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The Patient Will See You Now: The Future of Medicine Is in Your Hands (Inglese) Copertina rigida – 22 gen 2015


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Amazon.com: HASH(0xb06868b8) su 5 stelle 123 recensioni
54 di 59 persone hanno trovato utile la seguente recensione
HASH(0xa2f19030) su 5 stelle Nothing about me without me - rethinking healthcare consumption 4.5* 28 dicembre 2014
Di Jijnasu Forever - Pubblicato su Amazon.com
Formato: Copertina rigida Acquisto verificato
Topol's earlier book - The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care discussed quantified-self, and aspects of the app-centric health data logging and analyses and concluded that mHealth will form the basis of healthcare disruption. In this book, Topol provides a very interesting thought framework to deduce "what's next?"

The first section expands his assertion that paternalistic healthcare systems (personified by FDA, AMA, and traditionalists) is really behind the times and the notion "nothing about me without me" is increasingly becoming not only feasible but also demanded by the patients. Providing a detour explaining the evolution of interpretations of the Hippocrates oath, Topol uses that opportunity to take issue (yet again) with the AMA and the entire practice around guidelines. While arguing for increased access for patient-related information to the patients, Topol clearly acknowledges the difference in information and knowledge gaps and points out that mere access is not sufficient, but it is a critical step in rethinking patient engagement and direct participation. To further expand on these themes, Topol borrows Eisentien's characterization of printing press as a change agent and draws significant parallels with that transformation and smartphones, calling this the "Gutenberg moment". While a healthy skepticism is warranted in the claims of everything from holy wars to Renaissance to modern science and founding of american republic is attributed directly to the printing press, one cannot easily dismiss the "combinatorial intellectual activity" printing facilitated. Topol argues (successfully) further that the technology already exists to enable this remarkable period of creativity in healthcare. Using relatively recent episodes such as FDA v/s 23andme and Angelina Jolie's aggressive preventive measures, Topol provides a very informative and engaging view of how the healthcare system is clearly at an inflection point.

In the second section, Topol focuses primarily on the key enabling technologies that will make his vision of a democratized and personalized healthcare a reality. Moving beyond traditional logging devices, Topol paints a realistic vision of the technologies and the opportunities they are already creating such as from lab-on-a-chip to lab-in-body. Along the way, his insights on the failures of EMR systems (using OpenNotes as a contrast), potential of "pre-womb to tomb" predictive/diagnostic models is well worth the read. In fact, the chapter on the various -omics and their potential role (adapted from his famous paper in Cell) and examples on pre-diabetic and airway diseases in itself is worthy of investing in this book. A reader will also gain significant insights about some trailblazing companies like Theranos, QuantuMDx, etc. The discussion around how 3 of the 5 imaging technologies have already been miniaturized to hand-held devices is a clear indication of the realism embedded in Topol's assertions.

In the third section, Topol objectively analyses the import of these changes (cultural and technological) on how healthcare will be delivered and consumed. These discussions go beyond "disintermediation of doctors" and is a must-read for anyone interested in developing new service models. A few years ago, The Innovator's Prescription: A Disruptive Solution for Health Care, provided a radically new way to rethink service models - Topol's book does the same from the viewpoint of patient and the role of technology.

At times, Topol perhaps extends the patient advocacy too aggressively. For example, on a discussion crucifying Myriad and value of patents, he seem to dismiss the risk taken by private enterprises to generate these insights. While he fully acknowledges that information and knowledge gaps are critical, he uses a few hand-picked examples of how highly motivated individuals were able to be remarkably active with the diagnosis and treatment of their conditions (it is hard to say how generalizable these episodes are). Criticisms on AMA may also not be entirely fair and while there will always be "eminence-based medicine" as Topol characterizes it, there is no doubt that some of it needs to be modulated better with patient-centric approaches.

