Monthly Archives: May 2012

Talk to Your Patients About Virtual Care

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By Karin Krisher

virtual care

 

 

 

 

 

 

 

 

 

 

Maybe virtual care isn’t a topic you approach often.

Maybe that’s because of your own thoughts on the doctor/patient relationship, or maybe it’s because you feel your patients won’t be receptive. Whatever the reason, virtual diagnoses and treatments are an up-and-coming phenomena of which you, and your patients, should be aware.

Many insurance companies, including Aetna and Cigna, have made the leap to cover telemedicine. Many patients are searching for an economically sound solution for their health care issues. Many doctors are responding by taking their practices to the web. What can you do?

Simply discussing the possibility of virtual care with your patients will give you a better gauge for telemedicine’s potential.

It may seem counterintuitive at first—after all, isn’t the point of working in a practice that it allows you to develop a relationship with your patients that gives you better, personal knowledge to respond to their medical needs?

But in a changing global communication environment, that relationship can be developed over a vast space. Proximity shouldn’t dictate our ability to give and receive information. Further, doctors enjoy the ability to open up their schedules for appointments that require face-to-face examinations, and patients get the same freedom. The cost is also less for both parties.

Writes Phil Galewitz of Kaiser Health News, “One major obstacle has remained, however: Many state medical boards make it difficult for doctors to practice telemedicine, especially interstate care, by requiring a prior doctor-patient relationship, sometimes involving a prior medical exam.”

This stipulation could be reassuring to your patients, though, and isn’t necessarily a negative concept to hold onto for a moment as we ease our way into this new era of medicine. After we become comfortable with the idea, and telemedicine is a more widespread practice, this stipulation will likely fall to the wayside, giving way to a world in which your patients can choose their care from a wider range of practitioners, and you can expand your clientele to include more patients concerned with your specialty.

Whatever your feeling on the changing medical communication landscape, your patients should know that the option exists. Ask them for their opinion and their concerns to further your understanding of patient desires, and share your opinion and concerns with us– in a comment!

Understanding Depression: Talk to Your Patients About New Information

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By Karin Krisher

understanding depression

We know—the conversation about understanding depression is overdone—now.

But 20 years ago, depression was still relatively under the radar, and it took humble admissions from several prominent figures (most notably, Tipper Gore) for American society to recognize and generally accept that depression concerns a chemical imbalance, rather than a lifestyle choice.

Today, there persists a strong dichotomy in the treatment process: depressed people can either A) attempt to correct their chemical imbalance with prescription drugs, or B) change their lifestyle via therapy and personal effort, and wait for mood changes to come about naturally, depending on chosen environment.

But what if neither of these proposed solutions are actually solutions at all? What if depression is a fact about someone’s physical makeup, like blue eyes or big hands, and an attempt to “correct” it is doomed from the start? A newly published study suggested that might be the case.

depression pills

Understanding Depression in Chemical Terms

The study showed that those with higher releases of dopamine in the striatum and ventromedial prefrontal cortex are more willing to work hard for rewards. In other words, a dopamine flood to the areas of the brain that play roles in motivation and reward will motivate those people, regardless of the reward.

“On the other hand, those who were less willing to work hard for a reward had high dopamine levels in another area of the brain that plays a role in emotion and risk perception, the anterior insula.” (Janice Wood, PsychCentral) That lack of motivation persisted even when the participants had knowledge that the resulting reward would be less.

Though the study explicitly refers to motivation as it relates to effort, its implications for mental health are staggering. For so many years, we’ve been “treating” depression, anxiety, schizophrenia and ADD/ADHD as if dopamine was a transmitter whose powers could be harnessed and regulated. Now, the truth is becoming clear: Location, location, location.

If one’s brain were hardwired to release dopamine to certain areas, redirecting it would be a massive task that employed the powers of geneticists, neurologists and psychologists alike—perhaps so massive that we should reconsider the very fact of any effort to “correct” chemical imbalances, and change the way we talk about depression.

depression brain

Motivation is a huge factor in depression. If a person truly desires a reward, they’ll take the necessary initiative. In a world chock full of over-achievers, if a person isn’t willing to work hard because he or she doesn’t actually want the reward that badly, s/he is often faulted in a way, and relegated to a diagnosis of depression.

Or, taking it one step further, the reward the person wants might be different, as the release is in the area of the brain associated with emotion and risk. Perhaps (and this is speculative, but seems intuitive) s/he would be more motivated to take a large emotional risk for an emotional, rather than monetary, reward. But does that make that person, who the rest of society might label “unmotivated,” clinically depressed?

Talk About It

Talking to your patients about depression can be tough. Certainly, you don’t want to negate the reality of its existence. Certainly, what they feel is very real, and in this fast paced, whole-lot-of-work-for-little-reward world, stifling. Certainly, support is needed for that person to function happily amongst those who are in the striatum camp.

But what kind of support is the issue. Maybe we should focus on making the things we can’t change work for us, instead of trying, often without result, to change them. With that thought in mind, talk to your patients about depression and anxiety. It’s a reality that negatively impacts one in ten American adults—and now, we are learning, one that might never change.

That doesn’t mean there is no hope for overall happiness—only that hope needs a new direction.

Tell us about your experiences with understanding depression. Will this new information change how you view that conversation? In what ways?