Guest Contributor: Gary Schwitzer, publisher of HealthNewsReview.org

Disclaimer: the following is not an anti-screening message. It is, however, a call for improved accuracy,  balance and completeness in messages about screening tests.

I’ve scrutinized media messages about screening tests for 8 years. (I’ve done it longer than that, but, for the past 8 years, I’ve given far more systematic attention as I’ve been the daily publisher of HealthNewsReview.org.)2014 NMS 915

Why does this matter? Because this is the way many people get most of their health care information.

Some journalists have excelled, explaining the trade-offs of potential benefits and potential harms – yes, harms – from screening tests. But far more often, I’ve seen news stories that promote unhelpful themes:

  • Emphasizing or exaggerating potential benefits while minimizing or ignoring potential harms
  • Framing screening as if it were a mandate, not a choice
  • Emphasizing patient anecdotes of people who claim their life was saved by screening – something that can’t be proven
  • Missing the stories of people who make rational decisions not to be screened, or the stories of people who regret making ill-informed screening decisions

It is far easier to report about screening using only the perspectives of those who promote screening – some of them with a vested interest. It is far more difficult to explain nuance, evidence, and reasons why there can be harms from a supposedly simple screening test.

Since overdiagnosis and overtreatment are themes of this year’s Health Literacy Month blog posts, let’s start right there with a list of potential harms.

The reason there are evidence-based guidelines – such as those from the U.S. Preventive Services Task Force – to guide screening decisions, is that screening outside the boundaries of the best evidence leads to overdiagnosis and overtreatment. Continue Reading »

Contributor: Geri Lynn Baumblatt, Executive Director of Patient Engagement

Geri Baumblatt

Geri Lynn Baumblatt

Welcome to our 5th Annual Health Literacy Month series on Engaging the Patient!

This year, we’ll start by looking at how health literacy plays a role in too much or too little treatment. Even for clinicians, it’s challenging to sift through the latest evidence and arguments about when screening tests should be done, and what treatments should be considered for which patients. And the media coverage often conflates and confuses these issues even more. So where does that leave the rest of us?

This month, we’ve invited Gary Schwitzer of HealthNews Review, Shannon Brownlee, author of Overtreated, Becca Rothschild of the Choosing Wisely® campaign, and others to share their insights on how information is made available to the public, how it affects what are often life-changing treatment decisions, and how we can do a better job of helping people understand and navigate this mire of information and opinions.

After all, while we hope treatments will improve length of life, we also need to make sure people don’t expect that without also thinking about their quality of life like one of the biggest factors is pain.

Do we know how to describe and talk about pain so we can get the best treatment? Is the pain scale helpful or confusing? And what are the other challenges as people deal with chronic pain, pain from cancer and cancer treatments as well as the challenges of understanding pain medication?

Dr. Judy Paice, Dr. Amy Bucher and patients like Kerry O’Connell will take a closer look at this topic.

And, while these perspectives are valuable, we know no one campaign, blog series or story will address or solve these challenges. So please join the conversation — comment, ask questions, or share your story.

Read more about the origins of the nationally celebrated month here.

Contributor: Diana Dilger – Senior Health Writer, Emmi Solutions

Our choices are what give us a feeling of control over our lives, a sense of stability in what might otherwise feel like an endless, whirling chaos. But hundreds of tiny, seemingly insignificant things influence our decisions and emotions every day.

In fact, that’s the entire basis for the study of choice architecture. (For those for whom this is a new phrase, choice architecture is a term that basically means decisions may be influenced by how choices are presented.) Take, for example, the high tax on cigarettes intended to lead some people to not smoke as much. Some people herald this as a healthy nudge, while others shout that it’s a paternalistic infringement on our American right to choice.

But what about when you’re looking at shared decision making? After all, when it comes to people’s bodies and lives, there must be a certain level of care not to manipulate the presentation of information. But how possible is it to present genuinely unbiased data and do so in a way that’s not manipulating the structure of the information?

The first thing to consider is that everyone has their biases. In my work creating decision aids, I have biases, my medical advisory panel has theirs, and the writers and clinicians authoring research content in the literature also have theirs. This means that I have to be aware of my own biases and analyze them. (And because I know I may be blind to them, I have my editor keep an eye out for them, too.)

