This interactive case-based lesson from the Cleveland Clinic Center for Continuing Education requires participants to answer a series of multiple-choice questions about a hypothetical 66-year-old male patient who is complaining of chest pain. During this activity, participants will review primary risk factors for coronary artery disease, the signs and symptoms of a patient with an acute coronary syndrome, initial treatment strategies for acute myocardial infarction, and appropriate long-term, post-MI management strategies.

http://www.clevelandclinicmeded.com/online/casebased/decisionmaking/myocardial/

Missed Myocardial Infarction: ECG Strategies to Reduce the Risk

This course will review the epidemiology, etiology, pathophysiology, and clinical features of acute MI; state-of-the-art diagnostic and therapeutic techniques; the differential diagnosis of acute MI; and likely and rare complications that may occur.

http://www.cmeweb.com/gcourse_view.php?course_id=8252

Serial Assessment of Left Ventricular Remodeling by Measurement of Left Ventricular Torsion using Speckle Tracking Echocardiography in Patients with Acute Myocardial Infarction

 To determine whether left ventricular (LV) torsion assessed by speckle tracking imaging can predict progressive LV dilation after acute myocardial infarction (AMI).

 The authors studied 91 patients with AMI who were treated with primary coronary intervention and who underwent conventional and speckle tracking echocardiographies at initial presentation and three days and six months after first AMI. Patients were divided into two groups based on presence of LV remodeling at six months. They reported that “LV end-diastolic volume was not significantly different between the no-remodeling and remodeling groups;” however, LV torsion was “significantly decreased” in the remodeling group. They concluded that “decreased LV torsion assessed by speckle tracking echocardiography may predict late LV remodeling after reperfusion therapy after AMI.”

Time to Rheology in Acute Myocardial Infarction: Inflammation and Erythrocyte Aggregation as a Consequence and Not Necessarily as Precursors of the Disease

 Steinvil A, Berliner S, Shapira I, et al.

 To explore “the correlation between the time from symptom onset to the appearance of an inflammatory response and aggregated erythrocytes in the peripheral blood” of patients with acute coronary syndromes.

 The authors studied 223 patients with unstable angina and 205 with acute myocardial infarction (AMI) who underwent coronary catheterization. They reported that only the AMI group exhibited a “significant time-dependant increase in the concentrations of inflammation-sensitive biomarkers” and erythrocyte aggregation.

http://www.springerlink.com/content/04h537411j30316v/

Mild Heart Failure Is a Mortality Marker after a Non-ST-segment Acute Myocardial Infarction

 Nunez-Gil IJ, Garcia-Rubira JC, Luaces M, et al.

 To assess the prognostic value of mild heart failure (HF) in non-ST-elevation myocardial infarction (NSTEMI).

 Researchers studies 835 patients with NSTEMI and divided them into two groups base on Killip classification category (K1 and K2). They reported that “multi-vessel coronary disease and revascularization procedures were less common” in group K2 compared with K1; patients in K2 had “a worse prognosis in terms of maximum Killip class, death, and major adverse cardiovascular events.” The authors concluded that “HF at presentation in NSTEMI is linked to a poor prognosis, with increased short-term mortality.”

http://www.ejinme.com/article/S0953-6205%2810%2900112-3/abstract

Study to Evaluate the Safety and Efficacy of SCH 530348 in Addition to Standard of Care in Subjects with Acute Coronary Syndrome: Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRA•CER)

 This study will determine whether adding an experimental drug (SCH 530348) to the existing standard of care for preventing heart attack and stroke in patients with acute coronary syndrome will yield additional benefit. Patients who have a history of severe hypertension or valvular heart disease, who are currently taking blood thinners, and/or have a history of intracranial hemorrhage are ineligible for this study.

http://www.clinicaltrials.gov/ct2/show/NCT00527943

Study to Evaluate the Effect of Timing on the Administration of Bone Marrow Mononuclear Cells vs. Placebo in Patients with Acute Myocardial Infarction: The Transplantation in Myocardial Infarction Evaluation (TIME) Study

