Tuesday, October 26, 2010

Family Medicine: Learning in Chocolate Town, USA- Hershey, PA

The Dr. Synonymous Show October 26, 2010 
Family Medicine:  Learning in Chocolate town, USA- Hershey, PA
Patient Blog
Chat room favorite patient blogs, please post
Physician blog: Healthcare, etc.: Paternalism of Science  AFP Community Blog:  CAM
My blog
Book Suggestions

            How Doctors Think by Jerome Groopman, MD

            The Politics of Meaning by Michael Lerner

            A Cry Unheard by James J. Lynch

Hershey, PA:  Chocolate Town USA
            Site of my FM Residency Training: Health teams, Physician Extenders, Quest for Physicianship
Site of the FMEC, Inc NE Regional Meeting
                My three presentations
                                Pain Management the Family Medicine Way
                                Social Media for Geeks and Geezers
                                Consumer Oriented Human Centered Health Home
Thanks to the chat room and listeners
Next week we'll have a report on the FMEC, Inc meeting in Hershey, PA
November 9th, we'll interview Ken Bertka, MD, AAFP Past Board Member and OAFP Past President
I’m Dr Synonymous, Good Night

Dr Synonymous Show: Family Medicine: Building the Dream with Patients, Family Physicians and Social Media

Dr Synonymous Show October 19, 2010
Building the Dream with Patients, Family Physicians and Social Media
Salute to Patients
Overview of Show

Patient Blog “I Am Sick of Being as Big as a House”

Physician social media example: http://afpjournal.blogspot.com/2010/10/putting-depression-guidelines-into.html 

Dr Synonymous blog (FM: Ohio AFP Recharges the Dream) and tweets (Howard Dean interview on Radio Rounds)

Medical Information
            What’s in Placebos?

            Mexican Beer Lime Rash

            Social Media CDC

            Ohio Medicine Social Media Tool Kit

Communication with Dr Sarah Sams, President OAFP

            Let’s hear about the AAFP mtg in Denver last month

                        What happened?
                        Any interesting resolutions?
                        Advances for the specialty?

            How about Ohio AFP?  What’s happening at the state level?

            What’s surprising about being president?

            What else would you like to say to our listeners?

            Pipeline of family medicine workforce- status?

Sunday, October 24, 2010

Family Medicine: Using Social Media to Connect, Learn and Teach

It just sort of started.  Facebook, MySpace, YouTube suddenly showed up in conversation and then on my monitor. I don't remember the moment or the person who inspired me to take the plunge, but here I am using social media all over the place and there's still more. I added Twitter in late 2009 a few months after LinkedIn, which I actually signed into in 2008 when a nephew emailed me to connect with him on LinkedIn.  It's tough to find my user ID and password sometimes because there are so many sites. Worse if I haven't used one in a while like MySpace where my cousin, Sara has some great songs recorded.

The blog as Dr Synonymous started in April, 2010, followed by BlogTalk Radio in June.  Now they feed each other.  I blog the show outline and links so people can tell what might be on the podcast of the show before they listen.
The superphone happened in May, connecting me to the Internet and SM everywhere, even at the in-laws farm in Farmersville, OH (which is, to say the least, out in the country).

The people are the amazing part of SM use.  So many and so interesting and so many who share my interests, especially in family medicine and helping others.
Now I have about 175 friends on Facebook representing family, friends, family medicine, and West Point friends.  I look twice daily to peruse how folks are doing. I post my new blog posts and announce my blogtalk radio show on my Facebook page.  I wish relatives happy birthday and comment on posts of close relatives when big events occur. I may prod a grand-niece or grand-nephew about the time of day if they are hanging out on FB late into the nite (midnight to 1 AM).

Twitter is dynamite for bits of information screened per unit of time. I follow less than 100 people and entities, perusing them for info about health care, diseases, health care policy, etc. A weird one is asteroids, showing near misses of objects in space with earth.  I tweet all of my blog posts and my Dr Synonymous blogtalk radio shows so followers can just click on the link and see or hear the particular Dr Synonymous information.

LinkedIn is useful for professional connections with people in groups I joined, including professional organizations like the AMA, AAFP, etc. and past experiences such as Ranger, Airborne, Service Academy Graduates, Ohio State University, etc.  Others are future oriented such as Health 2.0, Innovation, Personalized Medicine, Patient Centered Medical Home, etc. I link my blog and blogtalk radio show into LinkedIn when appropriate for groups that may have an interest in the content.  The Dr Synonymous blog can always be reached from my Home page on LinkedIn.

I peruse lots of potential information daily and open a lot less info for in depth review. The useful info I tweet back for my followers on Twitter and/or email important articles to colleagues as indicated.

