An identified emerging threat to mankind (in the United States at least) is the smallest bacteria, Mycoplasma genitalium. It is sexually transmitted.

According to the University of Texas Medical Branch‘s (UTMB) Medical Discovery News, infection rate is up to 4% among young adults.

To humans’ pockets—

Chilly Saturday mornings such as today makes for a better appreciation of a warm cup of coffee and  re-swooning over the beautiful new machine from Steve Jobs’ garage of translated technology. I have read the bashing, it doesn’t matter.

It still passes as a looming (and welcome?) threat to everyone’s pockets.

If only all threats have benefits…

]]> http://ksdescartin.wordpress.com/2010/01/30/emerging-threats/feed/ 1 Timeless Boulevard UTMB Med News Disc ipadblog http://ksdescartin.wordpress.com/2010/01/28/shifting-paradigm-active-and-towards-more-efficient-patient-care/ http://ksdescartin.wordpress.com/2010/01/28/shifting-paradigm-active-and-towards-more-efficient-patient-care/#comments Thu, 28 Jan 2010 22:14:50 +0000 timelessboulevard http://storyofhealing.com/?p=475 ]]> The paradigm is shifting on patient care… and in many directions. One of the many things that is exciting about this century’s palpable heartbeat is a noticeable and rightfully unabashed effort by providers of medical and health care (and many others concerned) to wear their sneakers once again, run around, jump up and down, and explore further how patient care is delivered. The resulting new and wiser approach includes the actual patient in the team—having a more active role in the process. This, as we try to reduce (or eliminate) the insurance companies’ role, a separate story that I will leave to the experts.

Before I put the pins on three of today’s determined fragments of this big endeavor, let me hover a little bit.

One of the greatest luxuries this time allows us to enjoy are all the collaborative tools, venues, and even challenges before us. Anybody can work on their opus and offer a piece to the collective as a possible answer to life’s questions. As we have said before, the floodgates have released a sustained flow of enhanced communications (and thus, potential collaboration).

An example of this are the more social and interactive media platforms that our computers now boast. The internet is our drawing board for virtually anything. It’s our direct line to our sought-after answers and fielded questions… and, hilariously, it’s even an open album of  our idiosyncrasies, receptacle for the prosaic details  of our existence.

Kidding aside, there is actual sanity involved in the push for the expanded use of electronic health records. Year after year, the efforts evolve and expand in the hope they will be a sound solution to the fragmentation of patients’ records.

This highlights the first aspect of this shift.

Not only will they be a container for defragmented patient data, they offer convenience in many aspects of care.

1. Enhanced telemedicine options:

Perhaps we can learn from Denmark.

Again, perhaps not to replace face time but to enhance better communication among all players of care, especially between the patient and her doctor.

…he can go to the doctor without leaving home, using some simple medical devices and a notebook computer with a Web camera. He takes his own weekly medical readings, which are sent to his doctor via a Bluetooth connection and automatically logged into an electronic record.

—

All of this is possible because Mr. Danstrup lives in Denmark, a country that began embracing electronic health records and other health care information technology a decade ago. Today, virtually all primary care physicians and nearly half of the hospitalsuse electronic records, and officials are trying to encourage more “telemedicine” projects like the one started at Frederiksberg by Dr. Klaus Phanareth, a physician there.

The next aspect of the shift requires looking at ourselves, learning from our behaviors and their consequences.

The constant regrouping of human populations is now occurring at a faster rate  than yesterday, speeding the exchange of ideas. Consequently breakthroughs in the sciences and medicine are accelerating, too.

The Human Genome Project — which is now elaborated by many practical offshoots: personalized medicine, bioengineering, gene mapping, synthetic biology, etc. — was just the beginning.

The emerging new theories on aging—gene silencing, mitochondrial theory, and multiple hormone deficiency , are of particular interest. For my own learning, this warrants a second, third, and fourth look, with questions on how we can tease out perfected applications or at least practical, helpful, and safe ones. It’s not so much about answering the unromantic  question of numbers and immortality, but realizing the promise of gaining additional days of quality (or healthy) life lived.

2. Proactive and personalized clinical preventive medical approaches:

Another model of interest is the preventive and integrative approach.

The day has finally come for practical applications, and we are fortunate to have these protocols available albeit with some remaining questions. It’s pushing the state of the art at this point (with differing expert opinions) but could it also pave the way for a new paradigm that is more effective, more efficient, more caring?  Nonetheless, the question of cost and affordability still remains. How can this be made more accessible, should it be proven as one effective model of clinical preventive and integrative care?

Advil, hot tubs and surgery keep most of the Old Timers going, but Bellizzi has ventured further. Two summers ago he became a patient of Dr. Florence Comite, a Manhattan endocrinologist affiliated with Cenegenics Medical Institute. Cenegenics, a privately held company based in Las Vegas, claims to have 10,000 patients and annual revenue of $50 million, making it the country’s foremost purveyor of so-called age-management medicine.

