Saturday, March 31, 2012

Help wanted to repurpose physician knowledge.

Using social media to encourage using social media

Problem: How do we get great clinician educators--doctors with hearts of gold, infused with passion and brimming with insight, who have valuable and unique perspectives confined to their heads--to give Twitter a try?

The paradox here is that for many superb doctors who are passionate about doing right for patients, it is the service to this very passion that makes them very, very busy--so busy, in fact, that they are reluctant to explore the potential of a new platform to promote their passion. Since services like Twitter need to be tried to be understood, how do we break this barrier? (To use business language- how do we enable physician knowledge to scale?)

I have such a clinician in mind, and wrote about him here. I approached him in the gentlest way possible, taking great pains not to act like I, a medical newbie, was telling him how to do his job. I explained that it's the fact that his passion resonated with me that motivates my recommendation.

He replied something to the effect "Yeah, that sounds nice, but I'm too busy."

This isn't an isolated case. Rather, it points at a central hang-up in modern medicine that Bryan Vartabedian has called the need to Repurpose Physician Knowledge. Dr. Vartabedian is asking if we can develop systematic approach to sharing genuine medical insight?

I have an idea for this that can be implemented right now, and I need your help to pull try it out. Can you comment below in support of my clinician educator giving Twitter a try? If your comments could adhere to this general format, I'd be intensely gratified:

- Please please PLEASE use a nice, respectful tone.*
- State your general role in healthcare (patient, doctor, nurse, onlooker, med student, etc.)
- Why you think it's worth a shot. Feel free to condense your support to a single word like "Because" or a phrase like "Because I've learned from Twitter." Alternatively, feel free to elaborate away.
- Bonus: If you tailor your response to your perspective, holy smokes.

Let's develop a name for the process whereby the social media community approaches someone currently outside that community, someone who has been vetted by a respected voice from within the community, and this approach is made via the very social media platforms that said community is promoting. I'm thinking it should be called a social media intervention. Other ideas?

If this social media intervention works with my clinician, perhaps it can serve as a model for getting other doctors involved, serving as an early step toward systematizing the repurposing of physician knowledge.

*This really is important. At the risk of sounding condescending, NOTHING more effectively turns people off to trying something new than condescension.

Wednesday, March 28, 2012

Doctor, Can You Please Use Twitter?

Dr. Schreiber, San Augustine County, Texas

It's the old-school doctors who love to teach, and who would never even think of using something as (seemingly) frivolous as microblogging, who really should use Twitter. Let me give an example:

I'm a soon-to-be first year medical resident, and I'm terrified. Happily, I'm taking this awesome class on how not to kill patients with medications, and the teacher is a fantastic old-school clinician; a passionate teacher, quaking with insight, and firmly committed to doing right by his patients in the face of all the competing influences on a doctor's judgment.

Central to his class is the perspective that fancy new drugs are inherently risky. Why? Because the bottom line of drug development does not enlist sufficient subjects to evaluate true safety risks until after the medication appears in advertisements on the back of medical journals.

In short, he advises to stick with the tried-and-true. He's old-school, and he's awesome.

Although the theme of this blog touts innovation, I love old-school prudence that rubs experience and evidence in the face of marketers' narrative fallacies.

Unfortunately, most old-school folks abhor trends as perfunctory as Twitter. But a voice like this clinician's is a drop in the ocean of pharmaceutical marketing. His real passion is speaking truth to marketing, but he doesn't want to speak with the voice of Twitter.

I'll let you know if I change his mind. This is Daniel Kraft, but it could be my clinician educator:

Monday, March 26, 2012

The Mobile Health App Revolution: Why and How

A simple glance at James McGinnis's famous pie chart shows that behavior has dramatically more impact on health (measured by premature death) than does the quality of one's health care. 

McGinnis et al. Health Aff (Millwood) 2002;21(2):78-93

Yet, our nation's health expenditures continue to be directed disproportionately at the 10% slice. The simple reason for this is that we have tangible tools to deal with this fraction; we build facilities and fill them with personnel equipped to diagnose and treat this 10%, and we use medical schools to train physicians to run these facilities. We might do the same for the 40%, but we lack the tangible tools to do so (illustrated by the question mark below).

With effective behavior modification tools,
we could train for both the 10% and 40%.
What if mobile health apps are the tools to affect health behavior patterns? If so, we could begin to marshall the engines of health care against a much bigger piece of the pie.

Are apps the behavior modification tools we're looking for?

Since apps and other digital technologies have had such dramatic impact on other behaviors (witness all those hunched over their phones in elevators, streets, and dinner tables), it's certainly worth a try to apply them towards health behavior.

What about the role of medical school?

SUNY Upstate's teaching hospital is proudly constructing a new cancer center (illustrated in the graphics above), which is a welcome development for many in Upstate New York. It is inconceivable that a medical student will develop a new chemotherapy treatment or diagnostic modality, although they most certainly may help such developments in the lab.

Yet, it is entirely conceivable that a med student might develop an effective smoking cessation app, thereby preventing a number of cases of cancer. And we don't even have to build new facilities to achieve these results. This is even more impressive when we consider that the cancer center can only help those patients who can get themselves there, while the smoking cessation app can be accessed anywhere in the globe at almost no extra cost.

How? Please allow the obligatory reference to The Medium is the Message.

This crazy phrase means that if we teach medical students with books and lectures, they will treat their patients by reading books and lecturing them. This method has a poor track record; content in print is old, and patients don't remember lectures. If instead, students are taught with apps and other digitized tools, they will use apps and digital tools to treat their patients.

Medical schools need to put app development in the hands of medical students, point them at the 40%, and press play.