Category Archives: technology

Worrying ourselves sick

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You have a headache that won’t go away. In search of more information, you Google your symptoms and discover you might have eyestrain or tension. Or food allergies. Or meningitis. Possibly even a brain tumor.

How can the average person make sense of all the health information available on the Internet?

Often they can’t, and it may be to their detriment, suggests an American Medical News article outlining the increased anxiety some doctors are seeing among patients who research their symptoms online.

From the article:

The increase in using the Internet to self-diagnose comes at a time when many physicians are encouraging patients to be more involved in their medical care to help improve health outcomes, particularly for chronic illnesses. Some health professionals say researching medical concerns on reputable websites can be a positive step for patients, because it helps them become more educated about their health. In doing so, patients sometimes accurately diagnose themselves, particularly when it involves common illnesses, such as appendicitis and strep throat, doctors said.

More often, though, the large number of health websites, some of which are unreliable, mislead patients into thinking they have a medical problem, say health professionals. They say the outcome frequently is heightened patient anxiety and unnecessary screening tests that can result in medical complications. Cyberchondria also demands that physicians spend more time in office visits as they discuss why the individual thinks he or she has a particular disease, educate the patient on why that diagnosis is unlikely and then determine the true cause of the symptoms.

I can attest to some of this firsthand. For the past decade I’ve belonged to an online lymphoma discussion group. Lymphoma is one of those cancers whose symptoms are often vague. It isn’t easy for the layperson to distinguish between fevers and enlarged lymph nodes that might be a sign of lymphoma vs. fevers and enlarged lymph nodes that are a sign of something more benign, such as an infection.

On a regular basis, people join the group who haven’t been diagnosed with lymphoma (often they haven’t even had a biopsy yet) but are worried sick they might have it because of what they read on the Internet. Most of the time their fears turn out to be unfounded. In fact, some of the staunch old-timers in the group have started issuing a standard line of advice to these folks: Get off the Internet until you’ve had a chance to talk to your doctor and/or have a formal diagnosis. Some are reassured by this but others aren’t, and their distress can be painful to see.

A little bit of worried-well behavior is not necessarily bad. Sometimes it can prompt people to take necessary action. Sometimes the patient even turns out to be right. At what point, however, does it cross the line?

A question worth asking is whether cyberchondria is just another form of the classic hypochondria, amplified by easy access to online health information. Academic studies on cyberchondria seem to be few and far between. (When I conducted a search via the U.S. National Library of Medicine and National Institutes of Health, I found exactly five published reports.)

The most recent study appeared last month in the Journal of Anxiety Disorders. It explored whether health anxiety is linked to the online use of health information and concluded that yes, there’s an association and that individuals who already have underlying anxiety about their health can become worse the more time they spend researching health information online.

Perhaps this is at least partly a matter of degree. It’s one thing to worry; it’s quite another for the anxiety to escalate into full-blown hypochondria, which can become so obsessive as to interfere with careers, relationships and quality of life.

Among those interviewed by American Medical News was Dr. Rahul Khare, an assistant professor in the Department of Emergency Medicine at Northwestern University Feinberg School of Medicine in Chicago. Dr. Khare said he’s seeing an increase in cyberchondria, especially among young adults who show up in the emergency room after researching their symptoms online.

Patients are “way more knowledgeable” than they used to be, he noted. “But too much information without proper guidance can cause anxiety or fear.”

I don’t think we’d want to return to an era when patients were told a minimum of information and paternally advised not to worry. The challenge these days is just the opposite: learning how to sift through vast amounts of data and figuring out which pieces are relevant and which aren’t. It gives me a whole new respect for what it takes to learn how to think like a doctor.

Distracted at the bedside

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The patient was seriously sick and in the hospital. The doctors had doubled the dose he was taking of a blood-thinning medication to reduce his risk of stroke. But after evaluating his case a couple of days later, they decided to temporarily discontinue the medication and obtain an echocardiogram to make sure the drug was still needed.

A doctor-in-training took the order. As she began entering it in her smartphone, she was distracted by a text message about an upcoming party. She texted a response, the medical team moved on to the next patient… and the order to stop the medication was never completed.

