• Make a BJC Health appointment on your iDevice

Why rheumatologists may be sceptical about e-patients?

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By Dr Irwin Lim, Rheumatologist

Analogue Boy

Courtesy of Jenny Poole, Flicker

I’m currently enrolled in my first MOOC. That’s Massive Open Online Course. Yup, I didn’t know about these either until recently.

It’s titled Medicine in The Digital Age and runs on the edX platform.

This week, we’re looking at how patients have changed in this digital age and I just finished watching an interview between Dr Bryan Vartabedian (Dr V from 33charts) and Dr Roni Zeiger.

Here are some distilled thoughts regarding why doctors, and your rheumatologist, may be a little sceptical about the digital age when it relates to medicine.

Why?

It’s change, and it’s rapid change.

Medicine (and rheumatology) is a discipline that changes in very, very incremental ways. Change can be uncomfortable and this discomfort is felt particularly by those who traditionally control the way in which the field changes. Discomfort leads to a degree of push back.

Doctors invest huge energy in caring for people. We want to be effective and we’ve been taught certain ways & rules to work by to enable this. Now, the rules seem to be changing. That leads to a degree of uncertainty.

Doctors do worry when patients have so much access to information which they may not understand. This may potentially waste valuable time in the consult room discussing “irrelevant” information and may even cause harm if the patients follow recommendations from untrained others and from “untrustworthy” sources.

Of course, we could take a different view of this wonderful information access.

Patients may find answers to a heap of questions they have even before they see the doctor. The basics can be taken care of efficiently. And questions may then be more sophisticated with consult time spent in a more targetted way.

The power dynamic is changing. Patients, now armed with reams of information, can seem challenging at times. There is more pressure on the doctor. They need to be on top of their game. They need to be honest when they don’t know (and I think patients do accept & understand there is a limit to how much info any doctor can store in their brain).

Doctors can be uncomfortable with this power shift.

But hopefully, this relationship and dynamic will mature.

Information is not the same as knowledge.

The doctor, your rheumatologist, still plays the crucial role of providing context and experience to aid interpretation of the information.

It’s such an interesting time to be a doctor!

Please share your experiences with this changing patient-doctor relationship.

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
BJC Health’s vision is to create best care for people with arthritis. Contact us.
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Rheumatoid Arthritis Physiotherapy E-learning

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By Dr Irwin Lim, Rheumatologist

Inflammatory arthritis seems to not figure in the thoughts of many allied health professionals and general doctors not attuned to musculoskeletal disease.

The good news is that there are many moving to change this.

I was involved with the AS You See It program, which provided teaching to 500 physiotherapists around Australia and another few hundred via webinar (read about this campaign here).

I hope that made some difference.

I’m also very glad to see this new attempt to engage physiotherapists on this subject.

RAP-el

The RAP-el (Rheumatoid Arthritis Physiotherapy E-Learning) website was funded by Curtin University. I was invited to test out the site by A/Professor Andrew Briggs, a physiotherapist researcher. It’s really a very nice looking and informative site.

Andrew & the team behind the site have even published research to demonstrate the effectiveness of this e-learning initiative (see abstract).

RAP-el Mod

You don’t have to be a physiotherapist to access it. I think it gives information which is accurate and presented in an easy-to-digest format.

Check it out: www.rap-el.com.au

RAP-el case

The challenge is to attract physiotherapists to actually use it. Here’s where professional bodies and university groups need to become involved.

In Australia at least, physiotherapy groups seem far more concerned about sporting-related injury and mechanical musculoskeletal disorders than they are about the numerous types of inflammatory arthritis, and to some extent, osteoarthritis.

The teaching at both undergraduate level and postgraduate level on these common diseases that do present to physiotherapy clinics is inadequate.

More needs to be done so I’m happy to highlight this RAP-el site. Could you please help spread the word by sharing this with your physiotherapists (& chiropractors, osteopaths, etc)?

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
BJC Health’s vision is to create best care for people with arthritis. Contact us.
This blog focuses on arthritis, healthcare in general, and Connected Care. Please subscribe to keep in touch:
 
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Book appointments online with your rheumatologist

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By Dr Irwin Lim, Rheumatologist

This is an interesting topic I’ve discussed with some colleagues.

