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Healthcare and Social Media

Social media has been introduced to the healthcare industry and has made a global shift in how patients and healthcare professionals connect.  Physicians are now utilizing websites such as Facebook, Twitter, Instagram, and Tumblr to make their social media presence known. Most healthcare professionals use these sites to interact with their current and future patients and also to blog their ideas about certain healthcare topics such as birth control and weight loss.  These websites can provide some beneficial information to patients and also encourage dialogue between patients and providers, however if taken out of context, these website can pose some major ethical issues. Some ethical dilemmas that can derive from healthcare and social media sites include the distribution of medical advice via the social network, discussion of private health issues, improper contact with patients, inappropriately diagnosing patients, and misrepresentations of credentials among others (Lee, 2012). 

Such violations can result in disciplinary actions against the physician such as suspension of medical license or revoking a physician’s license all together (Lee, 2012).

A recent study conducted on 48 state medical boards reported that 44 of them have received reports of violations of online professionalism (Lee, 2012). The violations ranged anywhere from physicians asking their patients out on dates, to insulting their patients for their poor healthcare habits.  Other violations were severe enough to breach HIPPA laws such as that of a medical student videotaping a doctor inserting a chest tube into a patient whose face was clearly visible and then posting the video on YouTube (Lee, 2012).

Cases such as these can have major implications on the physicians and can cause them to lose their license to practice. It is important that physicians use better judgment when using social media sites for both professional and personal use. Although the physicians may not intend to cause harm to patients, use of social media can ultimately cause more harm than help.

Reference:

Lee, S. M. (2012). Social media in health care create risks, benefits. San Francisco Chronicle , Retrieved from http://www.sfgate.com/health/article/Social-media-in-health-care-create-risks-benefits-3650284.php

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Developing an Accountability Framework

Recently during my Healthcare Quality class we completed an assignment about accountability in healthcare and the key forces in which accountability is driven by. Accountability in healthcare is defined as “the procedure and process by which one party provides a justification and is held responsible for its actions by another party who has an interest in the action”. (Ransom, Joshi, Nash & Ransom, 2009) After learning about accountability I took the time to research further into the matter. A subject regarding accountability explained the development of and accountability framework. Simply put, accountability is maintained through two mechanisms known as accreditation standards and report cards. The first mechanism; Accreditation, are  standards that are generally maintained by The Joint Commission on Accreditation of Healthcare Organization (JACHO) and the National Committee for Quality Assurance (NCQA) These two organizations have standardized systems for accrediting hospitals and managed care organizations (McGlynn, 1997) . The other mechanism; report cards have been developed to maintain accurate records of hospitals, health plans, and physicians. For instance, information such as hospital mortality rates and procedure specific reports are released as public knowledge which as a result holds these facilities accountable for maintaining quality care for their patients. The most common example of a report card was developed by the NCQA’s Health Plan Employer Data and Information Set (HEDIS) (McGlynn, 1997).

The use of report cards as public knowledge is useful in developing an accountability framework because it allows the public to be aware of the type of care the facility is providing. The information provided in these reports cards requires each facility to be responsible for the information and record keeping for their facility (McGlynn, 1997). Once this information has been made public, the rise in quality will continue due to the facility being under direct comparison with similar facilities. I think the use of report cards to develop and accountability framework is a great idea. This will not only be and comprehensible tool for the public but it will also give mangers of facilities the opportunity to compare and complete external benchmarking quickly and efficiently.

Reference:

McGlynn, E. A. (1997). Six challenges in measuring the quality of health care. Health Affairs , 16(3), 7-21. Retrieved from http://content.healthaffairs.org/content/16/3/7.full.pdf

Ransom, E., Joshi, M., Nash, D., & Ransom, B. (2009).The healthcare quality book, vision, strategy, and tools. (2 ed.). Washington, DC: Health Administration Pr.

