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  • Mental Good: How healthcare professionals balance career and personal lives

    “To go beyond is as wrong as to fall short.”- Confucius

    About a month ago a colleague committed suicide just a day after her hospital duty . She was working 72 hours straight without sleep for weeks, but not even her family had an inkling she was about to take her own life.  Two days ago I talked to another friend who is disappointed with his medical career because of the so many challenges he is going through. He is beat up. Today, I talked to another healthcare professional and the same “tone of disillusionment”  is palpable as tears well in the corner of her eyes.

    “This is not what I signed up for medicine”  was the bottom line for this three healthcare professional.

    Disappointment, frustration or simply “burnt out”  is a well known but rarely verbalised, “not so secret” secret among colleagues in the healthcare profession. In fact, it is so common in the medical profession we’ve considered this part of the “normal challenges” of our career path and we expect every physician to survive it. Of course the sad reality is that not everyone survive this challenge.

    Some of them end up dead.

    While the cases of suicide among healthcare professionals maybe small and sporadic (an outlier) what surprises us the most is that nobody seem to have an inkling that physician or healthcare professional A is depressed and suicidal until he or she is actually dead or dying.  Are healthcare professionals good at hiding depression and frustrations or have the general public gotten used to the notion that healers ought to endure superhuman problems and heal themselves?

    The devil is in the small details.

    Most of the telltale signs of depression are what we see as “normal” in the day to day existence of a healthcare professional. Seventy Two hours straight duty? That’s normal. Most even brag about it. Felt bullied by a senior? “Oh thats just normal. That’s needed for you to harden up.” Sometimes, our health system exerts tons of pressure upon a healthcare professional, yet it doesn’t provide an outlet for overcoming stress, deprivation and disillusionment.

    When colleagues on rare occasions do come to me seeking advise on what to do with their career and personal life, I am tempted to answer drawing from my own experience. How do you balance professional and personal life really? I realized though that my experience might be an outlier too and would not be applicable to anyone else even if we thread the same career path.

    So i bring these dilemma for discussion here on our tweet chat.

    T1. As a healthcare professional, how do you balance professional and personal lives? Where do you draw the line of caring for others without harming your personal lives?

    I have seen obviously sick or sleep deprived physicians tending to patients, a dangerous situation for both patient and professional.  Where do you draw the line here?  If you are a patient, what would you suggest to your healthcare professional knowing he is sick or is sleep deprived?

    T2. What counsel would you give to a disillusioned, depressed colleague who seeks your advise,  besides seeking professional help? 

    We always give advise to disillusioned or depressed colleague but we rarely knew or had the chance to follow up if they really did.  What other advise can you give?

    T3. Can you give an example of the “lowest low” in your medical career and how were you able to overcome it?

    Join us this Saturday, May 20, 2017 9:00PM Manila time as we bring balancing life, depression and medical career into the discussions of health in the Philippines!

  • Correcting health misinformation on social media isn’t easy but not impossible

    I’ve seen  dubious health or medical information online in the past but what’s lamentable is that only a few health professionals took time to correct the misinformation.

    These are the possible explanations for this:

    1. We don’t care to do research on the health misinformation we see.
    2. We lack the necessary skills to distill  knowledge and communicate it to the general public
    3. We lack the skills to execute constructive criticisms  over social media.
    4. We lack networking skills to bring the conversation offline

    The common denominator to all of these is apathy. We don’t care that much because social media is nowhere our field of “expertise”.  We also assume that patients wouldn’t and shouldn’t believe these “fake” health information.

    Bad news is, we totally missed the train of opportunities on both instances, . Why? We assert that medical professionals should be the primary  source of medical information but failed miserably at putting our voice online.We make it hard for the general public to find credible healthcare voice online.  Majority of internet users do visit the Google search page before our clinics. Yet we somehow delude ourselves into thinking that the public will find our voice online without us doing our part.

    Why health professionals are not putting their voice online? Why are we so afraid of correcting health  information on social media?