Dr. Comite’s relationship to Bellizzi is like that of an ace mechanic to a classic car. Her job is to keep him finely tuned despite worn parts. “I consider what I do aggressive prevention, the basis of which is metabolism modulation,” Comite says. “Twenty years from now, this will be the standard of care.”

[via NY Times]

Read full article here or you may click on the screen capture above.

Solutions often surface with continued collaboration. This is the third aspect of the shift.

3. True collaboration via patient sensitive health care design:

Innovative institutions like the Institute for Clinical Systems Improvement (ICSI), a non-profit organization, work with this motive. Through its collaborative effort to “provide more patient-centered and value-driven care,” they, along with their member medical groups and health plans, seek out patients for their advisory council.

A more active patient role mean more than encouraging patients to adopt the advice of physicians, nutritionists and physical fitness advisors (in ideal integrative care practices), ICSI opens doors to actual patients’ input in its mission of treatment and care. This also is a good example of shifting paradigms by its democratization of the delivery of care  by including patients’ perspectives in its policies. This venue, at least for those patients benefiting in Minnesota, empowers patients in this active role to make care better and more affordable.

Enhanced telemedicine options, proactive and personalized clinical preventive approaches, and patient-sensitive health care design are only some of the attractive practical components contributing to this shift in patient care. Yet big, open questions remain. How can all these transformative practices be made palpable for the broad population of patients? How can components of care be defragmented and electronic health records be safeguarded against compromised quality? Can there be a realistic balance between excellent patient care and cost-effectiveness?

Maps via Google.

Here are some links to the news:

China View [with photos]

New York Times [via Associated Press]

Philippine Daily Inquirer [one of Philippines' national newspaper]

Here’s a link to a video of the said floods in various areas of the the metropolis.

[video via INITIATE 360 on YouTube]

Ways to donate towards supporting work that assist Typhoon Ondoy victims in the Philippines:

1.  TXTPower [magbayanihan@yahoo.com.ph]

This is a Philippine listed organization. There is a possibility that donations coming from the U.S. are not tax deductible, in case that is a concern. However, they have a Paypal account—thus, very convenient.

Please do your own research about the organization. I did my own— I gather and trust this to be a legal organization in the Philippines.

2. Philippine National Red Cross

No Paypal link as of this writing. There are other ways to donate  listed on their website. This venue is probably more  convenient for those who are in the Philippines.

3. American Red Cross

This is probably the safest, most convenient,  and best way for those outside the Philippines. As of this posting, they have not updated their marked beneficiaries yet—considering it has just been about a day since. However, there is a general donation page found in their website. It accepts all forms of convenient ways to donate.

Thank you.

Stay safe, dear friends!

For those who gave me a-okay for my Media In Medicine series e-interviews, I hope they can still remember me when I start knocking on their email doors again with my finally-written down Qs. For those whose correspondence I am all too happy to receive but have not replied yet, I hope you won’t tire checking in and seeing if I have actually risen from my blog-grave yet. And, of course, thank you for reading.

Conference

A little over a year ago in May, I flew to the beautiful Kansas City, Missouri to attend INMED‘s International Medicine Conference on Exploring Medical Missions at the University of Missouri Kansas City. It was a well-attended one with both medical and non-medical participants. As to medical conferences, INMED’s would be a good model of a modest and non-wasteful one. There was not much of the fancy schmancy swags we often find or expect in most medical conferences. And, the conference was still a hit sans good coffee.  A minute detail which can easily be fixed.

There were many exhibitors—medical mission sending organizations, financial groups, travel agents, hospitals, and even residency training programs. I’ve had the most interesting time meeting some of them and I had quite a few favorites.

My top 3 are:

Health Teams International (medical mission sending organization)

Mercy Ships (medical mission ship and sending organization)

Spanish Plus (Spanish language lessons for health care) The founder, Gene Flanery, hit home when he spoke Cebuano. It turns out he has lived as a missionary in the Philippines for 5 years in the past.

After the conference, I got together with a good friend, whom I have not seen after so many years. I was also very happy to see her again and another friend of ours in my wedding later on after this.

This was taken in one of our stops for that day, Kansas Zoo, on a Segway.

After I’ve almost fallen splat on concrete

for being overzealous with this awesome ride,

I’d say this is the coolest thing.

I surely would not mind having one.

Revisits

This conference brought me back to the summer of 1996 when I was still a pre-medical student in the Philippines. That was the time in life when I had one of the most valuable human experience that blessed my being with a wonderful new dimension and awakening. It was the time when I crossed the threshold which soon ushered me into more medical missions thereafter. It was in medical mission trips where I met many of the most wonderful people I know now. Some of them have become good friends who I still keep in touch with from time to time and some have remained a happy memory.

