Twitter buzz about papers does not mean citations later | Nature →

The title of this article should be updated to include ‘…for now’. Despite the number of active participants we see in our own online circles, the use of Twitter among academics is still relatively novel. Among my professional colleagues [1], I would estimate less than %10 actively participate online and even less than that use it as a professional tool [2]. Among my medical school classmates, use is muuuucch higher, but again, students are largely not using it as a professional tool and certainly not using it to keep up-to-date on the latest research. In the near future, this will change—more and more academics will become active on social networks and a greater percentage of their use will be for professional purposes.

  1. That is, more senior colleagues that I research with and those working as attendings.  ↩

  2. As opposed to using social media to keep up with friends and family or interacting with other for purely recreational purposes.  ↩

Doctors and Secondhand Stress | 33 charts →

An excellent post from Doctor V. I truly think this begins with scheduling. I have worked with physicians who regularly overbook their schedule; their care suffers. They don't think it does; they tell themselves that they are doing a service to their patients by squeezing an urgent appointment in, but neither is true. Good medicine takes time. Avoiding passing on secondhand stress is partially about mindfulness and focus when you walk in the exam room door, but this is certainly better accomplished when you aren't thinking about the 5 other patients already waiting.

Finally, Digital Health Startups Get The Same Toys As Everyone Else | Omada Health →

This is an older link, but I missed this news originally and think it is vitally important to anyone interested in medicine and technology. In the past, many tech companies that provide useful tools for startups (like Amazon Web Services) were not taking the necessary steps to become HIPAA-compliant (in terms of signing contracts; their services have been plenty secure for some time). Changes to HIPAA within the HITECH Act—which took effect in Sept 2013—meant these companies would have to start complying. Thus, many new tech tools are now available to digital health startups.

Medicine's Problem of 'Incidental Findings' | The Atlantic →

The notion of 'incidentalomas' and their consequences is well-known among doctors. The lay public is less informed. In writing about one of her own experiences with a patient, Danielle Ofri MD says:

Nevertheless, I felt boxed into a clinical corner, forced to order expensive and complicated tests to rule out the minute chance of malignancy.

This is the ultimate outcome—more tests and more stress for patients. Both doctors and patients are risk averse and will almost always want to pursue further workup of an incidental finding. As noted in this article, we need to anticipate the likelihood of incidental findings and have a plan to deal with them. Be proactive, not reactive.

Are Today’s New Surgeons Unprepared? | NY Times →

Pauline Chen MD presents, in her usual excellent fashion, an examination of resident work hour restrictions' impact. Restricting hours is proving to be far too a simplistic solution for a complex problem.

Doctors crowdsourcing primary care | Short White Coat →

Project ECHO was developed 'as a means of sharing specialist knowledge with primary care doctors practicing in rural New Mexico' using telemedicine technologies. Seems like such technologies may be better suited to providing specialist education for providers, rather than attempting to conduct specialist visits with patients.

cTAKES: Turning clinical notes into knowledge | Vector →

I’m happy to see this open source project from Boston Children’s. I was very impressed to read that cTAKES can ‘help build clinical timelines.’ Paper records compartmentalized data (e.g.—different sections for notes versus laboratory data) and did not lend themselves to re-orginization (e.g—stuff was written in ink). Moving around bits is obviously much easier and we need tools to put patient data into the most comprehensible order—chronologically.

Doctors need to take the reins of the mHealth movement | mHealth News →

Eric Wicklund reporting for mHealth News:

[Data overload] is what’s plaguing the mHealth movement right now—too much data coming in from too many locations that don’t have any effect on the patient-provider relationship, and which may even be having a harmful effect.

Something sorely missing from current medical education is data science. Med students and residents receive cursory classes in epidemiology and biostatistics, but so rudimentary it is basically useless. Physicians will be challenged more and more with massive amounts of data. We can sit back and let others—epidemiologists, data scientists, computer engineers, startups, etc—define what role such data will play in the practice of medicine or take on leadership in this arena. It starts with much needed medical education in data science.

You're Getting Too Much Healthcare | The Atlantic →

How do we cure this plague—an intimate understanding of the probabilistic nature of medicine and effective communication. Nothing in modern medicine is absolute [1]; every diagnostic investigation and therapeutic intervention comes with benefits and risks. Unfortunately, the human mind struggles with accurately quantifying probabilities, both as doctors and patients. This is why communication is so critical. The word ‘doctor’ finds its roots in the Latin word docere, to teach. We have to take the time to educate our patients, to help them understand the complex, probabilistic nature of medicine. Time is limited, but critical to ensuring high quality care.

