A Marriage Made in #HCSM Heaven

Priscilla Chan probably knows that she is going to be watched. What she may not know is that it won’t be the paparazzi alone who will be watching her closely.

No sooner did Chan get married to the most famous social media icon and gain an “M.D.” after her name than did Twitter go abuzz with anticipatory murmuring. (Read here and here). While the tabloids and major “news” outlets pondered the presence of a prenup, physicians on Twitter – an already selectively progressive sort – have been pinning high hopes and expectations on this new graduate.


It would seem – by reading the tweets – that with the Chan-Zuckerberg marriage announcement, a new potentiality was born. Doctors who currently utilize social media (myself included) have been trying to change the face of medicine and doctoring to something more human, more “social,” and more impactful. Unsurprising, then, is this sense of excitement among them regarding the joining of the human embodiments of the very two fields they themselves have been trying to marry – medicine and social media.

(A marriage made in #hcsm heaven, perhaps.)

The news that “tech’s newest first lady” received her medical degree, should be a reality check. One that reminds us that if there ever was a time think outside of the box during medical education, it is now. With “reasonable” residency work hours and access to more avenues of communication – including social media – than ever before, it is an enviably exciting time to be training to be doctor. How can there not be a rapid pace of innovation coming from the next few generations of physicians? The time seems ripe for it. (No pressure, Class of 2012.)

The potentiality of innovation is also a present reality and does not require marriage or a legal document (except in the form of HIPAA paperwork, at the moment) to exist. The etched portrait of the traditional physician, though on a steadfast rock, is weathering with the winds of time and the tides of social change. And with this transformation, creative medical minds have discovered more freedom to innovate and collaborate. This can be observed when following the work of forward thinkers (like Bryan Vartabedian or Eric Topol), bright minds (Mike Moore or recent med school grad, Aaron Stupple), innovative practitioners (Wendy Sue Swanson and Howard Luks), and dedicated academic clinicians (Vinny Arora, Ryan Madanick, and Katherine Chretien).

What we hope from the newly married, newly minted Dr. Priscilla Chan and her generation of doctors should be no more than what we hope to aspire as physicians currently practicing in the medical field. Hard as it may be, we need to keep our eyes and minds open and complacency out. Admittedly, I, too, am curious what further contributions Chan will make to the fields of social media and medicine. But I don’t want to pressure her just yet. As I remember it, internship is hard enough.

Addendum:

See Kevin Pho, MD’s well-written commentary here:

http://www.kevinmd.com/blog/2012/05/priscilla-chan-countrys-influential-doctor.html

I commented on his post in order to clarify my quote:

Great post, Kevin.

The particular quote in my blog, which could be differently worded in retrospect as I see it in this context, was referencing a hope that all of us – current physicians and medical trainees – would think big and outside of the box about the impact we can make with the resources we have. We should expect just as much out of our own abilities as we do from her. We may not be able to deliver on quite the scale she can, but I think we – as busy physicians – underestimate our ability to innovate and influence. I am quite sure, in fact, that Dr. Chan will be influential in the coming years. And it will be exciting to see.

Posted in Current Events, Medical Education, Social Media | Tagged , , , , , , , , , , , | Leave a comment

Is There Pressure to be Informed?

I recently had the opportunity to speak to employees of King County, WA about finding credible health information online. During the Q&A a few interesting questions were posed (rephrased here):

  1. Does my doctor expect me to have looked up my symptoms online?
  2. Does it help my doctor get to the diagnosis faster if I look my symptoms up online and come up with diagnoses, as well?

The person who asked question #1 told a story about reviewing some symptoms with his doctor at an appointment and being taken aback when his the doctor asked him, “And what did you find on the internet?” The patient had indeed looked up his symptoms online, and was surprised that his doctor knew. However, he was left wondering if he was actually expected to research his symptoms online before his appointments.

The second question is actally a good question that I had not considered but makes sense when looking at it from a patient’s perspective. Should patients do some “homework” prior to their appointments to help a doctor get to a diagnosis faster?

Regarding question number one, I often ask if there was something my patient thought he/she might have in order to make sure I address some concern that might be otherwise left unspoken during the visit. But I do not have an expectation that patients come in having “researched” their symptoms.

My answer to question #2 is based only on personal experience. It does not necessarily help me get to a diagnosis faster if a patient looks up his/her symptoms online. I have certainly had some patients who were able to come up with diagnoses that were correct. More often than not, though, the scenario in my office is one where a patient is concerned about the worst possible outcome (which, luckily, is not often the actual case). Then there are others who may have figured out their diagnoses but never mentioned it. As I do not have a well-studied answer to this question, I am open to hearing from physicians who might have had a different experience. That being said, I would not discourage a patient from using his own resources to find out more about his symptoms. However, he should keep in mind that after a detailed history (which is the part of the visit where the doctor gathers information from a patient’s story) and exam, the diagnosis could be very different depending on the actual details elicited and findings observed.

