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#ClinicSpeak & #SocialMedicine: social medicine the next healthcare revolution

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Are you engaging in social medicine? #ClinicSpeak #SocialMedicine #MSBlog

The current big topic in the study of evolution is 'cultural evolution' and how the human brain is wired to be social. We are social animals and like to be connected. This is why we are tribal and flock to cities in our billions. The real success of the internet, or the web, is the 'social web'. The most successful tech products are social products. Facebook, Whats-app, Instragram, Google+, Pinterest, Waze, etc. Why have we not picked-up on this in healthcare and run with it? I think it is because healthcare, similar to education, as a field is slow to adopt new technologies and ways of doing things. 

The perspective article below in a recent NEJM makes the case for shared clinics. or as I now prefer to call them 'social clinics'. The concept is not new; we have posted on the topic several times before under the term 'group clinics'. The current healthcare model in relation to MS diagnosis and management is based on a synchronous model of one-to-one consultations typically in specialised centres. This requires pwMS to travel long-distances, to get a cursory examination and very short amount of time with their HCP. Both the HCP and the user, you a pwMS, are more often than not dissatisfied with the consultation. There must be a better way of doing things.   

At Barts-MS we plan to change the options available to our patients and have been successful in getting a grant to test several new initiatives to make our service more responsive. We plan to expand our on-line offering; essentially a better curated and easier to navigate information portal. At present this is text-based, but we will need it to make it multimedia and include video and podcasts (see below). We now offer telephone and Skype clinics. We have tested a 'Falls and Bone Health' group clinic and are now in he process of testing a few more topics. Our annual MS Research Day needs to become a more frequent event, perhaps smaller and more focused. We envisage running these using a similar format to our MS Roadshows to the regional hospitals in our local network. If successful we hope to be able to make all these offerings a permanent feature at Barts Health. 

Most practice of medicine, including MS, is not rocket science and getting pwMS to self-manage and to help others self-manage is potentially a game-changer. Importantly, we are certain that if implemented well we can get better outcomes, whilst saving the NHS money. 

My family gave me a Google Home Assistant for my birthday last week. Although I am still learning and teaching the assistant it has already revolutionised my life. I simply speak to it to do tasks that used to take me minutes to complete. Already the device has killed our Sonos music system in the kitchen; over the weekend we have played all our music through Google Home. Can you imaging using the Google Home Assistant to deliver healthcare? For example, you simply say 'Hey Google, I have MS please tell me how to manage my MS fatigue'. The Google Assistant will then offer a selection of formats and you could, for example, choose a podcast to listen to on MS fatigue self-management. As the use of assistant is hands-free it will revolutionise how disabled pwMS communicate with their families, carers, HCPs and other pwMS. The potential applications for this technology are endless. 

If anybody from Google is reading this post, or if you have a contact within Google who can help, I would love to discuss implementing a MS self-management system using the Google Home Assistant. We live in exciting times; the potential that technology offers to change how we practice medicine is endless, but when we design these symptoms they need to be social.

If you are engaging in social medicine please let us know. Similarly, if you have any ideas around social medicine please share them. Thanks. 

Ramdas & Darzi. Adopting Innovations in Care Delivery — The Case of Shared Medical Appointments. N Engl J Med 2017; 376:1105-1107. 


...... Transformative innovations in care delivery often fail to spread. Consider shared medical appointments, in which patients receive one-on-one physician consultations in the presence of others with similar conditions. Shared appointments are used for routine care of chronic conditions, patient education, and even physical exams. Providers find that they can improve outcomes and patient satisfaction while dramatically reducing waiting times and costs.....

........ Patients benefit from interacting with their peers and hearing answers to questions that may be relevant to them. Doctors avoid repeating common advice, which improves their productivity and enables higher-quality interactions with individual patients. Increased system capacity reduces waiting times even for patients who opt for traditional one-on-one appointments. Shared appointments have been used successfully for over 15 years at the Cleveland Clinic, in the Kaiser Permanente system, and elsewhere......

...... Shared service delivery isn’t a new concept. Group interventions are common for primary prevention (e.g., encouraging smokers to quit) and secondary prevention (e.g., helping patients with chronic obstructive pulmonary disease to avoid complications). Group-based programs such as Alcoholics Anonymous and Weight Watchers allow people to acknowledge that they have a problem and start working toward solutions......

....... Given the effectiveness of group interventions, why aren’t doctors routinely using them to treat physical and mental conditions? We believe four crucial components are missing: rigorous scientific evidence supporting the value of shared appointments, easy ways to pilot and refine shared-appointment models before applying them in particular care settings, regulatory changes or incentives that support the use of such models, and relevant patient and clinician education. Such enablers are necessary for any highly innovative service-delivery model to become standard......

..... Shared medical appointments change the boundaries of health care services because fellow patients, rather than only the doctor, can provide information and support......

..... With any new delivery model, regulation and participation incentives influence uptake.....

...... Finally, patient education could stimulate interest in shared appointments.....

....... When altering an interaction as unstructured and personal as a doctor visit, patient education is critical. Many patients may hesitate to participate in a shared appointment for their annual physical, imagining that they would meet fellow patients in their underwear. In fact, in a typical shared physical for female patients at the Cleveland Clinic, the doctor performs pelvic and breast exams and discusses test results with each patient in private. The remainder of the appointment is conducted as a shared appointment. By sitting in on shared appointments as unbilled observers, patients can experience for themselves the less tangible benefits of peer interaction.....

...... Doctors also need education. Large health care organizations could experiment with new care models and invite doctors within their system to observe and learn......

....... Indeed, these needs apply to all new delivery models: to accelerate their adoption, we will need to embrace new strategies for collecting evidence on their outcomes; find safe, quick, and cheap ways to experiment; offer incentives to providers; and educate stakeholders....

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