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Clinical Knowledge Versus Clinical Judgment

Read Seth Godin’s most recent post, The Amateur Scientist. In a way that only Seth can do he tells how our culture has turned us all into authorities. Important stuff.

I couldn’t help but think how this applies to the Internet and our health. Unrestrained access to information has got us all thinking we know more than we do.  Godin wasn’t writing about the amateur physician but he might as well have been.

Missing from the black bag of the amateur physician is a tool called clinical judgment – the pivotal substrate necessary to tie together objective clinical information. Clinical judgment is the foundation of good medical decision-making. But you won’t find it on the Internet. It can’t be found in the cloud or the hive. It isn’t free and it’s tough to get. Read more »

Physicians And Open Source Health Advice

Last week someone posted on Twitter that they had swallowed a plastic toothpick. What to do? So they turned to the hive for help. “What should I do?” I thought as I read my Twitter feed. I was paralyzed in a way. I wanted to share my experience with hundreds of patients had swallowed pins, toothpicks and other pointy things. I specialize in just this sort of thing. But short of a random comment about gastric emptying, I kept to myself. Why? Because once I lend a hand I’m all in.

The simple offer of patient-specific advice constitutes a relationship in the eyes of the law. Once involved, I potentially share responsibility in whatever happens to someone. Crazy but true. It’s just a matter of time before slip-and-fall lawyers hold physicians accountable for helping out in the social sphere.

Doctors aren’t the only ones wearing targets. Read more »

*This blog post was originally published at 33 Charts*

The Importance Of Open-Ended Questions

I can spend 20 minutes interviewing a parent about their child and still not really understand them. During a consult, my interview centers on the objective elements in a child’s history. When evaluating a child for abdominal pain, for example, I have a panel of questions that cover what I need to know to generate a starting hypothesis.

But none of it helps me understand Mom.

Understanding where the parents are at is critical to both understanding a child’s problem as well as pitching a plan of care. Whether it’s revealed to me or not, parents often come to me with an agenda. If my plan doesn’t meet with their view of the situation, it’s going to be much harder for me to help that child get what she needs.

So at the end of my interview (usually when washing my hands) I launch one or all of the following questions:
Read more »

*This blog post was originally published at 33 Charts*

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. Read more »

5 Things Every MD Should Know Before Using Twitter

Let’s face it, Twitter isn’t that hard to figure out. The interface is intuitive and a little time on the application makes its basic function pretty obvious. But there are a couple of things that medical newbie’s might keep in mind before taking the leap on to Twitter. While I didn’t find myself in any kind of trouble, I had to figure a few things out on my own.

1.  Follow and listen.  Twitter is as much about listening as it is about talking. The best thing you can do to see how doctors are using microblogging to advance their platforms, practices and passions is look and listen. Pick a group of doctors (look at my follow list for some ideas) and follow them for a couple of weeks to see exactly what they do and how they interact with others. Don’t reinvent the wheel.

2.  Goof around now, but ultimately think how you want to use it. You likely won’t have any idea about how to use Twitter when you first jump in. And that’s okay. You can’t understand it’s power until you reach a sweet spot of followers and cultivate relationships that have some history and meaning (in Twitter terms, of course). Ultimately you do want to think about connecting with those who will put you where you want to be – whether it’s just raising your profile as an author or specifically drawing patients for lapband surgery, or whatever. But also keep in mind that you may start by goofing off and never stop … like me.

3.  You can follow whoever you darn well please. The world is full of self-ordained social media experts who spend their days working to make you feel like you don’t follow enough people. If you’re a physician with a real job you’re too busy to follow 30,000 people. Keep your eye on the ball and think about the network you want to develop. Whatever you do, don’t believe the nonsense that it’s ‘bad etiquette’ to not follow someone who follows you.

4.  Your patients and your hospital are listening. Social media is interesting. While we type in the privacy of our boxer shorts, the world reads what we write. And that includes your patients. While my grandmother used to tell me before going out, ‘don’t do anything you wouldn’t do in front of the Virgin Mary, I’m telling you, don’t Tweet anything you wouldn’t want your patients to see. You represent your personal brand, practice, and profession with that very first tweet. Keep in mind that some hospitals have social media/blogging policies. You might look into this before taking the plunge. If you keep your hospital/institution off your bio, commit to never discuss anything relating to patients and always vow to be a really nice guy you should be good.

5. What happens on Twitter stays on Twitter. Remember that everything you type will remain etched in the infosphere for eternity. This can be retrieved by future employers, partners, soon-to-be-ex-spouses or anyone else interested in seeing or exploiting what you’re really about. Exercise intelligent transparency. Be smart and use your frontal lobe before hitting ‘update’.

I was interviewed by the AMA News last week on doctors and Twitter and that’s what got me thinkin’ about this post.  I get a charge out of helping doctors recognize the power of connecting beyond their immediate environment. I hope this helps.

*This blog post was originally published at 33 Charts*

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