In another post, I will share more stories about that summer of 1996 in the mountains and barrios of Bukidnon in southern Philippines.

For now, here’s a photo of a friend from that summer. We met again in New York quite recently, after so many years since our summer “adventure” and then again in Mexico for my wedding celebration after that.

Later that day, also in New York, we met another old Summer Immersion friend who lives nearby.  A special treat for the three of us on that same day was a visit to his apartment where he still kept his old Bukidnon album (I guess we all had a certain version of this deeply memorable time). We crazily  scanned through some old photos and lived a moment of belly aches reading some of the old notes and messages that were delivered to one another by foot from one mountain barrio to another. I am so glad to know that our friend brought all that with him across the Pacific. I so willingly almost died laughing while we reminisced some of our insane and funny moments in the mountains that summer.

—

If I had kept a photo, I would also put up another memory I have with another friend I caught up with in Thailand in 2006 where she was doing a human rights project visit. This friend is among the very first friends I met on the first day of college.

Like the NPR story I linked to here on friendships made on the first semester of college, some friends I made from that phase in my life (together with our bit of extended associations) have indeed become amongst my enduring friends. This, no matter where life throws us around the globe.

Here is a photo with another friend whom I have also met in the first semester of college. We were in an island called Boracay in the Philippines for her wedding in 2007.

These are just a few photographs celebrating the paths crossed with folks and with these friends who continue to inspire me on many levels. I carry more inside of me and they will easily spill over this tiny space. It will never be enough. These are just some of the reasons why I celebrate journeys. The conference reminded me so much of these precious times in my life.

Timeless

The soul of international medicine (medical missions) and celebrating the beauty of life through meaningful friendships and meaningful work is not too far in color and flavor. In medical missions—it is in living and celebrating this journey by meaningful connection through humble service to those who otherwise might not have a chance to receive it. In friendships, it is in living and celebrating this journey by meaningful connections made while honoring and enjoying one another’s unique selves. Both circumstances are accounts of timeless moments.

This conference made me remember all these precious times and look forward to more of life’s journeys—living with meaning, pushing boundaries, and getting in touch with the ideal in the hopes of fulfilling a certain purpose while making me remember the very things that I celebrate about in my life.

The conference also allowed me to revisit many aspects and dimensions of myself. The complexity yet the simplicity of a dream I hope to be able to live not too long from now. Nothing grand. Nothing fancy. Just simple alignment of resource, intent, and purpose. To find my place, though small but hopefully meaningful, in this bigger world.

I have a long way to go…

Dith Pran, a photojournalist for The New York Times whose gruesome ordeal in the killing fields of Cambodia was re-created in a 1984 movie that gave him an eminence he tenaciously used to press for his people’s rights, died on Sunday at a hospital in New Brunswick, N.J. He was 65 and lived in Woodbridge, N.J.

 

He had been a journalistic partner of Mr. Schanberg, a Times correspondent assigned to Southeast Asia. He translated, took notes and pictures, and helped Mr. Schanberg maneuver in a fast-changing milieu. With the fall of Phnom Penh in 1975, Mr. Schanberg was forced from the country, and Mr. Dith became a prisoner of the Khmer Rouge, the Cambodian Communists.

 

Mr. Schanberg wrote about Mr. Dith in newspaper articles and in The New York Times Magazine, in a 1980 cover article titled “The Death and Life of Dith Pran.” (A book by the same title appeared in 1985.)

The story became the basis of the movie “The Killing Fields.”

 

The film, directed by Roland Joffé, showed Mr. Schanberg, played by Sam Waterston, arranging for Mr. Dith’s wife and children to be evacuated from Phnom Penh as danger mounted. Mr. Dith, portrayed by Dr. Haing S. Ngor (who won an Academy Award as best supporting actor), insisted on staying in Cambodia with Mr. Schanberg to keep reporting the news. He believed that his country could be saved only if other countries grasped the gathering tragedy and responded.

1. Panda Bear, M.D.’s Defending the Pie. An emergency physician’s opinion on medical quackery, “dis-ease”, and what one should be conscious of as a potential patient.

