Health Care Social Media #hcsm - Using it for advocacy & Prezi slides

I have used social media extensively to advance my advocacy for the Less is More Medicine movement. This includes blogging here to share the latest research and opinions, tweeting @LessIsMoreMed to spread the word, participating in related discussion groups (eg. Teaching Value in HealthCare on Google+), and using LinkedIn to connect with colleagues in my province who are also engaged in health care transformation. I also listen to podcasts (like the BS Medicine Podcast) to keep up to date on the latest studies relevant to this area and prescribe YouTube videos (like those of Dr Mike Evans) to patients to help them join me in shared decision-making or to help them self-manage using less harmful and costly measures.
 

Curious about how to use Social Media in your professional existence as a health care provider?

Here is the brief talk I gave to the UBC CPD Practice Survival Skills audience in Vancouver, Jun 13, 2015.

There is also an accompanying handout which highlights some of the key resources that will help guide you to (safely) using HCSM professionally.

The talk and handout present a fairly superficial overview of how one might use social media to advance a clinical or advocacy agenda, but hopefully it gives you a taste of how you might use this technology meaningfully. Or, it might encourage you to not use it at all, which is also a valid choice!

For me, #hcsm has been the foundation for this Less Is More work. It is the means by which I can make a big splash with no budget (other than my own investment of 'spare' time and web hosting fees), grow my expertise (with no advanced degree in health policy), and network with heavy hitters in this field (who I would otherwise be unable to access).

It is an incredibly powerful tool.

Source: https://prezi.com/zqkq47ihjazf/hscm-going-...

What Can Patients Do In The Face Of Physician Conflict Of Interest?

I had the pleasure of meeting Dr James Rickert, an orthopedic surgeon and a patient, at the Road to Right Care conference put on by the Lown Institute in March. Dr Rickert works with the The Society for Patient Centered Orthopedic Surgery, advocating for health care reform and patient care that puts the patient in the centre.

One of the topics that he writes and speaks about frequently is conflict of interest in medicine and the financial incentiviazation of care which may be unnecessary or harmful to patients. 

To that end, his most recent contribution to the Health Affairs blog, What Can Patients Do In The Face Of Physician Conflict Of Interest?, describes some the major issues that emerge when caring becomes a business. There are also suggested Action Steps for patients to take when confronting these concerns.

Strong relationships between patients and providers are the heart of healthcare; we must work together to improve our culture and hold providers to a high ethical standard to stop the erosion of trust.

Source: http://healthaffairs.org/blog/2015/04/10/w...

Transforming Primary Care: Rx | The Quiet Revolution (DOCUMENTARY)

Thanks to Dr Dave Elpern (Cell2Soul) who shared this video, a 90-min PBS documentary, Rx: The Quiet Revolution.

In this inspiring 90-minute documentary, filmmaker David Grubin – the son of a general practitioner – takes his camera across America to focus on the challenges and triumphs in our country’s health care delivery system. The four segments that comprise Rx: The Quiet Revolution introduce us to a diverse group of doctors, nurses, and health care professionals who are transforming the way we receive our medical care: lowering costs by placing the patient at the center of their practice

Certainly the vignettes of Dr. Loxterkamp remind me of Vancouver's Home ViVE program and the kind of doctoring I aspire to. Likewise, the Nuka approach is something that could work beautifully for Nunavut, if and when the people are ready.

The film highlights four programs that are revolutionizing the way health care is delivered. What they all have in common is a patient-centred approach, remembering that people and relationships are at the heart of health:

 

- On Lok Lifeways Program for All-inclusive Care of the Elderly (PACE) program: "On Lok’s goal is to allow frail and elderly seniors with chronic illnesses or disabilities — who would normally require nursing home care — to live with dignity in their own home"

- The Seaport Community Health Center, where Dr Loxterkamp is re-inventing the patient's medical home: "Some of our patients miss the 'old-fashioned country doctor,' the one they could call whenever they needed to be seen– before the computer, before a team of assistants separated them from their doctor, and when they mattered more than their disease."

- Alaska's Southcentral Foundation which developed the Nuka System of Care: "This is a name given to the whole health care system created, managed, and owned by Alaska Native people to achieve physical, mental, emotional and spiritual wellness. Nuka is an Alaska Native word used for strong, giant structures and living things. The relationship-based Nuka System of Care is comprised of organizational strategies and processes; medical, behavioral, dental and traditional practices; and supporting infrastructure that work together - in relationship - to support wellness."

-  The Center for Telehealth at the University of Mississippi Medical Center: Their Diabetes Telehealth Network aims to "provide people with diabetes more consistent and timely access to clinicians through the use of telehealth technology in their homes"

 

The documentary can be seen online in its entirety here.

Source: http://rxfilm.org/

Celebrity Medical Advice: Mark Cuban says "more is better" in Health Care

Twitter is a wonderful place to share ideas, learn quick tidbits, and to get a sense of the 'zeitgeist.'

Unfortunately, many people use it as a platform to share their crazy opinions and famous people are able to propagate all kinds of medically questionable myths (read Hoffman SJ and Tan C in BMJ re: following celebrities' medical advice). The Jenny McCarthy- and Gwyneth Paltrow-types persuade others with obvious contravention of science. However, the subversion of the process of medicine can also be subtle. 
 

BEWARE it may make you shudder to read it:

If you can afford to have your blood tested for everything available, do it quarterly so you have a baseline of your own personal health . . . 

a big failing of medicine = we wait till we are sick to have our blood tested and compare the results to “comparable demographics

- Mark Cuban (@mcuban)

Fortunately, before Mark Cuban (billionaire entrepreneur) could get too far with his "more is better" evangelism, Charles Ornstein (Pulitzer-Prize winning journalist, @charlesornstein) challenged him. Too bad that challenging people often makes them dig their heels in deeper.

