Hospital Songs

Featured Post: Twitter + Group Medical Visits = ?

Elizabeth Han — Sat, 06 Feb 2010 01:41:46 +0000

Update (Feb. 22nd, 2010): Thanks to Kevin, MD for featuring this post on “Twitter and Facebook Can Help Conduct Group Patient Visits”! I’m very honored!

Twitter + Group Medical Visits = ?

The concept is simple. Group Medical Visits already exist. So:

Take 10 minutes at the midpoint of the visit and have everyone tweet their feelings, keywords, anything! (with designated hashtag)
Visualize in real-time with Twitterfall
Discuss, discuss, discuss!

The rest of this post is about the argument in favor of the above.

Twitterfall makes Twitter parties sparkle.

I was thinking about how some “Twitter parties” revolve around a real-time Twitterfall projected on a wall.

Participants go about their party business, but constantly add tweets—appending each with the party’s hashtag (e.g., #med2) which can be fed into Twitterfall search.

The result is fascinating live information about what’s popular in the conversation.

And yeah, people are using it! Last February, the UK newspaper The Daily Telegraph made big news when they revealed that their integrated newroom featured Twitterfall projected right up “traditional” video feeds from heavyweights like BBC and CNN:

However, maybe you’re thinking: so why not just talk to people? Isn’t that the point of a party?

Sure. But I think that good topics easily get lost in a mishmash of party conversations.

I’ve sat in a meeting room with 10 people where 5 different conversations were going on and 1 word caught the attention of 8 people who suddenly perked up and wanted to be caught up on that 1 topic. Or maybe those 5 conversations were actually trending the same topic, but no one knew, so they didn’t engage with each other afterwards?

We are drowning in information yet thirsting for knowledge. How do you “see” a trend?

You can discuss, and listen, and overhear, but you’re only one person. How do you know what is being discussed? How do you know HOW it’s being discussed?

And what does this have to do with medicine?

The New Health Care needs to address some very 21st-century problems.

Support groups have been around forever. Some successful ones are electronic, like the wonderful breast cancer listserv of my home province, Newfoundland. Some are quite informal, just common folks getting together.

Now, as our life expectancies continue to grow, and we’re faced with the very 21st-century challenges of prevention of disease and management of chronic conditions, these group settings become very important.

Patients are recognizing the need to supplement the doctor-patient relationship. Patients want to talk to each other. Especially if they’re going to be in the tough spot for the long haul. This is why a community like PatientsLikeMe — targeted especially to incurable conditions — has absolutely thrived.

But they can’t do it alone.

Physicians should give it a lurk, sort of.

DrV coined the term pre-emptive online health literacy a while ago – i.e., knowing what your patients find when they consult Dr. Google and Dr. Wikipedia.

I wonder, shouldn’t this include some awareness of what your patients are saying about a condition/disease on the internet?

On occasion, wouldn’t patients benefit from a physician’s ability to confirm, explain, or debunk a trend that’s been propagating among a group?

But you’re probably not going to start skulking around corners or lurking in forums.

It has to be efficient. And non-intrusive.

The case for Twitter-supplemented group medical visits.

First, Group Medical Visits 101 (adapted from champsonline):

You receive an appointment to see your doctor together with 10 – 20 other patients who also have the same condition as you (e.g., high blood pressure or diabetes)
You get to spend about one hour with your Doctor discussing your condition and any other pertinent health problems that you may have.
You also get to speak to a Nutritionist or Health Educator and to learn from other patients who are also in your group

The Group Medical Visit is like the party.

We might get lots of great discussion, but wouldn’t it be nice if a portion of the visit could focus on addressing “trending topics”? So, once again:

Take 10 minutes at the midpoint of the visit and have everyone tweet their feelings, keywords, anything.
Visualize in real-time with Twitterfall.
Discuss, discuss, discuss!

*Alternatively, Twitterfall could be used for traditional non-face-to-face Twitter parties of a set duration. People from different locations, including remote ones, get terrific real-time information, but it’s easier to analyze than a text or video chat. And you don’t necessarily have to be sitting at the computer the entire time.

The Tweet Stream is organic.

