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JMIR a top health services and informatics journal June 23, 2007

Posted by Hans in : academics, research , add a comment

For those interested in publishing their work, you should consider the Journal of Medical Internet Research (JMIR). JMIR is now the #2 medical informatics journal based on the ISI/SCI impact factor ratings, with a rating of 2.9. The “impact factor rating” is a statistical measure of how frequently articles from a specific journal are referenced by other articles. The thinking is that “better” articles will be referenced more frequently. You can read more about this announcement here.

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The Imposter Phenomenon June 23, 2007

Posted by Hans in : academics , add a comment

I attended a fascinating presentation earlier this week. The presentation was about the “imposter phenomenon” by Diane Zorn (PhD candidate at York University).

The Imposter Phenomenon is when high achievers (e.g., graduate students, professors, lawyers, physicians, etc) are “plagued by the fear that they are not as capable or intelligent as others think they are, that they cannot keep repeating their sucesses, and that they will reventually be found out as frauds”, despite outstanding accomplishments and frequent praise.

What I found most interesting was that this phenomenon isn’t so much an individual’s fault (according to Diane Zorn), but the result of environmental and cultural forces. In graduate school, the university culture fosters unhealthy lifestyles and often unwittingly promotes this imposter phenomenon. Diane Zorn presented data that showed how working to get a PhD is detrimental to your health: loss of hobbies, isolationism, decreased and dysfunctional communication skills, high incidence of depression, high stress, and so on.

One interesting finding was about Harvard. Apparently, Diane gets very positive feedback whenever she runs a seminar/workshop on this topic at universities and companies across North American and Europe. Audience members seem to share about their own insecurities and generally support Diane’s thinking about the imposter phenomenon. The one time she presented at Harvard, she got a completely different response - basically they disagreed with her. When she asked the Harvard audience about their response, they basically said “We’re at Harvard. Why would we feel that way”. As Diane said, Harvard looks like a perfect opportunity for a case study.

Popularity: 19% [?]

Could ehealth raise public awareness of clinical conditions? June 13, 2007

Posted by Hans in : analysis, news, research , add a comment

I came accross an interesting article published in BMC Medicine titled “Do citizens have minimum medical knowledge? A survey”. The authors found a “consistent and dramatic lack of knowledge in the general public about the typical signs and risk factors of relevant clinical conditions”. What surprised me was that this finding seemed to apply to those with and without medical backgrounds. Okay, granted the study was conducted in Switzerland and the authors only investigated a few conditions (COPD/heart disease and HIV/AIDS), but I think that this finding could probably be replicated. Here are two examples from my family’s recent history:

A few years back, our family didn’t realize that our grandmother had a stroke. She complained of a headache and that she “wasn’t feeling well” and had trouble seeing. We noticed that she slept a bit more than usual, but figured it was because she was a) older (almost 90 years), b) wasn’t feeling well on the account of a flu or cold (it was in the winter), and c) her cataracts was getting worse. One day, she got out of bed and walked into a wall and fell because her left side felt weak. She wasn’t feeling well and so we took her to see our family physician. After some tests were run, he said that she experienced a minor stroke but that there was nothing we could do now. He said that if we had brought her in sooner, we could have done something to help her.

Looking back, our entire family felt quite guilty. We could have helped her more, but didn’t. But, was there anything that we could have done? I mean, her symptoms were so generic and could describe a flue or cold. She seemed okay – just a bit tired. We didn’t notice anything until she actually fell, as she was quite independent until then. Our physician said that in the elderly a prolonged “headache” was a warning signal since our grandmother had high-blood pressure. How come no-one told us that?

The second example is with my father. He’s usually up quite early, but one day he woke up late and seemed somewhat disoriented. He was up late the night before. That morning, he seemed to have trouble articulating words. I only noticed because he was supposed to drive me to the commuter train. He didn’t seem in any shape to drive so my sister ended-up driving me. I mentioned this to my supervisor (Alex Jadad - a physician) and he said that I should take my dad to the hospital immediately. Apparently, his symptoms suggested something called TIA or “Transient Ischemic Attack” – it’s like a temporary stroke. Again, there’s no way I would have even considered his condition serious.

