The Orthopedic Posterous

Musings of a Patient Centric, Social Media Savvy, HC 2.0 *Friendly* Orthopedic Surgeon 

An all too common occurence in the doctor's office... #hcr,#hcsm,#pm

Graphic from thisisindexed.com...

A few months ago I had a blog post that dealt with the issue this graphic brings to light. Until health care reform enables more physicians to spend more time with their patients--- or until Hello Health takes over health care ... the following post should prove quite useful.

For those interested in my previous post on this topic, please refer to: http://hjluks.posterous.com/new-patients-are-you-prepared-for-your-visit

The unfortunate reality today is that most physicians; primary care and *specialists* alike are pressed for time. Many feel the need to put many (perhaps too many) patients on their schedule and few physicians are sympathetic to the plight of the patients in the waiting room.

Physicians were taught how to interview their patients... but somebody forgot to teach the patient how to communicate with their physician!!!

Because of these issues, it is critical that you are organized and ready for your visit. Not only do you need to dress appropriately, but you should have a few accouterments with you and your thoughts should be organized and well rehearsed. If you are organized you will not be as nervous and you will be able to properly discuss the pertinent issues with the physician---thus enabling the physician to help you.

As mentioned in my previous post, a pen and paper are a must. A smart phone with Evernote would be useful to snap pictures of the algorithms or diagrams the doc might draw for you on the chart or a whiteboard.

Physicians are taught to organize their thoughts in a certain manner. You should spend a few hours getting your thoughts together... do not wait until the morning of the visit... you WILL forget something important. Issues for you to consider:

  • What are your symptoms?
  • When did your symptoms begin?
  • What were you doing when they began?
  • When your symptoms began, had you recently changed medicines, shoe-wear, exercise regimen, started taking herbs/supplements, etc, etc, etc ?
  • What precipitates your symptoms?
  • When are your symptoms worse? (Morning, evening, coughing, sitting, supine, prone, after eating, etc, etc,)
  • What relieves your symptoms?
  • Anyone in your family have similar medical problems?
  • Who have you seen for this problem?
  • What tests did they perform? (BRING COPIES WITH YOU)
  • What medications are you on? (BRING A LIST)
  • What other medical problems do you have?
  • What allergies do you have?
  • Have you had surgery previously?
  • Where, when, why?

For the exam, dress appropriately so the area that needs to be examined is accessible.

After the exam, your physician will review the pertinent studies which have been performed.... X-ray, blood tests, MRI, etc. Take notes!!!

After the physician has completed your history, physical exam and review of your studies they will likely arrive at a diagnosis, or a list of potential diagnoses. Take notes!!!

After the physician has discussed the diagnosis(es) with you, you will have the chance the ask questions... this is where most patients are too nervous to think quickly or clearly... and this is where it matters the most. If you have previously written down your questions, you will feel more confident and your thoughts will be more organized---thus allowing you to get the most out of your visit.

The questions you may want to address include (but are not limited to):

  • Are there other possible diagnoses?
  • Are there other experts I should consider seeing?
  • Do you feel comfortable treating patients with this?
  • Is further testing necessary (If the test will not change the plan of care, then it is possible that you do not require further tests)?
  • What are the non-surgical and surgical alternatives available to treat my condition?
  • What are the possible risks, side effects of the treatment?
  • What will happen if I choose not to have surgery?
  • What does the scientific literature or research recommend (many physicians still practice based on anecdotal experience [which might be appropriate, depending on the situation])
  • Ask for online content references. 
Hopefully this helps ... as usual... Do not consider this medical advice.  

Posted by Howard Luks 

Comments [8]

Great Graphic Depiction of a Common Doctors Dilemma #hcsm #pm #hcr

Everyday--- and hopefully in many other physicians' offices the graphic representation above is *playing out* in various scenarios.

  • How much information do you share with the patient...?
  • How do we give the patient enough *correct* or *pertinent* information without exceeding their capacity to absorb it?
  • How much is too much?
  • Is there such as thing as too much information?
  • many will say "yes"
  • many will say "no"
  • Some patients want to know *everything*
  • Some patients want to know "nothing"
What the risk for "analysis paralysis"?

