If you’re around my young daughters these days and happen to mention the flu shot, you’re likely to get an earful. “We got ours too late last year and got really sick,” they’ll tell you (as I look down in embarrassment). “It’s really important to get one.” They also, not surprisingly, were not at all upset when I made an appointment – nice and early! – for them to get vaccinated a few weeks ago. They knew it would hurt, but in the words of my 8-year-old, “it’s worth it.”

My girls – the walking pro-flu shot billboards that they are – were the first people I thought of when I came across a Stanford BeWell article this week on – you guessed it – the importance of flu shots. In the piece, infectious disease expert Cornelia L. Dekker, MD, answers questions about influenza and last year’s flu vaccine (which failed to protect people against several strains of the flu), and she reminds local readers that shots are being offered on campus for students, staff and faculty for free.

Previously: How one mom learned the importance of the flu shot – the hard way and Ask Stanford Med: Answers to your questions about seasonal influenza
Photo by cignoh

People who seek out medical information and want to have a more active role in their health care are increasingly becoming the norm. To learn more about this growing community of engaged patients, Inspire, the largest online community of e-patients in the United States, surveyed 13,633 of their members, representing 100 countries on six continents.

The results of the company’s survey were recently released in the online report “Insights from Engaged Patients: An analysis of the inaugural Inspire Survey” (link to .pdf). Among the key findings:

• About 55 percent of patients are “well-prepared for their doctor’s visits” and bring a buddy to assist with their appointment. (As one survey participant reported, “The more I inform myself with accurate information on the medications taken, or the medications available, the more I am able to have meaningful conversations with the doctors concerning treatment.”)
• 52 percent of patients are largely responsible for initiating conversation with their physicians about potential new treatments.
• Two-thirds of patients use social networks as a source of information and support for their health conditions.
• Half of all patients reported having difficulty with the affordability of their medications at some point in their life.
• 72 percent of U.S.-based patients reported experiencing some increase in their healthcare costs.

You might think that since the people surveyed were members of an online health community, they’d all be savvy, avid users of every kind of heath app and gadget. Nope. Instead, 72 percent of survey-takers reported they’d never used a smartphone app for their health-care needs. Moreover, less than half of the people surveyed reported feeling that such an app would be useful to them.

The rest of the report, which illustrates there are clear barriers that prevent people from adopting health-care technology and from getting the care and medications they need, is worth a read. (And, as a reminder, we’ve partnered with Inspire on a patient-focused series that appears here once a month.)

Previously: Engaging and empowering patients to strive for better health, “What might they be interested in learning from me?” Tips on medical advocacy and A wake-up call from a young e-patient: “I need to be heard”
Photo by UW Health

When I talked to William Newsome, MD, PhD, director of the Stanford Neurosciences Institute, about its annual symposium last week, he told me one of the pleasures of directing the institute is getting to pick speakers whose science he really likes.

We captured tweets, images and videos from those speakers on our Storify page, and they make it clear that Newsome has very diverse tastes. Topics ranged from aging and mental health policy to virtual reality for mice.

From Stanford, geneticist Anne Brunet, PhD, discussed her work on aging, particularly how stem cells in the brain change with age. Engineer Krishna Shenoy, PhD, described how his lab was reading signals from the brains of paralyzed people and using those to drive computer cursors or prosthetic limbs. Others discussed machine learning, new technologies for imaging the brain, the genetics of mental health disorders, and insights into how smells illicit behaviors in flies.

It’s worth a look at the Storify page to get a sense of the breadth of work encompassed under the banner of neuroscience.

Previously: “Are we there yet?” Exploring the promise, and the hype, of longevity research, My funny Valentine – or, how a tiny fish will change the world of aging research and Stanford researchers provide insights into how human neurons control muscle movement
Photo of Krishna Shenoy by Matt Beardsley

A landmark Institute of Medicine report released last last month showed that despite dramatic improvements in patient safety over the last 15 years, diagnostic errors have been the critical blind spot of health-care providers.

Kathryn McDonald, executive director of Stanford’s Center for Health Policy/Center for Primary Care and Outcomes Research, is a member of the committee that wrote the report, “Improving Diagnosis in Health Care.” I recently spoke with her about the report’s findings and also got her suggestions for limiting one of the most overlooked health-care dilemmas today. Among our Q&As:

Q: You outline eight goals that physicians and health-care providers should follow in their diagnostic practice. Which do you believe are the most significant?

