Fourth year medical students are trying to get The Ellen Show to their Match Day in San Antonio. Help this go viral. To that end that have a pretty talented mock up of Pharrell William’s ‘Happy’.
Fourth year medical students are trying to get The Ellen Show to their Match Day in San Antonio. Help this go viral. To that end that have a pretty talented mock up of Pharrell William’s ‘Happy’.
Vinod Khlosa has already made it clear Silicon Valley will be at the forefront of automating health care. He made waves last year by saying that 80% of what physicians do can be done as well or better by a computer.
I can’t fault the premise that diagnoses and interpretation of studies and prescription of therapies are soon to be carried out better by computers than physicians. Now making headlines is the famous IBM supercomputer Watson. The former Jeopardy champion is being trained at Sloan-Kettering and The Cleveland Clinic.
In Silicon Valley and other centers of innovation, investors and engineers talk casually about machines’ taking the place of doctors, serving as diagnosticians and even surgeons—doing the same work, with better results, for a lot less money. The idea, they say, is no more fanciful than the notion of self-driving cars, experimental versions of which are already cruising California streets.
Of course, it will be a generational shift to accept such automation without significant human interface. But such will come. Such is coming. As well, I feel pretty safe that my job as a surgeon as safe for a while longer.
An uninsured Seattle man has put out an ad offering to trade his 2006 Mustang GT for brain surgery. He provides an image from a MRI of his brain even. The poster doesn’t describe what symptoms he attributes to his arachnoid cyst but the relationship between arachnoid cysts and late symptoms is often difficult to establish.
Arachnoid cysts have been associated with headaches, nausea, seizures, vertigo and even in anecdotal cases with psychiatric symptoms or the onset of dementia. But the relationship is often hard to establish. Up to a third of people with chronic headaches have some sort of abnormality on there MRI, including arachnoid cysts. Relating the findings and the symptoms is often difficult; sometimes you have a finding on an MRI or a CT scan but it is a red herring as far as the symptoms are concerned.
Arachnoid cysts are collections of cerebrospinal fluid trapped between the brain and spinal cord and the arachnoid membrane. They’re primarily a congenital entity but can be associated with trauma, infection or be iatrogenic following surgery. The vast majority of cysts are discovered incidentally and associated with no major symptoms. While even asymptomatic cysts can progress to cause symptoms and they can be associated with post traumatic, or even spontaneous, hemorrhage the risk of such is low enough that in small asymptomatic cysts it is often more than reasonable to do nothing.
I’m a little bit dubious of the poster as he relates that he’s been thinking of trying to get to the cyst himself. However, if it’s an honest post I think the poster really needs to sit down with a neurosurgeon in consultation and go over the above in detail and discuss the best course of action.
I suppose health insurance is coming in 2014.
One of the big things the use of social media in medicine is supposed to do is help diminish the information disparity between providers and patients. Although knowledge asymmetry is present in many fields perhaps nowhere is it as large as in medicine. If you’ve never been in a surgery I can do all I can to explain it in an informed consent process but perhaps hearing about it, seeing it in real time.
That said I though the novelty of using social media during surgery would’ve died down by now. As well as its use. Its not like the social media observer experience has been widely adopted by patients. I’ve never run across a patient in practice whose referenced having used social media to experience surgery as part of their information gathering process. Not that I think the effort is fruitless but the whole ‘live’ experience is overstated. In effect these livetweets of surgery are a publicity stunt.
And yet, here we are in Houston with a proposed first use of Youtube and Pintrest in a livetweeting of a brain surgery.
“What will come out of this is a detailed, real-time sequence of what happens in a brain surgery through all the stages from preparation, to shaving the hair, to making the incision, to draping,” Dr. Kim says. “People are very anxious and want to know what goes on in a brain surgery like this.”
While Dr. Kim (left) works in the operating room, a team outside the room will work the social platforms. A brain tumor specialist will be present to help answer questions from the digital audience via Twitter. But the operation will expand to other social networks too.
Video clips from inside the operating room will be posted to YouTube, and photos shared on Pinterest. Storify compilations will recap each hour of the broadcast.
