Life Hacks for Doctors: An Introduction

Introducing The Efficient MD Wiki

Visit the Efficient MD Wiki at http://wiki.efficientmd.com.

Wikis — collaborative websites — are powerful tools for education. The Efficient MD Wiki is designed to help healthcare professionals and medical students discover clinical pearls, useful resources, life hacks, and strategies to improve the practice of medicine.

Although this Wiki is currently in its infancy, it is growing rapidly and needs your help. Please post your ideas, mnemonics, best practices, tricks, timesavers, presentations, helpful links, or other advice you'd care to share. (Don't worry if your writing is disorganized. Someone will always edit it later.)

While posting anonymously is allowed, if you'd like to have a link to your personal website added to the home page — as our way of saying thanks — please join the wiki and send us a message.

Please see the posting guidelines and disclaimer. The Efficient MD Wiki is an ongoing experiment, and comments are welcome.

Sincerely,

Joshua Schwimmer, MD, FACP, FASN; The Efficient MD Blog (in association with the American College of Physicians); Clinical Instructor in Medicine, Columbia University College of Physicians & Surgeons and Clinical Assistant Professor of Medicine, New York University School of Medicine

Ves Dimov, MD; Clinical Cases and Images; Clinical Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University

Efficient MD Links for 5.11.8

Image from Flickr

• The Internal Medicine Journal Search -- Search the top five medicine journals.
• Top 10 Memory Hacks from Lifehacker.
• Three Ways to Mitigate the Attention Crash, Yet Still Feel Informed from blogger Steve Rubel.
• Alltop's Lifehacks Page.
• A Pattern Language for Productivity, the downloadable version. An excellent exploration of strategies for getting things done.
• Prepping for Warren Buffett: The Art of the Elevator Pitch, by Tim Ferriss.
• Cleveland Clinic Alumni Magazine Features Founders of AskDrWiki by Clinical Cases and Images.
• How to Ruthlessly Reclaim Work Day Time.
• Tips: How NOT to Give a Presentation from Clinical Cases and Images. Invaluable advice as I write my talk on Life Hacks for Doctors.
  
  
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Links of Interest

Image via WikipediaThe following recently caught my attention on the web.

Clinical Cases and Images -- which contains a wealth of resources for technology in medicine -- posted 5 tips to stay up to date with the medical literature (click the link for a detailed discussion):

1. RSS Feeds for Journals.
2. Podcasts.
3. Persistent Searches.
4. Text-to-speech (TTS).
5. Blogs.

Struggling to Evade the Email Tsunami in the New York Times.

Paul Levy, CEO of Beth Israel Deaconess Medical Center, shares his hospital's "problem log" in Save Time; Improve Patient Care; Improve Work Life.

New study finds anticipating a laugh reduces our stress hormones.

A paper on network theory in PLoS medicine: It's the Network, Stupid: Why Everything in Medicine Is Connected.

Via Ted Eytan, MD: The “Showroom” Concept in Yogawear - applicable in health care?. Also from Dr. Eytan: Thoughts from the iPhone Developers Summit.

Via Read/WriteWeb: Health 2.0 - Apps & Trends to Watch.

The Health Sciences Library of the University of Buffalo has recently started its own Youtube channel with a variety of tutorials and answers to FAQs.

Sermo, the online network for physicians, just started a board for medical jobs:

Goodbye recruiters! On Sermo Jobs™ there are no more third parties—no recruiters, no headhunters, and no conflicts of interest. Sermo Jobs™ provides the perfect forum to connect with one another, discuss job opportunities, and network—all in real time.

Via Scientific American: Are pacemakers vulnerable to hackers?

Scientists from Harvard Medical School's Beth Israel Deaconess Medical Center in Boston, the University of Massachusetts Amherst and the University of Washington in Seattle say they were able to launch cyber strikes against and glean private patient data from an ICD's communication protocol while testing the device's safety and security.

Finally, Cats Cut Heart Attack Risk?

