thebiopsy:

amolutrankar and kvnwng, my co-hosts at the H&P, got a chance to interview one of Tumblr’s favorite docs, cranquis! Check out this hilarious interview with the good doctor (his voice has been altered to protect his anonymity) and let us know how we’re doing with the podcast! Remember to give us 5 stars on iTunes so we can continue producing!

A new episode of The H&P is now live, and we hope you’ll love listening to this one as much as we enjoyed recording it!

If you have any feedback or suggestions for us, reach out to us via social media, or tell us what you think by rating us on iTunes. We’d also love to hear if you have any suggestions for guests or topics!

Here’s another essay I wrote a few years ago about a particularly memorable patient encounter and the challenges of handling clinical situations that require us to operate beyond our training, outside our natural comfort zone.

intrainingdoc:

We would like to announce our new podcast “History & Physical,” hosted by Kevin Wang (wang-kevin), Amol Utrankar (amolutrankar) and Roheet Kakaday (thebiopsy).

The podcast aims to answer to question: “What does it mean to be a medical student of the 21st century?”

Listen to the first episode here or subscribe on iTunes.

Proud to be part of this exciting new collaboration! Pardon the cliche, but we genuinely want this to be a podcast by medical students, for medical students - so if you have any feedback, suggestions, or ideas for future episodes, do reach out!

Presenting Com(med)ore, a chronicle of my medical school experiences from White Coat Ceremony to Match Day. Of course, I’ll still keep on ‘medblr-ing’ about policy, technology, and the future of medicine, and continue to explore new directions for this Tumblr, but this is my foray—an experiment, if you will—into a less editorial and more narrative-reflective form of blogging.

iInequity?

After transforming the fields of personal computing, digital music, and mobile technology, Apple has set its sights on the next frontier: healthcare. With HealthKit, Apple’s new health tracking platform for iOS 8, wearable devices and mobile health are finally moving into the mainstream. It’s here, and it’s now.

For doctors, patients, and students, this could be a game-changer. Imagine a future where your vital signs, diet, and physical activity are monitored 24/7. Where your primary care physician can review your health behaviors and make constructive recommendations. Where your caregiver can receive a push notification for an abnormal reading and follow up instantly. Where practicing medicine isn’t just about treating disease in the hospital, but ensuring health in the community.

On the heels of its foray into healthcare, Apple’s new ad, “Strength,” presents its vision of the future—one in which a mobile phone isn’t simply an accessory, but an extension of the self. A fitness coach. An activity tracker. A digital repository for everything you are in everything you do, quantified, analyzed, and chronicled.

And while I’m optimistic about the opportunities, I’m also .. not. Because of our health system’s core concerns, Apple customers—the affluent, the young professionals, the tech-savvy, the socially privileged—rank at the bottom. Apple’s ad is empowering, but it’s also disheartening, because it points to a future in which our best efforts are being put towards our mildest challenges.

The conversation about quantified self and mobile health should not center on the needs of wellness-enthusiast yuppies, but about how we can use digital technologies to reach out to those our health system has currently marginalized. The people who need HealthKit the most aren’t the people in this ad, but those who all too-often fall through the health system’s cracks: the frequent flyers, the chronically ill, the uninsured and under-resourced.

Naturally, I can’t expect Apple, Samsung, or Google to concentrate their efforts on these populations anytime soon; after all, there’s no profit motive. But for physicians, social entrepreneurs, and digital health innovators, we have to redirect our efforts to address the challenges where they are most severe.

Call it the ‘ivory tower,’ visualized. According to the World Bank, a third of its online research reports are never downloaded, and only 13% are read by more than 250 users.

From the Washington Post:

It’s fair to assume that many big-idea reports with lofty goals to elevate the public discourse never get read by anyone other than the report writer and maybe an editor or two. Maybe the author’s spouse. Or mom.

Academic researchers are trained to excel in knowledge production, but what we need today is content translation: the ability to communicate one’s work to a public audience and to be an evidence-based advocate for social impact.

As an undergraduate researcher, I’ve interviewed scientists to understand how they see their role as leaders and influencers of society. Too often, the answer is  ”I produce the data; others draw conclusions and create policy.” Which doesn’t work if your data aren’t being seen or heard.

Medicine holds the unique privilege of sitting at the intersection of inquiry, practice, and advocacy. As aspiring physicians, it’s essential that our training not only cover how to conduct academic inquiry, but how to connect our insights to the broader public.

thebiopsy:

Dr. Jordan Grumet on why public storytelling matters in medicine. Lots of lessons to tease out here.

