Listening to private calls to gain insight in therapy

The New York Times Cases article this week examined how therapists sometimes get an unintended look inside the patient's life, by the phone calls they take. Therapists now find themselves able to gain insight beyond what is said in session, by how patients react to cell phone calls from children, spouses and others.

But I can't help but feel a little odd about this. I know the patient shouldn't expect privacy if they take a call in front of his or her therapist. But is it OK to put those conversations on the analytical table? Should the patient retain some control of what the therapist and patient talk about or should the therapist be free to bring up something that is observed? Maybe they do this already and cell phone calls are just another observation.

This is just one example of how technology is changing clinician-patient communication. What are others?

Patients finding support on social networking sites

The New York Times had an article today about a new Pew Center for Internet and American Life survey about how patients with chronic illnesses are finding new ways to cope online through social networks. Patients who once felt isolated now have a forum for sharing questions, hopes and ideas for coping with the particular complications of an illness. Fellow patients are able to relate to each other, in a way that their physicians may not be able to, simply because they physicians have never experienced actually living with an illness. Patients describe being in a neighborhood or a member of a community. Now even people with rare illness can have a support group, though they may never meet in person.

You can check the survey and data out here.

What doctors and patients are NOT talking about

The New York Times Well blog had an interesting article today about the issue that physicians and patients appear to not be talking about: a patient's weight. It is a difficult, but important, conversation to have. Weight plays a pivotal role in so many health issues. But physicians seem to not be bringing it up with their overweight patients. Some physicians may be embarrassed or may feel ill-equipped to make proper recommendations for weight loss. Some may just be discouraged that the advice will fall on deaf ears. Whatever the reason, failure to bring up this important health issues can have a real impact on the clinical relationship between physician and patient, as well as the interpersonal relationship. Patients know when they are overweight and if a physician doesn't bring it up or help discuss strategies for weight loss, the patient may feel like they are not getting the care they need. The weight-loss conversation may be difficult, but the alternative is worse.

Changing hospital culture to improve patient safety

Dr Pauline Chen's Doctor and Patient column this week explores how hospitals are trying to increase patient safety by encouraging disclosure of errors, so that physicians and administrators can learn from and improve on systematic errors. But Dr. Chen explores the difficulty directors of these types of disclosure problems have encountered. It takes more than just encouraging error disclosure, you have to change an entire hospital culture of that has come to fear mistakes because of fear that it will damage a long sought after career or result in a malpractice lawsuit. The article demonstrates that you cannot change an entire organizational culture by changing a policy on paper. This kind of shift in attitude will require long-term educational efforts and open dialogue about the importance of patient safety and how disclosing errors helps achieve that safety goal. Organizational culture does not change overnight. But ongoing, effective communication, can help achieve new cultural goals.

Seeking help for a rare illness by going where the researchers are

Along with an article about an FDA orphan drug conference last month, The Wall Street Journal also explored how one mom is using the conference as a chance to seek treatment for her daughters by going where the researchers are and talking with them face-to-face. The purpose of the conference is to encourage researchers to pursue funding and research for orphan drugs, that is drugs for very rare diseases. The FDA has set aside substantial money for orphan drugs, but few researchers pursue it. So the FDA has hosted conferences to encourage researchers to seek the funding and help them with the application process.

But the conference isn't just attracting researchers. It has also attracted one persistent mom, who visited the conference to pursue research to find a treatment for a rare illness affecting her twin daughters. The conference helped "demystify the process" for this mom and the researchers, but also showed what can happen by actually meeting and talking to each other.

Peer communication and the pressure to snack

There have a been a couple articles in the last couple weeks in The New York Times about snacking, including this Well blog article earlier this week about a recent article in Health Affairs. What I found interesting about these articles is not the data about how much children and adults snack, but the personal stories about parents who feel pressure to comply with the snacking culture. Parents may try to speak up about the endless supply of snacks at club meetings, soccer games and school, but may quickly retreat from the position when ridiculed or scorned by other parents. The stories give dramatic insight into how interpersonal and group communication impact health behaviors. As health care providers and health communicators create messages about health behaviors, they have to keep in mind the influence of peer groups. Otherwise, the messages, no matter how well crafted, may fall of deaf ears.