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Managing Information Overload In The Age Of Unlimited Information

Perhaps the biggest challenges facing the next generation of physicians is information overload.  The problem: Unlimited information on limited human bandwidth.  There’s simply too much to read and see.  For physicians the problem is compounded by a perceived responsibility to keep up.

But the idea that we actually can have our hands around everything is reflective of a time when doctors actually could know all there was to know.  Many of today’s physicians were raised at a time when a paper inbox and a pile of journals represented their only information inputs.  But things are very different now.

Here are a few ideas on controlling your inputs:

Accept that you can’t keep up. I raise this idea at the risk of sounding horribly pessimistic.  But it’s a critical first step in making peace with the new world around you.  Recognize that you are powerless over the volume of information available to any one doctor.  Then you can begin to develop realistic strategies for capturing what you need.

Understand the difference between what you want to know and what you need to know. These are two very different things. Capturing what you need to know is an approachable goal. Trying to capture all that you want to know is much more difficult and is likely to result in ongoing stress. I try to think of my information inputs in two categories: core inputs and wildcard inputs. My cores consist of clinical information on EPIC, 2-3 journals, 3 email accounts, and about a dozen blogs/news sites. My wildcard inputs include my Twitter feed, Google+, non-fiction books, and other interesting things that find their way into my world.

Allow time for serendipity. My cores are what I feel I need to stay on top of; my wildcards are the gravy – they’re where I get most of my good ideas. I try to crush my cores in the most efficient way possible (always a struggle) so that I can enjoy the serendipity of my wildcards.  My cores are my homework, my wildcards are playing.

Create a system that brings information to you. A decade ago we used the web to find information. Now information finds us through our social networks. Surround yourself with brilliant individuals who will bring you what you need. Use their eyes and ears find what you need. I have traditionally followed very select individuals on Twitter for this very reason.  Now on Google+ I am experimenting with circles that contain information from the best curators available.

I have been working recently with the folks from the C3N Project and I participate in their Social Cast network. Here I have some of the brightest health innovators in the free world sharing things in one very concentrated feed. They bring me information that I could never find. I also reciprocate with my best information.

Minimize noise. The key to successful input management is the minimization of noise. And on social channels this means listening to those with the best signal (information) and tuning out those making the most noise.  Ruthless tuning and control of who you let in is so important.  The sooner you abandon the dated concept of the ‘courtesy follow’ the closer you will be to defining the signal you need.  I struggle with email noise and work desperately to keep ads and non-critical communication out of my inbox.

But what if you miss something? You will.  Get over it.  Make peace with what you need to know and have fun with the rest.  Follow as little as you can get away with and then trust that if information is important, it will find you.

This is a work-in-progress for me and I’ll have more to say as I harness my ideas.  How do you manage inputs?

*This blog post was originally published at 33 Charts*


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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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