Making it easier to remember doctors' orders
When my mother was in the hospital recently, I got a closer look than I might have liked at how hard it can be for doctors and patients to communicate.
Patients rarely feel well. They can be stressed out. They can be on medication, as my mom, who's being treated for leukemia, is. It makes her thinking fuzzy. When Mom’s doctors stopped by and she wanted to ask a question, she was often thwarted by her own poor memory – unable to come up with the words she was looking for.
But patients of all kinds, seeing doctors for complaints as mundane as a strep throat to those more complicated, often forget what doctors tell them — from when to follow up to how long to use a medication and so on.
This collective cloudiness can cause an expensive problem for doctors — it requires them to answer the same questions over and over again.
"If I’m going to tell somebody who’s 50 years old, I’m going to cut your head open, and spread your frontal lobes and remove your tumor, you can understand the shock and the emotional reaction that those people have,” said Randall Porter, a neurosurgeon. “Even the most intelligent people come back two four weeks later — I don’t remember a word that you told me."
When his own father got sick, Porter found himself phoning his father's doctor after every appointment.
“As a physician myself I understood how inefficient that was for him,” Porter said, “because he’s basically repeating to me what he already told my dad."
That’s what led Porter to create a service to let doctors use a mobile device to create video recordings of their appointments. The service, which he later dubbed "Medical Memory,” now stores those video files on the cloud for patients to watch later.
Porter said he wanted a more efficient system. Plus, he said, he realized his patients were already recording their appointments.
"Patients ask if they record me with their iPad or their iPhone," he said. "The problem with that is, the recordings aren’t secure. The recordings can be used out of context at a later date. It’s not a good policy."
Many doctors confirm that informal patient recordings are already happening. But video alone won’t fix the problem of communication between doctors and patients, said Dr. Russ Phillips, director of Harvard Medical School's Center for Primary Care.
“I can, at every visit, tell somebody as my parting suggestion, that they lose weight. And I can tell you that very infrequently will that change anything about what a patient does,” he said.
Phillips said that patients who understand and recall medical instructions perfectly may still not act on them. Instead, he said, doctors need to get patients invested in decision making to boost the chances of following through on something like eating less, quitting cigarettes or losing weight. And, if the problem is a doctor who's too attached to fancy, complicated medical jargon, "then videoing," said Phillips, "is not going to be the solution.”
When it comes to video-taping doctor patient meetings doctors may have another concern as well: more work.
“If there’s video, is that just one more thing that they have to keep on top of," asked Debbie Harrison, assistant director or public policy at the National Business Group on Health. "Does this system lay on top of the current system, or does it replace the current system?"
Harrison, who also practices health care law, said what many doctors may wonder about such a system is not how likely it is to cause a malpractice suit, but instead the logistical details and costs — “How do I log this? How do I go back and look at it? Do I have to hire a transcriptionist if someone else is supposed to be able to scan the notes later?”
But Medical Memory says when practices use its service, follow up calls to doctors go down 25 percent. And when Stanicki, the social worker for my mom's case stopped by her hospital room, he was all for the video-taping of appointments.
Social workers are like the goalies of the hospital world — fielding questions nonstop. About patients retaining the information passed on to them by caregivers he said "people need to ask over and over."
He added, "It’s overwhelming. Medical info is overwhelming.”