Press "Enter" to skip to content

How Can We Personalize the Latest Treatment Recommendations?

So, I leave the country for a few days, and suddenly we’re no longer using baby aspirin. Wait, what?

Sunburned on One Side

I’m just back from taking our first full vacation in about 4 years, having accompanied my wife on a trip to northern Spain (see photo below), where she had a reunion with the class from her junior year of high school where she did a school year abroad program. We walked about 120 kilometers of the Camino de Santiago, an ancient pilgrim path that has been traversed for hundreds of years.

For the most part, we were off the grid, not using our phones except to take pictures, little wifi and very little email access.

An amazing trip, with time to reflect and get into your own thoughts and out of your own head while hiking in the beautiful countryside and up into the mountains. We all emerged happy and comforted and calm, with the left side of our bodies sunburned (hiking is one direction the entire time, so the sun was mostly on the one side of us).

Finally back in the U.S., and back at my desk, I logged onto my computer and found dozens of portal messages from patients, asking me whether I’d heard that they were no longer supposed to take aspirin, what did I think about this, and what should they do?

Personalizing for the Masses

The announcement had of course gotten a lot of press, including several confusing articles in the popular press, a lot of mentions on social media, and even a few pieces on the evening news. I’m thinking to myself, “How many of my notes from annual physicals include the phrase ‘Continue baby aspirin daily for primary prevention’ or even just ‘on ASA 81′”?

Just the other day, one of my partners at work sent out a group message to the rest of us, asking if we’d come up with a macro to message back to patients who sent this request, since everyone seems to be deluged with them. Was it possible to create some standardized templated note that we could send out to all of our patients explaining what this recommendation meant, and would allow patients to interpret for themselves individually what to do next about their aspirin use?

As I sat there looking at her message, I tried to formulate in my head what that would look like — perhaps a brief summary of the conclusion and recommendations which are going to be coming from the U.S. Preventive Services Task Force — but it felt like no matter what we wrote, we’d still hear back from patients: “Yes, but does this apply to me; what do you think I should do?”

Many of us have come up with templated macros that we use to let patients know that their blood tests all look fine, that the few things that are highlighted as abnormal are of no real clinical significance, and to call us if they have any questions or concerns. For the most part, however, I think our patients expect us to analyze all of the data of all of the studies and interpret them individually for them, for their particular case, for them as a singular human being.

Sure, it’s easy when patients send us a message asking what they can do to increase their basophils since they’re below the lower limit of normal, or how they can increase their mean platelet volume since it was flagged as out of range. “These are of no clinical concern, everything looks great, keep up the good work.” But when it comes to something like making a medical decision such as starting or stopping a medicine, it’s understandable that our patients expect individualization, they want to know what new recommendations mean for them in particular. This is how we would all want to be treated. None of us like getting pre-packaged generic responses that don’t really feel like anyone’s paying attention to you.

It reminds me of when you reach one of those automated customer service lines, and they say, “Tell us in a few words what you’re looking for, and we can direct you to the right place.” No matter how simply or clearly we say it (“The cable is still not working; the little lights on the box are still flashing red”), it always feels like we don’t end up in the right place, and we end up yelling “Representative!” at the phone over and over again until a live human being finally picks up.

EHR to the Rescue?

For now, at least, I’ve been replying individually to these patients with my own interpretation of what I’ve read about this new development, and telling my patients that many of them can continue, many of them are taking it because they have an absolute or relative indication for it, and even that for many of them it looks like a baby aspirin may in fact potentially be causing a risk of harm that makes it worth stopping. But it would be nice as we build a better electronic health record (EHR) if we could find ways that changes in practice management and new announcements and new recommendations could be quickly and easily communicated to patients in language they can understand.

For example, over the past couple of weeks, we’ve all received countless emails asking about booster shots, when can I get my booster shot, when are you going to have the booster shots, do I need a booster shot, is it safe to get a booster shot. Someday the system will be smart enough to say to the patient, “You’re not due for a booster shot for your Pfizer vaccine for another 6 weeks; give us a call then” or “The Moderna booster shot has not been authorized yet; please reach out to us after you see an announcement about this, and we’ll let you know” or “We have no record that you’ve even completed the primary COVID-19 vaccine series; why are you asking about a booster shot?”

The changing world of healthcare, new data from new studies, and changing standards of care make for an endless onslaught of information that needs to be processed and brought to our attention and to the attention of our patients, to keep them moving in the right direction.

Someday we’ll get there. For now, I’m hoping nothing else big will change in the next few days, as I try to get caught up.

Fred N. Pelzman, MD, of Weill Cornell Internal Medicine Associates and weekly blogger for MedPage Today, follows what’s going on in the world of primary care medicine from the perspective of his own practice.

Please enable JavaScript to view the comments powered by Disqus.

Source: MedicalNewsToday.com