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Posts for category: Perspectives

By Diji Vaughan, MD.,FAAP
May 11, 2013
Category: Perspectives

 

What’s a Patient Portal?

A portal just as is suggested by the Latin derivative, is basically a gateway or access into some space or situation.

Enter, the 21st Century! with yet another new technology: A Patient Portal. Alas! Patients can now enter and see aspects of their own health records and communicate with their doctors online! Technology and the sometimes friction laden-ride with the practice of medicine may have found a perfect fit.  Medicine today as an art form has many antecedents from the past, from Hippocrates through the Renaissance and the post WWII era that still shape many aspects of patient care, health care delivery and research. These past influences while valid did not anticipate the sprawling codes of zeros and ones and mega mass of bits and bytes in supercomputers that drive our world daily today. Troubling ethical and potential legal issues loom over different forms of electronic communication with patients, and their protected health information safety beyond the scope of this post.

Dr. Edmund Pellegrino, captured the paradox when he correctly stated, “being ill is a special state of human existence. It moves the patient into a position of dependence, vulnerability and exploitability. We hold medical knowledge in trust, it is not proprietary, for all of us (as providers of health care) have entered a covenant, and the sick have a claim on that knowledge”.

The availability and rising popularity of patient portals is very much in keeping with the position taken by the renowned physician and bioethicist quoted above. We all at some point in time have to access healthcare services for different concerns and we have a claim on the knowledge vested in those who provide medical services to us. As Dr. Wymyslo explains in the attached video link: http://bcove.me/dgcma7cq Patient portals have their own potential pitfalls too despite the strengths and advantages. Electronic health records have a certain permanency about them and a huge amount of discretion and due caveats rest with the patients when asking certain questions through the portal. Once these responses are posted on the portal they become permanent portions of the health record with diverse implications for all concerned.

Our efforts to launch a patient portal at our practice have found traction this year and will go live in July 2013. We have huge expectations as the community we’ve been privileged to serve over the past year has shown to be very receptive to patient engagement, family centered care and empowerment and we anticipate this service will complement their overall health care needs.

By Dr. Diji Vaughan
November 25, 2012
Category: Perspectives

 

What is CAM and what does it mean for my child?

CAM is an acronym for complimentary alternative medicine. The arm of the National Institute of Health (NIH) dedicated to providing information on CAM therapeutic options, and evidence for efficacy defines CAM as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. Conventional medicine is medicine as practiced by holders of M.D., D.O. degrees and by other allied health professionals, such as physical therapists, physician assistants, registered dieticians, psychologists, and registered nurses.

As the US health system migrates from an episodic care based model to a patient centered continuous care model among other changes in the offing, this crisp distinction between CAM and conventional medicine is certain to evolve.The 2007 National Health Interview Survey (NHIS), which included a comprehensive survey of CAM use by Americans, showed that approximately 38 percent of adults use CAM. As a practicing fellow of the American Academy of Pediatrics, this means at least 1:3 of the patients in my care may be using forms of CAM alongside conventional therapies with their parents or may elect to adopt it wholly (Alternative medicine) now or later.

Is CAM bad for my child?

Frankly any judgment on CAM is outside the realm of expertise of graduates of allopathic or osteopathic schools of medicine. The emphasis rather should be to equip the population with adequate information for informed decision-making. All care providers owe it to their patients to use the best of scientific evidence based health care practices whenever appropriate and to provide compassion and sensitivity to the patient's cultural, spiritual and emotional needs. Numerous CAM therapies are widely available to the public. Some of these CAM therapies maybe effective, there isn’t enough body of evidence in the medical literature to support efficacy of all CAM therapeutic options and more research is needed. This is where the quasi- caveat emptor and caveat venditor principle applies. There have been concerns about the safety of some CAM therapies, as reported in a small study from Australia in 2010 published in the Archives of Diseases in Children and Adolescents though the pedigree of controlled clinical trials required to evaluate the safety profiles of these CAM therapies are lacking in this study and the vast majority of others published to date.

CAM therapies have been broadly classified into (1) mind-body medicine, (2) biologically based therapies, (3) manipulative and body-based methods, (4) alternative medical systems, and (5) energy therapies. Biofeedback, Acupuncture, Music therapy, Animal therapy, and guided imagery are some of the popular CAM options commonly seen in pediatric centers and hospitals today.

Biologically based CAM therapies especially herbal therapies are especially common in my experience. They are classified as dietary supplements and outside the jurisdiction of the FDA sparing them the scrutiny of documented safety, efficacy and a profile of adverse effects before being made available for public consumption unlike conventional medications. This lack of regulation, purification and standardization presents unique challenges for the practicing pediatrician, since similarly labeled products from different manufactures may differ significantly in ingredient content and potency. This is especially concerning when pharmaceutically active ingredients like St John’s wort, melatonin etc. are involved. Heavy metal poisoning with lead after ingesting “tea” brewed specially at home for asthma in pottery imported from northern Africa led to significantly higher levels of lead in a patient in my care some years ago.  Exposure to heavy metals like lead and arsenic is a key concern with use of some biologically based CAM therapies imported from Asia. Certain cosmetic products while not strictly form of CAM but when imported from exotic places may pose similar risks from absorption of heavy metals through the skin with attendant health effects.

Credible sources as the National Center for Complementary and Alternative Medicine (www.nccam.nih.gov), the natural standard (www.naturalstandard.com) and discussing all treatment options being considered with your physician go a long way in safe guarding desired healthy outcomes. Our goal as aptly stated by Dr. Edward Trudeau in the 1800’s remains, “To cure sometimes, to relieve often, to comfort always”.

By 'Diji Vaughan, MD
July 11, 2012
Category: Perspectives
Tags: building  

In the words of Frederick Douglas, "It is easier to build strong children, than to repair broken men". While these timeless words from the late elder statesman were conceived in the context of the social and political issues of his time, they ring true to this day more than a century later. Let's build lives and healthy lifestyle choices, let's build safer neighborhoods, let's build stronger educational systems; let's build families.

An old Coca-Cola commercial, chimed the following words in my childhood, " I am the future of the world, I am the hope of my nation, I am tomorrow's people, I am the new inspiration... and we've got a song to sing to you, we've got a message to bring to you, we set a dream for you and for me and tomorrow......."

It's all about tomorrow, and our children, let's build together.