 National Heart, Lung, and Blood Institute

 This study will evaluate the safety and effectiveness of using adult stem cells for improving heart function in people who have had a recent heart attack and a percutaneous coronary intervention. Primary outcome is global and regional six-month left ventricular ejection fraction.

http://www.clinicaltrials.gov/ct2/show/NCT00684021

Study to Investigate the Role of Upstream High Dose Statin Treatment in Patients with ST Segment Elevation Myocardial Infarction

 Western Pennsylvania Hospital and West Penn Allegheny Health System

 Researchers will investigate the role of upstream 80 mg Atorvastastin-calcium in patients who are undergoing percutaneous intervention for acute ST segment elevation myocardial infarction.

http://www.clinicaltrials.gov/ct2/show/NCT01050348

This resource, part of the Pri-Med Patient Education Center, explains what happens to the heart and surrounding blood vessels during a heart attack and, depending on the location and amount of heart muscle involved, what effects it can have on a patient’s heart. Patients who visit this site can learn more about the primary risk factors for heart attack and atherosclerosis, the symptoms that may indicate the onset of a heart attack, the tests that may be used by their physicians to diagnose a heart attack or other coronary event, common-sense steps patients can take to prevent atherosclerosis and heart attack, and available treatment options and the factors that determine treatment selection.

Mayo Clinic: Acute Myocardial Infarction (Heart Attack)

Like many sites that offer information about myocardial infarction for patients and caregivers, this resource from the May Clinic explains, using easy-to-understand language, what a heart attack is and what causes it. What makes this site stand out is the information it provides that explain how heart attack care is measured and evaluated. Patients who visit this site can read about the treatments that are “widely accepted as the most appropriate form of treatment for the majority of patients diagnosed with heart attack,” enabling them to compare the care provided by their physicians with the accepted standards of care.

http://www.mayoclinic.org/quality/ami.html

Women with Gout Face Higher Risk of Myocardial Infarction

 indicate that women with gout face a nearly 40% greater risk of acute myocardial infarction compared with men who have been diagnosed with gout.

Preventing Myocardial Infarction and Stroke with a Simplified Bundle of Cardioprotective Medications

Researchers demonstrated that bundling fixed doses of a generic statin and an ACEI/ARB in a large, diverse population of patients with diabetes and/or coronary artery disease being treated in an integrated healthcare delivery system successfully reduced the risk of hospitalization for myocardial infarction and stroke.

How Would You Manage This Patient? Would You Anticoagulate for MI?

A search for “infarction” on the EchoJournal website retrieves a four-part collection of ultrasound videos showing an inferior wall MI in a patient who suffered a subdural hematoma, leading to non-sustained ventricular tachycardia, inferior ST segment depression, and these “wall motion abnormalities.”

Articles

Net Guide

Net Guide: Myocardial Infarction

One of the major components of the HITECH Act, Regional Extension Centers (RECs) will provide a wide range of technical support, education, and assistance to primary care practices that adopt EHRs with the goal of achieving meaningful use and qualifying for federal financial incentives.

It’s well known that the federal government is aggressively pursuing a strategy to encourage the implementation of health information technology (HIT) in the everyday

practice of medicine in this country. Many physicians, legislators, public health officials, and other observers believe that the quality of medical care delivered and the efficiency of the care delivery system depend upon the successful incorporation of technology initiatives at the point of care. To this end, the Health Information Technology for Economic and Clinical Health Act (HITECH) has dedicated a large amount of funding toward a nationwide HIT infrastructure. A key component of this initiative is to create an electronic health record (EHR) for everyone in the country by 2014.