With the clarity of discussion aided by well-chosen examples and analogies bereft of needless cheer-leading, over 50 pages of notes/references, excellent diagrams accompanying some of the key concepts, Topol's book is well-poised to define the next big discussion on healthcare. With the aggressive growth of wearables and smartphones showing no signs of slowing down, wider acknowledgement of patient participation as key for healthcare outcomes, changing delivery models such as ACOs in the US, some of Topol's vision may become reality sooner than even he seem to hope for. Nevertheless, Topol has succeeded in providing a clear thought framework to assess and harness the role of mobile technology in reshaping healthcare ecosystems.
36 di 39 persone hanno trovato utile la seguente recensione
HASH(0xa2f2dbf4) su 5 stelle The Patient Should READ This Now--An Essential Guide to How Technology Will Save Your Life! 24 dicembre 2014
Di John J. Nosta - Pubblicato su Amazon.com
Formato: Copertina rigida
Eric Topol's important new book reads like something out of the future! But the reality is that it's today's technology and today's context that allows readers to be enlightened and educated on the amazing convergence of technology, health and medicine. From physicians to patients, Topol's presentation and analysis make for a compelling read.

As a student of digital medicine, I found almost every page rich with important details and insights that helped my understand of the state of medicine my MY health--today and into the future. It's a cross between the New England Journal of Medicine and an Isaac Asimov novel--will all the facts and references aligned to completely support claims and observations.

But while this book contains important medical and scientific information, it's most significant value my be in its ability to connect with the real world and with real patients. In the final analysis, it's really more of a brilliantly written and fascinating instruction manual for health and wellness--starting today and leading us into a bold future!

The Patient Will See You Now" might also be expresses as "The Patient Should Read This Now" because it represents the future of innovation in medicine and how patient empowerment will fundamentally change the way we manage wellness and disease.
31 di 36 persone hanno trovato utile la seguente recensione
HASH(0xa2fa5090) su 5 stelle Medical Blockbuster Book of the Year: Written by a Leading Thinker of Healthcare’s Enlightenment 29 dicembre 2014
Di Dave Chase (@chasedave) - Pubblicato su Amazon.com
Formato: Copertina rigida
Dr. Topol does a terrific job of laying out the immense potential of smartphones and iMedicine technologies to democratize medicine like never before. He likens the smartphone’s potential to being the “Gutenberg Press” of medicine. Having seen these emerging technologies in action, this isn’t hyperbole. His writing style makes it very accessible for the lay person without any “dumbing down” that would be a turnoff to health professionals. This is a must read for anyone that cares about healthcare.

Dr. Topol mixes in the promise of emerging technologies and approaches with a sobering assessment of where the present healthcare system isn’t reaching its full potential. The book is very well sourced so one can easily find data that backs his assertions. The following are some choice quotes from the book that give you a small taste of what you are in for when you read Topol’s book:

*An ECG was emailed to me by a patient with the subject line “I’m in atrial fib, now what do I do?”, I knew the world had changed.
*We’ve never seen such a discrete challenge to the medical profession, but we’ve not had the platform or landscape for that to be accomplished. Until now.
*Increasing frustration and vexing aspects of health care today may influence a bottoms up movement, propelled by smartphones and social networks for improving the future of medicine
*Health care consumers are truly the Rodney Dangerfields of medicine: “I don’t get no respect.”
*Three Labradors and two Portuguese water dogs made the diagnosis of lung cancer with 99% accuracy! Similarly, dogs were able to detect prostate cancer via urine samples with 98% accuracy.
*Just as the first home pregnancy test of 1978 heralded a new era of consumer empowerment back then, these new products and companies are the precursor to an upcoming, unbridled capability of across-the-board lab testing anytime, anywhere.
*Is there any other walk of life when services are purchased but the purchaser doesn’t take ownership?
*Purchasing healthcare is like blindfolding shoppers in the hope that they can & will then shop smartly
*For blood pressure, a review of 52 prospective, randomized studies showed that people who took self-measurements had better blood pressure management versus those whose only monitoring came through usual care (e.g. at the doctor’s office).
*52 studies showed that people who took self-measurements had better blood pressure mgmt vs. usual care (e.g. at the MDs office)
*2 out of 3 doctors won’t email with their patients, which has been proven in multiple studies to markedly improve efficiency of practice
*There are 440,000 lethal, preventable events each year from care in hospitals, or roughly 1/6 of all deaths that occur in the US each year
*The majority of hospital CEOs think a hospital-building bubble has popped, with marked over-capacity---at least 40-50% excess of beds left in its wake. The result of this trend will be that the hospital room of the future will be the bedroom.
*Hospitals as they exist today are set up to fail. Their fiscal future is beyond bleak; their paradoxical harm instead of heal potential cannot be dismissed or substantively diminished.
*Just as the printing press was the great object around which modern culture has orbited, the smartphone and iMedicine are forcing a comparable transformation.
*When a reformation and a renaissance of medicine can take hold. Only then can we move from an era in which Desmore asserted, “medicine is not a science, [but] empiricism founded on a network of blunders” to a new medicine as a real data science with each individual capable of calling the shots, making the choices.
9 di 9 persone hanno trovato utile la seguente recensione
HASH(0xa2f31dc8) su 5 stelle DIY Health Care via Smartphones, Apps, and a Few Attachments! 11 gennaio 2015
Di Loyd Eskildson - Pubblicato su Amazon.com
Formato: Copertina rigida
Dr. Topol's overriding thesis is that the 'doctor knows best' days are gone - 'eminence-guided' medicine is being replaced by 'evidence-guided' medicine. Further, no more waiting an hour for one's appointment (7 minutes average time for existing patients, 12 minutes for new patients) - a rapidly increasing number of ailments and concerns can be handled by one's smart-phone. The really good news is that Dr. Topol is in full support of these trends - he recognizes that American medicine is the world's most fallible, inefficient enterprise.

Smartphones already can take blood-pressure reading, do an electrocardiogram (ECG) using apps approved by the FDA and validated in many clinical studies, attaching wearable wireless sensors allows measuring blood-oxygen and glucose levels, another attachment allows eardrum exams in the case of suspected ear infection. You can now get a video consultation with a doctor via smartphone at the same cost ($30 - $40) as the typical copay charge for employer health plans. Deloitte Price Waterhouse Cooper contends that as many as one in six doctor visits were virtual in 2014 and that this will soon become the norm.

Dr. Topol touts G.E.'s Vscan introduced in 2010, a portable ultrasound about the size of a book, with a wand connected by a wire. As part of a routine physical exam it gives him a view of the valves, chamber, etc, takes 1-2 minutes, costs about $8,000, and provides image resolution equal that of a $300,000 machine. The alternative is an $800 charge for sending someone to the echo lab where they do a 45-minute study. (Could reduce the $100 billion/year spent on ultrasound at least 50%.) But, cardiologists don't get reimbursed for doing this --> 20 million echocardiograms/year. Physicians now can combine bedside imaging with examining the patient and talking to them - and are less likely to react to incidental findings than before. (G.E. recently upgraded its Vscan. It is now pocket-sized, costs $7,900, and can now image carotid arteries and jugular veins, hip and knee joints, and the thorax. Physicians, however, balk at spending this amount of money on a piece of equipment, as well as the time required to learn how to use it. However, Topol points out that EMTs can use it and transmit the data obtained.)

There's more. In the next year or two, many Americans will wear wristwatches the continuously capture blood pressure and vital sign data with every heartbeat - allowing $4,500/night hospital beds and the associated risk of acquiring a drug-resistant infection to be replaced by one's bedroom. (The majority of hospital CEOs think there are too many hospital beds now.) Other wearable sensors now being developed include necklaces that can check the amount of fluid in one's lungs, contact lenses that can track glucose levels or eye pressure, and head bands that can capture one's brain waves. Smartphone attachments will also soon enable patients to perform an array of routine lab tests via their phone using small fluid samples in little labs the plug directly into those phones.

