Entering the Healthcare Social Media World: An Analogy

photo by jscreationzs at freedigitalphotos.net

OK. So it took me a little while to accept the idea of writing things for the world to see. I mean, I have done that before (written blogs about music and art and other random musings), but under a pseudonym. This time I write as me, myself, and I, without an identity crisis, and under my professional name. That is, my lay-my-reputation-on-the-line, name. This was a scary start and not dissimilar to signing my first order on the hospital wards followed by the letters “MD.”

What I didn’t expect is that entering the Health Care Social Media world as a physician feels a bit like going to a new school.  

I got accepted into this public school a few months ago – it is easy to get into, after all – and like a good student, I was quiet and listened astutely first and learned some of the nuances of this new environment.  I was slow in picking up on colloquialisms (I only just figured out that #FF does not stand for Freaky Friday, Fish Friday, or Fast Forward) and am still a little uncertain of the etiquette (do you ask to be retweeted or just hope to be?).

When you’re the new kid, there are a lot of dubious people who “follow” you (spammers, for example, or Twitterers whose interests seem quite different, even antithetical, to yours and seem to be lurking there, just waiting there for you to “slip up.”) It is easy to pick out who the popular kids were.  Or who tended to talk a lot. Or who tended to be funny. There are the brainiacs, the dreamers, and the pessimists, too. 

Of course, in this school there is a BMOC, of whom I knew before I thought social media might even be a good idea. For those of you currently involved in Health Care Social Media, you know who I am talking about. He is like the star quarterback. Everyone knows him and follows him. I secretly want to be followed by him but am too nervous to tell him. I just might faint if I see him in person.

I digress.

As long as I was in lecture and doing my homework, I felt comfortable in this school, the Social Media world. But the real truth comes out in recess (as in real life).  At some point, I had to go out and play. Was I going to play alone or try to play a pick-up game and hope to make friends? Since my twitter activity mimics my real personality for the most part – I don’t want to be a Dr. Jekyll and Mr. Hyde, which is easy to do in any online format – I am a little more reserved. I initially bring up random, non-controversial topics. No biters. No interest. It was easy to get disenchanted. I wanted to be part of the cliques. (Yes, there appear to be cliques here.)

At some point, though, you see a ball coming your way and you can either let it fly right past you or you can catch it and pass it (retweet). Do that a few times, and you demonstrate you are a team player. Choose your moves (tweets) wisely and you can be a trusted member of the team every time you play the pick-up game.  I have made a few good passes. I haven’t made it into the popular crowd, but I am always learning from them.

Lest you think it is all fun and games in this school, there is homework to keep me busy. A few hours a week of writing and editing keeps me out of trouble. I have even been graded at this school. What did I get on my report card for the first quarter? Well, according to Professor Klout, my score is 32. “You actively engage in the social web, constantly trying out new ways to interact and network. You’re exploring the ecosystem and making it work for you. Your level of activity and engagement shows that you ‘get it’, we predict you’ll be moving up.”

So, as the new kid in this school, I am doing ok. After all, it is better to pace yourself here. You don’t want to burn out too early and drop out before you earn your credits.  

OK, enough daydreaming…. Back to my homework.

Foodmatters: Deepening the Divide

“Man has been called the reasoning animal but he could with greater truthfulness be called the creature of suggestion. He is reasonable, but he is to a greater extent suggestible”

– from “The Theory and Practice of Advertising” (1903)

Sometimes people recommend movies to me and, if they are of a scientific nature, I try to watch them when my mind is ready to absorb and analyze the information. Some movies, such as An Inconvenient Truth, have inspired me to reevaluate my lifestyle and rekindle an appreciation for the world around us.

Last night, I watched Foodmatters. This movie, quite frankly, caused me to cringe. I neither refute nor support the movie’s claims regarding food as medicine or the use of high-dose vitamins in the treatment of disease. My intention here is not to assess the validity of the movie (which may not be worth the space on the web).

Unfortunately, the inaccurately titled Foodmatters had little to do with matters of food. Rather, it contained a concerning underlying message that the “medical industry” is greedy, maleficent, and a perpetuator of illness. I would argue that much of what was called the “medical industry” actually referred to the pharmaceutical industry. Regardless, an inordinate amount of film was devoted to Andrew W. Saul’s diatribes, whose propagandist approach really made it difficult to be open to any other aspect of the film. I suppose my reaction would have been expected had I known that Dr. Saul (who earned a PhD in Human Ethology) wrote a book entitled Fire Your Doctor!  Yes, with an exclamation point.

