Doctors & Social Media & Afib

From: Dr John M <[email protected]>
Date: Fri, Feb 28, 2014 at 10:33 AM

Doctors and Social Media — It’s time to embrace change.

Posted: 28 Feb 2014 04:07 AM PST

I recently took on a position of medical journal editor. It is with the Journal of Kentucky Medical Association.

It’s been a good learning experience. Part of the job of editorial board members is to write an opinion column. (Check, I’ve done that before.) What follows below was published in this month’s journal.

The editorial board put no restrictions on me. So I decided to write about social media and why it is time that doctors make the leap from analog to digital. (It breaks the less than 500 words rule.)

The Greek philosopher Heraclitus gets credit for the idea that change is central to the universe. Physicians know this doctrine well. For us, in the practice of medicine, change is a constant. And in recent years, a major vehicle for change is the Internet and social media. Facebook boasts more than a billion users, Twitter more than 120 million, and up to 80% of patients go online for health information. Google yourself and you will discover your digital footprint—whether you like it or not.

Social media expert Dr. Bryan Vartebedian (Texas Children’s Hospital/Baylor College of Medicine) writes that there are two realities of online reputation management: 1) you have no control over what people say; and 2) you have 100% control of the story you create. Yet doctors have been slow to embrace social media. That’s not surprising; we are hardwired to be risk-averse.

It’s true; engaging with social media brings risk. That which is digital is permanent—a sobering reality for sure.

But I ask: What medical intervention, what shot at making things better, comes free of risk? A rule of doctoring is that to do good a doctor must risk doing harm. A distinguished heart surgeon once consoled me—after I had caused a procedural complication—that if I didn’t want complications, I shouldn’t do anything.

It’s the same with engaging in social media. In the hyper-connected world of 2014, medical professionals have reached a fork in the road. One path is a road well traveled. On this familiar route, we continue to keep our heads down, stay in the weeds, out of trouble. Don’t wiggle; don’t rock the boat; check the boxes; fill out the forms and accept what comes. Don’t dare engage in the online conversation. Choosing this path is like not treating a disease: less ownership confers less personal risk.

The purpose of what follows is to encourage you to consider the other path: the path of engaging in the online conversation and using the tools of social media to enhance the good that can be done—for patients, for ourselves, and for the profession at large.

As a multi-year participant in social media, I see more benefit and opportunity than risk. Here are five factors to consider while pausing at that fork in the road.

First, consider the blank-slate status of the playing field for health care social media. Beyond common sense and decency, there are few rules. Digital natives—like me, and perhaps you—will make the rules. Pause for a moment here and consider that idea: making rules rather than following them. Sounds good, doesn’t it?

Second, as a doctor, you are different. People will listen to you; your voice matters. Currently the Internet overwhelms people with information but, too often, the details come in the form of highly edited groupspeak from medical societies, or pseudo-science from people selling things, or anecdotes from patient forums. What patients really want to read is what their doctor says. How does John Mandrola feel about anticoagulation; what does James Patrick Murphy say about opioid addiction, and how does Kathy Nieder feel about electronic medical records?

Third, social media can be therapeutic. It’s an understatement to say morale amongst caregivers is low, and sinking lower. The primary reason for this, I believe, is that joy is being debrided from our job. It’s as if joy is extra; there’s not time for it anymore. Bulleted HPIs and 10-pt review of systems replace the beautiful stories; white screens inhibit human-human connections; and appropriate use criteria supersede the pleasure of using clinical judgment. Social media offers an elixir, a chance to reflect about what is still so good about our work. When you write, or Tweet, or blog, or create videos, you are forced to dwell on the patient who actually lost the weight, the pacing lead that found the perfect branch of the coronary sinus, or the family who sent you a Thank You note for having had the courage to discuss end-of-life care. What’s more, the social aspect of social media connects you with colleagues across the world, not just your hospital’s doctors’ lounge. I regularly connect with colleagues in Germany, Australia, and the UK. This is nice.

Fourth, social media can make you a better doctor. The pace of change in health care is increasing. Look no farther than the new cholesterol and hypertension guidelines. In the course of three weeks in late 2013, two ensconced paradigms of cardiovascular medicine were upended. Social media covered the story in real time; print journal coverage came later. Another example: one of my favorite types of sessions at medical meetings is the pro/con debate. Social media brings these lively discussions to your smartphone or tablet. (In fact, as a participant in social media, you could be a debater.) The challenge for physicians of the past was having enough to do for patients. The challenge for today’s caregiver is about managing the expanding menu of options. Staying current and informed has never been more important. The micro-blogging platform Twitter allows easy curation of content from trusted sources as it comes available. Another aspect of creating content is the depth of knowledge it requires. In this way, I have no doubt that participating in social media has made me a more informed clinician.

Finally, the democracy of social media levels the playing field of influence–for patients, doctors and even journalists. The blog and Twitter feed of stage IV breast cancer patient Lisa Adams has stirred the mainstream of journalism and medicine. When writers Bill and Emma Keller (of the NY Times and the Guardian, respectively) weighed-in on Ms. Adams poignant posts, a torrent of criticism and conversation followed. The vastness of the response (from the New Yorker, Wired, NPR, Atlantic, The Nation, the American College of Oncology and many more outlets) removed any doubt that social media has transformed the sphere of influence.

