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Latest Posts

Are Doctors Afraid Of Social Media?

We sometimes forget that public transparency can be scary. I’ve found this particularly true for doctors. And they tell me so. This tweet from MD Anderson’s Dr. Garcia-Manero hints that the daily digital repartee that I take for granted isn’t so easy for the newbie:

And this comment came in today from a rheumatologist, Dr. Irwin Lim of BJC Health. It illustrates nicely the hesitancy physicians sometimes feel:

Our clinic’s business manager was pushing me to blog as a means to improve the profile of our group musculoskeletal clinic. I found myself quite afraid of this, as I had not previously participated in social media. I was also wary that I could not control patient comments. Eventually, I tiptoed into LinkedIn. I then started reading blogs and came across yours. Your posts have been very useful and have improved my resolve. A few days ago, I posted my first blog, and have since written a total of 6. It’s been quite enjoyable so far. The social media consultant engaged by the clinic wants me to now create content for YouTube. Some fear has returned, but I’ll hopefully be able to get over this, too.

Is fear specific to doctors? No, but I think the issues are magnified with medical professionals. Image, social voice/personality, permanency, and fear of legal repercussions are among concerns that are disproportionately felt by doctors. So can we mitigate this fear in any way and break the barriers to entry for doctors? Read more »

*This blog post was originally published at 33 Charts*

Social Networks For Doctors: One Place At A Time

I suspect that in the next couple of years we’ll see the emergence of a viable social network for physicians. It hasn’t happened yet, but I suspect that we’re getting close. Physicians are increasingly dabbling in mainstream social sites.

But maybe that’s a problem. After all, a doctor can only hang in so many places. If you have “The Facebook for Doctors,” do you expect us to spend our time there instead of on Facebook itself? Maybe we will, and maybe we won’t.

Beyond the obvious requirement of a network to deliver value, I think the rate-limiting factor is old-fashioned bandwidth. You can only be one place at a time. If I spend my days on Twitter, I’m not likely to spend my days on said doctor’s network. I will go there for particular things and to talk to certain people about specific issues, but like most doctors I’m not sure I can tell you exactly what I want. I’ll know it when I see it. (Actually I do, but I’m keeping it tip-top secret.) Read more »

*This blog post was originally published at 33 Charts*

Tweetchats: Are They Good For Doctors?

[Recently] some of us participated in the flagship physician Tweetchat (MDChat). Or better, I tried to participate between finishing up some calls and choking down a bean burrito.

When the idea was initially proposed to me I committed only to supporting its initiation with the occasional role of host. I’m simply overcommitted, but wanted to support Phil Baumann and those who were willing to try to break new ground. So I lurked, chewed, and pondered.

Doctors or not, everyone knows I’ve been a pretty lukewarm proponent of the tweetchat. I think they’re noisy, difficult to follow, and too abbreviated for constructive dialog. As early adopters I think we tend to put the novelty of the medium above its practicality.

With that said, chats can be fun. It’s a situation where I feel comfortable while at once restless. Kind of like at a medical staff meeting where the agenda doesn’t hold me quite as much as just being among my friends.

At the end of the day I might agree with Dr. Anonymous that the average physician new to social media might not find a twitter chat as the best way to spend a precious hour. For me that hour represents the better part of a blog post which, over the course of a month, will influence hundreds of readers and live forever.

But I suspect that there will always be those among us looking for companionship over content. And it’s hard to argue with that.

*This blog post was originally published at 33 Charts*

The Top 5 Doctors On Twitter

I got the honour to be included in the list of the top 5 [Twitter] doctors in medicine published by The Independent. The list was based on Twitterdoctors.net which uses the Klout algorithm for determining the influence of tweeting doctors:

TwitterDoctors.net updates hourly the influence of doctors tweeting based on their activity, RTs (retweets) and followers. The site began its list at the end of July and boasts “1287 doctors with more joining every day” from around the globe including Australia, Belgium, India, UK, Jamaica, Japan, Colombia and the USA.

On September 7, the top five most influential doctors are:

1. @DRoftheVaJayJay

2. @drdrew

3. @brontyman

4. @Berci

5. @hrana

It doesn’t mean that much, but it’s good to know people like the content I share day by day.

*This blog post was originally published at ScienceRoll*

Latest Interviews

How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

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Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

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Latest Cartoon

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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Click here for a musical take on over-testing.

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Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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