33 Charts

Less is More

2009-11-05T11:09:17-06:00

We all struggle with information overload. As consumers we struggle with tuning our feed. As writers and producers we struggle with delivering our message.

And there is no sign that things are lettin’ up.

Remarkably, however, it seems the future is about less.

Steve Rubel in April shuttered Micropersuasion in favor of a short-form Posterous lifestream. Leo Babauta after years of preaching Zen minimalism last week took an oath to keep his posts under 400 words. And the ultimate messenger Seth Godin recognized the value of a pithy message long before it was fashionable.

What do these guys know that many of us don’t? They know that focused human attention is a scarce commodity. They recognize that our burgeoning information economy will buoy those who deliver concise, effective messaging.

Humans don’t scale. The future belongs to those who can make their case in as little space as possible.

Facebook Won't Fix the Doctor-Patient Relationship

2009-11-04T13:41:50-06:00

I was flipping through some of Lee Aase’s slides recently and he made a point that I can’t seem to get out of my head. Social media, says Lee, will not make up for a bad product offering.

Lee was referring of course to hospital service. But the same wisdom can be applied to what doctors offer.

So how’s our offering? Do doctors give patients the time and attention necessary to address their unique concerns and educational needs? Not always. This isn’t necessarily the fault of the physician but it looks that way in the exam room where the problems of our healthcare system are most obvious.

When I listen to patients they want doctors who are accessible, responsive and interested. Then there’s the suggestion that the availability of physicians through social platforms is the fix. It’s said that we should be connected with out patients. The Conversation, after all, makes everything better.

But technology will not fix a strained relationship. Facebook is just a medium. It’s people and their passionate interests that make things happen. Social engagement, online or off, requires a dedicated interest in sharing and listening.

The medical profession is under the gun. As doctors we’re preoccupied with third party payers, malpractice premiums, and keeping the lights on. It’s not why we got into it but it’s where we’re at.

It’s a tough time for doctors to engage. Twitter won’t fix that.

Doctor-Patient Dialog on Social Media: A Bad Idea?

2009-11-02T12:06:19-06:00

Recently I wrote about how to handle things when patients try to engage doctors in the social media space. If you missed it you can read it here. If you want to save yourself 5 minutes consider the bottom line: Doctors and patients shouldn’t be discussing patient-specific issues in the social space.

I heard from Ted Eytan regarding my post:

The question is interesting: If the patient initiates the dialog is open discussion of a specific medical problem then okay?

I wish it were that simple.

It’s important to discriminate between what patients do on their own and what patients and physicians do together. Patients (lets call them people, shall we?) can effectively do as they please. You can live tweet your vasectomy or post your pathology report on your blog. Transparency is, after all, a badge of honor.

But when patients (I mean people) and doctors get together it gets a little trickier.

Here's why:

If it’s okay with you is it okay with me? Open discussion of privileged medical information requires written consent. Healthcare attorneys have suggested that the initiation of communication by the patient implies consent. But don’t look for me to be the guinea pig when this one’s tested in the courts. Bottom line: permission to discuss is a little more complicated than you might think.

Documentation. Physicians bear the responsibility of documenting everything that happens between doctor and patient. From state medical boards to third party payers, physicians are obligated to get it all down.

More importantly, the documentation on most social platforms isn’t detailed enough for other medical professionals or auditors to follow what’s gone on between you and your caregiver. Let’s not forget that Twitter has a habit of disappearing after a couple of weeks.

What are you really saying? Then there’s the issue of assessing a febrile infant in under 140 characters. If you’ve ever cared for the sick you know that sorting out problems isn’t always easy. Assessment of even the simplest medical issue requires clear responses to clearly understood questions. Current technology isn’t built for this kind of exchange (HelloHealth not included).

It just isn’t smart. Sharing detailed personal health information in a public forum isn’t smart. Sure the tongue-in-cheek comment about your ingrown toenail isn’t likely to create problems. Discussions about anything more serious isn’t for others to hear. Keep in mind that everyone from employers to insurance companies are tuning in to what you have to say.

So do we shutter the idea of any interaction between doctors and patients? Absolutely not. E-patients and physicians need to be together socially. This only helps our relationship. This is where the real power of social health lies.

There are plenty of very accessible and private formats by which you can communicate with your doctor. And if your doctor isn’t available by those means it’s really unlikely you’ll find her rootin’ around on Twitter.

Are Twitter Lists Exclusionary?

2009-11-01T08:10:02-06:00

Two of social media’s key thought leaders see Twitter lists differently.

Chris Brogan yesterday wrote that he felt Twitter lists were exclusionary and put people at risk for feeling left out. Robert Scoble shot back with the idea that lists are, by their very nature, exclusionary but necessary.

Despite his liberal use of capital letters, I have to side with Scoble on this one. After just a few days with Twitter lists I can say that my lists are quite exclusionary. That’s what makes them so useful. When I want to hear what doctors and nurses are talking about I can turn the channel to healthcare. This allows me to exclude all the social media wonks like Scoble and Brogan. And when I want Scoble, Brogan, Armano or Rubel I tune everyone else out by watching my Thought Leaders.

Will lists become the new metric of power? I’m not sure about that. I have some concern that ‘list ranking’ will miss the influentials who hang in niche areas on Twitter.

Right now the real benefit would appear to be the egos of our beloved social media gurus who can’t seem to keep up with their listings. Twitter attracts social media people who in turn want to pay homage to their social media heros. I anticipate they have the most to gain.

Power metric be damned, Twitter lists allow me to tune my human signal just a little bit better. And that puts me closer to where I need to be.