I can note my advisors’ influences because usually they’re pretty forthright with them. For example, surgeons tend to be pretty vehement that surgery is a strong treatment option. So when they come up with something pro-their bias, I can flag it as one on which I need to do a bit more outside research.Blog-Graphic-(09.24.14)

The next thing to consider is the audience’s bias. This can be trickier since not everyone has the same background. Continue Reading »

Contributor: Elizabeth Ferguson – Graduate Intern, Emmi Solutions

“Reason itself is fallible, and this fallibility must find a place in our logic” –Nicola Abbagnano

Elizabeth Ferguson

Elizabeth Ferguson

Healthcare is becoming more patient-centered, and patients are responsible for an increasing portion of the cost of their healthcare.

Neither of these statements are news, nor do they adequately describe the magnitude of the shifts occurring in the healthcare industry that lead to them. What both points do highlight, however, is that patients—or really, consumers—play in increasingly important role in determining what and how much care is appropriate for them. Locating this authority with the consumer drives many of the outcomes healthcare reform hopes to achieve, and results in measurable improvements across metrics that everyone can agree are desirable. However, like the statements above, it’s not that simple.

Humans have evolved what is, by any standard an awe-inspiring ability to perceive and interpret the world. We observe and internalize patterns of occurrences and other human behaviors that then guide our own actions and reactions, we unconsciously weigh and balance potential outcomes, and we constantly learn and build on our comprehension of the world around us.

But, we’re also emotional. Molded by the culture in which we are raised and our individual experiences, humans reach subjective judgments that inform their perception. Despite our incredible aptitude for logic and reason, we are still emotional—think “fight or flight” response—before we are Vulcan-like logic machines. As Dr. Joseph LeDoux, author of “The Emotional Brain,” explains: “the wiring of the brain at this point in our evolutionary history is such that connections from the emotional systems to the cognitive systems are stronger than connections from the cognitive systems to the emotional systems.” In essence, emotion informs our logic more than logic informs our emotion.

One subject on which the primacy of emotion can dramatically affect judgment is accurate perception of risk. Humans are terrible at assessing how dangerous something is, and are very easily manipulated and biased. Consider the social media explosion of concern over Ebola here in the United States. Ebola is trending, and often the tweets and posts reflect fears and reactions, not reality. In reality, a host of diseases endemic to or common in the United States (meningitis, tuberculosis, West Nile Virus, hepatitis, influenza) pose a far more significant risk to Americans than two closely monitored and extremely isolated patients at Emory. But none of those other diseases are a hemorrhagic fever. Now that is scary.

What does this have to do with patient-centered healthcare or paying more out of pocket?

Actually, quite a bit. If we’re asking patients to be informed consumers of their own healthcare—to weigh pros and cons, to assess risk and reward, and to accept the ramifications of their decisions—then it’s essential that they really understand their options, and the risks inherent in each. We need to take people who may have little to no experience in healthcare and explain complicated topics in ways that are meaningful and relevant to them. Truly patient-centered medicine requires an educated consumer who carefully weighs options and makes a choice based on their preferences. Informed consumers also weigh the economic trade offs between quality and cost, experience of physician and appointment availability, and seeking out or delaying preventive care. We cannot expect to reap the rewards of patient-centeredness and cost sharing without providing support for these new decision-makers. They must be educated, and thus far, our healthcare system hasn’t proven adept at doing so. Continue Reading »

Contributor: Kirstin Brockenborough, Mutlimedia Health Writing Intern – Emmi Solutions

Kirstin Brockenborough

Kirstin Brockenborough

When you hear the phrases “sexual education” or “sexual health”, what pops into your head? Did “abstinence” immediately enter your mind? Maybe you pictured yourself sitting in a classroom, facing a flustered P.E. teacher trying to quiet a bunch of snickering teenagers watching a hilariously dated video littered with ambiguous metaphors describe the act of sex. Maybe you thought about that painfully real slideshow with endless pictures of STI outbreaks on various body parts meant to instill fear in those who even dare to think about having unprotected sex. It’s possible that nothing comes to mind at all but feelings of confusion or exclusion could have come about. Yes, I realize these are obviously specific but I know numerous people can identify with at least one of these instances.

I recall those precious memories of being a preteen girl obsessed with glitter, rushing home to watch 106 & Park, wearing my first “real” bra, and obsessing about my first kiss from a boy. I also remember those extremely cautious sex talks with my parents about sex, peeking through hands whenever a movie’s highly dramatic sex scene would play in theaters, and having to repeat words like “penis” and “vagina” during class without giggling. Going from that to immediately learning about unwanted pregnancy and HIV/AIDS was the most confusing time I’d had.

A recently published study within Global Public Health, An International Journal for Research, Policy and Practice suggests sexual education should be taught earlier in childhood. The study urges policy makers, educators, and parents to start sexual wellness conversations earlier. It examines how there are currently no policies or programs focused specifically on kids in the beginning stages of puberty in various countries around the world. Most sexual health programs are narrowly focused on preventing unwanted pregnancy and HIV-prevention. These topics are important but do not solely encompass all aspects of effectively promoting sexual wellness.

