Transcript…  

 Yes…I mention visual during the video… I apologize  

Hi I am Howard Luks, this is your Orthopedic Minute.  The title of this one is:

 Non-VERBAL Cues in Healthcare.

I had an interesting day today, I had a few medical students here and we had a fun day the office hours.

We saw many patients some of whom who were very happy, some of which were somewhat happy, some of whom were not happy.  Yet — what was interesting was I knew as soon as I entered the doorway. On many occasions before going further in the room, I stepped out and I asked the medical students what they thought the patient was going to say about how they were feeling, whether they were feeling better, worse or the same — or whether or not they were satisfied with their physical therapy or surgical intervention etc? And what kept coming up was that they (the students) really did not know.

And that brings up one of the key elements of being an experienced clinician and really being able to teach.  It’s not only the facts that we need to teach students, it’s how to practice medicine, and it’s how interact with (verbally or non-verbally) patients and how to care for patients.

If you simply walk into a room and you see someone and they are smiling and their color is good and they just have this presence about them then you know they are doing well before you even ask your first question.  Then there are those who are tense and tight.  And then there are those who are looking at the ceiling or the floor or not looking straight at you in the face.  They are obviously the ones who are a little concerned and may have some unanswered questions that remain unresolved — and those are the ones that you may need to pay a little extra attention to.

Again we had a great day in the office — I think our students learned a lot — and the message at the end of the day was you need to pay attention to non-VERBAL cues in healthcare.  It’s a skill that takes a long time to perfect yet it’s extremely useful.  Have a great day.

Learn more about Non Verbal Cues in Healthcare – Medical Education at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Meredith Gould is a Sociologist by training (Ph.D., NYU), educator by experience, published author (8 books and one always in the works) and working writer for the health and healthcare industries.  She provides communication strategy and editorial services to healthcare industry thought leaders. Meredith was also recently named one of the top eleven people to follow in healthcare social media. She is  committed to using social media to build community and generate action and is a fellow member of the External Advisory Board at the  Mayo Clinic Center for Social Media.  

With regards to planning a social media presence, I have asked Meredith to share her insights and guidance – from a sociological perspective.    Many of you who are currently in the planning stages of your social media presence and strateg may find this approach and advice very useful.  

 1.      Please tell us briefly about your background, how you became interested in helping the healthcare community establish communities, and how your presence on #mccsm and sociological background have come together to help you assist those communities from your unique perspective.  

Briefly? I’ll try! I earned my doctorate in Sociology from New York University when theoretical work was valued somewhat more than numbers-crunching.  So although I learned quantitative methodologies, I was trained to think critically about what might be going on before designing multivariate research. I was also trained in qualitative methodologies, such as participant and non-participant observation, content analysis, and the like.

My work focused in part on how communities emerge independent of and sometimes within formal organizations. I was also among the first to insist that making a distinction between sex (biological status) and gender (social identity) was important.  I left academia after a decade for career in state government and then in the private sector as a marketing communications executive.  Sociology continued to inform my perceptions and strategic recommendations.

Meanwhile, personal health adventures got me interested in the healthcare industry. By 2007, I’d shifted my professional focus to healthcare. I discovered healthcare social media (#hcsm) in 2008 when I got onto Twitter. Once on Twitter, I swiftly became fascinated by how many conversations, while lively and thoughtful, did not seem to evince any sociological smarts.

I’ve made it my mission to ask inherently sociological questions during chats I attend. I’ve played this role on #hcsm, but also within the #hpm (hospice palliative medicine) chat community. I occasionally show up (or lurk) on #RNChat, #MDChat, #socpharm, and other industry-related conversations, waving the flag for critical social science thinking whenever I feel compelled ─ to the delight or dismay of some moderators.

  2.     Can you elaborate on what someone interested in establishing a presence in social media needs to consider from a sociological perspective?

First and foremost, anyone interested in social media needs to view “social” in sociological rather than colloquial terms. Colloquially, “social” means “chitchat.” Sociologically, “social” means “group.” 

We sociologists know and hope to teach others that groups rather than individuals create meaning.  For example, The healthcare industry is the mess it is today because of collective, not individual actions. Those collective actions take place within a social context as well as a political economy ─ these fall within the domain of social science.

We also know and hope to teach others that the process by which individuals form a group and that group becomes a community is a social process.  Social scientists on Twitter are keen on social media because it allows us to observe, track, and analyze that social process in real (or near-real) time.  Social media allows us to see how healthcare communities are created, sustained, and changed over time; not a lot of time because social media speeds everything up.

Practically speaking, anyone wishing to establish a social media presence needs to understand from the get-go that a particular type of participation is essential.  Participation must be consistent, ongoing, collegial, and collaborative.  It must be part of or help generate community.

Physicians, for example, can and should bring individual gifts/specialties to bear upon any given healthcare conversation, keeping in mind that conversation involves dialogue. The most successful healthcare industry participants are those who generously offer insights, direct others to resources, and contribute more than they take.

 3.     You recently left a comment on this blog about how most people, especially those trained in the “hard” sciences have not learned the social science that must be understood to use social media wisely and well. Can you elaborate?

Those of us who work in the natural and social sciences share respect for the scientific method.  Things can get a bit tense once we get into conversations about what constitutes data, data collection, validity, and reliability. 

Plus I do think we can agree that medical educators tend to train students to pay more attention to clinical variables. Not always or not exclusively, of course.  There are several medical specialties where social variables are routinely factored in ─ geriatric medicine, family medicine, come to mind.  I’m always delighted by the sociological sensibility among members of the Collaborative Family Health Association, for example.

My comment had more to do with a way of thinking and viewing the world.  The world is a social artifact.  During my presentation at the Mayo Clinic Center for Social Media’s first Social Residency Program, I talked about how health and healthcare social media strategists must pay more attention to social context. 

More specifically, I underscored the importance of looking beyond audience or target market demographics to explore cultural nuances within and between groups. Doing so does not come easily to those trained in the natural sciences, which is why I encourage physicians and other medical practitioners to get and stay in conversation with social scientists like me!

Meredith Gould, Ph.D.

@meredithgould

http://about.me/meredithgould

Learn more about Planning A Social Media Presence in Healthcare: A Sociological Perspective at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

In Part I we discussed why physicians and healthcare professionals should consider a social media presence.  The interest, both online and offline was fantastic — As I have alluded to in the past.  Physicians are no different than the billion or so who are already engaged online — but from a professional perspective they are simply more risk averse — and rightly so. They don’t want to expose themselves to malpractice risk and they certainly don’t want to waste money on a  healthcare – social media endeavor that was not properly prepared for — and did not bear fruit.   

A presence in healthcare and social media is a marathon — not a sprint.  

As with the preparation for any marathon — the training begins long before the event begins.   Planning for a digital media engagement is no different.   Your preparation for a healthcare social media presence must begin offline.

Social Media and Healthcare .. 

At its heart, digital media is about people, it is about relationships, and it is about communication.   A social media presence is about educating, engaging and growing your audience, improving outcomes, compliance and potentially the bottom line of your practice.

Planning your Healthcare Social Media Presence

First off… kudos to you and your organization… the more useful, truthful, open, transparent, meaningful and actionable healthcare content that exists online, the better off all our potential patients and the public at large will be!

For most physicians and healthcare professionals, a presence in social media will be part of an overall marketing strategy.  Do you have one?  Do you understand the difference between Inbound and Outbound marketing techniques  — and how it fits into your overall strategy?  If not, all the more reason to start at the beginning. In future posts we’ll also explore the intricacies of foundation setting, social media properties,  keywords, cornerstones, long tail versus short tail searches, inbound versus outbound marketing techniques and strategies, and search engine optimization (SEO).   

Social media has never been so prevalent. Everywhere we turn, we see the constant reference to social media. So it’s little surprise that an understanding of social media is a must for every type of organisation — especially in healthcare — and the key element to success is content.

As a physician, you possess an enormous wealth of knowledge and experience — Social media enables you to share that   knowledge base and experience across the spectrum of social media properties and simply educating those seeking information. But social media is no different than many traditional marketing and communications activities — and getting back to basics will help ensure your organisation maximizes its healthcare social media presence.

The following 7 tips will help you in your initial offline strategic planning initiatives for your healthcare  social media presence.

• Besides yourself… who else in your office or practice is going to participate? Be ruthless when assessing your desire, your bandwidth and your skill sets.  This may seem like a great idea now… but if you are not passionate and committed to it … it will quickly become a chore —and your online endeavor will be an abject failure.  
•  Communications and fostering relationships and thus a following means you or someone on your staff MUST be available to interact with patients who respond to  blog posts, Twitter posts or Facebook posts.   Not preparing for the two way nature of digital communication in healthcare and social media is like forgetting to suture a wound closed at the end of surgery.  
• Set up guidelines, understand the rules of the road and where the speedtraps and potholes lie. 
• Who is your audience?  Are you interested in attracting patients from nearby, or do you feel that you want to contribute quality content to patients and consumers on a global scale?  
• What is your message?  Do you perform anterior approach hip replacements through a one inch incision?  Do you or your practice offer something unique that sets you apart from other practices in your area?   If not, don’t sweat it… most of us are in the same position — and social media works for us!  
• What are you going to use as your foundation, anchor or homebase?  Are you going to invest in a website or a blog?  If you do, it’s worth it to spend the money on a custom WordPress platform verus a templated site which will ultimately limit your ability to scale your site, and to rank on google and other search engines. 
• Content:  Are you a curator, or a producer?  It is not nearly as onerous as you think to create a website full of original, useful, actionable content.   My 41st patient initiative is very useful when your web designer informs you that they will require your content in a few months.     You can also set up a Google Reader list which you can visit every morning where google has delivered to you the content that your determined you are interested in.  The lists can be driven by keywords or RSS feeds of blogs/sites you find engaging.  

Social Media Properties in Healthcare: 

As part of your planning, you have determined who will participate, what the rules of road are,  who your audience is, what your message is and where your ideas for fresh content might come from.

 Now comes the social part  

The art and practice of social media is  about being engaging, communicating, sharing and educating people who are interested in what you have to say.  They are not going to come to your site to find the information… not in this day and age.  You need to put your content in front of them, and that means sharing your content on the platforms that your audience has chosen to utilize. 

In a future post we will explore, in depth, the various social media properties that you can utilize to share your content and interact with your audience…. stay tuned.  

Learn more about Planning your Healthcare Social Media Presence … Your Digital Footprint: Part 2 at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Why doctors should establish a social media digital footprint in healthcare:

• Establishing a social media (digital) presence is rapidly becoming a necessity for healthcare professionals, medical practices, and institutions.  Many have recognized this fact… yet many more have not. 
• Doctors who recognize this need seek leadership, guidance, and best practice examples
• Truly useful tactical how-to’s and guidelines are lacking
• Human beings are innately social, health is social,  health care is NOT social —and needs to catch up — 
• Experienced physicians possess an enormous repository of knowledge and experience – why not share that with a wider audience?    

attribution: www.mydigitalfootprint.com

At its heart, digital media is about people, it is about relationships, and it is about communication.   Establishing a digital footprint, rooted as a social media presence is about educating, engaging and growing your audience, improving outcomes, compliance and potentially the bottom line of your practice.

Some simple undisputed facts about social media and technology. 

• 50% of the world’s population is under 30. 
• They do not communicate via e-mail or telephone. 
• Generation Y and generation Z consider e-mail passé. 
• The fastest growing segment on Facebook is women over 55 years of age.  
• SMS, direct messaging, micro-blogging and digital media is fast becoming the chosen communication standard.
• Drug/Medical related “Likes” on Facebook have skyrocketed. 

50% of the mobile Internet traffic in most countries is for Facebook. One on five patients flock to Facebook for healthcare information.  Imagine what this means for a bad patient experience?  The world has gone digital —social media is here to stay.  1 billion people simply cannot be wrong. 85% of people log onto their Facebook account every single day. 

Are your patients talking about you? And, most importantly, do you KNOW what they are saying?

When patients search online — on the platforms THEY chose — are they finding your content or information about your practice? 

Do you understand the Healthcare Digital Media Landscape? 

Do you understand the value propositions of establishing a social media digital footprint in the healthcare space?  

Simply put, social networking and digital technology enables individuals, physicians, hospitals, and patients to create online profiles and connect with one another.  Perhaps most relevant to the physicians and healthcare professionals are that the many of these patients are researching their providers and their respective institutions prior to their visit to your office —  they are checking your online reputation, and the message or image you portray. 

Physicians and Healthcare professional, in essence,  are building a brand to any consumer that may be interested.   

You can’t control the conversation but you can be a part of it.

Take a look at the Inforgraphic below…. This is taking place in a single minute — every minute — of most everyday within the digital world….  

Still think it’s a passing fad? Healthcare only lags the Oil Refinery Industry in terms of its social media presence and participation.  

Still think you do not need to establish some form of digital  presence on the healthcare social media stage? 

—Think again — 

http://goo.gl/Bwz1d By: Shanghai Web Designers

Learn more about Your Healthcare Social Media Digital Footprint: Part 1 – Why? at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Most of you are quite familiar with the rather astounding facts regarding medical errors.   There are many reasons why medical errors occur in healthcare. There are errors in omission, there are errors because of poor communication, there is the ever present risk of human error and perhaps the ever increasing stress on physicians to see more and more patients in less and less time. There are patient specific variables too — forgetting medication lists, etc.

 Avoiding Medical Errors:

You do not want to be a statistic:  

I am not here to recount or rehash the numbers. My goal is simply to apprise you of some very simple steps that you can take to try and avoid being another sad statistic.

Evan Falchuk, author of the SeeFirstBlog wrote an editorial recently guiding patients on avoiding mis-diagnoses.  Misdiagnoses, or mis-information — once perpetuated through your medical record, or amongst your medical providers, can play a huge role in enabling a medical error to occur. Evan goes through a number of steps that you can take to minimize the risks of medical errors.

Your Role in Avoiding Medical Errors: 

 One of the most important steps you can take, is to be as accurate as possible in filling out that annoying paperwork when you first enter a physician’s office. We all know how annoying it is to have to fill out the same paperwork, each and every time we enter a physician’s office. Unfortunately, if you are not complete and accurate in completing the paperwork, your physician may not have a complete and accurate picture of a significant portion of your past medical history. A very accurate history, including your family history, and the current and accurate list of your medications and current medical issues can be of very significant importance in determining what your current health status or disease may be. As health information exchanges, and collaborative networks enable the sharing of information – – – that can work both to your benefit, as well as  amplify the risk of harm.   Bad information in… bad information out.  These systems will be highly dependent on the quality of the information initially entered.

Look at Your Medical Record;

Recent studies have shown that both physicians… and even patients were very receptive to this concept.  This will give you a chance to verify the accuracy of the notes generated from your previous encounter … and question any comments your doctor may have added to the record.  

One very important steps you to take is to ask to see your medical record, obtain copies of previous notes, and verify them for accuracy.

 Assuming that your healthcare provider is beginning with a complete and accurate set of information about you, it is now very important for you to assist that provider by giving them a complete and accurate history of the issue that has brought you into their office. A symptom, or provoking factor, which may not seem important to you, may make all the difference in arriving at the proper diagnosis – – – and thus treatment plan. As a follow through, when your physician or healthcare provider is discussing their thoughts on your diagnosis, and a possible treatment plan, it is extremely important that you feel comfortable in questioning either the diagnosis or the treatment plan and asking whether other options or possible diagnoses are possible – – – and what, if any further steps are necessary to further improve the accuracy of the diagnosis and whether any treatment is necessary.