A large portion of the responsibility for implementing the provisions of the HITECH act rests with the Office of the National Coordinator for Health Information Technology (ONC), which has been tasked with distributing a portion of the HITECH funds. In order to foster the implementation and meaningful use of EHRs, ONC has $598 million at its disposal to establish Regional Extension Centers (RECs; 

). Of these, 60 have been awarded grants (up to $25 million) in order to promote the adoption of EHR systems in their local geographic areas (

). It is expected that each will be fully functional by December, 2010. The grants are to last for two years, and by December, 2012, each REC is expected to be functioning independently of any federal funds.

In addition to these centers, a Health Information Technology Research Center (HITRC) was funded at $50 million to oversee the RECs and serve as a national learning community for best practices of IT adoption (

). This process is developing at an extremely rapid pace; in fact, the HITRC website is still under development at writing.

The ambitious mission of the RECs is to have at least 100,000 primary care providers (defined as physicians or other healthcare providers, such as physician assistants or nurse practitioners, with prescriptive privileges in family medicine, general medicine, ob/gyn, or pediatric practices) be “meaningful users” of EHRs by early 2012 (

). The RECs will assist primary care physicians not only in the selection and implementation of an EHR, but also help to ensure that the software is used in such a way as to qualify the practitioner for the ARRA stimulus funds (ie, in accordance with “meaningful use” guidelines).

The recently released final guidelines on what constitutes “meaningful use” of an EHR define which eligible providers will qualify for the stimulus incentive for EHR adoption: a maximum of $44,000 under the Medicare program and nearly $64,000 for the Medicaid program (

Each REC will provide the support necessary to Regional Extension Centers:

1,000-2,000 primary care physicians to become meaningful users of an EHR. In fact, the strategy is to target those providers who are statistically least likely to adopt technology in their office—those in small, rural regions that treat the traditionally medically underserved; these are the so-called “priority primary care providers,” which include:

• Solo and small group practices (10 or less primary care providers) primarily focused on primary care

• Community health centers and rural health clinics

• Other settings that predominately serve un-insured, underinsured, and medically underserved populations

Once the eligible providers have been identified, what strategies will the RECs use to maximize the adoption of EHRs and ensure their “meaningful use?” It is envisioned that there will be a wide range of services offered with hands-on educational, technical, and logistical support. A selection criterion for the REC determination was their proximity to the eligible providers so that support could be provided on a face-to-face basis. Anticipated methods of lowering the current barriers to IT adoption include outreach and education, workforce support, tools and resources in all aspects of EHR and HIT adoption, vendor selection and preferred pricing, project management, practice and workflow redesign, system implementation, interoperability and health information exchange, and privacy and security.

Many RECs are currently selecting favored software vendors to facilitate the most cost-effective and user-friendly products to offer to providers. Due to the large number of potential installations offered, the RECs can negotiate discounted rates and favorable service guarantees with vendors and pass them on to their physician members. Therefore, much of the work in selecting the best systems and ensuring fair treatment can be spared the individual practitioners. Other RECs have decided not to adopt this strategy and will not be offering the service of suggesting “preferred” vendors.

Most small practices do not have the management expertise for the complicated changes that an EHR implementation requires. RECs can offer on-site readiness evaluations and participate in the process to prepare a small practice for the culture change that the conversion from paper to electronic workflow entails

RECs will help practices to map their current office workflow and suggest how it can be reconciled and/or modified to better fit the requirements of a given EHR system.

A major benefit of HIT adoption is that it enables coordination of care among different health provider entities. The HITRC FAQ page on the ONC website (

) says that the REC program “offers providers access to information and assists them with selecting and implementing certified EHRs, and integrating HIE [health information exchange] using those EHRs into provider care delivery and administrative workflows to enhance the quality and safety of care while protecting patients’ privacy.”

RECs will work with member practices to enure that patient data remains secure and the practice remains HIPAA compliant.

Finally, the REC can monitor their members’ utilization of the EHR to ensure that meaningful use is accomplished, thus serving the federal government’s goal of improving the quality of patient care. It is anticipated that multiple educational strategies will enhance each REC’s outreach. These could include CME seminars held in each region, webinars, and even individual office in-service sessions. Furthermore, the HITRC will oversee a national educational network and work in the development of best adoption practices to be shared among the RECs.