Sure, anybody can see somebody with a cold or some other minor complaint and the odds are good that nothing they do, provided they don’t get too jiggy with it, will do much harm. But let’s suppose that you have never rotated on a medical service or done your share of critical care. Suppose you have never worked in an emergency department or spent a few sloppy months on the labor and delivery floor. Imagine, if you can, seeing a provider for your family’s medical care who is treating your kids but has never had a lick of formal pediatric training or so little that she has never seen the really bad pediatric diseases that look like a little bit of nothing when they first present. Does your chiropractor, for example, know the odds that a fever in a neonate is some flavor of bacteremia that needs aggressive treatment?. Let us further suppose that while your chiropractor has spent hundreds of hours learning how a little normal misallignment in the spine can cause “dis-ease,” he has never had to recognize appendicitis, pancreatitis, or the first subtle hints of colon cancer. In short, while a lot of primary care is routine stuff, little potatoes that the school nurse would have to work at to screw up, not all of it is and if all you’re barely qualified for is to pass sick patients to somebody else as some kind of completely redundant middleman, maybe you should stick to the entertainment business and leave medicine to those with training.

Update (3-28-2008): This post has very intelligently proven its point. And I very much agree with most of its reasons. However, I personally believe that the complementary benefits of the ancient forms of healing should be explored and given its place. Nothing should be unknown to us. We should not block knowledge or even theories from disciplines outside of our hard-wired structures—modern structures at that. While I am totally for research and evidence based principles of care, I think western medicine has no monopoly of truth. Neither does eastern medicine. While there should be some form of check and balance as to proven fact and false claims, integration of these methods of care, especially when of great advantage to the patients, should be given a chance. Integrate the positive practices of these so called alternative principles (I speak mostly about activities like yoga, meditation, art therapy, etc.) as a complementary and gentle arm to patients’ ways to recovery with the current chemotherapy for example, but not cancel chemotherapy all together. As sometimes, some patients (and so do all of us) need positive reminders at the very least. I liken some complementary processes to the process of writing. Many times, it is not what we actually write but the process itself makes us learn and thus evoke self evolution.

2. New York Times’ Mixed Messenger by Peggy Orenstein. A realistic word on reality that has been existing for so long and many preferred to deny, ignore, or pretend otherwise. It is a sincere and sensible essay that I resonate with personally.

A few weeks ago, while stuck at the Chicago airport with my 4-year-old daughter, I struck up a conversation with a woman sitting in the gate area. After a time, she looked at my girl — who resembles my Japanese-American husband — commented on her height and asked, “Do you know if her birth parents were tall?

Most Americans watching Barack Obama’s campaign, even those who don’t support him, appreciate the historic significance of an African-American president. But for parents like me, Obama, as the first biracial candidate, symbolizes something else too: the future of race in this country, the paradigm and paradox of its simultaneous intransigence and disappearance.

I am myself biracial—East Indian and Filipino. In my own high school (a private Chinese school, with a small minority being Filipino — go figure!) in my home country, I experienced being teased for my “different” race. It came in the form of childish or thoughtless (though rarely cruel) comments about my ethnically distinct features and darker complexion—which now is simply seen as an exotic tan. But the reality is, these judgments or stereotyping coming at you in whatever form still speak of the reality that these biases and disrespect are passed on and learned, especially as a child.

This particular life experience along with my other social exposures has led me to further explore through the rest of my curiosity about other races and cultures. It led me to develop an awareness of the existence of the international community. It led me to celebrate my own diverse background. It led me to develop respect towards other people different from myself. This consciousness, sensitivity, and respect should be shared and brought to surface.

3. Dr. Val and the Voice of Reason’s Young Doctors are Easy Targets for Marketing Messages. This post points out the strong need for a more balanced solution to residents’ salary issue in urban areas.

Some attending physicians are understandably annoyed when residents don’t pay close attention to their carefully prepared lectures. Dr. Wes describes his frustration when his young protégés seem more interested in filling their bellies (with pharmaceutical sponsored luncheon fare) than their minds with his years of wisdom. Although I am absolutely sympathetic to Dr. Wes – and always tried hard to be attentive and respectful to my mentors – I wanted to point out that there is an underlying educational crisis at work in urban centers where some residents train. Here’s one NYC resident’s experience:

After taxes, my annual resident salary was about $39K/year. I worked at a hospital in New York City where rent for a small one-bedroom apartment was about $29K/year (which is now closer to $48K). Living on $10K/year in New York City is next to impossible (as you can imagine) and so my survival required undignified behaviors such as crashing “drug rep dinners,” working second jobs on post-call days, and living in crime infested places with lower rents. I got a job as a bartender at a fancy restaurant so that I could get a free meal and some survival cash now and then, and also worked an IT job from home.

This picture is not so different in the Philippines either. It so much is a reminder of accounts of low resident salaries there.

It does not help that he/she is made to work a whole lot of hours a week. Medical schooling and training has explained to us in some way or another why these traditional work hours are kept. I personally do not mind the required hours as long as the educational return would be worth the while. But that is another story. Medical schooling have at some point trained us not to complain about unfair returns in work situations. Or we simply do not have the energy left after all the toil required.

Here is the part where I rant at last.