The Irony of Bad Health Messaging

2009-10-31T07:40:06-05:00

Medical misinformation in the MSM is met with gnashing of the teeth.

Medical misinformation in the social space is often ignored.

Medical misinformation in the MSM is limited by one news cycle.

Medical misinformation in the social space is permanent and grows.

So where should we be spend our time getting the story straight?

3 Questions That Complete a Medical Interview

2009-10-29T16:18:01-05:00

I can spend 20 minutes interviewing a parent about their child and still not really understand them. During a consult, my interview centers on the objective elements in a child’s history. When evaluating a child for abdominal pain, for example, I have a panel of questions that cover what I need to know to generate a starting hypothesis.

But none of it helps me understand Mom.

Understanding where the parents are at is critical to both understanding a child’s problem as well as pitching a plan of care. Whether it’s revealed to me or not, parents often come to me with an agenda. If my plan doesn’t meet with their view of the situation, it’s going to be much harder for me to help that child get what she needs.

So at the end of my interview (usually when washing my hands) I launch one or all of the following questions:

Is there anything you forgot to mention?
What’s your biggest concern?
What do you understand about what’s going on with your child?

Despite having a few years under my belt I’m always amazed at my inability to predict what’s worrying a mother. This is why I ask. And trying to get at what a parent understands gives me a jumping off point for the education part of the visit.

The experts call these open-ended questions. In medical school I thought the open-ended question was academic nonsense. Now it makes my life a whole lot easier. It gives me what I need to know when helping a family navigate their child’s problem.

From what I understand these questions are equally helpful with adults.

When Doing Nothing is the Hardest Decision

2009-10-28T06:00:00-05:00

'Why I Ration Care' is an important essay published in this week's Newsweek. Christopher Moore, a father and emergency physician, talks about his recent care of a teen who presented with mild head trauma sustained during a soccer game. The piece details the decision to manage this low-risk child expectantly. The reflexive head CT was forgone in favor of observation.

Moore refers to his decision as a type of rationing of health care resources. I call it a refreshing example of good clinical judgment. If all physicians exercised this level of thinking on a daily basis it’s conceivable that ‘reform’ would be a foreign word.

But great judgment is easier said than done. Clinical decisions can be brutally difficult. Testing is easy. Exercising the judgment to not perform tests takes insight, experience, and confidence.

The drive to identify and fix has to be balanced with the patience and courage to watch and wait. This balance, when maintained successfully, defines the most skilled clinician.

Who Needs Twitter?

2009-10-27T08:20:05-05:00

I had lunch with a physician colleague recently. In the course of our discussion Twitter came up and I tried to explain its potential benefits. But despite my spot-on analogies he just didn’t understand why this would be of value to him.

Then I realized it may very well have no value for him.

As a middle-aged divorcee with college-aged children and a stable practice he freely admits that he doesn’t yearn for much. Investment into his career isn’t a priority. He has few aspirations beyond digital photography which he prefers to do alone. He’s actually very happy just as he is.

So what’s value proposition for Facebook with someone like this? What’s the return on involvement with Twitter? I’m not sure there is one.

There are those who recognize the value of relationships and there are those who don’t. There are those who recognize the value of relationships but find them less important. While the benefits of social media are obvious to those who reap the benefits, there are those who have no aspirations beyond what’s in their immediate environment.

And technology will never change that.

Cmp.ly Makes Conflict Disclosure Easier

2009-10-26T07:00:00-05:00

The issue of conflict of interest in social media has grown from an ethical discussion to a legal requirement. Under new Federal Trade Commission guidelines, material connections with special interests must be disclosed. But how do you disclose conflict of interest in 140 characters? And how do you let readers know you received serious payola or just a review copy of a book?

I stumbled on a service called cmp.ly which has developed a cool solution. Cmp.ly offers links to disclosure sites that detail your level of potential conflict. According to the founders, “CMP.ly disclosures follow a standard naming convention that is easy for readers to understand and can be used for disclosures in print, online, SMS, tweets or other digital communications.”

Let’s say you consult with a nutritional product company and you tweet a link to a story or study that puts the company in a favorable light. Just put http://cmp.ly/4 on the end of your tweet and you’re clean (or cleaner than before).

So it seems disclosure isn’t just for doctors anymore. Everyone from mommybloggers to techgeeks will be airing their connections soon. Cmp.ly makes it a little easier to do good.

Look for it on my posts when I’m feeling conflicted.

UpToDate - The Information Prescription

2009-10-23T17:42:48-05:00

UpToDate, arguably the most trusted information brand in medicine, is now in the patient information game with UpToDate for Patients. I ran into deputy editor Alison Hoppin (a pediatric gastroenterologist) at the American Academy of Pediatrics last week and she gave me a test drive. My bags are barely unpacked and I’m already using it in my practice.

I mean, what a concept. Draw content from some of the best minds in medicine, add skilled editorial input, and package it in an approachable format without the glitz. And unlike many supermarket health sites, UpToDate does not discriminate against the pediatric population. You’ll find many diseases and conditions covered equally well for children and adults (see celiac disease in children).

And I love this: UpToDate even offers information prescription pads for doctors. Beyond simply reminding patients where to go, this makes the point that it’s a doctor’s responsibility to help patients initiate navigation in the online space (what I like to call preemptive online health literacy).

This icon sequence on the patient entry page gives some hint to where UpToDate sees this going. Reference step 3: some patients will want the full nine yards and pay for physician-level information. And why not, really?

If UpToDate can expand its content and leverage its rock solid name with doctors, look for them to establish a powerful foothold with patients in the medical infosphere.