Survey: What Do You Think About Telemedicine?

Take our 2 minute survey and share your thoughts and opinions about the future (or lack thereof) of telemedicine!

Telemedicine is gaining at least a toe-hold in health care at both ends of the health care spectrum. For some large hospital groups and insurers it offers an ability to scale with significant cost savings, and on the other end individual physicians like those in concierge practices are using telemedicine to stay in touch with patients and offer services on-demand.

We're asking you for a few minutes of your time to take this survey an answer a couple of simple questions to see what providers are thinking about telemedicine.

We'll aggregate the answers and create a report outlining the sentiment of physicians and other providers around telemedicine.

Here's a direct link to share with your networks: https://storyteller.typeform.com/to/CFMq33

The Non-Traditional Pre-Med Student Effect

Guest post by Christopher A. Perez

Pre-medicine as we currently know it has to change.

I’m not talking about the required courses that have to be completed or the ultra-important MCAT. I’m referring to the notion that pre-med students must carry a full load of classes every semester in order to demonstrate to medical school admissions committees that they can “endure a rigorous schedule of classes”. Commonly, pre-med counselors advise students that they must take 16-18 credits a semester and for many students it’s just not possible.

The traditional student who attends a four-year university directly after high school is not as common anymore. Many students work because they don’t have the financial luxury to only concentrate on school while other students choose to first attend a community college because the cost of tuition is considerably cheaper. Then, there are also career changers. Career changers are students who already have a career but have decided to return to school in hopes of learning a different field then what they have previously studied. According to the National Center for Education Statistics (NCES), nearly three out of four college students are considered non-traditional (Choy). It is the single largest category of college students today. What makes up a non-traditional student? The NCES states that anyone who satisfies one of the following criteria is considered a non-traditional student:

• Delays enrollment (does not enter postsecondary education in the same calendar year that he or she finished high school);
• Attends part-time for at least part of the academic year;
• Works full-time (35 hours or more per week) while enrolled;
• Is considered financially independent for purposes of determining eligibility for financial
• Has dependents other than a spouse (usually children, but may also be caregivers of sick or elderly family members);
• Is a single parent (either not married or married but separated and has dependents), or  
• Does not have a high school diploma (completed high school with a GED or other high school completion certificate or did not finish high school) (Choy).

Getting into medical school is highly competitive and it’s time to level the playing field for all pre-meds, not just the “traditional” students. A student who excels academically whether they attend college part-time or first attended a community college should be placed in the same regard as the “traditional” pre-med student with the same academic statistics. The pre-medical community must remove all negative sentiments of “part-time” and “strength of class” (à la community college versus university courses) and adopt the idea of universal uniformity instead. This will expand the pool of suitable medical school candidates, increasing the competitiveness of getting into medical school which would ultimately benefit medical schools. It will also diversify the profile of matriculating students that are entering medical schools.

Guest post by Christopher A. Perez
Author of Getting into Medical School: A Comprehensive Guide for Non-Traditional Students

Choy, Susan. “Nontraditional Undergraduates.” National Center for Education Statistics. NECS 2002-12. U.S. Department of Education, 2002. Web. 1 Feb. 2014.

The Statistics Of Medicine

Guest post by Aaron Schenone MS IV

As medical students, future residents and physicians we’re used to the statistics. Whether it’s to assess for appropriate screening tools, treatments, or patient outcomes, we have experienced the positive impact evidence based practice has and will continue to have in medicine. But are statistics an absolute in patient care, and if so what are we in jeopardy of leaving behind?

As we move forward in a world with greater chronic disease prevalence, diminishing medical resources, and a financial reimbursement system incentivized by statistical outcomes, do patients always benefit? Of course many statistics provide reassurance. A patient with stage one colon cancer may find some solace in their statistical prognosis, but how should we use statistics with more advanced diseases?   After all, even after confronted with bad news, how many patients are still secretly awaiting a medical miracle?

Dilemmas are something we’re used to in medicine. As soon as we open the door we prepare for the battle between costs, outcomes, and the needs of our patients. In many cases these responsibilities are fairly congruent, but how do we approach when they’re not?

On night call I met an 85 year old man sitting in his chair gasping for breath. He had just had an unstrangulated hernia repair indicated for his refractory pain. However he also heart,  liver, and renal disease. He was lucky to have made it off the table and when confronted with these statistics, he wanted to operate. The pain was just too severe. That night we identified ruptured esophageal varices, and pulled more than a liter of frank blood from his stomach. He was intubated, stabilized and passed the next day.

Weighing our responsibilities to patient needs, while refraining from harming them, is absolutely tantamount to medical practice. However, all too often we find ourselves weighing those responsibilities against our inherent desire to ease suffering. Until statistics create a crystal ball, we will need to enter the patient’s room ready to comfort always, cure sometimes, and weigh our abilities to ease suffering against the potential risks of our care.

