Businessman and maverick, Mark Cuban recently opined “if you can afford to have your blood tested for everything available, do it quarterly so you have a baseline of your own personal health.” I’m unsure why he said quarterly, not weekly, daily or hourly. ‘
He further opined that this must be done to “create your own personal health profile and history. It will help you and create a base of knowledge for your children, their children, etc.” I assume etc. refers to grandchildren’s children.
I’m unclear what my grandchildren would gain from knowing my serum free testosterone levels in 2014. That’s a lot of data to enter in ancestry.com. For that matter, the size of my grandfather’s spleen in 1956 probably doesn’t affect the way I think about my mortality. That year he had a bout of Leishmaniasis, which, thankfully, isn’t a problem in Philadelphia.
Cuban further explained “a big failing of medicine = we wait till we are sick to have our blood tested and compare the results to “comparable demographics.”
At 3PM EST on December 10, 2014, medical and dental students at over 70 schools participated in the “National White Coat Die-In.” The event was organized on Facebook and spearheaded by students at University of California, San Francisco (UCSF) School of Medicine who described the event as “a demonstration in response to the events in Ferguson and New York because #BlackLivesMatter.”
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.
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.
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.
Remember 2009? The H1N1 pandemic we were all waiting for? I do. I was pregnant; H1N1 was particularly risky for pregnant women. The vaccine wasn’t available until after I had my baby, but when they held a clinic an hour north of where I live, I brought my husband there so we could both get our shots. My infant son was too young to be vaccinated, so I wanted to protect him through herd immunity.
A study came out recently on twitter messages from that time. How did pro-vaccine sentiments spread, versus anti-vaccine ones? Which messages were more contagious?
I talked to one of the authors, Marcel Salathe, today. He’s an infectious disease researcher studying the spread and transmission, not (just) of disease, but of information. “We assume people infect each other with opinions about vaccinations,” he said, and the H1N1 scare was a good opportunity to put some of his group’s theories to the test.
They collected nearly half a million tweets about the H1N1 flu vaccine. In 2009, H1N1 wasn’t included in the regular flu shot, and became available partway through flu season as a separate dose. With a possible pandemic looming, people had plenty of motivation to get the vaccine and encourage others to get it—butanti-vaccine sentiments were in circulation too.
The result, striking but perhaps not surprising: negative opinions were more contagious than positive ones. (Specifically, someone who read a lot of anti-vaccine messages was more likely to follow up by tweeting or retweeting negative messages of their own.)
Somewhere between the 20th century Bank ATM and the 25th century Tricorder, lays the EMR that we should have today.
Somewhere between the government-designed Meaningful Use EMR and the Holographic doctor in Star Trek, there should be a long stretch of disposable trial-and-error cycles of technology, changing and morphing from good to better to magical. For this to happen, we must release the EMR from its balls and chains. We must release the EMR from its life sentence in the salt mines of reimbursement, and understand that EMRs cannot, and will not, and should not, be held responsible for fixing the financial and physical health of the entire nation. In other words, lighten up folks …
A patient’s medical record contains all sorts of things, most of which diminish in importance as time goes by. Roughly speaking, a medical record contains quantifiable data (numbers), Boolean data (positive/negative), images (sometimes), and lots of plain, and not so plain, English (in the US).
The proliferation of prose and medical abbreviations in the medical record has been attacked a very long time ago by the World Health Organization (WHO), which gave us the International Classification of Disease (fondly known as ICD), attaching a code to each disease. With roots in the 19th century and with explicit rationale of facilitating international statistical research and public health, the codification of disease introduced the concept that caring for an individual patient should also be viewed as a global learning experience for humanity at large. Medicine was always a personal service, but medicine was also a science, and as long as those growing the science were not far removed from those delivering the service, both could symbiotically coexist.
Here’s another technically easy and culturally hard product: Patient Friendly Orders.
My version of this idea was born when I was admitted to the hospital for pneumonia about 5 years ago. Even though I had previously worked in that hospital, the quality of communication about my care between the patient and the medical team was poor. This got me thinking…
There should be a touchscreen by my bed that lists all the current doctors’ orders.
They’re not hidden in the chart. They’re not explained only in ephemeral conversations that occurred without me present. And of course, if they’re in front of me, they’re going to have to get written in English.
Let’s organize the orders, too. Imagine a loved one is hospitalized for a severe skin infection which also caused his diabetes to get way out of control. He has difficulty sleeping in the hospital and also needs pain control. All the orders — whether for diabetes, infection, sleep, or pain — are organized according to the problem they address. (While doctors’notes are generally organized by problem, their orders are not. I bet if we implemented Patient Friendly Orders, they’d be useful for doctors if only just for this reason.)
When the doctor or nurse or physical therapist comes in, the patient and family can have a conversation about the current plan, with that plan laid out in front of them. They make a shared decision, and the doctor can update the plan on the same touchscreen. “Sounds like a plan,” the patient says while actually looking at it. When you visit your loved one, he can show you the plan, too. If a question comes up about a given order, or why something is missing from the plan, you can make a note on the touchscreen so the medical team knows to address it when they next come by.Continue reading…
I really like Twitter. Its scrolling 140-character tableau of news nuggets fit perfectly on my hand held device, lap top and home personal computer. It’s easy to glance at between tasks and the advertising is blessedly minimal. I control the content by following and unfollowing other Twitter accounts with a simple click or a touch.
But why, physician-skeptics may ask, is Twitter any better than traditional web browsing, email, list-servs and handheld apps? I thought about that and am pleased to offer my Top Twelve reasons why every doc should include Twitter in their informatics medical bag.
1. Lit Headlines: The major medical journals use Twitter to efficiently describe their latest content with links.
2. Fame: Traditional print authors are publishing more and more about less and less. Getting peers to follow your original and insightful tweets is the new route to attaining status as an expert. I have more than 500 daily followers vs. how many actually read the average peer-reviewed article?
3. News Junkies: Some of your like-minded peers are freely aggregating and retweeting relevant headlines with links for your perusing efficiency. They can be indefatigable.
4. Kool-Aid Immunity: Did you know your Chief, Chair, VP, lead administrator or Dean wants to control all your communication? Twitter is an easy way to step out of the information bubble and monitor contrary news about that EHR, medical device, performance standards, your institution’s business partners, the competition and more.
5. Efficiency: Twitter trains you to be both brainy and brief. If you can’t fit it into 140 characters or less, you’re wasting your readers’ time.
You’ll never hear that when you call me. Never. You’ll also never get an automated answering system (I’m just referring to office hours, of course. Evenings and weekends the phone goes to Google Voice. More on
that below.) We are also in the middle of a communication revolution. There are now so many other ways patients can contact me other than the telephone, the silly thing is almost becoming obsolete. I took amoment the other day just to go through all the various ways patients contact me.
Still the most reliable fallback. Most synchronous form of communication: both parties willing and able to talk in real time. After hours, Google Voice (free) transcribes messages and texts them to my smart phone. As a rule, patients do not call my cell phone, although I’m not shy about giving out the number. Then again, those who have my cell number usually use it for…
At the moment, it’s just a few patients, but I anticipate more and more of them will partake as time goes on. It doesn’t happen very often, and so far it’s never been inappropriate. Med refill requests and pictures of kids’ rashes have been the mainstay so far. I like it. By it’s very nature, the people choosing to text me understand the limitations of synchronicity, ie, they don’t get bent out of shape if I don’t answer them right away, and they understand that it’s just for relatively minor issues. I also use it to communicate simple quick questions to specialists with all the same mutual understandings (minor issues only; response time unimportant).