Second Medical Opinions:  Not just for the physician you are seeing…   

Very few patients have a problem seeking a second opinion from another surgeon or specialist. I often encourage it. Do not be afraid that your physician will feel slighted or offended. They’ll get over it.   Putting another set of eyeballs on a difficult problem will frequently improve the accuracy of you diagnosis. Although many patients do in fact seek second or third opinions from a specialist, they rarely seek second opinions, if ever, on diagnostic studies. I’ve spoken about this on many occasions, here is but one example . Radiologists are no different than the physician whose office you are currently in. Many diagnostic facilities do not have specialists who read MRIs of one particular area or subspecialty within radiology. Many diagnostic facilities will have one radiologist read all studies. That is very much like an orthopedist who will operate on a spine, shoulder, knee, and a hand on the same day. That lack of sub specialization increases the likelihood of medical error. I will personally seek a second opinion on many patients’ MRI interpretations — If I do not agree with them. I strongly suggest, that you do the same. The very same holds true for pathology specimens. There are Pathologists who are highly sub specialized in certain areas and thus are far better qualified to determine  whether or not a tumor they’re looking at is malignant, benign, and what subtype of tumor it might be – – – which could make the world of difference when determining what treatments are available. This is an incredibly important yet tremendously underutilized second opinion mechanism. 

Second Opinions: Use your own voice and your own words …  

One significant consideration when seeking a second opinion, is that you do not want to be the source or the mechanism for perpetuating misinformation or misdiagnoses. When you seek a second opinion, you want to give that physician information that you feel is relevant and not necessarily information that you were given from the first opinion physician. Confirmation bias, or planting a seed in the ears of your second opinion physician’s mindset could simply lead to a perpetuation of a mis-diagnosis and result in a wasted opportunity for meaningful second opinion.

You MUST plan ahead for your physicians visit… 

Many of you when you arrive in our offices are nervous and this can have significant ramifications on the quality of the communication that we have. Even more importantly, once we have completed the history, as well as the physical exam, we enter into a discussion about what the possible diagnoses are — and of course what the possible treatment plans are.  If you have not understood the diagnosis nor some of the terms utilized when the treatment plan was discussed, then in all likelihood you are not remembering anything else the physician is saying to you.

• Bring a Friend: It is extremely important that you consider bringing someone else with you to the office to help you remember what transpired. 
• Write it Down: In addition, it is aptly imperative that you bring a notepad with you to record what you’re being told. 
• Keywords: Don’t be shy to ask the physician for a list of keywords or search terms so that you can go home and do your homework online to further improve your level of understanding of what was discussed. Lastly, not be afraid to ask a physician for a copy of a page that he or she may have written some diagrams or drawn out and algorithm, suggesting further treatment or diagnostic considerations.
• Ask if you physician, given the same diagnosis or treatment options would opt for the treatment they are recommending.  Recent studies and anecdotal reports might surprise you. 

 The data and research on medical errors is quite real. Many patients are being harmed, or meaningful treatment is being delayed — on a daily basis.  We all have a vested interest to change this. You can play a very significant role in minimizing the risk and to minimize your chance of being a medical statistic.

Learn more about Your Role in Avoiding Medical Errors 101… at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Technology is advancing at an extremely rapid pace.  It will effect how you find your doctor, communicate with your doctor, collect information about your disease … and it may impact how you and your physician interact.  

Your participation is greatly appreciated!  please share with all your friends !!  

Learn more about “Patient” Healthcare and Social Media Poll #hcsm : Please Share at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

I am preparing for a talk and wanted to query my readers and beyond… There are only 5 questions… and i very much appreciate your assistance!

THANK YOU !!!

Learn more about Healthcare and Social Media Survey #hcsm Pls RT at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Establishing a Social Media Presence in Healthcare

Background:

The world of healthcare is inherently siloed,  tethered,  fragmented and prone to poor communication and collaboration.  Today, healthcare workers solve their problems via traditional methods that are often costly, inefficient, nor timely.  Increasingly, more savvy healthcare workers are looking outside the system to digital media and communities for answers, but are challenged with uncertainty over concepts of usefulness, practicality, bandwidth issues, “ROI” and privacy concerns.

Establishing a digital presence is rapidly becoming a necessity for healthcare professionals, medical practices, and institutions.  Many have recognized this fact… yet many more have not. 

At its heart, digital media is about people, it is about relationships, and it is about communication^[1].  A social media presence is about educating, engaging and growing your audience, improving outcomes, compliance^[2] and potentially the bottom line of your practice.

Human beings are innately social, health is social, health care is not social – – – yet.

Physicians used to enjoy the ability to get to know their patients and the stories they had to tell.  The pressures brought on by fiscal, policy and political will has changed that.  We knew our patients, their families, the impact their issue was having on their quality of life as well as relevant important events in our patient’s lives.  There are those that believe that technology drives a wedge between the patient and the physician.  Alongside the other advantages noted, I strongly argue that the proper understanding and use of digital media can aid us in recovering that relationship we once enjoyed and cherished. 

According to a recent AMA study ^[3], which also cites a study by the Pew Internet Research Group, in 2011^[4], nearly 80% of  internet users, or 60% of all adults, have searched online for health information. These empowered or engaged patients are not just using the Internet to become more educated about their orthopedic issues, but they are actively seeking advice as well as support. Currently, the source of this “advice and content comes from a few engaging providers, a few engaging institutions, but most patients are exposed to a significant amount of commercialized nonsense driven by a profit motive. 

Simply put, social networking and digital technology enables individuals, physicians, hospitals, and patients to create online profiles and connect with one another.  Perhaps most relevant to the Orthopedic Surgeon is that the majority of these patients are researching their surgeon and their respective institutions prior to their visit to your office —  they are checking your online reputation, and the message or image you portray.  

Some simple undisputed facts about digital media and technology.  50% of the world’s population is under 30. They do not communicate via e-mail or telephone. Generation Y and generation Z consider e-mail passé. The fastest growing segment on Facebook is women over 55 years of age.  SMS, direct messaging, micro-blogging^[5] and digital media is fast becoming the chosen communication standard. 

Physicians may be early adopters of certain enabling technologies, such as the iPad — but they lag way behind when considering how to use technology to communicate and collaborate professionally. Most physicians have not adopted or shown an interest in engaging their patients anywhere except within the confines of their office. Only the Oil Refinery business lags healthcare in digital media adoption!  Despite the fact that email is giving way to more useful forms of communication, and despite the fact that 65% of patients have noted that they are willing to switch to a physician who is willing to engage them utilizing digital communications — most physicians have yet to adopt  the use of electronic communications with their patients.  They believe, sometimes in error that HIPAA prevents email communications with their patients. ^[6]

If Facebook were country, it would be the world’s third largest. Facebook’s traffic tops Google’s on a weekly basis in the United States. One in five couples meet online, one in five divorces are blamed on Facebook. What happens in Vegas, stays on Facebook, Twitter, Flickr – – – forever. Kindergarteners are learning on iPads. A new member joins LinkedIn every second.  The numbers are impressive and the adoption rates show no signs of slowing down

50% of the mobile Internet traffic in most countries is for Facebook. One on five patients flock to Facebook for healthcare information.^[7]  Imagine what this means for a bad patient experience. The world has gone digital, social media is here to stay. 1 billion people simply cannot be wrong. 85% of people log onto their Facebook account every single day.  Are they talking about you? And, most importantly, do you KNOW what they are saying?

Google is the number one search engine in the world; YouTube is nearly the second largest search engine in the world. If Wikipedia were made into a book, it would be 2 million pages long.

Do you still believe this is a passing fad?

Over 76% of consumers trust peer recommendations, either through social networks or more traditional means of communications. This compares to only 14% of consumers who have been shown to trust advertisements. In the past, word of mouth recommendations occurred offline at parties or dinners with friends.   Today’s hyper-connected world brought forth by digital communications has tremendously increased the magnitude, rapidity and reach of those who have something to say about you or your practice.   

A recent survey by the National Research Corporation^[8] found that 41% of patients look for medical content from social media sites, and 94% of those patients turn to Facebook. What percent of your patients are on Facebook? Are they reading your content? Do they know how to find your practice? Do you know what they’re saying about you? – – – Perhaps you should.

Digital or social media even impacts our off-line behavior. Researchers at MIT have discovered that having a deeply integrated social network can effect positive behavioral changes. Numerous other researchers have confirmed these findings.^[9]

Ready to Dive In?

The question is really not do we DO social media?  The question is how WELL do we DO social media; what are our goals? What is our message? Who is our audience?  How do we reach them?  How do we establish our digital presence — and how does this change the way we communicate and engage our patients, potential patients, caregivers and colleagues?

The return of investment of a digital media presence, in my opinion, is quite simple. Your business will remain relevant in five years.  There have been few studies published on the impact of a social media presence on the satisfaction surveys of existing patients, and studies which show that a digital presence can account for upwards of 15-20% of new patients entering your practice.   My own data (available upon request) shows that I receive more than 10 new patients inquires a because of my online presence.  That is not necessarily driven by my presence on platforms such as Twitter or Facebook.  Most patients note on many of the surveys I conduct that they found the videos and content on my site to be engaging and “comforting” when they were considering who to see for their orthopedic related issues.

Ed Bennett, Director of Web Strategy at the University of Maryland Healthcare System and a fellow Advisory Board Member of the Mayo Clinic for Social Media has been tracking the presence of physicians and hospitals on social media platforms for many years^[10]. Over the last few years there has been a significant jump in the number of healthcare professionals appearing on digital media stage. Physicians are beginning to get the message. They are starting to understand the opportunities that a deep digital presence presents them with.  Early adopters have a significant first to market advantage, if your strategy is executed properly.  

Even though studies reveal that most physicians participate in social media in some form or another in a personal capacity. From a professional perspective there exist many reasons why physicians are hesitant to engage on the social media stage^[11].   Perhaps it is naïveté,  fear, the lack of practical, actionable, and relevant social or digital guidelines put forth by our professional organizations, and perhaps most important– – – is the misunderstanding that it is too time consuming and will not contribute to their practices’ bottom line revenue growth.   

In 2011 it is simply no longer advisable to simply have a static, template driven online “presence” or no presence at all.   In today’s fast-paced world of digital communications, you must be where your potential patients chose to be. You must be in a position for them to find you on the platforms that THEY have chosen to use.  Perhaps a marketer or perhaps your practice manager suggested that you establish a website and a digital presence. How’s that working out for you? Does your marketer or practice manager understand the ranking algorithms that Google uses? Did they engage you and understand what your goals were?  What your message is?  Who your audience is?   Were policies and guidelines put in place not only for physicians’ activity, but for staff members and even for patients, in terms of a comment policy?  Is someone actively monitoring your presence (reputation) online? Someone SHOULD be. Whether it is you, a member of your staff or an outside trusted consultant, you must know what is being said about you in the digital arena.       

If your activities are being driven by a marketing “professional”, do they understand that YouTube is the second largest search engine in the world and that short videos are favored by many, as opposed to reading long text content? Do they understand how information is shared in the digital world? Perhaps most important to you as a physician, is not only how to properly position your practice so that people can find you – – – but that one of the key underpinnings of your strategy is to understand the impact all of this could have on your practice’s reputation. You have seen thousands of patients. You have restored the quality of life of many. It took you years to develop your reputation.  In today’s fast-paced digital world that reputation can evaporate in a moment.   Having a deep online presence is literally the only means to manage your online reputation; the best defensive is a great offense; drive positive, accurate content to counteract the inevitable negative comments that will arise on sites such as HealthGrades, Vitals, and Yelp.   

Motivation

Each and every physician who chooses to establish a digital presence will do so for different reasons.  For the vast majority of you, your main goals will be to increase your patient load, improve your office efficiency and streamline your practice workflows^[12]. Some of you may choose to enter the digital world in stealth mode simply to monitor your online reputation.  Opportunities, for those who are interested, expand way beyond these limited, productive, and worthwhile goals. 

The most meaningful reason to establish a presence is that patients can find you and perhaps learn a bit more about your perspective, approach and rapport with your patient base.  Second would be your ability to replicate the content that you share with forty or more patients every day in your office.  Why not convert that to print form and benefit from the fact that that content is now available to anyone who wishes to read it? There is far too much commercialized nonsense bombarding our patients online.   We can go a long way to drowning out a lot of the worthless content that Google references for a typical orthopedic search.  Some of the other more meaningful reasons to be present in digital media include establishing a robust two way communications portal with your patients. Providing patients with the ability to connect to or engage with your practice. Other reasons to establish an online presence include providing your patients with meaningful content, sharing health-related information with your patients, managing your reputation, humanizing the healthcare encounter, sharing news about recent talks you may have given, mentioning community outreach programs that you are running, and certainly offering customer service initiatives that consumers have grown accustomed to.

Reputation Management

The solution to pollution is dilution! How many times did we hear that in residency?   It rings more true than ever in our digitally connected and online global society. 

Online reputation management is the process of monitoring, addressing, and mitigating what is said about you on a search engine. Comments from dissatisfied patients— posted to blogs, Facebook pages, or websites, such as HealthGrades.com can directly affect the public’s perception of the physician and your practice. It is simply no longer acceptable from a viability perspective, to ignore what is being said about you online. Reputations are being built, managed, and potentially lost or degraded at a very rapid pace, given today’s environment. And while many healthcare professionals and physicians fear that by engaging in social media platforms opens the floodgates for negativity and potential public relation nightmares, that thinking could not be farther from the truth; social media is the ONLY way to protect your online reputation and head off negativity BEFORE they become online PR nightmares.

As mentioned previously, peer to peer recommendations carry far more weight than any traditional media campaigns. You need to enable your patients to tell their stories, to share their experiences with others and thus provide you with the most valuable form of advertising available. The patient’s experience with you and your staff is a critical component of a practice building initiative in this day and age!

Our own internal reviews and patient surveys bear this out.  Physicians, who routinely rank poorly in our surveys, have many poor reviews on these sites.  These also tend to be some of the worst performing physicians from a private referral or RVU perspective.  It is therefore incumbent on everyone in the group to be onboard with a reputation management engagement. Every member of your staff needs to understand that their behavior can affect the entire group’s reputation.   

No matter how wonderful you are, you will never make each and every patient happy.  Although most comments on these ranking sites tend to be positive, there are a fair number of negative comments as well.  Don’t think that only dissatisfied patients with a grudge are going online to discuss you and your practice.  What recourse do you have, if any, if a patient posts a poor comment about you or your group online?

Reputation management is by far one of the most meaningful reasons why physicians should be online today. There are at least four major physician ranking organizations that are most likely topping a Google search of your name. What are your patients saying about you online, do you know?  You should!

The cornerstone of reputation management is simply the knowledge of what’s being said about you online. Google enables you to do this in a very simple manner. You simply set up a Google Alert   for your name, your partners’ names, your assistance names, as well as your practice name. Every day Google will let you know if something has been said about you online.

Now that you’re aware of what’s being said online. What are you able to do if in fact you find content is not particularly complimentary. Therein lies one of the most important reasons— even for the most skeptical of surgeons out there — to have a deep digital presence. That simple reason is that you will drown out or dilute content or comments that exist on many of these physician grading platforms when a patient performs a Google search of your name. 

Online reputation management is primarily driven by search engine results. If you do not have an online presence and your website does not produce or offer content, which ranks well utilizing Google’s algorithms, then your ability to drive down, or drown out any negative reviews is non-existent.

If you have an evolving, progressive, web 2.0 compliant website which enables sharing (which significantly boosts your search engine optimization),  then when you Google your name or your practice’s name you will find that any untoward comments have been pushed down off the first page of a Google search.  More than 40% of people do not go beyond the first page of a Google search. Nearly 85% or more do not go below the second page. If you “own” your online existence, and if you “own” your message, these negative comments will not go away. People will simply not find them.

Perceived Obstacles

The two most common obstacles or roadblocks to establishing a digital presence is simply the lack of understanding of how it can affect your practice…. and then once you have reached that point you are not sure how to do move forward. Winston Churchill once said ”People like to change, they dislike being changed”  Hopefully I’ve provided you with enough proof that a digital presence is necessary, or at the very least meaningful – – – yet how do you go about actually establishing a web 2.0 compliant presence in the world of social and digital media? Unfortunately there are very very few tactical or practical resources or guidelines available to physicians who wish to undertake this endeavor on their own.  Most “professionals” simply do not understand the  healthcare space, nor do they understand how to properly “interact” in the world of social health. 