If you’ve read Dr. Grumet’s blog, you know that he has an incredibly moving, profoundly poetic way with words. Likewise, this talk from DotMed 2013 communicates a vulnerability, a passion that leaves the viewer speechless.

Incredible. This is, without a doubt, a must-watch.

Most of all, I love this (at 15:02):

We do such a good job of using social media and the Internet to tell people what we know, but we do a lousy job of telling people who we are.

So often, when we talk about Health 2.0, and participatory medicine, and patient empowerment, we focus on the leveling of the doctor-patient relationship through the elevation of the patient’s role. What Dr. Grumet brings to light here is that the ‘leveling’ is bidirectional. Digital dialogue affords doctors a chance to step off the pedestal, to extend empathy and reveal to the patient a caring self.

The compressed moments of clinical encounters rarely allow providers the time to tell a story; they scarcely have the time to elicit one. With emerging channels of doctor-patient communicationblogging, Twitter, Youtube, and moreproviders have the opportunity to change their approach from an interview to a conversation. Caring 2.0 - I love it.

What Can Jeff Bezos Teach Medicine?

I’ve just finished reading Brad Stone’s The Everything Store, a biography of Jeff Bezos and an entertaining chronicle of Amazon’s rise from retail startup to e-commerce giant. If you’re particularly interested in entrepreneurship, organizational leadership, or technology, you might find it a worthwhile read.

Iconic Silicon Valley thinkers are often typecast as extraordinarily visionary, wildly daring, and socially adrift, and Amazon’s Jeff Bezos is no exception to the rule. If Amazon hadn’t become so unbelievably successful, Bezos’ notable Jeffisms might otherwise have been remembered as insanity, rather than prophecy.

To anyone in healthcare, Bezos’ resilience, boldness, and quixotic spirit might represent the antithesis of medical thinking. And while startups and medical centers could not be more dissimilar, The Everything Store offers real insight for healthcare leadership:

  1. It’s all about the patient. Despite its ubiquity and prominence, Amazon’s profit margins remain infamously anemic. Why? Because consumer satisfaction is Jeff Bezos’ primary business strategy. Low prices drive loyalty, which drives reliance, which drives profitability. Bezos’ vision: “We don’t make money when we sell things. We make money when we help consumers make purchase decisions.” How might we impart a similar alignment of business-consumer interests in healthcare?
  2. Aspire to perpetually self-disrupt. Amazon exec Diego Piacentini observed, “It is far better to cannibalize yourself than to have someone else do it.” Indeed, successful businesses too often fail to anticipate disruptive trends on the horizon, eventually falling prey to market shifts. Amazon’s success as a tech mainstay is largely due to its constant reinvention; that a books and DVDs retailer anticipated its demise and pioneered tablets and cloud consumption is remarkable. Are the traditional institutions in healthcare ready for the disruptive threats of the 21st century, and can they innovate to survive?
  3. Your people matter, too. Not all in Seattle is good, though. The fuel to Amazon’s meteoric rise is its workforce, notably driven by its CEO’s ferocity and expectations of excellence. Brad Stone’s narrative reveals a Jeff Bezos so consumed by aspiration as to foster a culture of perfection, an intolerance of error. The numbers agree; the average employee stays at Amazon for 14 months, putting the firm third-lowest in the Fortune 500 for employee turnover. Medicine is no newcomer to provider burnout, a culture of overwork, and a pressure to constantly perform at the highest level. Can the healthcare system deliver in outcomes and quality while preserving its core structure, the people?

Naturally, the extension of startup thinking to healthcare has its limits. Rapid innovation and bold experimentation might win the day in Silicon Valley; in the clinic, adopting practices without evidence or making mistakes can mean lives lost. But in an industry where pagers are the communication standard, where EMRs resemble vestiges of Windows 95, where incentives are wired for volume rather than quality, perhaps we can take a page out of Jeff Bezos’ book.

As for The Everything Store, I’d recommend it as a riveting story for those who enjoyed Nick Bilton’s Hatching Twitter or Aaron Sorkin’s The Social Network. If you’re looking for a more thorough discussion of technological and sociological implications of Amazon’s advances or as a guidebook for managerial strategy, though, this probably isn’t your cup of tea.

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Reading suggestions are always welcomed via email, Twitter, or the “Ask Me” feature on the blog header!