Steven Zuckerman, MD, is the chief of neurology and medical information officer at Baton Rouge General Hospital, Baton Rouge, LA, and the physician editor-in-chief of MDNG: Neurology/Psychiatry edition.

Feature Articles

Regional Extension Centers (RECs) will provide a wide range of  support and assistance to practices that adopt EHRs.

Regional Extension Centers: Helping You Achieve Meaningful Use

StoryCorps recorded these conversations recounting the 27-year relationship of Brooklyn couple Danny and Annie Perasa as Danny faces mortality in his battle with an ultimately terminal cancer. We tear up over here at MDNG just writing about it, so have a tissue handy when you decide to watch.

More Problems with Social Media in Hospitals

When a man is brought to the hospital after being stabbed 12 times and nearly decapitated by a fellow nursing home resident, protocol typically dictates that hospital staff take pictures of the man and post them to Facebook…or the complete opposite of that; we haven’t read Standard Operating Procedure: Hospital Edition lately so we’re not sure.

The devastating floods that occurred in Pakistan this summer might be some of the worst ever recorded, but it’s tough to get a true feel for how massive they really were just from news reports. BBC Dimensions attempts to quantify it by overlaying the affected area “onto a map of where you are.” By entering our zip code, we can see that if such an event happened here, the floods would stretch from Maine to South Carolina, and cover half of Virginia and North Carolina, and completely submerge Maryland, New Jersey, and Vermont. You can also overlay events and objects in other fields of study including space, depths, ancient worlds, festivals and spectacles, the industrial age, and cities in history.

Nathan Sawaya quit his law practice to become a master lego builder and now uses a collection of over 1.5 million Lego pieces to build amazing structures, like Han Solo frozen in carbonite or soldiers raising the American flag on Iwo Jima, in his New York City studio.

When an eight-year-old child came into the emergency room unable to breathe and having seizures due to a rare hereditary disease, Dr. Kathy Corby put her iPhone to good use. The emergency room physician at Hazel Hawkins Memorial Hospital flipped through seven medical apps to help her identify appropriate medication, and proper respiratory management protocol, and determine whether the weather would permit the child to be transported via helicopter to another hospital once stable. Though the story (http://hcp.lv/d321fY) does not specify which apps Dr. Corby used, Fierce has put together three slideshows listing 15 free mobile medical apps for BlackBerry, the iPhone, and Android that you can put to good use in your own practice. You can also check out the App Wrap on page 4.

The creators of EvidenceChart.com want to help students and scientists “glean evidence from the research literature, articulate theories, and consider whether each piece of evidence supports or undermines” a given theory through the use of “a compact representation of the evidence.” Dealing with a difficult treatment decision could be made easier by lining up the evidence next to competing theories and indicating how strongly a theory opposes or confirms it. 

Check Up

Editors%u2019 picks for this month%u2019s best websites, news, resources, and online information for physicians.

Check UP: Primary Care September 2010

practice of medicine in this country. Many physicians, legislators, public health officials, and other observers believe that the quality of medical care delivered and the efficiency of the care delivery system depend upon the successful incorporation of technology initiatives at the point of care. To this end, the Health Information Technology for Economic and Clinical Health Act (HITECH) has dedicated a large amount of funding toward a nationwide HIT infrastructure.

A key component of this initiative is to create an electronic health record (EHR) for everyone in the country by 2014.

). Of these, 60 have been awarded grants (up to $25 million) in order to promote the adoption of EHR systems in their local geographic areas (http://hcp.lv/bIgtbV). It is expected that each will be fully functional by December, 2010. The grants are to last for two years, and by December, 2012, each REC is expected to be functioning independently of any federal funds.