Did the evidence provided sway Cuban? See the play-by-play on Forbes.

Source: http://www.forbes.com/sites/dandiamond/201...

Corruption: A devastating factor driving inappropriate health care in India

The Canberra Times highlights the challenges facing Indian citizens who seek medical attention in "Indian doctors shed light on massive medical procedure scandal."

Usually when I think about factors that drive inappropriate health care, I imagine it's a case of "good intentions and bad results." When doctors are trying their best for patients, sometime we go too far trying to fix a disease or result and lose sight of the person (the patient). Some negative pressures, like pharmaceutical marketing, fear of lawsuits, fear of being disliked, or a misunderstanding of the latest evidence can drive providers to do thinks that are not the "best care" though these choices may have seemed like good ideas at the time.

I never thought to put BAD INTENTIONS at the top of the list of things that drive health care providers to provide 'too much medicine' or to choose unwisely. It certainly happens (eg. Mount Sinai catheterization scandal, where people are told to lie in order to get in for unnecessary cardiac catetherizations paid by the public system), but – perhaps just by my wishful thinking – it's not as prevalent as bad acts driven by good intentions.

In India, maximizing profit appears to be the number one priority of some hospitals. Extra scans, surgeries, and avoidable deaths are all the result of doctors striving to meet "revenue targets" and taking bribes.

This is a devastating state of affairs.

One solution comes in the form of  Mission SLIM: the Society for Less Investigative Medicine. Hopefully they find success advocating against unnecessary tests and treatments, though they have their work cut out for them.

Source: http://www.canberratimes.com.au/world/indi...

Atul Gawande: why the health care system should stop trying to help everyone live longer

Quality matters. It's not just quantity that counts towards the end of our lives, and in fact, most people would choose "good time" over "any time." Physicians know this but for many reasons we can't always help patients have the best life possible before death.

Dr. Atul Gawande recently did an interview with the Washington Post on the subject, and it felt authentic. While admire his work, I do not consider myself an unconditional devotee. However, this article is truly amazing.

It is a call to action. He graciously and decisively invalidates all the excuses that physicians create to not tackle end-of-life discussions with patients, confessing some of the challenges along the way.

Read more in The Washington Post.

Some of my favourite excerpts are here:

HP: One tough question. I watched your lecture today with some primary care physicians. Their reaction was to say, “Of course all this information about the need for conversation in end-of-life care was revelatory to you, Dr. Gawande. You’re a surgeon.” In your telling of the story, how much did the culture of specialty care fail to prepare you adequately for the challenges recounted in your book?

AG: Look I’m a surgeon--highly procedural, geared towards always being able to offer something more. It’s no surprise that this field did have prepared us formally for these kinds of conversations. Furthermore, I’m in an academic medical center, high-end Mecca. Many people come there because they want that experimental therapy, the last ditch maneuver against all odds.

. . . If these [end of life] conversations are so important--and people across other fields seem to know it--we’re still not having them. It’s not happening for two-thirds of people with advanced cancers for example. We have evidence that these conversations are even less likely to happen for other common things people die of: congestive heart failure, for example.

Maybe that’s because families and patients tend to move on to a specialist rather than the primary care doctor for these conversations, but I often find primary care doctors aren’t having them, either.
HP: Even if they had the skill to have the conversation, that’s not really who the patients are looking to for these conversations.

AG: If you look at the studies, they find that having a palliative care doctor or geriatrician more closely involved in care can lead people to forego aggressive therapy sooner and have better outcomes--not only less suffering but even improved survival. But we don’t have enough of these doctors to go around. Furthermore, there’s something wrong with the idea that you outsource this kind of decision-making and discussion.
HP: One of your book’s saddest quotes comes from a hospice patient, who says: “The oncologist and the heart doctor told me that there’s nothing more they can do for me.” It’s as if palliative care and hospice are the consolation prizes we give you when we really can’t do anything more.

AG: . . .
Even when we are needing to handoff, I’m involving someone who is going to have palliative care or hospice or primary care team. I’m not involving them because there’s nothing more I can do. I’m involving them because we require other people’s expertise to help us achieve what we’re trying to do.
Source: http://www.washingtonpost.com/blogs/wonkbl...

Dr. Danielle Martin on Transforming Health Care: Three Big Ideas

In 2006, Dr Danielle Martin founded Canadian Doctors for Medicare, an organization which seeks to "provide a voice for Canadian doctors who want to strengthen and improve Canada's universal publicly-funded health care system" and advocates for "innovations in treatment and prevention services that are evidence-based and improve access, quality, equity and sustainability."

Dr. Martin's gave a keynote address at the Family Medicine Forum last week in Quebec and as I was at a CMA Healthcare Transformation Working Group meeting, I was unable to attend.

However, even those who weren't there we aware of the profound importance of her talk. She presented Three Big Ideas for transforming the Canadian Healthcare System. They are sensible, explicitly involve "Less is More Medicine," and are achievable.

She's also speaking on this topic in Vancouver on November 27th.

If you cannot attend one of her talks in person but want to know what her Three Big Ideas are, you still can. Fortunately, she was also the inaugural speaker for the Now or Never: Innovation in Health Care Forum series in Halifax and this was recorded, so you can view a similar talk in its entirety below:

I must admit, Dr Martin already had me won over long ago but her no-nonsense approach to defending, nay, promoting medicare solidified it. Her pointed responses to American politicians this spring had me howling with laughter (and cheering in agreement).

Watch the whole thing or just 2:55-4:00 of the video below if you want to see the bit where her education and passion allow her to shut down the opponents completely. *high five*

I think the Canadian Health Care system is in good hands with her vision.