Medical Practice in a Digital Age

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To help prepare budding docs for a medical practice in a digital age, I offer an elective called "Personalized Medicine 101- Digitizing Diagnosis for Doctors".  Personalized medicine is defined broadly in this elective, and I cover a range of topics intended to provide students who enroll in the course with background to mitigate the impending culture shock that would otherwise await them by the time they enter practice.  This is due to the fact that most medical schools continue to provide largely the same educational and training experience that their predecessors had decades ago, before the human genome project and the internet. 

Those who follow me on Twitter may have seen me use the #PM101 hashtag before.  #PM101 serves as the 'filing cabinet' for tweets (often with links to important articles or news commentary) with information relevant to this medical elective.  In fact, the original basis for my participation on Twitter derived solely from this function.

Students enrolled in PM101 must pass an open-book, take-home exam, which they are given several weeks to complete.  They must answer any four of ten short answer/essay questions provided to them.  

This week I've been tweeting each exam question upon completing it.  For those who missed the tweeted questions, and might be interested in our approach to solving this MedEd predicament, all 10 questions are summarized below, exactly as tweeted:

Storify by ‪@phylogenomics "‪#HeLa genome sequenced w/o consent" ‪http://bitly.com/ZnL5M7  is now Q1 in ‪#PM101 take-home exam. Welcome to ‪#meded2

Q2 on ‪#PM101 take-home exam asks how ‪#personalizedmedicine might reduce a "culture of misdiagnosis". ‪@DrLeanaWen ‪@ArtsPractica ‪@meganranney

Q3 on #PM101 take-home exam seeks input on the logic behind this topic in improving healthcare: bitly.com/V9RycL #PCOS #rheum

Q4 on #PM101 take-home exam: how you plan to adjust to ever-increasing sophistication of "Dr. Google" and his hordes of empowered patients?

Q5 on ‪#PM101 take-home exam: Should ‪#Ancestry be considered when formulating a diagnosis & treatment of individual patients? If so, how?

Q6 on #PM101 T-H exam: propose a model for repurposing #meded to include 'comprehensivist' training http://bitly.com/NsarG8

Q7 on ‪#PM101 TH exam: discuss (De)Personalized Medicine: ‪http://bitly.com/XHBQHk  including ‪#personalizedmedicine vs. ‪#EBM.

Q8 on ‪#PM101 TH exam: Assuming this became reality by 2023 ‪http://bitly.com/1038Jkh , how would it change the way U practice medicine? ‪#meded2

Q9 on ‪#PM101 TH exam: Are ‪#ePatients & SoMe interfering with or strengthening clinical science & clinical practice: ‪http://bitly.com/11WwNFM 

Q10 on #PM101 TH exam: By 2020, docs may routinely prescribe #mHealth Apps to patients. How best to integrate knowledge into core #meded?

 The tweets are but brief paraphrases of the actual exam questions themselves, which are necessarily more elaborate for the sake of clarity and completeness.  Nevertheless, this post provides a glimpse of particular topics I feel a doc-in-training should have an appreciation for prior to graduating from medical school.    

I wish to thank several engaged souls on Twitter who provided the inspiration behind some of the questions appearing on the exam (several named above), including @PracticalWisdom who forwarded to me the link for Q9. 

Panel recommends changing name of common disorder in women

NIH News posted this release today which describes a specially-convened NIH panel to change the "name of a common hormone disorder in women, polycystic ovary syndrome (PCOS)".  You see, the disease name "PCOS" does not properly reflect the nature of the disease, causing confusion in the healthcare community, and impeding progress in understanding and treating women who have this disease.  To many (without the disease, of course), this may seem trivial, but it's not.  An improperly named disease simply reflects confoundment on the part of the medical community about disease etiology and pathogenesis, and such a problem all too often ends up in inadequate patient care. 

A different example of an improperly named disease is "rheumatoid arthritis".  As my friend Kelly Young has mentioned on her RA Warrior blog many times, "this is not your grandmother's arthritis".  It has little to do with osteoarthritis, which affects many older people, and far more to do with systemic autoimmune disease leading to the destruction of many body systems.  I've posted before about RA on this blog (largely RA genetics; see archives), but my goal here instead is to inform the greater healthcare community of progress in addressing the nomenclature problem that has stymied individuals (largely women) with RA. 

Toward this end, yesterday the rheumatoid patient foundation (RPF) provided a press release announcing the "first awareness day for rheumatoid arthritis"; February 2nd was established as "Rheumatoid Awareness Day".  You can read more about the rationale behind the choice of this particular day at Kelly's blog post.  In the respective RPF banner, please note the missing word "arthritis"; that was on purpose.  The key point is to create better awareness in the healthcare community that rheumatoid disease (like PCOS mentioned above) has been inadequately addressed by the medical establishment, and a misnomer disease name is simply a reflection of this inadequacy.  To obtain proper healthcare, the rheumatoid disease patient community has banded together around the RPF, and now the establishment of Rheumatoid Awareness Day is an official step toward the goal of achieving necessary recognition similarly to what the PCOS disease community has accomplished.  Perhaps the sorely-needed official name change for rheumatoid arthritis is just around the corner.  

WE ARE CHARGED WITH PREPARING OUR MEDICAL STUDENTS TO BE LEADERS IN THEIR FIELDS. ARE WE LIVING UP TO OUR RESPONSIBILITY?