The weekly commitment to the Dr Synonymous Show on BlogTalk Radio every Tuesday night from 8-9 PM ET drives the rhythm of my sustained use of Social Media.  Family Medicine is dependent on patients for our existence, so I honor patients on each show, usually by reviewing a patient blog or two.  Their stories are great reminders about how illness and disease impact peoples lives and about how resilient people are.
I also discuss a physician blog or two and some medical information (the new flu shots, what vitamins may be helpful for health, etc.)  then some information sources that may help patients.

An interview with an educator, thought leader, physician leader or family medicine supporter is part of the show every two or three weeks. It takes a couple hours weekly to organize and support the show.  All of the shows are saved as podcasts that can be downloaded or listened to 24/7 by anyone.

Other SM people are very helpful citizens of the SM community.  Friends such as fellow family doctors Doctor Anonymous (the medical wizard of SM who does it all) and Jill of All Trades, patient bloggers such as  WarmSocks, SeaSpray, ThatsWhatSheSaid helped to promote my SM sites.

The wildest SM activity so far is the tweet chat on Sunday nights with #HCSM  (Healthcare Communication and Social Media) which includes forty to 80 of a possible 190 group members tweeting for one hour in response to two or three questions posed by a moderator.  It's like "drinking from a firehose" of tweets and information.

So, I'm an accidental social media citizen, hoping to learn and help others, especially seeking to help the cause of family medicine which serves so many.  As the need to "go viral" to bypass the sludge of the Medical Industrial Complex increases, the SM is a great way to get it done for the good of all.  Hi Tech, Hi Touch.  We need to make more time for the Hi Touch, paradoxically the Hi Tech becomes one way to make it. 

Saturday, October 16, 2010

Family Medicine: Ohio AFP is Recharging the Dream

The dream embodied in the letter of application to medical school is about helping people.  Service to others is at the heart of the dream of the physician- to- be.  Early in medical school at Ohio State, I looked for physicians who were living the dream.

The Ohio Academy of Family Physicians reached out to medical students with an opportunity to meet family doctors and serve on committees.  I visited Academy Headquarters on High Street where Florence Landis, the chapter executive director, introduced me to the caring attitude of Ohio Family Medicine.  She discussed available committees and we agreed that I would be on the Education Commission.

At my first meeting of the Education Commission, I listened to discussions about continuing education for family doctors. The comments of these physicians repeatedly came back to  patients and patient care.  Their cheerful demeanor and friendly engagement with each other was punctuated with humor and thoughtfulness.

As we stood up to leave at the end of the meeting, several of the doctors introduced themselves to me.  Dr.'s Jack Verhoff, Doug Longnecker, Jud Reamy, David Barr, Carl Spragg, were welcoming me.  A lasting vision of the meeting for me was a greeting, smile and firm handshake from Tenny Williams, MD.  (Tenny was about to become the chair of the soon to be established Department of Family Medicine at Ohio State.)  At that exact moment, I knew I belonged.

Since that meeting in early 1974, I've met hundreds of family physicians who are committed to patient care.  Their stories are fascinating and their commitments intense.  They are living the dream of helping and serving others.  And so am I.

Thanks and a salute to the early leaders of the Ohio Academy of Family Physicians for their vision about education and connection to medical students.  And thanks for their vision that employed Florence Landis as "The mother of us all" in those formative years.

Today I attended two committee meetings at the OAFP headquarters, noting the energy of those present, the commitment to patient care and the comaradie, peppered with compassion and humor.  I looked at the photos of past presidents on the walls of the conference room, including most of those present at my first meeting.  (And my photo, too).

Sarah Sams, MD, the "quilting doctor" and current president, holds the last spot in the photos.   She is delightful in her commitment to help the academy move into the next era with "good old family medicine" combined with the best technology that enables patients to get more quality time with their family doctor  She teaches young physicians and medical students who quickly note her love of patients and them. She attended the new Social Media Workgroup meeting, enthusiastically supporting the use of communication strategies that will deliver information about family medicine and our members to patients, medical students and societal leaders who will benefit.

Mike Sevilla, MD, social media enthusiast and chair of the workgroup helped Dr. Sams sign up for Twitter and send her first Tweet (that he photographed with his cell phone/camera).  With "high touch and high tech", the Ohio Academy of Family Physicians is "recharging the dream" to inspire more medical students to align with their personal dreams of helping people and serving others.

The Healthcare and Health Care Systems: What are the Rules?

How can we know the rules for the patient-physician engagement?  It's very confusing to patients and even to doctors.  What would the rules be if we get a chance to make them again?

Since that's not the case, I'll list a few thoughts about how the rules look for one family physician in Ohio (Me). 

