Thursday Thoughts | Distributing personal medical information via social networks

From a friend’s Facebook status:

Times have definitely changed. I am filling out my son’s paperwork for his well check with his new pediatrician and there is a spot to put your Facebook or Twitter account down to receive non urgent info about the patient!

We are clearly moving in the direction of social media and digital information, so I would love to hear your thoughts on the following (answers should assume consent from both parent and physician to use this type of interaction for non-urgent medical information):

  • Is it legal?
  • What about ethical?
  • What considerations would be required regarding this interaction?
  • What about privacy and security issues*?
  • Would all these considerations be a problem if there’s been consent from all parties?

And most importantly…

  • As a patient, would you consent to transferring non-urgent medical information this way?
  • What about as a physician or other healthcare provider?
*To play devil’s advocate, what makes these interactions any less safe than “snail-mailing” non-urgent info? Theoretically, can’t almost anyone open your mailbox and mail? Doesn’t snail-mail go through way more hands to get to someone than email? What makes them any less secure than cell phone voicemails? We learned from this incident that cell phone hacking is incredibly easy if you know the right people and technology. What do you think the differences are?

 Image: Free Digital Images | Kookkai_nak

 

Stop! Or I’ll…Dump Water On Your Head

A psychiatrist I was working with was recently talking to some families about the importance of following through with so-called “parenting-threats” you make to a child. As I listened in I thought how difficult it must be to consistently do that, especially if following through with the consequence adds an element of stress or difficulty to your situation. A quick interrogation of the Google machine turned up hundreds, if not thousands, of relevant blog posts and articles to confirm my suspicions that this was no easy feat.

Be Careful What You Say

Today I was considering that conversation and came to the conclusion that if anyone in my marriage would eventually have trouble with this, it would be my laid back and quiet husband, not me (because I’m so perfect and all). I’m the type of person who tends to be more over-bearing, outspoken and “in charge” (typically only in my own mind am I honestly in control of anything).

He’s the type of person that doesn’t say a whole lot. But, that means when he does decide to talk – you listen – because it’s either hilarious, important or absolutely ingenius (or occasionally borderline insane).

I remembered an incident from when we first started dating and realized my assessment of which of us was better at following through was apparently starkly inaccurate.

————————————–

  It was Spring of 2007, we’d known each other less than a year and were cooking dinner at his house one evening. I was in an ornery mood and doing something that I’m sure was purposefully annoying and painfully asinine in the name of flirting.

As I tapped and poked him in the ribs over and over, not unlike a four year old I watched in clinic trying to provoke a reaction out of his mother, Donnie said to me,

 

“If you do that again I will pour this entire bottle of water on your head.”

 

I thought,

“There is no way he will do that. We’re in his kitchen and it would make a huge mess and it would probably make me mad. I’m his new girlfriend…nobody wants their new girlfriend mad. He totally wouldn’t do that.

So…I poked him again…right in the ribs. And…

He poured bottled water over my head…right there in the middle of his kitchen.

 

Right there in front of God and everyone (and by everyone I mean Aubrey, his Zambian roommate who ended up as the best man in our wedding) my boyfriend dumped 12 ounces of bottled water onto my freshly-straightened hair and stared at me with an I-warned-you-you-dummy look on his face as spring water some kid in the Andes meticulously bottled by hand (what, you mean your water doesn’t come hand-bottled from the mountains? weak sauce.) dripped down my previously dry t-shirt, rolled down my legs and splatted onto the tile floor of his rent-house.

As I stood, soaking wet, in a puddle in the middle of his kitchen I never thought that incident would come back to me in 6 years as an indicator of how trustworthy he is.

 

And, I can tell you one thing, now when he tells me…

“Stop or I’ll…”

…I stop.

 

Usually.

 

It may seem silly or trivial, but it’s true – when people follow through on their word, even on things that are seemingly pointless (or even mean! like dumping water on your girlfriends freshly straightened hair), it builds trust.

Do you have trouble following through? Do you think this is an important aspect of gaining trust in relationships? Parents, how hard is it to consistently follow through with your kids?

