Online consultations can save valuable time for patients and doctors

Online consultations can save patients a visit to the surgery and doctors' time. Photograph: Alamy

Patients need to be able to consult their doctor online. Having to take half a day off work for a 10-minute consultation is a high price to pay when the technology exists that would allow it to be done online from the patient's home or work. For some patients, the travel involved in getting to an appointment is harmful in itself. I have seen patients with physical disabilities in pain from the long distances they have had to travel to see their specialist. In a few cases, the appointment itself has risks – cystic fibrosis patients can give each other infections when sat together in the same waiting room.

In my opinion, it's important to offer online consultations when they are appropriate. But for the best of reasons, many in the NHS remain deeply sceptical about consulting online. Time-pressed doctors and GPs are not sure what an online consultation actually is. They fear it might take up even more of their time.

Many doctors believe online consultation means sending emails – but we already know this doesn't work well. The back-and-forth nature of email means that getting detailed answers is slow and frustrating for doctor and patient alike. But we do know the right way to do online consultations: asynchronously, where a patient fills out a structured online questionnaire that the doctor checks at a later date; and synchronously, where both parties talk to each other at the same time, using video technology such as Skype.

At the moment, many face-to-face consultations involve the GP or doctor asking the patient the same set of routine questions at points through the year. "How have you been since I last saw you? Are you still taking the meds? Are there any side effects?" The list is long for safety reasons, but the repetition is unnecessary. This type of consultation can be easily switched to an online asynchronous method – saving a visit to the surgery and doctors' time, and allowing for a richer doctor-patient discussion. Back in 2010, the Mayo Clinic in the US found that online consultations could reduce the need for face-to-face appointments with GPs by 40%.

Doctors can devise the questions themselves and there are tried-and-tested programmes such as Instant Medical History (IMH).

IMH, part of the Mayo Clinic study, tailors the detail of follow-on questions to the speciality of the clinician, for example asking more questions about breathing for a chest specialist than for a GP. One obvious downside of online appointments is that the doctor cannot examine the patient, but not every appointment requires an examination – and if the doctor feels one is necessary they can call the patient in. In synchronous video consultations, a Skype conversation in the patient's home can give a doctor a valuable view of a patient's living conditions – information they might have previously missed.

No patient should be forced into using online consultations – but many want to be offered the option. Moving just a small proportion of these face-to-face consultations online can make a big difference for patients. Furthermore, online consultations allow more efficient and frequent interaction with a specialist and the advice received is available for sharing with the local GP. This completes the circle of care and means patients can access the best care wherever they live.

However, for online consultations to work effectively for both patient and doctor, they must be introduced correctly. If GPs and hospital staff give the impression they're not fully behind online consulting, patients will sense it and avoid the option. Similarly, if patients suspect that it has been introduced purely as a cost-saving measure, they will react badly.

GPs and doctors must move away from thinking they are too busy to consult online – indeed, it is precisely because they are so busy that they need online consultations.

Dr Mohammad Al-Ubaydli is chief executive and founder of Patients Know Best, a patient-controlled medical records system

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New doctors need more support as they begin their careers, survey finds

Almost three quarters (73%) of junior doctors say they do not have enough time to give patients the care they require. Photograph: Martin Argles for the Guardian

Over the coming weeks about 6,000 new junior doctors will start life on the wards. It is a tough and daunting experience, as they put into practice all the training they have received over the past four or five years.

Predictably, there is negative press coverage around this time, based on research from the Dr Foster unit and the department of acute medicine at Imperial College London. The article, published four years ago, did show a small increase in deaths at the start of August – but the findings did not demonstrate a causal link between the rise in mortalities and the influx of new doctors.

Since that research was first published, junior doctors have become better prepared for the transition from medical student to junior doctor: training is far more patient-focused at medical school, and there is a period of pre-job shadowing, dedicated induction programmes and close clinical supervision. But there is no doubt that this is a challenging time for both junior doctors and senior colleagues.

We conducted a survey of about 350 junior doctors who are just completing their first year on the hospital wards, which produced some interesting findings. It was encouraging to see that more than two thirds had chosen a career to help people, but disheartening that a third were re-considering their career choice due to their early experiences. After years of dedicated study, it is a telling sign of the major stresses placed on the shoulders of young doctors so early in their careers.

We must do more to support junior doctors. Though the profession clearly has a role to play, so too do NHS managers. They have the power to provide appropriate resourcing and support on the ward, which can affect morale. As our survey shows, three quarters of respondents said that they had struggled with long hours. A similar number had difficulty with heavy workloads, and more than a third had felt isolated.