"What Doctors Feel," Reviewed

In a recent interview, Malcolm Gladwell encouraged physician writers, “Help people understand what it really means to be a physician.” Danielle Ofri’s What Doctors Feel does exactly that, giving readers a richly insightful, deeply personal perspective into the clinician’s internal narrative.

Chronicling her own clinical experiences, Dr. Ofri weaves a portrait of the emotional challenges and inner dialogues that physicians navigate in the course of their bedside encounters. The revulsion toward a patient so decrepit or pungent as to almost be stripped of her humanity. The sense of drowning and decisional paralysis when tasked with life and death judgments in critical situations. The fear of errors in environments where the stakes are set so high, and the weight of practicing in a discipline and society that can be unforgiving of anything less than excellence. With each clinical vignette, What Doctors Feel brings to the forefront the emotions and personal narratives that are so ubiquitous—and yet, so often overlooked—in clinical medicine.

As a student, What Doctors Feel presents what lies ahead. In some ways, its descriptions of the trials and tribulations of medical education—the “hidden curriculum” of behavioral socialization, the tiresome burdens of clerkships and residency, the uneasy transition from outsider to provider—serve to foreshadow, to throw down the gauntlet, to say, “Here’s what’s coming; can you handle it?” Concurrently, though, it offers a sense of awareness, almost as if to inoculate; knowing what lies ahead, I feel better prepared to handle the emotional tolls that await and more motivated, in cohesion with my future peers and mentors, to strive for self-preservation amidst it all.

For the provider in me, What Doctors Feel brings to mind my own clinical experiences. As I read Dr. Ofri’s recollections of fear and panic while running her first code, I’m reminded of how overwhelmed and anxious I felt directing resources and managing patient care in my first cardiac arrest; how I felt the pressures of decisional urgency and bystander scrutiny in those critical moments; and how I questioned my own judgments in the weeks that followed. As I read her somber reflections on death, I’m taken back to my own tearful collapse the first time I set eyes on the rigidity and lividity of a lifeless body. In an age where privacy and the pressure to perform reign supreme, it’s not often that we, as providers, are able to discuss our emotions with others. Dr. Ofri’s writing conveys a comfort, to know that others have walked the same paths and struggled in the same circumstances, and to understand that we are not alone in our flaws and burdens.

Most of all, though, What Doctors Feel is a must-read for anyone who has, is, or will navigate the healthcare setting—in other words, everyone. Too often, medicine fails to impress upon weary, agitated patients why it is that their doctor was off the mark about a diagnosis. Why their doctor might always seem rushed or distracted by the burdens of a multitasked practice. Why medical prognoses and decisions are laden with the language of uncertainty and non-committal jargon. If we, as students and providers, could bring more patients into our worldview, we could form more meaningful partnerships and more easily arrive at a shared understanding. In this phenomenally heartfelt, exceptionally written insider view of doctoring, Dr. Ofri merits praise for closing that rift and bringing patients and providers closer together.

Online Professionalism: It Starts Offline

When we discuss online professionalism in healthcare, we often recite the same advice. Don’t discuss patient details. Don’t share content that reflects poorly on yourself or the medical community. Don’t mix personal life and professional image. (There’s often more don’ts than do’s, notice that?)

While all those rules are helpful and well-meaning, here’s the thing: they’re not enough. Online professionalism is about more than watching what you say and where you say it on digital channels. Social media responsibility extends beyond what you put online to what you do offline.

In 2014, privacy is virtually a myth. All it takes is an out-of-context Facebook photo from a party; a friend’s tweet of an all-too-candid remark you made over dinner; or a video from a “private event” that goes viral and sinks a presidential campaign. We can rely on our judgment, but we can’t rely on the judgment of our peers and social environments.

When content sharing is so simple and instantaneous, it’s not enough to rely on discretion to protect your public presence. The cardinal rule is this: online professionalism starts with offline conduct. Assume that any private moment could become public in an instant, and act accordingly. Unless you’re comfortable with your residency director, hospital administrator, or patient seeing it, avoid that unsavory ‘Kodak moment,’ and keep that snarky quip to yourself.

This isn’t an easy concept to come to terms with. We want to believe in the comfort of private spaces; we want to experience moments of social intimacy that are off the radar. But when every person is constantly connected, when every mobile device is a direct pipeline to permanence, these are hopes we adopt at our own risk.

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On a sidenote, I’ve been getting some wonderful comments and feedback recently on this blog. I can’t express how much I appreciate this; the opportunity to create conversations and engage a diverse community of global scholars is why I write. Thank you, all!