It makes sense. It’s convenient for patients/clients. It would save some time for administration/reception staff.

I assume if you are reading this blog, you’d feel pretty comfortable making an online booking with a restaurant. Why not make your appointments online?

Now, a few of my colleagues felt this was not a good idea. “Exposing” the appointment book was one worry. Mistakes and the hassles it might lead to was another.

There are usually workarounds to any concern, and I would bet, that in coming years, online appointments with your doctors and allied health professionals will become more and more common.

Use of IT in Health in general moves slower that other fields, but we will catch up.

At BJC Health, we’ve set up an online appointment system (see link).

In addition, there is a downloadable app, Appointuit, that connects to our appointment software.

I created this document to help patients see how easy if should be to use.

How to book a BJC Health appointment on your idevice

Now, I just hope it gets used and hope our IT backend holds up without technical glitches! There’s likely to be bugs to iron out but we wanted to give it a go. Any feedback would be great.

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
BJC Health’s vision is to create best care for people with arthritis. Contact us.
This blog focuses on arthritis, healthcare in general, and Connected Care. Please subscribe to keep in touch:
 
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Use your laptop while standing

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By Dr Irwin Lim, Rheumatologist

I just installed this in my man-cave.

I sit so so much at work. And while I would like to consult while standing, it might not be seen as that appropriate by my patients (I wonder if this is true?) who may need to sit due to the problem they’re consulting me about.

So, I really needed some option to work standing up at home. I hope this proves useful and comfortable.

It might prove an option for our staff. We’re also considering how we use electronic sit-stand desks.

I thought I’d share this as there must be many of you with the same issue. I’d love to hear your thoughts on how you’ve reduced the over-sitting at work.

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
BJC Health’s vision is to create best care for people with arthritis. Contact us.
This blog focuses on arthritis, healthcare in general, and Connected Care. Please subscribe to keep in touch:
 
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Welcome Tofacitinib. Now, how should I use you?

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By Dr Irwin Lim, Rheumatologist

I have not previously experienced a marketing campaign of this nature. The message repeated via mail, e-mail, print ads in medical newsletters. Clever design of the media with frequent reminders.

Xeljanz
The product, Pfixer’s Xeljanz. A new class of medication for rheumatoid arthritis is now available for use in Australia.

I’d written about it some years ago in this post: Tofa, would be nice if as cheap as Tofu.

It’s an exciting development and rheumatologists like, want and need options for their patients with rheumatoid who have disease which has not responded adequately to treatment.

Patients in Australia are fortunate that the government heavily subsidises the use of biologic disease-modifying medications (bDMARDs) if their disease has not been controlled by conventional disease-modifying medications (cDMARDs) such as Methotrexate, Sulphasalazine & Hydroxychloroquine.

There is access to Etanercept (Enbrel), Adalimumab (Humira), Infliximab (Remicade), Golimumab (Simponi), Certolizumab (Cimzia), Tocilizumab (Actemra), Rituximab (Mabthera) and Abatacept (Orencia).

Now, we have a 9th medication to consider, after the cDMARDs. This is a good thing.

But, we aren’t yet clever enough to know which of these medications is the best choice front-up for any individual patient. So, rheumatologists try to make educated “guesses” based on available evidence and their personal experience.

I summarise some earlier thoughts on how we choose here: With so many biologics for rheumatoid, how do you choose?

Specialists are usually creatures of habit. I think that’s one reason for the marketing blitz.

A major point of difference for Tofacitinib (Xeljanz) is that it is taken as a pill. So, you can swallow rather than inject or get infused.

Some may see this as a major advantage, others may not. Read the comments on this post: Would you like that IV, subcut or oral?

At the time of writing this post, I do not have a patient on Xeljanz. That’s surely going to change but I am grappling and considering which patient in which circumstance it would be most appropriate for.

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
BJC Health’s vision is to create best care for people with arthritis. Contact us.
This blog focuses on arthritis, healthcare in general, and Connected Care. Please subscribe to keep in touch:
 
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