By Suneel Dhand, MD

Many of the everyday coalface problems we face in health care are simply due to suboptimal communication. It could be the patient or family member who doesn’t know what’s going on in the hospital, the nurse who is confused about orders, or the doctor who doesn’t understand the reasoning behind the seemingly terrible administrative directive they are receiving.
Take it from me, as someone who has seen health care at close quarters on four different continents: This is a universal problem, and not a uniquely American one. So why is this? Why is health care notoriously so poor at times compared with other industries? Here are five reasons:


1. The fast-paced nature of health care. Medicine is an unpredictable and rushed environment — especially in the hospital. Physicians (and nurses) are rushed off their feet from start to finish, there are several things going on at any one time, and they have to multitask to the extreme. It would be wonderful to spend an hour with every patient, but that isn’t realistically going to happen. In our ever-squeezed time slots (taking away the whole other discussion about bureaucratic and reimbursement reasons), we have to remain focused and to the point, and that inevitably means that there’s not enough time to make sure everything is dealt with and explained as well as it could be.
2. There are too many things going on to keep track. In the hospital, patients will be subject to tests, procedures, and a stream of different doctors seeing them. I’ve previously named this problem “Too Many Cooks in the Kitchen Syndrome.” If we consider too that most of our patients are on the older side, it’s easy to see how things quickly become a confusing haze.
3. Complex problems that we are unprepared for. People don’t plan to be sick. Even fewer people are well-versed in medical terminology and the decisions that have to be made during acute medical illness. It may also be unrealistic to expect that even a highly educated member of the general public, would understand everything that they are told by their physician. It’s not like serving people food in a restaurant or fixing their sink.
4. Physician communication skills. A further aspect to this problem, which is not talked about nearly as much as it should be, is that physicians do not receive adequate communication skills training in medical school. What little amount of teaching that’s given, is woefully inadequate to prepare for life as a “customer service facing professional” (and yes, whether doctors like the term or not, that is what we are). The same applies to nursing school curriculums and most other health care professionals: we simply don’t put enough emphasis on the importance of solid communication in our everyday professional life.
5. Health care organizations have been slow to catch up. Health care institutions typically lag well behind other industries in applying communication and branding principles to their organizations. They frequently don’t communicate their message to patients effectively, tell the right stories, and even their internal communication tree from administration downwards, leaves a lot to be desired.

The solutions to the above problems lie with a complete rethink within many health care organizations and a shift in internal culture. Simple common sense answers lie at the heart of most of our communication deficits in the trenches. As health care continues its tumultuous and ever-changing journey, we need to always stay focused on how we communicate with our patients (both at an individual and organization level). Their experience matters, and is crucial to their full recovery and motivation. It’s not about satisfaction scores or meaningless tick boxes, but fundamental to delivering amazing health care.

Suneel Dhand is an internal medicine physician and author. He is the founder, DocSpeak Communications and co-founder, DocsDox. He blogs at his self-titled site, Suneel Dhand.
Source: https://www.kevinmd.com/blog/2018/01/health-communication-poor-5-reasons.html​

Rieback Medical-Legal Consultants medical expert witnesses assist Miami attorney Gary Friedman to a $13 million verdict. 

Manuel Diaz, 80, was blinded by an ophthalmologist who injected the wrong type of antibiotic into his right eye during cataract surgery in 2013. Diaz is one of 13 patients who allege that Dr. Jonathan Leon-Rosen blinded him during cataract surgery. Diaz reached a confidential settlement with Leon-Rosen, but not with Leon Medical Centers. In August, a Miami jury ordered Leon Medical Centers to pay Diaz $13 million because Leon-Rosen had acted as "an apparent agent" of the Medicare clinics, which have nearly 40,000 members in Miami-Dade. A second trial against Leon Medical Centers is scheduled to take place in November. Roberto Koltun/ Edited by Matias J. Ocner Miami Herald

BY DANIEL CHANG
dchang@miamiherald.com


When his eyesight became clouded by cataracts in 2013, 80-year-old Miguel Diaz of Miami Beach turned for help to the company he has trusted for years to provide his healthcare: Leon Medical Centers, one of South Florida’s most popular Medicare clinics.
The company, with seven clinics in Miami-Dade County staffed by doctors, dentists, optometrists, pharmacists and other providers, quickly set in motion the extensive healthcare machinery that is central to its appeal — dozens of medical services available under one roof.
In short order, Diaz said, Leon Medical Centers scheduled a visit with the ophthalmologist, arranged for cataract surgery and took charge of his post-operative care.

