" Researchers surveyed 183 University of Michigan Health System doctors: 102 residents and fellows and 81 attending physicians. Most said they weren't confident they could persuade patients to change their lifestyle habits. Only about one in 10 trainees and 17.3% of attending physicians were confident about counseling patients on diet and exercise." Howe et all, 2010
There are three major locations that influence the methods chosen:
1. In the Office/Hospital
You control what information the patient receives
vs. Physician Time; Expense of purchasing or creating resources
2. Community Resources
Doesn't require a lot of physician time
vs. May not have resource in your community
3. Online Resources
24 hr/7day access anywhere anonymous in many cases
vs. Physician needs to do some research about sites medical accuracy
Examples of In Office/Hospital Promotions
•paper based handouts
•reading material in the waiting room such as medical comics for kids and aboriginal teens.
•a nurse or other healthcare provider that runs educational sessions once a week
•referral sources within the hospital such as a diabetic counseling service
•use of a whiteboard to highlight key points
•one-on-one discussions during visits.
What others can you think of?
Examples of Community Promotions
•access to patient support groups
•organizations such as Kinsmen, Arthritis Society, Saskatchewan Cancer Society, FASD Support Network, Lung Association
•Aboriginal and immigrant specific programs
What responsibility do you have in helping patients connect to appropriate community groups?
Are their certain types of patients that are more likely to receive this type of support from you?
If you were to survey your community's resources, where do you think the gaps might exist?
Examples of Online Promotions
This section contains more information than the other locations because residents tend to lack awareness about what is currently available and how physicians are currently using online sites.
"My blogs saves time in exam room (when patients read content). Education occurs during, after, before & within visit." Seattle Mama Doc speaking at Swedish 100 conference.
" I think it will become malpractice to Not offer a social network prescription." Roni Zeiger MD Chief Health Strategist at Google
"If somebody has no clue about possible uses of data, should they be custodians of it?" E-Patient Dave
"The online health-information environment is going mobile. 17% of cell phone users have used their phone to look up health or medical information and 9% have software applications or "apps" on their phones that help them track or manage their health." PEW study
CBC reported "41 per cent of the Canadian adults polled said they turn to online sites centred around a specific disease, medical issue or health-related product. Nine per cent visit online patient communities such as chat rooms and support groups.What is perhaps most remarkable is that 67 per cent of the time they trust the information they're getting, the survey suggests."
1. Read Pilot Study of Providing Online Care in a Primary Care Setting
2. Take a look at the results of The Ferguson Report on The Most Useful Resource for 9 Dimensions of Medical Care--As Rated by the 191 Members of an Online Support Community
3. Look at the NNT site that might be useful for discussing evidence based risk issues.
4. The most accessed medical information sites in the US:
i. WebMD 15,700,000/mth
ii. NIH 10,800,000/mth
iii. Mayo Clinic 8,200,000/mth
What sites might be Canadian equivalents? How would you evaluate these sites? One method is to look for the Honour Code symbol. Look at the bottom of the most accessed sites in the US for the HonCode symbol. Why might it be missing from the NIH site? Check out this Canadian site.
5. Take a look at these recommended online patient support group sites including Facing Cancer Together. What type of patient might an online support group appeal to? What assumptions are you making based on age or other factors that might prevent you from recommending an online group?
Dr. Dan Sands, MD, MPH, the Senior Medical Informatics Director at Cisco Systems has the following suggestions for working with Internet savvy patients:
1. Break the ice - "Have you ever looked for health information online?"
2. Learn from them. "Have you found anything useful?"
3. Assist your patients. "Why give an outdated paper? Why not give info on the web that's being constantly updated?"
Based on what you have been reading in this section, what method of advocating for individual patients is missing in your practice? How can you use information from patients to build your "resource library"? How might you implement changes in your practice to improve your advocacy skills? What skills do you need to improve in order to be competent in Health Promotion? Have a conversation with two of your preceptors about how you might improve your advocacy skills with individual patients.