Planning for a Social Media Engagement

Like anything other endeavor you’ve undertaken in developing your practice strategy, you’ve gone through a thorough planning, and due diligence phase. Before you dive in to the world of digital media it is extremely important to begin with a very clear outline and strategy in place. Proper preparation begins OFFLINE. You need to define your goals. Is your goal to attract new patients, manage your online reputation, or simply to expand your referral network? It’s simply not enough to have a presence in social media; somehow it needs to tie in with your overall marketing objectives. You need to be able to articulate clearly what you hope to achieve through a social media engagement. You need to consider your limited bandwidth and determine how much time you will be able to commit, and who else in your office can or will be participating. This can help in determining just how many digital media properties you can manage.  You need to carefully assess not only yourself, but your staff —and each other’s core competencies, roles and ability to contribute to your network.

Establishing a set of clearly articulated guidelines is a must[13].  While there are many guides out there to assist you in creating disclaimers, and guidelines, I would strongly recommend consulting a legal entity well versed in this area.   In addition, roles are divvied out to know who’s going to monitor the various platforms you have chosen to establish a presence on.  For patients or people who choose to engage, you need to establish a clear comment policy, which will include prominent disclaimers so that your patients or potential patients clearly understand what the rules of the game are in terms of engaging with your practice. Enabling two way communications will drive business to your practice, but should be considered a relatively advanced offering.  Concentrate on mastering your foundation.  When you choose who is going to help you set up your website, or profile, be sure that the developers clearly understand that this may be something you will choose to “open up” as your comfort level improves and your desire to engage develops. 

A frequently overlooked aspect of establishing your online presence is exactly how you wish to frame your message.   You need to define your message, develop your message, and know how to articulate your message — and most important, you need to stay on message.  Your message can simply be a list of your offerings, and the content you’ve supplied to bolster the public’s confidence in your ability to handle their orthopedic issue.  Many physicians have initiated blogs to keep other physicians, patients and potential patients aware of the impact of the onslaught of regulations and changes we are soon to face as the healthcare landscape “matures”.  You may have a particular interest in one or more complex orthopedic problems that other surgeons are reluctant to handle.  Patients need to know that.  They need to know first and foremost that you exist, and second that you are capable of dealing with their complex issue.   This can be a powerful driver to your website from a “long tail” search SEO perspective.  Many people who search online do so in a sentence structure.  “Is surgery necessary for my meniscus tear, ” is a good example of a long tail search; as opposed to simply searching “meniscus tear”, which is considered a short tail keyword search.  Competing in the short tail keyword search area is expensive and not productive for small practices.  In long tail search, there are not a lot of searches for those keywords–but when a search is initiated–you have a very good chance of that patient finding you!

Once you have decided to commit the time, money and resources to establishing a digital presence, you need to commit to staying on course, and cultivate and manage that presence.  This is not nearly as time consuming as you may believe.    One of the worst things that you could possibly do is to establish a presence on a platform that is meant for engagement or two-way communication, yet you fail to respond when someone reached out or commented on one of digital media properties. Your website, Facebook Page, Twitter account or blog do NOT need to be updated frequently.  You should not feel rushed or fearful that you need to produce content on a daily basis. However, your Google Alerts and comment sections DO need to be monitored DAILY for comments, posts and opportunities to further engage with the patients who are reaching out to you. Remember, Quality matters far more than quantity.

Practical Guidance

The very basic tenet of establishing a network or digital presence is to establish a foundation, a core or a home base?  Given the multitude of platforms and tools available today, your core presence can be a website, a blog, a Facebook Page, or a robust profile page on one of the many Q & A based sites appearing these days.^[14]   Sites such as Twitter and Facebook function by allowing us to share and interact with the rest of the world.  But to interact on Twitter or Facebook,  it is best to have a website with great content to link back to.   By having a robust website, or blog, you will have meaningful content to share.  Although, not absolutely necessary websites or blogs are the most productive and scalable alternatives when considering what your home base should be.    That said, it will only take you 15 minutes to build out a robust profile on a site such as www.Avvo.com, or www.OrganizedWisdom.com; you can try this for a few weeks or months and see whether or not you feel you are ready to scale your presence, and then proceed with the development of a website. 

After assisting countless physicians and organizations in establishing a digital presence I usually witness an awakening which typically occurs as the fact that the technologies, applications, and platforms that exist today limit your costs, and merge seamlessly — so  that your  time commitment can be kept to a minimum.  A personal commitment of an hour or two a week is usually all that’s necessary.  By engaging staff members, medical students, marketing interns, and other interested members of your staff — you will find it is not difficult to not only establish, but maintain and grow an active digital presence.

Ready for a healthcare social media presence?

In order to execute on your game plan, you first need to establish your core presence online. Ideally, the foundation or the backbone of your online presence is your website.   I strongly suggest you do not utilize a template driven (cheap) website with pre-populated content. Google does not like to see the same content on multiple different sites. Google actually penalizes you for duplicate content and your site simply will not rank with Google and other search engines. Populating your website with custom meaningful content is a lot easier than you currently believe. I utilize what I call your “41st patient”[15] initiative. There is no need to change your current workflow and your time commitment is minimal at best. If you look at your content needs from a very simple strategic perspective, 85% of your business is generated by only a few, limited number of conditions.   To utilize the 41^st Patient concept, I suggest implementing the following strategy;  at the end of the day after you have dictated your note on your 40th patient, you simply pick up your dictaphone, and you dictate a small blurb on a particular subject, say, Meniscal Tears. Your dictation on the first day is simply, ‘What is a Meniscus?”  Your dictation on your next office day is…  “What is a Meniscus Tear”, and so on.   Within 2 months you have all the content you need for a dynamic, custom, professional appearing website. These dictations are then sent to your website developer or perhaps a staff member who can then place them in the appropriate position on your website.

Perhaps you feel that you have a unique message that you want to get across to your patients?  Either adding a blog to your existing site, or simply using a blogging platform such as Blogger, Posterous or WordPress will suit your needs just fine.   You may find that a blog may fit quite well into your framework, depending on your desires. While I strongly recommend you utilize the WordPress platform, the other mentioned are equally as simple to set up. If you are not familiar with WordPress, it is a very user-friendly, vibrant, easy to customize platform that most web developers utilize today. Not only that, you need absolutely no programming knowledge to be able to edit existing text, add posts, videos, pictures, or testimonials — and perform a fair amount of search engine optimization on your own.   Search engine optimization (SEO) is a term used to describe how your content or pages will rank among other content pages discussing the same topics.  There are some very basic simple strategies that you can learn so that your website will be visible to people searching online, at least on a local scale from a geographic perspective.   Proper use of key words, understanding the difference between short and long tail searches and proper “tagging” is a skill set you can develop in a matter of days.  

Stepping Onto the Healthcare Social Media Stage:

You have spent the time, money and resources to build out your foundation. Now you possess the capability to place your content where your patients or potential patients “reside” — online.    You now need to determine which platforms you want to have a presence on, and you need to understand the differences between them. You may want to share your content on Facebook, Twitter, YouTube, and Flickr (photographs) which are by far the most common, and offer you the most bang for your efforts. Hopefully during the formative and execution phase of your digital media strategy, you may have established a Twitter account (a passive presence just for monitoring) and a Facebook Page as well.   There are many tools and programs available that can automatically share your content from your website or blog to your various social media properties,  on a regularly scheduled basis.  This eases you of the burden of having to manually publish your content to these social platforms and they are an enormously efficient way to grow your network. There are a number of social media aggregating platforms such as HootSuite.com, and Tweetdeck.com.  The benefit of these aggregating platforms is simply that you post one message and it will populate all of your social media properties…. in seconds.  

Once comfortable on Twitter or Facebook, you need to realize that all of your interactions with your patients do not need to be based on your original content.  There are very simple efficient ways to share current news or interesting articles as well with your network.  Let’s say you want to share an orthopedic related news article with your patients via Facebook or Twitter. With a Google Reader [16]account you can very easily define a set of search terms, and every morning Google delivers you a list of the articles that meet your search criterion.  Utilizing an aggregating platform such as Hootsuite or Tweetdeck, you can now share that information with your network of patients, or potential patients with a single click… done!   Now you have put that timely useful information in front of your patients where THEY reside in the digital world.

Before posting to twitter, Facebook, or YouTube I strongly suggest you spend just a little time understanding how these platforms work, how people utilize them to communicate or share, and that you keep in the back of your mind that you never want to share anything on these platforms that you would not want your worst enemy to see. Keep in mind; you NEVER want to share any personal health information of any patient specific information online.   Once you’ve developed a certain comfort level on these platforms,  and you also understand how people are utilizing them; then you can sit down with your staff – – – and broaden your outreach by opening up on the dialogue with these powerful social media properties.  Welcome on stage. 

Conclusion: 

The rapid dissemination of knowledge and pace of our digitally connected world extends to our patients.  Many are online–and most are looking for information about their physician!  You need to be in control of that message and you need to know what they are saying about you.  Social media is NOT a passing fad.  Healthcare is ripe for social media based interactions.  Social or Digital Media is here to stay and the number of new healthcare social media platforms coming online is increasing at a dramatic pace.  Even the government recognizes the importance of these new online tools and will be utilizing patient driven data to support its value based initiatives; the medical environment in which we practice is evolving rapidly over the next few years and we have to be prepared.  Early adopters gain a significant advantage over their competitors (even Google ranks older content higher), but this should not be an endeavor that you rush into without proper preparation and planning.   The time is now to consider how a digital presence can assist you in assuring your practices viability and relevance as the healthcare landscape matures and adapts to the changes that digital media offers. 

Please feel free to reach to me with any questions or if you need assistance. 

Howard Luks MD

914-789-2735

howard@howardluksmd.com

Learn more about How to Prepare For and Execute An Online Presence In Healthcare at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

• healthcare system, 
• the patient, 
• the physician as a solo practitioner
• the device industry,
•  and healthcare institutions.

Clearly the number one value proposition chosen by most health care professionals for entering into the digital arena is to improve upon their ability to drive patients to their office, institution, promote a service line,  or to increase the use of their products.

Social Media and the Healthcare Marketing Industry

Outbound Marketing for Healthcare: 

Similar to its effects on many industries, social media has turned the healthcare marketing world upside down. Traditional healthcare marketing was and remains outbound in nature. That simply means that you are  pushing products or services on your customers or potential patients utilizing various one way,  unidirectional — and typically expensive channels. Typical examples of outbound marketing initiatives include:

• television
•  print
•  radio advertising
• direct mail initiatives 
• blast e-mail campaigns 

Inbound Marketing for Healthcare:

Over the last two years, and especially over the last number of months there’s been a tremendous focus on the value proposition of an inbound healthcare marketing strategy. Outbound  healthcare marketing efforts are on the decline. This is simply because people are now in control of the healthcare information they receive, and where they choose to receive it. In the outbound marketing world all the control was with the company.  This is no longer the case.  80% of consumers trust the recommendation of a friend or colleague.  16% or so trust the information contained within and advertisement.   Where are these healthcare consumers exchanging information about physicians, hospitals, diseases, products and other information they find useful — On Facebook, Twitter, and other internet/ social media platforms.   

To understand the nature of inbound marketing is to understand the evolution of social media and the effect this has had on where people choose to curate their content or information from. Inbound healthcare marketing initiatives focus on placing information about you, your practice, your product, or your hospital in front of your perspective audience where they reside online and on the platform that they choose to utilize.

Some of the most effective inbound healthcare marketing techniques include content marketing as well as social media participation. This includes

• blogs 
• video blogs
•  podcasts 
• And a “foundation”  —or dynamic web 2.0 compliant website.

 Once you have produced useful, actionable, meaningful educational health related content, you then need to combine this with a strong presence in social media. These efforts can dramatically increase the visibility of the healthcare content you have generated. The essence of inbound marketing is to allow your audience to share and spread your content through their own networks, whether it be on Twitter, Facebook or aggregators such as Digg, and Reddit. 

ROI of your Outbound vs Inbound Healthcare Initiatives

Outbound healthcare marketing initiatives are quite labor-intensive, require the assistance of expensive marketing professionals, media professionals —  and have a lower return on investment when compared to many successful inbound healthcare marketing initiatives. The cost of establishing a blog, generating meaningful content and utilizing an aggregating platform to share that content is far less expensive and time-consuming than developing a television, print ad campaign or direct mail campaign.   In addition, 80% or more of your customers or patients are online and searching for information about you. Outbound healthcare marketing initiatives, do nothing to improve your search engine optimization, nor do they assist you in online reputation management.

Inbound techniques offer you the ability to improve your:

• outreach
• ability to educate
• promote your service line
• promote your healthcare practice
• collaborate and engage
• google ranking
• reputation management 

and offer a lingering “residuals” effect —  long after the original content is published.  

Healthcare marketing channels have changed on a fundamental level.  Social media has revolutionized how we  interact not only with each other, but with many of the products and services that we may wish to utilize. We are moving away from marketing channels which focus on pounding information into people’s heads. The focus is now on inbound techniques, which primarily focus on adding value by providing meaningful information, and engaging your potential customers or patients in a far more meaningful, engaging and social manner.

Once again, as I’ve said many times over,  from a healthcare perspective — I feel that physicians have an obligation to produce  meaningful, educational healthcare content for patients to identify and utilize when researching online. This aids them in drowning out much of the commercialized nonsense that a typical google search produces.   That being said, most healthcare professionals who choose to establish a presence online will do so purely for marketing purposes.

The world has changed. Communication standards have changed. Does your healthcare marketing professional understand this? Do they understand the difference between inbound and outbound healthcare marketing initiatives, and how to promote your image, brand and service lines with a properly planned, and executed social media strategy? 

This is yet another reason why physicians, hospitals, device manufacturers, as well as the pharmaceutical industry need to place a social media agenda very high up in the ranks of importance when discussing their overall strategic and marketing initiatives.

Over 76% of consumers trust peer recommendations, either through social networks or more traditional means of communications. This compares to only 14% of consumers who have been shown to trust advertisements. In the past, word of mouth recommendations occurred offline at parties or dinners with friends.   Today’s hyper-connected world brought forth by digital communications has tremendously increased the magnitude, rapidity and reach of those who have something to say about you or your practice.   

In 2011 it is simply no longer advisable to simply have a static, template driven online “presence” or no presence at all.   In today’s fast-paced world of digital communications, you must be where your potential patients chose to be. You must be in a position for them to find you on the platforms that THEY have chosen to use. 

Possessing a firm understanding of the potential of a deep Inbound Healthcare Marketing strategy, combined with a deep digital healthcare presence is of paramount importance… especially  to healthcare providers who are being squeezed on all sides.   

Learn more about Social Media and Healthcare: Inbound vs. Outbound Marketing at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

I know you’re out there! I know many of you are ready to engage…. 

We’re going to build out this section with the tools necessary to give you tactical, meaningful, practical and actionable guidance that you can put to work immediately…  

First we’re building the Why….   with occassional posts related to How?   

I’ll get there… I’m only one person !!!

#thcsm : Tactical Guidance for Healthcare pros !

 Great video from Mike Cadgoan  — who blogs at Life In The Fast Lane…  

Follow the video with a view of this post from Ves Dimov, MD… 

Learn more about Healthcare and Social Media: Ready to Join the Conversation? at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

For physicians or healthcare providers thinking of establishing a digital presence, but have no idea where you will find the time to engage and develop content… RELAX!

Here is a very simple strategy. You do not need to change your workflow… at all.  No fear, no cumbersome tasks… just the production of meaningful personalized content.

Done.

Simple

#thcsm

Video Transcript: 

Good morning, I’m Howard Luks, this is going to be one of our first posts in tactical or practical guidance in digital media and in helping to establish your digital presence. I work with a number of physician groups, or large physician organizations, as well as, leaders in the industry and I’m helping them establish a digital footprint. We’re going to focus particularly about physicians and health care providers – and content creation.    

When I hear from them, once they have engaged and decide to have a website and they receive base camp or instruction sheet on the content that is necessary, what I immediately see in their eyes is fear, fright, ‘oh my God how many have come up with this content.’  This can be a HUGE stumbling block to creating a meaningful website full of quality content….. but it’s not —- really!

