Most physicians agree that we have an ethical obligation to help educate our patients about what’s going on with their health, but what does that look like in a world overwhelmed with digital health information? And how do we budget appropriate time when we’re already struggling to balance shorter appointment times, more documentation requirements and busier clinic schedules?
It’s estimated that 72 percent of patients get a majority of their health information online. With an abundance of biased and incorrect information on the internet, our responsibility as physicians has evolved from simply teaching patients about their health conditions to now include educating patients on where and how to find and identify reliable health information.
This premise goes back to why I use social media. We have a responsibility to share, or at the very least be cognizant of, reliable health information in the realm where our patients seek it. In the olden days that looked like an exam room; today it looks like a Google search.
Here are four ways to efficiently help ensure patients have the resources they need to find reliable health information, despite cramped clinic visits and time constraints.
- Ask: How can you possibly know where patients find their information if you don’t ask? I have patients come in with birth plans all the time and quite frequently they’ve printed them out from a website with little-to-no additional research into the (often very specific) things they’ve requested. You can’t possibly know or understand their views unless you ask.
- Take 2: I understand how limited our time is. I’m a resident with a busy clinic and short, often over-booked appointment slots, but taking two minutes to discuss reliable health information with your patients has great potential for improving patient care and decreasing un-needed visits and calls.
- Prep: Have pre-written, condition-specific information for your patients and include curated links to additional reliable information for those who may want it. It’s as simple as a “dot-phrase” on most major EMR systems or a copy/paste file you can quickly email or print.
- Encourage: Encourage your patients to take control of their health by being informed. Encourage them to ask questions and explain things back to you, so you’re certain they have a grasp on it. Encourage them to share what they’ve learned in their searches.
Danielle Jones, MD is a a fellow of The American Resident Project, where this post first appeared. Danielle went to college at Texas A&M University (Gig ‘Em Aggies!) and completed her medical school at Texas Tech. Dr. Jones is interested in fertility medicine, social media and health technology. Currently, Dr. Jones is an Ob/Gyn resident in Texas, where she lives with her husband, twin baby girls and three crazy dogs
Filed Under: THCB
Tagged: American Resident Project, Danielle Jones, Dr. Google, online health information, Social Media
Jun 19, 2014
The American Society of Clinical Oncology recently made public nearly all of the abstracts — more than 5,000 pieces of research — that were selected for the ASCO annual meeting, which kicked off in Chicago on the last day of May.
Sifting through those 5,000 abstracts would be an almost inhuman task: each abstract contains 2,000 characters. That’s 10 million characters of information about oncology created by experts that’s now available for the public to parse.
But as remarkable as the ASCO abstract drop is, that research is not the only overwhelming trove of communication on cancer created by doctors. One ASCO abstract (based on research by me and W2O colleagues Greg Matthews and Kayla Rodriguez) tells story of how, over the course of 2013, U.S. doctors tweeted about cancer 82,383 times. At 140 characters a tweet, that’s nearly 12 million characters.
We know there were 82,383 tweets because we counted them. Using our MDigitalLife database, which matches Twitter handles with verified profiles from the government’s physician database, we scanned all tweets by doctors for mentions of dozens of keywords associated with cancer over the course of calendar year 2013.
Continue reading “What Twitter Tells Us about the War on Cancer”
Filed Under: THCB
Tagged: ASCO, Brian Reid, Cancer, Oncology, Physicians, Social Media, Twitter
Jun 2, 2014
My 87 year-old father broke his hip this past weekend. He was in Michigan for a party for his 101 year-old sister, and fell as he tried to put away her wheelchair. The good news is that he’s otherwise pretty healthy, so he should do fine.
Still, getting old sucks.
During the whole situation around his injury, surgery, and upcoming recovery, one thing became very clear: technology can really make things much easier:
- I communicated with all of my siblings about what was going on and gave my “doctor’s perspective” to them via email.
- I updated friends and other family members via Facebook.
- I have used social media to communicate cousins about what is going to happen after he’s discharged from the hospital and coordinate our plans.
All in all, tech has really made things much easier.
This reality is in stark contrast to the recent headline I read on Medscape: “Doctors are Talking: EHRs Destroy the Patient Encounter.” The article talks about the use of scribes (a clerical person in the exam room, not a pal of the Pharisee) to compensate for the inefficiencies of the computer in the exam room. Physician reaction is predictable: most see electronic records as an intrusion of “big brother” into the exam room.