Advantages:

ideas arrive in parallel, yet are still discrete and understandable
less intimidating than yelling out an opinion
both individual words and longer ideas can be trended
trending topics and phrases auto-generated (the big concerns rise to the top)
Update (Feb. 6th, 2010): Ok, I just checked and Twitterfall actually doesn’t have this functionality yet. But Tweetdeck does! There’s a button at the bottom of each column “Show what’s popular in this column” which comes up with a tag cloud of terms, ids, and hashtags.
you get way more ideas than a traditional whiteboard brainstorm

Another way to look at it: the Google-fu argument!

Tweets are great. 140 characters is just enough to accommodate concepts…but also phrasing, context, and emotions.

For example, don’t you ever wonder how people’s Google search styles vary?

Your Google-fu ~= my Google-fu!

Dr. Schwimmer (@JoshuaSchwimmer) posted this great screenshot on Google’s search suggestions for the phrase “doctor’s are”. Just look at the diversity (and perversity?)! And that’s only given the first 2 words of the query!

Now imagine a Group Medical Visit. What are the concerns of the 20 people in the room? And with what terminology would they express themselves if left to their own devices?

It’s just too hard to identify these subtleties in a crowded room. And the New Health Care is supposed to be about finding your voice.

So that’s the idea!

For a fascinating example of simple Twitter meta-analysis, have a look at:

Chew and Eysenbach’s abstract
Pandemics in the Age of Twitter: Content Analysis of “Tweets” During the H1N1 Outbreak

The Great Evernote Reveal

Elizabeth Han — Fri, 02 Jul 2010 17:49:13 +0000

It occurred to me over the past week that if you were to get inside my Evernote, you would instantly learn so much about me.

In some ways, the structures of our individual “clouds” say a lot more about us than any diary could. E.g., “this is how I curate”, “this is what matters to me”, “this is my weakness – the stuff I need a cloud to help me remember”.

But this is also what makes Evernote so great. They never really tell you how to use it. It’s up to you. In this way, your Notebooks become insanely personal. And if you come up with something neat, maybe you’ll feature on the Evernote Tumblr.

Well, here’s a glimpse of mine (click to enlarge):

Blog Ideas: Did I think of something cool on the subway? I note it on my iTouch Evernote app and sync as soon as I get a network connection.
Clinical Notes: No patient information here. Just interesting clinical insights (right now, mostly useful tips for talking to patients).
Ethics: I love Virtual Mentor, the AMA’s SUPERB medical ethics journal. I work through the cases in my spare time and save them as notes. Tagging is invaluable here. For example, if I need notes on “abortion”, there you go. Also great for keeping notes on Medical Law.
Fiction: Bits and pieces of stories.
Press: The Evernote extension for Chrome and Firefox makes clipping my blog press easy-peasy. Never forget any URLs again!
Random: A little bit of everything – mostly my favourites from Ask Metafilter and images from websites.
Research: It started out as a repository for terms I didn’t understand in journal articles like “Principal Components Analysis”. Now I’m beginning to really like Evernote’s PDF capabilities – especially being able to embed and flip through whole articles inside a note – so I will be taking it out for a test drive as a Systematic Revew tool.
US Health Reform 2009: Possibly my most useful notebook EVER! I started collecting articles on the Health Reform debate in September 2009 by bookmarks, but it just didn’t cut it. Then I got Evernote and spent a few days going back through all the links I shared on Twitter re: HR and this baby was born! So, now, say I want to get all my saved articles on Medicare – I just click the “Medicare” tag. Of course, this notebook is quite interesting in earlier versions of Evernote as the Time Band shows when I added each note – it’s like seeing HR happen right before your eyes – unfortunately, the latest release seems to have scrapped that feature.

A question for you: Evernote and personal health info

One thing I noticed from my own notebooks was the conspicuous lack of personal health information. I have, of course, read all about the dangers of doctors storing any patient information in Evernote (HIPAA nightmare…), but I wonder whether patients themselves go ahead and keep records in Evernote?

Let me know if you’ve seen this!

And now I want to ask you: what’s in your Evernote and why? And, secondly, if you’re a patient, do you/would you store personal health information on it?

–

For further reading on Evernote in medicine and health, check out DrV’s post at 33charts: 8 Ways Physicians Can Use Evernote

MealUpgrade: Apps for Healthy Kids and Data.gov Feed the Upgrade Obsession

Elizabeth Han — Mon, 21 Jun 2010 21:59:18 +0000

Is there a more universal desire right now than the “upgrade”?

