Can Social Media reduce Physician Burnout?

In late fall of 2011 I was tired of medicine. While seeing patients was still enjoyable, I felt under-appreciated in my employment and frustrated by the endless BS that I dealt with--new laws undermining the trust my patients place in me, increasing requirements from insurance companies for ordering tests or medications, more forms to sign, less time with patients, a cumbersome EHR to learn, more non-CME education requirements from the system I belonged to...the list grew endless. Most of it boiled down to less control over my professional life and less time to spend with the people I enjoyed-family, friends and patients.

twitter

The following February I began writing a blog on my professional frustrations as well as the occasional reward. Shortly after that I discovered Twitter--first as a "lurker" listening in the background, then as an active participant. I met so many interesting people--physicians, e-patients, Social Media gurus, pharmacists, nurses, other healthcare providers, patient family members, the list is endless. Through Twitter my office knew early on about the multi-state fungal meningitis caused by tainted steroid vials, the Newtown shootings (unfortunately) and the Open Notes study. If Mayo and Cleveland Clinics were using Social Media to reach and teach their patients, it was likely that Social Media was not just a passing fad. Meanwhile my fascination with the phenomenon grew.

I began a master's level course on Social Media that is mind-blowing (and free) developed by +Bertalan Meskó, an MD-Phd from Hungary who is a Medical Futurist.

The Social MEDia Course

I read "The Creative Destruction of Medicine" by +Eric Topol who recently spoke  on the Colbert Report about the future of medicine. I submitted blogs and was  published by Dr. Kevin Pho, "social media's leading physician voice". In October of 2012 I attended Mayo Clinic's Social Media in Medicine Summit and met a few hundred people interested in how Social Media is changing medicine.  

In the process I found new ways to engage myself and my patients--using QR codes, putting up a white board in the exam rooms, recommending apps. 

RelayHealth

Patients now get a business card with the access site to a patient portal, my twitter handle and my blog site. They can contact me 24/7, understanding that I'll answer with the same availability as my email. 

Last year's experience served to recharge my professional gusto. Patients are more interesting, I deal with the non-stop frustrations with more aplomb and less emotional exhaustion. I look forward to seeing my new friends on the #hcsm tweetchat on Sunday night. Suddenly the future of medicine looks a lot less lonely and a lot more interesting. 

The Three "P"s of Mayo--Patient-centered, Physician-led and Collaborative Partnership

Last week I attended the Mayo Clinic's Annual Social Media Summit in Rochester. What most impressed me had nothing to do with the conference. On Tuesday afternoon before the Summit began I toured Mayo Clinic. It was supposed to be for an hour but lasted more than two because our group, consisting of one doctor and nineteen PR professionals, was so interested in the information being fed to us. I don't know why the publicity folks were so intrigued, but for me Mayo's philosophy of "patient-centered, physician-led" care hearkened back to a time when the patient-physician relationship was inviolate. It was stimulating to realize that my instincts of how medicine is best-practiced are right on target.

My myopic opinion regarding the fragmentation of healthcare sees the destruction of the patient-physician relationship by multiple entities, who are primarily interested in a piece of the economic pie, as central to our healthcare mess. At Mayo, no project moves forward unless there is a physician who champions it and it is the physician's responsibility to ensure that every project is dedicated to improving some aspect of patient care. Physicians are salaried so they spend the time necessary to care for patients and are not incentivized to increase the numbers of patients seen or do procedures to enhance the bottom line. 

Every person I met who worked for Mayo reiterated the importance of putting patient care and comfort first. It was incredibly refreshing. The Mayo logo emphasizes a patient-first policy as well. I'd seen the logo multiple times but somehow never thought about what the three shields represent. Our tour guide explained: Patient care, research and education. The educational aspect was obvious as we walked multiple floors of patient care areas. I noticed no TVs in patient waiting rooms but many had computer screens where patients could learn about their conditions. It is a refreshing and calming atmosphere without the cacophony of media noise. There is art everywhere. Waiting rooms are spacious and well-lit. Meditation rooms and educational spaces abound. 

Children's waiting area

Mayo has always represented excellent healthcare in my mind. Patient reports that come to me after a visit there are extraordinary due to the extent of the integrative care the patient experiences from multiple medical disciplines coming together. I expected to be impressed. I did not realize I would also be reassured. Putting patients first is what I'll continue to strive to do, despite insurance interference, governmental policies or EHR dysfunction.

The Lurking Physician

In addition to reading a number of medical bloggers, I "lurk" on twitter chats and try to watch twitter updates from the 88 people I am currently following. The majority of the people I follow are doctors who are interested in how social media can help patients, plus a few "learning" entities like Brainscape just to improve my language studying skills (which I highly recommend). I am just a neophyte to Social Media but am excited by its potential for my patients.