To me, the suggestion to use a scribe (increasing overhead by one FTE) to make the system profitable is ample evidence of EMR being anti-efficient.
Despite this, I continue to beat the drum for the use of technology as a positive force for health care improvement. In fact, I think that an increased use of tech is needed to truly make care better. Why do I do so, in face of the mounting frustrations of physicians with computerized records? Am I wrong, or are they?
Neither. The problem with electronic records is not with the tech itself, it is with the purpose of the medical record. Records are not for patient care or communication, they are the goods doctors give to the payors in exchange for money. They are the end-product of patient care, the product we sell. Doctors aren’t paid to give care, they are paid to document it. Electronic records simply make it so doctors can produce more documents in less time, complying with ever-increasingly complex rules for documentation.
Continue reading “Personal Tech”
Filed Under: Tech, THCB
Tagged: Connecting Tech, EHR Design, EHRs, Organizer Tech, Rob Lamberts, Social Media, Twistle
May 29, 2014
Doximity, known as the LinkedIn for doctors and a frequent Health 2.0 participant, raised $54 million in a Series C funding round led by T. Rowe Price and Draper Fisher Jurveston with participation from Morgan Stanley Investment Management.
Doximity claims more than 40% of US physicians as active users, and in January of this year announced that their physician network has grown to more than 250,000 members.
Doctors can use Doximity to collaborate on cases, further their careers, and stay up to date on specialty-specific news, but that’s not where they make their revenue.
“There are a lot of things we can do to make medical networking more efficient,” Doximity CEO Jeff Tangney told Health 2.0 when asked how the funds would be used.
“If you think about it, how would your life be different if you weren’t able to use email in your job? How out of touch would you be? That’s what it’s like to be a US physician. We see a lot of opportunity to improve the connectivity of physicians as a new business area.”
Like LinkedIn, Doximity is a recruiting tool for people looking to hire doctors. Tangney didn’t reveal all the numbers, but he did say that Doximity was cash flow positive in January for the first time. He also said that Doximity has 55 employees, somewhere around 200 hospital clients, and that a subscription to the recruiting product costs $12,000 per seat per year to send 50 messages per month.
With some back of the envelope math, and a guess of a burn of about $10-12 million a year, it figures out to about four subscribed seats per hospital. With about 5,000 hospitals in the US and some other revenue streams to pursue, it looks like Doximity has room to grow at a bare minimum.
Continue reading “Doximity Raises Another $54M to Pursue LinkedIn’s Business Model Too”
Filed Under: Health 2.0, THCB
Tagged: Doximity, Jeff Tangney, Kim Krueger, Matthew Holt, Physicians, Social Media
Apr 29, 2014
By DAVID DO, MD
WILD PREDICTION: It won’t be long before every patient has a Twitter feed, and doctors subscribe to them for real-time updates.
This is a time when the demands of being a physician are changing, and we need to leverage technology to maintain awareness of a huge number of patients. There is also increasing need for handoffs and communication between providers.
Here’s the bottom line: how can we improve technology when doctors seem so resistant? They are not happy with their EMRs, and rightly so, because they were built to do too much for too many.
Current system is inefficient
The EMR has become essential for documentation, billing, medical reasoning, and communication, among other things. Currently, documentation is built on a system of daily progress notes. If I consult a cardiologist about a case, he needs to go through each note, containing narratives, laboratory values, vital signs, and physical exams.
A patient with a seven-day hospital stay may have twenty notes that need synthesis to put together the story–this can take hours per patient!
In an age where more providers are involved in a patient’s care (whether due to duty hour restrictions, or the increasing presence of specialists for every problem), this inefficiency is not acceptable.
Continue reading “What an EMR Built on Twitter Would Look Like”
Filed Under: Tech, THCB
Tagged: David Do, Design, EHR, FutureMed, Social Media, Twitter
Apr 27, 2014
About three years ago, a new member of our Lung Cancer Survivors Support Community posted a message: she was taking Tarceva and wanted to discuss with fellow members everything about that cancer drug.
She titled her post, TARCEVA DIVAS AND DUDES DISCUSSION & SUPPORT. She saw a need to create a community within a community, and beginning with that modest post, she did it. She didn’t ask permission. She didn’t wait for us, or another member, to organize and lead a top-down discussion about Tarceva.
The ongoing discussion string became the place for our members to go to talk about Tarceva and next-generation lung cancer treatments.