I firmly believe that patients should be utilizing many available tools... both social media based as well as academically oriented platforms... to improve their understanding of their *disease* or condition, and to understand the options available. Unfortunately, many patients do not want to assume this responsibility, nor are they looking for much information from me. This may seem bizarre to the Particpatory Medicine, or patient centric savvy patient or provider, but it is what it is.

How much info is too much info... who decides how much is too much and when do some patients receive so much information that they reach the end of the curve and suffer from analysis paralysis???

Interesting subject matter

Posted by Howard Luks 

Comments [10]

Health Care Social Media ( #hcsm) Wrap Up--- and some additional thoughts

The trend is certainly intact... patients, other health care professionals and even hospital adminsitrators were all engaged this past week with the goal of improving their understanding of their condition, their *postion* or *role* in #hcsm and with the goal of helping *their* physicians engage the consumer utilizing Social Media.

Digital Communications:  Something that came up during last weekends #hcsm Tweetchat.... Is digital communication part and parcel of Social Media?  If a physician engages his patients by allowing email communication, is that considered a form of social media outreach.  I think the easy answer is no, but I do not think there is an easy answer to this issue.  Social Media outreach--- with the purpose of improving the knowledge base, access and health of our patients is  a relatively new concept.  In that context I believe that digital communications (email) should be considered a final common pathway of sorts...

In my own experience, patients, providers,  adminsitrators or interested 3rd parties are engaging me on twitter, FB or through my blog and website... if they desire to *take it to the next level* they email me through FB or my website and now the contact becomes memorialized in Outlook or Xobni.  Therefore, until HIPAA compliant mechanisms are in place to enable me to engage patients on FB or twitter, a compliant institutional encrypted server will need to serve that purpose.... so, for the time being I will continue to consider email to be an important component of a successful social media outreach program.  

FB/Twitter:

FB: More than 35 patients or potential patients reached out to my personal FB page this week...  I'm still trying to get my "professional page" going so *friending* them back will take some time.  If I can *borrow* some time from anyone to help complete our professional FB page, I will be eternally grateful.  

Twitter: Twitter usefulness continues to evolve and to be honest, continues to amaze me.  There are some absolutely brilliant people on there and I am engaging, learning, educating and interacting with them on a daily basis.

EMAIL:

55 emails were received this week.... issues were scattered. 

  • verifying surgical schedules and pre-op instructions
  • verifying pre-office visit information
  • questions they *forgot to ask*... patients still tend to be very nervous in a physicians office.  Thus the reason for this previous post.
  • clarification... pls bring a pad and pen to your visit. 
  • receipt of scanned medical records from previous providers.
  • two testimonials which I've yet to add to my site... Yes... the testimonials on my site are REAL and UNSOLICITED :-) 
  • three requests for interviews for "social media friendly" physicians.
  • two pictures and one video of patients sent to me to show how their incisions are healing and how they are progressing with their PT. 
  • A nice back and forth with a SoMe savvy hospital adminsitrator looking to gain a physicians perspective to guide their efforts at helping physicians in their network initiaite a SoMe *campaign*

Well... I'll keep it short and sweet.  As stated earlier, the trend is intact... Social media and health care--- with the purpose of educating, sharing, collaborating, and innovating are inexorably linked, hopefully forever. 

great stuff!

 

Posted by Howard Luks 

Comments [0]

Safety Gurus: Penalize Doctors Who Don’t Follow the Rules

Docs and nurses who fail to follow rules about hand hygiene or patient handoffs should lose their privileges for a week, Pronovost and Wachter suggest. They recommend loss of privileges for two weeks for surgeons who who fail to perform a “time-out” before surgery or don’t mark the surgical site to prevent wrong-site surgery.

Worthwhile concept... Hand washing, eliminating white coats, ties and safety checklists save lives. Docs push back against these lists because they *can*. Strange, but true.

Penalties and punitive threats exist in most hospital by-laws. Most penalties, however, are geared towards encouraging the physician to complete medical records (for billing purposes), and dictating reports in a timely manner (for JCAHO and billing purposes).

Perhaps it is time to extend those threats to situations when patient safety protocols are violated.