But when the ophthalmologist blinded Diaz in his right eye — as Diaz claimed in a lawsuit filed in Miami-Dade Circuit Court — Leon Medical Centers disavowed the doctor’s work, saying he was an independent contractor and not a staff physician, so they weren’t at fault.
                                                                                                ______________________
​Attorney Gary Friedman, who represents Diaz and 13 other patients who are suing, said Leon-Rosen no longer works for Leon Medical Centers. The doctor’s license and profile posted online by the Florida Department of Health makes no mention of the patients he allegedly injured.

​SANTA ANA, Calif. (KABC) --
Lizbeth and Elizabeth Gomez share a bond few siblings do: the 17-year-old fraternal twins were born just two minutes apart and both with cerebral palsy.

"We are really close. She gets really excited when I get home and we're always together," Lizbeth said.

Lizbeth was diagnosed with a more mild case of cerebral palsy. She took speech classes and dealt with some physical limitations. But Elizabeth has been in a wheelchair since a young age and needs a little more help understanding her classes.

"(Lizbeth) means a lot to me because she helps me overall in high school and all of my school years," Elizabeth said.

As the Century High School seniors prepare to graduate, Lizbeth began applying to colleges across the country. She set her eyes on Stanford, thinking it was a long shot.

Then she received an email congratulating her on her acceptance. Her major, inspired by her sister and others with cerebral palsy, will be bioengineering.

"I've always wanted to be able to help her and so I thought what better way than to major in bioengineering, where I can create a medical device or something that can help her out," Lizbeth said.

Lizbeth credits the Nicholas Academic Center for her success. The center helps underserved high school students through mentorship and tutoring. It encouraged Lizbeth to write about her and her sister's obstacles in her application.

"At the end of the day, they sort of united forces and figured out how they work with each other's strengths to get through school," said Rosa Diaz with the center.

This fall, the Gomez twins face their biggest challenge yet - being apart from each other.

"I told her, 'Can you take a picture of me when you go to Stanford so you can look at it at night?" Elizabeth said.

Source: http://abc7.com/society/oc-twin-w--cerebral-palsy-overcomes-odds-to-get-into-stanford/2057843/​

This article first appeared on the Kaiser Health News site.
Zika, the mosquito-borne virus that triggered public health alarm bells last summer, has receded from the spotlight. But, experts say, expect the virus to pose a renewed threat this year.
How great of a threat? That’s where it gets tricky.

No locally acquired cases of the virus have been reported in the United States this year. But as public health agencies gear up for mosquito season, uncertainty remains around what resources states may need and whether they will receive adequate federal support.

In addition, researchers still have questions about how the virus works and its long-term effects. These forces could complicate efforts to track outbreaks and provide accurate information about prevention and disease management.
“We still have much to learn. And much remains to be done,” Lyle Petersen, director of the Centers for Disease Control and Prevention’s Division of Vector-Borne Diseases, said last week at a House Energy and Commerce subcommittee hearing.

Zika, which can cause birth defects if contracted by pregnant women, is primarily transmitted by a mosquito more commonly found in southern areas of the country such as the Gulf Coast. Texas, Florida, Southern California and Louisiana were all deemed high-risk areas last year. It hit the Americas in 2015 and reached the United States via infected travelers.

Last year, 5,102 people in the United States were reported  with the disease — most contracted the virus while traveling in South and Central America. Sixty-four babies in the U.S. have been affected since the government began reporting outcomes last June. In rare cases, people who had not traveled abroad contracted Zika through a local mosquito or through sexual contact. Puerto Rico, a U.S. territory, had 34,963 cases in 2016.

Again this year, determining if areas are experiencing active Zika transmission will require active surveillance and testing — both of mosquitoes and of people potentially exposed. Most people who contract the virus don’t show visible symptoms.

Implementing that testing is challenging, experts said.
“Should you begin universal screenings in communities that are at risk?” asked Jeff Engel, executive director of the Council of State and Territorial Epidemiologists, which represents the specialists working in public health departments. “That is a tough resource question and probably is not feasible.”

RELATED: Zika Birth Defects Increase in US in 2016Last year, Congress appropriated $1.1 billion toward fighting Zika. That was split among research, overseas response and state public health efforts. In April, the CDC warned state officials those federal dollars were running out. They are projected to last through the end of this fiscal year, in September.

Meanwhile, the White House budget released Tuesday proposes establishing an emergency fund to finance responses to outbreaks like Zika. But it also calls for a $1.3 billion cut to the CDC and slashes $838 million from the National Institute of Allergy and Infectious Diseases, the agency behind vaccine development. So far, there has been little talk from Congress of approving extra funding.