Better yet, nearly instant upgrade. It actually gives me an absurd giddy feeling. Example: This weekend, I upgraded to WordPress 3.0. The interface doesn’t look that different, but I watched the video documenting the tweaks and fixes, and felt lighter anyway. It’s a little voice that squeals: my blog is shiny – and so am I.

So I get a kick out of MealUpgrade.com, a new website by Shape Up America and the National Turkey Foundation (bizarre? Scroll to the caveat…).

It’s an “app” submitted to the Apps for Healthy Kids Competition, an initiative by First Lady Michelle Obama to help combat childhood obesity. The competition challenges developers to build apps that use the USDA Nutrition Data Set (made available via the President’s Open Government project) in creative, engaging ways. Meal Upgrade allows you to choose a typical dish and learn how to “upgrade” it (reduce calories) by substituting ingredients.

For example, the snapshot below shows how to upgrade from a hamburger to a turkey burger, with other options like switching to whole wheat bread and having baked potato instead of fries.

Pluses:

I think kids will enjoy it, if only for the fun of hitting the Upgrade button and briefly sitting in uncertainty.
Could be quite educational. For example, you could have students guess upgrades and see if they correspond to what the app suggests.
It could also tie into doctor-education projects like the one mentioned recently by Healthymaginations, through which doctors learn how to “select, purchase, and cook” healthy food, hopefully influencing patients.

Not-so-pluses (but could be improved!):

It’s unfortunate that the website is not actually “working” in the background, because the possible meals that can be upgraded are “hard-coded”, so to speak. I would thus suggest:

Dramatically expanding the menu. For example, including snacks, desserts, and beverages.
Adding functionality that allows you to tell the app what ingredients you have available, and have it calculate in real-time the possible upgrades you can make to the dish of choice.
Allowing users to submit suggestions for upgrades. And vote on them too
Making a corresponding iPhone app so that you can begin planning upgrades on the go and at the grocery store.

And a caveat: as this project is sponsored by the National Turkey Foundation, the upgrades are heavily biased towards substituting turkey for other protein…slightly annoying yet understandable!

Parting words

The submission period for Apps for Health Kids is ending on June 30th (my birthday!) and then the voting will begin. I hope to see a lot of other great entries, and am super-psyched about the concept of Open Government.

Next, I’m thinking – Upgrade My Workout?

Lifehacker’s already got Upgrade Your Life so now let’s focus on specific parts of that!

No related posts.

The other cup of suffering.

Elizabeth Han — Thu, 17 Jun 2010 00:32:03 +0000

This is not the cup that you are looking for.

She was in for her hip.

“Anything I can do for you, Ms. _____?”

I’m only 5’ 2’’, but I had to bend over anyway to be level with her mouth. Her lips were dry, cracked, and trembling, yet they curved into what could only be a smile at my approach. Slowly, they formed a word.

“Water.” And as an afterthought, “Please.”

When I brought the styrofoam cup back to her, she stared inside for a moment before taking a sip. And then stared very hard at the leather-covered stool not a foot from the tips of my black oxfords.

Instinctively, I sat.

“Water,” she said again.

“Water?”

She gestured towards the computer screen, where her two x-rays were pulled up. There were huge metal pieces in the hip. Arthroplasty.

“This,” she pointed. “And this! Soon I won’t need the water anymore. Do you know what this means?”

- –

Turns out Ms. ______ was actually a coffee drinker. She lived down the street from a local-owned cafe that had vintage pictures of Marlene Dietrich and Mary Pickford on the walls. These ladies were her mother’s favourite. And Mary Pickford was Canadian, born right here in Toronto — did I know that? It actually took me a minute before I realized that I was being told a story.

“Water,” she repeated, poking at the styrofoam cup I’d given her.

She and her mother had this routine to do with water. Every morning, she took coffee and water for breakfast. She adored the coffee at the local cafe, but it was too strong for her. She asked her mother to go out, buy it, and bring it back.

“And I say, ‘Ma, remember to ask for a cup of hot water’ so I can dilute it. And she’s so happy to do this little job for me and swears she’ll have it.

“Then she goes out the door and I put the kettle on the stove. Why? Because she always forgets. And I need the hot water.

“Then she comes back with the coffee, beaming. And I’ve got this little cup of hot water to put in it. I pretend she got it for me and I never say a word about it.

“I say, ‘I love it, Ma. It’s perfect.’”

