A Medical Educator Joins Social Media: One Year Later

I just realized that yesterday was my one-year “anniversary” for joining Twitter.  Wow, what a ride it has been.  I have learned so much in this short year.  Here are a few take-home points:

1.      If physicians and other health care professionals are not becoming involved in social media, they are missing out on a “place” where many of the patients already are.

2.      Despite #1, there are late adopters who feel that social media is a “waste of time” for physicians.  That is ok.  Forcing them to “do social networking” will not be fruitful.

3.      Social media is a fantastic way to meet other like-minded individuals who have similar interests.  I never would have met a great group of people (some in real life) had I not joined social media.

4.      Patients crave information about their health.  If they want it via social networking routes, we should offer it to them.

5.      There is a lot of mis-information floating around on the internet.  It is a duty of physicians to combat this and provide correct information.  I fail to understand why physicians don’t embrace this more: it is advocacy in the truest sense!

6.      If you decide to join social media, start slow, but start.  It will take a while, like riding a bike is not learned in 15 minutes.

7.      Do not let social media take over your life.  The important things (family, friends, etc.) are still the important things, so don’t lose the priorities.

8.      Push the envelope.  It is time for curricula in social media within medical education to be formally written, and also to be disseminated.  Policies or guidelines are one thing, but curricula are another.

9.      There are many “tools” to make it easier to integrate social media into “what you do”.  Pick one or two, and use them.  It will make the process less overwhelming.

10.   Have fun!  There is some great learning, and in addition there are some fun people out there, and I am a better person for having met them virtually.

For Your Health

Today’s post is a little off the usual theme of Medical Education.  But then again, maybe it isn’t.  Why are those who do medical education involved in teaching others?  Among other things, because they enjoy the love of teaching.  I certainly do.  Today’s post is teaching by doing.

Yesterday, I ran in the Indianapolis “Mini-Marathon”, a 13.1 mile half marathon which is supposedly the largest half-marathon in the United States.  Wow, what an incredible day.  I have run it before, but there was something different about yesterday.

I got there early, after waking up before my alarm woke me up.  I stretched, got my stuff all ready to go (including having my phone with me, as well as gel packs), and was ready to go in my corral early.  I didn't see as many people that I know as I usually do.  It was great to see Dan Fulkerson, one of our Neurosurgeons.  In the corral, just before the start, I found another one of my Riley Hospital colleagues, Dr. Scott Walker, a pediatric anesthesiologist, and met his family.  An incredible sight of the race just before the start is here.

In the past, I have tended to come out too quickly, and I was determined not to do that again.  The first mile was just about where I wanted to be, and the next two were perfect.  I was feeling great at this point, and was on track to meet my goal.

For me, the nemesis has been the race track, which is just before mile #6 until just after mile #8.  I was determined not to slow down on the track.  I made it to the Yard of Bricks at a time which was perfect for me.  I felt really good at this point. 

Then I just plain petered out, along with many other runners.  I walked the water station at the end of the track, and just couldn’t recover.  The heat had gotten to me, and I simply couldn’t go any faster.  My legs were aching, along with my feet.

My GPS timekeeper shows the times from Mile #9 through the end with slower times during each consecutive mile.  This was a bummer, but I think that the lack of long training, and the heat took its toll on me.  But the atmosphere was just incredible.  It was wonderful seeing people running for causes, running for loved ones, running for their own health, or running "just because."  This alone is a reason to run the Mini.

For example, I saw military personnel decked out in full gear, with heavy backbacks, who did the entire race with this gear!  I saw a man who had an obvious stroke but who kept trudging along (actually passing me!).  I saw kids pushing their parents on.  I heard so many words of encouragement and songs from the many bands and cheerleaders along the way.  My favorites: the Circle City Cloggers, and the high school students decked out as Christmas ornaments!

So why have I continued to run the Mini-Marathon?  I am certainly sore afterwards.  It definitely takes a while to train for this (lesson for next time: train a bit longer, focusing on the longer distances).  Is it the thrill of running?  Is it the excitement?  Is it all of these things, plus some unknown factor?

Who knows?  I’m not sure, but I just signed up again for next year!  Here’s to my health and yours!

Interprofessional Education (IPE) – Learning How to Do and Teach It

Last week I had the incredible privilege of attending a workshop on interprofessional education (IPE). Although I believe that I have been inclusive of the views of other heath care professionals, this workshop opened my eyes to new possibilities for how we educate the future health care professionals in all areas.

First of all: kudos to the absolutely amazing people from the Centre (note Canadian spelling here, eh?) for Interprofessional Education at the University of Toronto.  Ivy, Mandy, Lynn and Belinda were just wonderful people to get to know (absolutely some of the friendliest people I’ve ever met).  They truly embody what the world of working together with other backgrounds can and should entail.  Their work is truly inspiring, and is all the more impressive given the limited amount of dedicated time that they have to do it.