Posted by Howard Luks 

Comments [0]

Senate's plan to salary physicians... Thanks to @DrWes

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There it is... in the mark up document above... page 24

– Insert a new bullet as follows: ―3. Promote care coordination between health care providers that transition health care providers away from fee-for-service based reimbursement and toward salary-based payments

Although it's in black and white... the *true colors* of the health care reform package effort are coming through loud and clear.

Physicians account for less than (I believe) 10% of the overall health care cost burden, yet are always in the cross-hairs. Should be an interesting week.

Posted by Howard Luks 

Comments [0]

Voted *one of the best* surgical blogs... ?

Bertalan Meskó, MD who graduated from the University of Debrecen, Medical School and Health Science Center in 2009  has been running the award-winning medical blog, Scienceroll, for almost 2 years now. He thinks medical education and communication between physicians and patients will be revolutionized with the tools and services of web 2.0.  His Webcina project empowers providers and patients to become more proficient in the 2.0 world. 

Today he recognized my website, www.howardluksmd.com and my blog as one of the best surgical blogs available to the 2.0 audience. I appreciate the plug... not sure I agree... there are some phenomenal blogs and sites out there... but once again, thanks @berci !!

Posted by Howard Luks 

Comments [0]

Health Care and Social Media... #hcsm weekly recap

Now that I have been closely observing the various interactions (and their origins) I have been having with patients, administrators, consumers, physicians and other health care professionals--- it is clear that the impact of digital communications and social media is pervasive throughout my daily activities. 

Clinical emails....

  • This week I addressed 74 emails generated through my website directly, referrals through Twitter, FB or from patients who were previously given the address...
  • 46 were first time contacts..
  •   6 were from health care consumers across the US looking for *assistance*.... one comment "...thanks again for your great site (and availability). Your whole approach is so refreshingly different from the usual Dr/patient relationship..."
  • 4 emails were from patients with relatively acute issues.... not sure this is the best means of using email/twitter.  Thankfully everything funnels through to my blackeberry so I will usually get the emails or DM in a timely manner. 
  • 8 emails were for med renewals... or requests for new medications. 
  • 2 emails actually came from patients in the hospital !!  Both were giving feedback on their progress with physical therapy, etc.
  • two complaints (about hosp food and operating room delay) were received. 
  • Received two emails with suggestions on things to add to my personal website.  www.howardluksmd.com
  • Avg age was 47, a bit younger than previous weeks. 
  • My secretary is very pleased with the fact that I am routinely utilizing email.... it is making her job easier and far more efficient.

Professional emails ....

  • 4 emails were from health care social media professionals looking to possibly develop a *relationship* with a practicing physician who could potentially complement their current team of social media *experts* .... this is very exciting and could spawn a new career interest. 
  • One email was from a software company looking to develop a #hcsm product and they are looking for a *partner* & front end user who is "social media savvy". 
  • Three emails came from other physicians looking for guidance or assistance in initiating a social media "campaign".  Their wording.  Seems like most physicians want to be "out there" predominantly for the percieved PR benefits. 
  • Received one offer to contribute to article to be submitted for publication to a major orthopedic journal.... topic: #hcsm and physicians

Four new patients to the office were referrals from Twitter or personal website. 

Seven patients came to the office with print-outs and information from online content sites, Wikipedia and other social media portals....eg.  (www.slaptears.com

Two patients noted that the link to the article they brought was from twitter.  The rest were the result of a google search. 

One patient asked if their data was available for upload to PHR... I didn't ask which PHR product they use. 

My group met with a Hybrid EMR vendor.... I mentioned that we will not proceed with purchase (it is our favorite product) until they have a patient communications portal and PHR or *PHR like* module.   I offered to assist them in developing the module from the viewpoint of a potential avid front end user. 

 

My twitter activity was minimal this week... too little time, and family comes first after taking care of my patients. 

 

Well... that was it.... any questions?  Anything else I should be looking for?

 

Posted by Howard Luks 

Comments [0]

Warning: The Deficits Are Coming! - The Wall Street Journal.

I thought you would be interested in the following story on WSJ.com.