Hand-held ultrasound devices are already available, and some medical schools now issue them in place of stethoscopes. Hand-held MRI machines aren't far behind, and UCLA engineers have a smartphone-sized device that can generate X-rays. The future will also bring microscopic sensors that can constantly survey one's blood for the first appearance of cancer, or tiny cracks in artery walls that can lead to heart attacks or strokes.

We've also known for awhile that people are more willing to disclose inner thoughts to a computer than a person. Coupled with appropriate software, this will allow better mental health assistance, and help make up for our shortage of mental health professionals.

Another benefit - social media will allow a person with a new illness to find others most closely resembling their condition, and help determine the best treatment.

Between 2009-2011, the number of physician visits fell 17% among privately insured patients in the U.S. Perhaps they're tired of waiting days for an appointment, then an hour or so to be seen in the office - all for a 5" visit (new patient) or 7" visit (new patient). A contributing factor is that there are many emerging alternatives, from retail clinics with nurses to DIY care. The really good news is that studies show that people taking self-measurements or via pharmacists had better blood pressure management vs. those only monitoring care through eg. doctor's office visits. Better outcomes have similarly been demonstrated for engaged patients with diabetes, obesity, multiple sclerosis, and many types of mental health disorders.

Other possible 'alternatives:' Dogs have been shown to diagnose lung cancer with 99% accuracy, detect prostate cancer via urine samples with 98% accuracy, and at the University of Pennsylvania, 90% accuracy in detection of ovarian cancer. How - via their odor-detecting skills, which scientists are now trying to replicate in smartphone apps.

Physicians also directly benefit - eg. anesthesiologist Brian Rothman uses an app (Vigivu) he helped create that allows him to track patients in up to four operating rooms at once, and notify him if vitals go out of range. J&J has introduced a computerized conscious sedation machine called Sedasys. Epocrates gives doctors basic information about drugs - dosing, and warnings about harmful interactions. Clinicam can take photos of a patient's condition and upload the images to the patient's electronic medical record. Isabel (and others) helps with diagnoses. Unfortunately, two out of three won't e-mail with their patients, a practice proven in multiple studies to markedly improve practice efficiency - reportedly because they aren't paid for such.

An important indirect benefit of electronic medical records is that eg. drug performance can be much more easily and quickly monitored, especially for population sub-groups (eg. age, race).
25 di 30 persone hanno trovato utile la seguente recensione
HASH(0xa2fa5480) su 5 stelle Dr. Eric Topol has his finger on the Pulse of the Future of Medicine 31 dicembre 2014
Di Kathy Mackey (@mkmackey) - Pubblicato su Amazon.com
Formato: Copertina rigida
Touching on every major trend in the industry, The Patient Will See You Now is not only a Who’s Who in digital health and medicine, it is a treasure chest for med tech enthusiasts and trend watchers. If it feels close to science fiction with stories of a future that listens to biomedical sensors reporting from inside our body to monitor chronic illness - the reality is the future is now.

Dr. Topol, a renowned cardiologist, beloved by his patients and peers, has enthusiastically lead the movement for digital health and personalized medicine. A stint on the Stephen Colbert show checking out an eardrum and using a smartphone heart monitor secured his place in the hearts of many and guaranteed a full speed ahead for “medical add-apters”, mhealth apps and the many sensors that fuel our Fitbits and other tracking devices. So much of this work gives hope to many and that is the inspiring message.

There is no question that Apple and its smartphone medical apps jumpstarted the movement but make no mistake, Topol and The Patient Will See You Now will be remembered as a primer and roadmap for patients and the medical community on what to do next encouraging patients to take control of their health and physicians to adopt the tools of the future.