McDonald: They are all important. I know that isn’t a satisfying answer, but this is a complex problem that requires a many-pronged, multi-level attack from education to payment system reforms. We tried to be bold and aspirational, while grounded in the existing evidence. I guess if I had to underscore a goal where I am most optimistic that it will make a difference in the short run, I’d point to the teamwork one. There is a growing evidence base that the benefits of teamwork accrue to all members of the team, so this recommendation has the potential to be a win-win for all involved. Improving diagnosis is quite challenging, partly because making a diagnosis is a collaborative effort and involves many, often iterative, steps — few simple ones. These steps can unfold over time, across different health-care settings, and usually involve diagnostic uncertainty. All the moving parts, all the different types of expertise, all the people involved, well that’s a call for teamwork. This IOM report and the challenge of improving diagnosis puts health-care organizations on the hook for ensuring that health-care professionals have knowledge and skills to engage in effective teamwork — both interprofessionally and intraprofessionally. And the goal doesn’t stop there. We also recommended, as part of this first goal, that health-care professionals and organizations should partner with patients and their families as diagnostic team members, and facilitate patient and family engagement in the diagnostic process, aligned with their needs, values and preferences.

Beth Duff-Brown is communications manager for the Center for Health Policy and Center for Primary and Outcomes Research (CHP/PCOR).

Previously: Better communication between caregivers reduces medical errors, study finds

The New York Times has written that Anna Deavere Smith, playwright, actress and professor, is the “ultimate impressionist. She does people’s souls.” It was Jonathan King’s soul that Smith summoned up at the Jonathan King Lecture on campus earlier this week. The lecture series, celebrating its 25^th year, honors King, who earned a master’s degree and PhD in computer science at Stanford and who became an advocate for patients’ rights after his cancer diagnosis in 1989. The series was created by friends and family to honor King’s memory and to carry on his message of “walking in the shoes of your patients.”

The event opened with a video of King during his life and battle with cancer, including portions of a talk he gave to medical students in which he said, “There is a line that divides people who have passed over to the condition I am in from everybody else.”

Smith weaved those words throughout her performance, as she brought to life patients she had interviewed in the course of her research for her landmark one-woman show “Let Me Down Easy.” Those real life patients included Hazel Merritt, a diabetic patient who had compelling reasons to refuse dialysis treatment; Ruth Katz, former associate dean of administration at Yale Medical School; Ann Richards, former Governor of Texas; and Eduardo Guerro, a patient who said, “You can’t turn dying into a picnic.”

What medical professionals CAN do however, Smith said, is recognize the whole person in the patient. “Take in everything they are, and that starts when you walk in the room and touch the patient,” Smith said. She then echoed King’s advice saying, “Get as close to your patients as possible.”

Smith also addressed the “line” that King referred to. “There is a matter of, of… aloneness for those who have passed over that line, and we can do better as humans and as a society to work to get over it. We need to imagine crossing that line, because we are all human, and we are all going to die.”

In the Q&A portion of the lecture, medical student Arunami Kohli thanked Smith for her moving performance and asked her how she got patients to speak so candidly. Smith’s answer: “I have found when people are in crisis, they want to restore their dignity, and when they do, they are so eloquent, they sing. Just remember to give patients that opportunity, to restore their dignity.”

Jacqueline Genovese is assistant director of the Medicine & the Muse Program within the Stanford Center for Biomedical Ethics. The center hosts the Jonathan King Lecture.

Previously: Actor Anna Deavere Smith on getting into and under the skin of a character

I’ve forgotten most of my childhood experiences – which is perfectly normal. But apparently my body remembers many of those experiences – and I learned while editing the new Stanford Medicine magazine that’s normal too. The fall issue’s special report, “Childhood: The road ahead,” is full of stories of researchers realizing the impact early experiences can have on adult health. Some of their discoveries are surprising.

“Some people think kids are protected by virtue of being kids. In fact, the opposite is true,” pediatric psychiatrist Victor Carrion, MD, told writer Erin Digitale, PhD, when she interviewed him for her story on the long-term effects of childhood trauma. Other writers found the same goes for other types of early damage: Kids are resilient but they also carry hidden scars.