    Most colleagues told me, they’d rather not talk or they might get into “trouble”. Things like online reputation being maligned or stepping on patient privacy rules are the biggest reason for not doing so. Second, most say they don’t have time for social media  in healthcare. Third, most lack the communication skills, that language over social media to connect well with the public. Fourth, which I think is the saddest, most healthcare professionals don’t correct misinformation until it is their reputation is at stake online.

    Most healthcare professionals are practically playing catch up with healthcare social media.

    There’s so much concentration on what physicians should not do on social media because of ethical concerns. That is a very valid reason for caution but it’s not enough. We also have to find creative strategies of using social media to provide a credible voice online and refute medical misinformation.

    Join #HealthXPh this Saturday April 8, 2017 9 PM Manila time as we discuss how credible health information can be placed online  and positively correct medical misinformation.

    • T1. As a healthcare professional, patient or patient advocate, how do you determine health/ medical misinformation online?
    • T2. Are healthcare professionals, patients or patient advocates allowed to refute fake health information online? Would you correct misinformation online? Why or why not?
    • T3. Give 3 tips on strategies you can take to correct medical misinformation on social media.

    Lets find creative ways of positively using social media to disseminate scientific, well researched health information online! Join this tweetchat!

  • Metric Matrix: How should we measure the impact of social media on clinical excellence?

    “What for? Can we achieve what we ought to achieve in healthcare without social media? We did that in the past, there’s no reason we can’t do that today!”

    After tooth combing available researches online, the above hypothesis seem logical.  There’s some evidence showing social media adding value to healthcare, but these are mostly qualitative studies. Qualitative studies  do not undergo rigid testing of hypothesis characteristic of a good scientific research.

    On the flip side, the absence of disputing evidence does not necessarily mean the hypothesis is valid.  It is just that we don’t have a metric yet to demonstrate the validity of that hypothesis. Such is the case for social media in healthcare.  To import metrics from other fields may also be too simplistic given our superficial understanding of social media behaviour of health stakeholders in relation to healthcare.

    Fortunately social media is considered a disruption in many fields, including healthcare. Desirable disruptions effectively short changes  accepted norms and processes usually in non conventional ways but achieve same or even better goals with uncanny efficiency. The true value of some disruption maybe demonstrable a later time when technology catches on.

    So let me state my alternative hypothesis. Social media might be a way to improve healthcare. The millions of social media users today couldn’t be just a technological spike. The use of social media in healthcare is self evident.

    Healthcare stakeholders engage each other on social media. Patients seek health information and find support groups on social media. Healthcare professionals have virtual communities to share knowledge and network with peers. Healthcare professionals seek social media in the hope of increasing scholarly activities such as research or to recruit population for larger studies. Healthcare organizations use social media for rapid information dissemination as well as engaging other healthcare stakeholders.

    The bottomline for engaging healthcare stakeholders are for me threefold- improve patient outcomes; achieve clinical excellence for healthcare professionals and humane, sustainable, fair provisions of quality healthcare for institutions. If somehow we have a way, a metric for demonstrating social media adding value to these three bottomline perhaps we have a way of sustaining or disputing my hypothesis.

    Let me focus on physicians clinical excellence for now and explore ways of showing impact or value of social media.

    A qualitative study by Kotwal et al showed the following determinants of clinical excellence in a hospital medicine: communicating effectively, appreciating partnerships and collaboration, having superior clinical judgment, being organized and efficient, connecting with patients, committing to continued growth and development, and being professional and humanistic “.

    Thus for social media to have an “impact” on physician clinical excellence, it has to demonstrate a significant significant improvement over time in any (or all) of the determinants from the baseline measure.

    There have been studies on social media as a communication, information dissemination tool in medicine. In the US for examples, Mishori et al looked at the adoption of twitter as an information dissemination platform of 3 big medical association networks. These 3 communities are growing but there’s  limited interaction within and across communities. Information dissemination is below its perceived potential. While the primary objective of the original goal seem to have been met, the study is critical on whether information dissemination alone constitute health “engagement” . Measuring how much engagement is attributed to social media in healthcare via this platform is another area ripe for research.

    • T1. What is healthcare engagement and how would social media add value to it?

