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Nurse’s Life Changed By Twitter

Dear @Twitter,

I so totally know how this sounds to write to a service, but I must confess: your little wings have changed the trajectory of my life and – for the most part – I think it’s been for the best.

I’ve been around for over 40 years, have seen many things, met all sorts of people and have – mostly – enjoyed my life. But I think every several hundred years, a tiny and almost insignificant tool comes out of nowhere and changes the world – like the wheel and zero, both of which are truly “nothing” (both are each shaped the same way). And yet the each not only changed the course of civilizations but also created them.

My son was born just before Twitter and in the last several years, my whole world-view has changed. Twitter has helped me to connect with people I *never* would have met without it. Twitter has launched me into totally different career-directions (plural) and I still don’t know where I’ll be next month because there are so many opportunities before us in today’s world. Twitter has rewired my brain, I’m sure of it.

Years ago I tried – hopelessly – to explain to people what Twitter was. I tried to convince doctors and nurses that Twitter could help them professionally by delivering relevant content and by connecting them with colleagues. But it was in vain.

It was not too long ago that it was unimaginable that doctors and nurses would be chatting in 140 characters like they do on @RNchat and @MD_chat.

I feel a bit better now that Twitter has hundreds of millions of users and is growing. I don’t know if Twitter Inc. will last, but the premise of Twitter is here to stay: the tweet is now a fundamental unit of communication in the 21st Century. It’s how we’ll connect (or disconnect) and it’s going to be the way millions of machines will follow each other and communicate and create an almost unimaginable world.

Only five years ago, nobody thought that the world would communicate publicly within 140 characters. Yes, people were text messaging – but that was between two people privately. To do so openly, globally and instantly was not even a thought.

Twitter has revealed a social construct that has been within us for a hundred thousand years which we never even knew existed.

Twitter is now a propellent for technological evolution. It’s a technology-spurring technology shifting the course of the human journey and there’s nothing we can do now to stop its curving of cultural space-time.

Twitter – and her sister-media – are so historic that there will be no history books written about them. For they are displacing the kinds of books you and I grew to know. That’s not even a claim-to-fame Guttenberg’s moveable type can make.

Am I a nut? Yes. Am I a nut to believe that Twitter is as big a deal as I think it is? Yes, perhaps – but I don’t think I’m the only one. All I can say is: Twitter, you’ve changed my life – for good or ill.

I wish I could list all of the wonderful people I’ve met via Twitter. It pains me to not mention all. But I would like to go on the public record about the people I can say I’m eternally grateful to you Twitter because without you I’d never find them:

  • @EdBennett – Thank you, Ed – you’re always doing the right thing
  • @KentBottles – Kent, you’re definitely helping to bring physicians into the 21st Century
  • @EricaHolt – Erica, you’re definitely my kind of Belgian-beer drinking buddy – you’re one smart cookie and the world needs to hear more about your views on today’s sparkly technology ;)
  • @JaeSelle – Jae, ‘cuz you’re digilicious.
  • @DaphneLeigh – Daphne, you’re wonderful and I hope you find the happiness you’re looking for – I love your humor, your endurance and you
  • @LizScherer – Liz, I love your straight-forward way of talking people back to reality
  • @BobFine – Bob, you’re just a flat-out, stand-up good guy; a real American
  • @Loren_Feldman Loren deleted his Twitter accounts (@1938media) but Loren is one of the most passionate people about social media – he deeply understands how important it is for us to be smart about these media. I knew about him before Twitter, but it was through the lens of Twitter that I came to appreciate him through his persona as 1938media. Loren – you have one of the most important voices on and about the Internet- and you’re funny as sh*t, which is really all that matters. I wish you the best in whatever you do. Truly.

A couple years ago, my 82-year old Hungarian mother, who survived WWII, asked me: “Phee-lip, vat eez dees Tveety, Tveetar thing I all-vays hear about on zee news?” I demonstrated it to her using TweetDeck. She “got it” within about 5 minutes.

She leaned back in her chair and said “If dees Tveetar vawz around during virld var two, the var vould have been completely different! So many lives could have been saved from that kurva Hitler’s madness before the var even started. But it could have gone dee other vay too.”

My mom’s no dummy – a woman who witnessed and survived the worst of humanity, who came to this country, started her own business and raised five kids. When someone like that says Twitter is world-changing, you listen.

Thank you, Twitter: you’ve changed my life in ways you’ll never know. You’re bigger than the Beatles! :)

If you ever land, may it be in a safe and warm place.


*This blog post was originally published at Phil Baumann*

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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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