Internet Course at UC Davis Extension

I have found the extension course on the Internet and the Future of Patient Care to be great. This was my first on-line course and I really learned a lot. Not only did I learn about taking on-line courses but got ideas on teaching on-line courses.Through this course I identified further areas of research interest and I did not expect that. Being an Internet user since the first browsers in the late 90's I thought I knew a lot about the Internet and its influence on health care. This course really reminded me how little I actually know and exposed me to new and interesting areas for me to explore. Hope to see you out there.......

Second Life as a Health Care Tool

I recently joined Second Life and adopted an aviator who I named Roy Valerian. “Roy” because it was easy and “Valerian” because that is what Second Life suggested I use. I took an on line training course and also had an orientation to “Davis Island” which is used for Second Life at UC Davis for health care modeling and research. I also attended an on-line seminar titled Brain and Behavior by Malachi Pelunia.  The seminar I attended was titled “An Evening in Second Life with Philip Farber.” I guess Mr. Farber was a philosopher. And his discussion was about the “Neurology of Success”. I think it was a recorded session and I could hear others asking questions to the lecturer but I could not interact myself. It was kind of fun.

I am improving my skills in Second Life. It is a large and complex environment and really takes some work up front to get started. I was very surprised at my formal session with my classmates in the Health Informatics program at UC Davis. I noticed that I was nervous with a new group and I found myself staying near the avatar of a close friend, it seemed to make me more comfortable. I found my behavior very interesting. I think this brief encounter shows me that there is real potential for a human connection in Second Life.

I have considered how Second Life might be used in the physician-patient or nurse-patient relationship. I really believe there is a lot of potential in the area of psychiatric care and in patient counseling and teaching. I was quite moved by the “virtual hallucinations” on Davis Island. Frankly it was scary and I believe there is potential for patients to be able to really share with their provider the thoughts and behaviors they may have been experiencing. I think additionally there may be the potential for patients to ask their physician or provider questions they may be too embarrassed to ask face to face.  Maybe questions about illicit drug use or even sexual concerns or intimacy problems could be addressed using avatars. I can also see Second Life to be a safe environment where a patient could ask about psychological fears the patient may have.

I think a provider could “assign” patients directed Second Life activities in the area of patient teaching. Maybe the patient “attends” a weekly education session for a patient who is newly diagnosed with hypertension. These sessions could be led by nutrition specialists, providers, pharmacists and even other patients who are in good control and have made positive lifestyle changes that improved their hypertension. I also think Second Life could be a good environment for group sessions for some, like an AA meeting or other type of group activity. I also can see virtual patient tours of clinics, hospitals or health centers as a good potential use for Second Life.

Last, I think Second Life has endless opportunity for provider training. I think back to my training as a flight and field nurse. I think Second Life could give great opportunities for training emergency personnel in the concepts of incident safety and triage.  The most difficult situations in my nursing career have been complex ethical dilemmas. I think Second Life could be used to set up ethical scenarios for training purposes. I think “being there” would be much different than reading scenarios on paper and then saying “what would you do?”  I think this ethical training could be used for providers and ethics committees. I also think a form of this ethical training could be developed for provider-patient end-of-life discussions. Second Life has real potential as a tool for patient and provider education and for specific patient care situations.

Unintended Consequences

I was quite interested in reading the October 14 Wall Street Journal Blog on Health and the business of health at (http://blogs.wsj.com/health/2010/10/14/people-are-suing-hospitals-for-malpractice-more-frequently-report-finds/). The blog describes that malpractice claims against hospitals are on the rise. The blog describes a rise to over 44,000 claims which will cost over 8.6 billion dollars.” The article goes no to conclude the rise in malpractice suits for hospitals is one, due to an actual reduction in tort reform and two, more physicians being employed by hospitals. 

Personally I was quite disappointed that tort reform was not part of the new health care bill. My thirty years in health care has convinced me that our litigious society has negatively impacted the delivery and cost of health care. I have watched colleagues and friends who are great people and even better practitioners suffer because of malicious, and unwarranted law suites. I know there is a time and place for law in health care but it is definitely overused and abused in my opinion. I hope that some form of tort reform is planned for revisions to the Patient Protection and Affordable Care Act.

Over the past several years I have been watching with interest as more and more hospitals and health care systems in the United States started hiring physicians. My experience is that most physicians “hired” by hospitals are actually part of a group of physicians. For example, in my community one or two emergency department physician groups are hired to cover the emergency departments of several local hospitals. Over the past few years these emergency department provider groups have added Hospitalists to their ranks. A hospitalist is a practitioner who works in the hospital to manage patient care and provide care continuity. Hospitalists usually do not carry a practice of patients in a private clinic setting outside the hospital.  It only makes sense to work with the emergency physician groups; these groups are formed, mature and have experience contracting with the hospitals.

Law suits against hospitals and hospital systems, versus ones against individual practitioners must be a dream-come-true for the malpractice attorneys. The award pot went from large to enormous. It will be interesting to watch these cases and see if the awards are even higher than before. I do not think this litigious trend will be good for patients, insurers, hospitals and we the public, who will ultimately pay the price. I hope this rise in law suits will prompt legislators to pursue stronger tort reform and possible amendments to the Patient Protection and Affordable Care Act.

Hello

Okay...set up my blog. I am now one my way.....if I only had the time to blog more!