm.ahrq.gov/perspective.aspx?perspectiveID=72. (Accessed on 11th January 2013)

2. World Health Organisation [online]. Safety and security on the Internet: Challenges and advances in Member States. Global Observatory for eHealth series - Volume 4. Available from: http://www.who.int/goe/publications/goe_security_web.pdf. (Accessed on 11th January 2013)

3. GMC [online] Doctors’ use of social media. A draft for consultation. Available from: http://www.gmc-uk.org/Draft_explanatory_guidance___Doctors_use_of_social_media.pdf_48499903.pdf. (Accessed on 11th January 2013)

4. Evans I, Thornton H, Chalmers I, Glasziou P. Foreword – Goldacre B. Testing treatments: Better Research for Better Healthcare. Second Edition 2011, Pinter & Martin Ltd.

5. http://www.ipsos-mori.com/

6. Chretien KC, Greysen S, Chretien J, Kind T. Online posting of unprofessional content by medical students. JAMA. 2009;30(12):1309-1315.

References cont.

7. Federation of State Medical Boards, Model Policy Guidelines for Appropriate Use of Social Media and Social Networking in Medical Practice. April 2012, page 9.

8. Understanding the factors that influence the adoption and meaningful use of social media by physicians to share medical information. J Med Internet Res. 2012 Sep 24;14(5):e117.

9. Bahner DP, Adkins E, Patel N, Donley C, Nagel R, Kman NE. How we use social media to supplement a novel curriculum in medical education. Med Teach. 2012;34(6):439-44

10. Lewis G, Sheringham J, Kalim K. Mastering Public Health. September 2008. Royal Society of Medicine Press Limited.

11. http://www.healthknowledge.org.uk/

12. Montague E, Perchonok J. Health and wellness technology use by historically underserved health consumers: Systematic Review. J Med Internet Res. 2012; 14(3): e78

Workshop

Groups of 5-10 people

Question: How can we improve the health literacy of the most vulnerable?

Discussion