Month: June 2013

Where I’ve been… PART I

This is simply a recollection of my journey in medicine.  I’ve been working on this post for several months.  Here is part I 

      It’s been a little more than 10 years since I first landed on a dark tarmac in the West Indies, ready to begin my journey in medicine..
     It started out in Grenada, a small island in the Eastern Caribbean. As a student at St. George’s University, my first true clinical experience began in the 3rd world. The people were warm, welcoming delightful and generally happy with their lives. They had access to some healthcare, but nothing like what we have in the United States. I recall open air hospital wards, smiling children with irreparable cardiac defects, held by their mothers with the weight of the world on their emotionally battered faces. I remember a middle aged woman with an advanced lymphoma, engulfing her throat, unable to swallow, wasting away.  I didn’t know much ” medicine” at this time, but I left Grenada after 2 years, feeling lucky to be part of the US healthcare system that can do so much more.
     The next 2 years of medical school were spent in in Brooklyn New York at a large tertiary care center. Despite being a completely different environment from Grenada,  there was no shortage of illness, despair and poor outcomes. “1st world” diseases were rampant. Obesity, diabetes, heart disease ravaging disenfranchised patients with little hope advancing beyond their current social state. It was difficult to believe despite all our money and technology, how limited our system felt. The hospital was hemorrhaging money like the trauma patient in the ER. The sun was completely blotted out in this downtrodden neighborhood. It was darkened not by the tropical canopies I saw in the West Indies, but by abandoned broken down buildings. It was a different kind of island. It was an island of socioeconomic isolation, poor health and a healthcare system pushed to the brink.
     Next, it was on to an Internal Medicine residency. In this era of multi-system chronic diseases I felt medicine is where I could make the greatest impact. At Drexel University/ Hahnemann Hospital in Philadelphia, I saw the same 1st world diseases I saw in Brooklyn, New York. As a resident, I spent long hours providing hands on care to patients ravaged by chronic disease. End stage renal disease on dialysis, heart failure patients awaiting transplant, copd patients intubated in the ICU, HIV patients with exotic infections and so on. I saw countless complex patients often nearing the end of their journey, their bodies beaten to submission by chronic diseases. I kept asking myself night after night, how could this be happening to so many people. In theory their conditions seemed preventable with simple behavior change. And despite these patient behaviors, I kept asking how could our healthcare system let these patients get so sick. Overworked, and numb from the experience, I started to lose empathy for patients and faith in our healthcare system. From the geographic isolation of 3rd world Grenada, to the socioeconomic isolation of the Brooklyn ghetto, I too was stuck on an island. I always had inclination to do primary care, but everyone around me specialized or became a hospitalist. After sacrificing many years of my life I expected this would be my moment to shine and change the world. Instead, I was a drift at sea, with no direction.


The Gandolfini Effect

     The James Gandolfini death is big news around the New York area. Everyone is still talking about it. A few days ago, while driving home from work, I was listening to the local sports talk radio show.  The afternoon host is a powerful voice in local sports and heads up a top rated show. I always enjoy listening to his opinions, even when it veers into non-sports related topics, such as the death of James Gandolfini. On this particular show, the host invited his own renowned cardiologist to discuss this event. The premise of this segment was benevolent. The host thought that by bringing attention to cardiovascular disease and sudden death, some lives could be saved.
     Now when you discuss medical news on a public stage, the effects are wide and far reaching. Sure, by discussing this tragic death with millions of listeners, hopefully a few people will learn not to ignore their health and get the help they need to save their life. But by also bringing such massive media attention to what is unfortunately a relatively common occurrence in health care (cardiovascular disease, heart attacks and death) it will undoubtedly create extra panic and fear.
      Diagnosing cardiovascular disease is anything but an exact science. There are numerous subtleties and considerations when it comes to deciding if symptoms are cardiac or not. But these subtleties are not considered in the panic and fear world of mainstream media that is trying to do good in the realm of public health. So yes, talking about James Gandolfini will lead to a few more over weight middle aged guys to get the appropriate work up and diagnosis for their cardiovascular disease. But what about the thousands who don’t have any disease, and may never, who will undoubtedly walk into their doctor’s office wanting to be “tested.” Many will get a bevy of testing done, even when it’s not appropriate. The Gandolfini effect will result in hundreds and thousands, if not millions of wasted healthcare dollars. In this view, I can argue, those wasted dollars, if spent properly may have saved lives. It’s just as possible,that the net effect of this radio hosts public service attempt will be more lives lost than saved.
      As I was listening to this famous cardiologist implore the audience to get “checked out” I was frustrated. There was not a single mention of the preventable factors that could’ve saved James Gandolfini’s life. It was all about getting tested and “fixed,” Although this cardiologist didn’t say it directly, to a lay person, his message almost sounded like he was advocating screening for cardiovascular disease with testing, such as stress tests. There is absolutely no scientific basis for this. 
     The whole conversation was infuriating. The final minutes of this segment went from being public service to live advertisement for this cardiologists practice and hospital. Normally I admire this host, when he leaves his comfort zone of sports to discuss topics he is less familiar with. But this was just awful. Thanks to him, the Gandolfini effect will be multiplied in my practice.
    By the time I got home on this particular day, I started to experience severe chest pain. But that’s not because of the segment on James Gandolfini. It’s because finally after 15 infuriating minutes, this host finally started talking about sports and my New York Mets. I don’t need a stress test. I don’t need a cardiologist. What I really need is a power hitting outfielder.