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Providing care with minimal benefit

Nurses and doctors in hospital settings are often troubled with having to care for terminally ill patients with no possibility of making a full recovery. These patients are often in the Intensive Care Unit which is a very stressful environment to work in. After working for several months on a patient who shows no progress, some nurses may feel that their effort is going to waste on a patient who should not be in their care. Cases such as that of Terri Schiavo, who remained in the hospital in a vegetative state for over 15 years due to a lengthy court case between family members is a perfect example for this blog. Not only did Mrs. Schiavo require around the clock care, but she showed no signs of improvement and nurses and doctors were constantly under attack when the court case became public knowledge. As a nursing manager or CEO of the hospital it is important to keep the moral of staff members working in such a stressful situation, although it is often a difficult task to take on.

Although it may be difficult for the families to make decisions about the end of life care, I think it is important for families to understand the role of the hospital. Hospitals are not designed to house patients without any possibility of recovery. They were built to treat, cure, and discharge patients that are able to do for themselves. Although I do believe that families should have all the time they need to make the right decisions for their loved ones, I strongly believe that once the doctor has stated there is nothing else that can be done, families should utilize the hospice facilities. These types of facilities are designed to care for patients who are facing end of life decisions. The staff members are trained to provide quality care and help families make the best choices for their loved ones. Families should not look at hospice care as a place that has given up on their loved ones, rather a place that will provide the best possible care for their loved ones in their current state. 

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Doctors withholding medical treatment information

Recently a study conducted by the American Medical Association’s Institute of Ethics revealed that 30 % of more than 700 doctors surveyed stated that they sometimes withhold medical information about treatment options from patients they believe will not be able to afford it (Stanculescu, 2012) . On the contrary to this survey, according to the AMA’s code of medical ethics, physicians have been obliged to assure the release of medically appropriate treatment alternatives, regardless of cost (Stanculescu, 2012). Some of the reasons doctors have begun withholding information from patients is from the fear of being asked to cheat insurance companies so that patients can receive care they are not eligible for. Another reason stems from those doctors whose revenue is tied to managed care companies. However, many doctors who participated in the survey stated that time constraints is the number one difficulty and reason for withholding medical information. Doctors are expected to explain difficult medical information to patient’s who often don’t have the time to comprehend (Stanculescu, 2012).

Although there are doctors who believe in censoring medical information based on a patients inability to pay, there are other medical professionals who believe that the act of withholding information is wrong. These professionals argue that doctors can be wrong about the medical coverage or the patient may have other resources which are unknown by the doctor. It is a known fact that many health insurance plans do not cover liver transplants, however thousands of transplants take place every year through private donations of organizations (Stanculescu, 2012). All in all, these medical professionals should not consider cost when prescribing treatment as finances is not an ethical issue, as patient care is.

I would have to agree that doctors should not withhold medical information from patients. The financial ability or inability to pay for treatment should not be a factor when prescribing treatment to the patient. It is up to the patient to provide the financial resources to pay for the treatment. Many doctors stated that they felt bad if they had to tell a patient about a treatment that they could not afford, however if I were in their shoes, I would rather tell the patient about the treatment and they have a chance to receive the help they need rather than withhold the information and never give them the chance at life.

Reference:

Stanculescu , C. (2012, July 08). Are doctors withholding treatment info?. Retrieved from http://abcnews.go.com/Health/story?id=116722&page=1

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 Patient Perspective

When adverse events or medical errors occur, many physicians feel the need to cover it up and try to move forward with the patient without explaining to them what has happened, what can be done at that time and what will be done in the future to prevent this from happening again. Doctors often have a fear of being sued for medical malpractice after causing a medical error, therefore they never accept responsibility for what has happen to the patient. The problem with this situation is that nothing is done to ensure that this does not occur again; therefore another patient can become a victim of a medical error. Doctors have to be willing to accept their fate and do whatever is necessary to ensure that they are completely honest with the patient. By being honest and forthcoming with the patient, doctors and medical staff can obtain the patient’s perspective which is an important part of treatment.

A patient’s perspective is one of the most important factors when determining whether and adverse event has occurred.  These events are a traumatic time in the life of the patient and it is important to gauge their thoughts about how they are feelings, their thoughts about what has happen, and their opinion about the remaining course of their treatment.

