Storytelling, Narrative Medicine and the Digital Age

Narrative medicine and reflective exercises have been a very important tool in the education of medical professionals.  With social media's integration into the fabric of society, it is important for today's trainees to understand the implications of public storytelling on one's professional persona.  This recent editorial and article on the topic in the journal Academic Medicine this month describe the divide between digital natives and digital immigrants, and how each might have different viewpoints of how storytelling is disseminated.

And then here is another recent piece in the Atlantic about the topic, in which the author reflects on her writing about a patient experience and whether it should or should not be published.

I don’t claim to have any of the answers for this myself.  What is the correct approach to disseminating storytelling or narratives about patient encounters?  Do others learn from it or not?  Some pioneers are addressing this situation directly.  Dr. Bryan Vartabedian, who has spoken at our institution about the public physician, has just announced a MOOC related to Medicine in the Digital Age.

What I do know is that medical schools really MUST teach this material to students and trainees.  It is our obligation to the future of the profession to understand digital literacy and the impact of our storytelling on patients, each other and ourselves, given how easy it is to push out blogs into the public space.

Thanks for reading.

Enhancing Social Media within Medicine

So Twitter recently announced that it now has a video feature (up to 30 seconds).  See this post.

I wonder how we can use such an opportunity in medicine and medical education,  Will short snippets or "nuggets" of information now be sent via Twitter from one doctor to another?  Interesting to see what will come of this.  The hope would be that health care professionals would use it for dissemination of information that IS allowed in the public space, and not to violate privacy laws.

For those interested in learning more about social media within medicine, here is a nice review from JMIR on the topic, published within the last year.  The enhancement of such services is a great example of how innovation in technology has the potential to improve communication and education.

Reflections in Medicine and Medical Education 2014

2014 has been a tumultuous year, especially in medicine.  Frustrations with electronic health record systems, the Ebola virus, reactions to the Ebola virus, response to the new MOC requirements, burnout, and many others all contributed to the complexities that exist in medicine.  In medical education, questions like "what do the milestones really mean?" are common thoughts emanating from educators.  I'm not even touching Entrustable Professional Activities either!

Our school also passed a new conflict of interest policy.  I was privileged to lead this effort in 2014, and, despite unanimous approval of the policy in less than a year, I continue to get more questions "what about my situation?  Is that ok?"

In short, it is a tough time to be in medicine, no doubt.  Increased fear of being sued, decreased reimbursement, more regulatory requirements, and the uncertainty of exactly where medicine is going make for challenging times.

So how do people cope with this?  

Some choose to go "nose to the grindstone" and work harder.

Some decide to "call it quits" and leave medicine.

Some opt to "fight back", through advocacy in the form of blogs saying "enough is enough".

Some take a step back and say "at least I have a job and job security".

Some are put off by the "it's a job" phrasing, opting for "it's a profession, and unfortunately it is slowly eroding".

I know that resiliency is a helpful trait to handle all the changes, but still, I don't have all the answers.  I strongly believe that in the end, what I do matters, to learners, to patients, and to future learners and patients.  What trainees do matters.  What doctors and other healthcare professionals do matters.

That, coupled with blessings of continued good health, allows me a little peace in a hectic world moving at a frenetic pace.  Just try to search for your own similar peace.

Happy Holidays to All!

Alex

Conflict of Interest: Managing Scandal

I have had the privilege of chairing the Industry Relations Conflict of Interest Committee at the Indiana University School of Medicine, the medical school where I work, over the past year.  I have learned a lot about interactions of academic physicians with industry, and have certainly heard differing opinions on the topic.  Our policies were recently approved (unanimously, I might add!) by all of the pertinent committees, and already, many faculty have had comments and questions about specifics of the policy.

One common theme that we have also heard is that “regulatory agencies and administrative bodies” have hurt the field of medicine.  I certainly understand the additional burdens of what it takes to practice medicine, and how those burdens can actually damage the patient-physician relationship.  However, when one looks at why conflict of interest policies are put in place, one needn’t look very far to see why it is necessary.