One issue that relates to the rules is about the business model of the patient and their family. What do you spend your money on and what do you expect someone else to buy for you under various contractual relationships? 
Another issue is the business model of the third party that is paying someone else's money to the doctor for services rendered to the patient...but limited by several rules (only 4 diagnoses fit on the bill per visit; a physical involves no treatment for illness or disease; an illness or disease mgmt visit is not a physical or prevention but some insurances allow the physician to do both types of services in the same encounter, but both services will be billed ala WarmSocks blog example.  The physician only has a certain amount of bits of service to deliver per day, so one patient can't decide to use it all or no one else gets any service...etc.).

Another issue is the physician's business model, who they work for and what happens to the bills they generate and the money they generate and who pays their overhead, etc. The physician's tasks per unit of time may be mandated by the employer of the physician. They may be pressed to see more and more people per day to generate more revenue for the employer or group.

The physician is selling knowledge and skills to someone. Those who wish the physician to use more knowledge and skills for their health and sickness will be asked to find a way to pay more.  Time is limited and determined by the physician or the entity (e.g., physician's employer) that makes the rules about how money is distributed for services.

Most third parties only pay for one visit to an individual physician per patient per day.  A woman being seen for an annual woman's prevention exam generally needs another appointment or two or three if she has a problem with arthritis, diabetes, depression, needs a mole removed, etc.
The patient rarely knows the definitions listed in their payment contract with an insurance company for different types of services.  The physician also doesn't know what deal an insurance company has with a particular patient.

That's my first post about "the rules" of engagement in the family doctor's office.  It may change daily due to the volatility of "the rules".  The situation begs for the patient to take back their health care from the night.  Partner with your family physician to educate and protect each other from the buzz saw known as the Medical Industrial Complex. 

More later on health system issues after a couple posts about The Human Centered Health Home.

Wednesday, October 13, 2010

Dr Synonymous Show: Family Medicine and Family Nurse Practitioners: A Timely Partnership

The Dr. Synonymous Show October 12, 2010
Dr Synonymous on #BlogTalkRadio http://tobtr.com/s/1257444
Happy Ten’s Day plus two (10/10/10 Where were you?)
Patient Blog WarmSocks:   "Doctors and Groceries and Rules"
Physician Blog Dr Rob:  http://bit.ly/csvkmp "What is a Patient" 
Do we know the rules yet?

The RWJ report for the Institute of Medicine:
The Future of Nursing: Leading Change, Advancing Health - Institute of Medicine:

AAFP Takes Issue With IOM Report Calling for Greater Nursing Role -- AAFP News Now -- American Academy of Family Physicians

Good post from American Journal of Nursing about the IOM report with a nursing perspective at  wp.me/prthD-1wp

AMA - AMA Responds to IOM Report on Future of Nursing http://t.co/MS0P6P0

Books to Ponder: New Rules for the New Economy by Kevin Kelly 1998
How Healthy is Your Family Tree by Carol Krause 1995
The Visionary’s Handbook  (9 paradoxes that will shape the future of your business) by Taylor and Wacker 2000

Interview with Catherine Johnson, FNP PhD
                How are the babies?
How was the trip to NM?  Silver City, NM
Let’s hear about the nurse practice program you are developing for Mt Carmel
What do you think of the future of nursing practice? The IOM report?
Where is the profession now? Physicians are concerned about boundaries, scope of practice, licensure, etc.  How are nurse practitioners with those issues these days?
30 million patients where’s the care?  Who’s the care?
Inter disciplinary communication may be difficult at times.  How is it when communicating professionally with social workers or SW educators?  Physicians? How do we best serve patients?
Any thoughts about what your FNP grads are going to be doing? What practice models?
What’s the Ohio practice market look like for the next ten years?
Thanks for your insights, Dr Johnson, and for joining us on the Dr Synonymous Show
This is Dr Synonymous, Good Night

Listen to a podcast of the show 24/7 at the blogtalk radio link at the top of this blog.

Saturday, October 9, 2010

Dr Synonymous Show October 5, 2010 Connecting Patients and Doctors. Factoids and Reflections