Meaningful use of EMRs The ambitious mission of the RECs is to have at least 100,000 primary care providers (defined as physicians or other healthcare providers, such as physician assistants or nurse practitioners, with prescriptive privileges in family medicine, general medicine, ob/gyn, or pediatric practices) be “meaningful users” of EHRs by early 2012 (

The recently released final guidelines on what  constitutes “meaningful use” of an EHR define which eligible providers will qualify for the stimulus incentive for EHR adoption: a maximum of $44,000 under the Medicare program and nearly $64,000 for the Medicaid program (

Each REC will provide the support necessary to 1,000-2,000 primary care physicians to become meaningful users of an EHR. In fact, the strategy is to target those providers who are statistically least likely to adopt technology in their office—those in small, rural regions that treat the traditionally medically underserved; these are the so-called “priority primary care providers,” which include:

Most small practices do not have the management expertise for the complicated changes that an EHR implementation requires. RECs can offer on-site readiness evaluations and participate in the process to prepare a small practice for the culture change that the conversion from paper to electronic workflow entails Practice and workflow design RECs will help practices to map their current office workflow and suggest how it can be reconciled and/or modified to better fit the requirements of a given EHR system.

Health information exchange A major benefit of HIT adoption is that it enables coordination of care among different health provider entities. The HITRC FAQ page on the ONC website (

One of the major components of the HITECH Act, Regional Extension Centers will provide a wide range of technical support, education, and assistance.

Regional Extension Centers: Helping You Achieve Meaningful Use 1

Patients are empowering themselves to become more involved drivers in their healthcare journey, many times turning to the Internet to obtain health information. And although the right information can be decidedly useful, plenty of information online can be out of date and plain wrong, and it’s what the patient does with that information that counts. So, how can you help?

In the spirit of e-mail, e-commerce, e-books, and e-prescribing, it’s time to get familiar with the term “e-patients.” Only this time, the “e” doesn’t mean electronic. It stands for patients who are “equipped,” “enabled,” “empowered,” and “engaged” with information. The term comes from the late Tom Ferguson, MD (www.doctom.com), who had written and lectured about empowered consumers of healthcare from 1975 until his death in 2006. Ferguson’s legacy lives in part through the Society for Participatory Medicine (

), incorporated in 2009 to serve empowered, engaged patients and encourage others to take more control over their own health and healthcare.

Ferguson saw healthcare as a partnership between healthcare professionals, patients, and support systems. According to the society, “Participatory Medicine is a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners.”

Many patients are carrying the torch for the movement these days, but few as zestfully as a New Hampshire cancer-survivor-turned-patient-advocate named Dave deBronkart, aka “e-Patient Dave” (

DeBronkart wrote a book about his experience battling kidney cancer that had metastasized to his lung, Laugh, Sing and Eat Like a Pig: How an Empowered Patient Beat Stage IV Cancer (and what healthcare can learn from it), and now has made it his job to preach the word of patient empowerment.

Initially after his 2007 cancer diagnosis, deBronkart acted like anyone who had to confront his own mortality. He turned to the Internet and started asking questions of his doctor, who happened to be pretty tech-savvy himself. Soon, Daniel Z. Sands, MD, director of medical informatics at Cisco Systems (

), primary care physician at Beth Israel Deaconess Medical Center in Boston (BIDMC; 

), and MDNG editorial board member, became deBronkart’s physician and partner in care.

“At no point did I decide that I was going to take this all into my own hands,” deBronkart says. “I needed expert help.”

A marketing consultant with good computer skills, deBronkart already was a user of BIDMC’s PatientSite portal (

)—which Sands helped create&mdash;before the cancer diagnosis. “It’s not something that all of a sudden came along when I got sick,” he notes.

DeBronkart found some reassurance and a community of other oncology patients from the public website of the Association of Cancer Online Resources (www.acor.org): “It’s the best source of information on the Internet about what to do about kidney cancer,” deBronkart says. He took the information he gathered and started asking a lot of questions. “If I find something, I ask, ‘What do you think about that?’” deBronkart says. His engagement in his own care helped deBronkart through multiple rounds of treatment, and now his cancer is in remission. deBronkart quit his job last year to become a full-time advocate for e-patients as co-chair of the Society for Participatory Medicine. “Much to my surprise, I went from almost dead from cancer in two years to chairman of a medical society,” he says.

