Friends visiting New York City this summer keep asking if it’s safe. As in, will they be catching and suffering from novel H1N1 (swine) flu.
I like to think my friends are pretty sharp, discerning folks (after all, they’re choosing my company) so I have to attribute these inappropriate questions to a wider problem.
For reference, here’s the latest and thought probably not last NYC DOH guideline on H1N1, which notes about 900 hospitalization and 45 deaths in H1N1+ patients over three months. About three quarters of these patients had at least one risk factor such as existing lung disease.
So why were ED’s swamped in May? Why are my friends still afraid to come to NYC? Dr. David Newman has some thoughts in EPMonthly:
…with constant messages of swine flu lethality on the nightly news, it is little surprise that ED’s in New York City, departments in a chronic state of over-crowding and crisis, were soon bursting at the seams with record volumes. In some institutions daily ED volumes doubled, as EP’s worked through third-world conditions of extreme crowding, questionable hygiene, extended wait times, and swarms of infectious, coughing congregates all within arm’s reach of each other.
The impact is clear: lives were lost. High quality studies have shown repeatedly that when ED’s experience crowding patients in need of rapid, high intensity care are identified later, treated more slowly, and devoted fewer resources. Mortality goes up during crowding in virtually every condition that has been studied, including MI, sepsis, and others. The irony is stark: Once a critical mass is reached, the more that come to be saved, the fewer we can save.
…The overall management of information during the swine flu of 2009, despite some progress in our access to information, was misguided and dangerous. Frantic media outlets drove a nation to fabricated fears, while state-level institutions not only failed to contain or counteract these messages, but also used expensive, fruitless, prescription-only pills, available to most only in their local ED’s, as a means of false comfort. Instead of using honest information to provide safety, comfort and education, the approach created panic, cost money and resources, and took lives.
All of this was preventable and is reversible for the future. There is no reason why the media cannot be recruited into the information dissemination process…
Unfortunately, there is a good reason why: Responsibly framing public health risks is no longer a role that suits traditional media. They’ve decided it’s just not in their interest.
I remarked on this years ago with West Nile virus, which never will never kill as many as, say, food poisoning or swimming pool accidents.
There are many factors driving the public appetite for health risk information — and that’s understandable. I think it’s even ok for news organizations to shuffle around reporting to some extent, to satiate those desires.
But what happened in NYC this spring was media malpractice — night after night, opportunities to put the risks of swine flu in perspective were passed up for breathless reporting. I recall one occasion in which a phalanx of reporters were camped outside a hospital I worked at, providing next to no detail about an infant who died it respiratory distress. It turns out this child did not have H1N1, but communicating that was not a priority — by the next day the lead story was ED’s are overcrowded and schools are closing.
EPMonthly ran a nice sidebar from Dr. Jim Augustine, enumerating the ways in which ED docs can engage the media to get the right message out.
But I’m more encouraged by approaches to bypass traditional media and reach patients directly. Yesterday I heard some encouraging news from the CDC: their emergency twitter feed has over 500,000 followers. Millions saw their videos. This is amazing reach, for public health communication.
It wasn’t enough to help ED’s this spring. But individual hospitals and the CDC is ramping up their use of social media, even as traditional news sources decline in influence. It’s really the first good viral news I’ve heard in a while.
*This blog post was originally published at Blogborygmi*
I recently created a focus group survey of physician bloggers to determine how they (and their patients) typically receive food and drug alerts. Twenty people responded. The results to 5 key questions are displayed below.
My most interesting take home messages:
1. Most physicians surveyed first receive drug alerts via eNewsletters from companies like MedPage Today and Medscape. (This is consistent with the large number of page views achieved by these sites/month).
2. Most patients find out about recalls via mainstream media – TV and newspapers.
3. EMRs, ePrescribing tools, coaching programs, and social media networks (like Twitter) are perceived to be the most valuable means of disseminating targeted recall information to the right person at the right time.
Being the first group of parents to have to have to parent an all digital generation of kids, it’s no wonder our brains go on overload trying to sort out not only how to use all things digital but keep our developing kids safe and thriving in their ever digital lives.
I talked about these issues today on Fox25 Boston and highlighted the new social media and sexting tips out from the American Academy of Pediatrics in honor of Internet safety month. Here’s the clip of the segment with all the details:
To remember the key points of the new AAP tips, I came up with the mnemonic “TECH”:
T: talk to your kids about their technology use and what they think of technology and the issues they hear about online.
E: educate yourself about the technology your kids are using, your kids about the issues, and your community about the need for youth education programs in schools as support for the issues
C: check your kids online profiles and logs often, and sometimes without warning
H: have a family tech use plan and follow-through when violations occur.
We know how to parent off line. We know how to create consequences when curfews are broken and expectations for social rules and proper behavior are not met. What we have to do now is modify our already great parenting skills to the online world. These tips are the first step!
Plus, keep in mind, you are not alone. Not only are all the parents around you in the same boat but you have experts like me here to help answer your questions about the high tech lives of kids.
I had a great chat after the segment with many FoxNews25 viewers and will post what we talked about soon so everyone can benefit. In the meantime, if you have questions about your own “Networked Family” or a story to share from your own “Networked Family” archives, email me at ideas@pediatricsnow.com.
*This blog post was originally published at Dr. Gwenn Is In*
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*
New Media guru Clay Shirky was the keynote speaker at the Management of Change conference in Norfolk, Virginia. His recent book, Here Comes Everybody, is considered a must-read by most web 2.0 enthusiasts. Clay and I escaped the conference for a tête-á-tête at a local Starbucks where we wrestled with the thorny issues of healthcare and crowd sourcing.
Dr. Val: I’ve noticed that there is a difference between being right and being influential. Doctors are having a hard time adjusting their tone to be more compelling in a social media culture. What do you think physicians can do to be more influential online?
Shirky: The problem is that, since we all die eventually, everyone will be unhappy with their healthcare at some point. This creates a social dilemma that’s neither transitory nor small. First, there will always be snake oil salesmen peddling “eternal life,” and second, there will always be an unhappy faction who rail against the medical establishment. You should not try to stamp out that faction, but referee it. Federalist Papers No. 10 states that faction is the normal case of government – the trick is not to allow factions to gain disproportionate power. Physicians need to realize that patients have different priorities than they do, and speak to those as much as possible.
Dr. Val: What do you mean that we have different priorities?
Shirky: Take Medpedia for example – physicians are eager to write about rare types of liver cancer, but they don’t want to write about the basics of biopsy technique. For the physician, it’s perfectly obvious what a liver biopsy entails, so he/she doesn’t think to write about it. But the patient is probably more interested in learning about biopsy procedure than the scientific details of a rare liver cancer. The entries in Medpedia strongly reflect physician interests and priorities, though the resource is ultimately supposed to serve the educational needs of patients.
Dr. Val: What’s the best way to close that gap in priorities?
Shirky: We need to fuse the conversation between physicians and patients. The more they work together, the more valuable the content will be.
Dr. Val: What do you think about the trend towards “user-generated healthcare?”
Shirky: It’s important to have checks and balances. When lay people discuss medicine, their unguided conversation can degenerate into vitamin hucksterism. I think that whole movement was initiated when the FDA decided not to regulate the supplement industry – people have been used to getting input from others who aren’t scientifically qualified. Now everyone gives medical advice, and people listen.
Social media is a very new phenomenon. We have not figured out how to apply good checks and balances yet – amateurs’ opinions and voices can drown out the experts. We want to believe that everyone’s opinion is equally valid – but that’s just not the case. In the end, quality and clarity of messaging is a source of power.
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