I’d like to thank @thuc for graciously designing some possible logos for our humble account, which until now has just used the famous “Twitter egg”. Please choose one of the selections. Results will be announced at the September 29, 2011 #meded chat!
I just took part in the UNC School of Medicine’s Internal Medicine Interest Group session. These type of panels were recently discussed in a New England Journal of Medicine Perspective, as well as that week’s #meded Twitter chat (you can read the transcript of that chat here). Man was I in for a surprise!
With all of the talk about the lack of generalists in medicine and waning interest in Internal Medicine, I only expected about 20 or 30 students to show up. Instead, I arrived to see about 150 or so students with a nearly-completely filled auditorium.
What should I attribute this to?
I found out later that it was the first of the “Career Opportunity Series” luncheons for the new first year medical students. That might be a good reason.
I’d like to think that there was some other great reason for so many students showing up. Maybe they all really want to go into IM (or at least think they do at this juncture). Maybe they heard that I was going to be on the panel (yeah, right!).
Maybe they are truly “undifferentiated” and are taking every opportunity they can to figure out the right career choice for them (the “idealist” viewpoint”)…
Or maybe it was just the free pizza.
In the very early part of January I made the decision to start blogging. Little did I know what was in store for me when I did. Even though I’ve had my own “personal” Facebook account since 2008, it was not until January that I began to experience the “intersection” of Healthcare and Social Media.
With that in mind, here are a few of the things I’ve learned in my first 6 months as a medical professional in Social Media:
These points really just skim the surface of what is out there to be learned and experienced. I continue to learn more about Social Media each day. I remind myself that my own expertise lies in my medical skills and knowledge. I am not an expert by any means in Journalism, Communication, Marketing, or Education, all of which are aspects of Social Media that I need to learn from experts in these areas so that I can develop my skills more broadly in this arena.
To those who have helped me grow since January, thank you. I have made some great friends and relationships, and hope to make many many more.
As an attending and the program director in a university practice, I have the opportunity to read a lot of notes that other people have written. Many of these notes are written by residents and fellows, often from my own program. In doing so, I often come across a phrase in the opening line of a note that really irritates me, which might go something like this:
“Mrs. Smith is a very pleasant 54-year old woman who…”
Why does this bother me, you might ask?
Other words are similarly inappropiate in this context; the word that most frequently comes to mind is “unfortunate”.
“Mrs. Smith is an unfortunate 54-year old woman…”
Although it may seem that you are empathizing with the patient, I doubt that a patient would want to actually see a doctor write in their note that they are “unfortunate”. The consequence of their problems may be unfortunate, but not the patient him or herself.
By no means do I intend to say that this issue is confined to trainees; I see the same descriptions among seasoned physicians. My best explanation for this is that no one really ever went over their notes, or that they were just never told to change it. If you find yourself saying this is your own notes, ask yourself why…and consider omitting it next time.
It just doesn’t look right in the blog format, so click here if you’d like to read my poem.
Below is the brief backstory…if you’re interested in what happened. Please read the poem first.
A little while back, I saw a patient in my reflux practice who had recently stopped her PPI and substituted licorice root to help keep her acid reflux symptoms under control. She told me that her symptoms were still under good control with the licorice root, and asked me if I was all right with her staying on it instead. Since she did not have any mucosal injury (esophagitis) or other complications from GERD, my main question that I had to answer was about the safety of licorice root .
So I looked it up, just to be sure I was doing my due diligence. If you aren’t aware of the possible side effects of licorice root, the major ones to be aware of are:
Fortunately, these only tend to occur at large doses (> 3 grams per day for several weeks) when the licorice root contains glycyrrhizin. In short, I thought it was fine for her since she was otherwise in good health, and the dose was not that large.
Nonetheless, there is an important reminder here: just because something is natural, doesn’t mean it is completely without side effects. Even natural substances are still chemicals.
If you are a patient, please discuss all of your supplements with your physicians. In this case in particular, extreme use can actually cause rare life threatening problems. If you are a doctor or other healthcare professional, be sure to ask your patients about any herbs and supplements they might be taking.
“There are no difficult patients; only patients with difficult problems.” I learned this mantra from a colleague and have used it to help shape my practice for quite some time now.
A few recent comments online about “difficult patients” have bothered me. When I tweeted a similar quote the other day, one person on Twitter insinuated that I was naive to say this. One medical website even has a subsection under “Patient Relations” called “Difficult Patients”. Kevin Pho blogged about a similar issue recently, as has Dr. Maria Yang. My take is somewhat different, but the basic premise is the same.
This is by no means a naive philosophy. The simple statement can be applied in every situation. The concept of a “difficult” patient is, well, difficult to comprehend. In whose mind is the patient difficult? Invariably, in the treating physician’s mind, but like many things in medicine, the concept can have different meanings for different observers.
Kevin Pho’s post referred to a study by Hinchey and Jackson published this month in Journal of General Internal Medicine, that explored both patient and physician factors in situations where patients are considered “difficult”. You may have your own ideas of what makes a patient “difficult” that are not addressed exactly in this article.
Instead of considering the patient “difficult” in the first place, I would suggest another approach when faced with such a patient:
Try to understand what is driving the behavior or the situation that makes the patient seem difficult.
I couldn’t possibly list all of the possible reasons that might make a patient seem difficult, but here are a few options to consider:
There are innumerable other reasons I’m sure you could come up with. However, ultimately the underlying reasons for the “difficulty” are usually not things that the patient can control without external assistance. Even in the unusual situation of Munchausen syndrome, in which patients harm themselves for secondary gain, there is a significant underlying disorder that warrants discussion and treatment.
