April 3rd, 2011 by Bryan Vartabedian, M.D. in Opinion
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Patient care is increasingly under third party control. And as a consequence I make fewer decisions regarding the brand of medication used in my patients.
So the role of a pharmaceutical rep comes into question. If I don’t choose which medication my patients will use, why would a representative call on me? And as American medicine becomes more centralized and standardized, I wonder how and why industry will connect with treating physicians. Pharma it seems is asking the same question: Of the core medications I prescribe, I see far fewer reps these days and our relationships are markedly different from a decade ago.
I don’t miss the pitch. But I find the element of human support to be important. For example, recently the FDA issued a black box warning for the concomitant use of Remicade and 6-MP. My representative visited to be sure that I was aware of the changes in the product insert. Sure the information was in my mailbox – along with 6 inches of pulp spam. It’s basic attenionomics: I’m more likely to hear a person than a letter. Read more »
*This blog post was originally published at 33 Charts*
March 29th, 2011 by Bryan Vartabedian, M.D. in Opinion
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I frequently talk about the visibility of doctors in the online space. How can doctors make content, contribute to the broader dialog, and be more visible? Maybe I need to spend less time pushing the idea that every doctor needs to create. Most doctors, after all, just want to listen and watch. Maybe we need to be cultivating dedicated communicators.
There’s a role evolving where physicians are formally involved in the creation of content and the maintenance of dialog. Wendy Swanson at Seattle Children’s Hospital and Claire McCarthy at Boston Children’s Hospital come to mind as good examples. Both serve as models for how institutions can leverage the voice of an individual for a branded online identity while contributing to the common good. Both are evolving as conversation agents on social platforms and IRL. Call them medical conversation agents of new media. Read more »
*This blog post was originally published at 33 Charts*
March 19th, 2011 by Bryan Vartabedian, M.D. in True Stories
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This week I lost one of my patients, Cooper. He was a feisty 4-year-old with mitochondrial depletion syndrome. I began looking after him as an infant when he wouldn’t stop screaming. I saw him through surgeries, diagnostic rabbit trails, and ultimately helped with the painful decision to undergo small bowel transplantation. Inexplicable symptoms and strange complications defined his short life. While he spent his final days in considerable pain, his lucid moments were spent throwing marshmallows at his siblings. It sort of encapsulates who he was. Great spirit.
Independent of the circumstances, a child’s death is always brutally difficult to process. It’s counterintuitive. And facing Cooper’s parents for the first time after his passing was strangely difficult for me. When he was alive I always had a plan. Every sign, symptom, and problem had a systematic approach. But when faced with the most inconceivable process, I found myself awkwardly at odds with how to handle the dialog. In a hospital my calculated clinical role has a way of sheltering me from a parent’s reality. At a funeral it’s different. Read more »
*This blog post was originally published at 33 Charts*
March 9th, 2011 by Bryan Vartabedian, M.D. in Better Health Network, Opinion
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How comfortable are we with uncertainty? I struggle with this question every day. I treat children with abdominal pain. Some of these children suffer with crohns disease, eosinophilic esophagitis, and other serious problems. Some children struggle with abdominal pain from anxiety or social concerns. I see all kinds.
But kids are tricky, and sometimes I can’t pinpoint the problem. Trudging forward with more testing is often the simplest option since it involves little thinking. And some parents perceive endless testing as “thorough.”
The question ultimately becomes: When do we stop? Once we’ve taken a sensible first approach to a child’s problem and judged that the likelihood of serious pathology is slim, when and how do we suggest that we wait before going any further? This requires the most sensitive negotiation. It’s about finding a way to make a family comfortable despite the absence of absolute certainty. This is easier said than done. Parents can unintentionally advocate for themselves and their worries by insisting on the full-court press. Alternatively they may refuse invasive studies when absolutely indicated.
All of this is for good reason: You can’t be objective with your own kids.
Pediatrics is tricky business and managing parental uncertainty is perhaps my biggest preoccupation. As I’ve suggested before, sometimes convincing a family to do less represents the most challenging approach.
*This blog post was originally published at 33 Charts*
March 4th, 2011 by Bryan Vartabedian, M.D. in Opinion, True Stories
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This week a reporter cornered me on the issue of professional behavior in the social space. How is it defined? I didn’t have an answer. But it’s something that I think about.
Perhaps there isn’t much to think about. As a “representative” of my hospital and a physician to the children in my community, how I behave in public isn’t any different than a decade ago. Social media is just another public space. Sometimes it’s easy to forget that we’re in public. When I’m wrapped up in a Twitter thread it’s easy to forget that the world is watching. But the solution is simple: Always remember that the world is watching.
On Twitter I think and behave as I do in public: Very much myself but considerate of those around me. I always think about how I might be perceived.
Here’s a better question, online or off: What is professional behavior? I have a pediatrician friend who, along with the rest of his staff, wears polo shirts and khaki shorts in the summer. The kids love it. One of my buttoned-down colleagues suggested that this type of dress is “unprofessional.” Or take a handful of physicians and ask them to review a year of my blog posts and my Twitter feed. I can assure you that some will identify elements that they find “unprofessional.” I believe I keep things above board.
This is all so subjective.
The reporter was also interested in how I separate my professional and personal identities in the online space. I’m not sure the two can be properly divided. The line is increasingly smudged. I try to keep Facebook as something of a personal space. I think it was Charlene Li who suggested that she only “friends” people she knows well enough to have over for dinner. That’s evolving as my rule as well. But independent of how I define “well enough,” Facebook is still a public space. My comments and photos can be copied to just about anywhere.
Social media has not forced the need for new standards of physician conduct. We just need to be smarter than we were before. Everyone’s watching.
*This blog post was originally published at 33 Charts*