She looked away and took a breath.

“But one day there won’t be that little cup anymore. I’ll be going to the cafe myself and some stranger like you will get the water for me. And I will never say I love it again.”

- –

She was scared to death, she told me. But not about her hip.

“That’s just a part of my body.”

But, she continued, your mother is a bigger part of your body, just as you were once the most ostentatious part of hers.

Her mother had dementia, or Alzheimer’s or something like that: she couldn’t even say the word. It was bad.

She was her mother’s sole caregiver. But with her own health and mobility growing increasingly precarious, she knew she would soon have no choice but to put her closest confidante, the biggest part of her own body, in an institution.

So, yes – the water. That was the real threat. The agony. The nightmare. Now I’m afraid of it too, and I’m only the one who sat down.

- -

I definitely think it is worth wondering:

What stories are we missing?

And what/who are we really seeing? The ailment, the patient, the story, or the nightmare?

Disclaimer: This is a work of fiction inspired by collective real-life experiences.

No related posts.

We’re All Still Jenny from the Block: An Exhortation to Local Hospitals

Elizabeth Han — Tue, 01 Jun 2010 00:29:08 +0000

“There are surely no better people in this world than locals who find themselves at home.” –(Me)

Guess what? I’ve suspected it for a while, but now I know. For me, local is still king. I recently found a stellar blog on pregnancy by Sunnybrook Health Sciences Center here in Toronto. And it made me more happy than another hospital social media success story in XYZ city ever could.

Look at Toronto in this picture. Look at Sunnybrook. We may be tiny, square, and pink, but with this blog, the pink thing has the Mother’s Touch. That’s something to smile about, I think!

“Mother’s Touch”

Mother’s Touch follows two mommys-to-be (both due in Fall 2010) on their pregnancy journey, with all the posts written by the mommys themselves. So far, they’ve tackled topics ranging from what to do with ballooning breasts, to the big reveal of the gender of Andrea’s baby (I won’t spoil the surprise ). It’s a darling endeavor by a hospital that, along with Bloorview Kids Rehab and Mount Sinai Hospital, seems to be leading the internet media charge in Toronto.

But mommy-blogging isn’t a new idea – why the excitement?

Mommy-blogging has been around for a while. 23andMe has an entire community dedicated to this. Individual mommys have been at it for years on their own Blogger- and WordPress- islands, and many have amassed devoted followings that persist even after the babies are not-so-baby anymore.

However, I would like to posit to each hospital interested in social media yet afraid of saturation: you still have something very valuable to offer. You have local.

Local is the best.

There is something immensely potent about local. The benefit of social media is supposed to be the connections forged with strangers at opposite ends of the earth – and that’s still a great perk – but definitely not at the risk of losing local.

If I were pregnant, I’d want the best of both worlds. I’d have a look at 23andMe’s stuff. But if I’m having my baby at Sunnybrook, I want to talk to women who have experienced Sunnybrook. I want to read Mother’s Touch; I want to join a local Twitter hashtag conversation (#preggersinTO, anybody?); I want to be connected to women who will be due the same time as I. There are so many possibilities for a local hospital to do something…maybe not novel, but certainly remarkable.

So far, Sunnybrook seems pretty ahead. Here’s a part I clipped from their website:

That’s 6 different modes of social media they are currently into! Wonderful!

I have also been very glad to find a lot of other Toronto health organizations tweeting and Facebooking, but I think they need to go further. I won’t name any names, but it’s a little sad when hospitals Tweet like crazy…and yet a search for Twitter on their websites yields 0 hits.

Come on Toronto! This is my battle exhortation to you! Lead the way!

To end off: a reflection from my own life…

Mother’s Touch is just one blog. But it makes me think that this is the end of an era. This is the new What to Expect When You’re Expecting. True, I’ve never read WTEWYE, but I remember when my own dear Mommy was pregnant with my sister. I was 11 years old and utterly perplexed by the stack of pregnancy books on her dresser. Wasn’t it enough just to see and feel herself being pregnant, and talking to Daddy and me? I didn’t truly appreciate the need of the patient, my mother, for empowerment and knowledge. I believe now that she would have found a blog run by the local hospital pretty useful. Even years later, she still remarks on how much she was surprised by the top-notch care she received at delivery and convalescence…

I can’t help thinking: wouldn’t it have been so much more comforting simply to, well, know?