The web and social media are a great source of information for patients and families of all types, including those facing surgery. I applaud providers and hospitals and others for putting such information out there and using social media. The live presentation of that information though and, especially, the hype surrounding such seems overdone. Five years from now we will neither be giving fanfare to livetweets of surgery nor will be doing it on a regular basis. In some respects it seems a waste of resources in using social media and the internet to distribute information.
If you want to tune in though the livetweet begins today at 9am central time and can be found @houstonhospital.
Social media, the internet has created a remarkable, egalitarian communication conduit between those at all levels of an enterprise. It has incredible, somewhat recognized promise, promise as a utility for transparency. If those at the top are willing to embrace it. When it comes to health care perhaps no one of more prominence embraced social media more fully than Paul Levy.
Now the CEO of Beth Israel Deaconnes Medical Center in Boston is stepping down. Levy’s time leading BIDMC has almost universally been regarded as success in terms of the revitalization of the hospital’s finances, his push for transparency and the general reorganization of the workings of the facility. Not that his time hasn’t been without notable controversy. All that considered, I’ll certainly remember Mr. Levy for how much he shared from the inside including on his blog Running A Hospital.
He used that medium of recent to post the email he shared with the BIDMC community. In it he says,
I have been coming to a conclusion over the last several months, perhaps prompted by reaching my 60th birthday, which is often a time for checking in and deciding on the next stage of life. I recently traveled to Africa and while biking through the Atlas Mountains had plenty of time in a less cluttered environment to think this through.
While I remain strongly committed to the fight for patient quality and safety, worker-led process improvement, and transparency, our organization needs a fresh perspective to reach new heights in these arenas. Likewise, for me personally, while it has been nine great years working with outstanding people, that is longer than I have spent in any one job, and I need some new challenges.
So, last night, I informed the Chair of our Board that I will be stepping down as CEO. We will work out an appropriate transition period, and things will continue to run smoothly here. I leave confident that the Board will find many able candidates to succeed me.
He does promise to continue his presence online. Which is certainly a good thing.
I don’t know Mr. Levy personally. This Pre-Rounds column I wrote for Medscape is my sole interaction with him. However, I’ve certainly kept up with what he’s had to share through social media and enjoyed it. I hope he finds success in whatever new challenges he takes on, and I hope he keeps sharing his observations.
The intersection of social media and privacy has made an older generation, and even some of my own generation, incredibly uncomfortable. There is talk of present and future consequences. Lost jobs, lost income, civil judgments, loss of respect/embarrassment, even criminal penalties for all that you put online. There is an idea that the blurring of intimate boundaries will come back and bite a whole generation.
Being online has responsibilities and consequences, no doubt. But Facebook isn’t going to cost most people a future job or a future election. The social rules are, as we speak, changing in terms of how we judge people for their private lives that they make public. The whole world is using social media and putting themselves out there. Tough to judge someone for your same acts.
Because those involved in health care and social media have the often near unique oppurutinities to not only dismiss their own privacy online but to do so for others. Horrific stories are rife. Take this one for example,
William Wells arrived at the emergency room at St. Mary Medical Center in Long Beach on April 9 mortally wounded. The 60-year-old had been stabbed more than a dozen times by a fellow nursing home resident, his throat slashed so savagely he was almost decapitated.
Instead of focusing on treating him, an employee said, St. Mary nurses and other hospital staff did the unthinkable: They snapped photos of the dying man and posted them on Facebook.
It is unfortunate if such scares providers and health systems away from social media like blogs, Facebook and Twitter.
As Ed Bennett comments,
“We already have guidelines; social media is simply another form of communication. It’s no different from e-mail or talking to someone in an elevator,” Bennett said. “The safe advice is to assume anything you put out on a social media site has the potential to be public.”
It’s a form of communication with the potential, as all others, to be abused. But more importantly, it has great potential to further provider-patient discourse and aid in health.
No patient privacy protections will ever be perfect. No patient-provider communication rules will ever absolutely guarantee professionalism and accurate information at all times. But guidelines and rules can limit such problems while furthering patient’s access. That holds no matter the medium.
The proliferation of easy mass communication tools should be embraced by health care, not cowered from. As always there are appropriate and inappropriate uses which health care providers should be counseled on and which should carry rewards and penalties. But just because social media is new shouldn’t make it scary.