When I was a senior clerk rotating in a tertiary hospital in the Philippines, I shared the most unnecessary experience with my classmates at its obstetrics and gynecology department. Sadly, a big part of that rotation was spent trying to survive the attitude problems and work ethic of the residents. There was absolutely some line crossing—I’ve felt we had been disrespected as medical students in being used as personal errand runners. I mean, I have no qualms about helping out. Someone has to do the scut work and all that relates to hospital work. But this is absolutely not about that. This is about the absence of teaching, especially in comparison to the other departments we rotated through. We sat through their Grand Rounds but no further resident-mentor roles were assumed except when attendings were present. They just went about their work and treated us like nuisances or like we owed them our lives.

Some examples I can remember of the day to day… It was lunch time and the important ward work was done for the moment. The residents paged one clerk to the office, and I reported right away, as the page was a stat. Once there, I found these residents having lunch and taking their time (which I would fairly recognize as their right but excludes the right to usurp my time). A resident told me in a condescending tone to go a few blocks off the hospital to the copy service, as she needed it for her personal presentation to an attending. Another time, they placed the same stat page during lunch time and told one of us to deliver invitation letters to various clinics around town for an upcoming department affair. When a group mate of mine was made to do this task, there was no regard for transportation expenses (in a place where very few students had their own cars, we had to take cab rides or less convenient jeepney rides to get around). He had to spend for his trip around town to deliver invitation letters because the resident running the department was too cheap to buy stamps! Another student recounted being called in from the clerk’s quarters to go to the department office at lunch —just to purchase a bottle of soda! And the page was stat!

Truthfully, these unpleasant experiences would have been easily forgotten had there been some effort to mentor. But there was none. Or at the very least, maintaining ethical behavior. (I am glad to have realized at the time that it was unwise to go head-on with the immaturity in front of me. So, my group mates and I took the rather hard but honorable route of just woefully taking it—though honestly, this was a case of just avoiding fuss to survive the rotation and moving on.) In fairness, there was one resident who broke free from the gang mentality and taught us some at least as she should, while maintaining appropriate boundaries between her professional requests and her personal wishes.

I was so terribly disappointed at my rotation that I decided to do my required post-graduate year at another hospital in a different city—one of the best decisions I have made in my medical life! (Perhaps I will write about this much better experience here someday.) I expressed my thoughts (albeit distilled to “I did not have a very good experience as a clerk here. I am applying elsewhere for internship.”) to the attending who sat as chair of the program in a casual encounter when I was about to graduate and submit an application for the post-grad match.

Fortunately, we later had another rotation in a maternity and puericulture center, where we received a fair and most educational obstetrics experience. I am very thankful for that chance sans the nightmare bunch who were supposedly our mentors.

It is a sad recollection for me. It is the first time I have written about it. It mainly remained as an interns’ quarters chat. I hope the situation subsequently evolved, and that later batches have had a more rewarding experience.

Having recounted my stories, I still keep in mind and heart my appreciation and enormous respect for the better role models (including those in obstetrics) whom I have met before and afterwards.

That said, let me end my noise now.

But just for a second, let us step back and check on the point of why we are in these endeavors. Why do we keep abreast of technological primes? Why do we check out these tools and get excited when it adds to our medical gadgetry?

Because we must all know the bottom line—that it could potentially complement our beloved art and science, the practice of medicine. That in its ideal form, we are able to reach newer heights, we are able to accomplish beyond a dream—better quality of life, better approach to problems of chronic diseases and achieving better outcomes, better management protocols towards these diseases that too often take over lives, better understanding and interpretation of research results, better ethics and compassion towards another life. And what of this science? What of this art? The human factor, the providers skillfully delivering care to patients and the patients themselves, are the life blood of all these work. Arguably, no technology can suffice for the lack of humanity in all of these. In the practice of medicine, in the aim to heal, success lies in how we effectively transmit our best knowledge with the use of the best tools available and with the most underrated factor of all, our selves—our evolved selves.

Here are two examples of those humans today, If I may. Dean Kamen and Ray Kurzweil.

Here is Dean Kamen and his solutions at DEKA Research.

Dean Kamen is an inventor, an entrepreneur and a tireless advocate for science and technology. His roles as inventor and advocate are intertwined — his own passion for technology and its practical uses has driven his personal determination to spread the word about technology’s virtues and by so doing to change the culture of the United States. His vast knowledge of the physical sciences, combined with his ability to integrate the fundamental laws of physics with the most modern technologies, has led to the development of breakthrough processes and products.

At DEKA, we focus on technologies that enhance quality of life. In many cases that means developing medical devices and products that aid the people who need it most. Some of these allow healthcare professionals to deliver better care, while some enable people to live better lives, with more mobility, more freedom, and less discomfort. Some of these products are used for surgical procedures and the administration of medicines, while some are designed for people to use themselves, freeing them from the constraints of hospitals. All have one thing in common–making life better.