Fibro-what? A Social Dictionary For Medicine

Elizabeth Han — Sun, 25 Apr 2010 19:55:03 +0000

My favourite online dictionary is, without a doubt, Wordnik.

Do you think we need a social dictionary like Wordnik for medicine?

Here’s the thing. I’ve always said that the reason I’m not retaining new words is that I don’t really understand how they’re used: Wordnik remedies this problem by providing a plethora of contextual clues. Here’s a rundown of my favourite features using the examples of “fibromyalgia” and “h1n1”:

Examples. This section pulls the oddest sentences (not intentionally, I’m sure, but the result is often very original) featuring your word from a vast array of unconventional sources, including CNN transcripts, diary entries, and classic literature.

The worst part about having the fibromyalgia is looking foward to being able to go to bed. —bettyalready Diary Entry

WEIL: I would say that fibromyalgia is a subset of chronic pain syndrome. —CNN Transcript Nov 10, 2004

Lyrica for nerve pain and fibromyalgia is now a $2.5 billion-a-year product, but smoking cessation treatment Chantix hasn’t lived up to expectations because of links to depression and suicidal thoughts. —Kansas City Star: Front Page

On Twitter. The latest tweets containing your word. If we could somehow filter out the spammy tweets, how great would this tool be to gauge the hive mind!

Flickr. These are some photos for h1n1. Check out the masks!

Related. Sort of like a thesaurus. I know it looks a bit sparse (there are more under the Related tab), but compared to typical online dictionaries (some of which don’t even contain fibromyalgia), this is pretty good!

Stats. Charts and graphs showing frequency of occurrence, punctuation patterns, and more.
Comments. There are some good social networking features like the ability to favourite, comment, and create lists of words.

Plus, Wordnik has all the typical features of a dictionary including definitions from multiple sources, pronunciations, and etymologies.

Now, I know there are a lot of medical dictionaries out there. It also seems that communities such as PatientsLikeMe have sections that are starting to look like social medical dictionaries – for example, a search for Lyrica pulls up related forum posts, and detailed information like side effects that Wordnik does not have (click to enlarge):

Yet I feel that there might be room for something more “social” than the rigid definitions on The Free Dictionary’s Medical Dictionary (although it’s pretty good) yet more systematically organized than the PatientsLikeMe forums.

Another reason: as much as patients are being empowered by the internet, I wonder if the adventure for most even gets as far as signing up for a website like PatientsLikeMe. If a reliable, crowd-sourced, and dynamic medical dictionary could show up as the number one hit on Google for their queries, perhaps useful medical knowledge would reach the most people most quickly.

In the meantime, Wordnik is actually having a 2010 Developer’s Challenge right now, so if you’re inspired by this post, get cracking and maybe the medical community will one day owe you a debt of gratitude!

Bant: A Stylish Diabetes iPhone App from Toronto’s University Health Network

Elizabeth Han — Fri, 09 Apr 2010 04:47:06 +0000

Toronto’s Medicine 2.0 scene is heating up!

Hot on the heels of my recent visit to the Center for Global eHealth Innovations in Toronto, the Center released an exciting new (and free!) iPhone app for Type I diabetics to track their blood sugar: Bant.

Bant is short for Banting, the Canadian who discovered insulin at – where else? – University of Toronto in 1921. And not only is the name stylish, but so is the design.

I downloaded the app yesterday and gave it a spin, with impressive results:

The first screen is Readings (left), where you select the meal for which you want to add a glucose reading. Then you can simply drag and drop the appropriate marker to the desired time and concentration on the graph. The blue section indicates the goal concentration range.

As you accumulate data points, you can view a graphical summary under Trends (left).
Individual readings can also be adjusted from the Bant Book screen (middle), which includes the options to add text notes and/or share your thoughts via Twitter (right).

Another great feature is Community, which taps you into the diabetes conversations on Twitter, identified by certain hashtags.
Finally, there are terrific options (shown below) to export the data to your Google Health account and to email (as a .csv attachment).

So who does this help?

Bant is targeted towards Type I diabetics, especially children and teenagers – a demographic that often has trouble with tracking blood glucose regularly. It is hoped that the community and sharing features of Bant will keep it a hit long after the novelty of entering readings into an iPhone/iPod Touch wears off.