The member became known by some as the Tarceva Diva, and for the purposes of this story, that’s what I’ll call her. This story is not specifically about Tarceva, or even about lung cancer, but instead, it’s a celebration of an unsung hero who helped thousands of people.
There have been well over 8,000 posts in less than three years’ time–about 250 posts per month–in just that series of hundreds of “Divas and Dudes” discussion strings. That’s a constant, dedicated stream of treatment insights from-the-front-lines of people worldwide affected directly by lung cancer.
“WELCOME TO TARCEVALAND!!!” she’d proclaim to a new member, or “newbie.” She could insert humor into the discussions without making light of the seriousness of members’ illnesses. The activity in the Tarceva sub-community grew so quickly that the Tarceva Diva created another discussion topic, TARCEVA SIDE EFFECT BUSTERS, which created yet another resource for members.
Continue reading “The Legacy of the Tarceva Diva”
Filed Under: Uncategorized
Tagged: Brian Loew, Cancer, Lung cancer, Patient Communities, Social Media, Support Groups, Tarceva
Feb 27, 2014
The two columns by Bill and Emma Keller about Lisa Bonchek Adams unleashed fury this week from supporters who questioned the manner in which Adams, who has metastatic breast cancer, “lives her disease” through her blog and Twitter feed.
Amid reams of articles, blogs, tweets and Facebook posts, patient advocate and breast cancer survivor posted Liza Bernstein grabbed our attention for posting a brilliant yet simple observation. Responding to an article in Gigaom, Bernstein noted that Bill Keller wrote this of Adams:
“Her digital presence is no doubt a comfort to many of her followers. On the other hand, as cancer experts I consulted pointed out…”
And Keller went on to describe what those experts thought.
Bernstein and other e-patients know well that Lisa Adams is an expert. In her response, Bernstein said that while Adams “is not a doctor or a researcher, [she] is a highly engaged, empowered, and educated patient who, as far as I know, has never shared her story lightly.”
Perhaps unintentionally, Keller’s supposition that Adams is a “comfort” to other patients compared with the analysis he provides from “cancer experts” marginalizes what people like Adams bring to others affected by cancer.
Continue reading “In Praise of Lisa Bonchek Adams, Breast Cancer Expert”
Filed Under: Uncategorized
Tagged: Brian Loew, Cancer, e-patients, FutureMed, Inspire.com, Patients, Social Media, Wellness
Jan 16, 2014
Thanks to the technologic allure of iPhones replacing stethoscopes, apps substituting for doctors and electronic information substituting for having to actually talk to patients, this thoroughly modern correspondent is all about medical-social media.
Think Facebook for the flu. Twitter for tinnitus. Egads, listen to the typical consultant, pundit or futurist and it’s easy to believe that we’re on the verge of a silicon-based health care revolution.
But then reality intrudes and some skeptic somewhere always asks about the bang for the buck, the juice for the squeeze, the return for the investment. It’s a good question.
For something of an answer, consider the results appearing in a recently published randomized clinical trial by researchers at UCLA. Over a 4 month period, “at risk persons” were recruited for a clinical research trial with on-line ads (Facebook banners, Craigslist, for example) as well as announcements in community settings and venues. Once subjects met the inclusion criteria and had a unique Facebook account, they were randomly assigned to one of two treatment arms.
One treatment arm used a closed Facebook group to coach persons about their at risk condition. The other treatment arm similarly used Facebook to coach persons about general health improvement. Lay “Peer Leaders,” who were given a three hour training session on “epidemiology of the condition or general health subjects and ways of using Facebook to discuss health and stigmatizing topics,” were assigned to lead the groups.
Peer Leaders attempted to reach out to their assigned group persons with messaging, chats and wall posts. Once the link was established, the relationship in the intervention group included communication about prevention and treatment of the condition. At the end of 1, 2 and three months of the study, participants completed a variety of surveys.
57 individuals were in the control general health group and 55 were in the condition coaching group. According to the surveys, intervention patients were ultimately statistically significantly more likely to agree to condition testing (44%) than the control patients (20%). Because there were few participants, the modest decrease in actual tests or risk behaviors were not statistically meaningful.
This correspondent’s take:
While this was a small study, this is the first time that I have seen reasonable proof that social media by itself can move the behavior needle. On the other hand, this did not result in a patient engagement stampede toward better care or hard clinical outcomes. A majority of participants (56%) did not appear to benefit. Nonetheless, the results do support the inclusion of Facebook-style closed group social media in the suite of population health management services.
