healthcare technology

Obtaining informed consent is one of the most important things that a surgeon does.

I’d argue that obtaining informed consent is one of the most important things that a surgeon does — akin to the last stitch of an aortic anastomosis, the life-saving jolt of electricity to jumpstart a fibrillating heart, or the first pass of a scalpel during an emergent laparotomy.

Informed consent defines 21st-century medicine, contrasting sharply to the days of paternalistic care. Informed consent, when done properly, puts decision making into the hands of our patients. It can serve as a checkpoint to discuss goals of care and what constitutes a meaningful life for a particular patient.

It’s time we teach our trainees how to obtain informed consent the proper way. We need to slow down, pull up a chair, and look people in the eyes. We need to truly know our patients — how they understand their diagnoses, how they interface with medicine, their socioeconomic status, and education level. We must address goals of care with clear “if-then” statements.

When I teach younger residents how to obtain informed consent I often harp on a concept I learned in my undergraduate psychology class called theory of mind. Theory of mind is defined as “being able to infer the full range of mental states (beliefs, desires, intentions, imagination, emotions, etc.) that cause action.” In my opinion, theory of mind is an integral part of the consenting process that allows us to reverse roles, to see the world how our patients see it.

Halfway through obtaining informed consent from my patient, my attending steps in. He snags a stool from the corner of the room. He sits directly in front of the sick man.  He talks about what life will be like for him as a new amputee.

He emphasizes the importance of diabetes control and smoking cessation. We may do everything we can and the man still may die. Would he want to live if it meant he could never go home again? He conveys the gravity of the current situation in a way that is pitch perfect.  This, I think to myself, is how it’s done.

For surgeon trainees, just like making our first cut, informed consent is a skill learned by example and should be done under the watchful eye of our mentors. It’s time to pay it forward. Next time you are the chief resident, the senior attending, or anywhere in between, take a trainee with you and teach him or her how to obtain informed consent the right way. Do away with the notions of “efficiency” and speed. Your patients and your pupils will be eternally grateful.

New survey data from digital health agency Klick Health shows that diabetes patients who use digital tools to manage their health also feel healthier.

Klick Health employed Survey Sampling International (SSI) to poll 2,000 American adults with diabetes either online or via the telephone.

Based on responses about how they use technology to manage their health, they segmented the group into three categories: those who manage their health daily or weekly with integrated digital technologies (integrators), those who go online to seek health information on a monthly basis (seekers), and those who don’t use the internet to manage their health at all (traditionalists).

The integrators group, the true digital health users, made up just 18 percent of the sample, but 13 percent of integrators reported being in excellent health. Seekers made up 47 percent of the sample and 4 percent of seekers said they were in excellent health. Finally, the remaining 35 percent were traditionalists, and only 2 percent of that group reported being in excellent health. 

Because it’s a survey based on self-reported health status, the data doesn’t prove that connected patients are actually healthier than non-connected patients. But it does provide evidence that either they’re healthier or they believe they’re healthier, which is significant in and of itself.

Thanks to technology, Gary Sullivan enjoys a new kind of relationship with his doctor. If he wakes up with a routine health question, the 73-year-old retired engineer simply taps out a secure message into his doctor’s electronic health records system. His Kaiser Permanente physician will answer later that day, sparing Sullivan a visit to the clinic near his Littleton, Colo., home and giving his doctor time to see those with more urgent needs.

Once you took medical questions directly to your doctor, who advised, tested and treated you. Today, not only are we turning to the Internet for everyday medical information, we’re also generating our own health data: using a smartphone, for example, to investigate a child’s ear pain or monitor blood pressure. We’re learning from our peers online how to cope and find new treatments. Our doctors can keep our records electronically, accessible to us through a patient portal. Some of us can make video visits with doctors, who can offer diagnoses and treatment plans via computer or smartphone.

With all these advances, a traditional paternalism in medicine is changing, too.

Google Translate has only 57.7% accuracy when used for medical phrase translations and should not be trusted for important medical communications.

However, it still remains the most easily available and free initial mode of communication between a doctor and patient when language is a barrier.

Although caution is needed when life saving or legal communications are necessary, it can be a useful adjunct to human translation services when these are not available.

Read the research paper below which formed the above conclusion.

Communication is the cornerstone of medicine, without which we cannot interact with our patients. The General Medical Council’s Good Medical Practice states that “Doctors must listen to patients, take account of their views, and respond honestly to their questions. However, we still often interact with patients who do not speak the local language.

In the United Kingdom most hospitals have access to translation services, but they are expensive and often cumbersome. A complex and nuanced medical, ethical, and treatment discussion with patients whose knowledge of the local language is inadequate remains challenging. Indeed, even in a native language there is an element of translation from medical to lay terminology.

We recently treated a very sick child in our paediatric intensive care unit. The parents did not speak English, and there were no human translators available. Reluctantly we resorted to a web based translation tool. We were uncertain whether Google Translate was accurately translating our complex medical phrases. Fortunately our patient recovered, and a human translator later reassured us that we had conveyed information accurately.

We aimed to evaluate the accuracy and usefulness of Google Translate in translating common English medical statements.

Ten medical phrases were evaluated in 26 languages (8 Western European, 5 Eastern European, 11 Asian, and 2 African), giving 260 translated phrases. Of the total translations, 150 (57.7%) were correct while 110 (42.3%) were wrong. African languages scored lowest (45% correct), followed by Asian languages (46%), Eastern European next with 62%, and Western European languages were most accurate at 74%. The medical phrase that was best translated across all languages was “Your husband has the opportunity to donate his organs” (88.5%), while “Your child has been fitting” was translated accurately in only 7.7% (table⇓). Swahili scored lowest with only 10% correct, while Portuguese scored highest at 90%.