Four days later the patient was rushed into emergency open-heart surgery to stem internal bleeding caused by too high a dose of blood thinner.

This real-life case appears in the online Morbidity and Mortality Rounds of the U.S. Agency for Healthcare Research and Quality and offers an alarming example of an issue that’s becoming increasingly prevalent in health care: the distractions and multitasking associated with information technology.

If the news coverage lately is any indication, there’s reason for growing concern.

The AHRQ case report is but one instance. Although the patient fortunately survived, it was at the cost of a potentially risky emergency surgery and lengthier hospital stay.

A recent article in the New York Times cited several other examples. In one case, a neurosurgeon apparently got distracted while using a wireless headset to make personal calls in the OR, and the patient wound up partially paralyzed. Other examples included a nurse checking airfare prices online during spinal surgery, intensive care unit staffers using hospital computers to visit eBay and Amazon, and technicians texting or talking on their cell phones during surgery.

It had to happen, I suppose. Smartphones, texting, tablets, Twitter and the like are such a common part of everyday life that it’s inevitable they would spill over into the health care setting. What’s concerning are the implications for patient care, where the stakes are so high.

From the New York Times article:

“You walk around the hospital, and what you see is not funny,” said Dr. Peter J. Papadakos, an anesthesiologist and director of critical care at the University of Rochester Medical Center in upstate New York, who added that he had seen nurses, doctors and other staff members glued to their phones, computers and iPads.

“You justify carrying devices around the hospital to do medical records,” he said. “But you can surf the Internet or do Facebook, and sometimes, for whatever reason, Facebook is more tempting.”

“My gut feeling is lives are in danger,” said Dr. Papadakos, who recently published an article on “electronic distraction” in Anesthesiology News, a journal. “We’re not educating people about the problem, and it’s getting worse.”

Patient safety is clearly the most critical issue, but technology may also be exacting a toll on the human connection so essential in health care. Josephine Ensign, a nurse practitioner and blogger in Seattle, last week described an encounter outside a hospital elevator with three employees absorbed in their smartphones.

“Their smartphones collided, and they looked up dazedly, sheepishly apologizing as they stepped on to the elevator,” she wrote. “Then all three resumed communing with their smartphones.”

She writes:

When my father was in the hospital last year, I noticed that his nurses spent much more time on the mobile computer stations outside of his room than they did in direct patient care. He had some terrific nurses, and they told me that they hated how much time they had to spend in checking and entering patient data in the computers. The legitimate use of technology in health care is all in the name of patient safety. But at what cost does it come in terms of the human interaction necessary as the core of all healing?

I’m not sure what the answer should be. Outlawing mobile devices and computers is simply not going to happen; after all, there’s a worthwhile place for technology in health care. And when technology is done well, it can enhance care and increase safety, observes Dr. John Halamka, chief information officer at Beth Israel Deaconess Hospital in Boston and chief information officer and dean for technology at Harvard Medical School.

The real issue seems to lie in the day-to-day details, Halamka writes in a commentary accompanying the AHRQ case study. “Mobile devices are becoming an increasingly important part of the clinical workday. Leveraging the benefits while applying technology and policy risk mitigations will result in their optimal use.”

Read more about it here and here.

Photo: Wikimedia Commons

Trend-spotting in health care

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We’re still a few weeks away from 2012, but apparently it’s not too soon to take a look at some of the trends shaping what happens in health care next year.

Pricewaterhouse Cooper LLC issued a report last week on the top 12 trends to watch in 2012. Their summary of the findings:

In 2012, health industry organizations will connect in new ways with each other and their consumers as they wade through economic, regulatory, and political uncertainty. Some are stepping forward in cooperation; others are rewriting the rules of competition.

Among the key issues, we’ll see value move from theory to reality, investments ramp up in informatics, the effects of drug shortages, insurers gear up to compete in a new insurance exchange marketplace, pharma companies slim down and healthcare increasing its social media presence.

That’s the view from 90,000 feet. But what does it all mean for the ordinary person? Here’s how some of these trends might show up at the level of the patient/consumer experience:

- Expect to see information technology, i.e. computers, become much more widespread, from the hospital room to the exam room.