 A simple strategy:  Think of it as your 21^st or 41^st, or 51^st patient?  Our workflow is simple.  We dictate. We dictate every single note about every single patient at the end of each and every visit. We say a lot of the same things each and every day. That is content. That is important, meaningful, content that patients will find useful. So my advice is quite simple. Don’t look at the entire list of content that your website provider or developer is asking for. Let’s break it down, one topic at a time.

Let’s take orthopedics for example; I can get a typical sports medicine doctor up on the internet with a deep digital presence in two months with all the content that he/she will find necessary for quite a while. The Sports medicine world can be broken down very simply into a number of specific injuries. So, your 41^st patient dictation on the first day is going to be — What is a meniscus?  How long will that take you?   Day two will be: What is a meniscus tear? And so on.  You’re going to sit down at your desk in the end of the day after completing your office notes, you’re going to pick up your Dictaphone and you’re going to dictate what it a meniscus tear. Maybe two or three days later your 41^st patient is going to be… ‘why does a meniscus tear hurt?’ Your 41^st patient on the 3^rd day, a few days later is going to be… ‘what are your options in the treatment of a meniscus tear?’ You’ve had this discussion all day long. Each section will take you 2-4 minutes… maximum.  

This is going to roll off your tongue into your Dictaphone. It’s going to be transcribed. You’re going to send it to me, or your website developer. . Then we’re going to be able tag it, and turn it into an SEO machine and in turn you now possess meaningful content on your webpage. Boom! You have a topic done. It’s simple. It took you two minutes to dictate this. It will take a day to transcribe it and another day for it to be up on your website. Guess what? In a month and a half or two months, you have a website full of content. Simple,  practical, tactical digital guidance. Have a good day.

Learn more about Your 41st Patient: Practical (Tactical) Guidance to Develop Website Content…. at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Great!  What? Where? How? When? Who to engage? Best practices? Risks?  These are all the variables you need to consider.  

There are many healthcare providers and institutions or start up platforms who are beginning to engage on the healthcare social media scene. Many more are lurking in the #hcsm chats … and hopefully they are learning why — from a patients perspective, physicians’ perspective, industry perspective and and institutional perspective — exactly why it is so very important that we have this conversation and continue to engage interested observers or participants….

HOWEVER…

Once the decision is made to engage… these same people will require real world, best practice examples on how to proceed, who to follow,  who to learn from(and perhaps, who to hire)… BEWARE of self proclaimed social media *experts*!!  

It is my hope that a new twitter hashtag …   #thcsm , where the T=tactical will enable those of us with experience in the space to assist  those looking to initiate the process.   Feel free to reach out hjluks (at) gmail (dot) com

Thoughts?

Learn more about Health Care and Social Media… The Need For TACTICAL Guidance at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

This article from the NY Times , is very timely, and focuses on a very important conversation we need to have.

I’ve written many times on this topic before… and usually begin with … “One day a physician will look in the mirror and see a patient looking back at them”. This article brings that theory into reality.  That physician is going to know who to call, how to get an appointment tomorrow, which specialist to enlist on their team…. and they will know where to dive deep into the scientific circles focusing on the disease they are dealing with.  Will their patients’ have those same opportunities… no!  

Now, the article does not reference or mention the concept of improving our health care system so that a patient has the same degree of access to professionals or content that this physician-patient has, but it gets to an equally important point ~perhaps…

When faced with a certain diagnosis, the treatment of which the physician/patient is fluent in – – –will that physician choose the same treatment that he or she recommends to patients on a daily basis? This is an extremely important consideration. If some physicians are not willing to undergo the same treatments that they recommend day in and day out, then why are they recommending them to patients?

To a large extent, it all comes down to communications, and an appropriate discussion about the choices available, the risks associated with those choices, and an in-depth, transparent, and meaningful — informed decision-making process. Values, stories, content, evidence, transparency, validity, access and communication are all appropriate descriptors of a meaningful encounter when a medical professional is disucssing treatment options or opportunities with a patient.  

If the physician engages in an open dialogue, they may actually learn a thing or two…. and learn to be conversant about the patient communitieis that exist —and the enormous value they bring to these very same decision making moments.  Those very same communities may save a physicians own life one day!  I know they will assist me. 

Learn more about One Day I Will See A Patient in The Mirror Looking Back At ME! at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Video Transcript… Lightly edited: 

 Healthcare and Social Media: The Orthopedic Minute

Good morning, I am Howard Luks.  News Flash:  Healthcare Technology is advancing at an incredibly rapid space…  imagine that !

 As a physician it’s hard not to notice.  Not only in terms of devices and manufacturing, but in terms of the cloud, the computer, social media, our ability to communicate—  these are all enabling healthcare technologies that could enable or allow us to diagnose and potentially its treat.

 Where can this go wrong or where has it gone wrong.  As I have heard quoted recently by a physician on the West Coast giving a talk on TED.  “I guarantee you that if a patient enters my institution today with an amputation on a limb, many physician wouldn’t believe it unless a CAT Scan or an MRI was obtained to confirm it”.

  I am not sure that was a joke, I am not sure that that’s the way that healthcare isn’t being practiced quite widely across our country.

 The art of the physical examination, the art of the interaction between a patient and a physician is being lost. Is it because of technology? Perhaps,  a little.  Is it because of other issues — such as time constraints, decrease in reimbursements, heightened risk aversion due to fear and malpractice — yes.  I think all of those variables enter into the equation.  However, we as physicians must recognize the changes that are taking place and we must realize what our role or position is — and we must learn how to incorporate  that technology — to benefit you the patient as well as us,  the physicians.  Technology cannot supplant or replace that relationship that exist between a patient and a physician.  That relationship that is based upon us listening to you, us trying to work with you to get more information from you about the reason why you are in your office.  We then need to actually perform a physical examination, they don’t make an iPhone app to that — and if they do— its not going to do the same job as the two hands that I was born with. 

 Taking into account patient’s history, their physical examination, their complaints and then their x-ray or MRI findings creates a story.  Then you delve deeply into what type of effects the issues are having on your quality of life.  And then you complete the story by determining the personality of that injury or how that issue in particular issue is effecting you — and then we review the personalized choices and discuss what you believe you want to do about it.

So healthcare technology has a role, I think that role is limited, I think that role is over utilized and over prescribed.  Right now I think we need to head back to the basics.  The art of a physical examination and a physician-patient encounter — and in the end we will all be better because of it, have a great day.

Thanks to www.transcriptionsservice.com for their assistance.

Learn more about Back to Basics… The (lost) Art of The Patient-Physician Interaction at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Tell Me Your Story… “Let Patients Heal Healthcare” @epatientDave

 Your story, the issues you face and how they affect you and your loved ones matter ! It is of paramount importance that your personal insights, values and the effect the issue at hand is having on your quality of life is critical to delivering personalized, appropriate, efficient, and possibly evidence-based medical advice or surgical decision making.  This message is sub-speciality agnostic — it is not purely to assist you in your Orthopedic needs.   It pertains to all interactions you have across the healthcare spectrum.  

And…

If you find your provider is not willing to listen… simple… move on!  You can find many of us who do care.  

 Video Transcript: Lightly edited

Good morning I am Dr. Howard Luks, this is your Orthopedic Minute.  Tell us your (healthcare) story. I am willing to listen, I want to know why, because your story matters how your issue, your injury, your diseases effects you and effects those around you — and effects your quality of life.  It matters enormously in determining what treatment regimens may assist you and could put you in a different treatment algorithm. We will choose to initiate a plan specifically gearing the treatment towards you and your needs.  It will take into account your quality of your life.  The (healthcare) decision will take into account how your injury or disease effects your ability to go to work, to play with your children, to play with your grandchildren etcetera.  There are so many variables involved.  But to make that informed decision I need to hear your story. I need to know your story and I need to assist you by engaging in a shared decision making process.

Healthcare as a whole needs to do that but at least I can start with my little piece of the world — and by doing that — hopefully the concept spreads as many of the people who I met at the Mayo Clinic for their recent Healthcare and Social Media course had stated this past week herein Rochester, MN.  Especially the conclusion of @e-patientDave — let patients heal healthcare.  By telling your stories, incorporating your quality of life, your decision-making variables etc,— we can all go a very long way to making this a better healthcare system and making each interaction that you have with a physician far better more effective and more efficient one.  Have a great day.

Learn more about Tell Us YOUR Story – Patient Centered Care at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Establishing your digital presence as a physician… where to begin? 

I am very happy to receive a lot of requests from physicians to assist them in establishing a digital presence.  This is a huge step — in the right direction.  Where do you start? How? 

Your social media strategy as a healthcare professional needs to begin with an anchor, a foundation or a home base.  That can be a blog, or a deeply integrated website… it doesn’t matter.   You need to define and control the message and manage your tiny piece of cloud based real estate as you would manage your office ( I hope:-))  Then utilize your outposts… FB, Twitter, etc.. to share your knowledge and content with others…. Sound good? 

feel free to reach out– as many have… I more than willing to assist you! 

Video Transcript: Lightly edited

HealthCare and Social Media : Orthopedic Minute:

 My name is Howard Luks and this is your Orthopedic Minute. 

 I have been at a bunch wonderful folks at a number of conferences recently.  I have met a number of healthcare executives, various device manufacturer executives, and I have met with a lot of physicians.  I have actually been quite pleased because I have been recognized by a number of those physicians and executives simply because of my social media presence. 

 How do I venture into the HealthCare-Social Media World ???

 I’m interested… I get it… The question that keeps you arising is what do I do, how long does it take, and how do I do it— I am interested in getting into “social media” or — “I am not quite sure how to do it.”  My answer is usually you have to begin with a home base, a foundation, if you will… and that could either be a blog or well-outfitted Healthcare 2.0 *compliant* website.

 Either way you need to be able to produce actionable, meaningful, evidence based (perhaps) content — and then you need to use your *outposts* in social media such as Facebook, Twitter and YouTube to link back to the articles and the content that you are producing.  This has been the message that I have put forth this week and this was obviously for a very limited audience.  But I hope you find it useful. As usual,  feel free to reach out to me anytime you are in need of a hand.  or a little bit of assistance.  I would love to help you take care, bye. 

Hjluks (at) gmail

Learn more about A Health Care Professional’s Social Media Strategy…. The Basics at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Video Transcript… 

Healthcare and Social Media: The Orthopedic Minute:

 Good morning I am Howard Luks this is your Orthopedic Minute.  (Being a physician).. this is not just a job.  What do I mean by that?  That’s how I approach my day and I will look forward to getting up and getting to the office and seeing patients or going to the operating room and seeing patients.  I particularly enjoy seeing patients back in follow up,  who I have treated previously. Why?  Because I see them myself, I do not rely on office extenders, physicians’ assistant, or nurse practitioners etcetera.  I am not saying they don’t have a critical role in the healthcare process, they absolutely do.  What I am saying is that the pleasure that I derive from practicing medicine is helping you.  I frequently have people come in and say thank you and they are offering gifts, etc.

 That is wonderful and I really appreciate it.  However, watching you walk into the room when six months prior (to your knee replacement) you required the aid of a cane or a walker — and I see a smile on your face and I know that your quality of life has been improved, you have made my day. 

 That is the reason why I am a physician. That is the reason why I practice medicine and that is the reason why I come to work everyday.  I couldn’t imagine doing it any other way.  I hope we have a great day bye.

Learn more about It’s Not Just a Job…. at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Video Transcript: Lightly edited

Healthcare and Social Media: The Orthopedic Minute:

 Good morning I am Howard Luks and this is your Orthopedic Minute.

Osteoarthritis and a Recent Injury:

 There are many causes of osteoarthritis.  Osteoarthritis is the loss of cartilage or cushioning within your joints.  One of the major causes of osteoarthritis is trauma.  It could be from a fall, from a car accident or from simply hitting your knee very hard against an object.  What happens is the cartilage suffers an injury,  but because it has such a slow metabolism it can take years or even a decade for effects of the injury to *show itself*. 

Researchers at MIT have found that if we intervene within the first twenty four to forty eight hours with a *simple* steroid injection we may prevent the injury from resulting in damage to that cartilage and thus prevent the onset of post traumatic osteoarthritis — and thus a life long issue with pain and disability that usually accompanies arthritis. 

 Interesting study I am going to reference it above, take care, have a great day.

Perhaps the new strategy for treatment of a recent knee injury is RICES … Rest, Ice, Compression, Elevation and Steroid?  Hmmmm

Learn more about Osteoarthritis: A Common Cause ~ and Possible Prevention at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Many of these degenerative tears or issues can be safely observed with out worry about further degeneration or suffering.  Unfortunately, many people are told they need surgery simply because “a tear”  was found on an MRI.  If your complaints are not put in proper context following an appropriate physical examination –then you may not need surgery — most don’t.  Most degenerative issues present themselves as a *quality of life* issue.  That simply means that if you have pain, that pain is severe, and it is limiting your quality of life —and your pain fails to improve with non-surgical treatment — then you might want to consider surgery, if your surgeon feels that your goals and expectations are realistic given the findings on the study.  

Make sense?

Take home message :   Not all abnormal MRI findings are truly abnormal… most are a consequence of aging or our lifestyle. Not all findings on MRIs require treatment. Keep this in mind when discussing your options with your surgeon.

Learn more about As We Mature (age), Things Change… at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

The Orthopedic Minute:

 Shiny New Objects: Not Always in Your Best Interest

Every shiny new object that appears on the healthcare scene may not actually be in your best interest. The Institute of Medicine recently asked the FDA to look into their fast track (510(k)) approval process because of issues found years after certain devices had been implanted in thousands of patients.

The Institute of Medicine’s much-anticipated independent review of the FDA’s 510(k) clearance program for medical devices recommended that the entire program be scrapped in favor of a new protocol to ensure the devices are safe and effective.

 The FDA, it appears,  wasn’t impressed with what the IOM said… so the fast track approval process remains in place, for now.

What does that mean for you?  It means that patients, and doctors can’t really be sure that the latest technological advancements or offerings are going to be in their best interest.  Many are skeptical that the FDA is acting in the public’s best interest.   Medications recently taken off the shelves in many countries around the world, remain on the shelves in the US because the FDA doesn’t feel it poses a significant risk.  Many patients with metal on metal hip replacements— as opposed to the gold standard metal on plastic — now have to undergo testing as recommended by the FDA to see if the metal ions floating around patient’s bodies are an issue.  

Those of you considering surgery that may utilize the latest in joint replacement technologies would be well served by doing your research and asking your doctor about whether or not you want to be an early adopter or stick with the gold standards that have served patients very well for many decades.    

Learn more about Healthcare Technology … The Latest is NOT Always the Greatest at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Have you been told you should have, or at least that you should consider having Orthopedic Surgery?

 Do you know why?  —   It’s a simple question that many people can not answer after meeting with their surgeon.  They understand they have a “tear” or whatever, but they do not know that many *tears* have non-surgical treatment options.  So, why is the surgery being considered?  Were your values accounted for? Your quality of life issues? Your lifestyle?  Each injury or orthopedic problem may behave differently in different individuals.  Some may chose to have surgery and some may not

As a specialty that usually treats pain, we deal with seeking to improve your quality of life.  Not all “abnormalities” seen on an MRI require surgical intervention.  If you have exhausted appropriate non-operative alternatives and you believe that your quality of life is suffering, then perhaps surgery is indicated.   Not sure ??? See below.  

Learn more about Are You Considering Having Orthopedic Surgery? at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Healthcare and Social Media

The Art of Communication

Healthcare Literacy

Do your patients speak “Doctor”?  If not, perhaps you shouldn’t either.

Healthcare literacy is a tremendous issue physicians face when communicating with their patients. We certainly do not do our part to address nor diminish this problem when we speak in terms that only we can understand.

Patient Goals and Expectations

I recently accompanied a family member to a physician’s office. I was privy to this conversation and have approval to share it with you. When the patient in question asked the physician what the plan was,  the physician stated that” due to the presence of spinal stenosis and concomitant lateral recess stenosis we plan on decompressing the disk-ridge complex  as well of the posterior elements which should easier pain”".

Really?

We can do a lot better, we have to. 