I’ve opened up commenting. Probably a smart and long overdue idea if I want to promote discussion on Residency Notes. And that’s certainly a big goal of mine.
When I relaunched the blog I thought I’d get cute and help support OpenID, which is an open source online ID project wherein a single ID can allow you to log into any participating website. Well, forget that. No more logging in, no Captha, no more hoops to jump through. If you have something to say, then say it.
Grand Rounds is six years old. Considering things age in hyper dog years on the internet, that is a lifetime. What Nick Genes put together has been impressive. For the past year I’ve gotten to be a part of it. Today Grand Rounds, in my opinion, continues to serve an important function as part of the social network of medical bloggers. It continues to be a reference point for the medical blogosphere. It’s important; which is why I’m here putting this together at 3 am instead of sleeping prior to my call.
To the wonderful bloggers who make Grand Rounds work each week, “I don’t know half of you half as well as I should like; and I like less than half of you half as well as you deserve.”
I imagine Grand Rounds continuing to go strong but it only does so on the efforts of those who contribute and volunteer. If you’re interested in hosting a future date of Grand Rounds please drop me a line.
I’ve picked a few from amongst the dozens of excellent posts submitted. Consider it my quirky self indulgence to go with a couple of narratives this week.
As the house officer drew up a dose of morphine, the old physician spoke, “Doctor, at which medical school did you train?”
The house officer told him.
“Ah, well then, do you know John Hunter?”
“John Hunter… The man who grafted a human tooth onto a cock’s comb, who stole the corpse of the Irish Giant, who described semen held in the mouth as having a warmth similar to spices and who proved the contagiousness of venereal disease by self-inoculation?”
I recall the thrill of reciting the Hippocratic Oath for the first time as part of a ritualistic White Coat Ceremony. It felt like the incantation somehow connected me to a long line of great men, from Hippocrates to Benjamin Rush to my childhood family doctor. It marked a distinct line between the life I had already lived and the medical profession that was to become a considerable part of my identity. But is the Hippocratic Oath an outdated, out of touch relic in the complex modern world?
From The Patients Perspective
I’ve learned a lot from the patient bloggers who contribute to Grand Rounds. As well, they’ve been the backbone of making Grand Rounds work. Kerri and Amy and Laurie and others have never shied away from helping make Grand Rounds work. This week they all come strong again with their submissions
Up until now it’s been all about me and my #$%@ chronic illness. That wasn’t so bad, for me. Far tougher is the realization that someone you love — someone who’s been the rock of your existence — may not be so invincible after all.
Luckily, my brother-in-law is a physician in Germany, and after hearing about the symptoms, suggested we might be facing a case of Lyme disease.
Phantom exercises help decrease pain in patients with traumatic amputations and phantom limb pain. Although a small study, the researchers showed that “exercising” the phantom limb results in better pain relief than just general exercise.
1. Practice What You Say
2. Never Tell On A First Date
3. Be Casual Yet Confident
Patient safety is a healthcare discipline that takes a critical look at how well intention meets outcome. It’s one of the six key dimensions of quality described in the IOM reports that first quantified how often people are harmed as a result of seeking care, then outlined improvement strategies.
Today’s list allows me to share 25 tweeps I’ve identified as valuable patient safety resources, visionaries, or exemplars.
[My physical therapist and I] talked about writing and teaching and graduate school, and we talked about rescue dogs and traffic and commuting.
And even though she was there because I have PCD and bronchiectasis and I was literally choking in phlegm before she arrived, it didn’t really come up.
It wasn’t that my illnesses were invisible (um, hello hacking cough and vigorous clapping) but they were not defining.
Until three years ago, I was also a marathon walker and a racewalking coach for an organization that trains endurance athletes who raise funds to fight blood cancers.
I never got better. I never walked another half-marathon. I never got back to my daily routines. I never felt healthy again.
From The Providers
That doctors, nurses, pharmacists and others find time to blog shows the value of online self publishing. Maybe as one of them taking time to do so I’m a little biased. Like most I tend to actually on intermittently touch on actual clinical issues and instead comment on life within the health care system.
of the things i encounter in my work, the one i find most disturbing is family murders. for some reason they happen with too much frequency in our country. it seems that some people, when life is too much for them are not happy to only put a bullet through their own head, but they feel the need to wipe out their entire family first. in my opinion it is a dastardly and cowardly act for which there is no excuse…ever.