As deBronkart can attest to simply by being alive, patient engagement often pays off. A 2009 study from the AARP (

) found that the 30-day hospital readmission rate for patients with chronic diseases who were not much engaged in their care was twice that of those who did take a more active role. The researchers found similar trends with medical errors, care coordination, and communication between the patients’ healthcare providers.

The Internet, of course, has changed the dynamic of the physician-patient relationship and of disease care in that information is more accessible than ever before and that patients can more readily find others with similar conditions. A Harris Interactive poll (

) published in August found that 88% of adult Internet users in the U.S. searched for health information at least once in the last year, and 53% said they discussed their online findings with a health professional.

The wide availability of information works two ways, though. “Doctors use Google just like patients,” notes Ronald Epstein, MD, professor of family medicine and director, Center for Communication and Disparities Research, University of Rochester (

). “In a way, we’ve got a shared resource. As physicians, we no longer have claim to secret knowledge.”

While that can be good for patients, it’s often hard to figure out which information is helpful and which is inappropriate, out of date, or just plain wrong.

), producer of electronic medical reference databases, found that more than 60% of primary care physicians like it when patients bring in information they printed from the Internet and believe it helps them communicate with their patients. Yet only 5% of the doctors completely agreed with the statement that such information is useful to treatment.

A decade ago, Charles M. Kilo, MD, now chief medical officer of Oregon Health & Science University (

), a Portland, Oregon practice set up as a new approach to primary care. Among other things, the practice focuses on empowering patients with information and building strong patient-physician relationships.

“Engaging patients is an evidence-based intervention to try to improve care,” according to Kilo. “Just having access to information doesn’t necessarily mean you are more empowered, but it’s a good start.”

Sure, Kilo does have some reservations. “The Internet is not a great tool for patients in an unadulterated form,” he says. People do get a lot of misconceptions from reading online health information, such as having a fever and believing that they have five symptoms indicating malaria.

But the Internet still can be helpful as an adjunct to physician advice. “We shouldn’t throw out the baby with the bathwater,” says Kilo. “I find it really simple to re-correct their course.”

Kilo would like to see patients take the attitude that they are engaged in prevention and/or care of a chronic disease. “There’s no reason to be put off by this,” he says. “We want people to ask questions.”

One physician who thinks patients can, and do, go too far with Internet search is Scott Haig, MD, assistant clinical professor, orthopedic surgery, Columbia University College of Physicians and Surgeons (

), and occasional contributor to Time magazine (

). Haig penned a controversial commentary in Time in 2007 (

) about “brainsuckers,” a common physician term for patients who spend lots of time researching minutiae about their doctors’ personal lives and waste their doctors’ time with irrelevant, confrontational questions.

“There’s so much information (as well as misinformation) in medicine—and, yes, a lot of it can be Googled&mdash;that one major responsibility of an expert is to know what to ignore,” Haig wrote in that article.

Haig says it’s exceedingly easy to get a paper published these days and that pharmaceutical and medical device makers spend big bucks marketing their expensive new products, so there’s a lot of questionable scientific information floating around. For example, some recent medical literature suggests operating on broken clavicles, something Haig has never done in nearly 30 years of practice. “I think it’s malpractice. I think it’s unethical. I think it’s immoral,” Haig says.

But it’s also very profitable. “How do you tell people this?” Haig wonders.

The Harris Interactive poll specifically used the term “cyberchondriacs” to refer to the 32% of U.S. adults who frequently used the Internet to search for information about health and healthcare—up from 22% a year ago. (Sands personally finds the word “pejorative,” noting, “There were people on the lunatic fringe before the Internet.”)