- Out-of-pocket costs for health care will continue to rise, forcing many people to think harder about whether to seek care at the doctor’s office or the emergency room. In a survey by Pricewaterhouse Cooper, nearly half of the respondents said they had decided to skip a doctor visit or prescription drug in the past year because of the cost, and one in 10 had done so at least five times.

- Value will be important. Health organizations are under growing pressure to deliver quality, affordable care that keeps their patients satisfied; those that fall short could wind up being financially penalized. Patients can expect to see more surveys asking them for their opinion.The real test, of course, will be whether patient preferences lead to meaningful changes in how care is provided.

- Look for care delivery systems to become more integrated. There are many incentives to do so: efficiency, savings and better coordination of care. According to Pricewaterhouse Cooper, health insurers invested $2 billion last year to acquire or align with physician groups, clinics and hospitals. For patients, there could be more confusion in the short run as the players reposition themselves on the chessboard. In the long run, though, it’s believed that care will be better when it’s less fragmented. Whether this actually will become the case remains debatable; the concept of “accountable care organizations,” contained within the 2010 health care reform bill, has plenty of critics.

- A retail spin is coming to the health insurance market. States are expected to start certifying health plans in October 2012 for participation in health insurance exchanges, allowing consumers to shop for their own health care coverage. This could be a real benefit for people who aren’t otherwise able to obtain affordable health insurance. But the option could be underutilized if consumers don’t have enough information or education to compare plans and make good decisions.

- Is your hospital or clinic on Facebook? If not, they risk getting left behind. The social media are emerging as an important way of reaching out to patients and the community. One-third of the respondents in the Pricewaterhouse Cooper survey – and half of the respondents under age 35 – said they had used social media channels to connect with health care organizations or with other people with shared health interests.

Euro RSCG, a global marketing and communications agency (and the same company that forecast the concepts we now know as corporate social responsibility and helicopter parenting), last week issued its own trend outlook.

The top five trends identified: a rising use of medical tourism, telemedicine and personalized medicine; an increasing worldwide incidence of diabetes; and a rise in cyberchondria, or the tendency of people to Google their symptoms and misdiagnose themselves. According to Euro RSCG, all five of these trends signal a cultural shift in the attitudes, beliefs and values that shape how we think and talk about health care.

Photo: Wikimedia Commons

The wisdom of the crowd

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After two trips to the pediatrician this past May, Deborah Copaken Kogan’s 4-year-old son, Leo, was still sick. He had a rash that was worsening. His face began to swell.

Kogan posted a picture of Leo on Facebook, and within minutes she received a phone call from a friend who’d seen the photo and recognized what was wrong: Leo had Kawasaki disease, a rare condition that causes the arteries to swell.

How did Kogan’s friend manage to make the correct diagnosis? Because her own son had been hospitalized a few years earlier with the same thing.

There’s a certain amount of power in bringing people together to share their health care experiences and learn from each other. Kogan’s story isn’t the first time a serious health condition has been diagnosed with the help of the social media; earlier this year a 4-year-old child in the U.K. was diagnosed with leukemia on the basis of a photo his father posted on Facebook.

These are two of the more dramatic examples of what can happen when health information is crowd-sourced. More typical, though, is the day-to-day sharing that takes place as people compare notes, seek advice and swap stories about their own experiences – and in doing so, enlarge their horizons in ways both helpful and valuable.

I bring this up because October is Health Literacy Awareness Month. Much attention will be focused this month, and rightfully so, on the difficulty of being a low-literacy patient in the high-literacy world of health care.

There’s another form of literacy, though, and it’s not defined by the ability to read a prescription label or follow the doctor’s directions. It’s the literacy contained within the experience of being a patient, of living with a chronic or serious condition, of being the parent of a sick child, and learning how to navigate that experience with competence.

Jenn Sprung, who blogs at Cleverly Disguised as Cake, received only minimal information from the geneticist she and her husband consulted when one of their children was born five years ago with a rare genetic disorder. The social media were pivotal in educating her to help her son, she writes:

These are places to go for support, when people’s problems are not being addressed by their medical teams. What they search for is understanding, satisfactory answers to questions they have not already found. Sometimes, with a less common diagnosis, the Internet is the only place one may find support for particular conditions.