An interview with Dr. Joseph Cafazzo, who leads the project, also hinted at rewarding users with iTunes credits to maintain an incentive for adherence. Talks are in progress with Apple to make this a reality.

Personally, I also wonder how Bant would look on the iPad. If we ever get to the point where tablets become fixtures in doctor’s offices, you could easily bring up a patient’s data on Google Health or from the .csv file (sent from patient to doctor by secure email). Popping up the history of diabetes-related tweets could also be a stimulating topic of conversation.

Looking ahead…

You know, people used to scoff at me when I said that Twitter could be used to track blood sugar. I couldn’t even win them to microblogging, much less health microblogging. Well, now here’s something we can all try for ourselves, which I think is the key.

Just because an app is out there doesn’t mean it will be adopted in great numbers. However, I feel strongly that just by innovating and making projects like Bant available for free, the groundwork is being laid for design to get better and better.

Things have to be used before we can even think about how to make them more usable. I’m so glad we have the opportunity to do so!

Mount Sinai Hospital’s VitalHub, the Latest in iPhone + EMR

Elizabeth Han — Fri, 26 Mar 2010 20:03:43 +0000

Just wanted to post about VitalHub, the latest in iPhone + EMR — being developed and implemented in-house at Mount Sinai Hospital in Toronto!

Watch the beautiful video of it in action, courtesy of the Apple website.

The essentials:

VitalHub allows health care professionals to access records from 66 applications being used at Mount Sinai Hospital, including those storing clinical data, reference materials, and patient information.

“We now have access to exactly what we have in our computers here in the hospital. We can get access to our patients’ data whenever and wherever we want it. Knowing what’s happening with their drugs, radiology, laboratory values, microbiology results — it really enables me to make decisions on the go.”

Access from anywhere.

“Whether using Wi-Fi or 3G on iPhone, doctors can access VitalHub no matter where they are,” explains Dwivedi. “They can review a patient chart before they come into the hospital, whether they are at home, in a restaurant, or at an airport.”

Security is provided by password and VPN certificates.

FYI, Sinai is one of several large hospitals located just down the street from U of T/MaRS/Center for Global eHealth Innovations (and also where I did my honors thesis!) so I think this is very exciting for the downtown Toronto eHealth conversation!

Yesterday, I was reading on Hans Oh’s blog that eHealth seems to be becoming “mainstream” — in that it’s cool to be devoting time, effort, and research monies towards it, there are articles on NEJM about it – and it seems that VitalHub, which is very openly promoted by the hospital, is an example of that happening in Canada. I am glad to see that people are really noticing what Dr. David Kibbe said: that actually many physicians have been happy to adopt the iPhone, but such a small percentage have adoped EMRs. It might just be that we have been waiting for innovations like this, piggybacking on technologies that are already accepted by health care workers.

We’ll keep an eye on the official website, Apple’s site, and the Baron Group blog for further information in the coming months.

Torontonians (and others), what do you think?

Storytelling 2.0: Part I – Telling Better Stories in Medicine

Elizabeth Han — Thu, 18 Mar 2010 03:02:45 +0000

Tell me a story and I will follow. Tell me your story and I am so on board it’s ridiculous.

I work at a children’s hospital that has a blog. But Bloorview Kids Rehab does more than post. It tells stories.

“Lena distracts herself by threading bravery beads onto necklaces — each marking a painful procedure or special accomplishment.” [+]
“Taryn, a girl 10 days his junior, is Jake’s girlfriend. This incredible blond-haired girl with deep dimples on both cheeks donates all her tooth fairy money to PMD research so she can help find a cure for Jake’s disease.” [+]

Note that it’s not just the facts; it’s the style. It’s like being there. Parents of children with disabilities even guest-post:

When my son with disabilities was younger, I often felt a failure because I still grieved for him. Why did I feel sad, mad, guilty and anxious – when I adored my son and he brought me such delight?

And that makes the BLOOM blog stand out.

- -

I’ve been thinking a lot about this storytelling business.

I just finished reading Tribes by Seth Godin, which argues that leadership requires a manifesto. I think that the manifesto is a story. It resonates because it is so intensely personal.

Who are we? How did we get here? What will we achieve?

One facet of Medicine 2.0 is caught up in the toys: like iPad for EMR – Twitter for pandemic-tracking — even my own research, an emotion recognition engine.

But we must not forget that the central unit, the ideal granularity of our work is always the patient. The patient, who has the need. Who lives the story.