I think programs promoting self-positivity, diverse healthy relationships, and continuing efforts to eliminate the taboo around sex are all things that preteens should have as a foundation to build on into adulthood. It’s especially important for kids to know how to decipher confusing messages about sex from movies and TV shows, the internet, their parents, teachers, friends, and even strangers on the street.

What do you think? Should sexual education be taught at an earlier age? Let us know your opinion in the comments.

Kirstin is the Multimedia Health Writing Intern at Emmi Solutions. She is a Virginia native currently working on her bachelor’s in Broadcast Journalism (TV) at Columbia College Chicago. Kirstin plans to combine her interest in public health and multimedia skills to pursue a career in health communications.

Guest Contributor: Jeffrey McWilliams, MD

Jeffrey McWilliams, MD

Jeffrey McWilliams, MD

In the spring of 1954, Roger Bannister triumphed in an epic battle of man versus the elements. Banister, a runner at Oxford trained with a relentless pursuit of breaking the 4-minute mile. This feat had never been accomplished, being deemed impossible by all others. Dedication, commitment and focus paid off on that spring day, when Bannister became immortalized in history as the first man to run a mile in less than 4 minutes. Soon after this accomplishment, two other runners were also able to replicate this amazing feat. A once unheard of accomplishment soon became the measuring stick for success by runners everywhere.

An awesome history lesson, but how does this relate to our lives? What does this have to do with me? In every realm of society, there are standards. There are standards in education, healthcare and economics. In the hospital, we focus on core measures, time to treat and responses to patients’ needs. As individuals, we have unwritten measures on how we treat others based on our social expectations and affiliation with the ancient saying “do unto others as you would have them do unto you.” Standards are vital for a productive society.

Now I’m not suggesting we just strive harder to meet standards in all walks of life – instead I’m saying let’s take it to the next level. I suggest, like Bannister, we focus on being the standard, not limited by society’s definition or constraints. As parents, spouses and healthcare workers, let us raise the bar of what is expected. We should create the norm. Whether done at home or in the hospital, your influence can create a new standard.

Over the past sixty years, the four-minute mile has been broken many times with 17 seconds shaved off of the 1954 record. What if Bannister had said to himself, “Four minutes? That is crazy! There is no way that is possible!” What if he had not dared to question society’s constraints?

Better yet, what can we accomplish if we dare to strive for excellence? Dare to set the standards.

“If we all did the things we are really capable of doing, we would literally astound ourselves.” – Thomas A. Edison

Dr. Jeffrey McWilliams is the Director of Customer Service at Leading Edge Medical Associates in East Texas. He is a self-proclaimed advocate for changing the world one person at a time – whether it be a hurting patient or a selfless frontline medical warrior. Read more from Dr. McWilliams on advocatesofexcellence.com

Contributor: Diana Dilger – Senior Health Writer, Emmi Solutions

Diana Dilger

Diana Dilger

Dr. Craig Bowron recently wrote an insightful article in the Washington Post about why people are unable to sidestep aggressive treatment with their elderly loved ones, mostly focusing on the feelings of guilt most of us have around not doing “enough.” Having done extensive research on end-of-life care, including a ride-along with a hospice agency social worker, I couldn’t agree with him more. Most people don’t want to let their loved ones – and, if they’re being honest, themselves – down. Somehow putting their sick loved ones through aggressive treatment that’s hard on the body (and hard on the caregivers, both emotionally and logistically) feels more active and more loving than letting the loved one lay at home without professional medical attention.

But do they really have to die at a hospital? With hospice, people can die in a comfortable, familiar place, not shoved full of tubes, or poisonous or harsh medicines. There are medical professionals to attend to the discomfort of dying and help caregivers with logistical decisions. And I know at this point, many people know about hospice and its benefits. I’m not preaching any ground-breaking news here.

What may be less discussed is the fact that most Americans want to die at home (Time/CNN poll, 2000). And I know what we say in a poll or what we think about strangers dying or death as an abstract concept, or even sometimes our own deaths can be an entirely different ball game from when we’re faced with the death of someone we love. Suddenly the feelings of guilt, of responsibility, of wanting medicine to “step up” and somehow stop death or prolong life take over.

But as Dr. Bowron points out, medicine can only do so much. And just because a treatment could prolong someone’s life, does that make it worth it? At some point we have to ask ourselves, to what end? What will this procedure accomplish? Is this worth the suffering or discomfort it may cause? Continue Reading »

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