Second, it opened my eyes to some awesome people who are already here working for my own institution (Indiana University), whom I had not yet met.  It is fascinating when people work so hard in their own arena and do not know that others with like-minded interests are sometimes literally right around the corner.

Third, it reinforced the belief that no matter what health care field one may work, it is still all about the patient!  I am reminded of this every day in my work, and this workshop cemented that even more.

Fourth, it is exciting to see that my own institution has a plan for how to embed IPE into the curricula of the medical school, the nursing school, the school of social work, the dental school, the school of optometry, the school of rehabilitation sciences, and others (we do not have a school of pharmacy).  There is much work to be done, but we are well on our way.

I was not originally scheduled to go to this, but had the privilege of attending portions of the workshop.  I am so glad that I did, even if I missed some of the sessions for patient care duties.  It has invigorated my interest in what I do in medical education.  And isn't it great to be invigorated every once in a while?

Here are two links on IPE in medical education.

University of Toronto Centre for Interprofessional Education

AAMC Core Competencies for interprofessional collaborative practice

Disseminating the Message

I have had a blast the past few weeks.  I enjoyed a great vacation with my family.  I was privileged to give a Grand Rounds presentation on how doctors can use social media responsibly to improve education and health in general.  What a great opportunity, capped off by several across the country watching the live stream and others live tweeting specific points from the presentation.

Today, a segment on physicians using social media is airing on the radio show Sound Medicine.  I have to say that doing this segment was simply a phenomenal time, and an honor to work with the incredible people from Sound Medicine.  Nora Hiatt, Barbara Lewis, and of course, Dr. Kathy Miller, are complete professionals, who left me wanting to come back as soon as possible to do another show.  The radio show that is Sound Medicine is an example of what is good in medicine, and how we can educate not only other health care professionals but also patients and families.  Click here for more information about Sound Medicine.

So what’s the point of this post?  Disseminate the message.  Make it simple.  Social media can really help medicine and ultimately, patient care.  Doctors should not blindly jump in without a plan, but should definitely consider joining in social media to deliver information, ideally for the betterment of patients.  It is an opportunity to provide factual content to a place where many of the patients currently exist: on the internet, looking up health information.  We have an obligation to our patients to educate them how they want to be educated: let’s make good on that obligation.

The Costs of Health Care – Change Can Occur

Health care is currently undergoing much change.  Unfortunately, the care provided in the United States ranks not as high as expected given the costs.  The US health care system is the most expensive in the world.  Yes, we have amazing medical centers here, and incredible research is done here, with successes seen every day.  But, along with those successes come the harsh reality that care is uneven for the entire population, simply costs too much, and this is affecting our entire country.

Health insurance costs are through the roof.  It costs so much for a family to comfortably cover health insurance costs, as to be prohibitive for many.  Companies are struggling to be able to provide health insurance benefits to their workers and families.  Some patients choose not to have health insurance due to excessive costs.

No one REALLY knows how much specific treatments and diagnostic tests cost (and even then, the costs vary significantly from place to place).  Doctors order things every day, without understanding what the cost is to the patient and to society.  Patients get billed for many different services that they may not even be aware of (e.g., a “facility” charge, a specialist charge, an imaging charge, as well as other costs hidden until the bill arrives).

This is a problem, and it is a massive one.  But rather harping on “what is wrong with health care”, I prefer to take the high road.  I prefer to highlight solutions—and one was just rolled out earlier today.

I am talking about the Choosing Wisely campaign.  This is as good as it gets, and demonstrates that doctors and the organizations which they belong to want to try to fix some of the costs associated with care.  Specifically, this initiative is looking to focus on the “overuse” in medicine that is so common today. 

There are tests that physicians and other health care professionals order on patients which unfortunately have NOT been proven to improve care.  In fact, sometimes these tests lead to more unnecessary tests, without improving outcomes.  It is the outcomes that matter most.

The American Board of Internal Medicine Foundation (or ABIM Foundation, for short) worked with multiple medical organizations to determine 5 tests within each specialty which should NOT be ordered for common issues pertinent to that organization.  In the first roll out, announced today, 9 specialties each discussed 5 tests which should be avoided in specific, common patient care scenarios.  What a fantastic idea!!

While there may be other potential solutions for lowering the costs of health care, the reality is that it still is physicians and other health care professionals who order these tests.  If they can decrease the ordering of unnecessary tests, costs will be reduced, plain and simple.

This is NOT rationing, in my opinion.  It is simply working smarter to do things which are the right thing to do (or to avoid things which are the wrong thing to do).  It means explaining to patients that a CT scan is not necessary for that headache.  It means not ordering an MRI for that patient with low back pain who likely has a low probability of having a rare condition causing that pain.  A simply way of explaining it is "first do no harm"--what I learned on the first day of medical school is still just as important as every other thing I learned.

Please support this cause.  It is really a noble one, and should and will be promoted throughout medicine, whether it involves patients seen by primary care physicians or those seen by specialists.  What I really like is the approach to roll this out not to just the physicians and medical organizations, but to the lay public as well.  It will also be mentioned in Consumer Reports later this year.