When asked what they had found most challenging when dealing with patients during their first year, 73% of junior doctors said they didn't have enough time to give patients the care they required, and nearly half were working beyond the maximum working hours stipulated by European law.

Managers have an important role in providing a safe learning environment. They should be accessible, and receptive to concerns, queries and new ideas. They will have a pivotal role in delivering Sir Bruce Keogh's vision, set out in his recent review into the quality of care and treatment provided by 14 hospital trusts in England.

I share his belief that junior doctors should not just be seen as the clinical leaders of tomorrow, but the clinical leaders of today. We must harness their enthusiasm and support them to become a valuable and respected member of the team.

Junior doctors are at the frontline of patient care, they understand the challenges faced by both patient and management and are, therefore, a valuable source of intelligence. They are capable of providing real insights and seeing things that affect patient safety.

The NHS has come under sustained fire and we need to nurture it back to health. Junior doctors represent the present and our future, and have a core role in restoring pride in our healthcare system, which we often forget is the envy of many countries.

So spare a thought for the thousands of young doctors who have embarked on a lifetime of dedicated hard work and study, and whose actions are a matter of life and death.

Dr Pallavi Bradshaw is medicolegal adviser at the Medical Protection Society.

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

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New doctors need more support as they begin their careers, survey finds

Almost three quarters (73%) of junior doctors say they do not have enough time to give patients the care they require. Photograph: Martin Argles for the Guardian

Over the coming weeks about 6,000 new junior doctors will start life on the wards. It is a tough and daunting experience, as they put into practice all the training they have received over the past four or five years.

Predictably, there is negative press coverage around this time, based on research from the Dr Foster unit and the department of acute medicine at Imperial College London. The article, published four years ago, did show a small increase in deaths at the start of August – but the findings did not demonstrate a causal link between the rise in mortalities and the influx of new doctors.

Since that research was first published, junior doctors have become better prepared for the transition from medical student to junior doctor: training is far more patient-focused at medical school, and there is a period of pre-job shadowing, dedicated induction programmes and close clinical supervision. But there is no doubt that this is a challenging time for both junior doctors and senior colleagues.

We conducted a survey of about 350 junior doctors who are just completing their first year on the hospital wards, which produced some interesting findings. It was encouraging to see that more than two thirds had chosen a career to help people, but disheartening that a third were re-considering their career choice due to their early experiences. After years of dedicated study, it is a telling sign of the major stresses placed on the shoulders of young doctors so early in their careers.

We must do more to support junior doctors. Though the profession clearly has a role to play, so too do NHS managers. They have the power to provide appropriate resourcing and support on the ward, which can affect morale. As our survey shows, three quarters of respondents said that they had struggled with long hours. A similar number had difficulty with heavy workloads, and more than a third had felt isolated.

When asked what they had found most challenging when dealing with patients during their first year, 73% of junior doctors said they didn't have enough time to give patients the care they required, and nearly half were working beyond the maximum working hours stipulated by European law.

Managers have an important role in providing a safe learning environment. They should be accessible, and receptive to concerns, queries and new ideas. They will have a pivotal role in delivering Sir Bruce Keogh's vision, set out in his recent review into the quality of care and treatment provided by 14 hospital trusts in England.

I share his belief that junior doctors should not just be seen as the clinical leaders of tomorrow, but the clinical leaders of today. We must harness their enthusiasm and support them to become a valuable and respected member of the team.

Junior doctors are at the frontline of patient care, they understand the challenges faced by both patient and management and are, therefore, a valuable source of intelligence. They are capable of providing real insights and seeing things that affect patient safety.

The NHS has come under sustained fire and we need to nurture it back to health. Junior doctors represent the present and our future, and have a core role in restoring pride in our healthcare system, which we often forget is the envy of many countries.

So spare a thought for the thousands of young doctors who have embarked on a lifetime of dedicated hard work and study, and whose actions are a matter of life and death.

Dr Pallavi Bradshaw is medicolegal adviser at the Medical Protection Society.

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

View the original article here

Working time directive hinders junior doctors' progress

One significant barrier to the training of junior doctors is the EU time directive which enforces a maximum working week of 48 hours. Photograph: Martin Argles

August has earned an unfortunate nickname in the NHS; the "killing season", so called because of the effect of an influx of 6,000 newly qualified medical graduates into hospitals across the country. Research shows that this leads to a 6% rise in patient death rates during the same month each year. One reason this happens is because the juniors are not receiving the right level of support in their first few weeks of work, putting them under huge pressure and putting patients at risk.