The following is a guest post by an academic colleague and social media buddy of mine, Kaylan A. Baban, MD MPH, who is a new Course Director at Icahn School of Medicine at Mt. Sinai, as well as a developer of eye health smartphone applications.  Dr. Baban is launching a new medical student elective at Mt. Sinai called Healthcare 2.0 that promises to bring budding docs up to speed in the new world of digital medicine.  The post below is part of the Course Description from this new elective.  Find out more about Dr. Baban at LinkedIn.  Her Twitter handle is @KaylanBaban. 

Healthcare 2.0: Preparing medical students for the dawn of digital medicine

Technology is progressing at lightning speed, revolutionizing every aspect of healthcare and life.  As medical educators, we are charged with not only providing a strong foundation in basic science and clinical knowledge, but also preparing our students to be leaders in the avant garde of healthcare as it is will be practiced tomorrow.

As a robust virtual professional presence becomes more vital to the modern physician, so too does the need to responsibly manage that presence.  It is critical to guide students not only regarding actions to avoid in order to protect themselves and their patients, but also regarding affirmative steps that can maximize educational, professional, and health benefits to themselves and the patients in their care.

Social media, mobile technologies, electronic health records, and health information technologies are quickly becoming the present of modern healthcare, and will certainly be its future.  One implication of this shift is that modern healthcare is quickly becoming a highly interdisciplinary field; one that requires an unprecedented level of technological savvy for full participation.  Physicians who are not comfortably conversant in the use of these technologies will be unable to fully participate in, much less lead, the conversation.  It is our responsibility to step out of the silo in which healthcare has traditionally been housed, and guide our students’ exposure to this reality of modern healthcare.

Physicians and patients alike are poised to benefit enormously from these new technologies.  As such, standards of care will shift.  Savvy patients will, and to some extent already do, expect their physicians to avail themselves – in a critical and responsible manner – of technologies that streamline care and communication.  This will be true not only in “boutique” practices, but also among the underserved populations our students may seek to serve domestically or abroad, since those populations stand to benefit perhaps more than any other.  As standards of care shift, today’s medical students must be prepared to lead the way.  We have a responsibility – to them and their future patients – to give them the foundation to do so.

Twitter and the World of Personalized Medicine

 As part of my role on the Advisory Board of the Mayo Clinic Center for Social Media, I provided a ~ 400-word essay for the following book, newly-released in 2012: 

You can learn more about the book at the MCCSM website, or purchase at Amazon, including a Kindle Edition version. 

The goal of this project, and the book, was to tap into the combined expertise of MCCSM Advisory Board members to address the following question: "What's your best advice about getting started with social media for me or my organization?"  

In keeping with a "personalized" theme, the mission was to express in everyday language, from our own particular perspectives, whatever advice we felt was appropriate for someone just starting to look at social media as a professional tool.  In my case, Twitter was THE key foot in the door into the world of social media.  Below, in quotes, is my ~ 400-word essay you will find in this book.  

"While the historical progression of social media may have transitioned from blogs to Facebook to Twitter, my recommendation would be to start with Twitter (via TweetDeck, where you can monitor multiple columns of tweet sources).  Your initial goal would be to 1) identify the most credible sources of information on a particular topic area (e.g. health care social media or #hcsm) and 2) follow the conversations there. Starting with the names of just a few people (e.g. @westr) or venues (#hcsm), by following the streams, and then “Following” other people (tweeps) or venues (e.g. #bcsm, #meded, or #rheum), you are quickly on your way to amplifying your information stream.  Of course, one of the biggest attractions of Twitter, to me at least, is that many tweets contain hypertext links to original journal articles, respectable magazine or newspaper articles, blogs and web-only sources of information (e.g. WebMD) that provide details supporting the underlying theme of the tweet.  After using Twitter for about 18 months, I now rely on it as my primary source of daily professional information.  Of course, it doubles as a source of personal information if you wish to include that as part of your information stream.  Since you compose your information stream to suit your particular interests (e.g. “e-Patient”), it ends up becoming a network of interrelated themes that can be as broad or narrow as you wish, and which you can modify according to your daily needs (face it, needs change often).

            As a professor at a medical school, one of my goals is to train budding Docs in the use of social media.  Why?  1) Because that’s where the greatest abundance of medical information is available, and 2) that’s where patients are!  To this end, I implement such training in an elective called Personalized Medicine 101, as well as via a yearly “Twitter Tutorial” talk available to the Upstate Med community at large.  Additionally, through other speaking venues, I attempt to reach others on the impact of social media, including established physicians in our geographical community (see my guest post at KevinMD.com on “Female physicians on Twitter”), as well as fellow e-patients in our virtual community (see mention at “Fibromuscular Dysplasia” blog by Kari Ulrich, RN).

Since the majority of my Twitter use involves exchanging information for pedagogical purposes, and since Twitter does not maintain a running archive of tweets (only up to one week or so), I obtain backup support through a web program called BackupMy.Net.  A description of this service and its value to people like myself was published at SMHN in May of 2011 (paywall; copy provided on request).  

The beauty of Twitter involves its range of capabilities.  It’s as easy as you want to make it, but as complex and powerful as you could want it to be, so it’s difficult to get bored with its utility. In fact, beware, Twitter can be addictive!"

Elsewhere in the book you will find essays on blogging, Facebook, YouTube, Pinterest, social networking, legal issues in social media (by Dan Goldman, JD), and a number of other key topics you won't want to miss.