These two questions from the audience, however, brings to light our changing roles in healthcare. Certainly, the doctor-patient relationship has undergone yet another evolution with the concept of the e-patient, distant now from its paternalistic beginnings. But, in the midst of (at the end of?) the Information Age and, perhaps, heading into an “Understanding Age,” are there now new expectations placed on patients by others or by themselves?  Is there a certain degree of pressure to be an informed patient on those who may or may not be comfortable synthesizing this type of information? Is there an expectation that one knows everything about his/her own medical condition? Is there more pressure involved in just being a patient today? Sometimes, I think there is.

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Where Do You See Yourself in Eleven Years?

A recent Harvard Business Review article entitled “Career Plans Are Dangerous” suggests that the where-do-you-see-yourself-in-five-years question is essentially irrelevant in the modern world.

“…increasingly, the world is not this predictable. And it is in settings of high uncertainty where traditional career planning is both a waste of time and potentially dangerous. A career plan can lead you into a false sense of confidence, where you fail to see opportunities as they arise and miss taking smart steps you otherwise hadn’t planned for.”

The authors assert that this does not apply to certain professions, like nursing. Well, yes and no. The answer to where one sees oneself in 5 years is partially dependent on what the field looks like by that time, and the changes in medicine in the past decade have approached top-speed, and this not even accounting for any advances in pharmaceuticals, medical devices, or screening technology. If one looks simply at the changes in one-to-one provision of healthcare and the doctor-patient interaction (including EMR adoption, shorter appointments, patient portals, concept of e-patients, generational changes in expectations, creation of midlevel providers, rise in urgent care facilities, and healthcare social media), one realizes – like the old Oldsmobile commercials – that this is not your father’s medical system anymore.

There is a long lead-in period to becoming a doctor. If you decide at 18 (when one is expected to somehow definitively know what career will make one happy until retirement) to be a doctor, you still have at least 11 years before you practice independently in your field. Perspective: The students who are entering college this year determined to be a doctor will complete residency training in 2023 or later. Where will you be in 2023?

My hope is that future generations of doctors have or create opportunities to think outside of the box as they are training. The end point is not the medical degree. Regardless of all the time and money put into it, the degree might even be the beginning… because everything can change by the time these students get out.

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MDs: Advice for the Next Generation

This past weekend, I had the opportunity to meet with local medical students as part of an American College of Physicians (ACP) mentorship brunch. I sat with a small group of second year medical students ready to impart my “wisdom.” Mostly, I wanted to be available to answer questions the students had for me. But I knew there were certain thoughts (a few of many) I wanted to share:

  • You may not recognize the medical field you once knew when you first decided to embark on this path. After all, several years pass between the time you make the decision to become a doctor and when you actually start practicing medicine. When I first went into med school, I knew of wealthy primary care doctors who spent 30 minutes or an hour with each patient. Keeping your mind open and not getting too hung up on expectations of what medicine should look like will serve you well and help curb future burnout.
  • Think outside of the box. This has nothing to do with the least likely diagnosis in a case and more to do with the practice of medicine. It’s ok to think creatively. Medical training, at least when I went through it, does little to encourage innovative ideas. If doctors don’t get creative, other interested parties will be eager to impose their ideas on your care of your patient, often with their own self-interests in mind. This can be great (for example, a useful new device or protocol). But it is often done with less knowledge of the unique complexities of the actual practice of medicine. Doctors know what doctors do better than anyone else. As a group, we are incredibly bright, but we can’t make much progress with our heads buried in the texbooks.
  • Balance it out. It is easy to fill 24 hours a day (or more) with medicine. If you can learn to balance school with other positive activities you have always enjoyed, you won’t feel overtaken by this life of medicine later. Even if it is just dabbling in that activity now and again when you find some time, it will be worth it.
  • Watch your digital footprint now. I was – luckily – never faced with this worry as a student. Following doctors who exhibit professionalism online can give you a better understanding of how to use the web in a productive manner and avoid the pitfalls of a web presence. Sometimes you just need good examples.

What words of wisdom do you have for the next generation of MDs?

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Are doctors on television just hams?

I recently came across a blogpost entitled “Everyone is Taking to the Camera- Pass the HAM please.” In it, the writer (a published author) says:

I have never seen more Doctors, Lawyers, Judges and ex-politicians on television than I have in the last few years….

Dr. Phil and Dr. Oz certainly must have been good Doctors, but think how much more they have learned on air with a staff and producers that can access any fact in minutes. Working for a producer doing new shows every day is much more demanding than working for patients. These Docs are quite camera friendly and seem to adapt well to the nuances of live TV; including pauses for commercials. Their message is popular and it seems that they here to stay.

….

What conclusions have I drawn from this diverse group of professionals that strayed into the small screen from other high paying professions? I believe deep down we are all HAMS looking for a modicum of fame.

I felt compelled to leave a response and, as you can see, it turned out to be a mini-blogpost. So I share part of it with you here and welcome your own thoughts and opinions.

I think I would have agreed with you on the “ham”-factor a few years ago. I guess I still do to some extent. Any person living in the public eye (including the one online) is likely to be craving an audience, after all. But, as a general practitioner earnestly interested in how accurately the media relays health information, I am less concerned these days about how people (doctors) got onto television and more concerned about the messages they are relaying.