A few years ago, my aunt who suffers from Alzheimer ’s disease was admitted into a skilled nursing facility for rehabilitation after a fall. At that time, she was in the beginning stages of the disease so we were hopeful that once she was able to walk again, she would return home. During her stay at the facility, my aunt was a victim of a medical error. She was given the wrong medication; luckily after several test and visits with the doctor, there was no real harm done to her. The best part about this negative situation is that the facility did not try to “cover-up” the mistake they made. They immediately contacted the next of kin, her primary care physician, and were able to rectify the situation quickly. The facility completed the additional tests that were run as a result of the error free of charge as well as applied other discounts to her care and stay. For these reasons, my grandfather, who is in charge of her care did not sue or threaten to sue as the error was worked out by the facility acknowledging their mistakes. Everyone’s situation is not as fortunate as our family, however giving the patient or patient’s family a chance to make the best decision for their family is a very important factor after and adverse event has occurred. 

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From Patients to Lab Rats

Living in a world where new medications, health care technologies, and medical treatments appear each day, we also have to recognize that new diseases will sprout into existence as well. Once these unfamiliar diseases develop, a lot of research goes into the process of finding a course of treatment or an actual cure. During the research process, there are a series of test, scans, and questionnaires that have to be done to figure out what is going on within a person’s body. This research, regardless of the disease or reason has to be taken with the mindset of the patient’s improvement as the top priority. Sadly, not all patients are treated the same. Some patients who suffer from such rare illnesses are often subject to becoming research subjects. Instead of doctors providing the best course of treatment for the patient to try and maintain their quality of life, they often determine that the patient is not able to be cured and then begin using them as “lab rats”.

Not only does this situation happen in the case of patients suffering from rare diseases but it also happens within of arenas of healthcare. According to the New York Times, medical professionals were used by the Central Intelligence Agency’s (C.I.A.) for the interrogations of terrorism suspects. These medical professionals were assigned to monitor the C.I.A.’s use of waterboarding, sleep deprivation and other methods of interrogation to ensure that they stayed within the limits of the law (Risen , 2010). However, while the medical staff was conducting the monitoring sessions, they turned the detainees into research subjects by helping the agency to calibrate the level of pain experienced by the detainees during the interrogation (Risen , 2010). At this point, the medical professionals made an unethical decision to treat the detainees as research subjects rather than patients.

Regardless of what the medical professionals were summoned to do, they went against their Hippocratic Oath by helping the C.I.A. to commit harmful acts against the patients. They also did not hold true to the portion of the oath which states that would provide care to the benefit of the patient.

References:

Risen , J. (2010, June 07). Medical ethics lapses cited in interrogations. The New York Times . Retrieved from http://www.nytimes.com/2010/06/07/world/07doctors.html

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Organs for Sale...

Many of you have heard of the “black market”. Although it does not have a physical address the black market encompasses the most illegally bought and sold products or services throughout the world.  Examples of products sold on the black market are illegal drugs or weapons that have been smuggled into the country and sold out of the line of sight of government officials and law enforcement. Some countries also endure the service sector of the black market in the form of prostitution. Some may believe the black market is only for the sale of harmful or “bad things” within our country however the black market has been introduced in the world of healthcare as well. Due to the fact that there is currently a shortage of donated organs, the black market has become an answer for desperate healthcare consumers in need of organs for themselves of family members.  One of the most common organs sold illegally in the black market are kidneys (Schulman, 2012). The shortage of these organs has led to many violations of laws for countries all over the world. 

The sale of organs has become so prevalent in some parts of the world that they have even been done for reasons such as the purchase of materialistic things. For example, a Chinese news station reported that a 17 year old resident of China sold his Kidney so he could purchase and iPhone. Sales of organs for reasons such as these have led the black market to profit a total of $75 million dollars a year according to the International Business Times (Schulman, 2012).  Some ethicist believes that the sale of organs puts a value on human life and that in part is corrupting the meaning of human dignity. Others believe that there would be more willing donors if they or their families received some benefits from their donation.

In my opinion, a dollar amount should never determine the value of a human life. If we begin to sale organs, then only the healthcare consumers who could afford it would be able to receive the organs. This would leave out the poor people who are in need of help as well. People also may become desperate for the sale of organs and start committing crimes in order to sale the organs of others for a profit. Putting a dollar value on organs will open up a plethora of unethical activities within the field of healthcare and therefore I am against the sale of human organs.

