EPtalk by Dr. Jayne 7/7/22

I’m back in the swing of things post-camp and am grateful that all was quiet at my day job. Now I’m wearing my blogger hat and wading through several hundred emails trying to figure out what happened in the healthcare IT world while I was gone.

There were the usual press releases, government updates, emails from my professional organizations, and what seems like more than my share of messages that should have been flagged as spam yet were sitting in my inbox. I had links to a handful of interesting journal articles, some clinical updates, and of course the latest and greatest about monkeypox (which is apparently still awaiting a new name courtesy of the World Health Organization).

The first article that caught my eye looked at using data from Twitter to better understand how the public thinks of FDA-approved versus off-label use of medications to treat COVID-19. The authors used natural language processing to evaluate 600,000 tweets that originated in the US between January 2020 and November 2021. They examined content mentioning four drugs that received a lot of attention during the pandemic. Both molnupiravir and remdesivir were FDA-approved treatments for COVID, where hydroxychloroquine and ivermectin had only anecdotal evidence for their use.

Not surprisingly, the authors found that the unapproved agents were mentioned more often, especially during pandemic surges. They also found that Republicans were more likely to support the unapproved agents than Democrats. Individuals with healthcare backgrounds opposed the unapproved agents more than the general population. The authors concluded that “social media users have different perceptions and stances on off-label versus FDA-authorized drug use across different stages of COVID-19, indicating that health systems, regulatory agencies, and policymakers should design ‘targeted’ strategies to monitor and reduce misinformation for promoting safe drug use.” This certainly becomes more difficult in states where governmental agencies and the courts took steps to promote or protect the use of unauthorized drugs. It will be interesting to see how this continues to play out now that we’re no longer in the most explosive phases of the pandemic.

The next article that caught my attention was about decision fatigue. The term refers to “a state of mental overload that can impede a person’s ability to continue making decisions.” Whether they’re small decisions or more significant ones, decision fatigue can leave individuals feeling “overwhelmed, anxious, or stressed” and can interfere with ongoing decision-making ability. According to the psychiatrist featured in the article, individuals make over 35,000 decisions during the course of a day, consciously or not. The COVID-19 pandemic has added stress for physicians as we navigate decisions in an increasingly complex healthcare environment. She notes that physicians have “had to make decisions we never had to make before, and we’ve had to manage the anxiety of our patients.”

Many of us have also had to manage the anxiety of family members as well as their healthcare needs, from helping them schedule vaccine appointments to making sure they can navigate through the web of in-person versus virtual visits over the past two years. One member of my family postponed a joint replacement during the pandemic and was just able to have surgery last month, which was a great relief. Decision fatigue can leave people feeling tired, drained, or with foggy thoughts. People are also likely to engage in unproductive processes as a result, via procrastination, avoidance, indecision, or impulsivity. We’ve all seen enough pandemic buying to explain the latter, and I’ve definitely seen the first three among my friends and colleagues as well.

Strategies for overcoming decision fatigue include creating daily routines, making lists to help avoid random decisions, simplifying repetitive processes through services such as automatic bill pay, and reducing tasks and activities that don’t provide value. The psychiatrist notes that “research shows that the best time to make decisions is in the morning” which is a time “when we make the most accurate and thoughtful decisions, and we tend to be more cautious and meticulous.” It makes sense to me – I know that by the end of the workday, my brain is pretty much fried.

The third item that caught my eye was an ONC blog that talked about health equity by design. It summarized some of the findings of ONC’s Health Information Technology Advisory Committee (HITAC) as it looked at creating equity in data collection, interoperability, artificial intelligence, bias, and crossing the digital divide. Since data collection is important to understanding outcomes and measuring change, it will be important to capture information on race, ethnicity, sex, language, disability, sexual orientation, gender identity, and social determinants of health. Although many organizations are doing a good job capturing these elements, I often see charts where many of the fields are blank.

Bias is important especially where artificial intelligence is concerned. There have been numerous articles in the last several years looking at how particular models perform when factors are different from the data set on which the model was trained, such as when a particular demographic isn’t adequately represented in the data set. There have been significant changes in how we manage certain laboratory values based on evidence versus old ideas that race is more of a factor than it should have been.

One example of this is kidney function. In the past, race was used to set different reference ranges for certain lab values. Scientists have realized that using race can be problematic since it doesn’t necessarily represent a specific genetic makeup or group of underlying biological characteristics. I’m excited about efforts to deliver healthcare in a more equitable manner, and especially initiatives that use technology to ensure quality care for all. I’ll definitely be watching to see where some of these efforts go.

Speaking of excitement, it’s July, which means the beginning of Internship year for many newly minted physicians as well as residency promotions for other trainees. My medical school recently reached out to me asking for help inspiring the incoming MD class, who will be receiving their white coats in a ceremony later this month. I trained at a time when there wasn’t any ceremony and we just felt lucky to get a coat that fit (and many in the class didn’t, which resulted in a lot of swapping after the fact) as we raced into our third year of medical school.

New students receive theirs in the first year after several orientation weeks, and they’re not only sized properly, but are embroidered with their names and the school crest. I’m sure it instills a sense of pride and accomplishment, although based on the state of healthcare today, I’m not sure I have any inspiring thoughts for those entering a system that seems more dysfunctional than it did even a few short years ago.

What do you wish you had known when you started your journey in healthcare or healthcare information technology? What would you tell today’s entering medical students? Leave a comment or email me.

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