Archive for April 2011

The Twitter diagnosis: A doctor’s dilemma

Several miles into a long run last week, I started to feel a pang of pain with which I had grown familiar. I knew I would need to stop to “shake it out,” then slow my pace substantially until I could regain my stride and run through it. Because I’d had the same pang around the same mile for the past two weeks, I started thinking that I should talk to my family doctor about it. My first thought wasn’t to call her office – it was early on a Saturday morning, after all – it was to tweet it.

In addition to my personal Twitter account, I am one of the administrators for TAFP’s account and I know several of our family physician members who follow our feed. My tweet (from my personal account) would have gone like this: “Need advice: Sharp pain in the outside of my left knee near my kneecap around mile 7. Is this serious? Should I wear a brace?” With the remaining 15 characters, I would have tagged a few physician friends, none of whom is my personal family doctor.

As I kept plodding through the miles, I decided it would be unprofessional for me to use TAFP members — even those I consider to be friends — to give me a free diagnosis. However, I wondered if it would even be possible or ethical for a physician to give a diagnosis in 140 characters.

The way people communicate is obviously changing. Thanks to smart phones, we’re always plugged in checking e-mail, texts, and social media apps like Twitter and Facebook. More people post more information about themselves online, and connect with others by reading a digest of friends’ activities rather than calling, visiting, or (gasp) sending a letter.

Doctors are no exception. A growing faction of physicians supports expanding the use of social media to hash out ideas and drive reform for our health care system, market their practices, and share health information with medical students and patients. Some of these tweets are traceable through their hashtags, including #FMrevolution and #hcsm.

As explored on a recent blog post from KevinMD.com, the author writes that the application of social media to health care is “a strong candidate for bottom-up change.”

“It’s at least worth considering that, appropriately utilized, social media could do something for the doctor-patient relationship akin to what Facebook and Twitter is doing for family, friends, and business relations all over the world. … Many physicians and medical students that I know have not yet begun to wade into the Twitter waters or explore blogging. These tools must be engaged with before they are applied. I think there’s reason to believe that the very act of engagement will stimulate ideas for implementation. If big changes in health care are going to be bottom-up, and these social media tools are truly useful, then simple exposure to physicians on the ground may likely instigate much progress.”

 To satisfy my original question, I sent a tweet that tagged a few active tweeting doctors. In their experience, had they come across any barriers working with social media? Did they think these applications could only be used for social purposes, or could they be expanded for clinical purposes as well?

Respondents said that they had come across barriers, the biggest being concern for patient privacy that limits what a doctor can actually say. There are also personal-professional boundaries. However, they resoundingly supported social media being used for more than just making friends.

They said that patients seem more prepared to incorporate some social media into their medical care than doctors, and that physicians must overcome larger mental and perceived barriers for adoption. One said he faces the task of convincing skeptics that social media can be used for professional purposes, particularly when on the job. If he checks medical apps or blogs on his phone, “it’s viewed as disinterest or assumed that I am texting friends.”

There are obvious differences between having a living, breathing patient on your exam table for a 15-minute office visit and reading a string of patient-written micro-posts. Particularly for primary care, which often calls for a multi-organ-system diagnosis, Twitter consults could oversimplify a patient’s care and take the doctor out of the driver’s seat. That may be why one responder said that patients could benefit from Twitter consults with some specialists.

As a benefit, Twitter provides access to a wide database of information-sharing and knowledge that, in one source’s opinion, can be beneficial to educating medical students. To me, this is the whole point. Twitter can either mean throwing information out into a larger audience to gauge response (as I did for this post), or it can mean tagging a specific person to have a semi-private conversation (as long as both agree in its use).

In the end, I scheduled a visit to my family physician and had a conversation much longer than a 140-character tweet. She inquired about things I hadn’t considered, and I walked away with a wealth of helpful advice to keep my knees in good shape for the race and in the years to come. We can talk Twitter on my next visit.

[Special thanks to @DrJonathan, @mdstudent31, and @danamlewis for contributing to this post. To all — please comment and let me know what you think. How are you using social media in your personal and professional life?]

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Reflections of a pre-med student

As a pre-medical student and journalism/biology double major at UT, I was extremely excited when I saw TAFP’s internship posting. I thought it would be a great opportunity to learn more about what issues concern family physicians—a career I’m interested in—while applying and improving my journalistic skills. During my time at TAFP I’ve learned a lot about the issues family physicians face and that there is plenty a physician must care about outside of the exam room.

Last week I wrote a short article summarizing the results of the 2011 Main Residency Match and how family medicine fared.  I was glad to see that family medicine is on the increase, but seeing that only about half the residency spots were filled by U.S. graduates while other specialties were almost exclusively filled with these students put into perspective that family medicine isn’t an alluring future for many U.S. medical students.

Match Graph

As a pre-medical student, the Match Day data made me stop and reflect on my personal thoughts about family medicine. The first thing that came to mind is how medical debt pushes people away from the field of family medicine.

Before I was an intern at TAFP I knew about physician payment and medical school debt superficially—that family doctors aren’t the highest-paid doctors and that medical school is expensive. But, after interviewing physicians for various stories I was able to think about these issues with more depth and often draw upon a personal story they shared with me.  

One physician told me she is encouraging her daughter to look at options besides medical school because of the massive debt.  Others told me that the huge pay gap between family physicians and medical specialists plays a big factor in driving medical students away from primary care and into more lucrative fields. This certainly came through in the Match Day data as residencies in fields with the highest pay grade were the most popular.

Income Gap

I also thought about the new problems I’ve learned about, like the struggle between family docs and nurse practitioners for practice domains or how IMGs in Texas face licensing roadblocks that cause some to leave the state altogether. It worries me to see all the health professional shortage areas in Texas, then learn about IMGs leaving and U.S. medical students going to other fields. And seeing the huge pay gaps between specialties and general practice is frustrating.

Despite the problems facing family medicine, what I find more memorable are the qualities of the family physicians I have interviewed and researched for stories. Every family doc I have spoken to is a high-caliber person whose impact on their community isn’t limited to their practice. Some speak out on behalf of TAFP; others organize community events to promote wellness or lead medical trips to foreign countries to help underserved communities.

It is especially inspiring for me to talk with female family docs who are established and successful physicians and moms at the same time. When thinking about the timeline of education and residency, I’ve wondered how women find time to find a partner and start a family. It is reassuring to talk to female doctors who have done just that.

Besides talking with family docs, I’ve learned about other topics that make me feel more optimistic about the future of family medicine. I’ve learned a lot about the health care reform law and how it relates to primary care physicians, and I’m glad to see Congress includes provisions that highlight primary care physicians as an important foundation of the health care system that needs to be supported.

What makes me feel the best about family medicine are physicians deciding to turn their practices into “medical homes” where patients and doctors get to know each other and forge a trusting relationship, care is coordinated, and technology is embraced to enhance communication between patient and physician.  My grandfather, Opa as I call him, was a medical student in Italy in the 1940s; he wasn’t able to become a licensed physician because he had to escape as a political refugee. Nonetheless, the stories he tells me about practicing medicine radiate the passion he feels about caring and reaching out to the patient above all else. I believe the medical home embodies how he believes medicine ought to be practiced.

All in all, my experience at TAFP has shown me many sides to what family docs must face to care for their patients. While problems exist, I’m excited about the future of family medicine, especially with the health care reform law including provisions supporting family docs, and I hope the family residency Match Day numbers are even better next year.

 Monica Kortsha is TAFP’s spring communications intern. She is a third-year pre-med/journalism student at the University of Texas at Austin.

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