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The Rise Of The Medical Blogosphere

It would appear that doctors and nurses in the social space have finally arrived. This week marked the first Blog World Expo with a track dedicated to the medical blogger. BWE brought together some of the web’s most visible medical minds including Kevin Pho (KevinMD), Rob Lamberts (Musings of a Distractible Mind), Kim McAllister (Emergiblog), Bob Coffield (Health Care Law Blog), Paul Levy (Running a Hospital) Mike Sevilla (Doctor Anonymous), and Nick Genes (Blogborygmi), and many more.

From health privacy to the ethical obligation of doctors to be visible on Twitter, the panel-based dialog at Blog World Expo raised as many questions as answers. Medical professionals in the online space face remarkable challenges, especially with regard to transparency, personal boundaries, and the definition of patient privacy. It’s clear that our technology is ahead of our legal and ethical dialog.

Despite those challenges, doctors and nurses in the social space have a remarkable opportunity to build on what’s been done. Many of those at the Blog World Expo medical track have created the digital inroads that are changing the way the world sees doctors and nurses.

Among other things, the experience at Blog World Expo proved to me that online socialization will never replace the power of just getting together. It’s amazing to meet people you have watched for so long. And when you’ve sat and visited, a writer’s online voice seems to make more sense.

Thanks to Johnson & Johnson for sponsoring our track. And an even bigger thanks to Dr. Val Jones (Better Health) for pulling it all together and giving medical bloggers a voice at one of the world’s largest social media meetings.

Hopefully the role of medical professionals at Blog World Expo will continue to grow. Here are a few things I’d like to see in meetings to come:

  • Think outside the blog. While he had a lot of discussion about blogs, they’re slowly evolving as a secondary notion in the social media space. The online world now runs in real time. We need to explore the role of live socialization in medicine.
  • Bring in the smart people. We need to import the wisdom of non-medical social gurus to help our messaging on health. I would love to hear Steve Rubel tell me now lifestreaming could be applied in some creative way as a physician. We could all take some lessons from Chris Brogan on ways to cultivate our networks.
  • Expand the role of social patient. Ultimately they are why we’re here. I expect we could all learn a lot from their involvement in the dialog.

Perhaps there are other things social health professionals need to be talking about. Let me know what you think.

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One Response to “The Rise Of The Medical Blogosphere”

  1. Margareet Polaneczky, MD says:

    Thanks for posting this. I wish I’d been there to meet everyone….

    I have one persistent concern, however, and that is the funding by a pharmaceutical company for “the” meeting of medical bloggers. My personal opinion is that the meetings going forward should be free of any industry funding.

    Would love to hear if others have thoughts on this matter.


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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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