The report also includes a Q&A with former President Jimmy Carter on discrimination against women and girls, which he considers the most serious human rights problem on Earth. The online version of the magazine includes audio of the Carter conversation.

Other highlights of the magazine’s special report include:

• “Go to bed“: An article on the devastating toll inadequate sleep takes on teens, with an update on efforts, including a Stanford project, to fix the problem.
• “When I grow up“: A report on the growing need for support of chronically ill children making the jump to adult care, and on the progress that’s being made.
• “Beyond behavior“: A story about a high school student’s return to health after an assault, and the new type of therapy that helped her.
• “Rocket men“: A feature about three rocket-combustion experts teaming up with a pediatrician to analyze the breath of critically ill children at warp speed.
• “Warm welcomes“: An article on blending Western medicine into traditional culture to reduce newborn mortality in the developing world.
• “Bad for the bone“: A quick look at a new way to study the toll of childhood disease on bones.

The issue also has an article on a surprising role for viruses in human embryos, as well as a report from India on how vision, investment and medical know-how has brought about an ambulance system — now 10 years old and one of the most important advances in global health today. The online version includes a video showing the ambulance system in action.

Many thanks to Lucile Packard Children’s Hospital Stanford, which helped support this issue.

Previously: This summer’s Stanford Medicine magazine shows some skin, Stanford Medicine magazine reports on time’s intersection with health and Stanford Medicine magazine traverses the immune system
Illustration from the cover of Stanford Medicine magazine’s fall 2015 issue by Christopher Silas Neal

On his first day as an attending physician at Stanford, Abraham Verghese, MD, noticed something unusual. “I was struck by the fact that the house staff were spending a great deal of time wedded to their computers,” he recalled. “And it was not their doing. They didn’t sign on to do that.”

His experience reflects an increasingly common trend in modern medicine: With the introduction of new medical technologies­­, physicians today find themselves spending more time at the monitor and less time at the bedside.

Verghese recounted his story to a packed room of physicians and clinical educators who had traveled to Stanford from places as far flung as Brazil and Australia to attend the inaugural Stanford Medicine 25 Symposium.

The two-day event provided attendees with the tools to foster and encourage a robust bedside medicine culture at their home institutions.

The time is right, said Verghese. Today, many physicians and educators are advocating for a more hands-on approach to medicine. At the same time, an increasing number of bedside medicine programs are popping up at universities and hospitals worldwide: “I’m hoping that this is the moment when we all come together, and we stay together and connected in this effort to take what we all believe are fundamental and important skills – important to the welfare of the patient, important to practice cost-effective medicine, important in choosing wisely – and we form a community with solidarity around that theme.”

Throughout the symposium, participants learned the basics of evidence-based physical diagnosis from Steve McGee, MD, author of a textbook of the same name and a professor of medicine at the University of Washington. They learned how to schedule and program consistent teaching rounds, and how to incorporate technology without losing connection with the patient. They also heard from Andrew Elder, MD, professor of medicine at Edinburgh University and Junaid Zaman, MD, a postdoctoral researcher at Imperial College London and Stanford, about the MRCP PACES examination – a high stakes clinical exam that all medical school graduates in the UK must pass to continue their postgraduate education, an exam run and administered by Elder.

During an afternoon panel, experts from Johns Hopkins, Stanford, the Seattle VA, and the University of Alabama, Birmingham discussed ways to create a bedside medicine culture. Ideas included inviting master clinicians to teach at the bedside and hosting regular workshops. But, the panelists agreed, the support of community is critical. “It’s really hard to build a bedside medicine experience,” noted Brian Garibaldi, MD, of Johns Hopkins. “Community is key.”

Continue Reading »

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

Any Stanford student knows all too well that the immense campus, with its seemingly eternal sunshine and endless rows of palm trees, can make it difficult to want to get outside and experience the real world. When it comes to medical education, this creates a very real concern: Is it possible to experience the full diversity of our health-care system when you are living in the so-called “Stanford bubble” – an idyllic college campus in one of the wealthiest counties in the United States?