Ten Trends in American Medicine

Via The Med Innovation Blog:

1) American Doctors Seek Reform
2) Convenience Care Will Be Wave of Future
3) High Tech, High Touch Will Prevail
4) Achieving Quality and Performance Goals Unlikely
5) Ideas That Lower Costs Are Scarce
6) Doctors Need New Capital Partners
7) “Cottage Industry” to Transform
8) More Minimal Invasiveness and Robotic Surgeries
9) Problems of Managed Care
10) Information Technology Will Fall Short of Promises

Three Visions of the Future of Healthcare

Below are juxtaposed three visions of the future of healthcare. The first is from Microsoft, a conceptual video which echoes 2001. But the computers don't remind me of HAL. They remind me of, um, the iPhone. The video follows a pre-diabetic (presumably type 2) patient as she's out on her run, with all her physiologic data being automatically uploaded to her personal health record, which is then sent to a researcher who enrolls her in a clinical trial... For more commentary, see Dr. Bill Crounse's post on Microsoft's Health Blog. (Did you know they had a health blog?)



The second video is of Dr. Jay Parkinson -- who's in the running for medical iconoclast of the year -- displaying the Myca Platform. Myca aims to be a revolutionary interface for the medical record. Here's a description from the website:

Myca is a technology platform that opens intelligent channels between patients and doctors. It supports access to a better care experience through the entire range of connections, from live video communications, video mail, chat and secure email to face-to-face office visits. It is designed to use everyday consumer technologies and be consumer-friendly.

What the Myca platform delivers:

* Video, voice and data communications across multiple platforms and channels, including mobile phones and PCs
* Practice automation through documenting and archiving of communication
* Intelligent system offers rules to validate diagnoses delivered through a compelling, easy-to-use interface
* On-line personal health records
* Secure access to each interaction for patients and doctors
* Integrated scheduling and billing
* Integration with remote monitoring devices and services
* Online prescriptions with dosage guardrails and medication interactions alerts
* Automatic medical coding for diagnostics and therapy
* Ability to add nutrition and wellness features to support preventive medicine

With a single communications and clinical information platform, Myca offers an elegant solution to the three top healthcare issues; access, high-quality medical care, and cost management.

Finally, the third video was taken at the recent EconHealth conference in New York. It features executives of many popular Health 2.0 Websites describing their vision of the future (and present) of healthcare. The Panelists include Raj Amin, CEO and co-founder, HealthiNation; Steven H. Krein, CEO and co-founder, OrganizedWisdom; Daniel Palestrant, CEO, Sermo; Dean Stephens, president & COO, Healthline. The Moderator is Michael Mason, Health Editor of the New York Times.

Recommended Books

Thoughts on Patient-Physician Email

I'm a believer in patient-physician email communication. Let's face it -- just about every profession has enthusiastically adopted email as a rapid, non-interrupting, easily documented form of communication -- so why hasn't medicine?

There are many reasons. Here are just a few:

1. Physicians -- particularly older physicians -- may simply not use email. A recent study showed that less than half of physicians use email for medicial practice.

2. Physicians may fear providing patients easy access to them through email. Some providers I've spoken to worry that their inboxes will be filled with long, nonspecific complaints from patients rather than communications on important topics. One study even suggested that emailing patients could decrease provider income.

3. HIPAA. The Health Insurance Portability and Accountability Act requires that electronic protected health information (EPHI), including email, be communicated in a secure way -- that is, through an encrypted system. There are many commercial services available that allow encrypted patient-physician communications. For examples, of this search Google for [HIPAA and email]. In practice, however, most physicians do not have access to these encrypted email systems and are unwilling to pay for these services. In addition, patients may be unwilling to use proprietary online systems to communicate with their doctors when their everyday (unencrypted) email system is quick and simple. I've had patients complain unhappily that an encrypted online email system was too complicated to use, and why couldn't they just send me a plain old email...?

The time for the typical office visit has shrunk. Due to many factors including declining reimbursement and the need to see more patients per day, most office visits are now scheduled for 15 minutes or less. Neither physicians or patients are happy about this. Fifteen minutes is hardly enough time for adequate patient education or for forming a bond with your physician.