Image: photostock / FreeDigitalPhotos.net

Image: Paul | FreeDigitalPhotos.net

Silly Faces

365 Days of (Mobile) Photos – Week 12

September 14 – September 20

Hippocrates Money
Day 78: Class meeting today - they gave us each $5,000 in fake money and had us bid on "values." They wouldn't let me just put mine in a high interest savings account instead of spending it...what the heck ever happened to saving?
New Rug
Day 79: Finally found a rug for the living room!
Silly Faces
Day 80: "I said make a silly face!" ... "Ummm, I did. I flared my nostrils."
eLife Downtown
Day 81: "Don't worry about tomorrow." Matthew 6:34
Fruity Pebble
Day 82: Classmate made Fruity Pebble treats for us. Um, awesome! They were really good. Especially when I didn't get a lunch break, but still had "food."
P.S. No lunch? What's up with that, Psychiatry?!
Rainbow
Day 83: Hard to see here, but there was a tiny rainbow on the way to clinic.
West Elm Duvet
Day 84: New duvet cover! West Elm Blocked Tulip pattern.

Bachmann Earned Wakefield’s Vote

  Last week my husband was watching the CNN Republican debate in our bedroom as I sorted articles of clothing from my overflowing closet into trash and donate piles. When I caught a second between “what was I drinking when I bought this” and “did I seriously wear that” thoughts I half-listened in to the comments coming from the TV. However, when Minnesota’s 6th district representative started talking about my state and the HPV vaccine she managed to recruit my undivided attention.

CNN Debate, c/o Denver Post
CNN Tea Party Debate Picture from Denver Post

  Once Michele Bachmann’s statements crossed the line between executive orders and entered the territory of science and health care it was obvious to anyone that she was out of her league. It doesn’t take a rocket scientist to know that anecdotal statements and political figures are not acceptable sources of medical or scientific advice.

Her statements at the debate were so deep in propaganda and “innocent little girl” statements that even Herman and Chomsky weren’t sure if we were still discussing recipients of a vaccine or had moved on to victims of kidnapping and cults.

But, then she fully strayed from politics and went on to say really bizarre things about the vaccine, like that it caused mental retardation. It hasn’t been officially confirmed, but I heard she won over Andrew Wakefield’s vote with that one.

However, despite the outright ridiculous nature of her statements, I’m trying to look on the bright side of her blatant disregard for research and reality.

 

Representative Bachmann has ignited a conversation about the HPV vaccine that has been quiet for some time. In the past week there has been an array of positive and factual information written about the HPV vaccine. My Twitter feed and blog roll has been inundated with information from people of much more qualified backgrounds regarding the purpose, safety and relative risks of this vaccine. If you want some quick, basic information with lots of sources in graphic format check out David McCandless’ infographic.

Here’s the thing – the group of people who would tend to take what Ms. Bachmann says to heart are those who are less likely to be discussing the HPV vaccine in the first place. While the conversation may have been ignited for the wrong reasons – inaccurate information from an unqualified source – maybe parents will at least bring this up with their child’s provider now. Or maybe they will happen upon one of the great news articles or blogs written on the subject since Bachmann took her bizarre stance on the vaccine.

The more liberal side of the fence probably doesn’t believe anything out of her mouth anyway, so I’m not really concerned about it affecting their likelihood of choosing to to vaccinate against HPV.

Your view on the pros and cons of the HPV vaccine are just that – yours. The choice to vaccinate or not vaccinate against HPV is a choice to be made by parents and their teenagers. There are not many things in medicine that can actually prevent cancer, but the Hepatitis C and HPV vaccines can. I encourage parents and teenagers to use reliable sources to come up with their views on if this vaccine is necessary for them or their children. I hope they know the realities of HPV and cervical cancer and understand the proven benefits and side effects of the vaccine.

In the end, I’d ask that Michele Bachmann and other politicians refrain from spreading lies about potentially life-saving medical interventions for their own perceived gain. However, if they are going to continue to do it, which they most certainly are, I hope that we can use these types of statements as a reason to put factual information into the hands of those who need it.

 

Shift Change on MomMD
Reliable Information on the HPV Vaccine:

 

 

Image: Koilocytes, Flickr Creative Commons | euthman.
Image: Sura Nualpradid | FreeDigitalPhotos.net

Defeated, Confused, Sad Doctor

What Medical School Doesn’t Teach Us

In the course of our work as doctors we will undoubtedly witness events that change the life of our patients, but coming into medical school I never realized how directly some of these events would also change my life. 

Often in medicine we see people at the worst possible time. Our patients are usually sick or grieving and rarely happy to be in our presence, no matter how great we might think we are. More often than not, they are experiencing things we’ve never experienced, things we understand on a molecular or biochemical level, but not on a palpable, emotional level. We don’t know what it’s like to live in their shoes, so we draw on our experiences, the experiences of past patients we’ve seen and the knowledge we’ve gained in our training and do our best to play the role of both healer and comforter.