Among the online cancer forums, it’s common to see participants asking questions that get right to the heart of what the experience is really like: “I have a sore throat from radiation therapy. Has anyone else had this? How long will it last?” “Where do I find out more about clinical trials?” “My oncologist has recommended a stem cell transplant. What should I expect?”

“I want to know people’s opinions, experiences, successes, losses,” a cancer forum participant wrote recently. Doctors don’t always provide the detailed information many people need, someone else wrote. “Most oncologists aren’t really good at dealing with side effects or just say ‘that’s normal’ when people need advice or a prescription that will help alleviate the symptom.”

A study published last year in the Journal of Internet Medical Research reinforces that the benefits of crowd support go beyond the “feel-good” domain. The study’s authors surveyed about 1,300 people who participated in PatientsLikeMe, an online personal research platform, and concluded there was a wide range of benefits that was highest among those who used the site most extensively.

Among the findings: 72 percent of the respondents said the site was either moderately or very helpful in understanding symptoms they were experiencing, and 52 percent found it helpful in understanding side effects of their medical treatment.

The jury is still out on how to balance these benefits against potential harm from online misinformation.

Overall, though, the authors saw results that were mostly positive:

Patients reported making more informed treatment decisions as a result of using the site, particularly around managing side effects. Members felt that they were managing their symptoms better and were better able to communicate with peers experiencing the same problems.

It seems patients can indeed become more knowledgeable and more engaged in their care - more literate at being a patient, in fact - when they connect with the wisdom of the crowd.

Photo: Wikimedia Commons

FarmVille, Angry Birds and other online compulsions

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FarmVille, I am so over you.

Once upon a time I couldn’t get enough of you. Planting all those virtual crops, watching them grow and raking them in at harvest time was – there’s no other word for it - addicting.

I checked obsessively on the progress of my online farm. I racked up the points as if they were $100 chips in a life-or-death poker game. I confess to becoming rather greedy in the online store. I wanted an apple orchard! A barn and silo! Heck, two barns! Flocks of chickens and ducks! The pony my parents wouldn’t let me have in real life!

Alas, the novelty soon wore off. I visited my virtual farm less and less often. My crops withered and died. I let the fields go fallow.

All told, my fascination with FarmVille lasted about three months – pretty brief, considering the compulsive draw of so many online activities these days.

I had mostly forgotten about my FarmVille phase until I came across a study last week about the compulsive behavior of many smartphone users. The study appears in the latest issue of the Personal and Ubiquitous Computing journal and examines what the authors dubbed the checking habit: “brief, repetitive inspection of dynamic content quickly accessible on the device.”

Among the findings: Many smartphone users frequently and repetitively check their phone each day, more out of habit than any real need to do so. The average was 34 times a day. These visits generally lasted less than half a minute, but they often were a gateway behavior for using other smartphone applications and seemed to lead to greater overall smartphone use over time.

Many people have wondered, and rightly so, whether Internet and mobile technology are giving rise to a whole new category of addictive behaviors.

Anna Kendrick, star of “Twilight,” confessed earlier this year to an obsession with Angry Birds and wondered whether she needs therapy to break herself of the habit. In a guest post this week at Kevin, MD, Dr. Dinah Miller, who blogs at Shrink Rap, analyzed her own compulsion to play Angry Birds and concluded the game is fun, easy to play yet challenging enough to keep the user from becoming bored. Besides, she writes, “It clears my mind and occupies my time in a relatively angst-free way.”

Is it accurate to characterize online games and applications as addictive? Internet gaming doesn’t formally qualify (yet) as a psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV. Calling it an addiction may be doing a disservice to alcohol, gambling and other dependencies that are severely disruptive, put the user’s health at risk and are sometimes fatal.

The authors of the smartphone study stopped short of describing frequent checking habits as an addiction. The majority of the smartphone users who were studied felt the habit was annoying rather than problematic, they wrote.