Learn more about Do Your Patients Speak “Doctor”? at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Therefore, the concept put forth by Nicholas Carr that Google is “Making us Stupid” , may have some basis in reality, in part due to the technologies available to us… but is this a problem of  volume, or our ability to isolate, drill down and find the content we are looking for.  The platforms that exist enhance our ability to create and share … and thus push an enormous volume of content our way everyday.  Is this necessarily an argument  of  volume and search or it is a problem due to the lack of enabling technology to filter the streams of information available?     

Shirky does not believe this is an information volume issue… or at least that’s how I interpreted this … and he puts forth the argument that we do not have a problem with Information Overload — and resulting Analysis Paralysis….  Clay believes this is a problem of Filtering.  His keynote… thanks to BlipTV is worthy of your time.  

It is not difficult for many of us who “search” for information on Google’s servers to identify with the issues that Shirky is referencing.   Sure, perseverance eventually prevails (and I usually use my twitter *friends* to help) … but I strongly agree with his contention that we need better filtering tools.    I imagine (take that for what it’s worth)  there is a multi-billion dollar industry — with a very clear and unambiguous model —that  will be founded in the area of making it easy to FIND the content we are looking for, in a narrowed down, accurate , faster and simpler UI than exists online today.   

Learn more about Filtering versus Overload : Information and Content in The Digital Age at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Friends love to share with friends…. 

Once strangers, my twitter *friends* and I share many meaningful learning experiences.  We learn about each other, and we learn by reading and digesting the content generated by — or curated by those we respect most.  

Enter the physicians office…. the old magazines … the *best* doctor photos on the wall, and the staff set behind a glass window.  Following a long wait, you have your 5-7 minutes with your chosen physician.   Will they engage in a caring meaningful manner … or rush through, head down in the computer to be sure they can code a level 4 visit?  Will they cater their responses to your specific values and needs? Do they understand your values, needs, job, family obligations, etc…?  Perhaps they do, but perhaps they don’t.  Either way, they should — because it matters.

Every now and then I am reminded why I enjoy sharing and learning with my online *friends*…. it’s another one of those light bulb moments… when I witness a physician going out of his/her way to make sure that their patients are treated as people, not a disease —- and in a manner that respects that person and their social needs.  

Enter Dr. Steve Eisenberg. An Oncologist from California who utilizes his talents to let his patients forget for a few precious moments that they are potentially being treated for a lethal diagnosis.  

Steve was recognized on the Today show, ummm — today.… well worth a look…. and  special enough to deserve recognition.  

What will you do to change healthcare tomorrow?  

Learn more about Humans are Innately Social, Health is Social –Healthcare is Not Social — Yet. at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

I receive many questions through my website, and most are replied to —but very few people come back to continue the discussion.

Today was quite different…   and….

This highlights first hand why our presence at the doorstep of Healthcare and Social Media matters!!!

Shawna’s first note came to my site late last week: You can follow the threaded comments here.

I followed through with a series of suggestions:

Shawna came back Her response should be read carefully– particularly near the end

…again, thk u doctor luks…your responding renews my hope a bit b/c i have not been able to get any of my doc’s to listen to me. they are very dismissive, and the “normal” MRI report finding has not helped.

once i experienced the callousness of the OS, who ordered the MRI, i decided i would not be returning after i’d had my MRI, and instead, opted to return to my GP provider (a physician’s asst.), hoping she would be more concerned than he appeared to be, and willing to send me to another OS, given my symptoms haven’t changed. however, i did not find that to be the case. she explained, considering the “normal” MRI finding, she didn’t feel there was any other cause known to her (that hadn’t already been considered by the MRI) that might be responsible for the pain i’m in. nor, was she willing to take a very pro-active approach of trying find out either, i felt.

the most i got out of her was, she conceded to have my case reviewed by her supervising doctor, but she was very resistant even to helping me, in the meantime, to find ways to deal with pain i’m in, which i found equally frustrating, as not knowing what’s causing the pain. i assumed there could be no harm in providing me, at the least, with the things i know are available to doctor’s to help ease a patient’s discomfort, but i had every one of my requests shot down, as if i had no right to ask. when i asked to have a basic brace to help support me (on a temporary basis) b/c i am not able to walk w/o limping and using a cane, she told me they were only for ligament injuries; when i asked if she could provide medication (not the vicodin i had been given at first), but rather some other pain med that might work in tandem perhaps with the anti-inflammatory meds i already had, she refused-stating those were enough; when i even asked could i receive a cortisone shot(s) in my knee to help numb it (the way I had for my wrist previously), she stated they were only for a situation like my wrist tendonitis; and finally, when i asked if i were a candidate for PT, perhaps they could help relieve the pain, she said, only as a last option-that she needed to be “conservative” in her approach. (unbelievable)

so, saying ALL that to say (my apologies for the length), i appreciate your suggestions that MRI’s are not the only diagnostic tool available, and that another pair of eyes might yield a different result-it gives me something to take to my next appt at the GP’s, with the senior doctor on staff-before i have to completely give up, and just resign myself to live with this pain. i only hope this time, i’m met with more than resistance, b/c you’re right, this definitely does affect the quality of my life.

i just don’t know what rights i have, if any, b/c i’m afraid i don’t belong to the best HMO, and i fear that is what is, in part, behind much of the low quality of care i’ve received so far. 

at any rate, i appreciate your taking time out to answer me.

Next… I sent out a quick tweet to my favorite patient advocate and favorite  e-patient  :-)

Trisha repsonded:

Then it happened, An e-Patient was born!

Many of us, over and over have spoken and written about how we feel we are stuck in a #hcsm echo chamber and we frequently question whether or not further engagement at this level is worth it.  Well — Shawna, and all the other Shawna’s out there… let me tell you this.  YOU are the reason why I am active online and have such a dense digital footprint (compared to others in healthcare).  And because of our little interaction today… I’m going to continue to remain active in the echo-chamber, because every now and then someone new who needs our assistance knocks on the door.

Welcome!!

Learn more about The Birth of an *e*-Patient at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Click here to view the embedded video.

This week, The New York Times published a very interesting article advising caution about shiny new objects that appear on the horizon in medicine.  The article focused on whether or not the newest technology available in medicine is frequentlythe best technology or intervention available for you. The take-home message of the article was simply that because something is shiny and new does not necessarily mean it is in your best interest. Although this story plays in many spaces,  it is especially true in medicine. It is even more significant in the sub-specialty realm of Orthopedic Surgery. It is not uncommon for a new technology to work wonderfully in a laboratory, or in a small subset of patients during early clinical trials – – – only to find out years later that there are significant problems with that new technology— and it is relegated to the graveyard of historical significance only.

Many people come walking in to my office with a newspaper ad or a newspaper article highlighting a new technology and they are wondering whether it is relevant to them. I enjoy having these conversations with people. It broadens my perspective and knowledge base,  and hopefully broadens theirs too.  If necessary,  I temper their enthusiasm for a new procedure with a discussion of  one of many examples  where a new technology  came onto the orthopedic scene,  became the must do or must have procedure — only to find out years later it was injuring people.

If you read an article or see an ad about a new technology, a new medication, cream or ointment — and it touts being the best option for you — I caution you to peel back the curtain and understand that it takes years for us to determine if new technologies are in fact better than pre-existing technologies.  Without knowing it,  even though these shiny new objects are FDA approved, etc —  if you choose to undergo a procedure with a new technology you may in fact be signing up to be a guinea pig.

Please don’t take this short piece the wrong way. There are plenty of new technologies which prolong lives, save lives, and dramatically improve people’s quality of life.  I simply want to implore you to have a meaningful sit down and lengthy discussion with your surgeon or primary care physician  about these new technologies — and what they could potentially offer you — AND what the potential downsides are.

Lastly, don’t forget, this is the dawning of the age of social media and the intersection of healthcare. You have tremendous resources available to you online to ask patients who have undergone these procedures,   or to find other people who are currently considering these same procedures.   In some instances you also have the ability to converse with physicians as well. You can engage and educate one another as you work towards a decision as to whether or not you will be the next in line to try this new procedure.

Learn more about The Latest Technology … is NOT Always the Greatest Technology at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

…and we should NOT think like mechanics.

Orthopedists and Twitter

Thanks to an orthopedic colleague, Dr. Katherine Burns, the Orthopedic community and any other interested parties on twitter were given a chance to observe for the first a well done live tweeting of an orthopedic meeting — focusing predominantly on the shoulder. Now,  those of you have been around twitter for a long time,  and certainly those of you who attended many healthcare meetings, and certainly healthcare marketing meetings clearly know that live tweeting of events is nothing new, however,  from an orthopedic perspective — this was a big leap forward.

We are not mechanics… We treat patients, not MRI findings

The one upsetting issue is a theme that I see repeated over and over in the realm of orthopedic surgery,  both in resident education, in what many people are told in offices around the world,  as well as the focus of much of the literature that I read in the realm of shoulder surgery.   That is the issue of *Mechanical Thinking*. Something is broken or torn so I must fix it!

A not insignificant focus withing the orthopedic literature —  and certainly most of this meeting which was live tweeted focused on how to fix something, what techniques could be utilized to fix something, and what the overall results were from utilizing those techniques. The didactic sessions were followed by a laboratory session where the surgeon attendees were actually able to perform the surgery on cadavers in order to hone their skills.  That’s all well and good.  HOWEVER, this assumes that surgery was *necessary* or advisable in the first place. There was very little discussion centered about who needs surgery, when they need surgery, or why they need surgery.

A Patient Centric Approach

I received many questions through my website and certainly in my office in the form of second opinions where people put forth the issue that surgery was being recommended to repair a rotator cuff tear – – – yet they had relatively little if any discomfort.  Many people offered that their pain was having little if any effect on their quality of life … and important Shared Decision Making principle.  These were typically situations where they most likely had shoulder pain for a short period of time and were referred for an MRI (perhaps a little early), a rotator cuff tear was identified and purely mechanical thinking led to the recommendation for surgery.  Since the recommendation, most of the patients who presented had already realized significant improvement in their pain and they were wondering whether surgery was indicated.

Orthopedic surgeons have been taught in the past that most tears *need* to be fixed. Again, mechanical thinking – – – if something is broken, we must fix it. We now know that this  is probably not true. Why don’t I use the word probably? I use the word probably simply because we don’t have enough evidence to say with absolute certainty what tears need to be fixed and which tears do not need to be fixed. Very few surgeons would argue that acute or posttraumatic tears of the rotator cuff truly deserve to be fixed. However, many tears, or in fact most tears of the rotator cuff are attritional in nature — this is where the tissue simply wore out.  The analogy that I frequently use is — your favorite pair of blue jeans you’ve been wearing for years. You look down one day or you feel a breeze around your knee and you look down and there is a hole in the front of your bluejeans.  Did you rip it purposefully,  did you lean on it or kneel on it or inflict some form of trauma to your pants ? No, the tissue,  or in this case the fabric simply wore out.    So if that tissue is wearing out and we choose to repair it what’s the likelihood that the tissue has the ability to heal?  If it is *successfully* repaired – – – because the tissue is degenerative, what’s to prevent it from simply tearing again?  Once again, we simply do not have good answers to those questions.

Do I *need* surgery?

The same issue came up with  labral tears. There was a lot of discussion about techniques to be utilized to fix labral tears, what techniques should be utilized in various age groups, etc.  The number one number question in my mind,  however,  was not well addressed.  That question of course is — “Do labral tears need to be fixed?”   In many situations the answer is clearly yes. If your shoulder is unstable or dislocating then you need to have your labor repaired to minimize the risk of re-dislocation. If you are an overhead athlete and you sustain a labral tear, do you need to have that repaired?  Occasionally the answer is yes. Unfortunately, some recent literature has shown that the vast majority of high-performance overhead athletes are not able to return to their prior level of function following a labral repair. Are surgeons informing these overhead athletes about these facts?  There are many surgical success stories where we are clearly able to return a high-performance athletes back to their usual function.  But it does not appear that labral surgery in this unique patient population is often successful … in weekend warriors and many high school or college players, a repair appears to be successful.  But the margin for success is not high.

So, by and large this was a good week for the world of Orthopedics and Social Media. There are many more orthopedic surgeons on Twitter and other social media properties. This will ultimately prove to be a *good thing* for people searching for quality orthopedic information.

Eminence  vs Evidence Based Medicine and Surgical Decision Making

On the flip side .. due to the persistence of Eminence Based Medicine in the community and the issue of purely mechanical thinking  — I simply suggest that you temper your decision to proceed with a recommended surgery until you obtain a very clear understanding and an adequate  discussion about the evidence that exists as to why the suggestion for shoulder surgery is  being made — prior to you considering   surgery.  Have a clear understanding of what shared decision-making principles are. Perhaps even utilize the multitude of shared decision-making tools which are available to you on the Internet. If your surgeon is either not willing or capable of discussing the evidence or going through a shared decision making process with you — consider a second opinion—  or moving on.

Learn more about Decision Making for Labral Tears and Rotator Cuff Tears at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Last year, my Mom had her first operation: a total knee replacement.

Active and curious, and having recently celebrated her 29th birthday again, her mother was turning 100 shortly and needed assistance.  Mom wasn’t able to get around well enough to help, with her osteoarthritis and pain.

A month before the operation she asked me, “What can I eat to heal and recover from the surgery?”

It turns out that there’s a good answer to this. It can be divided into wound healing, building bone, rebuilding muscle and guarding against weight gain.

A blog is too short to cover each category in depth, but fortunately, there is a largely untapped literature about nutrition and post-operative care.

The key: wounds heal from the inside out. Many patients need additional arginine and vitamin C, just to name two nutrients, pre-operatively and post operatively.  Lowering oxidative stress improves healing.  The peri-operative period is the most critical.

Building bone is a function of vitamin D, calcium and magnesium, and the right hormones.  Smoking prevents bone from being built. And food can facilitate it.

Rebuilding muscle is something that has nutrition, and dietary protein, at the center. I often encourage my patients to have a little protein-rich food at every meal, especially breakfast.  Omega-3 fatty acids, especially DHA (almost solely from fish and from algae, which is where fish get their DHA) improve muscle building post-op.  My Mom took them.

Recent data have shown that total knee patients gain an average of 14 pounds post-op, and it’s not all muscle.  Gaining that much weight post-op delays recovery and increases instability.

Post-op patients need satisfying, lower calorie recipes written on prescription slips: high calorie, high sugar foods that are highly processed should never appear, and would never be reimbursed.  But strategic nutrition can improve strength, healing, flexibility and stamina. And should.

Although my grandmother passed away just after reaching 100, my Mom has recently returned from Hawaii, Carmel, New York City and points unknown, without a cane or a pain pill, nearly as good as new.  In fact, better.

(c) John La Puma, MD
@johnlapuma
http://drjohnlapuma.com

Learn more about Pre and Post Operative Nutritional Considerations… at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Are we defined by our laboratory and MRI findings….

We as physicians are commonly trained to treat disease, not patients.   Another way of looking at it is that we are trained to think mechanically.  If ”X” is present, administer “y” and if  “A” is broken, we must fix it.   Orthopedic surgeons in particular are frequently trained to treat MRI findings and not necessarily how to incorporate patient values, or the tailor a treatment plan based on  how a disease effects a patient’s quality of life.  Many  surgeons are  not typically considering the patient’s underlying emotional status and the influence that this will have on the patient’s ultimate recovery.  At risk patients have significant anxiety and other psycho-social issues that affect their ability  with regards to medical decision making and recovery from medical intervention.

Research has shown that *at risk* patients are agnostic with respect to socioeconomic background, age, or gender. The at risk patient has significant anxiety, perhaps low-grade chronic depression and certainly diminished coping skills.  In order to put in place or create an environment that ensures successful treatment of a disease state, it is imperative that the surgeon identify the at risk population preoperatively. This will enable us to put the proper mechanisms  in place in order to insure a proper setting or environment for functional improvement in the postoperative setting. Identifying an at risk patient does not necessarily mean that the patient should not consider a proposed procedure – – – instead it should alert the physician that a multi-modal approach with the inclusion of social workers or psychiatrists and psychologists may be necessary.

