better health by designLearn More

The green laces may not be a daft idea

Researchers from Harvard University have just published a study entitled The Red Sneakers Effect. They conclude that:

A series of studies demonstrates that people confer higher status and competence to non- conforming rather than conforming individuals. These positive inferences derived from signals of nonconformity are mediated by perceived autonomy and moderated by individual differences in need for uniqueness in the observers. An investigation of boundary conditions demonstrates that the positive inferences disappear when the observer is unfamiliar with the environment, when the nonconforming behavior is depicted as unintentional, and in the absence of expected norms and shared standards of formal conduct.

It is unlikely that sneakers and torn jeans will impress people when consulting a healthcare professional. However if that practitioner wears green shoe laces or eye catching socks it might not do his or her credibility any harm.

Picture by Kaleb Fulgham

What is your approach when you know you can’t cure?

The upper respiratory tract infection or common cold is the commonest reason people  see a doctor. There is no ‘cure’. The symptoms last three to ten days and eventually resolve. Some symptoms take longer to resolve than others. Those with a cold have to bear with the discomfort for a few days or even weeks.

Placebo treatment has been reported to improve subjective and objective measures of disease in up to 30–40% of patients with a wide range of clinical conditions. A review of 8 clinical trials on the effects of antitussive medicines on cough associated with acute upper respiratory tract infection shows that 85% of the reduction in cough is related to treatment with placebo, and only 15% attributable to the active ingredient. R Eccles

Twenty-seven patients were randomized to placebo treatment and 27 to the no-treatment group (mean age 22.6 years). The median difference between post- and pretreatment CF was −3 in the no-treatment group and −18 in the placebo group (p = .0003). There was a significant increase in CST in the placebo group compared with no treatment (p = .027). Lee et al

However is it ethical to recommend treatment which is not proven to have any pharmacological effect?

OTC cough medicines do not appear more effective than placebo in relieving symptoms of acute cough. Even if statistically significant, effect sizes were small and of doubtful clinical relevance. The number of trials in each category was small, and the results of this systematic review have to be interpreted with caution. Based on the available evidence from a small number of studies, we cannot recommend OTC cough medicines as a first line treatment for children with acute cough. Schroder and Fahey

Experts are still pondering. Meantime what will you do today when you see that person with a cold who is still coughing a week later?
It has traditionally been assumed that deception is an indispensible component of successful placebo use. Therefore, placebos have been attacked because they are deceptive, and defended on the grounds that the deception is illusory or that the beneficent intentions of the physician justify the deception. However, a proper understanding of the placebo effect shows that deception need play no essential role in eliciting this powerful therapeutic modality; physicians can use nondeceptive means to promote a positive placebo response in their patients. Brody

Although the available evidence is incomplete and confusing at times there can be little doubt that the prevalence of placebo use outside of clinical trials is not negligible and that views and attitudes on placebos use differ considerably among individuals, both health care professionals and patients. Further research is needed to clarify these issues. Fassler et al

Picture by Sarah-Rose

The doctor is a busy lady

My friend Alex is a good daughter. She would accompany her mother to the clinic for injections every two weeks. They would wait patiently in the waiting room before they were called in to have the treatment. Alex’s mother was a diabetic. Because of her treatment she needed regular meals. At one visit Alex went up to the reception desk and asked how long before it was her mother’s turn.

You see she is a diabetic and needs some food.

The response was jarring:

The doctor is a professor.  She is a very busy lady. She will see you when she is free.

Alex tells me that professor was a wonderful doctor and would have been horrified to hear that the receptionist had been so rude. Do you know what the person who saw you customer, client or patient just before you said to that person? Isn’t it your business to know?

Picture by Ronnie Scotch Finger

How do you prepare for work?

I don’t know him personally but I don’t imagine that Michael Phelps dives into a pool when he isn’t ready to race. Similarly Usain Bolt might look like he jumped off the viewing stands and popped himself on the starting blocks but in truth his mind and his body are ready to make him the fastest man on dry land. However when we arrive at work we might still be thinking about the argument at home, the traffic jam or the news. We might arrive a bit disheveled, a bit breathless or a tad tired. We might not hear the first few things we are told or notice more than we can take in at a glance of our first customer client or patient. However to perform at our peak we might consider what might get us in the zone so that our performance is not in question.

Picture by Jörn Guy Süß

Are you catering to those who need you?

40 years ago people older than 65 years of age were a minority in the population. In the very near future they will be a significant minority and for some service providers they will be the majority. Healthcare is a good example. However the population may be ageing but it is also changing.

This aging population has many options from which to choose and they are looking for more than just a particular retailer, restaurant, product or service. They want their purchase to count: to satisfy mental, emotional and even spiritual needs as well. Older consumers: Redefining Health and Wellness as they age.