Warning: The Deficits Are Coming!

http://online.wsj.com/article/SB10001424052970203585004574392620693542630.html

The Wall Street Journal Mobile Reader for iPhoneTM delivers the latest global news, financial events, market insights and information to keep you ahead of the curve. Get the information you depend on plus entertainment, culture, and sports coverage when, where, and how you want it from the most credible source for news and information. Click below to download the WSJ Mobile Reader for free from the iTunes App Store.

http://www.wsj.com/iphoneinstall

Sent from my iPhone

Posted by Howard Luks 

Comments [0]

A Laymans view of the Health Care landscape and the need for reform... including his well formualted plan.

After the needless death of his father, the author, a business executive, began a personal exploration of a health-care industry that for years has delivered poor service and irregular quality at astonishingly high cost. It is a system, he argues, that is not worth preserving in anything like its current form. And the health-care reform now being contemplated will not fix it. Here’s a radical solution to an agonizing problem.

This truly is a must-read for anyone even remotely interested in the issues and complexities that exist in the health care system. For a *layman*, David's grasp of the issues and his suggestions for a consumer centric approach demonstrate a grasp or level understanding of the issues at that far exceeds that of many insiders and docs who have been trying to work from within for decades.

A great article...

Posted by Howard Luks 

Comments [0]

Health Care and Social Media #hcsm #hcr A Breakdown from *the trenches*. Part II

We were busy tonight... after seeing patients we were tabulating poll results and looking deeper into the agism concept that older individuals will not utilize Soc Med with the same zest as younger generations. 

Social Media Update:

Yesterday two patients received notification of an article pertinent to their condition through twitter... I posted the article and emailed them about tweet.  I do not think we can specifically address an article to a patient on twitter without revealing their diagnosis....

Today... One patient showed up with MY LIST I had on this blog a few weeks ago about how to prepare for first appointment with an orthopedist!

Poll

Today. 42 ppl answered a poll.... avg age was 41.  Range 15-81....

  1. would you use email to communicate with my office36/42=yes
  2. have you used email to communicate with a physician 8/42=yes
  3. would you use twitter or facebook to communicate with a physician 12/42-= yes
  4. have you used twitter or FB to communicate with physician 1/42=yes
  5. Can Social Media *change* the way medicine is practiced... 24/42=yes  (seems like an outlier)
  6. Have you used social media specifically (not google search for article) to research a health care topic. 28/42=yes (including an 80 yr old)

Concerns about Soc Media/Email communication: (answers written in, only 25 gave me responses.)

  1. Not sure how to use social media to reach out.
  2. WILL YOU REALLY ANSWER MY EMAILS !!  (they don't trust that docs will adopt these technologies) --- by far, the most interesting answer!
  3. Privacy (a distant third) eg. who else can read my email?  Will you be the one reading/answering my email?  

Email Breakdown

We pulled nearly 100 recent emails:

  • all were *appropriate* for email communication---short concise, easy to answer issues, questions. 
  • One complaint...
  • many used to reschedule appointments, surgery dates.
  • nearly 1/3 used for clarification of discussion we had about disease, procedure, risks, expectations, etc.
  • 12 ppl offered links to articles they thought I might find interesting!!!  Great stuff
  • One programmer editted my website--- some nice subtle changes... love it!
  • My secretary believes emails---and my replies--- saved her well over 3-4 hours of *work* 
  • Average age was 48...  range 16-80+
  • Patients under 35 interested in return to sports, driving, etc.
  • Patients over 35 concerned with return to work, pain, "any questions I forgot to ask".  
  • No one person sent more than 3 emails... I have only had one person *abuse* the **priviledge** of email communication. 

Bottom line... social media and email communication in health care is here to stay.  This is only the tippy top of the iceberg.  Who cares if I don't get paid to answer the email.  In a timely manner I was easily able to address *important* open issues, put patients at ease, offload some of my secretaries incredible workload and allow her to concentrate on activities that drive ROI.... scheduling new patient visits, surgeries, studies, etc.  

Agism--- the *elderly* are clearly adopting these technologies and using them wisely.  Do not ignore them if you are considering a soc med campaign!!!  

Lot's of *work* accomplished today....  

 

Posted by Howard Luks 

Comments [2]