Support the Choosing Wisely cause.  It is an example of physicians choosing to put what is right and what they can do right now to improve health care first, and their own pocketbooks second.  I know that I will put it into practice immediately, especially when seeing patients and teaching medical trainees at the point of care.

For a list of the 45 statements from the 9 organizations, click here. 

Social Media and Disseminating Medical Information

I attended a one-day conference on Social Media yesterday.  It was really fascinating to see how many tools are out there to help measure, improve and monitor a social networking presence (for both persons and for companies).  I have previously mentioned that return on investment is not critical to my presence in social media.  However, this conference opened my eyes to the importance of this, and I now believe it should be absolutely taken into account, especially if one goal is to disseminate information, enhance communication and learn from others.

Some ask why I, as a medical educator physician, have become involved in Social Media.  My reasons have not changed.  I do it because physicians need a presence for social networking, since the majority of patients who use the internet are already looking for medical information online.  Physicians have an obligation to society to disseminate clear, succinct and truthful health care messages to combat online misinformation that is unfortunately too common; what better way than to use social networking to accomplish this?  Let’s meet our patients where they are, which is on social media.  Add to all of this the importance of role modeling the intersection of social media and medicine with learners, all the while maintaining a professional demeanor.

I gave a presentation on social media in medicine and medical education two days prior to this conference, as a Department of Pediatrics Grand Rounds.  This was my first formal scholarly presentation on this topic.  It was simply a blast to be able to present this information to my colleagues.  The conference was very well attended.  Some were skeptical, and a few probably remain skeptical.  Some came up to me later and in emails and asked “How can I get started in social media, for the betterment of my patient care?”  This was the biggest compliment of all (and bigger than more Twitter followers, in my opinion).  It demonstrates that people listen and are willing to learn and try new things, and want to put patient care first and foremost.

Here are a few examples of how social media and mobile technology have the potential to improve patient care:

Social Media helps find kidney donors

Small opportunities for mobile technology in medicine

Open-heart surgery is live-tweeted

What are your thoughts on using social media to help improve patient care?

[For those interested in the tweets during the Grand Rounds conference, please see the hashtag #IUPedsGrRounds, with the transcript available here.]

Social Media for Physicians

Social media for physicians: what's all the buzz about?

 

I've read some great posts on social media in medicine recently.  Here are a few of my own thoughts (in no particular order), after reflecting on some great writing:

 

1.  Patients--lots of them--are looking online for health information. If doctors are not finding them there, then those patients may be getting information from others who may not have the requisite knowledge, thus increasing the chances of dissemination of mis-information.

2. Yes, doctors understand that they need to be careful and keep privacy in mind. HIPAA has been around for several years now.  Docs get it.  But if they let that hesitancy get in the way, they miss the opportunity to educate.  That is a lost opportunity.

3. The cost of advertising on social media is measured in time.  Yes, it is a doctor's most precious commodity, but it is not like an investment in a many-million-dollar new scanner.  The benefits are definitely worth it. And there is a Return on Investment (not only financial, but also in opportunities for meeting new people and forging new relationships). 

4. Good communication skills should never be forgotten. Yes, doctors still need to know how to communicate with patients one-on-one. But again, patients are already in the social media environment.  Why not meet them there?  See #1.

5. Doctors need to embrace the technology, not just complain about the "new generation" and their obsession with technology (which may not necessarily be true).  The new tools are here to stay.  Either get on the bus or risk being left in the dust.  It's similar to saying "I'm not going to try to improve my practice because I like the old way." That would not fly.  So why are doctors so hesitant to try and taste the water from the social media fountain?

6. We need to role model the balance of this new communication method with "traditional communication" for the trainees.  But did the old way really work?  Unfortunately, the medical profession is less trusted than it has ever been.  Maybe the new generation has ideas for how to remedy this, and some of those ideas will come from social media.  Let's listen and learn!

7. Let's study the impact of social media like we study the impact of the newest drug. Certainly, we know that some drugs work better for some conditions than other drugs.  But what about the impact of a patient education app on real patient outcomes?  Or the impact on physician knowledge and attitudes?  How about a randomized trial of a medical education app to teach murmurs (half the trainees) compared with a simulation mannequin that focuses on teaching murmurs (the other half of the trainees)?

8. It's fun!  I have learned so much from meeting people I never would have met had I not joined Twitter.   Plus, social media is not like email that has to be answered.  If I don't have time today, well, then that is ok.  Some days I may "use" social media a lot, and other days not at all.

9. The opportunity to have conversations with others with similar interests is definitely one worth exploring.  And there are others out there with similar interests, both down the hall, and across the globe.  It is easy to walk 20 feet and ask the colleague down the hall, but what an opportunity to learn from the colleague several thousand miles away!

10. The opportunities to present a clear public health message are undeniable.  Isn't that a responsibility which the medical field should take on and own?