Participatory Medicine, Patient Values and the Master Surgeon

I’ve always stated that great surgeons know how to perform  most procedures well within their area of specialty. More importantly they know how to deal with complications as they arise and work towards the best situation possible to improve the likelihood of success.  I’ve also been quoted as saying is that a master surgeon approaches patients as people,  and not diseases. A master surgeon incorporates patient values, and can identify the at risk patient and institute measures to effectively manage and treat those patients both pre-and post-operatively and perhaps more importantly they can identify the at risk patient who should not be indicated for surgery.

For many patients it is impossible to separate the emotional and physical aspects of recovery from surgery or other disease states. There is frequently a mismatch between a patient’s subjective complaints versus the surgeon’s thoughts on objective impairment. It is the psychological issues and the coping skills of the patient that perhaps lead to this mismatch. Cognitive behavioral therapy and other non-conventional treatment modalities may prove to have a crucial role in aligning these issues.

What this boils down to is the art of patient – physician communication. It is incumbent upon the physician to have a clear sense of what the patient understands about their disease and to engage them further to improve their level of understanding. We can go further and  provide the patient with information, booklets, or links to a website  the patient can then review in the comfort of their own home or with other family members.

Those of you who frequent this blog understand that I am a strong believer in shared decision-making principles. I believe that a patient should clearly understand  their diagnosis,  the future implications of their disease, what the treatment alternatives are and what the risks of either nonoperative or operative treatment are and how the choice of surgical or nonsurgical management might affect them.

The *Personality* of an Injury (or disease state) …

I’ve spoken before about the low touch- high technology approach to orthopedics that is far too prevalent in our society. Not only does this lead to over testing and over treatment – – – it lends itself to  ignoring the quality-of-life impact the disease/injury in question is having on the patient. When surgery is considered, this leaves many patients at risk for poor functional outcomes simply because the surgeon may not have recognized or addressed the non-physical  functional needs of the patient.  Orthopedic surgery cannot simply be defined as fixing a broken part, without the clear understanding of how our intervention affects a patient, and the fact that how a patient reacts to surgical or nonsurgical management, is simply not mechanical.

We need to treat our patients as people and not as disease states.  We need to treat patients and not MRI findings. It is no longer advisable, nor perhaps acceptable, to look at a patient as possessing a mechanical issue and not consider the impact of whatever intervention we recommend on their lifestyle and quality of life.

Learn more about Treat Patients as People… Not Diseases at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Every Saturday morning growing up in a sleepy Long Island suburb, I was shuttled off to my grandfather’s house.   While I loved spending time with him, he had other ideas in mind  He loved gardening, but as he got on in years it became more and more difficult for him to keep his garden up to snuff.  Cheap labor was at hand … a grandson who adored him.  I actually enjoyed helping him and learned a ton along the way.  Jump forward 30 years.  I am now the gardener… but my kids want no part of it  So, I have this thing for certain wildflowers and lots of hills and rocks to cover.  I also have deer, part shade, gophers and sandy soil.  Going to local nurseries only offered me your average, everyday wildflowers.   I wanted a more varied appearance to my hills and different specimens.   I went online… and was blown away by the sheer number of plants available on some sites.  Analysis paralysis set in and I could not make up my mind what to plant where.   A few years ago I stumbled onto a phenomenal site which offered me the opportunity to set my parameters (sun, deer, drought resistance, etc), set the size of the lot to be planted and push a button.  Boom.  A list of plants and a set of plans for planting them appropriately was immediately available.  Purchase done… plants in , garden looks great.

Many physicians are not fearful of technology.  Many in fact are quite tech savvy.  They are early adopters of smart phones, tablets and other cool gizmos — except when it comes to implementing technology  in their office.   Many do not understand how the technology would complement their workflows or compensate for the work arounds their employees utilize on a daily basis.  Many physicians may not be able to determine whether or not their co-pays have been collected in a timely matter… or how a technology that assures they are collected scales in efficiency to the point that an ROI is achieved in year 1 or 2.  Dragon, standard dictation, templates, touch screens, scribes, etc… Custom pdf’s for consents, pre-op information, post-operative instructions and guidance.  Where do I find all these things, how do I incorporate them into my workflow and what plugs into where to make sure it all works and that everyone plays nicely in the sandbox together.  Are you going to hire a consultant for 35k to tell you what you probably already know?  Are you going to pay that same consultant 50k to implement the plan because you can’t figure it out for yourself or task your staff efficiently and effectively?  I hope not.

The healthcare technology industry insiders need to take a deep look into the pain point in physicians offices, push forward technologies that ease the pain — and come up with a templated system that walks the physician through a needs analysis, the cost structure, implementation or execution strategies, spells out step by step how their systems will work together and ultimately what the benefit will be in terms of being able to see more new patients,  have a better engaged, happier, more efficient staff and a more profitable, leaner practice.   The potential ROI follows next and hopefully the story is complete.  Right now the *picture* isn’t complete.  Many physicians need guidance and a clearer understanding of exactly why they need technology, how to implement it, and when they should expect to see a return.  IF the message is not absolutely crystal clear... the physician will dis-engage and stay with paper and fax machines.  These same industry leaders also need to learn how to play well with others and align their strategies in an anti-competitive and comfortable manner.   Together they can map the pain points and post strategies for implementation that will guide physicians looking for simple, elegant, structured, lean technological solutions… without the typical pain and suffering that accompanies a technology roll-out.  Impossible you say… I doubt it.  Not if they want their technologies embraced by more than 5% of the US physician population.

I called the manager of the nursery site I mentioned before.  They told me that they saw a 35% + jump in purchases when they initiated their custom pre-planned garden plans… and the avg number of plants ordered per person also jumped significantly.   Health care execs… take notice.

Learn more about Healthcare and Technology : Garnering Interest in Your Product at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Physicians, Healthcare and Social Media…

As Ted Eytan found out when he questioned the (anonymous) physicians on Sermo —  many physicians are simply not interested in establishing an online social media presence.   Why … most state (??with some naiveté??) that “risk” is the overwhelming variable they’re concerned with.  Yet, I imagine some of these very same physicians are the same ones with static Web (-)0.5 type platforms who state that they “are the best”, the premiere practice”, utilize state of the art modalities, etc.  There’s probably more risk involved in their promotional language then a venture along well trodden social media circles where we have *established* and have discussed on multiple occassions what many of the risks entail and how to avoid the landmines that  exist .

Many physicians also state that they are not interested in healthcare related social media endeavors because they do not feel that there is a pot of gold at the end of the healthcare-social media rainbow.

Social Media Use in an Active Healthcare Practice…

If the past two week scales or even maintains the level of new patients (7-10%)[addendum 1/26/2012: now averaging 12-15%] entering my office because of my social media presence AND the information presented on my website … then I can emphatically state that the ROI of your time, resources and the presentation of your content in a transparent, meaningful, evidence based (if possible) manner — will pay off quite well for your practice.  Perhaps even far more important than that (and a more difficult to measure ROI), the patients will be entering your office far better prepared, far better informed, and far more comfortable.   That means they will already have a reasonable understanding of what they might be suffering from, they will be far more comfortable with you because they have seen your videos and are comfortable with your demeanor and presentation —and all this, in the end makes your *job* in the office far more engaging, more productive and more efficient.

So, to recap …. When your blog or website presents meaningful content without the commercialized hype sooooo many marketers are pushing you to use — patients will …

1. Find you ( because of your digital property exposure)

2. Like  you (if they don’t like your videos or content, they’re not coming to your office)

3. Probably *trust* you more than a doc they found in the phone book

4. Interact in the office with you in a far more efficient manner since they already have digested the content you presented to them online — which you can re-visit right then and there to reinforce what you have just told them.

5. Dramatically improve your patient satisfaction scores … (data available on request )

Why Should Physicians Engage in Social Media…

In the end… my presence online is to support the spread of meaningful, trustworthy, evidence based (when available), actionable information and guidance to patients and consumers from around the world.  I am personally not looking at my engagement  from an ROI perspective… I continue to feel that physicians have a moral obligation to fill Google’s servers with quality content to drown out the commercialized nonsense that exists online today … but for those of you in search of bringing patients in your door — the message here is clear. It works… it’s happening … and it’s the message, social media is only the medium — and the risk is manageable.

Learn more about Healthcare and Social Media… the ROI is Real, but the *Message* Matters at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

For those of us who are fairly active every Sunday on the #hcsm or Tuesday on the #mdchat twitter chats — it often feels that we regurgitate or talk about the same issues — over and over.  While this activity is important to support the newcomers and help drive adoption, it also runs the risk of leaving the most savvy behind due to burnout or dis-interest. Some of the topics mentioned below, should maintain the interest of those of us who have been around for a while… and at the same time, provide useful hints to those considering leaving their lurking status and becoming an active contributor.

*We* are starting to have some of the conversations that are sorely needed and necessary to aid in the maturation of the healthcare and social media landscape and to carry on with our desire to have social media play a large (and meaningful) role in leveling the healthcare landscape for all (with computer access)…

For physicians on social media… when is a doctor-patient relationship established — and what risks are you taking by providing advice on a public platform?  This was a short piece on the www.imedicalapps.com website by Joseph McMenamin, MD, JD.  I found it interesting that he felt he had to conclude an article about disclaimers with a disclaimer — but, all kidding aside, this is a topic that physicians need guidance on.   For now, do not engage patients on public platforms, and be very careful about providing anything that can be construed of as advice on a public stream.   Although there is no case law on this yet… you do not want to be the guinea pig  .

There has been a lot of attention of late paid to who can utilize the content you post on a public stream.

Michael Zimmer asks if it is Ethical to Harvest Public Twitter Accounts Without Consent?

IMHO, of course it’s OK…. as long as the person/persons/platform/network ,etc do not alter the content, or the context, and utilize proper attribution.

How should doctors behave on a public social media stream?   If a physician is thought to be unprofessional, how should that be handled?  Unfortunately there are no rules as of yet, aside from HIPAA and basic some guidelines from the AMA.

@Doctor_V, on his 33charts blog posted Unprofessional Physician Behavior on Twitter.  This stirred quite a flurry of comments and Bryan has closed them… but let’s just say that there were plenty of well thought out opinions on the issues presented.  Though there were a number of issues raised by many in terms of who was singled out, how she was singled out and why she was singled out —  this post initiated a discussion that I believe we need to have as physicians establish a digital presence in a very public environment.

Two of the blog responses to Bryan’s post were:

ShadowFox who blogs at Movin’ Meat — who followed through with his own guidelines for discussing clinical medicine in a public environment.

and Wendy Sue Swanson, MD (@SeattleMamaDocs) posted this on her blog.  I’m a Physician on Twitter: Patient Privacy

Atul Gawande presented a commencement address to the graduates at Harvard Medical School.  While it was a very well written and well delivered address… with a useful message— I wonder if medical students are the right audience for this?  Yes, they are the future… however, they are about to leave medical school and be taught by physicians who over-treat, over-utilize, own MRI facilities, or surgery centers and practice under the  CYA and FFS models which led to many of the cost issues we face in healthcare today.    I doubt that an attending is going to listen to an intern when they try to articulate what they learned from Atul at their commencement.

Oprah is gone!!! by Dr.Jen Gunter:  The Queen of “medical woo” is off the air.

Social Media vs. Social Circles.

 Social Networks are like that pre-schooler’s party(where the whole class is invited). Rather then being made up of “friends.” they are repositories of people whose existence you acknowledge. You connect with everyone you’ve ever met because the tools have not been developed to create more complex social circles that make up mature adult relationships. It makes sense that the evolution of digital social will follow the same developmental path we take as humans.

Squandering Medicare’s Money : An Op-Ed piece in the NYT by Rita Redberg.   Obviously a very polarizing piece — but the days of Eminence Based decision making in medicine are nearing an end.  Not all decisions can be made on Evidence Based Medicine (because we do not have the evidence), but many decisions can be… and need to be if providing healthcare is going to be affordable or sustainable going forward.  It wouldn’t hurt to also address: Malpractice Reform, CYA Medicine, FFS and self referral issues, Fraud, Over-Utilization, etc….

Kudos to @carlosRizo and his colleagues at the Innovation Cell in Toronto… their recent publication proves that the social web is going to disrupt … and hopefully facilitate the pace at which research and patient insights are indexed, catalogued and recognized by investigators and industry — and push the research envelope to adopt these new technologies.

The G8 met this week and the *internet* was up for discussion.  This summit was most likely (cynical snicker) directed behind the scenes by many industries that are being disrupted by the social web … and they are seeking to tax, or legislate their way back to a profitable balance sheet.

Let’s hope that these nations recognize the world wide web for what it is… so we can continue to pursue our agenda of improving patients’ access to useful, actionable content, quality providers, and “friends” or networks where they can share their thoughts, fears, knowledge, hopes and desires— all in the quest to improve the outcomes for all.
Follow @hjluks

Learn more about Social Media & Healthcare: Discussions We Need to Have to Move Forward at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Physicians: Healthcare Technology for Your Office

Phreesia is certainly not new on the healthcare scene… but the intent of this Healthcare Tech section is not necessarily to highlight the latest start-up or the newest kid on the block.  Perhaps something slick and new will catch my eye and  I will bring it to your attention— but this section will hopefully provide you with healthcare technology options that have already proven themselves in the market and can bring a true ROI to a technology spend.

What is Phreesia:

Phreesia is a venture backed NYC company that was founded in 2005.  The concept went from a napkin to fruition with 45 million in the bank in short order… Why?

Because Phreesia replaces the traditional clipboard, pen and paper you hand out to your patients.

Here’s how it works:

• Patient arrives and is handed Phreesia.
• New patients type information directly into the device.
  • hand-writing issues-gone
  • legibility
  • intuitive and simple to use
• Returning patients verify rather than re-enter info.
• All electronic signatures are captured and insurance verified.

Probably the most critical issue  (from the physician’s perspective) that many practice managers and engaged physicians will enjoy is that the co-pay is collected through the terminal.  Many,many offices fail to collect co-pays at the time of the visit, and once the patient leaves, there is a good chance you will not capture that income, or you will spend a significant amount of money and FTE time to collect it.  With the razor thin margins that exist in healthcare today —

YOUR MARGIN IS IN THE CO-PAY ITSELF !

Not collecting $250-$500 dollars in co-pays per day adds up very rapidly.

Patients will love the phreesia too… and your front desk staff is freed up from many previous tasks (verification, copying cards, collecting co-pays) to help those who may require assistance.

Patients can simply sit comfortably and thumb through the information and be sure that it is accurate. Click, swipe their CC and return the unit.  Done.

Cool extended use… perhaps some day they will incorporate the ability for the patient to verify the accuracy of their prior encounter note or progress note that the physician dictated.

Phreesia is also theoretically gerrm-free! The phreesia pads have antimicrobial coating which helps protect against the transfer of germs from user to user.

With physicians wondering whether or not to spend money on technology because of the illusive nature of a proven ROI,  the folks at Phreesia have a technology that could theoretically pay for itself quite handsomely if it enables you to please patients, free up your front office staff, verify insurance and collect co-pays.

And… NO, I do not work for them

Learn more about Cool Healthcare Technology: Phreesia at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

OK, I’m sitting.

“Your daughter (MY daughter ) painted the dining room wall today”

Me: “ok”

Her : ” You’re not upset”

Me: Nope… I have paint brushes and in 5 minutes we’ll have it all fixed up.”  ”Bye”

Perspective matters!

I see some of the most horrible injuries everyday.  I see lives ruined, families literally ripped apart and I treat people who may never be able to walk, work, love or learn ever again.

Anyone of *us* who is not able to see life through that filter and appreciate every living moment with the ones they love is missing out on a truly special opportunity.

’nuff said.

Learn more about Your daughter painted on the dining room wall…. at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

~To sell their products.

I watched a few videos… most of them showcase experts who are paid consultants or are physicians who receive royalties payments of perhaps millions of dollars a year.  Now… am i supposed to be appreciative of their efforts to provide me with a platform to *share*, *collaborate* , and *learn* from my conflicted colleagues ???  Sure hope not.

EMR companies failed early on because the back end developers had no clue about the workflow issues faced by  the front end user.  This isn’t very different.  There are those of us who are well seasoned in terms of our social media exposure.  We understand the tools and know how to craft a meaningful message.  Once again, the backend crafted a site they think the front end will like…. not so sure about that.