“Funding from Congress has been critical for our response to Zika. However, additional support will be needed,” said Rick Bright, director of the federal Biomedical Advanced Research and Development Authority, a subsidiary of the U.S. Department of Health and Human Services, at the hearing.

Some advocates also warn an ongoing hiring freeze at HHS could limit the agency’s capacity to support a Zika response.

“Obviously we live in tough times when it comes to budget constraints,” said Tom Skinner, a CDC spokesman. “And we have to find creative ways to do the best we can with what we’re given.”

If those constraints thwart surveillance efforts this year, experts warned, it will make it harder to know precisely when Zika hits. That blind spot puts women of childbearing age — for whom the virus’ consequences are most dramatic — at greater risk. Reports highlight microcephaly as a significant consequence, but a burgeoning field of research suggests its impact on children may be broader, and may manifest years after a child is born.

“Without active surveillance — I’m worried we missed [many cases of] Zika last year and we’ll miss Zika this year,” said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, in Houston. “If you’re a woman of reproductive age, living on the Gulf Coast of the United States, or Arizona or Southern California, and you’re pregnant or might be pregnant — you don’t really know if Zika’s in your area or not.”

Texas, which experienced six cases of local Zika transmission last year, has identified counties it deems most vulnerable. All pregnant women in those areas are advised to get Zika screenings as part of their routine prenatal care. The state works with the CDC to monitor how many pregnant women test positive and intends to monitor babies born to mothers who experienced infection.

But long-term follow-up will probably require more funding, noted Chris Van Deusen, a spokesman for Texas’ Department of State Health Services. And leveraging prenatal care to push Zika testing has its own shortcomings. Many women most at risk are low-income, Van Deusen noted, and therefore less likely to interact with the health care system, or get prenatal care. Those people won’t be tested or accounted for in the state’s Zika tracking efforts.

RELATED: Cancer: Could Zika Be Used to Treat the Deadliest Brain Tumor?That, Hotez said, compromises authorities’ ability to discover Zika when it hits and then get the word out. “The only way we identify Zika outbreaks like [last year’s] in South Florida is through serendipity,” he said.

Testing is another concern. Current tests are unreliable in identifying Zika among patients previously infected with related viruses, such as dengue.

Limited resources could also strain the states’ ability to process tests efficiently. Last year, the volume of patient samples sent for Zika testing overwhelmed laboratories in some affected areas, noted Kelly Wroblewski, director of infectious disease at the Association of Public Health Laboratories.

The surge translated to delays in determining if women had Zika. That could continue this year, since universal testing in affected areas is a burden that many of these labs don’t have the resources to meet.

If the virus spreads, Wroblewski said, “we may find a capacity gap.”

Many states also lack the infrastructure to adequately address an outbreak. Surveillance of mosquito-borne diseases is virtually nonexistent in many states, according to a 2014 reportfrom the Council of State and Territorial Epidemiologists. Mosquito surveillance among states dropped from 96 percent in 2004 to 80 percent in 2012. In many areas, mosquito eradication has shrunk along with dwindling public health budgets.

“We need better mosquito control methods, we need better surveillance,” Petersen said at last week’s hearing. “We need to develop more of a nationally standard approach to vector control and laboratory testing. … This will require a sustained effort to rebuild infrastructure.”

The scarcity of resources is compounded by scientists’ limited knowledge of the virus.

Experts are “discovering new things every day,” particularly regarding how the virus plays out after birth, Engel said. Beyond an obvious condition like microcephaly — which results in an abnormally small head and brain impairment — it’s tough to say just how consequential the disease can be. Preliminary work suggests children without microcephaly whose mothers carried the virus may have developmental issues later in life. But the extent of those issues — and the odds they do in fact manifest — is unclear. And limited knowledge about how Zika interacts with similar viruses means available tests aren’t always accurate.

“Unfortunately, it’s the problem with these rapidly emerging diseases; you can’t get the research up quickly enough to get the best answers,” said Scott Weaver, director of the Institute for Human Infections and Immunity at the University of Texas Medical Branch in Galveston.

Because Zika’s long-term consequences remain murky, states are trying to keep tabs on children whose mothers tested positive. Beyond Texas, Louisiana is also tracking children for at least three years after birth, even if they don’t show obvious symptoms. But that assumes a surveillance system is robust enough to track all mothers who carried the virus. It also assumes sufficient resources to keep monitoring children. Those, experts said, are hardly guaranteed. And they still might not be enough.

“It’s going to take a generation of pediatric neurologists to study and sort this out,” Hotez said. “This is just the beginning.”
​
This KHN story also ran in USA Today .

Source: http://www.newsweek.com/coming-summer-maybe-return-zika-virus-617852​