The researchers also offered this perspective on being hooked on technology and Internet use:

Recent theories suggest that [I]nternet and media “addiction” is rather a struggle to maintain effective self-regulation over problematic habit-driven behavior. In other words, addiction and habits are parts of the same continuum, but what we colloquially describe as Internet or media addiction is better described as overuse due to loss of self-control.

It’s entirely possible, of course, for someone to become so focused on checking their smartphone or playing Angry Birds that other aspects of their lives are neglected. Sometimes the best course of action is to do what Dr. Phil famously advised a FarmVille-obsessed mom who couldn’t stop: “Unplug it and walk away.”

The convenience factor

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There’s a debate brewing in the Twin Cities metro area about how many radiation therapy facilities are enough.

For those who may have missed it, a story in the St. Paul Pioneer Press last week outlined the details: There’s a moratorium in 14 Minnesota counties, mainly in the metro area, on construction of new radiation treatment centers for cancer patients, ostensibly to prevent overbuilding and to hold down costs. But new facilities continue to be built in communities just outside the moratorium zone, raising questions about the validity of the argument for no new construction.

An excerpt from the article:

Critics contend the new centers amount to an argument for repealing the moratorium since they show patient needs in the metro area aren’t being met by existing centers.

“To me, it raises questions as to what is the basis for the moratorium in the first place,” said Dr. Tom Flynn of Minnesota Oncology, a physician group that was trying in 2007 to build a cancer center in Woodbury. “The important issues to address are patient access and choice, which the moratorium interferes with.”

The ban serves an important purpose, supporters say, in helping the state avoid unnecessary duplication of costly services that might ultimately drive up health costs and the premiums people pay for health insurance.

There are multiple issues entangled here: cost, consumer choice, availability of services and the free-market system embraced by the American economy. I’m going to single out only one, however – the convenience factor.

How important is it for health care services to be convenient for patients? How should we define “convenient”? Does it make a difference in outcomes when health services are more convenient for people to use? And finally, do convenience and access amount to the same thing or is there a difference between the two?

Radiation therapy facilities offer an interesting case study in these dynamics. Therapeutic radiation is a critical tool in successfully treating cancer, so it’s obviously important to ensure patients have access to this form of advanced care.

The Pioneer Press article includes an interview with a patient, Bonnie Lachman, who recently started receiving radiation treatment at a new facility near her home town of New Richmond, Wis.:

The center opened this month, and Lachman says she much prefers the three-mile drive to the new facility to the 30-mile trips she would otherwise make every day to the Twin Cities for care.

“This is a piece of cake,” Lachman said last week following the second of 33 radiation treatments she’s scheduled to receive in the coming weeks. “I was very happy to come here.”

It’s not hard to see why. Therapeutic radiation must be administered five days a week, usually for four to six weeks and sometimes longer. It can be a genuine hardship when patients have to travel for treatment, especially when they aren’t feeling well or perhaps can’t drive themselves.

To what extent, however, can patient convenience be used as one of the justifications for new facilities? The PiPress article notes there’s at least one radiation treatment center within a 20-minute drive for virtually everyone who lives in the metro area. For sure, it’s convenient, but is it essential, given the enormous price tag of building, equipping and maintaining these services?

The question takes on even more weight when you contrast this situation with rural Minnesota, where these specialized facilities are few and far between. The radiation therapy service at the Willmar Regional Cancer Center, for instance, is the only one within at least a 60-mile radius. For some patients, it’s not only an issue of an inconvenient two-hour round trip five days a week; it can also be about overall access to care. Are there patients who opt to forego radiation therapy because the travel is too much of a burden? I’m fairly certain there are.

There’s evidence that patient convenience indeed plays a role in how people seek health care or adhere to a medication regimen. A study published in 2008 in the Health Informatics Journal, for instance, supports the use of mobile technology to make it easier and more convenient for chronic diseases to be well-managed, especially among populations that are underserved. Other studies have tied the convenience factor to overuse of the emergency room, the rise in the number of retail clinics and the development of new and simpler drug regimens.

Ultimately, then, convenience matters. It seems to especially matter when there isn’t enough of it. What’s unclear, though, is whether there’s such a thing as too much convenience. Is there a breaking point at which the emphasis on convenience starts to detract from wise use of resources? These are questions that consumers and policymakers alike ought to be pondering more closely.