A doctor might find himself deemed camera-worthy by producers after a stint on a matchmaking reality show. Or after being interviewed by Oprah. But what these professionals do with their position is ultimately what counts because their influence is huge. I cannot say whether working for patients or working for producers is more demanding, as I am in full-time clinical practice and have not done the latter. But to me, a big challenge is the fact that ratings (and not responsibility) drive content on television and that medicine discussed on television shows may be anything but “real” for the sake of viewership.

Luckily, more and more doctors are using social media to try to correct misinformation or relay more relevant medical issues without the sensationalism characteristic of television. These physicians might even use video to spread the word. We need good quality information, especially heath information, on television and it ultimately does not matter to me whether this comes from a HAM.

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Posted in Pop Culture, Social Media | Tagged , , , , , , , , | 4 Comments

Winners, Losers at the Golden Globes

Beautiful dresses, talented actors.… What’s not to like about last night’s Golden Globes? Well, how about this little detail from the NYTimes that surprised me:

 6:27 P.M. |To Smoke or Not to Smoke at The Globes

Here’s the difference between Hollywood on screen and off: cigarettes. On screen they are taboo. If you see one it’s accompanied by some carefully scripted moralizing about the ills of smoking. And even then the folks at scenesmoking.org are wary. But here, they give the things away. Seriously. Out on the smoking balcony where we saw Sean Penn pacing and puffing a couple of years ago, tables are thoughtfully stocked with little glass holders crammed with dozens and dozens of recessed-filtered Parliaments. As for drinking don’t even ask.

— Michael Cieply

I cast no judgment on individuals who smoke. In fact, I cringe when others refer to smoking as “ugly” or “disgusting,” both very strong and judgmental adjectives. My job as a physician is to teach people about the harms of smoking and to help them try to quit when they are ready.

Though Hollywood often seems to live by different rules than “the rest of us,” I am fairly certain they are no more immune from the dangers of smoking. That is why I found this “thoughtful” provision of carcinogens at the Golden Globes to be a poor choice from a health and health economics perspective. People should be allowed to smoke if they wish, but maybe the Golden Globes should reconsider having cigarettes readily available next year.

No one but Big Tobacco wins when it comes to smoking.

————

*As an aside -because I can’t help but comment on the fashion- my three favorite dresses of the Golden Globes were worn by Berenice Bejo (Elie Saab), Rooney Mara (Nina Ricci), and Nicole Kidman (Versace).

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Posted in Current Events, Film, Pop Culture | Tagged , , , , , , , , , , | 2 Comments

Dear TV Producers, You Forgot to Say “Don’t Try This at Home.”

Confession: I have been watching the reality show The Real Housewives of Beverly Hills. I don’t typically have time to watch television, but I end up attaching myself to one reality series for a season. Most often, it is a design competition or cooking show that I watch once a week, such as Project Runway or Top Chef.

Quite frankly, I don’t take shows like The Real Housewives seriously and often wonder if it is bordering on obscene to have such lavish lifestyles displayed on the televisions of homes across America (and around the world) during these hard economic times. But I was particularly disappointed in some of the footage that was shown on last night’s episode. On the show, one of the castmembers took an unknown amount of xanax (a prescription drug that can cause drowsiness and is used for particular types of anxiety) for a flight and was also filmed drinking alcohol (also an unknown amount, though it appeared to be more than 1 drink) while on it. She was clearly affected by the combination, exhibiting psychomotor slowing and slurred speech that was surprisingly more inappropriate than usual for this particular person. What’s worse is that her friends found her all the more entertaining while overly intoxicated and never once cautioned her (or the audience) against combining xanax and alcohol. As a matter of fact, I would argue, this combo seemed to be promoted by portraying this person as entertaining and funny and by devoting a fair amount of air time to her intoxicated state.

The risks of xanax-plus-alcohol were dangerously downplayed here. Both substances depress the central nervous system and can cause coma and death whe taken in excess quantities or used together. The combination of even small amounts can lead to dangerous levels of sedation, poor judgment, and unsafe situations.

I did a web search on the topic of xanax and alcohol and this particular episode to see if anyone else had commented on the high risk behavior depicted in the show. None of the search results explicitly pointed out the dangers of mixing the two drugs. In fact, most blogposts and articles painted it as “awesome entertainment.” The unfortunate fact is, though, that we now live in a time where more Americans die from prescription drugs than from car crashes.  So what makes for good television ratings makes a doctor like me cringe. Xanax is a high-risk medication. Irresponsible use of high-risk prescription drugs should not be glorified on television.

Dear producers, if you want to put that sort of behavior on TV – which I would rather you didn’t – then at least include a stern cautionary warning about it, even if it is only in writing at the end of the episode.

Hopefully, this particular castmember’s own doctor is watching the show and reminds her at her next appointment not to mix xanax and alcohol. Hopefully.

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Posted in Current Events, Patient education/tips, Pop Culture | Tagged , , , , | 4 Comments