About: Aaron Schenone MS IV is presently a fourth year medical student applying to internal medicine residency. He is a consultant with a Biotech Company Histogen Inc. where he applies Oncologic, Biocompatibility, Regenerative Medicine, and Tissue Engineering. He is a Siteman Cancer Summer Scholar Recipient, and have continued with the institute investigating both clinical and basic projects within soft tissue sarcomas. He was also the President of the Dermatology and Oncology Clubs in 2012 and finished Ironman New Zealand in 2002 before starting this whole medical adventure.

Submit a guest post and get the word out. 

TruClinc - A telemedicine platform that is gaining acceptance with providers.

Telemedicine is finally getting off of the ground with TruClinic.

Very different from the doc-in-a-box model of other telemedicine players, TruClinic is the first truly embedded technology that closely fits how providers already work.

TruClinic has been built into a full telemedicine platform with a knack for tackling hard integrations, bottom-up user growth, and jaw-dropping uses. TruClinic’s cloud-based portal gives providders and patients access to each other from anywhere. All they need is a computing device, Internet connection, and a webcam, smart phone or tablet. From remotely wiring every home on the Goshute Reservation to facilitating interactions between a mother and her newborn child in an ICU to hosting surgical followup appointments, the uses of an always on, instantly connected telemedicine platform are only starting to be realized.

TruClinic is already being used actively by both small individual physician clinics, and larger hospital and clinic chains like the University of Utah Health Care that serves 5 surroundings states in a referral area encompassing more than 10 percent of the continental US and where TruClinc helps the U to reach their clients better, particularly in fields that mostly require communication, like mental health or post-surgery follow-up.

The University of Utah Health Care System is a thought leader in telemedicine. Here's a video:

You can request a demo of TruClinic here.

One of the places that this is likely to be addopted first by individual physicians is around concierge or cosmetic medicine, where a very high-touch interaction at a distance can really have an effect on an ability to scale and interact with more patients in the same amount of time.

Theranos - It’s now worth more than $9 billion, and poised to change health care.

I see a lot of startups that look at some form of incremental increase. Theranos is looking to remake the diagnostic and blood testing industry entirely.

Theranos is a story worth learning about: Could there be one of the first real moves towards always-on diagnosis technology that really drives preventive medicine forward?

Holmes had then just spent the summer working in a lab at the Genome Institute in Singapore, a post she had been able to fill thanks to having learned Mandarin in her spare hours as a Houston teenager. Upon returning to Palo Alto, she showed Robertson a patent application she had just written. As a freshman, Holmes had taken Robertson’s seminar on advanced drug-delivery devices–things like patches, pills, and even a contact-lens-like film that secreted glaucoma medication–but now she had invented one the likes of which Robertson had never conceived. It was a wearable patch that, in addition to administering a drug, would monitor variables in the patient’s blood to see if the therapy was having the desired effect, and adjust the dosage accordingly.

“I remember her saying, ‘And we could put a cellphone chip on it, and it could telemeter out to the doctor or the patient what was going on,’ ” Robertson recounts. “And I kind of kicked myself. I’d consulted in this area for 30 years, but I’d never said, here we make all these gizmos that measure, and all these systems that deliver, but I never brought the two together.”

It's Not Possible To Be Fully Human If You Are Being Surveilled 24/7

Groklaw has now shut down it's operations to avoid exposing all of it's email to government surveillance.

Groklaw is a site that provided deep analysis of the legal system, providing explanations of ongoing court cases. Now it's joined other online services like Lavabit that have closed down in order to protect their users privacy.

You can read the entire story here but the following I found especially compelling:

...What I do know is it's not possible to be fully human if you are being surveilled 24/7.

Harvard's Berkman Center had an online class on cybersecurity and internet privacy some years ago, and the resources of the class are still online. It was about how to enhance privacy in an online world, speaking of quaint, with titles of articles like, "Is Big Brother Listening?"

And how.

You'll find all the laws in the US related to privacy and surveillance there. Not that anyone seems to follow any laws that get in their way these days. Or if they find they need a law to make conduct lawful, they just write a new law or reinterpret an old one and keep on going. That's not the rule of law as I understood the term.

Anyway, one resource was excerpts from a book by Janna Malamud Smith,"Private Matters: In Defense of the Personal Life", and I encourage you to read it. I encourage the President and the NSA to read it too. I know. They aren't listening to me. Not that way, anyhow. But it's important, because the point of the book is that privacy is vital to being human, which is why one of the worst punishments there is is total surveillance:

One way of beginning to understand privacy is by looking at what happens to people in extreme situations where it is absent. Recalling his time in Auschwitz, Primo Levi observed that "solitude in a Camp is more precious and rare than bread." Solitude is one state of privacy, and even amidst the overwhelming death, starvation, and horror of the camps, Levi knew he missed it.... Levi spent much of his life finding words for his camp experience. How, he wonders aloud in Survival in Auschwitz, do you describe "the demolition of a man," an offense for which "our language lacks words."...

