26 March 2013

Abuse of AD/HD Medication: Sensational News vs. Important Information

The following post began as an email message about an article published in the New York Times the first weekend of February. Apparently, I saved the message draft, but forgot to finish and send it. Upon finding it this afternoon, I thought the content more appropriate as a blog post, and I have edited it accordingly.

Schwarz, Alan. “Drown in a Stream of Prescriptions.New York Times. February 3, 2013.


As someone who takes stimulant medication for AD/HD, I am ambivalent about this kind of media attention. Each person reads such an article with preexistent bias. For some it reinforces the belief that these medications are dangerous. For others it serves as evidence of fear-mongering and the stigmatization of mental ill-health by news media.

Here the subject is the abuse of stimulant medications prescribed for AD/HD, or perhaps, more broadly, the responsibility of psychiatrists and other mental health professionals for the health and safety of those in their care. However, regardless of the topic, so long as it is contentious, the same pattern ensues.

Each side selects a few facts to justify its position and to defend against the opposition. These selections have little to do with the information's relevance to the wider population. The driving question is “Will people react to this information with emotion?” As a result, the information chosen tends to concern only a few specific individuals. Information lacking sufficient emotional “punch,” even if relevant to far more people, goes unmentioned.

The rift between sides grows larger. Meaningful conversations about the issue become less common. The information that is useful and relevant to the most people gets the least circulation.

09 November 2012

Web Feeds for Mental Health Advocates

Note: All feeds listed provide fee-free content, feeds with open-licensed content are indicated.

New to web feeds?

Web feeds—sometimes called newsfeeds or just feeds, often prefixed with the feed format (e.g. RSS, Atom), and usually (but not always) indicated with this [orange news feed icon] feed icon—are a great way to get information from several sources all in one place. To use them, you'll need a feed reader. A couple of my favorites are Google Reader (web) and Pulse (Android, iPhone/iPad, or web).

Blogs

LD News feed
Learning disability and childhood mental health news headlines with descriptions from LD Online (a service of Washington, DC PBS affiliate, WETA-TV).
Mental Healthcare Reform feed
National Council for Community Behavioral Healthcare
NAMI Blog feed
National Alliance for Mental Illness
Psychiatric News Alert feed
Psychiatric News; American Psychiatric Publishing.
The blog from the Psychiatric News sees new content most weekdays, and the feed contains full posts. Despite some redundancy, both the blog and the newsletter (below) are worth keeping an eye on. The newsletter contains information never posted to the blog, and blog posts sometimes contain information that doesn't appear in the newsletter until two or more issues in the future.
SAMHSA Dialogue Blog feed
Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services.
Contains …up-to-date information including articles from SAMHSA staff, announcements of new programs, links to reports, grant opportunities, and ways to connect to other resources… (“About”, SAMHSA Blog.).
TWLoHA Blog feed & TWLoHA News feed
To Write Love on Her Arms

Journals and other Publications

Data, Outcomes, and Quality feed
Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services.
Reports and data sets related to behavioral health, mental illness, and substance abuse.
Depression Research and Treatment feed
Open-access (Creative Commons Attribution 3.0); Hindawi Publishing.
PLoS ONE Alerts: Mental Health feed
Open-access (Creative Commons Attribution 2.5); Public Library of Science.
Psychiatric News feed
Bi-weekly newsletter from the American Psychiatric Association.
This feed is updated when a new issue is published (alternate Fridays) and contains headlines (with links) for the latest issue.
Translational Psychiatry feed
Open-access (Creative Commons Attribution-Noncommercial-Share Alike 3.0 or Creative Commons Attribution-Noncommercial-No Derivative Works 3.0); Nature Publishing Group.
Contents for the current issue with link, author(s), and full citation.

03 May 2012

Thoughts on Software (lacking) Usability: Electronic Medical Records

This post is written in response to the post Globe article on EMRs: status and the safety issue on the e-patients.net blog.

The abundance of hard-to-use software is the only issue that repeatedly gives me reason to reconsider my decision to leave the programming field.

Here's my take on the origin of the problem:

In order to develop software with good (much less excellent) usability, the design process must include collecting data about day-to-day operations in the context where the software will be used. That rarely happens. Instead, the standard process is to meet with a ‘customer’ and discuss their requirements. Often, the ‘customer’ in that meeting is a management-level company representative with little personal experience with the nitty-gritty of those day-to-day operations and who will seldom (if ever) use the software that's being developed.

It's a poor substitute, at best, and leads to a functional but hard to use end-product. At best, the result is cream of the crap.

An better approach would borrow an number of methods, including participant observation, from cultural anthropology to gather data about how information is obtained, used, and communicated in day-to-day operations.

For EMR software, this would mean data collection in in various healthcare facilities. It would require following staff to observe information flow; perhaps even hands-on experience working in an information-saturated non-clinical role.

The executive rumored to have scoffed at the idea of usability as a criterion probably understood this—specifically, he probably understood the kind of time and resources (i.e. money) necessary to develop software specifications the right way. That is, he understood that it would cut into his bottom line more than he was willing to accept.

After all, the only thing with such amazing ability to trump common sense is concern for one's own wallet.