Continue reading “Can Social Media Really Influence Health Behaviors? A Small Clinical Trial Argues The Answer Is Yes.”
Filed Under: Uncategorized
Tagged: Facebook, Jaan Sidorov, patient engagement, Social Media, Twitter
Sep 14, 2013
A few weeks ago, a middle-aged man decided to tweet about his mother’s illness from her bedside. The tweets went viral and became the subject of a national conversation. The man, of course, was NPR anchorman Scott Simon, and his reflections about his mother’s illness and ultimate death are poignant, insightful, and well worth your time.
Those same days, and unaware of Simon’s real-time reports, I also found myself caring for my hospitalized mother, and I made the same decision – to tweet from the bedside. (As with Simon’s mom, mine didn’t quite understand what Twitter is, but trusted her son that this was a good thing to do.) Being with my mother during a four-day inpatient stay offered a window into how things actually work at my own hospital, where I’ve practiced for three decades, and into the worlds of hospital care and patient safety, my professional passions. In this blog, I’ll take advantage of the absence of a 140-character limit to explore some of the lessons I learned.
First a little background. My mother is a delightful 77-year-old woman who lives with my 83-year-old father in Boca Raton, Florida. She has been generally healthy through her life. Two years ago, a lung nodule being followed on serial CT scans was diagnosed as cancer, and she underwent a right lower lobectomy, which left her mildly short of breath but with a reasonably good prognosis. In her left lower lung is another small nodule; it too is now is being followed with serial scans. While that remaining nodule may yet prove cancerous, it does not light up on PET scan nor has it grown in a year. So we’re continuing to track it, with crossed fingers.
Unfortunately, after a challenging recovery from her lung surgery, about a year ago Mom developed a small bowel obstruction (SBO). For those of you who aren’t clinical, this is one of life’s most painful events: the bowel, blocked, begins to swell as its contents back up, eventually leading to intractable nausea and vomiting, and excruciating pain. Bowel obstruction is rare in a “virgin” abdomen – the vast majority of cases result from scar tissue (“adhesions”) that formed after prior surgery. In my mother’s case, of course, we worried that the SBO was a result of metastatic lung cancer, but the investigation showed only scar tissue, probably from a hysterectomy done decades earlier.
Continue reading “#MomInHospital”
Filed Under: THCB
Tagged: Bob Wachter, End of Life Care, ER Visits, hospitalization, Hospitals, LEAN, Nurses, Patient Safety, Patients, Quality, Scott Simon, Social Media, Twitter, UCSF
Aug 17, 2013
In the past few years, the fortunate among us have recognised the hazards of living with an overabundance of food (obesity, diabetes) and have started to change our diets. But most of us do not yet understand that Facebook is to the mind what sugar is to the body. Facebook feed is easy to digest. It has made it easy to consume small bites of trivial matter, tidbits that don’t really concern our lives and don’t require thinking. That’s why we experience almost no saturation. Unlike reading books and long magazine articles (which require thinking), we can swallow limitless quantities of photos and status updates, which are bright-coloured candies for the mind. Sadly, we are still far away from beginning to recognise how toxic Facebook can be.
Facebook misleads. Take the following event (borrowed from a Facebook friend). A bloke you knew in high school, whom you’ve not met or spoken to in real life since you left high school, has got married. He posts pictures of his wedding taken by a snazzy professional photographer. The pictures gather hundreds of likes and comments. Your friends shower your high school mate with congratulations. There are discussions about the bride’s dress, the tasty food, the fancy hotel, but absolutely no one knows that the reason they are really getting married is because the bride is pregnant with your mate’s baby. Facebook leads us to walk around with the completely wrong idea about our friends’ lives. So holiday pictures are over-liked. Stressful outbursts go unshared. A new job is immediately updated. Being fired is never made note of. Your friends might subscribe to a lot of “Causes”. In real life they do nothing about those causes.
We are not rational enough to be exposed to Facebook. Watching a video of your mother in a dance club is going to change your attitude towards your parents, regardless of your real relationship with them. If you think you can compensate with the strength of your own inner contemplation, you are wrong. Bankers and investors – who have powerful incentives to keep you hooked so that Facebook can make a profit – have shown that they cannot. The only solution: cut yourself off from using Facebook entirely.
Continue reading “Facebook Is Bad For You – and Giving Up Using It Will Make You Happier”
Filed Under: OP-ED, THCB
Tagged: Akshat Rathi, Facebook, Social Media, Wellness
Apr 15, 2013