 Reference: 

Schulman, M. (2012). Kidneys for sale: A reconsideration. Retrieved from http://www.scu.edu/ethics/practicing/focusareas/medical/kidney-sale.html

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VIP vs. General Population 

Although the baby boomer generations of the 1960’s are in the retirement stages of their lives, it seems that some of the younger population has taken on the role as the baby boomers of today. These elite groups of baby boomers are among the wealthy of the population ranging from movie stars to singers and young entrepreneurs.  Recently, one of Hollywood’s wealthiest couples gave birth to a beautiful baby girl at New York's Lenox Hill Hospital (Grossberg, 2012). Singer, song writer, and actress Beyonce and music mogul rapper Jay- Z Carter were yet again in the spotlight; however they were not there in good spirits. Both mother and father were in the spotlight due to accusations of causing unpleasant birth for other parents within the hospital. New mothers and patients of the hospital have stated they were mistreated by the hospital staff and the Carter’s security team. Some parents claimed they were moved to different rooms, asked to leave the neonatal ICU and others claimed their birthing and breastfeeding classes were canceled due to the birth of baby Carter. Contrary to the reports, hospitals officials denies the claims of the treatment to the other mothers and further denies the claims that the Carter family rented out a section of the hospital for their personal use (Grossberg, 2012).

This article is one of many that surface when hospitals are caring for wealthy patients. Examples such as the birth of baby Carter promote ethical issues that hospitals have to deal with every day. However, not only do famous patients receive special treatment, hospitals also are accused of providing elite care for patients such as financial donors of the hospital, trustees’ family members, and board of trustee members. Although it is important that the privacy of any patient is protected, every patient should be treated equally when seeking care regardless of their social status. Therefore if hospitals are making special arrangement for wealthier patients, I believe that these hospitals need to be held accountable and policies need to be implemented to ensure that this does not continue to happen.

References:

Grossberg, J. (2012, January 09). Retrieved from http://today.msnbc.msn.com/id/45934223/ns/today-entertainment/t/hospital-denies-beyonce-rented-whole-floor-birth/

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Higher quality equals higher cost…

Hospitals strive to provide a high standard of quality when providing care to their patients. Many hospitals are working to revamp their quality improvement standards by becoming patient centered and advancing the patient experience. Millions of dollars are going into hospital renovations, new technology, training programs for personnel and new treatments for patients suffering from terminal diseases such as cancer, HIV, and heart disease. With the advancements being made to the quality of care patients are receiving, one has to wonder what the effect of higher quality will have on the cost of patient care, after all someone has to foot the bill. For example, heart disease is one of the leading causes of death in the United States therefore researchers and cardiologist have made and continue to make advancements in the study of treating, preventing and curing patients suffering from the disease. Over the years the treatment of heart disease has evolved from oxygen and morphine to cardiac catheterizations, angioplasties, and the placement of a medicated stent. The cost of these treatments has also evolved from hundreds of dollars to thousands of dollars.

However, the advancing of treatment is not the issue. The problem lies within the organization where the treatments take place. Two hospitals located in the same city can charge different amounts for the same treatment just because they are ranked higher in quality than the other. Although the service that you receive at one facility is exactly the same as another, hospitals will charge more to cover the cost of the patient experience.

Therefore, one has to wonder if the patient experience is worth the added cost of the service. Does a better hospital experience really help the patient’s recovery process? After volunteering at several locations where patient experience was a priority and facilities where patient experience was not so important, I can agree that higher quality of care does add to the cost but it is well worth it. As a patient, it is comforting to know that the care you receive is centered on you. The healing process is also easier when the environment is comfortable, the staff recognizes the unique needs of individual patients, and the doctors treating you are highly recommended in their field.

Reference:

Brown , D. (2009, July 26). As health-care quality rises, so does price. The Washington Post . Retrieved from http://www.washingtonpost.com/wp-dyn/content/article/2009/07/25/AR2009072502381.html?sid=ST2009072600012

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Death With Dignity

I recently read an article in the New York Times regarding a family who faced a challenging time in their lives. The article described the life and death of a 60 year old father and husband who taught at a day care center. The man was diagnosed with amyotrophic lateral sclerosis also known as A.L.S. or Lou Gehrig’s disease just two years prior to his death and according to his wife; he was not able to die in the manner he has wished. His wife also stated that her husband wanted to have the option to end his life but did not because “death with dignity” law had not been passed in the state of Massachusetts.  A.L.S. is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. This terminal illness has no course of treatment or hope of recovery.  Before death, the disease can leave the patient totally paralyzed.