    There is evidence showing healthcare professionals create virtual communities and share knowledge on social media. These same virtual communities exhibit what Rolls et al termed as clinicians’ tribal behaviours that may in fact limit the sharing of knowledge across communities. The impact of these virtual communities and the extent of collaboration and sharing of knowledge via social media should be another good area for research in healthcare social media.

    • T2. How would social media improve offline collaboration among healthcare professionals? How should we measure this?

    How does physician trust peers on social media? Panahi et al  found that the “majority of participants established trust on social media mainly through previous personal interaction, authenticity and relevancy of voice, professional standing, consistency of communication, peer recommendation, and non-anonymous and moderated sites.” Healthcare professional credentialing over social media

    • T3. Is social media a valid platform for credentialing healthcare professionals? How do you check peer’s credentials over social media?

    Standardized metrics for measuring the impact of social media to these determinants has yet to be developed. But the bottomline of all these- social media adding value to healthcare vis a vis clinical excellence, is that it adds up value in improving patient outcomes. Thats another area ripe for research.

    Join us this Metric Matrix Saturday March 11, 2017 9PM Manila time as #HealthXPh discusses how should we measure the impact of social media on clinical excellence among healthcare professionals?

    • T1. What is healthcare engagement and how would social media add value to it?
    • T2. How would social media improve offline collaboration among healthcare professionals? How should we measure this?
    • T3. Is social media a valid platform for credentialing healthcare professionals? How do you check peer’s credentials over social media?

    REFERENCES:

    1. Househ M. The use of social media in healthcare: organizational, clinical, and patient perspectives. Stud Health Technol Inform. 2013;183:244–248
    2. Kotwal S1, Peña I, Howell E, Wright S.J Defining Clinical Excellence in Hospital Medicine: A Qualitative Study.Contin Educ Health Prof. 2017 Winter;37(1):3-8. doi: 10.1097/CEH.0000000000000145.
    3. Rolls K, Hansen M, Jackson D, Elliott D. How Health Care Professionals Use Social Media to Create Virtual Communities: An Integrative Review. Eysenbach G, ed. Journal of Medical Internet Research. 2016;18(6):e166. doi:10.2196/jmir.5312.
    4. Panahi S, Watson J, Partridge H Fostering interpersonal trust on social media: physicians’ perspectives and experiences Postgraduate Medical Journal 2016;92:70-73.
    5. Mishori R, Singh LO, Levy B, Newport C. Mapping Physician Twitter Networks: Describing How They Work as a First Step in Understanding Connectivity, Information Flow, and Message Diffusion. Eysenbach G, ed. Journal of Medical Internet Research. 2014;16(4):e107. doi:10.2196/jmir.3006.
    6. Griffiths F, Dobermann T, Cave JAK, et al. The Impact of Online Social Networks on Health and Health Systems: A Scoping Review and Case Studies. Policy & Internet. 2015;7(4):473-496. doi:10.1002/poi3.97.
    7. Houry D, Swahn MH, Hankin A. Social Media, Public Scholarship, and Injury Prevention. Western Journal of Emergency Medicine. 2014;15(5):565-566. doi:10.5811/westjem.2014.5.22754.
    8. Thackeray R, Neiger BL, Smith AK, Van Wagenen SB. Adoption and use of social media among public health departments. BMC Public Health. 2012;12:242. doi:10.1186/1471-2458-12-242.

  • Ethical Considerations of using Social Media in Healthcare Research

    Social media has the potential of increasing public awareness and participation in healthcare research. It is a promising new area for exploring “how patients conceptualize and communicate specific health issues”. The heightened public awareness encourages more enrollment and participation in potentially beneficial clinical trials.

    Healthcare research on social media poses new ethical dilemmas however. Such research on a new public environment may require new ethical guidelines. Privacy issues remains on top of these ethical concerns. Without clear guidelines, investigators are at loss on how to meet their responsibilities to participants and the medical profession. Should they ask consent for investigating healthcare data that are on public space?

    Finally, interpreting data from social media healthcare research remains a challenge. To be valid, data mining, monitoring signals and validation of social media vocabularies often needs corroboration from other methods of obtaining healthcare information.

