Why not incorporate empathy in to engineering to address unmet needs in healthcare?

One of our core values is continuous learning and remaining hungry for information that challenge our perspectives. This is what led us to start a reading list. In light of this, I picked our first two books to be Why We Revolt by Dr. Victor Montori and  An Epidemic of Empathy in Healthcare by Dr. Thomas H. Lee. Both books focus on the need to deliver more careful and kinder healthcare while pointing out the significant changes that have taken place in the healthcare system.

I was instantly drawn to these books since Josh and I are tackling the problem of seroma, which is a post-surgical complication that most often develops once patients go home (multiple weeks from surgery). Our open conversations with many patients who experienced drains, the standard-of-care in mitigating the risk of seroma, suggested that these devices were far from delivering careful or kind healthcare. Partly because, they were created for use by healthcare professionals and they are not very easy to use by patients, especially at home. This topic of translation of devices from professional to lay people use has received increasingly more attention over the past 20 years as more and more healthcare occurs outside of a professional healthcare facility.  For example, in a recent publication Dr. Kortum studied the usability of various medical devices by lay people and found most to be less usable than a microwave oven.

As I read Why We Revolt, I was especially drawn to a paragraph in chapter called Burden. Dr. Montori describes Minimally Disruptive Medicine in the following way.  “Minimally disruptive care calls for programs that are easy to access and use, their content coherent, their care continuous and coordinated across all involved. It forbids the delegation of medical errands to patients and families and of considering them as unpaid extensions of the healthcare’s industrial workforce. Because so much care must be unavoidably completed by the patient, every effort should be made to free self-care from waste by enhancing its meaning, feasibility, and value to patient. Every portion of work ultimately assigned to the patient must be designed with the most overwhelmed patient in mind.”

As an endocrinologist, Dr. Montori focuses extensively on the burden placed on patients by unplanned clinic visits, complications with prescriptions, etc. While reading, I wondered about the issues that are specific to those who are recovering from surgeries at home, at times only 6 hours after a major surgery! Postoperative patients are certainly overwhelmed as they begin the heal at home. For example, on the day of a hip surgery, I arrived home with a prescription in my hand for two medical devices one for icing and one for moving the hip. Neither one of these were manageable by my mother or myself at the time. My husband had to set them up each time. These were devices used in professional facilities that were prescribed to me for home use. I think they helped in how fast I healed, but I cannot imagine them being operated by caregivers who are unlike my husband, mechanical engineer and a hands on person. This is only one example, but as more care takes place at home, there are many more examples of cumbersome, professional grade devices used at home by patients and their caregivers when they are truly overwhelmed.

In contrast, anywhere we turn, there is an increasing emphasis on patient experience, satisfaction, or patient reported outcomes. Some of the reimbursement being tied to such measures, many in the healthcare arena are focusing on how to assess them as well as in the creation of processes that allow better and kinder care. One piece that is less understood or appreciated is the role of engineers in making devices or solutions that are compassionate. For years, as a faculty member, I instructed my students to really understand the human side of the problem and encouraged them not to overlook the fact that engineering profession demands that we create solutions with a positive impact on the society. In other words, we need duplicate what is happening in healthcare in engineering and technology fields as well. Specifically, we need to bring humanity and care into our professional work. This is imperative in biomedical engineering where technologies are utilized to improve the health of those who are ill or not feeling well. As biomedical engineers, we have to listen to patients, surgeons, hospitals, and understand their pain. We should then be able to engineer a solution that is more meaningful and potentially more successful in addressing the unmet needs. I think we need an epidemic of empathy in engineering similar to the call made by Dr. Lee in his book.

Improving clinical outcomes and patient satisfaction by Laura Long, RN, PhD

I first encountered Jackson Pratt (JP) drains back in the 1970s, while in nursing school at Boston College caring for postop patients following mastectomy or hernia repair. Over several decades as a visiting nurse, I’ve instructed innumerable patients about drain care--how to strip the drains, measure the output, and ensure the grenade shaped bulbs are compressed to provide suction.

In 2012, following my own bilateral mastectomy, I was discharged from Mass General as a patient and went home with four drains. It occurred to me that in over forty years, little about JP drains has improved. The awkwardness of stripping the tubing continues to be a challenge. The weight of accumulating drainage in the bulbs puts tension on the tubing, causing discomfort and the risk of spillage. Anchoring the drains and tubing inside clothing or for showering requires trial and error for most. The suction is optimal only briefly, after emptying and measuring the output, when the bulb is squeezed by hand and recapped; once drainage begins to inflate the bulb and blood fibrin in the tubing becomes clotty again, the suction is diminished.

Like most patients, I looked forward to having my drains removed. Four years later, axillary metastases required I undergo a lymph node dissection, which meant another bulky postop JP drain. Unfortunately, after the drain was removed I developed a seroma--an accumulation of serous fluid under the skin, requiring several additional visits to the surgeon’s office at MGH for needle aspiration.

The development of an improved device providing consistent suction to remove fluid and minimize the risk of seroma sounds long overdue. A low-profile device close to the body, more easily emptied and measured would be a significant improvement over the bulky JP “grenades” that hang awkwardly and are difficult to manage.

After being introduced to SOMAVAC I’m excited by the prospect that clinicians and patients may soon see a significant improvement in a postop drainage device. From a postop standpoint, a device with continuous suction will offer consistent drainage of the fluid accumulating between tissue layers that may promote earlier healing and seroma prevention. From a patient perspective, a compact drainage collection device with fewer steps and reduced risk of mishap will ease anxiety at an already stressful time. And from a nursing perspective, I envision improved clinical outcomes and patient satisfaction with SOMAVAC.

Laura Long, RN, PhD

VNA Care Liaison

Boston, MA

Dr. Laura Long is an RN Liaison with VNA Care in Boston, MA. She is an instructor at the College of Holy Cross in Worcester, MA and in the Masters of Healthcare Administration program at Framingham State University. Laura has metastatic breast cancer (stage 3b) and is actively receiving care at Massachusetts General Hospital in Boston.

Observation of Breast Cancer Awareness Month

Observation of Breast Cancer Awareness Month

October is the Breast Cancer Awareness month. As 1 in 8 women experience breast cancer, many of us know someone who is touched by this. We show our solidarity and appreciation in different ways by wearing pink, by donating funds a non-profit organization of our choice, and other means. I wanted to take this opportunity to speak about a different aspect of breast cancer which relates to the needs of patients, surgeons, loved ones from the research and scientific community in general.

Reflecting on 100 Days of Acceleration

SOMAVAC Medical Solutions was launched on April 28th and a lot happened since.  An idea for a device to remove fluid and minimize the risk of seroma became the basis of a viable medical device that will help surgical patients recover more easily at home. The problem statement originated from surgeons, and their desire to create better solutions to reduce the risk of complications after mastectomies or hernia repairs. Our one-on-one interviews with patients shed light on the patients’ struggle with the current standard of care.  This is why we re-evaluated and re-designed - multiple times over the summer!  

We need to pay more attention to patients' experience at home after major surgeries

We need to pay more attention to patients' experience at home after major surgeries

... about 30 years ago patients were discharged to home on average at 9 days after surgeries. Nowadays, this number is reduced to 4.8 days. This reduction helps to minimize hospital acquired conditions and makes patients happier overall. However, one unseen aspect of this is that patients are discharged to home with tools that are meant to be used in the hospitals.