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Swanson: Physicians Have An Ethical Duty To Participate In Social Media

Wendy Sue Swanson, MD

Most physicians still don’t see the need to blog, Tweet, or spend time on Facebook. They groan when you ask if they participate on social media platforms. “I’m too busy seeing patients,” they say, “and why would I expose myself to legal risk? Someone might think that I’m giving medical advice, or disclosing personal information about patients online.”

While these fears are pervasive, early adopters of social media like Dr. Wendy Swanson (and yours truly, by the way) have a different view. Not only should physicians become active in social media, but they have an ethical responsibility to do so.

Wendy is a pediatrician, mother, and blogger at Seattle Children’s Hospital. My friend “ePatient Dave” deBronkart recently encouraged me to watch an excellent video of Wendy speaking at the Swedish Symposium 2010 conference. I’d like to summarize Wendy’s pro-social media arguments for you here, with the hope of luring more of my peers to join the conversation online!

1. Television is the main source of health information for the average American. Sixty second news segments and shows like Gray’s Anatomy form the basis for medical “education” for millions of patients. Whether they realize it or not, patient perceptions of health issues are colored by mainstream media. As healthcare professionals and scientists know, many news reports are inaccurate in their portrayal of research studies, and TV shows are often intentional fantasy. Physicians interested in educating the public about health issues must raise their voices in order to provide a sanity check and counter point to false and misleading information. Social Media (like blogs) provide a low barrier to entry (and potentially very large reach) for healthcare professionals.

2. Being the last to know about a health story can undermine your credibility with patients. Blogs are now generally recognized as a type of media outlet, and bloggers (like journalists) can request embargoed copies of important research studies and press releases that are distributed to mainstream media outlets. As a physician blogger, you can stay on top of the latest research by joining embargo lists and preparing your response to breaking news before it hits the mainstream media. Not only does this offer online readers your nuanced review of the story, but your patients will not catch you unawares when they ask you your opinion of (for example) ABC’s health story of the day.

3. Urban legends can slow down the progress of science. When urban legends are generated online, the public believes that the government has a responsibility to review the issue with careful research. While this research may be warranted, in many cases the fabricated fear ends up funneling limited research dollars towards debunking concerns rather than discovering cures. According to Wendy, millions of NIH dollars have been spent on disproving urban legends (such as a link between vaccines and autism) rather than more worthy causes. Physicians who care about allocating research dollars for maximal impact in patient health outcomes must speak out.

4. Physicians must not let people who produce and market healthcare products control the conversation. Many of the sources of health information online are provided by companies with an agenda. Whether they make money by advertising a product, or they are engaged in marketing for industry sponsors, or they are the manufacturer of a medicine or product, they have financial skin in the game. Having financial interest in the subject at hand influences the way you frame news and information. Physicians must step forward as impartial data decipherers. How else will patients be empowered with accurate information upon which to make educated health decisions?

5. Tradition methods of disseminating scientific information are too slow and have a small reach. There is great “intellectual property” sitting in hospitals and clinics all over the country. The old method of sharing information (discussing research at scientific assemblies) is slow and has a limited audience. For example, Wendy said that when her husband presented his critical research at a meeting there were 7 people in his audience. When she writes about the same subject on her blog, she might receive 7000 viewers in a single day.

6. Blogging can save time in the office. Most physicians repeat themselves a lot. That’s because patients with similar problems have similar questions. Physicians can compile a FAQ list of blog posts so that their patients can read about key topics in advance of their office visit. This speeds the educational process along and allows the clinician to spend his/her face-to-face time on more challenging and individual concerns.

7. Patients may confuse experience with expertise. Storytelling is a powerful tool of persuasion. In the hands of an expert who is familiar with the scientific literature, an illustrative story can drive home a point that positively impacts behavior. However, “horror stories” told by those who’ve had a certain experience (for example, Jenny McCarthy’s son developed autism at an age when he also received some vaccines) can confuse correlation with causation and negatively impact behavior (parents across the U.S. are now fearful of vaccinating their children). Physicians have the distinct advantage of being able to contextualize the “n=1″ stories based on a larger picture. Social media is a great way to counteract misinformation spread by the (often well-meaning) experienced who happen to lack expertise.

8. Dissemination of expert opinion through social media can save lives. It may take years for large organizations or professional societies to change position statements to reflect new research. However, recommendations by individual physicians can be rapidly disseminated online. For example, new research suggests that children from the ages of 1-2 who sit in forward-facing car seats are at higher risk of death in accident situations. Previously, it was believed that rear-facing car seats were only necessary for children 1 year and younger. It is likely that the American Academy of Pediatrics will update their recommendations to include rear-facing car seats for all children up to age 2, but they have not done so yet. Dr. Swanson is encouraging her patients to follow her evidence-based safety advice — and doing so may save the lives of 1-2 year olds who have the misfortune of being in a motor vehicle accident.

In summary, physicians should strongly consider adding their voice to the online community via Social Media platforms. In so doing they can combat health misinformation, provide timely objective analysis, educate patients, advance science, gain credibility, reduce industry bias, and influence health behaviors for the better. Without “voices of reason” online, the quality of health information suffers — leaving patients to wade through half truths, horror-stories, media buzz, and throngs of snake oil salesmen. We must not leave our patients to the wolves. Please join the conversation!

**Healthcare professionals and science journalists interested in contributing to the Better Health blog should contact editorial director Maria Gifford by email at ”maria -dot- gifford at getbetterhealth -dot- com.” Guest posting is a nice way to explore the medium of blogging without having to commit to running a blog.**

Follow Wendy on Twitter: @SeattleMamaDoc


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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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