Photo: Wikimedia Commons

Putting radiation in perspective

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The images of the destruction in Japan from last week’s major earthquake and tsunami have been horrifying. But as wrenching as they are, at least we can see them. Not so with radiation that may be leaking from a quake-damaged nuclear power reactor.

Radiation is like a stealth warrior. You can’t see, hear or feel it. Those with the highest and most immediate exposure, such as nuclear power plant workers, tend to show the effects within hours, days or weeks. But for most of the population, the health effects from lower-level exposure might not manifest themselves until 20 or 30 years later.

Rather scary? Well, yes. Here are a few facts, however, to help put things in perspective: The radiation risk to the Japanese public is low, at least for now. People can limit their exposure further simply by staying indoors. The health risk from radiation exposure depends on the type of radiation, the amount and length of exposure, as well as one’s cumulative lifetime dose.

From a New York Times article explaining the potential effects of radiation exposure from the disaster in Japan:

The more likely risk for the public is that of low-level exposures, which can increase the risk of cancer many years later. Again, the danger depends on the length of exposure and what types of radioactive materials to which one is exposed.

Some radioactive materials are readily absorbed by the body and linger there. Iodine, for example, goes to the thyroid gland, and strontium to the bone, and they emit radiation inside the body that over time can lead to cancer or leukemia. Other radioactive materials, like tritium, pass quickly through the body.

The article also notes that one of the main long-term risks isn’t from direct exposure per se. It’s from radioactive fallout that can enter the food chain, contaminating streams and offshore ocean water, for instance, or orchards, vegetable gardens and pastures.

Although many people are frightened of radiation, there’s an important point to keep in mind: We’re all exposed to radiation every day, primarily from natural and background sources. And for the average American, the single biggest source of exposure isn’t from nuclear power plants or clouds of radioactive fallout; it’s from medical imaging. Experts have calculated that CT scans and nuclear medicine account for more than one-third of the total radiation exposure and three-fourths of the medical imaging radiation exposure among the U.S. population.

How much radiation do you think you absorb on a daily basis? Here’s an online calculator from the EPA that helps you estimate your risk. (You’ll need to know the local altitude; Willmar is about 1,100 feet above sea level.) You can also keep track of your lifetime dose of medical-related radiation with this calculator from Xrayrisk.com, a site sponsored by the American Society of Radiologic Technologists. It includes the basics such as chest X-rays and dental X-rays, along with CT scans, nuclear medicine and interventional procedures. For more information on therapeutic radiation involved in cancer treatment, click here.

Photo: Associated Press

Paging Dr. Google

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Three years have gone by since Time magazine published a now-infamous essay about patients who Google. According to the author, Dr. Scott Haig, Googlers were among the worst possible patients, armed with “a barrage of excruciatingly well-informed questions” and spewing sentences “burst with misused, mispronounced words and half-baked ideas.” His disdain couldn’t have been more clear.

Unfortunately Dr. Haig committed the classic logical error of assuming “this patient is a Googler, this patient is obnoxious, therefore all patients who Google are obnoxious.”

But the genie was already out of the bottle. Although many information-empowered patients were quick to denounce him, more than a few physicians must have privately applauded Dr. Haig for giving voice to some of their own misgivings about patients’ use of the Internet.

The medical world has always been rather ambivalent about symptom-Googling and online research by patients. Will patients overreact or draw the wrong conclusions from what they read online? Will they show up in the exam room with a stack of printouts? Most of all, will it alter the doctor-patient relationship when patients have better access to information?

The tide, it seems, might be slowly beginning to turn on this issue. Not too long ago, Time magazine printed another essay about patients who Google – only this time, it was titled “Googling symptoms helps patients and doctors.”

Oh, sure, the cast of characters included a supercilious, condescending, eye-rolling intern and nurse. But guess what? It wasn’t the patient who was the problem, writes Dr. Zachary Meisel: “The real problem was with my team: we weren’t well equipped to deal with her online homework – and it became a distraction.”