Here is a prime example.  The Journal of Patient Safety had to deal with this recent example with its own editor.  Dr. Charles Denham, the [now] former editor of the journal, failed to disclose his own financial conflicts of interest with organizations which paid him.  This impacted recommendations he made with respect to clinical guidelines that center around optimizing patient safety.

What is interesting to me is that sometimes, how one handles a scandal can be as important as the scandal itself.  Covering it up, hiding it, or trying to sweep it under the rug are all examples of ways that don’t work.  It is amazing that it is this same sense of “doing the right thing” that parents try to teach their children.  What impressed me in this example is how the journal chose to address this.  The journal has opted to tighten its own policies and processes around conflict of interest, for authors, editors and others who make decisions about articles within the journal.  They even published an article describing what they plan to do. 

For anyone wondering how to handle a scandal, THIS is how to handle a scandal.  Admit the wrongdoing, describe what steps need to be taken for the better, and, simply, apologize.  As written in this NPR piece, “airing the dirty laundry”, while painful, is a necessary step.  

I applaud Dr. Albert Wu, Dr. David Bates and the journal editors for demonstrating the right way to manage this situation.  I think this is a great learning experience for the patient safety movement, for editors, and for all physicians who interact with industry.  Conflicts of interest are complex, but it all comes back to the fact that there is a public trust that must be put front and center.  If we violate that trust, then we have done a disservice to the profession, to ourselves, and, most importantly, to our patients.

Randomized Controlled Trials, Social Media and "Intention to Tweet"

I have to hand it to cardiologists: for years they have created the most innovative and fun names for trials that are conducted.  As a generalist, I still remember the DIG trial from way back when, or the RALES trial, sometimes referencing names of trials when discussed medications for common conditions such as heart failure.  As therapy evolves, we get a PARADIGM-HF shift, some might say!

Today, I was sent a tweet about a fascinating trial, the “Intention to Tweet” trial (hats off again to our cardiology colleagues: TNOTY (Trial Name of the Year).  This trial was a randomized trial of social media to see the impact of social media on views of articles within one journal, Circulation.  In the intervention group, they tweeted out links to half of the articles, and a link to the Facebook page.  In the control group, no tweets were sent.  Kudos to Lee Aase for a wonderful review of what was done in the study, and what it might mean for the future. 

Essentially, what the authors found was that there was no difference in clicks between the articles which had tweets sent/Facebook page links, and those which did not.  Some might refer to this as a “negative trial”.  I think that, in medicine, we need to see results of “negative trials” that show something was ineffective or not better than “usual care”, just like we need to see results that demonstrate a positive effect of an intervention.

But here is the clincher for this: I have seen several tweets from physicians and other scientists who are meaningful users of social media who are questioning the results or the design of the trial.  Some might interpret this as a “defeat” for social media.  

Looking on the Altmetrics page for this particular article, however, paints a different picture.  Recall that this article was announced and sent out TODAY (11/19/14) as an early release article.  The Altmetrics description for this article puts it at the 92^nd percentile of all articles within this Circulation journal.  It is in the 94^th percentile for all articles of a similar age.  94^th percentile!  That is pretty awesome!  Compared with other articles of a similar age in this journal Circulation, it ranks 2^nd, in the 85^th percentile.  Again, this article came out TODAY.

So here is the kicker.  This article on social media, based on these Altmetrics data, has “gone viral” on social media (at least compared with other articles from this same journal), and is ranked quite favorably in one metric used to gauge social media impact (that metric being “Altmetrics”).  I think that suggests exactly the opposite of what the conclusion did (meaning that dissemination of THIS ARTICLE via social media made it quite a favorable article), which could be interpreted as "social media does have an impact on readership of journal articles.  See this screenshot from Altmetrics from 10:30 pm EST on 11/19/14.