The “death with dignity” act was passed in both Oregon in 1997 and Washington in 2009 giving patients suffering from a terminal illness with no hope of recovery the right to receive a lethal medication from a physician to voluntarily end their lives. The wife of the Massachusetts man has hope that this law will be passed in her state so no other family has to go through the same painful death as her husband. However, Catholic’s heavily populate the state of Massachusetts and are opposed to the direct, intentional, and purposeful taking of a human life. Therefore if the law ends up on the ballot in November, advocates for the law may have a difficult time retrieving votes.

This law poses and ethical dilemma between pro life advocates and death with dignity advocates. Pro life advocates believe that the passing of voluntary killing will promote involuntary killing in the future. Whereas dignity advocates believe that with proper restrictions on the drug and qualifications to receive the drug, patients will have the right to die with dignity and peace.

Like many people, I am on the fence about passing the law. Taking the life of a human whether it’s voluntary or involuntary is still ultimately ending a life, and that goes against everything many of us have been taught. Who are we to decide when it’s time to die? Does this mean we are trying to play God or any other higher being one may serve? For now, I will remain on the fence about the decision, for one may never be able to decide unless we are put into a situation such as the wife and husband of Massachusetts.

Link to New York Times Article:

http://newoldage.blogs.nytimes.com/2012/05/29/massachusetts-debates-death-with-dignity/?ref=health

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What is quality in healthcare?

There is no single definition of quality as it can be defined differently depending on the situation it pertains to. However, there are some common factors that are universal when it comes to measuring quality regardless of the entity.  For instance, there are different grades of quality in relation to products, services and customer experiences. Each element of quality can then be broken down into different factors. For example, the quality of a product such as food can be determined but the look, feel, smell, and taste of the item. The presentation of the food is the first impression, whether the food looks and smells edible as well as whether the food is cooked to the right temperature will affect the quality measurements drawn by the consumer.  Another factor that affects the quality would be the service rendered. Sticking with the food example, the service will be an important part of the quality test. Consumers want to know that there food was handled with clean hands and prepared on clean surfaces while simultaneously have fast service with exceptional servers. Finally, the over customer experience has a tremendous effect on quality.  Each element has to flow with one another to create a positive customer experience. For example, if a restaurant has incredible food but the service from their staff is horrible and the wait times are too long, the restaurant will receive poor quality reviews from consumers. For this reason, it is important for restaurants owners to put a emphasis on consumer satisfaction with the food, the service and the environment in which they operate.

The same elements of quality go for the field healthcare. Within healthcare, quality of care is the degree to which health service for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (Ransom, Joshi, Nash & Ransom, 2009).  Healthcare affiliates alike agree that healthcare should be safe, effective, efficient, timely, patient, centered and equitable (Ransom, Joshi, Nash & Ransom, 2009).  These six elements can have a drastic affect on patient satisfaction and the quality results within the hospital.

Within my internship during my undergrad experience I got a chance to work with the department of volunteer services at a hospital here in Orlando. Before I became an active intern, I did not realize how much volunteers actually contributed to the overall quality of the hospital. The director of volunteer services along with hospital administration has changed the duties of an active volunteer. As a volunteer, you are taken through a process which ensures that you are first and foremost focused on patient centered care. Your process includes orientation, accountability statements, trainings, and observations to ensure that you are helping the patient have an overall great customer experience. With all of these steps you are taught to tackle the 3 universal factors of quality, delivering a great product with impeccable service while simultaneously improving the customer experience. With that being said the quality of healthcare for patients at that particular hospital have skyrocketed simply because administration understands the need for quality and the affects it can have on the hospital as a whole.

Reference:

Ransom, E., Joshi, M., Nash, D., & Ransom, B. (2009). The healthcare quality book, vision, strategy, and tools. (2 ed.). Washington, DC: Health Administration Pr.