The Dr Synonymous Show October 5, 2010 blogtalkradio.com/drsynonymous
Disclaimer:  We're not practicing medicine on the show.  That's best done with your own family doctor.
Overview of Show
Patient blog:  Dr Fatty Finds Fitness- a Texas family physician/patient in online 100 day weight loss collaboration (http://Drfattyfindsfitness.blogspot.com)
Recognize Chat Room
Medical Student Show “http://RadioRounds.org” episode 408 Dr Synonymous and Steve Deal interviewed about the medical home and the Human Centered Health Home (HCHH)
Physician blogs and tweats: http://theNNT.com a new decision support site for physicians and patients, the American Family Physician Community Blog on Cultural Competence 9/29
                The #hpm daily on Twitter newsletter about hospice and palliative care.
Dr Synonymous Blog 10/2/2010 on Human Centered Health Home: Connecting Patients and Family Physicians. 
Flu is here, discussion of 3 flu types in the flu shot which now includes H1N1.  CDC recommends that all get immunized.
Tips from Medical Journals
                Health Policy Graham Center p.601 AFP:  Med students specialty selection swayed by expected salary. $3.5 million difference in lifetime earnings specialists vs. primary care physicians
                Chat room do you agree that med students can be swayed by money?
Books I recommend
                The Mind and the Brain by Schwartz, OCD therapy section is helpful
Web Sites I recommend: http://lef.org Life Extension Foundation Magazine Great Vitamin D3 information, testosterone replacement therapy and estrogen replacement therapy well covered
Vitamins and Supplements that I recommend
                Multivitamin with minerals, recommended in  JAMA Nov 2002
                Omega 3 Fish Oil 2000-3000 mg. daily  from lef.org   
                Vitamin D3 2000 IU from lef.org 12/2009
                B Complex 50 lef.org
Gene Wright, MD, Past President of OAFP died in Lima last week.  He had a big heart, always caring, always helpful.  Thanks for your friendship and leadership, Gene.

My Family Doctor through age 22: George Martin, MD Miamisburg, OH. My aunt had worked for him as receptionist.“It won’t hurt” he said, before penicillin shots, "I’ll bet you a nickel".  I always won the nickel. 
Chat room: any memorable family doctors in your lives you wish to honor?
Thanks to the chat room
Next week we finish the interview with Dr Catherine Johnson, FNP
Remember the Dr Anonymous Show Thurs nights at 9 PM on Blogtalk Radio
FMEC Mtg in Hershey, PA Halloween Weekend
I’m Dr Synonymous… good night

Saturday, October 2, 2010

The Human Centered Health Home: Connecting Patient and Physician

The Human Centered Health Home (HCHH) as defined by our Center for Innovation in Family and Community Health is best supported by patient-physician processes which include: respecting, protecting, connecting, detecting, correcting, and reflecting.  Previous posts discussed respecting (7/2/2010) and protecting (7/28/2010 and 8/24/2010 ).  This post introduces connecting for both patient and physician, starting with human to human connection in which both humans somehow recognize their equality and common ground.  The dyad of patient and physician are able to accomplish more if they remember and reaffirm their humanity first.

A behavior that helps to separate them from outside distractions should begin the engagement.  Usually this behavior is touch: a handshake with a greeting and appropriate eye contact may be a good start, while a hand on the shoulder or touch of the forearm may fit better for many.  The thought for both is about greeting an important person with unique attributes who is a neighbor with shared community values.  The need for both is to escape from their last activity and the technology that surrounds them.

The touch strategy has to be altered and "framed in disinfectants" if infection is involved.   A person who is coughing should remember to cough into their elbow and make a commitment to prevent the spread of their infection to their physician and office staff.  Hand sanitizer is liberally placed in physician offices so patients can minimize spread of infection to others by following the rules of "Champion Hand Washing" promoted by the award winning program of Henry the Hand (www.henrythehand.com).  Likewise, the family physician, who is frequently exposed to infected individuals, will follow the same guidelines.  Many physicians wash their hands or sanitize them in the patient's presence, sometimes more than once depending on types of contact during each encounter.

The physician also has to recognize their time issues as an element of respect toward the patient that may impact the quality of connection.  If the physician is delayed in their connection to the patient, the physician should speak to the issue, "I'm sorry to hold you up" or "I'm sorry for your wait".  Unfortunately, physicians can't reveal what they were doing that delayed them due to patient confidentiality.  Other comments about physician timeliness are located elsewhere in this series and in some excellent patient and physician blogs.

The human soon to further assume the role of patient gets the most benefit if they are focused and help the physician to focus on this encounter.  A neighborly patient will greet the neighborly physician with eye contact, touch and a connecting comment, such as, "Hi, Dr Smith, how is your new baby doing?" or "You look ready for winter with your bright sweater, Dr. Jones."  The connecting comment should be genuine and help to refresh the physician's humanity (which has just been relating to another person/ patient's humanity and health/ disease  issues possibly followed by, or concurrent with,  interaction with electronic devices) including an intention to separate the physician from distracting technology.

As we get closer to mandatory electronic medical records (EMR) for all patients, they and physicians are vulnerable to more technology driven distractions. We should  remember to start the visit with something that "doesn't compute", i.e. humans.  The basis of the HCHH is the human encounter of the dyad, not the technology and not "the numbers".  It is about two worthy, neighborly humans first and foremost.  The complex work of the dyad is best if it starts with two connected humans.