Enter email, a service which allows more time for physician patient-communication and helps people feel closer to their doctor. A few potential uses for email include:

• Asking about lab results
• Reporting potential side effects of medications
• Clarifying whether it's safe to take a certain medication
• Reporting home blood pressure readings
• Reporting blood sugar readings
• Giving positive feedback
• Giving negative feedback
• Asking for prescription renewals
• Reporting new minor (but important) symptoms
• Communication new medical issues when out of the country
• And many others

Of course, any of these communications could also be made with a phone call -- but with a lot more hassle for everyone involved.

Take this example. Let's say a patient on a cholesterol lowering medication (Lipitor) has a twinge of pain in his left arm. He's heard that Lipitor can cause muscle problems, and is concerned that the twinge might be caused by the medication. One option is to schedule an office visit, but he's reluctant to do this for such a minor problem. Another option is to call the doctor's office, speak with a secretary (who would then take time deciding about the severity of the problem), have a note left for the doctor, who would then call him back later in the day to reassure him that this twinge doesn't represent a problem with Lipitor. Or the patient might not even ask the question, figuring that the pain is nothing significant, but still remain worried that it's a side effect of his medication and might even stop taking the Lipitor out of concern.

Alternatively, he could write an email describing the problem and receive a reply reassuring him that the pain is not consistent with a side effect from the Lipitor and he should make an appointment to be seen if it continues. Simple, almost effortless, and everyone is satisfied.

To summarize:

• Many patients would like to email their physicians.
• Many physicians are either unfamiliar with email or uncomfortable with giving patients the additional access that email provides.
• Email has the potential to strengthen the physician-patient relationship and improve both patient education and the quality of care.
• The HIPAA privacy law prohibits email between physicians and patients unless this communication is encrypted.
• Many commercial solutions for encrypted email between physicians and patients exist. Unfortunately, many of these solutions are either expensive, proprietary, and/or cumbersome to use. (If you would like to suggest a commercial email system that is inexpensive/free and easy to use, please comment.)
• Encrypted email systems that are cumbersome to use and/or require an elaborate login process will frustrate patients and discourage them from emailing providers.
• Many patients would prefer to use plain, unencrypted email to communicate with their physicians.

Ideally, an encrypted email system between patients and providers should be used. But what if one is not available and/or the patient would like to give permission to communicate protected health information over insecure, unencrypted email?

Different institutions have come up with their own solutions to this problem. This is an excerpt from Yale's Guidance on the Use of Email Containing Protected Health Information:

A provider may obtain informed consent from a patient via electronic messaging (e.g., email) by conducting the following consent exchange upon presentation of a patient query via electronic messaging (this example is for an email exchange):

I will be happy to respond to your query but to do so via email you must provide your consent, recognizing that email is not a secure form of communication. There is some risk that any protected health information that may be contained in such email may be disclosed to, or intercepted by, unauthorized third parties. I will use the minimum necessary amount of protected health information to respond to your query.

If you wish to conduct this discussion via email, please indicate your acceptance of this risk with your email reply. Alternatively, please call my office to arrange a phone conversation or office visit.

Columbia University also has a policy on email on their HIPAA information page:

If a patient requests email communications containing their PHI, the individual receiving the request must obtain a completed Request for Email Communications form from the patient AND must provide the patient with the Important Information about Provider/Patient Email form prior to processing the patient’s request.

(If you're interested, I've extracted the text from the forms on Kidney Notes.)

If you have other solutions to the problem of physician-patient email, please feel free to comment.

(This three part series was originally posted on Tech Medicine.)

Google's Design Principles

Google posted ten design principles on the Official Google Blog. Many of the principles also apply to improving the practice of medicine:

1. Focus on people—their lives, their work, their dreams.
2. Every millisecond counts.
3. Simplicity is powerful.
4. Engage beginners and attract experts.
5. Dare to innovate.
6. Design for the world.
7. Plan for today's and tomorrow's business.
8. Delight the eye without distracting the mind.
9. Be worthy of people's trust.
10. Add a human touch.

See also: Google User Experience, Ten True Things

Doctors and Emotion in the New York Times

Image via Wikipedia

From an essay in the New York Times:

A young doctor sat down with a terminal lung cancer patient and her husband to discuss the woman’s gloomy prognosis. The patient began to cry. Then the doctor did, too.

The scene was undoubtedly moving. But should physicians display this much emotion at the bedside?