  But, as medical students, sometimes our pool of past patients with similar experiences to draw on is limited. How do we ensure we are the best providers for our patients when we may have absolutely no clue how they are feeling? I truly believe that, as medical students, we have a very important role on the healthcare team, but when our experiences are limited what do we base our actions off of?

I believe Social Media has a role to play here.

————————————————————————————————————————————-

  Because I’m interested in Ob/Gyn and Reproductive Endocrinology I keep track, via Twitter and blogs, of several women’s journeys through infertility and pregnancy loss. I have silently watched from the sidelines as they supported each other through loss, openly shared their heartache with strangers and occasionally even expressed what they wished friends, family & medical professionals had done or not done for them while they were hurting. 

So, when I happened to be the first provider into the room to see a woman who was miscarrying, I wasn’t entirely uncomfortable. I’ve never been through pregnancy loss or talked at length with any friends who have experienced it, but it was almost like I had an army of compassionate friends in my back pocket providing me with insight I could not possibly have had otherwise.

Without these women I would have asked a quick list of questions and gotten the heck out of that room, because quite honestly, I would have been uncomfortable and entirely at a loss for what to say without making things worse.

Instead, I knew that this patient likely wanted someone to listen to her story, that she probably would benefit from hearing that this wasn’t her fault and there was nothing she could have done differently or better. I understood how important it was to let her know she was allowed to feel however she felt, whether that be completely devastated, functionally numb or even relieved. She needed to hear from someone else that she was allowed to grieve, that any feelings of loss were wholly valid and that, even though I had no idea on a personal level what she was going through, I was going to do everything I could to support her while she was there.

These ladies are my teachersmy professorsmy examples. Without trying, without being paid, without PowerPoints or lectures, they taught me how to be a compassionate caretaker in a situation I did not understand.

  As I walked out of my patient’s room that day I knew she still had a long road ahead of her, but I was confident that, if even just a little, I had helped her. I left that day realizing that, without my presence in Social Media, the night would have likely gone very differently. I left knowing that nothing in medical school would ever have prepared me to be confident enough to begin to handle a situation I could not possibly understand.

Most importantly, I left knowing she had helped me more than I had helped her, because she had opened my eyes to the fact that everyone around us is a teacher…even on the internet.

Medical school teaches us how to handle situations we can control, ones we can fix or change or at least slow down – not how to handle emotionally-heavy situations where a negative outcome is inevitable and immediate…only experience teaches that.

————————————————————————————————————————————-

 

I wrote this several months ago as a thank you to my Twitter friends who have dealt with this situation publicly and today I finally decided to share it here. So, thank you for letting a bystander hang out in your world every once in a while and for being open about your struggles, losses and triumphs. You, along with all the other patients, activists, and advocates I interact with, both online and off, are making me a more compassionate, informed and confident care giver. You teach me things I will never learn in school, help me keep up-to-date on literature and are a huge asset…not only to me, but to my future patients.

Image: Sura Nualpradid | FreeDigitalPhotos.net
Image: Ambro | FreeDigitalPhotos.net

Family Walk

365 Days in (Mobile) Photos – Week 11

September 7 – September 13

Diet Vanilla Coke
Day 71: Made time for a coke run today. Forgot how much I love Sonic drinks.
Cookies
Day 72: Had 2 of these in my bag from a bakesale at the hospital today. Wrigley dug them out, ripped through the wrapping and went to town. He had them both eaten before I even had a clue. Sound familiar? A few Google searches, call to emergency vet clinic and several hours later he was still acting like Wrigley, so I guess he's ok.
Church At eLife
Day 73: Happy 4th Birthday, eLife. We have loved spending the past 2 years celebrating God's work with y'all! Thanks for the love, support and acceptance!
Keva Juice
Day 74: Discovered this place with a Groupon a while back. Ever wonder how stores makes money by using Groupon? We are the prime example. We did make a copy-cat recipe of one of their Red Bull Smoothies that has saved us some money, but sometimes you just want the real thing!
Closet Cleaning
Day 75: Cleaned a trash bag full of donate-worthy clothes out of here today and still have way too many clothes. True Life: I'm a Clothing Hoarder.
Green House & Garden
Day 76: Went to an estate sale today. Everything was wayyy overpriced, but the house was gorgeous (and ginormous) and had a garden & greenhouse out back.
Family Walk
Day 77: Walking the dogs...our family has 16 legs. But one of Sage's is gimp for some reason. I see a vet visit in our future.

Interviewing for Medical School

20110906-114402.jpg

  As a member of the admission’s committee at our school and as someone who recently(ish) went through the application and interview process (twice), I get asked a lot if I have any advice for those in the midst of attempting to get into medical school. I’m a bit long winded
(I know, you’re shocked), so I thought I’d write out my typical answers here to avoid pushing my Tweet count any higher than it already is.