“The quote-unquote empowered patient is usually being empowered by advertising,” according to Haig. However, his general impression is that people are getting smarter about separating hype from reality and do have suspicions about some of the things they read online. “The bad news is, no one trusts the trusted sites,” says Haig, who notes that the word “doctor” means “teacher.”

 (www.youtube.com) with instructions for patients. “I got tired of explaining the exercises I recommend for post-op care,” Haig says. He started providing patients with links to the videos, but he found that almost nobody went to the site.

“The patient empowerment concept has a really nice ring to it,” Haig says, acknowledging that patients can and should be partners with him in their own care. “But when you’re really hurting, you want to talk to someone,” he says.

There has to be a balance between patient activation and assertiveness on one hand and patient trust on the other, according to Epstein. Patients often find information that contradicts or goes beyond what the physician suggests, and people don’t always think clearly when they are sick.

“Even when you think you’re thinking clearly, there may be fear or lapses in judgment,” Epstein says. A good physician should be able to help the patient synthesize and explain all kinds of information without being paternalistic.

“To think of doctor-patient relationships as partnerships…is to use collective wisdom to come to an appropriate path in dealing with pain and suffering,” Epstein explains.

Epstein co-authored a study published in Health Affairs in July (

), which concluded that primary care physicians must improve their communication skills in order to deliver “patient-centered care.” The increased talk of the patient-centered medical home and the Patient Protection and Affordable Care Act’s focus on primary care heightens this need, according to researchers from Rochester, the University of Toronto (www.deptmedicine.utoronto.ca), and the American Board of Internal Medicine Foundation (

For example, Epstein says a patient newly diagnosed with colon cancer may think she’d rather be dead than undergo a colostomy. “The doc needs to show that there are other options,” Epstein says.

Saying to a patient, “I’d like you to think with me about all the pros and cons” is one way to approach the situation, according to Epstein. “Patient-centered care is not just giving patients what they want or what they think they want.” It’s about putting the patient’s welfare first in delivering care and medical advice.

“For patients that are a little bit ‘out there,’ I think it’s important that we listen to them, but that we be really clear about what we believe,” Sands concurs. “It’s important that we educate them. We shouldn’t just laugh and turn up our noses at them.”

A paper published in the Archives of Internal Medicine in August (

) found major discrepancies between what physicians believe their hospitalized patients know about their conditions and what patients say they actually learned from their doctors.

Only 18% of patients could correctly recall their doctor’s name, though two-thirds of physicians surveyed at Waterbury Hospital (

) in Connecticut said they thought the patients knew their names. Just 57% of patients knew their diagnoses, while 77% of physicians thought the hospitalized patients did. A whopping 90% of those who received a new medication while in the hospital said they had not been warned about potential side effects.

Less than half of patients said that they had discussed fears and anxieties about treatments with their doctors, though nearly all physicians believed they had such a discussion.

Though the patients in this particular study tended to be older, less educated, and poorer than average, Epstein says physicians everywhere have plenty of room to improve communication skills. He instructs his students to ask open-ended questions. “That’s a habit that physicians don’t always have,” Epstein says. “People start telling you very useful things.”

According to Epstein, patients “can be assertive without being aggressive.”

Indeed, deBronkart does not advocate being pushy with doctors. “I do assert that someone should know what their options are and be able to go after it,” he says.

“Don’t be a jerk to your partner,” the man known as “e-Patient Dave” advises. “It’s not participatory to go in and tell your doctor he is stupid.”

Physicians gradually seem to be warming up to the idea of empowered and engaged patients, according to deBronkart. “I can tell you with certainty that this is shifting,” he says.

And his own physician? “It’s much more enjoyable to practice this way,” Sands says.

Neil Versel is an award-winning freelance health IT blogger and journalist. He also writes the FierceHealth IT and FierceEMR newsletters.

September 2010

Net Guide: Myocardial Infarction

Regional Extension Centers: Helping You Achieve Meaningful Use

Check UP: Primary Care September 2010

Regional Extension Centers: Helping You Achieve Meaningful Use 1

E-patients: What You Need to Know

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