Last month, I was intimidated to learn that all consultation notes had to be dictated, having never had to do this before. Ok, I was downright worried! Fortunately, the hospital has a service that handles the technical side, and they even gave us Residents a little brochure with the standard headings to start us off. I clung to that yellow tri-fold of paper for dear life.
At the risk of being ridiculed, I volunteer to be on the Emergency Medicine Death Panel! I relish the opportunity to establish some futility and idiocy standards. We need to declare what is clearly dead already, what will certainly be dead in a few moments, and identify elements of the system which we would all be comfortable seeing dead.
Death is an important player in EM and yet shockingly, we habitually/traditionally/culturally fail to recognize death and make ridiculous statements about it.
I have commented on this topic multiple times in the past. In short, medical blogs are not a source of “actionable” medical information. The same principle applies to Wikipedia. You must be treated by an expert – not a “crowd” – as in the “wisdom of crowds” concept used by Wikipedia.
It’s like the scientists think if they keep reporting the same evidence, eventually someone will listen. A new study in Archives found that exercise is still good for you. And it’s never too late to start.
Healthy Business, Policy, Technology & Law
It is a great time to be wonkish. That might be a poor adjective. It is an interesting time to be wonkish. The potential for change of the American health care system is there and likely, even if the change proves less dramatic than some would like. Indeed this week is policy heavy and our bloggers comment on a whole range of issues. One of them even celebrates a birthday to go along with Grand Rounds.
Baucus’s 233-page “leaflet” of a health bill captures the essence of President Obama’s reform framework, including key insurance reforms like restricting denial of coverage based on pre-existing conditions, an individual mandate on basic insurance, and the creation of insurance exchanges. In contrast to the other bills, this particular bill can be loosely summarized by a couple of numbers.
In 1997, after undergoing daily dialysis for five years, she received her first transplant. Most of the cost of the dialysis and the transplant, totaling hundreds of thousands of dollars, was absorbed by the federal Medicare program, which provides broad coverage for those with end-stage renal disease.
By late 2003, her transplanted kidney had failed, and she returned to dialysis, covered by the government at $9,300 a month, more than three times the cost of the pills. Then 15 months ago, Medicare paid for her second transplant — total charges, $125,000 — and the 36-month clock began ticking again.
“If they had just paid for the pills, I’d still have my kidney,” said Ms. Whitaker
The Health Business Blog is four years old with over 2000 posts.
I wonder who gets the better deal, the car salesmen whose profession is to sell cars all day long or myself whose profession is to manage all day long. It will be like this with the meaningful use implementations. Everyone is going to be running the race, so before you begin the race. Let’s talk about obstacles for the race pertaining to vendor management.
Are some things that we tend to regard as essential really not that important? Could they perhaps be doing more harm than good?
One of the problems facing our health care system is that there are so many people involved who are looking out for their own best interests, rather than what is best for the system as a whole and patients as individuals. The sheer force of the lobbying power that has descended on Washington this summer is evidence of that.
Hopefully as time goes by and CER becomes more common, we’ll see health care that is influenced primarily by science, data, and patient outcomes, without regard for who may or may not profit from the results of the research.
[David Goldhill] notes, quite wisely, that “insurance” is generally used to pay for unexpected expenses (tree falls on your roof, car accident) not routine expenses. Thus (his example) nobody would think it reasonable that you would use car insurance to pay for gas while we all expect health insurance to pay for every checkup.
Therefore, he reasons, no amount of mandated cost control can overcome the intrinsic distortion created by a third party paying consumers’ costs.
In my world of oncology, some groups of surgeons and radiation oncologists have teamed up to provide prostate cancer care. Prostate cancer can be often be treated by either modality. In the older procedure-based model, these two groups would have fiercely competed for the same patient. But, working together, they can actually do what’s best for the patient.
Consumer Driven Healthcare will arise as “consumers” themselves slowly chip away at the walls and take over city.
In the midst of much healthcare reform talk, not Alzheimer’s Disease reportenough attention seems focused on ensuring healthcare systems’ preparedness to deal with cognitive health issues -with Alzheimer’s Disease as the most dramatic example- which are predicted to grow given aging population trends.