How has this been factored into your plans for how you will respond?

Picture by Nicolas Alejandro

Trust me

Is there anything about how you appear today that might reduce your credibility with your client, customer or patient? Does anything about you diminish the impression you’d like to create?

A majority of participants reported that wearing an easy to read name tag (77%), neat grooming (65%), and professional dress (59%) were important when first meeting a family member’s ICU physician, while a minority felt that physician sex (3%), race (3%), age (10%), absence of visible tattoos (30%) and piercings (39%), or wearing a white coat (32%) were important.

Third, we affirmed that regardless of dress, professionalism, neat grooming, and a clear name tag are perceived as a requisite by patient families. These results suggest that while families may not express preferences for how physicians dress, there may be subconscious associations with well-recognized physician uniforms including white coats and scrubs. Given the importance of effective communication in the ICU, physicians may want to consider that their attire could influence family rapport, trust, and confidence. Selena Au

Picture by Rodrigo Santos

Show and tell

Nothing is as compelling as seeing a vision of  yourself in the future. Increasingly healthcare professionals have the scope to offer people a vision of the future. It’s possible to display projected changes on avatars, websites or infographics. How might you show people what might happen in the foreseeable future?

Recent literature shows that new technologies can be used to promote patient engagement. The present contribution focuses on Virtual Worlds (VWs), namely virtual environments that multiple users can experience together thanks to the use of avatars. Indeed, VWs offer interesting opportunities for patient engagement interventions on two levels. On the individual level, customized avatars are known to have relationships with users’ inner experience and Self-conception, so that they may constitute a peculiar additional tool for psychological assessment. Moreover, they are able to promote healthy behaviors thanks to a strong vicarious reinforcement (Proteus effect). On the collective level, VWs constitute an ideal platform to support the emergence of collective flow states (Networked Flow) which are related to the patients’ creative activity and well-being. Healthy Avatars, Healthy People: Care Engagement Through the Shared Experience of Virtual Worlds

Picture by Trina Alexander

Are you worried they’ll never stop talking?

It’s a busy day at work and the next customer, client or patient settles in to tell you something. Are you secretly asking yourself:

 How long will this take?

Will it pay off allowing them to take a couple of minutes to speak about whatever’s on their mind? Have you tried it and timed how long before they stop?

Studies have even shown that participants are willing to give up between 17% and 25% of the monetary reward offered for talking about others in order to feel the intrinsic rewards of talking about themselves. And outside of the lab, 40% of our everyday speech is devoted to telling other people how we feel or what we think. That’s almost half! Belle Beth Cooper

So if you want to do something special for your client, customer or patient give them a chance to say what they want- you might be surprised that it doesn’t take that long and pays enormous dividends.

Picture by Stiller Beobachter

How will your respond to the next ‘big idea’?

You can bet that just around the corner there will be another ‘break though’ in healthcare.

A new drug will be launched, a new procedure will be advertised, a new expert will pop up claiming to have found a cure. It won’t take much, just swallow the pill as often as they recommend and see the magic for yourself.

So if you are in healthcare you will find yourself subject to advertising, information, journal articles, patient enquiries and it seems Dr. Google’s recommendations.

The neatly packaged product will promise anything from increasing longevity, symptom relief and possibly enhanced function if only you would prescribe it for the next person with this condition that you see in your clinic.

It isn’t a case of might, its a case of when this happens.  How will your respond?

Although in the majority of critical incidents GPs considered initial information inadequate and used further evidence or colleague opinion before prescribing, in many incidents GPs relied heavily on the pharmaceutical industry as the major information source. This is disquieting since information from representatives may be misleading, biased, contain inaccuracies that doctors fail to recognize and encourage less rational prescribing. Prosser et al

Picture by  malik ml williams

Is there such a thing as simple administrative task?

Jane was invited back to have a repeat colonoscopy ( examination of the bowel). Her specialist wasn’t happy that he had a clear view through her bowel last year and he couldn’t be completely reassuring. Meantime Jane had noticed a change in her bowel habit and was now worried.

So she made an appointment with her doctor who practiced several suburbs away. It is a vagary of the system that although the specialist invited her back she had to get a letter from her family doctor to accept the invitation. Her doctor didn’t ask whether she was worried about it or why she had made an appointment that particular day given that the specialists note to her was a month ago. He simply wrote:

This lady needs a repeat colonoscopy as per your previous records. Thank you for seeing her again.

Two minutes later she was handing her credit card to the receptionist and walking out of the building.

Lost opportunity. Is there such a thing as a simple administrative chore or what we choose to make of an opportunity presented to practice our art?

Picture by madamepsychosis