Watch Dean Kamen on TED—Technology, Entertainment, Design by clicking on the screen shot below.

However, I could not go on after sharing about Mr. Kamen here without a bit of a personal anecdote. When my husband and I first carried a conversation over the phone, he babbled about him for an hour and a half. We were just getting to know each other then. Perhaps half floating in the air myself at that moment while listening and dancing along to this particular courtship song, I could remember nothing much from that conversation but the Segway man whom he photographed while being interviewed by his friend for the magazine, Make. After that conversation, I affirmed myself once more as a geek having been immensely attracted to the person who burnt my ears with his bit of adventure to Segway-land—Manchester, New Hampshire. Apparently, it worked as I am now married to this good man.

Back to business and on to Ray Kurzweil, another great inventor and futurist who is best known for his theories and writings on Singularity.

At the onset of the twenty-first century, humanity stands on the verge of the most transforming and the most thrilling period in its history. It will be an era in which the very nature of what it means to be human will be both enriched and challenged, as our species breaks the shackles of its genetic legacy and achieves inconceivable heights of intelligence, material progress, and longevity.

For over three decades, the great inventor and futurist Ray Kurzweil has been one of the most respected and provocative advocates of the role of technology in our future. In his classic The Age of Spiritual Machines, he presented the daring argument that with the ever-accelerating rate of technological change, computers would rival the full range of human intelligence at its best. Now, in The Singularity Is Near, he examines the next step in this inexorable evolutionary process: the union of human and machine, in which the knowledge and skills embedded in our brains will be combined with the vastly greater capacity, speed, and knowledge-sharing ability of our own creations.

Watch Ray Kurzweil on TED by clicking on the screen shot below.

There is a lot going on in his equally busy web site, though truly a fun and a leaping-ly educational way to spend some of your time in.

Then of course comes the iPhone‘s firmware Version 2.0, superbly titled in Wired as The Tech Rx for Doctors: The iPhone. This article explores further its possible medical use.

The arrival this June of an enterprise-friendly iPhone is exciting to more than just business users. Doctors, too, are eyeing Apple’s handheld and wondering if it could kill off the old-fashioned clipboard and X-ray light box once and for all.

“If you could use the gesture-based way of manipulating images on the iPhone and actually manipulate a stack of X-rays or CT scans, that would be a huge selling point,” says Adam Flanders, director of informatics at Thomas Jefferson University and an expert in medical imaging.

To date, such a feature has remained a pipe dream due to most smartphones’ inability to handle the sophisticated compression techniques used on large medical images. Also, most phones lack the requisite memory and image-processing capabilities.

While treatments have multiplied, the operations and processes for delivering those medicines haven’t kept pace, slowing health improvement in developing and developed countries.

“There is an implementation bottleneck,” said Jim Yong Kim, a Harvard Medical School professor and former director of the World Health Organization’s HIV/AIDS program said. “We know how to do so many things already, but we’re not delivering them.”

Kim urged the creation of a new science of healthcare delivery that would systematically evaluate which techniques worked and which didn’t.

There is more to this interesting discussion accounted by Wired. You may read the rest of the article here.

Unlike biological evolution, there is perhaps no misunderstanding over a missing link here. At present, we are more aware of our potential than previous generations, especially our creative potential as human beings willing to learn more and live more. However, a very tricky resource allocation issue and a multitude of complex factors (realities of the great digital divide for one) lie before humanity in this particular challenge to use the best of (medical) technology as effective tools. Addressing the great need in developing nations (as well as in the developed nations) is another addition to this challenge. Humans need to evolve as well in bettering themselves individually and collectively as vessels for these efforts in technology to be worth the while. We, as humans, as physicians and health care professionals, need to not only hold these gadgets in our hands, we must understand their greatest value is in the uplift of human life. The examples above help me believe we are definitely getting there.

If only we can develop our selves as fast as we can create our technology.

Happy Easter!

Most health professionals contemplate international service and are inspired by the prospects. Yet few are confident about where to begin.

Who should attend?

    * Academics (health professionals, social scientists, computer scientists, engineers)

    * Software and Web 2.0 application developers

    * Consultants, vendors, venture capitalists, business leaders, CIOs

    * End-users (health professionals, consumers, payors)

 You may go to the above websites for more conference details.

In May of 2007, I wrote a post about Medicine 2.0. It dealt with my own exploration and understanding of the interesting place of medical and health care professionals, medical students, academics, researchers, medical leaders and learners, and patients along the arteries and veins of Web 2.0. I then proceeded with exploring further focusing more on its soul—media (focusing on the gifts of the new media) than its intimidating surname—2.0. However, I do not dislike the geeky appeal of the numeric assignment. It has a been a wonderful ride since—one of very open learning avenues and exchanging thoughts with so many interesting folks behind the writings and blogs. I am delighted to have expressed my humble voice this way about a discipline that is a lifetime endeavor. Though 2.0 is just one amongst its expansive collaterals, I speak and write proudly and with ever more curiosity about this revolutionary means of communicating and sharing medical knowledge.