  1. Genomic medicine has the potential to change this and bring us closer to more precise, personalized medicine, but we have a long way to go in this field.  ↩

Why Are Doctors Still Using the Stethoscope and Manila Folder? | Medscape →

Michael Splinter:

Yet when I walk into my doctor’s office, it is a time warp — not back 25 years but more like 200 years…[The stethoscope] is a truly archaic device and yet we trust our lives and health to it in a way that is out of touch with the world we live in today. The stethoscope has no ability to record information; it has no ability to analyze information. Its successful usage depends totally on the practitioner at the moment. I wonder how much harm and delay the stethoscope causes these days in missed diagnosis or inaccurate conclusions.

An excellent question and all around great post, especially regarding paper medical records.

Certification Exams: Are We Testing Recall or Judgment? | Am Board of Pediatrics →

Great to see a medical board seriously thinking about and discussing open-book exams. This post from the American Board of Pediatrics does a nice job laying out the pros and cons of such a system. Two important issues they raise:

Previous exams have “ample psychometric data in support of [their] fairness, validity, and reliability”—Although any new testing format would need to undergo a tremendous amount of testing, this should in no way hinder improving an exam. The above statement means that the ABP board exam has good internal validity [1] but has no bearing on its external validity [2]. Board exams, at all levels, need to reflect the real-world practice of medicine. Kevin Pho MD wrote eloquently about this over 3 years ago on his blog.

Cheating—This is a solvable problem by controlling the testing environment. Test-takers could be limited to a select number of commonly used resources, not the full internet [3]. Or, all internet traffic for the examinees could be monitored. The potential for cheating should not be a significant barrier to changing exam formats. Even with the current exam mechanisms, cheating happens.

I previously wrote about why exactly I think we need open-book testing in medical eduction. The practice of medicine is about finding the right answer for your patient, not how you find that answer.

  1. That is, how well the exam tests what it is supposed to test and performs year-to-year between similarly skilled test-takers.  ↩

  2. How well the exam tests someone’s skill at actually practicing medicine.  ↩

  3. Admittedly, such a system would have its own issues, most notably implicit endorsement of certain clinical resources.  ↩

Scientists Now Know When You'll Get The Flu Nine Weeks Before It Happens | FastCo Exist →

This new algorithm from researchers at Columbia University’s Mailman School of Public Health combines data from Google Flu Trends and weekly reporting from the CDC’s surveillance network. Apparently, the addition of the CDC data dramatically improved predictions over just using Google Flu Trends.

How accurate and predictive would such models be if we could combine data from Google, Facebook, and Twitter with real-time results from a large network of hospital microbiology labs? Hospital micro labs generate a ton of useful data each day, yet it sits siloed within each hospitals’ walls.

Enhancing Physicians’ Use of Clinical Guidelines | JAMA →

Peter Pronovost MD PhD:

The EMR is just one source of data in an information ecosystem that includes, for example, infusion pumps, ventilators, and an ever-growing list of home diagnostic devices. None of these technologies communicate and share data. Rather than being the solution to providing better quality and achieving lower costs, the EMR can be the documentation tool for the information ecosystem. The enhancement of the ecosystem will be software applications, written on an interface platform, linking the EMR to multiple devices, creating an information ecosystem.

Everything Dr Provonost discusses in this piece is spot on, but we need something more. It needs to be easier to use a guideline than to not use it. We need a ‘frictionless’ experience to unite guidelines and patient care. Clinical guidelines and computerized physician order entry (CPOE) should not be two separate things, but one and the same. Order sets [1] are a rudimentary version of this frictionless experience. We need to take the next step and place the evidence directly next to the orders with data from the ‘information ecosystem’ informing both the evidence and order choices [2]. All of this technology exists; now we only need the time, money, and will to bridge the gulf between guidelines and care.

  1. Paper forms (now electronic) prefilled with choices for diagnostic tests and medication orders for a given condition.  ↩

  2. For example, let’s say a child is admitted to the hospital for community-acquired pneumonia and this child has a history of anaphylaxis with penicillin. The system would automatically recognize ampicillin and cephalosporins are not ideal for this particular patient and only give clindamycin as an appropriate choice. The system would also tap the hospital’s antibiogram to inform antibiotic choices.  ↩

Medical research needs kids, but parents not aware of opportunities | Mott Children's Hosp/Univ of Michigan →

Overall, 44% of parents indicate they would consider allowing their children to participate in medical research if he/she had the disease being studied.

I find that number dishearteningly low. Pediatric medicine has long suffered from being a neglected area of research. Many important research questions exist in pediatrics and we need the active participation of parents and children to answer them. To me, this number says we need more active engagement with parents and children to empower them as partners in our research endeavors.