  Since it’s currently interview season for hopeful medical students this post will focus on interviewing, next semester I’ll work on putting one together about applications in general. If you ever have questions about anything related to getting into medical school please feel free to ask.

Interviewer Perspective

  • Be normal. As an interviewer I run very laid back, get-to-know-you interviews. The person I’m interviewing has been deemed by powers higher than I to have the intellectual ability to function well and survive medical school, therefore my goal is to determine how they interact with people and how well they will fit in at our school. So, from the perspective of an interviewer, my advice is to do your best to be a normal human. Don’t be cocky or rude or obscene, don’t take over the interview and ask me questions before I clarify everything in your app I had questions about. Just sit up straight, look put-together, act professional and be yourself…as long as your self isn’t cocky, rude and obscene.

The Week Before

  • Anticipate the questions. Print this list of common interview questions out then go through and hand write an answer to each of them. Yes, really. Print it out. On real paper. With ink. On your iPad? Nope. In Microsoft Word? Nope. Using Evernote? No. Get it yet? Print it out. On real life, honest-to-God, made from trees (or recycled compost hippie stuff) paper and use an actual writing utensil to hand write your answers. Why? This is more of an exercise in getting to know yourself than it is in deciding what specific answers you’d give to questions. I have a tendency to blank when I’m very nervous and this practice helped me not memorize answers, but to be well-versed in quickly coming up with subject matter to discuss before I was under pressure to do so in an interview. If you think you’d be tempted to memorize and recite these answers, this practice is not for you.

The Day Before

  • Iron your suit. Yes, you should wear a suit. I don’t care if your best friend Earl is wearing slacks and a button up, you should wear a suit. Why? Because 90% of the other people there will have suits on and you don’t want to feel inadequate the moment you set foot into your future school. Whether you buy into or not, you are how you look. People are going to judge you based on what you’re wearing no matter how much you hate it. So, look the part. You don’t need a $2000 Gucci suit (would a Gucci suit cost more than that? does Gucci even make suits? not gonna lie, I’ve never been in a Gucci store and I think my $15 purse and budget-obsessed brain would melt into a babbling puddle of tears if I even passed one from the interstate), you just need to look nice enough to feel confident. In the end this suggestion is less about what you’re wearing and more about how you feel in it. I don’t remember what anyone I’ve interviewed was wearing, but I do remember how what I wore to my interviews affected my confidence. And I do remember thanking God I wasn’t that girl who showed up in grey slacks and a teal blouse.
  • Look over your application. While you should already be 100% sure that everything in your app is truthful, you need to make sure you remember exactly what’s in those 20 pages of information that’s supposed to give some AdCom an idea of your competency as a future physician. This is particularly important if the school you’re interviewing at had secondary applications that you filled out, because the questions may have varied between schools.

The Night Before

  • Go to bed early. You need to get a good night’s rest, you don’t want to be that guy who showed up for his interview with bags under his eyes from partying too hard before his interviews. Or that guy who showed up late. Your brain works best and you feel most confident when you are well-rested, so get off this blog (mark my words I will never tell anyone to get off my blog ever again. swear.) and Facebook and Twitter and go to sleep.

The Day Of

  • Set your alarm early. Get up in time to go for a run, do some yoga or move your body in some way before you get ready for the day. It doesn’t have to be long or intense, just move around a bit and wake your brain up.
  • Eat something. Make sure you have breakfast even if that’s not typically on your schedule. Lunch times are occasionally unpredictable at interviews and you don’t want to be starving during that 10am financial aid informational or in the middle of an interview.
  • Relax and assess the school. At this point you’ve done your work – you kicked butt in OChem (or maybe not, either way), you applied (hopefully early), you got an interview and you prepared adequately using some really awesome tips from a blogging 3rd year in Texas. Now, your job is to figure out if you like the school. You are not there simply to be judged by a bunch of AdComs, you need to decide what you like and dislike about the school. Ask questions, get information and take a step back to evaluate what you think of the place.
  • Make a list. Write down your pros and cons throughout the day. It seems silly and trivial in the midst of your interview day, because you think it should be easy to remember everything, but it’s not. Just keep a list so when you’re coming up with your ranking list or choosing which of your 8 offers to accept you’ll be basing it off your actual thoughts and feelings from interview day and not what you think you remember.