Dr. Meisel writes:

… To debate whether patients should or should not Google their symptoms (which a surprising number of doctors seem to enjoy engaging in) is an absurd exercise. Patients already are doing it, it is now a fact of normal patient behavior, and it will only increase as Internet technology becomes ever more ubiquitous. The average Joe has more health information at his fingertips – both credible and charlatan – than all the medical libraries ever built put together. So the real question is, What can professionals do to translate this phenomenon into better health for their patients and the public?

Hallelujah.

Although health care professionals will probably continue to struggle with this for many more years, there at least is a growing recognition that the Internet, when used appropriately and effectively, can be a powerful tool for patient care.

But what this entire debate seems to be missing is the significant number of Americans who don’t even have access to online health information, let alone the wherewithal to become Googlers.

The Pew Research Center recently released a report examining Americans’ information-seeking behavior online, and the results are concerning. Among the findings: People of color, people with disabilities, older adults and adults with limited income and education are among the least likely to obtain health information online. Among adults with a college degree, for instance, 93 percent of those surveyed said they went online for health information; for those who had less than a high school education, it was 38 percent.

Those who had broadband were more likely to go online than those who had dial-up access. Rural respondents also used the Internet at lower rates than either urban or suburban residents.

There’s already a health literacy gap between those who are well educated and those who are less so. Health disparities among Americans who are minority and poor have been well documented. Now we also have a growing health information gap between the Internet haves and have-nots.

Which should we worry about more: the fact that patients have access to Google and might misuse it, or the fact that hundreds of thousands of people are disadvantaged by not having online access at all?

Photo: Wikimedia Commons

Techno seniors

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This year for Christmas, my siblings and I gave our dad a Kindle. Apparently we aren’t alone in wanting to introduce technology to older parents to help make their lives easier and more enjoyable.

It was with a great deal of interest that I read this article from the New Old Age blog at the New York Times, outlining some of the issues for older adults in choosing, using and becoming adept with the many forms of digital communication.

It makes an important point: Just because someone is older doesn’t mean they’re unable or unwilling to learn something new. (Dad wanted a Kindle and even helped pick out the one with the features he liked best.) The main thing, according to the article, is to make it worth their while:

Experts say the key to making tech work for Mom and Dad is not to buy the newest cool thing, but to look for a device or software that fulfills a basic need, that does something they particularly want to do. And it’s helpful if the learning curve involves an element or two already familiar to them.

The writer offers several examples: for instance, Skype’s video calling service that allows older parents who no longer travel to connect with their family for the holidays.

As is so often the case, the comments in response to the article are almost as illuminating as the article itself – especially the responses from readers who objected to the ongoing stereotype of older adults as technology-resistant and unable to learn. “Are you telling me my brain will stop working as soon as I reach the age when you youngsters decide to patronize me?” one person asked.

The teensy keypad on my dad’s new Kindle brings up another issue: the manufacturers’ apparent blindness to engineering, design and marketing that’s user-friendly to older consumers. How is someone with arthritis or vision impairment supposed to use those little bitty keys? “The tech industry done a rotten job of selling their products, both hard and soft, to people over 50!” one of the New York Times commenters wrote. “How can we older folk get to know what is available, let alone how to use it, if no effort is made to try to sell to us?”

Perhaps older people simply have a more realistic, or utilitarian, perspective on technology and are less likely to be wowed by something simply because it’s new. This lesson was driven home rather bluntly at the GeriPal geriatrics and palliative care blog, where a study on the benefits of telemonitoring for patients with heart failure was recently analyzed. The study found that telemonitoring made no difference in outcomes for these patients, prompting the blogger to ask, “Is all this enthusiasm for telemonitoring justified?”

Well, yes and no. When technology falls short, sometimes it’s because it isn’t being used in ways that are most effective. On the other hand, adopting new technology for the sake of newness doesn’t automatically guarantee it’ll be helpful.

I suspect that for many older people, having the latest electronic toy just isn’t a priority. What tends to matter most for them is whether a new gadget will improve their quality of life. Deliver something they can use and enjoy, and they’ll adapt with minimal trouble, the same as any other age group. Come to think of it, this is a standard more people should follow, regardless of how old they are.