~One day these industry behemoths will catch on.

As an orthopedist, I’ll stick with OrthoMind for now.   They are passionate about what they are doing, they are Orthopedists themselves… and they are executing reasonably well.

Learn more about Industry Driven Professional Healthcare Platforms…. #fail at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Square has brought an elegant application to the marketplace which could help physicians’ office run in a simpler, more elegant, and more efficient manner. And all the while they will be saving on expenses since Square charges a 2.75% flat fee on all credit card transactions.

Set up is a snap, and they even send you a free credit card scanner which fits into your iPad or iPhone.

There are so many interesting platforms and technologies hitting the market —  physicians may want to embrace them, and I will highlight a few here every so often.  Some of the technology is geared towards running a smoother, more efficient and more profitable office.  Other technology platforms I will discuss can be utilized to improve how you share information and content with your patients.  Even more, some of the platforms will be those which you can introduce your patients to so that they can utilize them to  modify their lifestyle and hopefully encourage healthier behavior patterns, etc.

I thought Square was a great first start… I find their platform to be elegant, simple and seamless.   Check it out…  let me know what you think.

Learn more about Cool Healthcare Tech : Square at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Bryan Vartabedian, MD‘s post today is quite relevant to those of us who frequently talk about the intersection of health care and social media.  His achnowledgment of the fact that 80% of patients search for health care information online is no longer news rings true for many.  We’ve known these facts for years thanks to the work of the Pew Internet Group and @SusannahFox.

The real issue that patients face when searching for information online pertains to the :

1. Quality of the information they are receiving.
2. Health Literacy: Their ability to interpret and incorporate the content or information they are reading.

A simple google search on many medical conditions reveals the issue of quality.   Most of the top search results are commercially biased (at best), mis-leading and occasionally even harmful.

Many physicians, such as Wendy Sue Swanson , Ves Dimov and many many others are trying hard to change the quality of the information available online to patients and interested parties.  Val Jones has started a project called HealthyRT to call attention to the poor quality of health information available online, and allow a number of physicians (me included ) to help vet information sources and hopefully give patients a place to start in their search for quality health information.  Along the same lines,  I have also started a page on my website called Social Health, Social Help for the same reason.

Health literacy is a huge issue.  ”*Even basic literacy is an issue we face in the world today. Health literacy varies by context and setting and is not necessarily related to years of education or general reading ability. A person who functions adequately at home or work may have marginal or inadequate literacy in a health care environment*”. According to the Agency for Health Care Research and Quality Report, Literacy and Health Outcomes (January 2004) —low health literacy is linked to higher rates of hospitalization and higher use of expensive emergency services. This evidence-based literature review highlights numerous studies that provide a detailed analysis of the correlation between low health literacy and poor health.

Health literacy will NOT be an easy issue to deal with.

Physicians and other health care professionals need  to be cognizant of this issue and try their best to present the information or the content they develop or curate  in an *easy to read* manner which enables and/or empowers the individual trying to understand what all this information means .

Learn more about Health Information… at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Pitching is NOT a very “safe” activity when it comes to children who are still growing.  Shoulder problems are on the rise as parents and coaches have forgotten (or never learned) the basic tenets of protecting our children from common overuse injuries of the shoulder and the elbow due to pitching.

Childhood Elbow and Shoulder Injury Prevention: Obey Pitch Counts! 

First… pediatric elbow and shoulder injuries can be very severe and can result in permanent, lifelong damage to your child’s arm!

Second… your child is likely not “the best on team” and “can not ” make it to the big leagues”!  Remember, we’re talking about living the rest of their lives without debilitating shoulder and elbow pain.  If your coach or doctor recommends resting a player… please abide by those instructions.  

ANY YOUNG PITCHER WITH COMPLAINTS OF PAIN SHOULD IMMEDIATELY STOP PITCHING.

Third…  When treating a pediatric or childhood shoulder or elbow throwing injury — Don’t let anyone tell you that shoulder surgery will return your little pitcher to perfect condition… it doesn’t happen in professional sports and it won’t happen to your child.

Fourth…  Preventing pediatric shoulder and elbow pitching injuries starts with proper preparation.  Late in the winter get your child off tossing a ball,  and working on lower extremity strengthening and abdominal strengthening months before they plan on tossing from a mound.  More than 75% of the torque or force needed to toss a ball comes from below their chest and requires strong, stable and able legs, pelvis, abdomen and lower back muscles.

Fifth… Obey the pitch count recommendations!!   They are there for a reason and they are reasonably (not 100%) effective at preventing most childhood overuse shoulder and elbow pitching injuries.   Many parents let their kids pitch with the team, hire a pitching coach, and practice with their children on their own.  If your little one is throwing with full force, each and every toss counts towards to the pitch count.

Pitching Recommendations : Pediatric Shoulder and Elbow Injury Prevention Strategies:

Recommended limits for youth pitchers are as follows:

• Recommended limits for 9-10 year old pitchers:

  • 50 pitches per game

  • 75 pitches per week

  • 1000 pitches per season

  • 2000 pitches per year

• Recommended limits for 11-12 year old pitchers:

  • 75 pitches per game

  • 100 pitches per week

  • 1000 pitches per season

  • 3000 pitches per year

• Recommended limits for 13-14 year old pitchers:

  • 75 pitches per game

  • 125 pitches per week

  • 1000 pitches per season

  • 3000 pitches per year

Feel free to download this Pitch Count Advisory to minimize the risk of a pitching related injury to your youngsters shoulder or elbow.  Share it with other parents, coaches, etc…   Pitching Recommendations_Pitch Counts

Learn more about Pediatric Shoulder and Elbow Injury Prevention: Obeying Pitch Counts at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Many physicians believe, rightly or wrongly that if they were able to accomplish their goal, the procedure was a success.  With all due respect I beg to differ.   Certainly there are circumstances where risky procedures are being undertaken for heroic measures… and the success of the procedure may simply be that the goal was accomplished… but I am referring to far more common elective or semi-elective interventions.

I firmly believe that the road to a surgical *success* begins long before you are wheeled into the operating room.  It begins in the office — with the proper patient selection and proper indication of a patient for said procedure.   We know that many patients present with studies which reveal *abnormalities* … but in many of the those cases, those *abnormalities* are a consequence of aging, overuse, etc and pose no risk to the patient — and are having no significant impact on that patinet’s quality of life.

If that patient is indicated for surgery, should it ever be deemed a success ???

For those patients who are properly indicated for a surgical procedure, assuming the procedure was properly performed, and the intended goal was met… is the surgery a success???

I contend that the answer to that question is no.  And I teach my residents that every day.  I also encourage them to come to the office with me over the next few weeks to meet these patients and determine for themselves, based on the offered or elicited feedback as to whether or not the surgery was in fact * successful*.   If the patient is doing well, and they are satisfied with their pain relief, level of function and quality of life… I think it’s pretty safe to say that the procedure was a success.

Thoughts?

Learn more about Care Beyond (and before) the Gloves at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

 IN THE pursuit of safe, effective, and cost-effective medicine, evidence is king. The medical profession believes that treatments should be studied in clinical trials, then compared against other regimens, before deciding what’s best for patients. Congress and the Obama administration have strongly endorsed this process by allocating money to evaluate the most effective treatments, in order to spare the public, and insurers, the burden of unnecessary procedures.

This op-ed brings to attention the issues physicians and the public faces when considering just exactly what is implied (in reality) by the term “Evidence Based Medicine”.

We would all love to believe that the term EBM implies that a rigorously peer reviewed, conflict free article will help physicians and patients by guiding them on the appropriate treatment criterion and recommendations for a certain ailment or disease.  Unfortunately, we are learning that the conflicts of interest that exist within the medical–industrial complex frequently lead to the publication of guidelines that are sometimes not only not in the patients best interest… but are potentially dangerous.

When a physician does not possess enough evidence to recommend a certain treatment vs another, they rely on their experience, teachings and knowledge base… so called eminence based medicine.   For decades, this was the accepted standard of care.   As we peel back the layers on the processes that produce these clinical pathways or treatment guidelines, we may in-fact discover that eminence based medicine wasn’t such a bad standard after all…. ???

Stay tuned as the Evidence-Based Medicine story roars on…

Learn more about “Evidence Based Medicine”… and Conflicts of Interest at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Standing at the periphery we have people, patients, physicians, nurses, other allied healthcare professionals, executives from hospitals, marketing firms, the pharmaceutical industry, the device manufacturing industry, IT professionals and many curious observers.

Do all the aforementioned individuals, who each have their own vested interest in healthcare and social media, have the same goals and objectives when they’re entering the intersection.  Clearly, the answer to that is no.  Social media, when appropriately deployed in healthcare will have the ability to broadly disrupt our ability to teach, learn, educate, and to propagate (and collect) appropriate content and information.

Aside from all the *individuals* mentioned.  We also have to deal with the issue of personal versus professional; and  small business versus enterprise applications of social media in the healthcare marketplace.

Adoption, engagement, relationship building, and learning how to utilize the tools that the medium provides will go a long way to improving one’s ability to gain understanding and knowledge and aid in decision-making support when necessary.

Applications of social media and health care on the enterprise level have yet to emerge  to any large extent.  My own experience of trying to deploy Social Cast or Yammer on our campus has been an abject failure.

The majority of people entering the intersection of healthcare and social media remain within the *echo chamber*.   They are just starting to explore and understand what the underlying potential is.  They’re establishing relationships,  determining who to follow, determining how to  properly curate and perhaps even generate content meaningful to those who follow them.

But this is only the beginning — the very first steps that someone entering into the space needs to take to become comfortable and qualified to a point — prior to  diving deeper into the opportunities that engagement in healthcare and social media allow.

Those of us who have been within the intersection for a number of years now are starting to think more deeply about what exactly your presence in healthcare and social media could potentially look like.

Phil Baumann, as always, recently had a fairly provocative post titled “The Cold Straight up Truth about Social Media and Healthcare“.  For those who are comfortable in the early stages of their presence in healthcare and social media I think this is very useful article to read.  I think this thoughtful piece will enable many of us to begin to move beyond the echo chamber and further towards the ultimate definitions and goals of social media in healthcare.

Why did I title this blog an “intriguing continuum?”  I did so because there are new people entering intersection everyday.  These people come from all walks of life, from many countries around the world and from many different professions.  Some have a well thought out goal or game plan in mind.  Most have absolutely no idea what’s going on.  Ted Eytan,  recently discussed the fact that he was asked by the Sermo staff to pose a question to their physician base about the their desire to participate in a  social media endeavor in the near future.  The resounding overall theme of the answers was no, to put it kindly.  I wonder if a significant percentage  of the participants in the poll  had anything more than a basic understanding of the concepts/definitions many of us have proposed when it comes to a presence in healthcare and social media.  My guess is that they did not and that they were merely thinking of Facebook and twitter and not much beyond that.

This is just the beginning… and this will take a long time to *figure out*.  We need legislative (HIPAA) reform, we need a better understanding of how people interact and learn from each other, we need to better understand the learning process and we need to do so in a manner that encourages those on the periphery to become a shareholder so to speak.  This is clearly an instance where the more people who have skin in the game, the better off we will all be.

Learn more about Social Media in Healthcare… an *Intriguing* Continuum at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

In my small area of the healthcare universe,  I practice amongst many large single specialty groups.  This brings to light yet another trend that I find more puzzling than disturbing:  Maximum Income and *Minimal* Satisfaction.

First, allow me to digress for a moment….

Ted Eytan put up a very interesting series of posts recently— his first was regarding the attitudes of practicing physicians (on Sermo) toward social media;  his second post dealt with the opinions of future physicians whom he had interviewed.   Ted was asked to post a question on Sermo to see if  physicians  see themselves utilizing *social media*  in the near future.  The threaded comments which followed — perhaps because of the anonymous nature of the posting —  were at times downright nasty.  Many of the physicians clearly displayed their  level of dissatisfaction with their current situation and the healthcare system as a whole.  They utilized this question (and many others on Sermo) as a springboard to launch into a tirade as to why they would never entertain engagement in social media or even other forms of electronic communication.

Much is written today about how physicians feel about the issues they face on a day to day basis within the medical-industrial complex.   The references to doctor dissatisfaction abound… literally everywhere.  Is it surprising that the NY Times reported  how new physicians are choosing specialties without call responsibility or after-hours responsibility and instead seeking “quality of life”.   Whether these younger physicians are feeding off of some of the emotional dissatisfaction they witness on rounds or in direct contact with their professors and educators —  I do not know.   Whether this is a perceived flight to safety or simply a desire to lessen their work burden is also a bit unclear.

Discussions about physician dissatisfaction occur at every water cooler, in every operating room lounge, and that every dinner many of us attend.  But I often wonder if any of my colleagues are actively pursuing workflow changes, office efficiencies, or changes to their daily habits which may improve their level of job satisfaction.  Interestingly, when I pose that question to my colleagues… the answer always seems to focus on finding another job… hmmm.

Back to the topic….

Many of the large multispecialty or single specialty groups I mentioned above incorporate the use of a physicians assistants as well as nurse practitioners to assist with their office throughput.  With regards to achieving top-line revenue improvements this is certainly a more efficient model then the model I have chosen to practice or utilize in my practice.  Now relax a moment… I am not knocking the entirety of the  MSG model… it clearly works — Kaiser, Mayo, etc having proven that…. I am referencing groups which use their size and personnel solely to achieve throughput and revenue gains.

I always ask myself what level of satisfaction  could  these physicians possibly gain when their interaction with the patient is very short, and frequently *incomplete*.  They are on a hamster wheel that is churning 70-80 patients through their office on a typical day — per  physician.    I imagine the interaction achieved by physician practicing alone and able to truly engage and personally educate that person in your office is far more satisfying.  In addition, from a surgical perspective, where does one  derive satisfaction from if  you do not in fact see the results of your surgical efforts?   My guess is that these surgeons’ *satisfaction* is derived through maximal revenue generation and not necessarily maximal patient satisfaction.

Last week in my office, I received 5  emails germane to this topic.  Three simply mentioned how satisfied they were with their encounter in the office in terms of the time they were given, the time I took to listen to their complaints, and the time I took to explain the natural history of their disease.  Two of the e-mails came from long-term patients who are many years out from surgery —  yet ventured onto my website and decided that they would touch base.  Clearly, the practice method I have chosen encourages this form of engagement.  Also seen in last week were at least six follow-up total knee replacement patients who were simply ecstatic about the results they had achieved.  When you sit in a room with a patient who put their trust in you, underwent a *big* surgical procedure, were assisted through a tough therapy program, and now emerge as a functional person pursuing all of their chosen activities of daily living because they are no longer in pain —That simply makes my day.

From a work perspective, there’s no greater level of satisfaction that I could ask for.

Yes… a career in medicine is difficult today — we are being pulled and squeezed by all four extremities by multiple intermediaries.  But didn’t most of us enter the field of  medicine to help people?  Unless you know that you have actually helped someone and interacted directly with the patient that you have helped I do not see how one derives any significant degree of satisfaction from your chosen profession as a physician???  Perhaps I am simply being naive?

Golfers know this concept well.  Most of us hack a ball around 7000 yards of beautiful green grass (and woods, lakes, marsh, etc).  Perhaps we hack three or four balls —  If we’re unable to find the ones that went awry.  So what brings us back once a month or once a week.  It is that one perfect shot that you hit on that one hole — A shot that you set up, executed, and exited perfectly.  That is one of the only shots you’re going to remember from the entire day and that is the shot that you’re going to remember when you’re driving back to the golf course the next time.

That helps define why I get up and do what I do every day.   I am looking to see that I have actually made a difference in someone’s life.  I don’t require verbal platitudes.  You can see it in most of your patients faces.  If you put your computer or your pencil down and simply watch your patient’s expressions you can often learn far more than a 20 min. discussion when your face is buried in your iPad.

Job satisfaction in healthcare today is difficult to come by.   Especially for physicians who are self-employed or in a small group.  Remember that idealistic person who applied to medical school and sat before the admissions committee?   I bet you all stated that you “want to help people”.  Now that you have had that opportunity —   how do you assess your level of satisfaction?