Social Media in Medical Education

A little late, but here’s a post on my Social Media in Medical Education project. 

As part of my Leadership course, we had to complete a scholarly project. I chose to look into social media use by our students at the Stony Brook University School of Medicine.When I presented the work at our graduation, I got a few puzzled looks.

What does social media, or “Facebook” have to do with medical school, medicine, healthcare etc?
This was the question that some of my colleagues asked. This was the question that I presume many of my colleagues were thinking.

To me, it’s pretty simple.

As physicians (and all healthcare providers) one of our fundamental mandates is to connect with people. It is this deep connection between physician and patient, and the success of this connection that determines healthcare outcomes.

Civilization has progressed because of advances in “connections.” The written word, the printing press, the telephone, television, the world wide web. They were all advances in communication that has improved how   people connect to one another. In the history of mankind, no form of communication and connection has progressed faster than social media. Billions of people have connected through social media in less than a decade.There is something about social media that appeals to the modern human being. It simply works.

As physicians, where connecting with our patients means everything, how can we possibly ignore social media?

I certainly can’t ignore it. So I’ve decided to begin a fact finding mission by surveying our medical students to gauge their opinion on social media. I primarily focused on social media and its potential applications to medical education

The process began by formulating a 10 question survey. I had to keep it short and sweet. Our students have very little time to spare, and are often inundated with survey requests.

I used Qualtrics (for the 1st time!) to create and distribute the survey. A tip, for anyone thinking of doing a survey study. Familiarize yourself with the software before sending it!I made a mistake, that only allowed 1 person to complete the survey. Subsequent people were not able to. I had to resend the survey to everyone!
Furthermore, don’t ever send a survey on April 1st. If it fails (like mine ) people will think it’s an April fools joke!

We have 530 students and I got about a 10% response rate. I’ve been told this isn’t terrible, though more would’ve been nice. The nice thing is, we had almost equal distribution of 1st to 4th year students.

Here are some key facts I discovered

100% use Wikipedia
94% use YouTube
81% use Facebook
less than 25% use LinkedIn, Twitter.

I think the value of Wikipedia and YouTube as education tools is quite obvious.
LinkedIn as a professional networking tool is a missed opportunity.
Twitter as multifaceted educational and networking tool is also a missed opportunity.

86% of the students use “Social media” for personal reasons atleast 2-3 times a week. Not a surpise. But here’s what suprised me
73% use “social media”  2-3 times a week for educational or professional reasons.

This tells me, students are actively on social media, learning and participating independently. We as educators need to meet them out there and take advantage of their enthusiasm.

Next up, I looked at their opinions on some of the perceived advantages of social media in education.
I was surprised at how only half of the students felt “learning could be fun” and “more interactive.” My impression was, students crave a more enjoyable interactive experience.

Next I looked at opinions on its disadvantages or “concerns.”
Not surprisingly, “Security” is a common concern. In an era, where we are constantly worried about privacy and professionalism of our trainees on social media, their concern on this matter is reassuring.

More than half the students cited how it would not help them do better on exams. Not surprising, but this hints at the underlying culture of our current medical school system. This is a culture that demands our students maximize their grades and exam scores above other skills. This is a whole topic of discussion onto itself

The most interesting analysis came from comparing different demographics of our students.
Although the sample size was small, the results were statistically significant

3rd and 4th year clinical students were more likely to think learning using social media would be fun. I interpret this as pre-clinical students being bogged down in books and exams, with very little time for “fun” educational activities. The pre-clinical 1st and 2nd years also thought social medial could potentially make the quality of their education worse. So there definitely was a lot of skepticism from our pre-clinical students.

Interestingly, we noted differences between male and female students.
Female students felt social media encourages collaboration, team work and could potentially increase interaction between students.
Male students felt social media would not be as effective as current learning methods and has the potential to make their education worse. This also indicates significant skepticism from our male students.

Despite the mixed results, this was a rewarding, fun and successful research project. My goal was to establish some sort of opinion baseline on social media’s applicability to medical education. The results indicate there are great opportunities but also significant concerns and skepticism.

Ultimately, I think there is a definite trend towards different ways to connect with our patients and students. Social media is the obvious choice based on its track record in the general public. Now it’s about us as healthcare providers, and educators to continue to push the boundaries of our creativity and comfort levels to find new innovative ways to deliver our expertise.