The Efficient MD

2009-11-10T13:47:00.001-05:00

“Find locations near you for both the seasonal and H1N1 flu vaccine http://bit.ly/4nOr53” -@google

2009-11-07T12:28:00.001-05:00

Today's xkcd (my favorite webcomic): "Organ Donor." http://xkcd.com/659/

Dr. Jay Parkinson's Slides from the Feast Conference

2009-10-17T14:39:00.004-04:00

The Feast 2009

View more documents from jayparkinsonmd.

More information on The Feast Conference here.

2009-10-10T15:15:00.001-04:00

Image by Stephanie Booth via Flickr

8 Ways Physicians Can Use Evernote.

Demo of MDCalc.com by Graham Walker

2009-10-10T12:37:00.002-04:00

Can't see the demo? Click here.

Editing HealthGrades Doctor Ratings

2009-10-04T23:50:00.002-04:00

Image via CrunchBase

Editing your information on HealthGrades is non-intuitive. Here's the link.

2009-10-03T11:43:00.001-04:00

The New PubMed. http://ping.fm/ttUHZ http://ping.fm/YWixu

2009-09-19T13:01:00.000-04:00

"Is an efficient physician necessarily a good doctor?" http://ping.fm/0c9HQ

2009-08-14T11:08:00.001-04:00

Someone please prove me wrong: A table of the benefits of common medical therapies (aspirin, statins, etc.) DOESN'T EXIST.

2009-08-02T12:12:00.001-04:00

Ben Franklin in the NYT Pursuit of Happiness Blog (http://ping.fm/pUvLu)

Information Overload, the Index Medicus, and PubMed

2009-07-28T08:00:00.001-04:00

Image by Nuevo Anden via Flickr

The growth of medical knowledge is difficult to visualize. One classic representation is the Index Medicus — a comprehensive index of medical journal articles — whose bound copies filled the shelves of medical libraries for 125 years. In 2004, however, the National Library of Medicine decided to stop publishing the Index. The first reason was practical: the Index Medicus had grown from 82 pounds in 1985 to an estimated 152 pounds in 2004. The second and more important reason was the widespread availability of the search engine PubMed — an electronic database of medical literature available for free via the Internet — which made the printed index obsolete. Compared to the Index Medicus, PubMed was more convenient, could be searched more easily, could be updated more quickly, and certainly weighed less. Copies of the Index Medicus are now a historical curiosity; many physicians now search the medical literature exclusively through PubMed.

The story of the Index Medicus and its successor, PubMed, illustrates three ideas.

First, the quantity of new medical information is more than any single physician can absorb, and keeping up to date with this expanding body of knowledge is challenging. As of April 2009, for example, PubMed contained information on 18,782,970 citations in the medical literature and was adding over 670,000 new entries per year. Doctors must not only absorb this flood of new ideas about treating, diagnosing, preventing, and understanding disease — deciding which information is relevant and which is not — but also learn how to apply and explain this knowledge to the patient sitting with them in the exam room or laying ill in a hospital bed.

Second, in parallel with this unprecedented expansion in medical knowledge, new media and technologies have emerged — of which PubMed is one example — which has made the task of searching, organizing, and retrieving relevant information easier. Potential sources of information for physicians include not only printed journal articles like those indexed in PubMed, but lectures, case conferences, and newer Internet resources such as reference tools (e.g., UpToDate), discussion groups, online expert systems, clinical resource tools, and podcasts.

Third, the expansion of medical information and proliferation of new technologies has required physicians to develop new skills and strategies to keep their knowledge current. Often, the availability of new knowledge overwhelms physicians’ ability to process it, a condition known as information overload. In physician’s offices, one symptom of information overload is the common spectacle of unread piles of medical journals stacked up on every available horizontal space.

While many medical schools now require classes on searching the medical literature and evidence-based medicine, few resources have been available designed to teach physicians how to learn and practice medicine more efficiently. That's why, over two years ago, I started writing The Efficient MD blog.

Since then, I'm glad to report that online resources for physicians have proliferated. Ways of improving efficiency and reducing information overload are now common topics on medical blogs. For example, see recents posts in Life in the Fast Lane, Clinical Cases and Images, and Musings of a Distractible Mind. (For more great ideas, see the list in the sidebar.)

Thanks for reading!

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(Much appreciation to Jacque-Lynne Schulman, Stephen Greenberg, Margaret Vugrin, and Dean Giustini for helping me with an updated estimate of the weight of the Index Medicus. Any inaccuracies in this post are, of course, my own.)

The New Hello Health Video

2009-07-20T10:43:00.001-04:00

Via Hello Health, Jay Parkinson's brainchild.