Please welcome, one of my favorite reads on the medical web, Bertalan Mesko. He is a medical student at the University of Debrecen in Hungary. He is one of the active proponents in educating the rest of us about the endless possibilities of Medicine 2.0 among many other interesting things that he shares about in his blog, Scienceroll. Recently, he travelled from Debrecen to Los Angeles, New Haven, and New York and gave a presentation in a conference called Medicine Meets Virtual Reality and another one at Yale University. I am honored to share about this interview here today.

1. How did you get started with your takes on Web 2.0 in Medicine?

In January, 2007, I came across the online presentation of Vesselin Dimov who is a physician in Cleveland. I think he is the first person to write about this subject on his blog in the blogosphere and that presentation opened my mind. I knew these tools, services and websites provided by the realm of web 2.0 could change the way medicine is practised, so I started to write about this special field of medicine and launched a blog carnival under the name of Medicine 2.0 later in 2007.

2. Who coined the term Medicine 2.0? Do you consider yourself one of its pioneers?

I have no idea who used this term for the first time. Anyway, it’s a hard question. I consider myself as a member of the „second generation”, because it wouldn’t be fair to call myself a pioneer. If someone has mentors, he obviously cannot be a pioneer and I do have mentors like Ves Dimov, Attila Csordas, Scott Shreeve and Bob Coffield.

3. You recently presented at the Medicine Meets Virtual Reality Conference, would you care to share that experience from a professional, cultural, and general standpoint?

Wow, it should be quite a long answer. From a professional standpoint, it was good to see physicians and scientists are really open to these new opportunities of web 2.0. They tend to create a new form of medical practises (e.g. Jay Parkinson), they know how much these tools can ease their own job. And that’s why they liked my presentation and the live Second Life simulation. From a cultural standpoint, that is a different world. The system of health care or medical education is totally different from ours. Your medical education is based more on clinical practise. And generally, the main difference, according to my experience, between the USA and our region is that if you have new ideas, you can go further more easily than your competitors.

4. How was the Yale University presentation experience? Can you share with us a sample question raised by your audience there?

I’m humbled to spend some days around Yale and to give a presentation at the School of Medicine of Yale was probably the best thing I’ve ever done. Sometimes everything works. I think I gave my best slideshow ever at Yale. The questions raised by the audience were focused on search engines. A major concern of the residents was that it’s quite hard to find relevant and useful information in Pubmed in seconds. And when they have a patient and have to make a decision fast, they need to have a great tool with which they can get the right information in time because getting tens of thousands of results after making a search for a medical condition cannot be efficient. That’s why we’re currently working on a personalized medical search engine for medical professionals which I will present soon on Scienceroll.

5. What difficult issues (if any) have you encountered in developing your Second Life in terms of sharing medical information?

The medical exercises organized in Second Life by the Ann Myers Medical Center will never be as realistic as real medical education. But educating or learning without geographical borders is just fantastic. I especially enjoyed learning from US physicians and discussing medical cases with Brazilian, German or English medical students. In this virtual world, we have all the tools to educate interactively (descriptions, animations, simulations anbd reliable websites). The only concern I still have is about credibility. We have to ensure all of the visitors that we’re real physicians and medical students. That’s why I will construct soon a page for listing our credentials and any kind of data regarding our professional life.

6. In your opinion, does SL have an imminent future as a tool or even a venue for medical education?

Second Life was centered around casinos and entertainment in the past. But as casinos were forbidden, we have now the space and opportunity to focus on education. I think the virtual world has an educational golden age nowadays. So yes, even if most of people think it has no future, I’m absolutely sure about it’s future role in medical education.

7. Do you have anything to say about the tide of social media (networking sites like within3, iMedix) in relation to medicine? Can you share a personal thought or two regarding the role of this new media (digital, web, internet) in medicine at present? And your thoughts about the future?

I’m pretty sure this new kind of media will play a major role in the future of medicine. With these community sites, not just the physician-physician interaction becomes easier (e.g. Sermo.com), but doctors can communicate with their patients in a more efficient way. It’s not about making a diagnosis on-line, but making contact faster with patients. I plan to work as a geneticist probably in a personalized genetic company and I hope I will not only be able to tell my patient about their own genetic background but to show them some reliable and useful resources where they could find even more information. Web can be the best friend of a physician if used in the right way for the right purpose.

