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The Best Social Tool For Doctors And Patients

We all want technology to improve communication between doctors and patients. We fantasize that social tools will open doors and bridge the expanding divide between doctors and patients.

I’m wondering if it’s a case of unicorns and rainbows: Fancy new tools to do the old thing in a less-effective way. I’m guessing that if Facebook was the old platform for doctor-patient dialog and the telephone was invented this year, everyone would be clamoring to use the phone (“Dude, this is amazing…you can hear them talk.”)

I like the telephone. Written copy misses intonation, timing, pitch, and all the other rich elements of human speech. Subtle changes in a parent’s voice tell me if I’ve made my point and exactly how I need to proceed [with caring for their child]. Unspoken words on a screen are so one-dimensional.

Of course, email has a tightly-defined place in patient communication. And real-time social interaction between patient and clinic will evolve to have a clear role in patient care. But for now, the phone remains one of the most effective tools for helping doctor and patient really understand one another.

[Image credit: Cemagraphics]

*This blog post was originally published at 33 Charts*

Some Things About Medicine Will Never Change

I just can’t imagine life today as a medical student. Every medical publication in the palm of your hand. The capacity to create an audience and publish at your own will.  Real-time dialog between students, faculty, anyone. Global reach from your phone. It’s mind-boggling really.

This is in stark contrast to my experience. My world was centered on index cards, textbooks and pens with different colors. We communicated via Post-it notes on the door of the student lounge. There were no apps and our only game was foozball. As a first year I scheduled time to compose H&Ps on the library’s only Macintosh II computer. This was plugged into the new Apple LaserWriter with WYSIWYG. Hi tech we were. We thought.

Being distractible and restless, I’m going to guess that if I had access to the communication platforms and tools available to today’s students, I might not have made it through. The inputs must be staggering and I imagine that discipline with personal bandwidth has become a critical key to survival. Read more »

*This blog post was originally published at 33 Charts*

Should Children’s Hospitals Do Social Media?

I [recently] participated in an interview for an upcoming publication. As the interview wound down, the dialog downshifted into small talk that included, among other things, hospital blogs.

The interviewer (who had recently been exploring the blogging community) asked me what I thought about Thrive’s (Boston Children’s Hospital blog) recent birthday nod to Seattle Mama Doc (Seattle Children’s Hospital blog). More specifically, did I think it was unusual that one children’s hospital would congratulate a competing institution on its one-year anniversary?

I thought the question was odd but it got me thinking: Do children’s hospitals compete in the social space? I don’t think so. They shouldn’t. And if they were competing, what would they be competing for?

Children’s hospitals are inherently regional. Parents of the northwest see Seattle Children’s as the end of the earth. In the northeast, Boston Children’s is the bee’s knees. And while specialty service lines like congenital heart surgery may draw patients from around the world, most kids come from their corner of the world.

Then there’s the broader question about the point of a blog for a children’s hospital. Is it a marketing gimmick or does it serve a higher function? Read more »

*This blog post was originally published at 33 Charts*

The AMA’s Policy On Professionalism In The Use Of Social Media

A new policy on professionalism in the use of social media was [recently] adopted by the American Medical Association (AMA). The AMA Office of Media Relations was kind enough to share a copy of the policy:

The Internet has created the ability for medical students and physicians to communicate and share information quickly and to reach millions of people easily. Participating in social networking and other similar Internet opportunities can support physicians’ personal expression, enable individual physicians to have a professional presence online, foster collegiality and camaraderie within the profession, provide opportunity to widely disseminate public health messages and other health communication. Social networks, blogs, and other forms of communication online also create new challenges to the patient-physician relationship. Physicians should weigh a number of considerations when maintaining a presence online:

(a)  Physicians should be cognizant of standards of patient privacy and confidentiality that must be maintained in all environments, including online, and must refrain from posting identifiable patient information online.

(b)  When using the Internet for social networking, physicians should use privacy settings to safeguard personal information and content to the extent possible, but should realize that privacy settings are not absolute and that once on the Internet, content is likely there permanently. Thus, physicians should routinely monitor their own Internet presence to ensure that the personal and professional information on their own sites and, to the extent possible, content posted about them by others, is accurate and appropriate. Read more »

*This blog post was originally published at 33 Charts*

When A Patient Contacts A Doctor On Twitter

When perusing my Twitter feed [one] morning, I stumbled onto this post directed to me:

Patients reaching me in public social spaces is becoming a regular thing. I’ve discussed this in the past, but I think it bears repeating. So here’s what I did:

I understood the mom’s needs. Patients resort to “nontraditional” means of communication when the traditional channels fail to meet their needs. Recognize that these patients (or parents in my case) are simply advocating for themselves. My specialty struggles with a shortage of physicians, so we’re dependent upon phone triage to sort out the really sick from the less-than-sick. It’s an imperfect system and consequently parents find themselves having to speak up when the gravity of their child’s condition hasn’t been properly appreciated.

I took the conversation offline. I don’t discuss patient problems in places where others can see, so my first order of business in this case was to get the conversation to a place where it can be private. I called the mom, found out what was going on, and rearranged her appointment to a time appropriate to the child’s problem. Read more »

*This blog post was originally published at 33 Charts*

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.

***

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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