The story is important.

Lest technology – heck, anything – subsume the patient, we need to tell better stories.

Quick example: Twitter in the real world

Here’s a quick example of a story that engaged me.

I had gathered these vague impressions that Twitter could be useful in health beyond networking. There was an abstract somewhere about mining tweets for medical keywords. I’d heard that some people tweeted their blood sugars? I was not too sure.

Then I saw Nick Dawson’s (@nickdawson) beautiful Prezi:

One sentence: “This weekend in Richmond, it snowed…it snowed a lot.”

A single sentence on the first pane against a backdrop of snow, and I knew it was going to be a good story. And it was. The blizzard spoke and this Virginia hospital responded, using Twitter and Facebook to reach thousands of followers.

Love it.

Prezi’s not bad, either.

- -

The question is: how can we achieve more like this?

Many stories are used to broadcast.

But even for the one-on-one doctor-patient relationship, good stories breed good communication and empathy.

I was also reading how some physicians are frustrated by EMRs because the data organization impedes the story. These are all points to consider.

That’s all for now.

In Part II, I’ll cover several of my recent web finds that may be useful for medical storytelling, or at least inspire us to (further) glory!

It’s Not “Patient Empowerment” If You Feel Powerless: A Story About Today

Elizabeth Han — Thu, 04 Mar 2010 06:14:15 +0000

This is a story about today.

So you’re a patient. You’ve been waiting a long, long time. This place never gets better. Even though this is “your appointment” and “your day”, despite knowing that the doctors are so, so nice — wonderful, really – you find yourself cringing at the unmistakable “busy” in the air.

We’re two hours behind schedule, you hear someone whisper from behind a pulled curtain, and you start to feel foolish.

Maybe you shouldn’t ask this question, you think. Maybe you need to do some more research…

Which is ridiculous, since research is all you’ve been doing! Even though you’ve been saving this question, carefully Google-searching, bookmarking, even scanning scholarly articles in foreign journals about the wrong gender and the wrong age bracket.

The unease unclenches and clenches again like a fist in your stomach.

Finally, they come in and probe, and smile, and reassure – doing their job you know — but still you don’t ask the question.

Why not?

You wonder how they would feel about the anxiety that has led you to Google. You wonder if what you know could possibly stack up against what they know.

Well, you really haven’t looked at everything… Maybe the forums have something to say about it. Try again next month?

So you go home. Your transport is here anyway. It’s always on time. And so is the internet.

- -

Today, a question was not asked.

Problem is, today could be any day.

We who work in health care may still be only a small slice of people’s lives — and I sincerely hope that their relationships with us will never define who they are — but our advice is shockingly weighty. It’s sometimes even alive, if you can imagine that.

Patients take it home with them. And it probably does live with them.

Therefore, I am disappointed when a question is not asked.

I am not sure if this disappointment has a direction or whether it is only a kind of haze – suspended, obscuring, and not quite right. But I think it means something.

It means that we have built fences. Psychological fences. We are told that good fences make good neighbours, but I for one don’t want to talk to people through fences. When we erect too many fences, at some point somebody ends up taking the path of least resistance. Like avoiding communication and seeking out answers on the internet.

A path that perhaps provides short-term relief but eventually pretty much leads to more speculation, uncertainty, anxiety.

(Image: Makz on Flickr)

I’m not saying the internet is evil. Of course not. I’m a huge advocate of patient empowerment and e-patients. And online research and tools most certainly can help inform patient decisions, as well as provide a certain level of community and emotional support.

I just, at times, become wary of curiosity unchecked. I hope that no matter what they discover in their research – no matter how busy and efficiency-obsessed health care workers may look on a particular day – that patients will continue to feel comfortable discussing their online findings with us.

To give a related example, this brings to mind my recent post on Twitter + Group Medical Visits. There, several readers brought up the utility of a physician being aware of Twitter trending topics within the group between visits, so that they can be further discussed at the next Group Visit with input from a medical professional. So while it’s excellent to have more conversation overall, I hope that internet conversations will not be disjoint from in-person conversations between doctor and patient.

Ask the question.

If the description of your prescribed drug in a paper from Medline is making you feel nervous, speak up. If your email list of fellow (insert condition here) patients stumbles upon an interesting concern, let us know.

It’s really not “patient empowerment” if you feel powerless.