Last year, the government decided to take action in the hope of addressing the issues of the graduate handover. It introduced a mentoring system to try to provide enough good quality support to new doctors, giving them access to senior staff who could help to guide them through those first few weeks. The effects of these measures should start to filter through this year. However, they only address part of the problem. The NHS has been trying to work around the EU's strict rules on working hours that have been stifling the training of new doctors since 2009.

One of the more significant barriers to the successful training of junior doctors is the EU time directive. These guidelines enforce a maximum working week of 48 hours. While that may seem like a good thing in principle, and in many other professions it would not cause a problem, this means that junior doctors are unable to steadily climb the steep learning curve of their new roles. Their shifts are not long enough to encounter the wide range of conditions and treatments that they need to experience to ensure their development, meaning effectively that juniors have to down tools halfway through an important training session. This is particularly relevant in specialist fields like surgery where procedures can take hours to complete.

By limiting the hours junior doctors can work and train, the EU rules are putting them under huge pressure to perform well and learn an enormous amount of information in a disjointed manner. The stress that goes with this stop-start situation certainly cannot be reducing their anxiety about the new position and if this situation continues we are likely to see a drop in doctors joining the NHS after they graduate.

Additionally, the poor image projected by the constant NHS bashing that results will eventually stick, diminishing the ability of the public sector to deliver and fuelling the progression towards privatisation of the NHS. This could push healthcare "free at the point of use" out of our grasp.

It is crucial that we give graduates an NHS environment where they are encouraged to thrive rather than a culture where they are scapegoats from the off. They must be allowed to learn in a "real-life" situation, without a curfew applying part way through the process. Otherwise we could end up with uninformed process being delivered in our hospitals, such as the sad state of palliative care found in the Liverpool Pathway project.

The part played by mentoring and support can go some way to improving the situation, but junior doctors need to be given the freedom to learn on the job, otherwise we could find we have a population of downbeat, demotivated senior staff in our hospitals, serving only to exacerbate the problem.

Gayna Hart is managing director of healthcare software provider, Quicksilva

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

View the original article here

New doctors need more support as they begin their careers, survey finds

Almost three quarters (73%) of junior doctors say they do not have enough time to give patients the care they require. Photograph: Martin Argles for the Guardian

Over the coming weeks about 6,000 new junior doctors will start life on the wards. It is a tough and daunting experience, as they put into practice all the training they have received over the past four or five years.

Predictably, there is negative press coverage around this time, based on research from the Dr Foster unit and the department of acute medicine at Imperial College London. The article, published four years ago, did show a small increase in deaths at the start of August – but the findings did not demonstrate a causal link between the rise in mortalities and the influx of new doctors.

Since that research was first published, junior doctors have become better prepared for the transition from medical student to junior doctor: training is far more patient-focused at medical school, and there is a period of pre-job shadowing, dedicated induction programmes and close clinical supervision. But there is no doubt that this is a challenging time for both junior doctors and senior colleagues.

We conducted a survey of about 350 junior doctors who are just completing their first year on the hospital wards, which produced some interesting findings. It was encouraging to see that more than two thirds had chosen a career to help people, but disheartening that a third were re-considering their career choice due to their early experiences. After years of dedicated study, it is a telling sign of the major stresses placed on the shoulders of young doctors so early in their careers.

We must do more to support junior doctors. Though the profession clearly has a role to play, so too do NHS managers. They have the power to provide appropriate resourcing and support on the ward, which can affect morale. As our survey shows, three quarters of respondents said that they had struggled with long hours. A similar number had difficulty with heavy workloads, and more than a third had felt isolated.

When asked what they had found most challenging when dealing with patients during their first year, 73% of junior doctors said they didn't have enough time to give patients the care they required, and nearly half were working beyond the maximum working hours stipulated by European law.

Managers have an important role in providing a safe learning environment. They should be accessible, and receptive to concerns, queries and new ideas. They will have a pivotal role in delivering Sir Bruce Keogh's vision, set out in his recent review into the quality of care and treatment provided by 14 hospital trusts in England.

I share his belief that junior doctors should not just be seen as the clinical leaders of tomorrow, but the clinical leaders of today. We must harness their enthusiasm and support them to become a valuable and respected member of the team.

Junior doctors are at the frontline of patient care, they understand the challenges faced by both patient and management and are, therefore, a valuable source of intelligence. They are capable of providing real insights and seeing things that affect patient safety.

The NHS has come under sustained fire and we need to nurture it back to health. Junior doctors represent the present and our future, and have a core role in restoring pride in our healthcare system, which we often forget is the envy of many countries.