8. What do you hope to achieve in the long run or advocate for with your work at Scienceroll?

It was only a blog with 20 readers, now it has more then 1500 readers a day. My aim is to become one of the most reliable resources of web 2.0 and medicine. I would like to present my slideshow at more and more conferences to show physicians this new world of web. That’s why I have already given slideshows at several local clinics and departments and I took a journey to the US. I also would like to be a good genetic blogger to become a good geneticist. I have a more than normal passion for personalized genetics and I’m pretty sure my future will totally be dedicated to this field of medicine. So blogging or writing about web 2.0 and medicine is just my hobby.

10. How do you balance your time as a medical student and as a successful medical blogger?

First, I’m not a good sleeper, second I’m enthusiastic about my blog. I just love blogging and informing my readers about the most recent improvements of web 2.0 and medicine or genetics. I also like interacting people from around the world and getting many e-mails, suggestions and tips. Blogging can totally change your career. I feel lucky and try to encourage others to start their own blogs. So back to the question, during the day I’m a medical student and this is my top priority, of course. But during the night, I browse the net, organize my web projects, etc. Writing blog posts became one of the most important tasks in my daily routine.

Wonderful!

Here is his most recent slideshow presentation. In a few clicks, you will be provided with awareness and some brilliant synthesis of knowledge snippets from many roads, scattered points, nooks, and crannies.

[splashcast MPWF5381CE]

Thank you very much, Berci, for your time and generous attention to this interview. All the best in your endeavors!

First, here is something close to the heart, an open journal site that presents experiments in video format. JoVE.

Journal of Visualized Experiments (JoVE) is a peer reviewed, open access, online journal devoted to the publication of biological research in a video format.

For a sample, view this experiment on “A Craniotomy Surgery Procedure for the Chronic Imaging of the Brain” by clicking on the screen shot below. Have I mentioned that I love film? Woot! Have fun!

Thanks, Gaurav Parikh for sharing this site.

WorldVistA is an open source, low cost software that handles electronic health records. It was originally created by the U.S. Department of Veterans Affairs for use in their hospitals and facilities. Now, the rest of the world can use it too.

WorldVistA’s mission is to improve healthcare worldwide by making medical information technology better and universally affordable.

WorldVistA seeks to help those who choose to adopt the VistA system to successfully master, install, and maintain the software for their own use. WorldVistA will strive to guide VistA adopters and programmers towards developing a community based on principles of open, collaborative, peer review software development and dissemination.

Here are excerpts of Thomas Goetz article on the New York Times, “Physician, Upgrade Thyself,” when this software was first introduced to the public.

Health care providers have been dreaming about electronic records for so long that the idea has begun to seem like vaporware, a never-to-be-realized fantasy similar to flying cars and jetpacks. But there is already a clear software standard, an open-source system that’s low-cost, easy to use and readily available. It could be the key to the health care system we ought to have already.

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Want to see the best knee surgeon in the country? If he’s using WorldVistA, he can check out your online records at his house or office. If you switch jobs and move to a new insurance plan, you won’t need to build a new medical history and FedEx old records around. With your permission, your files will be accessible to your new providers instantly. In this way, electronic medical records generate better care and lower costs.

WorldVistA isn’t perfect. It isn’t as customizable as some proprietary systems, and its graphical interface isn’t as intuitive or as polished. Worse, its back-office functions — staffing and billing — aren’t all that strong. Major hospitals and health maintenance organizations in search of a Cadillac are free to spend the dollars to buy one.

But for the vast majority of health care providers, WorldVistA is what they’ve been waiting for: a low-cost, simple-to-use system that makes it easier to provide quality health care.

I end today’s post with another personal favorite, PLoS Medicine or the Public Library of Science Medicine.

PLoS Medicine believes that medical research is an international public resource. The journal provides an open-access venue for important, peer-reviewed advances in all disciplines. With the ultimate aim of improving human health, we encourage research and comment that address the global burden of disease.

PLoS Medicine…is an open-access, peer-reviewed medical journal published monthly online by the Public Library of Science (PLoS), a nonprofit organization.

Here is a message from the PLoS founders,”A Medical Journal for the Internet Age.”

The Internet is awash with medical information. Eight hundred million people have direct access to the Internet [1], and in the United States over 60% have searched for health or medical information on the Web [2]. Go to any search engine and type in the name of a disease or drug, and you will be directed to hundreds of sites, ranging from the sound and useful to the quackish and dangerous. Google “medical” and you get 85 million pages, “drug,” 40 million, and “health,” 230 million.

But something is conspicuously missing. The most reliable medical information on the Internet—the contents of peer-reviewed medical journals—is hidden from the public and most of the world’s physicians. Although most medical journals are available online, their publishers limit access to those who choose, and can afford, to pay for access. This should not, and need not, be so.

I agree!