When Doctors Make Mistakes by Pauline Chen

2009-07-11T13:44:00.000-04:00

Dr. Pauline Chen writes in the New York Times:

"I called Dr. Colin P. West recently, a practicing general internist and the associate director of the internal medicine residency training program at the Mayo Clinic in Rochester, Minn. About three years ago, Dr. West and his colleagues published an article in The Journal of the American Medical Association on the effect of errors on physicians-in-training and on the outcomes of their future patients. The researchers found that self-perceived errors not only increased the risk of burnout and depression but also adversely affected subsequent patient care. Over time, young doctors who believed they had made errors in the past felt less and less empathy toward their patients, which then led to an even greater risk of subsequent errors."

Medical Bloggers go to Washington

2009-07-10T09:27:00.000-04:00

Via Dr. Wes:

Dr. Wes will stop blogging briefly to participate in a press conference next week entitled "Putting Patients First", to be held at the National Press Club in Washington on 17 July 2009 from 9AM-12 noon EST.

Dr. Val Jones (of the blog "Better Health") has graciously invited me to participate along with other nurse, nurse practitioner and physician bloggers to discuss issues of health care reform that directly affect doctor/patient relationship from an "Outside the Beltway" perspective. The keynote speaker for the event will be Congressman Paul Ryan, (R-Wisconsin), ranking member, House Budget Committee and the moderator will be Rea Blakey, Emmy award-winning health reporter and news anchor, previously with ABC, CNN, and now with Discovery Health.

Participants will include:

Primary Care Panelists:
Kevin Pho, M.D., Internist and author of the popular KevinMD.com blog

Rob Lamberts, M.D., Med/Peds specialist and author of Musings of a Distractible Mind

Alan Dappen, M.D., Family Physician and Better Health contributor

Valerie Tinley, N.P., Nurse Practitioner and Better Health contributor

Specialty Care Panelists:

Kim McAllister, R.N., Emergency Medicine nurse and author of Emergiblog

Westby Fisher, M.D., Cardiac Electrophysiologist and author of Dr. Wes

Rich Fogoros, M.D., Cardiologist (and yes, another Cardiac Electrophysiologist) and author of The Covert Rationing Blog And Fixing American Healthcare

Jim Herndon, M.D., past president of the American Academy of Orthopaedic Surgeons and Better Health contributor

Screenshot of Medical Apps for the iPhone

2009-07-08T14:35:00.000-04:00

Case Study of a Physician's Use of the iPhone 3GS (Part 1)

2009-07-04T12:05:00.007-04:00

I recently upgraded my original iPhone, which I purchased two years ago, to the iPhone 3GS. Truthfully, I wasn't expecting much of a change. Sure, I read the marketing hype — faster processor! 3G speed! GPS! voice control! better camera! — but I didn't expect the new model to make much of a difference in my daily clinical practice as a nephrologist.

Boy, was I wrong. I've been using the 3GS so much that by the end of the day, I've not only burned through the iPhone's battery, but I often burn through the external battery in my Mophie Juice Pack Air case as well. (I highly recommend the Mophie, by the way, which removes a subtle disincentive to using the device because you're worried you may run out of battery life.)

The following is a multi-part description of my own use of the iPhone 3GS. In my experience, the best way to learn to use a new gadget is to look over the shoulders of others, watch how they use it, ask lots of questions, and experiment constantly. (Most iPhone owners are familiar with the phenomenon of having someone grab their phone, scroll through the applications they have installed and ask, "What's that one do?")

So if you have an iPhone, and are a health care professional or patient, this will hopefully be helpful. Even if you don't have an iPhone, some of the applications I describe are available for other PDAs — or they soon will be, since the iPhone has significantly raised the bar for what a mobile device can accomplish.

(Original drafts of these posts were written on the iPhone app BlogPress.)

Advice for New Interns

2009-07-03T11:49:00.000-04:00

Edwin Leap provides advice for new interns:

1) It’s going to be hard. Deal with it. The less you whine, the more you will be loved and trusted. Learn to be strong, learn to power through your fatigue. And remember that it often takes more energy to avoid work than to just do it.

2) Do the right thing. Ethically, professionally, morally. Be the one everyone can count on to do the right thing; however hard it may be.

3) Humans, to paraphrase Blaise Pascal, are glorious and wretched. Capable of nearly angelic goodness and demonic evil, they will both thrill and disappoint you. Be neither too judgmental nor too naive. And remember that you, dear ones, are human as well.

Via Dr. Wes.

Steve Jobs and Hospital Employees

2009-07-03T00:48:00.000-04:00

The Secret Diary of Steve Jobs:

Steve, while hospitalized in Tennessee, fired several hospital employees who could not satisfactorily answer the question, "What do you do here?"