So spare a thought for the thousands of young doctors who have embarked on a lifetime of dedicated hard work and study, and whose actions are a matter of life and death.

Dr Pallavi Bradshaw is medicolegal adviser at the Medical Protection Society.

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

View the original article here

Doctors worried about influx of super-sized babies across the world

Deseret News Monday 19th August, 2013

Rising rates in obesity have increased the risk of having an overweight baby. Babies born weighing more than 13 pounds have recently made headlines, and the new trend is causing concern among doctors.

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When prescribing antibiotics, doctors most often choose strongest types of drugs

Main Category: MRSA / Drug Resistance
Also Included In: Primary Care / General Practice
Article Date: 05 Aug 2013 - 0:00 PDT Current ratings for:
When prescribing antibiotics, doctors most often choose strongest types of drugs

When U.S. physicians prescribe antibiotics, more than 60 percent of the time they choose some of the strongest types of antibiotics, referred to as "broad spectrum," which are capable of killing multiple kinds of bacteria, University of Utah researchers show in a new study.

Unfortunately, in more than 25 percent of such prescriptions are useless because the infection stems from a virus, which cannot be treated with antibiotics. This overuse of antibiotics has a number of downsides, including that these types of drugs kill more of the "good" bacteria found in our bodies - which may lead to more side effects - and also contribute to the growth of antibiotic-resistant bacteria, according to Adam L. Hersh, M.D., Ph.D., an infectious disease expert, assistant professor of pediatrics at the University of Utah School of Medicine and senior author on a study published July 29, 2013, in the Journal of Antimicrobial Chemotherapy.

Discerning whether an infection is viral or bacterial can be tricky, according to Hersh, which probably accounts for much of the overuse of antibiotics. "It seems that the natural bias, when there is uncertainty about an infection's cause, is to err on the side of prescribing antibiotics," he says. "Our study found that the majority of prescriptions are for antibiotics that kill a wider range of bacteria, and that they are most likely to be given when they're not needed, such as in cases of viral infections."

The types of illnesses where doctors seem to choose stronger antibiotics include respiratory problems, skin infections and urinary tract infections, which in many cases would be better treated by other antibiotics that are less likely to cause resistance.

Hersh, Andrew T. Pavia, M.D., also an infectious disease expert and professor of pediatrics at the University of Utah, Lauri A. Hicks, D.O., a medical epidemiologist at the U.S. Centers for Disease Control and Prevention, and University of California, San Francisco, medical student Daniel J. Shapiro, conducted the study using a public database with information on ambulatory care visits at physician offices and hospital-based outpatient and emergency departments nationwide. Studying data from between 2007-2009, they identified a sample of 238,624 visits by patients 18 and older at those medical facilities and found that 61 percent of antibiotic prescriptions were for broad-spectrum drugs, such as Levaquin®. Narrow-spectrum antibiotics, such as amoxicillin and doxycycline, comprised the remaining 39 percent of antibiotic prescriptions.

Based on the sample of 238,000-plus visits, the researchers estimate there was an average of 985 million annual ambulatory care visits for the 2007-2009 period, with antibiotics being prescribed in an estimated 101 million of those visits each year - 62 million in which broad-spectrum antibiotics were prescribed and 39 million that resulted in narrow-spectrum antibiotics prescriptions.

While this study looked only at adult ambulatory care visits, the prescription pattern for children is similar, according to Hersh. "Many antibiotics prescribed for children are unnecessary, particularly for conditions caused by viruses, where antibiotics don't help at all," he says. "Even when an antibiotic is indicated, such as for strep throat or some ear infection, physicians often prescribe and antibiotic such as a Z-Pak, which can be less effective than amoxicillin."

Hicks emphasizes that antibiotic overuse among children and adults is a serious problem and a threat to everyone's health. "The biggest problem with using antibiotics when they're not needed is the development of antibiotic resistance, which is when bacteria survive by outsmarting the antibiotic," she says. "Common infections become difficult to treat, and when you really need an antibiotic, it may not work."

Uncertainty about the cause of an infection is one factor in the overuse of broad-spectrum antibiotics, but there are other influences too, according to Hersh. This includes a misperception by physicians that their patients expect an antibiotic if they take the time to see the doctor. But Hersh believes this second factor is changing, due in part to major efforts to educate people about the problems associated with overuse of antibiotics, such as CDC's "Get Smart: Know When Antibiotics Work" program.

"The public is increasingly aware of the downside and side effects of antibiotics," Hersh says. "Actually, when they see their doctor, most patients just want an explanation as to what's wrong and are open to considering why an antibiotic wouldn't be helpful."