Anyway, I’m wondering if greater and more widespread use of the Internet for health purposes could increase awareness of symptoms of clinical conditions. I’m involved in the health care system and am well educated and yet had no clue what to look for. If educated medical folks like paramedics have difficulty, what chance to non-medical folk have?

There are probably two things that need to be done: better education of medical conditions and better use of technology.

What if mobile phone developers or even telecommunications companies provided some services that really could be helpful? For example, could some sort of software be developed where the primary user inputs some basic data (age, sex, existing conditions) and then ever so often, you get a text message asking you a few questions about your health or some health promotion note? I know this is somewhat “pie-in-the-sky” thinking, but we should see how we can use commonly available tools to really help people. Maybe it could be targetted – like having patients who have heart disease get these messages reminding them about warning signs or to monitor certain physiological measures. It’s a thought.

I would probably argue that the greatest challenge, with or without technology, will be to get the attention of regular people (like me) to know when something is potentially dangerous or not. We probably won’t get there until we start wearing bio-medical devices like a “shirt”. Even then we probably couldn’t monitor everything.

Popularity: 19% [?]

Patients want more performance information available online. Where do we go from here? June 12, 2007

Posted by Hans in : analysis, news, research , add a comment

Came across an interesting little blurb reporting on a survey. In the the survey conducted in the UK, nearly 80% of patients want “more information on how their NHS hospital performs available on the internet”. Nothing too shocking, right?

My first thought was to question whether or not this matters. From my personal experience working in the health care system, I’ve heard that some patients don’t really want to know. They may want to know if their providers are doing a great job (i.e., excellent or above average), but if access to physicians or services is very limited, patients (at least anecdotally) don’t want to know – care, however “below average” it may be, is still better than no care at all. As I continued to read the report, I thought this finding was particularly interesting:

Of those surveyed, 38% said they would use it to challenge or seek reassurance from their doctor, whilst only a minority (around 16%) would use it to choose or change their provider

Aha – just as I thought. People just want to know they aren’t receiving sub-standard care.

Just some other thoughts that I have about making comparative performance data available to the public:

  • There needs to be some better efforts in helping the public understand and make sense of the data that’s available. In Ontario, hospital performance is reported annually (OHA/Ministry of Health Hospital Report). I helped compile some data for a hospital a few years back for the initial report and I don’t think that the actual reporting and knowledge translation has gotten much better. Leafing through some of these reports is a challenge as you are just bombarded with numbers, tables, and figures.
  • A senior executive that I used to work for once told me that comparative performance data is mostly for marketing purposes (both internal and external). If you get excellent results, you promote the heck out of it and market yourself as a leader, hopefully being rewarded with either extra funding from the government or attracting more donations to your foundation. If your results aren’t so great (or “below average”), then you use it to kick-start some new internal “improvement” program while asking for more $$. “Well, we didn’t perform as well as we could because of financial constraints and challenges…”.
  • Now, what does “below average” or “above average” really mean? I suppose from research perspective, it’s like asking for the difference between statistical significance and clinical significance. When I take a look at some figures (Example: 2006 Acute Care report), I’d be hard-pressed to tell you what the difference on some of these tables. On page 50 looking at the table reporting adverse events for community hospitals, we see that Rouge Valley Hospital (Scarborough) was identified as “above average” while Sault Area Hospital (Sault Ste. Mary) was only “average” for the rate of Nurse Sensitive Medical Adverse Events. When we look at the actual numbers, Rouge Valley is 0.3 while the Sault Area hospital is 0.4 (note, I couldn’t even find what the denominator is (I think it’s a percentage, but I can’t be sure). In the case of a below average, Ross Memorial Hospital is 2.6 which seems quite a bit off from the other two I mentioned. But in reality, what does this mean to a patient?

    • Hey, I don’t want to give the wrong impression. I think it’s great that this type of information is becoming easier to access. I think it’s great that hospital executives are starting to examine performance (which I hope is a good proxy for the hard to define term “quality of care”). I think it’s great that patients and the public are starting to become more interested in the type and quality of care they are receiving. My question is “what is the next step”? Patients asked for performance data. The health system has responded. What is the response? Do we ask for more? Do we demand changes? Do we just say “thanks” and go on our way because my health provider is doing okay? Was this a make-work exercise if we don’t act on it? Where do we go from here?

    I don’t have the answers but I’m hoping that as a group, we can figure something out.

    Popularity: 19% [?]