I recently presented at an Indiana University Medical Student Council Leadership conference. One of the other speakers, Dr. Richard Gunderman, a radiology professor and author, told attendees about the importance of narrative. “If you can tell a story, you are a leader. Stories are powerful. Medicine is story-penic.” He went further, speaking a truth well known to today’s clinicians: “there are things in medicine that need to be said. But it takes courage to speak candidly…. If you are courageous, you are a leader.”

My recent experience provides proof of this concept. Although I am an academic nobody, at the 2013 Heart Rhythm Society Sessions I shared a stage with three other distinguished leaders in the field. Why? Dr. Rich Fogel, the president of HRS said this when I posed the why me question to him: “John, you say things we need to hear.” Social media gives regular doctors a voice, a chance to influence.

Perchance I have piqued your interest in social media, that the benefits outweigh the risks, the peril of not engaging greater than engaging. If so, I invite you to read my Ten Simple Rules for doctors on social media and follow me on Twitter at @DrJohnM.

John Mandrola, MD

Related posts:

Ten simple rules for doctors on Social Media
As a novel communication tool, Social Media will improve doctoring.
Social Media as an agent for change in healthcare information

13 things to know about Atrial Fibrillation

Posted: 27 Feb 2014 07:15 AM PST

Here are 13 things I tell AF patients.

I am sorry that you have AF. Welcome to the club, there are many members. (Three million Americans and counting.)
I know how it feels.
Your fatigue, shortness of breath and uneasiness in the chest are most likely related to your AF.
AF may pass without treatment. Really.
Important new work suggests AF is modifiable with lifestyle measures. As in you can help yourself.
AF isn’t immediately life-threatening, though it feels so.
Worrying about AF is like worrying about getting gray hair and wrinkles. Plus, excessive worry makes AF more likely to occur.
Emergency rooms treat all AF in the same way. One hammer — often a big one.
There is no “cure” for AF. (See #5)
The treatment of AF can be worse than the disease.
The worst (and most non-reversible) thing that can happen with AF is a stroke. For AF patients with more than one of these conditions: Age> 75, high blood pressure, diabetes, heart failure, or previous stroke, the only means of lowering stroke risk is to take an anticoagulant drug. Sorry about the skin bruises; a stroke is worse. Know you CHADS-VASc score.
The treasure of AF ablation includes eliminating AF episodes without taking medicines. But AF ablation is not like squishing a blockage or doing a stress test. It will be hard on you. It works 60-80% of the time, has to be repeated one-third of the time and has a list of very serious complications.
If your AF heart rate is not excessive, it’s unlikely that you will develop heart failure. Likewise, if you have none of the 5 risks for stroke, or you take anti-coagulant drugs, AF is unlikely to cause a stroke. In these cases, you don’t have to take an AF-rhythm drug(s) or have an ablation. You can live with AF. You might not be as good as you were, but you will continue to be.

There’s obviously more than 13 things to say about AF. It’s a complicated disease with many different ways to the same end. We need adequate time with our patients to give them this kind of powerful knowledge. They need time to digest all the possible treatments, or perhaps no treatment. Patients need to weigh the disease against the treatments.

All this is why AF treatment should not be rushed.

JMM

Related posts:

The best tool for treating atrial fibrillation
Answering the critics of atrial fibrillation ablation
Is it better to burn or freeze atrial fibrillation?

Mostly good points I agree with, but he massively underestimates the impact of uncontrolled AFIB on people's lives in my view. Yes,
in some milder cases with lower intensity and more benign arrhythmia you can just 'learn to live with it', but that ignores the relentless ongoing progression of remodeling as well only making any future attempts to address it that much harder to pull off. Dr John is a well meaning EP in my view and has some good points to share but like many docs, their view can be skewed to a degree by inly seeing patients in snapshot 15 to 30 minute meetings once or twice a year.

And, as a not overly experienced ablationist, but one representing the typical average ablationist out there, I notice that he often conveys less confidence in the procedural process of current ablation tech, as that more or less reflects his own experience. Which is another reason I urge folks to shoot for the most experienced EP the can for an ablation when the time comes, and one who exudes confidence in their own ability to dramatically improve your life with much reduced risk and had the track record to support that confidence.

Its easy to take a snapshot too of a set of stats like that to build one's case, but in the process lose track of the ongoing dynamic of actually living with the beast long term as it inexorably gets worst when little is done about it with good effect. Dr J did have a few runs of AF during bike racing, but from his reports it was very transitory and infrequent so far. We all know how easy it is to dismiss or push aside AFIB when you are back in NSR. But 'just living with it' as is, straight up, as he suggest is not realistic unless you have truly asymptomatic persistent AFIB and don't even realize it. Still, the odds of having your ticket punched early definitely increase even in that best case scenario
that just might accommodate a 'just live with it' cavalier approach.

Shannon



Edited 1 time(s). Last edit at 03/04/2014 08:01AM by Shannon.