With the media and political attention focused on the health insurance coverage debate, it may be hard to get anyone in the U.S. to think about other policy issues that affect health. But a group of prominent docs, including ACP president Joseph Stubbs, are giving it a try. They published a letter in BMJ and The Lancet urging politicians to take strong action on climate change.
The Clinical Corner
Patients turn with incredible frequency to the internet for health information. So much of it is questionable, to put the right information out there is a challenge. Here are some fine efforts.
Forty percent of 120 volunteers taking anti-heartburn drugs called proton pump inhibitors (PPIs) had a rebound increase in gastric acid secretion, resulting in acid levels above their starting levels.
[A] single dose of the H1N1 vaccine will offer protection for most adults within three weeks of vaccination.
How does a person prevent gout? The basic tenet is to minimize uric acid production in the body, and/or to prevent its precipitation into crystals within the body’s tissues and fluids. There are risk factors associated with suffering from gout, so doing one’s best to mitigate these is the proper approach.
The best clinical description of asthma in later antiquity is offered by the master clinician, Aretaeus of Cappadocia (1st century A.D.). The numerous mentions of “asthma” in the extensive writings of Galen (130-200 A.D.) appear to be in general agreement with the Hippocratic texts.
Some of the best things we read are difficult to classify. They’re multidisciplinary or they look at situations in such a new light that we can’t really put them in a box. The following are submissions of note that I enjoyed but didn’t think fit into the categories above.
Bullying is also being defined more broadly now as not only repeated taunts or attacks, but as spreading rumors and social exclusion. Whether it happens on the playground or on Facebook, bullying is destructive to any community or school. Bullies and their victims are more likely than their peers to experience depression, suicidal thoughts, less likely to finish high school or hold down a job. Bullying is traumatic for everyone involved and the grief and the experience and difficulty of moving forward with life is the same as people who have lived through other traumas.
I read that McKinsey, one of the leading Management Consultancy firms is expected to recommend 25% cost cuts at Vogue. They have already advised a 10% staffing cut in The NHS to achieve a saving of £20 billion by 2014.
In actual fact the NHS could have saved even more money by doing away with the likes of McKinsey.
That does it for Grand Rounds this week. Marking six years. I hope you enjoyed it. Until next week at MedLibLog take care.
For just about a year now I’ve helped run the day-to-day operations of Grand Rounds, the premiere medical blog carnival.
Now I have a new personal blog. It also happens to be, I believe, the 6th anniversary of Grand Rounds. Combine the two and you get me hosting Grand Rounds; a one time deal.
I’ll be hosting it Grand Rounds Vol. 6, No. 1 here on Tuesday, September 22nd. Consider this a call for submissions for a Birthday Theme Edition. Please send any and all of your best to colinson(at)gmail(dot)com with a subject of ‘Grand Rounds Submission’. I’m looking forward to it.
The deadline is going to be Monday, September 21st at Midnight (Central Standard Time; GMT – 5).
Four months ago I dropped off the face of the internet. I had been writing for nearly four years on a blog entitled From Medskool, first at Blogger and then on a hosted domain with a custom WordPress theme. It was a cathartic, personal endeavor that was often meandering I admit. But it had some staying power, some longevity. Four years is nothing to sneeze at in terms of blog-age.
And then it vanished. It was more of a fluke than anything to be honest. I simply was out of the country, away from the internet and email and I failed to pay my hosting company. It turns out it was a needed break as I transitioned from medical school to residency.
Now I’m back to it.
I’m a surgical intern with an interest in neurosurgery and healthcare policy, amongst other things. I help run the day-to-day operations for Grand Rounds and write a weekly column for Medscape entitled Pre-Rounds.
I imagine this blog will cover whatever my heart fancies but may tend towards surgical and neurosurgical cases, healthcare policy, politics, neuroanatomy, and personal stories from residency. There is a custom theme pending and I hope to have my archived posts from From Medskool back up and part of the blog soon. The continuity will make the site more lively and fun; interesting to see how my opinion and voice has changed over five years. I encourage you to keep coming back, to comment and to get involved with the medical blogging community; including Grand Rounds.
It’s good to be back.