One function of privacy is to provide a safe space away from terror or other assaultive experiences. When you remove a person's ability to sequester herself, or intimate information about herself, you make her extremely vulnerable....

The totalitarian state watches everyone, but keeps its own plans secret. Privacy is seen as dangerous because it enhances resistance. Constantly spying and then confronting people with what are often petty transgressions is a way of maintaining social control and unnerving and disempowering opposition....

And even when one shakes real pursuers, it is often hard to rid oneself of the feeling of being watched -- which is why surveillance is an extremely powerful way to control people. The mind's tendency to still feel observed when alone... can be inhibiting. ... Feeling watched, but not knowing for sure, nor knowing if, when, or how the hostile surveyor may strike, people often become fearful, constricted, and distracted.

I've quoted from that book before, back when the CNET reporters' emails were read by HP. We thought that was awful. And it was. HP ended up giving them money to try to make it up to them. Little did we know.

Ms. Smith continues:

Safe privacy is an important component of autonomy, freedom, and thus psychological well-being, in any society that values individuals. ... Summed up briefly, a statement of "how not to dehumanize people" might read: Don't terrorize or humiliate. Don't starve, freeze, exhaust. Don't demean or impose degrading submission. Don't force separation from loved ones. Don't make demands in an incomprehensible language. Don't refuse to listen closely. Don't destroy privacy. Terrorists of all sorts destroy privacy both by corrupting it into secrecy and by using hostile surveillance to undo its useful sanctuary.

But if we describe a standard for treating people humanely, why does stripping privacy violate it? And what is privacy? In his landmark book, Privacy and Freemom, Alan Westin names four states of privacy: solitude, anonymity, reserve, and intimacy. The reasons for valuing privacy become more apparent as we explore these states....

The essence of solitude, and all privacy, is a sense of choice and control. You control who watches or learns about you. You choose to leave and return. ...

Intimacy is a private state because in it people relax their public front either physically or emotionally or, occasionally, both. They tell personal stories, exchange looks, or touch privately. They may ignore each other without offending. They may have sex. They may speak frankly using words they would not use in front of others, expressing ideas and feelings -- positive or negative -- that are unacceptable in public. (I don't think I ever got over his death. She seems unable to stop lying to her mother. He looks flabby in those running shorts. I feel horny. In spite of everything, I still long to see them. I am so angry at you I could scream. That joke is disgusting, but it's really funny.) Shielded from forced exposure, a person often feels more able to expose himself.

I hope that makes it clear why I can't continue. There is now no shield from forced exposure. Nothing in that parenthetical thought list is terrorism-related, but no one can feel protected enough from forced exposure any more to say anything the least bit like that to anyone in an email, particularly from the US out or to the US in, but really anywhere. You don't expect a stranger to read your private communications to a friend. And once you know they can, what is there to say? Constricted and distracted. That's it exactly. That's how I feel.

The Shadowy Price Fixing World Of The AMA & RUC

Want to know how the AMA controls prices for healt care in the US?

The RUC (of the AMA) meets in secret to divvy up roughly $85 billion in U.S. taxpayer money every year. And that’s just the start of it. Because of the way the system is set up, the values the RUC comes up with wind up shaping the very structure of the U.S. health care sector, creating the perverse financial incentives that dictate how U.S. doctors behave, and affecting the annual expenditure of nearly one-fifth of the United State's GDP.

From this article from Washington Monthly

While these doctors always discuss the “value” of each procedure in terms of the amount of time, work, and overhead required of them to perform it, the implication of that “value” is not lost on anyone in the room: they are, essentially, haggling over what their own salaries should be. “No one ever says the word ‘price,’ ” a doctor on the committee told me after the April meeting. “But yeah, everyone knows we’re talking about money.”

That doctor spoke to me on condition of anonymity in part because all the committee members, as well as more than a hundred or so of their advisers and consultants, are required before each meeting to sign what was described to me as a “draconian” nondisclosure agreement. They are not allowed to talk about the specifics of what is discussed, and they are not allowed to remove any of the literature handed out behind those double doors. Neither the minutes nor the surveys they use to arrive at their decisions are ever published, and the meetings, which last about five days each time, are always closed to both the public and the press. After that meeting in April, there was not so much as a single headline, not in any major newspaper, not even on the wonkiest of the TV shows, announcing that it had taken place at all.

In a free market society, there’s a name for this kind of thing—for when a roomful of professionals from the same trade meet behind closed doors to agree on how much their services should be worth. It’s called price-fixing. And in any other industry, it’s illegal—grounds for a federal investigation into antitrust abuse, at the least.

Via this post on Medical Spa MD