When I was a medical student, I shadowed a Family Physician who used alternative medications to treat things like acne. I will freely admit that I was hesitant about accepting it at first. Really, at the end of the day (literally) I only had the time and brain space to memorize hundreds of drugs along with their mechanism of action, indications, adverse effects, and interactions. But, as Complementary and Alternative Medicine (CAM) is becoming more acceptable as a choice that patients might take, physicians are making strides to learn more about these treatments. I am not an expert, so I learn from my peers and from journal publications. There is also a small subset of MD physicians who have been trained in CAM, as well.

As CAM becomes more popular (and lucrative), the providers of this approach gain more trust and credibility from the general public. My hope is that naturopathic students – whom I have heard from insiders can have a deeply negative attitude towards allopathic medicine – are taught to be open-minded towards Western medicine, as well. If patients pick up a sense of disdain or judgment from an alternative medicine spokesperson – Dr. Saul, being a not-so-subtle example – it might deepen what I felt was a closing divide between two potentially integrative fields.

Scalpel, Forceps…Pen?: The Role of Creative Writing in Medical Education

A recent article in The Wall Street Journal reported a trend on teaching humanities in medical school to comply with a recommendation to teach compassionate care. While clinical acumen is important, empathy is a trait that really enables a physician to connect with his/her patient, thereby improving the healthcare experience of that patient. The argument for teaching courses like “narrative medicine” – where students write about their experiences – along with anatomy and pathology, is that exploring and understanding the human side of medicine will enable these doctors-in-training to grow into compassionate physicians.

Writing about medical training is not a new concept, however. I had a chance to sit down with physician-author Emily R. Transue, MD*, who started Mind, Body, and Pen, a creative writing class for medical students that is offered every winter (an ideal time for self-reflection in the Pacific Northwest). She has been teaching this class voluntarily for eleven years at the University of Washington Medical School. In fact, she has had to cap class enrollment to 15 students due to high interest and to optimize the experience for both herself and her students.

“Writing is about honing and maintaining skills for empathy,” Dr. Transue says. She argues that the vast majority of students who apply to medical schools are actually quite empathetic. However, during the course of traditional medical education, empathy can be “beaten out of them…. There is little opportunity for self-expression, and [medical students and residents] don’t have a sense of permission to be affected by experiences.” Dr. Transue’s class gives them that permission. It allows students to process some of the challenging aspects of becoming a doctor. By writing about the death of a patient or the strain on a young marriage, students have an avenue to help bring emotions and feelings “outside of their heads.” In addition, the medical students, who are notoriously competitive, listen to pieces written and read aloud by their peers and have to resist the urge to “one-up” each other. It encourages focused listening and reflection on another’s emotions.

If medical students are inherently compassionate, at what point are the skills for empathy being squelched? Dr. Transue feels the answer may actually be in the culture of residency. Medical residents are role models for impressionable medical students. Historically, the prevailing culture has been one of proving your worth as a physician. This means being a “gunner” at all costs. Not showing weakness. Being a sort of superman in the face of extraordinary circumstances (life, death, illness, sleep-deprivation, strained relationships, depression). Medical students are learning the ropes – more than just the clinical ones – from these residents and the cycle continues.

Humanities courses can allow medical students to maintain their already empathetic nature. But to continue to preserve it, exercises that allow for reflection of clinical experience in real-time would be valuable in residency, as well. It is during this stage that burnout rates are high and critical decisions are being made regarding specialty choice. One might argue that courses similar to Dr. Transue’s creative writing class could increase the likelihood of residents choosing to practice in primary care fields.

*Emily R. Transue, MD is the author of : On Call: A Doctor’s Days and Nights in Residency and Patient by Patient: Lessons in Love, Loss, Hope, and Healing from a Doctor’s Practice. She practices at The Polyclinic in Seattle, WA.

