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Why Family Medicine Needs Social Media

I wasn’t able to attend the Annual Leadership Forum (ALF) and the National Conference of Special Constituencies (NCSC) meetings in person this year. This is an annual meeting in Kansas City put on by the American Academy of Family Physicians (AAFP). I know that it can be hard to believe that someone actually likes going to a meeting. However, for me, these meetings always re-energize me and connect me with people with a passion for Family Medicine.

In 2010, there were only a few of us utilizing social media tools like twitter and facebook (including my blog posts from Thursday & Friday). However, just a year later, there seems to have been an explosion of people utilizing these platforms to a point yesterday when I saw a bunch of people signing up for the first time during the meeting. Even members of the AAFP Board of Directors were creating twitter accounts yesterday. Wow!

I really believe that this year, 2011, is when the Family Medicine community will more fully embrace social media, not only as a means of socialization, but also as a means of advocacy for our specialty. Here are some other reasons why I believe that Family Medicine needs social media:

  • Maintaining The Meeting Momentum: How often does this happen to you? At the meeting/event, you’re all psyched up and ready to conquer the world! Then in the car and/or on the plane ride home, you get overwhelmed with the reality of returning to work and all that energy from the meeting is gone – yielding to the status quo of home. Well, that doesn’t need to happen with social media. You can remain connected with all those great people you met. In fact, what I have found is that those great people keep you motivated through all those day-to-day challenges. Why aren’t you signed up for twitter or facebook yet?
  • Join the #FMRevolution: Dr. Jay Lee, the 2012 Conference Chair/Convener for the NCSC meeting, wrote a compelling essay called “#FMRevolution – Family Medicine Revolution” back in March. In my opinion, this has picked up a lot of traction in the Family Medicine social media community. If you haven’t read this blog post, you must. In fact, the California Academy is going to unveil an entire website on this topic coming up on Friday, May 13, 2011 and undoubtedly this premiere will be a social media event. Join the revolution!
  • Letting The World Know About Family Medicine Events: Even though I was in my office seeing patients yesterday, I was able to track the activities a the ALF/NCSC meetings through twitter. The week prior, I was part of a group of people tweeting out at the Annual Spring Conference at the Society of Teachers of Family Medicine (STFM) meeting in New Orleans. On Monday & Tuesday, May 9-10 in Washington DC, the AAFP has an opportunity to broadcast to the world the Family Medicine Congressional Conference. (Just a suggestion, please don’t use #fmcc as the hashtag, as people will not know what that is. Gotta use something like #FamMed or #FMRevolution. The EMS folks used #EMSOnTheHill recently and it worked out well for them)
  • What Is A Family Physician?: Social media gives the opportunity to start an online dialogue. At the previously mentioned STFM meeting, we got into a great discussion about why Family Medicine really has not done a great job of defining who we are and what we do to our own patients, to the public at large, to payors, and to legislators? Mark Ryan, Family Physician from Virginia, carried this discussion onto social media with his post “How Do I Define Family Medicine?” (including a comment from a medical student) Can you imagine that? Crowdsourcing the definition of Family Medicine. What an incredible way to do it via social media. It is discussions like this that need to take place to help our specialty.

There are so many more reasons why Family Medicine needs social media. Feel free to jot your reasons below in the comment section. Are you new to social media? Did you just sign up for twitter at the ALF/NCSC meeting? Welcome! As you start using this stuff more, please feel free to let us know your questions. There are already a lot of knowledgeable people in the Family Medicine community using this stuff.

Once you start becoming more familiar with how things work, I challenge you to get your voice out there by writing a blog post (like my post entitled “What Is A Family Medicine Leader?“), by recording a youtube video, or by whatever means you feel comfortable with. Family Medicine needs us, and more importantly, our patients need us! Let your voice be heard!

*This blog post was originally published at Family Medicine Rocks Blog - Mike Sevilla, MD*

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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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