    Join #HealthXPh chat this Saturday January 21, 2017 9:00 PM Manila time as we discuss these ethical issues in conducting healthcare research on social media:

    • T1. Is informed consent needed when using data gathered from social media?
      T2. Should investigators make public their intentions of doing healthcare social media research? Why? or why not?
      T3.What are the limitations of healthcare research on social media??

    Just use the hashtag #HealthXPh when joining this twitter chat on Saturday.

    Header photo/poster courtesy of  Matthew S. Katz MD; Disease-specific hashtags for online communication about cancer care. 2015 ASCO Annual Meeting publication

    References:

    1. Sedrak MS, Cohen RB, Merchant RM, Schapira MM. Cancer Communication in the Social Media Age. JAMA Oncol. 2016;2(6):822-823. doi:10.1001/jamaoncol.2015.5475
    2. Matthew S. Katz et al. J Clin Oncol 33, 2015 (suppl; abstr 6520)
    3. Denecke K; Ethical aspects of using medical social media in healthcare applications.Stud Health Technol Inform. 2014;198:55-62.
    4. Holly A. Taylor, Ellen Kuwana, and Benjamin S. Wilfond; Ethical Implications of Social Media in Health Care Research; The American Journal Of Bioethics Vol. 14 , Iss. 10,2014

  • Should Physicians mind their “Webside Manners”?

    Approximately 87% of US adults are online. Of these, a huge 72% seek health information online. Trust for physicians remains high though as 70% of these adults would seek a healthcare professional’s help  for major medical conditions.

    Contrast this trend with how many of physicians are taking advantage of information technology to provide healthcare information online or even clinical care from a distance.  A measly 3% of physicians engages patients online. Even if one in three US physicians use or is planning to use telemedicine, the actual usage of telemedicine by patients is lower though at about 9-15%.

    What these statistics are saying is this: patients are going online for health information but our healthcare system is slow to adapt. The advantages of Telehealth and telemedicine especially for the archipelagic Philippines is pretty obvious but so are the staggering challenges.

    How about Social Media?

    Telemedicine is broadly defined as providing clinical care from a distance, using telecommunication and information technologies. Strictly speaking, social media isn’t part of telemedicine yet. Dr. Joseph Kim pointed out though that there’s a small (albeit increasing) percentage of doctors who use social media to provide health information and professional networking.

    Extending Bedside Manners

    The traditional physician-patient interaction in the clinical setting is governed by a set of attributes, behaviour or communication skills called “bedside manners”. Studies have shown that bedside manners ultimately affect delivery of care. The entry of information technology into actual patient-physician interaction clearly changes too the clinical setting. Perhaps this is an opportune moment for examining how effective a physician’s manners are in the light of information technology or maybe, we need to expand our concept of manners.

    Webside Manners

    The concept of webside manners came with the advent of telemedicine. While “bedside manners” pertains to how a healthcare professional interacts and communicates with a patient in a face to face encounter, webside manners probably refers to how the healthcare professional interacts or communicates with a patient over a medium (of information technology) to provide clinical care.

    So lets talk about “webside manners” this Saturday November 26, 2016 at 9PM Manila time and determine whether it should be (or it should be not) part of our bedside manners:

    • T1. Does Telemedicine have a role in clinical care? How about Social Media?Why or why not?
    • T2. Should our bedside manners need extending, to include webside manners with the advent of information technologies like telemedicine or social media?
    • T3. What webside manners do you think are most needed?

     

    Don’t forget to include hashtag #healthxph when joining the chat on Saturday at 9PM Manila time. See you!

    Image: https://commons.wikimedia.org/wiki/File:Telemedicine_Consult.jpg

    Resources:

    http://www.pewinternet.org/data-trend/internet-use/latest-stats/
    http://www.pewinternet.org/2013/01/15/health-online-2013/

    https://en.wikipedia.org/wiki/Telemedicine
    https://www.accessrx.com/blog/current-health-news/how-many-family-doctors-are-using-telemedicine/
    http://www.mobihealthnews.com/45682/survey-9-percent-of-consumers-have-used-a-telehealth-service