The Vaccine-Autism (Dis)connection

photo by Sura Nualpradid (freedigitalphotos.net)

A recent briefing by the King County Public Health Department addressed the recent retraction of Andrew Wakefield’s pivotal, but extremely flawed – fraudulent – article in Lancet.  Recall that the initial 1998 publication implicated MMR vaccination in the development of autism and started a trend of significant hesitancy towards vaccination of children.  Unfortunately, this hesitancy has become prevalent among parents AND some medical professionals.

Jeffrey S. Duchin, MD, Chief of the Communicable Disease Epidemiology and Immunization Section sent out a memo after the Lancet RETRACTED the original article written by Wakefield. The briefing is directed at providers, but is available on the kingcounty.gov website: http://www.kingcounty.gov/healthservices/health/communicable/immunization/~/media/health/publichealth/documents/communicable/VaccineHesitantParentsIssueBrief.ashx

Page one of this briefing is useful for both providers and patients who want to know more about why the medical community has come to find Wakefield’s research unethical and fraudulent and the impact Wakefield’s assertions have made over the past several years. Page two is useful for providers who want to educate patients who still feel dubious about vaccinating their children (which, by the way, is still quite likely, as much of the public is unaware of the momentous Lancet retraction).  

Is the medical community beating a dead horse? Probably not. As widely publicized and accepted as Wakefield’s Lancet article was, it will take an even more significant effort to undo the damage done.

“In 2008, there were more cases of measles reported in the US than in any other year since 1997, with >90% of cases occurring in unvaccinated individuals or in those whose vaccination status was unknown. The current pertussis epidemic in California is the largest since 1955.”

It was a public figure who fueled the controversial fire a few years ago. Is it likely that any celebrity would educate the public about the importance of vaccination as fervently? Perhaps social media and the blogosphere have the power to clean up the mess Wakefield left behind. (Imagine: A big “S” on this blogger’s white coat).

Practicing Medicine with Cultural Awareness

picture by Salvatore Vuono (freedigitalphotos.net)

The US is a “melting pot.” But that does not mean we are a homogeneous amalgam of cultural identity. What is distinctly American is that almost all of us (perhaps 99% of the US population) are not truly Americans in the purest sense of ethnic origin. This means that in one working day, a physician might be faced with 5 or more different cultural perspectives on medicine and personal health. Being aware of our own biases about healthcare based on Western medical education and practicing with a sensitivity to other cultures are key to a mutually fulfilling relationship between doctor and patient.
So what’s a doctor to do? Most of the time, we improvise and observe patterns. But now, I think I have found a better answer.

I just obtained a copy of Culture and Clinical Care, edited by Juliene G. Lipson and Suzanne L. Dibble. This book was recommended –oddly enough- by a representative from the Department of Labor and Industries. So far, I have limited my reading to the ethnic groups I tend to see in my office, but it does appear to be a great reference to have in the office. The 35 chapters are alphabetically organized by ethnicity, from Afghans to (Former) Yugoslavians, including Native Americans and Hawaiians.

Here are some tidbits from the book:

– You should use “Mr.” or “Mrs.” When addressing older patients. Use of the first name may be disrespectful.
– Chinese language is expressive and often sounds loud to non-Chinese people. Chinese may sound unintentionally abrupt when speaking English.
– Chinese patients may not ask questions due to respect for the doctor, but may nod at everything.
– Food is important for health, balancing “cold and hot” or “yin and yang.” For example, nausea/vomiting is thought to be from too much yin, so they treat with hot soup/broth. Diarrhea is caused by too much yang, treated with yin foods (fruits, vegetables)
– During the first 30 days postpartum, Chinese mothers may be told by family members to not go outdoors, shower, or bathe, because her pores are believed to be “open” and illness can enter the body.
– The eldest male in the household is often the spokesperson.
– Menopause is viewed as normal and they tend to have fewer symptoms than European Americans.

South Asian/East Indian
– They may find a loud voice to be disrespectful.
– Traditionally, it is disrespectful for a woman to sit with legs crossed or apart
– When sick, they may be passive and expect to rest while the family takes up responsibilities.

– Unlike many other cultures, depression is not stigmatized, and, in fact, it triggers family members to interact more to show that they love and value the depressed person
– Tend to be stoic about pain
– Tend to view larger body size as a sign of good health.
– They often do not associate diet and exercise with health.