Learn more about Healthcare Trends: Maximum Income and Minimal Satisfaction … at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Analysis paralysis is common in patients who are not used to looking for health care information online — and those who are not sure how to vet the information they have received.  Unfortunately, well meaning family and friends may simply complicate the issue because we all have friends of a friend whose husband’s niece had the same problem

This brings to the forefront two principles that I discuss often.

First… physicians and other healthcare providers need to be more engaged online and need to be creating more content.  Right now the content available when you Google a certain topic is either commercially oriented, dated or possibly completely inaccurate.   Google has completely changed around their algorithm to determine SEO. This is probably good for the consumer as it will drown out the influence of many of the content farms and websites that simply want you to click through page after page of meaningless information to drive their revenues.

Second… The true power of social media lies within the ability of your network of twitter, facebook and true friends to guide you and help you vet the websites and  information available — and along the way point you to sites that the “crowd” feels has useful, accurate and meaningful information.   Perhaps your network might even point you towards a health care professional who welcomes  Participatory Medicine or Empowered patients.

If you find yourself completely consumed by the information you have reviewed and you have a 12 inch stack of papers sitting in front of you …

• Stand up
• Turn off your computer
• Leave the paperwork alone
• Do not go back to google … for now
• Go out and do something fun… or at least distracting.
• Wake up the next morning…
• Head to twitter and perhaps to the Health Care Hashtag Project by the Fox Group.
• Start searching and engaging with patients or practitioners and find some folks you are comfortable with.
• You will inevitably be pointed to info sources and probably a patient driven (disease specific) website where you will find many people like you with the same goal.

This approach should allow you to drown out the noise, download actionable, meaningful content which you can digest …  and improve your understanding of the disease you suffer from.    After you have digested the information, you will have many questions…. now bring them with you to your Participatory Medicine proficient physician and review them together as a team.

End of analysis paralysis… I hope.

Learn more about Analysis Paralysis In Healthcare Decision Making at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Medicine is (too) slowly becoming more patient centric. The patient needs to be at the center of the health care equation. While physician experts clearly know more about when a procedure is indicated or how a procedure should be performed…. they do not know what the affect of that procedure will be on every single patient… nor do they know if every patient who “qualifies” for a procedure, wants one.  Here are some concepts that anyone who works in health care should be fluent in….

Shared Decision Making , Informed choice, defining the “personality of an injury or disease and, Participatory Medicine.

The empowered patient and participatory medicine population are changing the landscape of the way medicine should be *practiced*…. and health care providers should be paying attention and listening.

Empowered patients have seen research that their physicians have not yet read. They can share that information and improve the level of understanding of their entire treatment team. But the provider needs to open to receiving that information. They need to be willing to interact with that “e”patient who may in fact be an expert in their disease.

The health care landscape is evolving rapidly. 85% of patients are researching their disease, their physicians and the health care system online. Many are becoming *experts* of sorts… those of us (in the #hcr system) who ignore this movement do so at their own peril.

Don’t even try to tell my dad how to change his coumadin dose when his INR is high or low!!! You’ll immediately know what I am referring too above !!

Be kind to me!!

Learn more about Should Empowered Patients Be Considered *Experts*? at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

There has been a lot of recent *talk* and social media chatter around testimonials — their usefulness, believability and influence on a patient’s decisions to visit a particular physician.

Opinions, as expected, are all over the place.

There are still a number of law suits floating around trying to prevent patients from posting to sites like Vitals.com, Healthgrades.com, Yelp.com and AngiesList.com .  Some physicians are also putting clauses into the paperwork you sign when you enter their practice that you will not engage in online discussions about him or her.

Why is the medical community so paranoid about this?

Tobin Arthur, CEO of iMedExchange had a very nice article on this topic on KevinMD’s blog.  The issue resurfaced today on Kevin’s blog — but there were very few responses to the guest post.  The author of the guest post, Dr. Neil Baum, suggested to physicians that the physician should post quotes from their patients onto their site — after obtaining appropriate approvals.

Testimonials by themselves just scratch the surface of the bigger issue at hand, and that is online reputation management.

Over the next few short years, I venture to guess that your online reputation will far exceed your offline reputation in terms of overall impact and importance.

The ability of cloud based platforms to reach the masses… will be more powerful and more pervasive than current word of mouth methods to discuss or determine someone’s reputation.

What can a physician do right now, even if they have no desire to establish an online presence?

Google Alerts:  Google allows you to define the search term, frequency and how you would like to be notified.  I have found this invaluable.  I know exactly when someone posts something about me online, regardless of the site it is on.   Why is this important?   What if the message is on a site you can not respond to?   Don’t you want to know what people are saying about you???? Can you please everyone and every patient everyday?  No.  Will one poor post on Vitals end your reputation, NO! BUT… what if you have 4 or 5 bad reviews and most of the reviewers site the same issue?   Now you will know exactly what you need to do to prevent further bad reviews from appearing on these sites.

Consider establishing a digital footprint … Website (it’s not nearly as hard as you think it is); Blog; also not nearly as difficult as you think it might be.  How many patients a day do you talk to?  How many times do you discuss the natural history of rotator cuff tears, diabetes, hypertension, etc.  Quite a lot, I imagine.   Well… if you had a website or a blog you simply dictate virtually the same discussion and upload the transcript.  Done.  A topic borne

Bottom line… whether you want to be online or not, you ARE!  People are talking about you.   Do you want to monitor and try and control the message?  Do you want to know if your front desk is chasing people away?  I imagine you do.  Set up a google alert and start watching. When you are ready to venture further … call me, I will be more than happy to assist you.

Lastly… I do not believe that physicians should be posting testimonials directly on their site.  I believe the patients should be given the ability to post a testimonial directly on a physicians site.  Since this site opened up 3 months ago I have received a lot of praise from many patients who want to be able to post a testimonial on their time and at a computer they are comfortable with.   You always have the option to moderate the comments if you so chose.

Learn more about Health Care~Social Media: Testimonials … and reputation *management*. at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Many physicians and other health care professionals are just starting to consider entering the intersection of health care and social media. Many will need guidance and support… and some will have some very basic questions which I hope this video addresses.   Your only choice you should need to make is whether to engage or not… you shouldn’t have to fuss over the plethora of social media platforms, aggregators, professional *tools* etc…

Keep It Simple.    Every ounce of your effort is worth it!!

Click here to view the embedded video.

Transcript will be up when available….

Learn more about Health Care, Social Media: Operating Systems, Devices and Platforms… do they matter? at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

The times they are a changin’… yes they are.

Doctors, hospitals, payers, pharma, device manufacturers and the VC folks better be well versed in what’s will soon be showing at a theatre near you.

In no particular order of importance.

ACO: Accountable Care Organizations: Nobody actually knows what the final language shaping these potential monstrosities will be … so it may be a bit pre-mature for any mid or late stage planning.

ACOs, by definition have the potential to save money and encourage the quality practice of medicine.  But the culture of change within the halls of healthcare which would be necessary to achieve those goals will likely not materialize.

ACEs: Acute Care Events.  The ACE trials have produced promising results.  They are getting docs to the table with institutions to propose rates for coverage of certain targeted DRGs such as total joint replacements.  In the end, they get the newco to compete against the other local institution’s newco for the contract to provide care.  If doctors and hospitals align and both have skin in the game… cost control will materialize.  Interesting to note that gainsharing, typically forbidden by CMS, is legal under an ACE framework.

Co-management agreements.  Far more common form of alignment between institutions and physicians.  It’s a good place to start and to become comfortable with each other in preparation for the potential ACO train approaching.  Key point is that all parties now have skin in the game to control costs.

Captive PCs and Hospital Employed Physicians… This is a huge current trend and will likely be the dominant trend for new physician hires for the foreseeable future.  Those of us who have been in practice for a while and have been *successful* do not understand why this trend is so popular… but it pays to keep a close eye on this.

CONSOLIDATION !!!!   Physicians groups are consolidating, Hospitals are consolidating and the Payers are also consolidating.

What does this mean for the Orthopedic Industry and anyone who conducts business with us?   Currently, or in the very near future many physicians will be economically advantaged by saving the hospital money on the procedures they perform.  They will be incented to meet nationally recognized discharge criteria and to diminish their length of stay.  Again, if physicians has an economic incentive to save money, there are many ways for them to do so… and industry players would be wise to stay abreast of the latest trends and current practice patterns.

As I toured the American Academy of Orthopedic Surgeons (AAOS) meeting this past month I was astonished at the number of one or two product FUNDED start-ups which either offer more complicated me-too products or worse — they offer a product which is an add-on (from a cost perspective) to a traditional procedure.

Lets say I can perform procedure X with a 99% success rate and widget Z can increase that rate to 100%.  But the implants and disposables for procedure X cost 10,000 and widget Z costs $1000.   Does widget Z have any chance at gaining traction… nope.  Not where healthcare is heading.  They would be wise to find a suitor , now.

Pixie dust.  There are a multitude of compounds and proteins that are made for us to sprinkle on fractures, etc at the end of the surgical case — and they may increase the healing rate.  If the healing rate improves 3-5%, is it worth it to spend 7500-10000 dollars for the pixie dust???  Probably not.

The future of Orthopedic Surgery lies in our ability to manipulate the biological milieu which governs the healing response.   Improved surgical outcomes will not be related to the plethora of companies producing stronger rope, stronger anchors, etc.  Healing is a biological event, far more than it is a mechanical one.  Vitamin D levels, calcium, and serum protein levels matter just as much as the number of screws we are using when it comes to fracture healing.  At $1 for a vit D tablet and $1000 for certain screws…. I would take my vitamin D

Now, of course I have over-simplified… but I am not too far off base.   Physicians have the ability to dramatically decrease the cost of providing a certain service if they are incented to do so.  Fairly soon, the majority of physicians will be incented to do so. The Orthopedic Industry is going to undergo a process of consolidation as never seen before… and me-too products and start ups with expensive disposables will not be at many AAOS conferences.

Of course, I may be wrong, this is just my opinion and not the opinion of my group or the hospitals I work at.

Learn more about Health Care Trends and the Orthopedic Industry at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

This is by far (still) the number one question I am asked by reporters, columnists, other health care providers, etc.

That in and of itself shows how far *we* have to go!

I tend to be an early adopter of technology —when encountered with a new and intriguing technology I try to figure out if it fits into my workflow, enables my workflow or allows me to be more efficient or even a *better* doctor.  It soon became obvious that many social media platforms would fit very easily into my daily workflow.

Contrary to popular belief … I had no *exit strategy* in mind.

My decision to further my interests in health care and social media wasn’t a simple conscious decision.  As an innately social person — and physician I always enjoyed sharing information with people/patients in my office utilizing various digital or analog modalities.  It almost seems as if my foray into social media and health care was simply destined to happen.

Did I enter the healthcare and social media intersection for an immediate ROI and an increase in patient load?  No!   For me—there was a larger purpose that goes all the way back to why I wanted to be a doctor in the first place.  It was a far more altruistic endeavor than most believe.

When I initially entered the *intersection*  of social media and healthcare , construction of the intersection had only just began.  There were a few of us there talking about the possibilities and the enabling nature of the technology — but initially that was it.

• What ifs….?
• What about….?
• How about….?

It would be many months before some of the many brilliant minds I have met online started to focus their energies, resources and capital which enabled them to break free of what soon became a well populated echo chamber.

I teach (and learn) all day.  I teach students. I teach residents. I teach nurses. I teach patients (people). I teach attorneys and juries too.   It was a logical progression for me to adapt to these online platforms for what seemed to be the purpose of teaching others what I know about Orthopedic Surgery and Healthcare.

As I became more comfortable online, I began to initiate searches as if I were a patient.  I did not like what I found.  I found the majority of the information available to be commercially biased, out-dated,  factually lacking, self promotional — and occasionally just plain wrong.

That cemented my desire to try and play a larger role in the social media and healthcare community.

As my online presence has evolved I now have the privilege to share what I know with many, many colleagues, interested observers, the press, pharma, commercial clients and patients too.  My affiliations have enabled me to reach audiences all over the world via webinars, live panels or discussions and as an invited lecturer.

Along the way I have also learned a lot!  There are many truly wonderful and gifted writers, bloggers and twitter *friends* who love curating content from all over the web to present it in a simple micro-blogging stream that enables me to stay up to date in many areas where I would have fallen behind if it weren’t for those I chose to follow.

After all, the only way to improve the value of the content available online is to continually engage with my colleagues, patients and other experts in the field of health care.

Furthermore, other health care providers initiate an online presence everyday.  Some may elect to establish a digital footprint with a blog or website full of actionable, timely, and factually correct information.

The more *good* quality content the better— because one day I will look in the mirror and see a patient looking back at me.

Learn more about Why…. at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

Over time, by never seeking the antithetical, through accumulating subscriptions to magazines, stacks of books and hours of television, you can become so confident in your world-view no one could dissuade you.

Remember, there’s always someone out there willing to sell eyeballs to advertisers by offering a guaranteed audience of people looking for validation. Ask yourself if you are in that audience.

In science, you move closer to the truth by seeking evidence to the contrary. Perhaps the same method should inform your opinions as well.

Confirmation Bias (in medicine):

We are all guilty of this from time to time. Confirmation is something that resident physicians in particular are guilty of more so than experienced, qualified physicians.   Resident physcians and attending physicians alike may quickly form a diagnosis in their mind during a brief discussion with a patient.  Now they will try to convince themselves (sub-consciously) that the other complaints and physical exam fit that diagnosis.   They force the rest of the interaction in a certain direction.  Surprisingly… when a cross sectional study such as an MRI does NOT reveal the diagnosis they were suspecting — the usual response is that the MRI “missed it”.  And the confirmation bias persists.

I have seen many second opinions  when the patient either had surgery or plans surgery for a presumed diagnosis, not yet confirmed with imaging studies.  After taking 5-10 minutes to listen to the patient— the real diagnosis usually reveals itself.   Now, I’m not claiming to be Dr. House (who is guilty of confirmation bias too), but I certainly give the patient enough time to talk until a solid list of differential diagnoses have formed in my mind.   And we don’t stop talking until that occurs.    If the light bulb doesn’t illuminate, I simply say ” I don’t know” and “let’s go to the computer and look this up”.

This is a very important concept for residents to grasp early on in their training… not all snapping in the knee is a meniscus tear … not all shoulder pain is a rotator cuff tear and not all back pain is a pinched nerve.  Listen to your patient… ask the right questions and the correct diagnosis will usually reveal itself.

Patients are also guilty of confirmation bias.  When many patients are online looking for information, they are usually (certainly not always) starting with a presumed diagnosis given by a physician, friend, or a googled page.  Now they search deeper and deeper into that diagnosis — even if the hints are there that this may not be the correct diagnosis.  It is not very hard to force a soft square object into a hexagon shaped cup.

One of the roles of experienced physicians and diagnosticians is to educate… residents, colleagues at the water cooler and of course — patients.  Patients are online and searching.  If they start their search with a reasonable foundation and instructions on how to minimize confirmation bias… a more educational and more productive search will ensue.

Learn more about Confirmation Bias at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.

from alterian.com

There have been a half dozen or so articles over the last year which really hammer home the true potential of the intersection of social media and healthcare.

We witnessed  patients who were been able to tweet from their hospital room to help the docs arrive at the correct diagnosis…

We saw a patient receive a kidney donation from someone he did not know on Facebook…because of a post of his.

The BBC this week published an article that simply ads fuel to the fire, so to speak.    In this article a Facebook friend, who happened to be a doctor or surgeon sent his friend to the ER immediately upon reading his posts.   The diagnosis… a ruptured appendix.   Another life saved.  Might have traditional medicine worked… sure.  But here it was the issue of Nudges that I speak about often in modifying behavior… this wasn’t a gentle nudge… but it was a nudge nonetheless!

from mhealth360.com

Social media is here  to stay… and its position and power in health care is ever expanding as well.

Get on board… the train is being loaded.

We are all patients !!

Learn more about Social Media and Health Care.. It works ! at Howard J. Luks, MD - Howard J. Luks, MD - Chief of Sports Medicine and Arthroscopy.