Brainscape

Suddenly the ability to followup with patients directly without a medical assistant playing messenger in between seems more attainable. Communications would be cleaner and both physicians and patients would be better served. Right now I do this on a small scale by using email but this is fraught with difficulty. Patients send me their information and sometimes they cannot open my email response because it is encrypted (per HIPPA requirements). Other times their emails are caught by my spam filter and I never see them! As I've written about in previous posts, there are recommendations by august bodies like the AMA on how to use email professionally but frankly, they are both out-of-date and a little out-of-touch with their recommendations. However, having said that, HIPPA fines are substantive so no one wants to be caught in the wrong while communicating with patients.

In the meantime, patients are becoming more web and social media savvy. It is exciting to have a patient come in who has been on the Mayo clinic website and is asking about what preventive steps they should be taking instead of me initiating the discussion. It makes me feel like a partner in their care instead of a mother giving advice. I am a mother and I enjoy that role. Nurturing is part of healthcare but when I feel more like the disciplinarian then an advisor, neither I nor the patient are likely to benefit.

The "early adopter" physicians and e-patients on Twitter, Facebook, Google+ and LinkedIn, among others, are working hard to improve the lines of communication so that patient care is better. It's an exciting time to be involved and I am looking forward to learning more and sharing a lot.

I've got some bad news and some good news

That's the old joke, right? "I've got good news and bad news-the bad news is that you have Alzheimer's. That good news is that you're going to meet lots of new people." Unfortunately telling people bad news is no joke and I mused on the experience today as I read an oncologist letter to me regarding one of my patients with a terminal cancer. How do you do that day in and day out? This morning I had to tell a patient, a former smoker, that his chest xray was abnormal and he needs further tests. I've known this patient for years and am worried about him. Maybe it will turn out OK...maybe not.

The fact that it bothers me is a good thing. It reassures me that patients' concerns remain foremost in my practice of medicine. I notice when it's time for a vacation or at least a few days break from my office, that one of the first things I lose is empathy. When a patient comes in with a problem that seems simple and unnecessary for a doctor's visit, if my first reaction is "this guy's wasting my time" I have to stop and think "why do I feel that way?" Usually it has nothing to do with the patient and everything to do with me--worried about my daughter who is working in a third world country, worried about my mom's forgetfulness and is it something more insidious, etc.

It is curious to see how individuals react to a life-threatening illness. Most of them have such dignity. Often it is the family members whose behaviors become difficult, which in turn makes the emotional turmoil to a patient worse. I remember memorizing Kubler-Ross's Stages of Grief in medical school. I have been amazed at how much that optional course has enabled me to help patients and their families by better understanding what they are going through. Although things are improving immensely, with programs like Baptist East's Cancer Resource Center and Friend4Life as well as specific coordinated care centers for certain cancers, the system is still difficult to navigate.  

Often, once a patient begins the work of honing down the diagnosis and determining the treatment of their life-threatening illness, the primary-care physician loses contact with him/her. If my patient is constantly in other doctor's offices, undergoing uncomfortable procedures and treatment, it is hard for me to add the burden of another doctor's visit. This is where I see social media as an exciting place for improving care and remaining in contact with my patients. It would be easy to check-in with patients privately on a business Facebook page (which I don't have yet) or send  private tweets on how they are doing (once all the HIPAA compliant rules are in place). Even now they can send me a secure email private message. These channels would help me to identify when I might need to step in, give advice or just more support. The future is here and I'd like to embrace it. Family physicians have been giving patients bad news for a couple of hundred years. But only in the recent past have we stopped walking their journey with them. I don't think that's good medicine, for the patient or for me.

Social Media and ... mental health.

First of all--this blog has nothing to do with healthcare, other than my own mental health. This afternoon was a small demonstration of what an powerful tool social media can be. My husband was visiting our neighbor down the street for a play date for our airedale, Ensign.  The yard is large and somehow he found a way under the fence into the nature preserve behind. Tim called but Ensign had disappeared. While one friend combed the bushes in gloves and boots, four more of us looked through the neighborhood, knocking on doors and feeling frightened because we live in a VERY urban neighborhood full of heavy cars. Four hours later night fell and we had to give up the search. Nauseated and exhausted I texted a friend regarding our loss.

She suggested that I post the disappearance on Facebook. Not very hopeful, but needing something to do, I wrote a description of the dog, where he was last seen and included a picture. Within twenty-three minutes the following post appeared:

• Whitney I know who has him!
  

  13 hours ago ·
• Kathy Nieder You're kidding?
  

  13 hours ago · 
• Whitney No I'm not!
  

  13 hours ago · 
• Whitney I'm waiting for him to give me his number so I can give it to you but he just posted that there was an Airedale terrier in his back yard and he lives in Clifton....
  

  13 hours ago ·
• Ashley Lynn OMG I HOPE ITS HIM!
  

  13 hours ago ·
• Barry I HOPE SO AS WELL...
  

  13 hours ago · 
• Leigh US TOO!
  

  13 hours ago ·
• Kathy Nieder IT'S HIM!!!!!

Our graphic artist friend Barry, who had been one of the four people combing the neighborhood, made up a poster and was on the way out the door to print several and hang them up when I called him with the news. So here is his post on my timeline:

Ensign had no idea what the fuss was about but my husband and I were ecstatic. As a bonus, I got to sleep last night, soundly and well.