Next time you are faced with a patient you find “difficult”, try considering why you are feeling that way, and explore what the driving force behind the patient’s situation might be. You will open up the relationship with your patient and hopefully improve your patient’s outcome.
This past week was a pretty exciting, relatively controversial week for people interested in Health Care in Social Media. If you don’t know what happened, you can listen to Dr. Mike Sevilla’s podcast about it here. Although it is certainly not the end of the discussion, there has been a new flurry of activity today since MommyDoctor (@mommy_doctor) has apparently deleted her Twitter account.
In my opinion, the “system” (i.e., social media and the exuberant discussion that occurred) worked perfectly. It worked just like it should. I am not trying to insinuate that I am “pro” Dr. Vartabedian (@Doctor_V) and “anti” MommyDoctor. On the contrary, I have been listening intently to both sides.
How did the system work perfectly?
Both Dr. V and MommyDoctor chose to enter social media, blog and tweet. Neither was forced to do so. They did so in the fashion they felt was appropriate. Both were at liberty to comment on the other’s posts. MommyDoctor chose to tweet what she did, Dr. V chose to call her out publicly. Dr. V took one approach, MommyDoctor took another.
And we chose to comment. Many people chose to use their freedom of expression to lambast him for lambasting her. However, if we don’t think it’s right to call someone out and be the “police” of Social Media, then what makes it right to tell someone else that they were wrong to speak out? It’s sort of contradicting ourselves.
As a result of the brouhaha, Dr. V took one action (remained steadfast in his convictions), and MommyDoctor took another (decided to leave the space). But don’t mistake choice for an obligation. MommyDoctor was not “forced” to leave. Was she “bullied” as some would suggest? If a single blogpost constitutes bullying in your mind then I can see how you’d think that. Nonetheless, at no point did Dr. V request that MommyDoctor go away. She listened to the community and took the action that best suited her values. It was her own choice.
In the last few weeks, several #meded tweeps have been bouncing the idea around about starting a Twitter chat dedicated to discussing issues related to medical education. One night, Vinny Arora (@FutureDocs) made the proclamation that she thought we had now reached a “critical mass” of people interested in pursuing a #meded chat…
With that in mind, I decided to just sit down and make it happen. So here goes the big announcement…
The weekly #meded chat will take place at Thursday nights at 9 pm Eastern time (US).
All of the ins and outs have not been completely worked out, but here are the basics for the time being:
Those of us who were in the discussions about the arrangements realized that it would probably be too difficult to accommodate both the European and North American contingents at an appropriate time (this time slot is 1:00 am GMT). AnneMarie Cunningham (@amcunningham) is thinking about a second time slot that would suit the European #meded interest group better, but for now we will use the Thursday night time slot as our initial footprint. If it has to move around a bit, so be it.
We hope that this chat group will advancer collaborative efforts toward and permit rapid exchange of great ideas in medical education.
This is a work in progress, so your feedback is greatly appreciated!
A well-established medical blogger Dr. Bryan Vartabedian (aka @Doctor_V, a fellow gastroenterologist whom I recently had the pleasure of meeting at DDW 2011 #DDW11) seemed to ignite a firestorm this week amongst #hcsm tweeps with his post about a specific incident he saw on Twitter. He was (is) of the opinion that:
I read the blog and was sure that most people would be of the same opinion. With only a few exceptions, most of the doctors I have encountered on Twitter have maintained a professional attitude, with a few notable exceptions, as documented in a recent JAMA Letter to the Editor. I was definitely not expecting the eruption of sentiment from several others.
What transpired felt like a political debate between conservatives and liberals. As a moderate I found it intriguing to listen to both sides and take it in, like an argument between the Dems and GOP on the appropriate way to decrease the deficit. Let’s at least agree that those who have differing opinions are not going to agree, and neither side is truly “correct” or “incorrect”.
To explain the basic themes of those that espouse the opposite view of Dr. Vartabedian:
I am going to limit the remainder of this discussion to Point #1, professionalism. Do we have a responsibility to maintain a certain level of decorum in every aspect of our lives, or just certain aspects? If just certain aspects, in which ones are we permitted to let loose? Is the Social Media space the appropriate place to drop our guard?
This is a matter of fervent discussion among medical educators and ethicists. In a recent article in the Annals of Internal Medicine, Drs. Mostaghimi and Crotty said “social networks may be considered the new millenium’s elevator”. We all know of doctors that do not keep quiet in the elevator no matter how often they are reminded of the issue of patient privacy. The same can be said for online personae.
I have recently become more interested in the issue of medical professionalism after attending talks at the recent GI Training Directors workshop as well as a seminar series led by Drs. Sylvia and Richard Cruess from McMaster, who are leaders in this area. They stressed that there is a gradient of professionalism and a learning curve that occurs over the years of education, training, and practice.
Two attributes of professional behavior are are germane to the discussion at hand: Morality/Ethical behavior, and Responsibility to Profession. The fact that the internet and social media are new does not excuse the behavior, which was clearly less moral or ethical than optimal, nor does the novelty of the space eliminate the Responsibility to Profession that all who are physicians should maintain. But just like there are some physicians whose medical knowledge, patient care, or interpersonal communication skills are less than optimal, we must realize that there are some doctors whose professionalism is so as well.
For those of us who enjoy educating, it behooves us to try to engender excellence among all of our colleagues. We have a long way to go, but let’s keep working at it.
Gut Check Blog 