A Few Days Later

  • Say thanks. Email your interviewers and thank them for taking the time to talk to you. In all honesty, they’ve likely already evaluated you and this won’t have any bearing on your likelihood of acceptance, but it’s common courtesy. Interviewing and evaluating applicants is a time-consuming, mentally taxing process, so make sure your interviewer knows you appreciate their taking time out from a busy schedule to talk to you.

GOOD LUCK!

 

*Note: This advice is simply what worked for me when I was interviewing for medical school, it may or may not be the best way for you to prepare. Please use whatever method you feel is best.

Image: Ambro | FreeDigitalPhotos.net

Sunset over El Paseo

365 Days of (Mobile) Photos – Week 10

September 1 – September 6

Justin's Drawing
Day 64: Justin drew this of us in lecture at the Betty Ford Center. I'm third from left.
Donnie's Drawing
Sunset over El Paseo
Day 66: Sunset over El Paseo Dr. in Desert Springs, CA. Great end to a great week.
Texas By Plane
Day 67: Ah, that looks a little more familiar...almost back in West Texas.
Gig 'Em Aggies
Day 68: First A&M game of the year - Gig 'Em Aggies!
This was a great day for more reasons than I can count.
Pretty Sage :)
Day 69: Pretty Sage enjoying the fabulous Labor Day weather. Wonderful weather for dinner on the patio with Donnie and the crazy canines.

Lifehouse Social
Day 70: Lifehouse Social.

High Five Wrigley

Compulsive Phone Checking?

Good Morning from California.
California Sunrise - Tuesday, 8/30

It’s 9:30am on a gorgeous, albeit scorching hot, morning in Rancho Mirage, California and I’m leaving a group lecture on the family dynamics of addiction at a world-renowned addiction treatment facility. As if it’s been magnetically cued I find my right hand patting the rear pocket of my jeans in search of an iPhone.

It’s not there.

After looking around to make sure no one watched me patting my own rear I am awe struck at the fact that, for no reason at all and without thinking about it, I compulsively reached for my cell phone.

As many of you know I just returned from a week long medical student program at The Betty Ford Center where I was taught about addiction from lectures by world-famous experts and through immersion into their patient treatment program. The center, with great reason, does not allow cell phones on campus and on Monday morning I suddenly found myself connection-less for the first time in years. I remembered an article I had read on CNN not long ago that discussed the addictive nature of smartphone checking.

So, there I am in the middle of a drug and alcohol addiction treatment center finding myself addicted to my phone. Or, as the article and this research paper suggest, addicted to checking – a repetitive behavior eerily similar to the training method I used to teach Wrigley to give me a high five.

High Five Wrigley

Behavior. TREAT! Behavior. TREAT! Behavior. TREAT! Behavior. Behavior. Behavior. TREAT! Behavior. Behavior. Behavior. TREAT! Behavior. TREAT! Behavior. Behavior. Behavior. Behavior. Behavior. Behavior. Behavior. Behavior. Behavior. TREAT!

An email essentially becomes a dog treat. Still with me?

It’s not hard to see how this could distracting enough to affect your real-life interactions and productivity.

“Dad said I can’t wear foil antennas and stick my fork in a socket while standing in that puddle of water. Can I pleeeeeeeease?”
…mustcheckphone-couldbeexciting*…
“Sure honey, eat your lunch first.”

So, how do we stop?

Cell PhoneNot unlike AA and other 12-Step programs the article suggests that the first step to stopping this behavior is recognizing that you’re doing it. Honestly, even after reading that article (before I was forced phone-less last week) I didn’t realize how often I was checking my phone in the course of a day. I think being aware of this has helped some, because it now seems I’m not mindlessly looking at it ad nauseum for no conscious reason. Now, I just check my phone somewhere in the vicinity of 40 times a day and think about checking it, but stop myself, an additional 35.

Baby steps, right?

Anyone else finding themselves checking their phone for no reason other than pure compulsive behavior? 

Image: Ambro / FreeDigitalPhotos.net

Quote from hilarious Oatmeal Comic.

August 28

365 Days of (Mobile) Photos – Week 9

August 24 – August 30

August 24
Day 57: Cute little owl book bag my mom got me for my birthday. The owls make me think of my grandpa.
August 25
Day 58: Leafy Latte.
August 26
Day 59: Three hour shelf exam this morning, finally mailed Aleece's birthday card this afternoon and movie date to see "The Help."
August 27
Day 60: Dinner & Margaritas with my Cousin and her friends.
August 28
Day 61: I don't think we're in West Texas anymore.
August 29
Day 62: FaceTime with Donnie and a very confused Wrigley.

August 30
Day 63: Long, exhausting day, but definitely enjoying the experience.