I applaud the authors for developing such a trial and Circulation for having social media editors in the first place.  Those of us who “believe” in the power of social media to teach, to learn and to advocate appreciate the scientific principles which went into creating this trial.  I do agree with one sentence in the conclusion that “further research is necessary to understand and quantify the ways in which social media can increase the impact of research”.  

This article is a wonderful first step towards understanding these concepts, and provides a meaningful way to understand how to consider the impact.  As a social media editor for a journal myself (JCEHP), I plan to reference this article and use it in descriptions of how social media can impact journals, and ultimately, patient health and outcomes.

Medical Education: What Matters

So I've been in Chicago for the past few days at the inaugural Association of American Medical Colleges (AAMC) Medical Education meeting and the Society for Academic CME (SACME) meeting.  What a showcase of incredible learning opportunities!  Here are just a few of my take home thoughts and reflections from the past few days.

1. Healthcare in the U.S. has real problems, and medical education can really contribute to fixing this. We need to start calling ourselves healthcare learning systems. Medical education matters!

2. Getting one's message out to others (whether in the form of an abstract for a future presentation, or in a manuscript for a peer-reviewed publication) means that one has to be mindful of words.  Words matter!

3. Technology can be used to improve communication and healthcare, but we must be careful that technology in and of itself is not a solution.  People matter!

4. Seeing old friends and meeting new people create a wonderful community of learners, and together we can tackle problems better as a group than as individuals. Connections matter!

I still have another day of learning here, and lots more people to meet!  Thank you to the organizers for a wonderful meeting!

[for the record, I wrote and posted this piece while on the "L" headed to the meeting]

Connecting from Afar: 2014 Stanford MedX

The 2014 Stanford MedX conference is going on this weekend at Stanford.  I was not able to attend (mostly due to time pressures and the fact that there are other medical meetings which I am attending this week).  In fact, I’m headed to Washington DC in a few days, where, along with Kathy Chretien and Ryan Madanick, I’ll be giving a presentation at Academic Internal Medicine Week to internal medicine educators about how to effectively use social media. 

The MedX conference sounds like a phenomenal meeting for participants to learn about the intersection of medicine and emerging technology, where the patient voice and experience was highlighted.   An announcement was even made that for the 2015 conference next year, the meeting will feature medical education as a theme.

Many people whom I respect and follow on social media networks are at the 2014 MedX conference currently, both presenting and sharing content.  There is even a live stream from the main hall that can be viewed by anyone, whether in attendance or not.  That is really cool.  I was able to view this live stream for a short while yesterday and contribute to the meeting from afar via intermittent tweets.

The Friday event had over 13,000 tweets, which is amazing.  This morning, I am still trying to catch up on some of the tweets from both Friday and Saturday.  One of the sessions which was not streamed live, but tweeted heavily, featured technology and social media within medical education.  Several well-known “tech enthusiasts” within medicine were presenting sessions there, including Bryan Vartabedian and Warren Wiechmann.  I feel somewhat knowledgable about the topic, as these two icons were the keynote speakers at our first two “Mobile Computing in Medical Education” conferences the past two years.  Other influencers like Susannah Fox and Wendy Sue Swanson, whom I still have not met in person, are influencing the crucial conversations that abound at such vibrant meetings. 

I’ve written several posts about tweeting medical meetings in the past, and am fascinated with this as a way to disseminate information to others.  It is innovative that MedX is live streaming the main stage for anyone, regardless of whether s/he registered or not.  What a great way to connect with others who could not be present this weekend in California!  Kudos to Larry Chu and others at Stanford for a great meeting and for the ability of non-participants (a better term may be “indirect participants”) to connect.  Sorry I could not be there in person, but I’m certainly there in spirit!

I realize this post is not doing justice to the many other wonderful people contributing to MedX and from whom I am gaining innumerable insights.  Thanks to all for your presentations and your tweets!