I’ve certainly felt the effects of the Stanford bubble, but interestingly, working with a diverse population of patients has not been my primary challenge. Stanford has a wide net of connections with the Peninsula region and larger Bay Area – from clinics serving the urban underserved in East Palo Alto to flu vaccination programs reaching a rural population in the Central Valley farmlands. Those experiences are widely accessible to anybody who seeks them out.

No, my problem with the Stanford bubble is not about the patients – but rather the doctors. Doctors are known for being overworked and stressed, right? It certainly doesn’t seem that way in our bubble, where speaking with our outstanding pre-clinical faculty about their careers brings inspiring stories of cutting-edge research achievements, clinics filled with fulfilling cases and grateful patients and many years of training bright up-and-coming doctors. On the contrary, my faculty mentors speak highly of the balance they’ve found in their professional lives – clinic one day, research the next and teaching in between.

But is this really representative of the real world? When you step outside the realm of “academic medicine,” the picture seems to change considerably. It’s not a secret that, among physicians nationwide, burnout is widespread and pervasive – afflicting 46 percent of doctors in a recent study. Burnout was defined as “emotional exhaustion, depersonalization and low personal accomplishment.” To be honest, I can’t say that I’ve ever observed anything like that in my pre-clinical years, let alone in 46 percent of our faculty. As pre-clinical medical students, burnout is something that we hear about constantly, but witness never, allowing us to convince ourselves that it’s just some abstract idea that doesn’t apply to us.

I’m constantly inspired by my teachers and mentors here at Stanford. I will consider myself incredibly fortunate if I manage to step into their shoes at some point in my career. But part of me that wonders if we’re really seeing the full picture as pre-clinical students. We’re being shielded from the “front lines” – the thousands and thousands of primary care doctors who work tirelessly under the strains that our health-care system imposes on private practice physicians. Are we being set up for an unpleasant surprise later on? How can we possibly avoid being part of the 46 percent if we don’t have a good awareness that it exists? Perhaps it’s time to start bringing these questions into the medical school bubble.

Nathaniel Fleming is a second-year medical student and a native Oregonian. His interests include health policy and clinical research. 

Photo by Norbert von der Groeben

Earlier this week, California Governor Jerry Brown signed the controversial “End of Life Option Act,” which will take effect in 2016 and allow medically assisted suicide in the state. The news was the topic of KQED’s Forum yesterday, and Stanford bioethicist David Magnus, PhD, was one of the featured guests.

Magnus noted that the law is likely to affect a very small percentage of the population, and he thinks the debate surrounding it “reflects a much, much deeper problem in how we deal with communication and care at end of life. This isn’t really going to solve that problem…” Another show guest, Toni Broaddus, California campaign director of Compassion & Choices, agreed that more conversation between doctors and patients is needed, but said this can help: “We hope that what part of this law does, in addition to providing relief from those who need it at the end of life [is] create the room and the opportunity for doctors to talk with their dying patients about all of the options…”

The entire conversation is worth a listen.

Previously: How would you like to die? Tell your doctor in a letter, Study: Doctors would choose less aggressive end-of-life care for themselves, Stanford experts weigh in on spate of “right to try” laws for the terminally ill, On a mission to transform end-of-life care and The importance of patient/doctor end-of-life discussions

Preventing falls from windows may not be something that’s on the mind of every parent – especially this time of year. But as the Indian summer continues here in the Bay Area and elsewhere, windows in homes may be left open, leaving kids vulnerable to accidents.

Over on the Healthier, Happier Lives Blog yesterday, Daniel Imler, MD, assistant professor of pediatric emergency medicine, talked about injuries caused by falls, noting that the most common kinds are extremity fractures, traumatic brain injuries, and damage to the cervical spine. After saying that “window screens only offer minimal help,” he also outlined some preventive tips for parents:

Move furniture away from windows and prevent children from climbing over. Locking all closed doors and windows is a great preventative measure as well. If you do open a window safety locks can help keep the window open only 4 inches for safety. Some families choose to install windows that open from the top down on floors above the ground level.

Previously: A young child, a falling cabinet, and a Life Flight rescue, Carseats save lives, but only if kids are buckled in and Rattled by one child’s injury, a whole family becomes accident-prone
Photo by Kalexander2010