He urges patients to play a larger role by asking their doctor two questions: Do I really need this antibiotic? And, is this antibiotic the best choice for my infection?

"Both doctors and patients have a role in ensuring the effectiveness of antibiotics is preserved by using them only when needed," Pavia says.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Doctors say HPV vaccine is safe and "grossly underutilized"

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Main Category: Immune System / Vaccines
Also Included In: Cancer / Oncology
Article Date: 27 Jul 2013 - 0:00 PDT Current ratings for:
Doctors say HPV vaccine is safe and "grossly underutilized"

Amid parents' concern for their daughters over the timing and safety of vaccination shots against human papillomavirus (HPV), the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) have released a statement saying the vaccine is "safe, effective and grossly underutilized."

At a recent press conference, data from the CDC revealed that vaccination rates in girls aged between 13-17 years declined between 2011 and 2012. The current level of HPV vaccine coverage is 33% - falling far short of the 80% coverage target set by the Healthy People 2020 initiative from the US Department of Health and Human Services.

Dr. Tom Frieden, director of CDC says:

"Progress increasing HPV vaccination has stalled, risking the health of the next generation. Doctors need to step up their efforts by talking to parents about the importance of HPV vaccine, just as they do other vaccines, and ensure its given at every opportunity."

There are 70 million Americans currently infected with HPV, according to the CDC, with 14 million people becoming newly infected every year.

The public health body says that if the levels of HPV vaccine uptake stay as they are - with 33% coverage instead of the 2020 initiative's 80% - an additional 4,400 women will be diagnosed with cervical cancer, producing 1,400 extra deaths from the disease.

HPV is a common sexually transmitted virus. Infection with HPV can lead to abnormal tissue growth and changes to cells in the cervix, which can lead to cervical cancer. It is also known to be a cause of genital warts.

Medical News Today recently reported that HPV is linked to a third of throat cancers. Researchers from Cancer Research UK and the University of Oxford found that HPV16 is linked to oropharyngeal cancer.

The HPV vaccine was introduced in the US in 2006. There are two options available - the bivalent vaccine (Cervarix) and the quadrivalent vaccine (Gardasil). The immunizations are given in three shots over a six-month period.

The HPV vaccination can be given to girls from 9 years of age, but is recommended between 11 and 12 years of age. It is also recommended for girls and women aged between 13 and 26 who have not already been properly vaccinated having missed all or some of the immunisation shots.

Data from a CDC national immunization survey (NIS-Teen) reveals that parents feel there are gaps in knowledge about the vaccine, specifically a lack of understanding on why it is recommended at such an early age.

Dr. Frieden says:

"Parents need reassurance that HPV vaccine is recommended at 11 or 12 because it should be given well in advance of any sexual activity. We don't wait for exposure to occur before we vaccinate with any other routinely recommended vaccine."

From the NIS-Teen data, parents also reported that safety concerns were one of the reasons they were reluctant to agree to their daughters receiving the HPV vaccine.

When the vaccination was first introduced, there was a media frenzy surrounding some reports of side effects associated with the vaccination, with some parents saying their daughters had experienced serious blackouts, chronic fatigue and even partial paralysis.

However, the CDC says that no serious safety concerns have been identified in direct relation to the use of the vaccine over the seven years since it was first licenced.

The CDC adds that reports of adverse events, which must be sent in to the regulators with any new drug or vaccine, have fallen steadily between 2008 and 2012. The proportion of adverse events reported as serious has also declined - from 12.7% in 2009 to 7.8% in 2012.

Parents and caregivers are encouraged to ask about vaccination every time they take children for a healthcare visit. The CDC also says healthcare officials should be firmer and more consistent with parents in recommending the HPV vaccine, particularly for the benefit of 11- and 12-year-olds.

The HPV vaccine is covered under the Affordable Care Act, meaning that the majority of private healthcare insurers must cover the vaccine at a reasonable price. The CDC say this should encourage parents to ensure their daughters receive the HPV vaccine.

Written by Honor Whiteman

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posted by Adam on 27 Jul 2013 at 4:48 am

Wasn't thalidomide proclaimed safe for use by pregnant women for morning sickness - until more than 10,000 birth defects occurred? And wasn't there controversy in Texas about the governor requiring this HPV vaccine by executive order while questions arose about his and his staff's links to the HPV manufacturer? It's been out only 7 years, so if the first parents gave it to an 11-year old, she's only 18 now. I think I'll wait to see what happens when she tries to have kids in a few more years....

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'Doctors say HPV vaccine is safe and "grossly underutilized"'

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