Photo: Wikimedia Commons

Into the tunnel

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So far, I’ve managed to make it through life without needing to undergo a magnetic resonance imaging scan.

I’ve heard the experience can be rather, uh, claustrophobic. Although I’m usually OK with confined spaces, I’m not sure I’d like the sensation of being enclosed in the noisy metal tunnel of the MRI machine.

Multiply the “not like” factor by 10 times or so and you might have an experience like this one described by Dr. Allen Roberts, an ex-Marine, emergency room doctor and blogger from Texas who goes by the name of GruntDoc.

Dr. Roberts recently needed an MRI of his shoulder. He didn’t think the scan was going to be a big deal. He was even rather amused when the technologists “gave me a little black bulb ‘to squeeze if there’s a problem.’”

Then came the trip into the tunnel:

…The first thing I thought of, looking at the fiberglass tunnel lining with two light strips embedded in it was HAL from 2001, which is weird. Then I realized my heart rate was up, my hands and feet were sweating.

“Wow, this isn’t going to happen to me, is it?” was the higher-brain function; “get me the heck outta here” was what my midbrain was yelling. I’m a rational guy, so I can think my way through this.

Just by putting my chin on my chest I can clearly see I’m out of the tunnel from the knees down, I can see the control room windows, I could relatively easily wriggle out. “Not. Having. It,” sayeth the midbrain, and by this time the lower functions have decided to side with the midbrain, now I’m starting to hyperventilate, a little, and the upper brain had a realization that’s never happened before: “You’re not going to reason yourself through this, and you’re going to have a full on panic attack if you don’t get out of this tunnel.”

The techs quickly slide him out, he apologizes, declines a chance to try the procedure again and goes home humiliated. He writes: “I’m a middle aged man, a doctor, I knew what this would be like, and it went almost as poorly as it possibly could.”

There there, Dr. Roberts. Welcome to the club.

Medical care, let’s face it, often involves exposing patients to sights, sounds and experiences that can be unsettling and even trigger panic. Take MRI claustrophobia and anxiety, which are thought to occur among somewhere between 1 percent and 5 percent of patients. Some patients get so anxious that, like Dr. Roberts, they have to be removed from the machine before the scan is completed.

When I blogged last year about needle phobia, I heard from someone who can’t tolerate needle procedures unless she’s fully sedated.

And what about fear of blood? Or dental procedures? Or anesthesia? It’s not always clear how prevalent these phobias are because these people, understandably, tend to avoid settings that can trigger their fears. Their reluctance to see a doctor or dentist can sometimes be exacerbated by clinicians who are impatient or dismissive of them for being “irrational.” The woman with needle phobia probably speaks for many of them:

 I try to negotiate with medical providers on alternatives, but somehow they think if they reject my reasonable accommodations, I will agree. I won’t. I will forgo treatment or diagnostic procedures if they involve a needle unless I am sedated. Fact is, most of the medical profession has no clue that people like me (and there are lots of us) exist since their close-mindedness has resulted in our avoiding even presenting ourselves for medical advice. My hope is that – somehow – those like me can connect and speak with a unified voice in favor of revised protocols that accommodate our condition. Otherwise, most of us are destined to shortened lives due to lack of medical care.

GruntDoc’s experience prompted several of his blog visitors to relate similar stories about their own encounters with the MRI machine. One person had a few flashes of panic, “though not enough to pull me out of the tube.” From someone else: “Didn’t have a clue that I was claustrophic and laughed at the possibility. Never even got started. Freaked out all the way home.”

There are ways, of course, to make an MRI scan more tolerable. Sedation can help; so can placing the patient in a prone position, or lying face down, if this is feasible. Ear plugs, music and sleep masks also can help distract the patient and make him or her feel slightly less trapped in the MRI tunnel.

As for Dr. Roberts, his brief trip into MRI land was eye-opening. “I now have more empathy for those who tell me they’re claustrophobic in the MRI tunnel (I have ordered sedation liberally before, and will continue to),” he writes. “But, I always thought, in the back of my head, ‘what’s up with that?’, and now I know. In spades.”

Image: “The Scream,” Edvard Munch,  from a series of paintings and prints, 1893-1910