The iPhone as Mobile Computer

2009-07-01T12:12:00.000-04:00

John Gruber from Daring Fireball recently wrote on the iPhone as mobile computer. Gruber, one of my favorite technology commentators, convinced me that blogging from the iPhone can actually work well. (This post, for example, was written entirely on the 3GS.)

Gina Trapani asked her Twitter followers if they were planning to buy a 3GS, and she compiled the 175 answers into a single post for her weblog. I love the first one, from Meg Hourihan:

Yes, iPhone = my computer, and $399 is worth it. Haven’t bought new laptop since late 06 and don’t plan to for long time.

The Reading List

2009-07-01T11:10:00.001-04:00

Alert readers will notice a new addition to The Efficient MD blog's sidebar — a continually updated "reading list" of posts from other websites I enjoy, most of which have information on new technologies and advice on improving the practice of medicine. (Of course, it goes without saying that this list is a small selection of the many great medical blogs out there.)

Best Practices for Communicating Test Results

2009-06-30T21:38:00.004-04:00

Via one widely quoted Archives of Internal Medicine study:

To our knowledge, no guidelines exist to delineate the processes that practices should use to manage test results. Based on our review of the literature and a pilot study that we conducted, we defined "good processes" for managing test results as the following: (1) all results are routed to the responsible physician; (2) the physician signs off on all results; (3) the practice informs patients of all results, normal and abnormal, at least in general terms; (4) the practice documents that the patient has been informed; and (5) patients are told to call after a certain time interval if they have not been notified of their results.

The Most Creative People in Health Care

2009-06-19T23:43:00.003-04:00

Image by KidneyNotes via Flickr

Fast Company published a list of the "Top 10 Most Creative People in Health Care." Equally interesting is ScienceRoll's list of 10 people they missed.

David Pogue's Productivity Secrets

2009-06-19T23:18:00.004-04:00

Image by stevegarfield via Flickr

David Pogue is the technology editor of the New York Times. Some interesting ideas. Worth a look.

"Dear David," wrote a reader recently. "When will you share your productivity tips with us? Not everyone can write five books a year, file two columns a week, churn out a daily blog, speak 40 times a year and film a video every Thursday. What are your secrets?

Dealing with Information Overload

2009-04-02T21:12:00.005-04:00

Information overload is an occupational hazard of practicing medicine, especially if you spend time online. There's too much potentially useful stuff out there for one person to process effectively: journals, news sites, RSS feeds, wikis, blogs, webinars, Flickr, Facebook groups, CME courses, Google alerts... And don't get me started on Twitter.

Two of my favorite medical bloggers—Bertalan Meskó from ScienceRoll and Dr. Ves Dimov from Clinical Cases & Images—recently shared their methods for dealing with information overload.

Clinical Cases & Images uses Twitter innovatively, to share interesting items from his feed reader, which he then aggregates into blog posts: "Health News of the Day," for example, and "Selection of My Twitter Favorites." (What's Twitter? Twitter is an instant messaging service, a microblog, a social networking phenomenon, a chatroom, the best crowdsourcing utility ever invented, or a colossal waste of time — depending on who you ask.) Ves also discusses using Google Reader, Google Bookmarks, and shares his backup strategies.

Bertalan Meskó from ScienceRoll writes about using Tweetdeck to filter the 1000 (!) users he follows on Twitter. He also uses Friendfeed and the "best of the day" feature to identify interesting discussions. He mentions Microplaza, Twilerts, and Tweetbeep—three services I've never heard of—to filter out interesting discussions and posts. Bertalan also uses Google Alerts—of which I'm a great fan—to track any content published about him or other topics of interest. He ends with my Life Hacks for Doctors presentation, which has received more than 10,000 views to date. (w00t.)

What strategies and resources do you use to deal with information overload?

How Doctors Learn (and a Request for Help)

2009-03-22T21:28:00.012-04:00

I'm in the middle of writing a chapter on "How Doctors Learn." Seems a straightforward topic, right? Sit down and listen to lectures, flip through journals, examine and treat patients, and look up anything you don't know. Of course, the process of learning medicine is worlds more complex than that, but it's not something we usually spend time thinking about. So to help make sense of it all, I fired up my well-worn copy of MindManager and constructed the following mind map. (Click for larger version in new window.)

I'm betting half of you will say I've made a simple process, complicated — and the other half will say I've made something complicated, simple. But please: tell me either way. Do you disagree with the way I've divided learning — self-directed, directed, and undirected? Is there a major learning technique or resource I've missed? (Other than, you know, "mind mapping.")

Please note this is version 1.0 of this diagram, and I welcome your comments.