#MDchat transcript

Healthcare Social Media Transcript

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RichmondDoc

Mark, family doc in #RVA; mostly lurking tonight as I get ready to head out on the road soon. #mdchat
Tue Oct 11 18:01:13 PDT 2011

MedPedsDoctor

Alex Djuricich, Med-Peds doc in Indianapolis, just getting to Tw since early am. #mdchat
Tue Oct 11 18:02:33 PDT 2011

NateOsit

Hi all! Nate here, your friendly Health IT geek! Tuning in tonight to chat with #MDchat and #mhsm
Tue Oct 11 18:03:11 PDT 2011

apjonas

@MD_chat Hi, Phil and all. Pat Jonas, MD here, Holistic Family Physician in OH. Looking fwd to learning on #MDChat
Tue Oct 11 18:03:56 PDT 2011

MD_chat

T1 OccupyHealth: How might OccupyWallStreet impact discourse re: healthcare reform? What are your hopes/concerns? #MDchat
Tue Oct 11 18:05:03 PDT 2011

EMIMDoc

Hi! David Marcus, EM/IM in Queens, NY. Will be on for a bit then will have to go... #MDchat.
Tue Oct 11 18:05:33 PDT 2011

T1 We should be outraged at the condition of our healthcare. We pay more for care

RichmondDoc ElinSilveous

per capita than anyone else; lacking results. #mdchat

Tue Oct 11 18:07:43 PDT 2011

Hi everyone. Elin here, sitting in for awhile from Southern Oregon. #MDChat
Tue Oct 11 18:08:04 PDT 2011

RichmondDoc

T1 We are first per capita in #healthcare costs, yet we are 37th in @WHONews rankings of health outcomes. #mdchat
Tue Oct 11 18:08:09 PDT 2011

MedPedsDoctor

Given that health care costs are the biggest impact on the GDP, discussions about what to do with HC are a BIG deal #mdchat
Tue Oct 11 18:08:14 PDT 2011

RichmondDoc

T1 We are the worst among developed Western nations in the quality of the healthcare we provide...despite the costs. #mdchat
Tue Oct 11 18:08:39 PDT 2011

EMIMDoc

Agree with all you guys are saying, but for some reason people become sheepish around healthcare. There is no rage. #MDchat
Tue Oct 11 18:09:15 PDT 2011

RichmondDoc

@MedPedsDoctor Ah...I am too optimistic, then. #mdchat

Tue Oct 11 18:09:53 PDT 2011

EMIMDoc

@RichmondDoc I wish. I think the only way that will happen is if this movement develops into a mature, long term type of thing. #MDchat
Tue Oct 11 18:10:36 PDT 2011

JediPD

Part of the cost differential between US & other Western countries is their SUBSIDIZED pharma drugs. In US it is 24c of each HC $ #mdchat
Tue Oct 11 18:11:14 PDT 2011

RichmondDoc

@EMIMDoc Long term movement is indeed necessary...but every long term movement has to start with a kernel of activism. #mdchat
Tue Oct 11 18:11:34 PDT 2011

ElinSilveous

@RichmondDoc Many ARE outraged! Re Healthcare, GDP, CER... #MDChat

Tue Oct 11 18:11:46 PDT 2011

apjonas

T1 Focus on insurance reform is over emphasized. Changing Health Care (2 words) is more important well addressed. 2 much blurr #MDChat
Tue Oct 11 18:11:59 PDT 2011

MedPedsDoctor

Great article on how docs can help control costs: http://t.co/WukKcvs5 #mdchat
Tue Oct 11 18:12:21 PDT 2011

MedPedsDoctor

Mark: love your phrase: kernel of activism. Now THAT is how advocacy truly starts! #mdchat
Tue Oct 11 18:13:02 PDT 2011

RichmondDoc

@ElinSilveous And we should *all* be outraged...but for now many of the costs are borne by employers--but this is changing. #mdchat
Tue Oct 11 18:13:05 PDT 2011

RichmondDoc

@ElinSilveous There is more and more cost shifting onto patients/employees/families. There is a limit to what can be tolerated. #mdchat
Tue Oct 11 18:13:39 PDT 2011

JediPD

Over there it is subsidized and Negotiated down by Foreign relations of each country. @RichmondDoc #mdchat
Tue Oct 11 18:13:42 PDT 2011

katellington

T1 The relationship between health and life for 99%. Example, foreclosures are making people sick, literally. #OccupyHealth #MDChat
Tue Oct 11 18:13:44 PDT 2011

RichmondDoc

@NateOsit @JediPD PhRMA has more lobbyists on Capitol Hill than there are legislators. Deck is notably stacked. #mdchat
Tue Oct 11 18:14:20 PDT 2011

EMIMDoc

@apjonas And also, health insurance does NOT equal health care. They are in business to make money, provide certain benefits, etc. #MDchat
Tue Oct 11 18:14:20 PDT 2011

RichmondDoc

@JediPD And as a result, patients pay far less for necessary medications... #mdchat
Tue Oct 11 18:14:36 PDT 2011

RichmondDoc

@katellington Welcome. Join me on my soapbox. ;) #mdchat

Tue Oct 11 18:14:51 PDT 2011

ElinSilveous

Understood RT @RichmondDoc: @ElinSilveous There is more and more cost shifting onto patients/employees/families. There is a limit.. #mdchat
Tue Oct 11 18:15:17 PDT 2011

NateOsit

@katellington Hi Kate! Thanks for coming! :) #MDchat

Tue Oct 11 18:15:23 PDT 2011

miller7

For those not familiar with 1st order change and 2nd order change (Bateson), most #healthcare change is 1st order #MDchat
Tue Oct 11 18:15:36 PDT 2011

apjonas

@katellington Hi Kate, welcome! #MDChat

Tue Oct 11 18:15:48 PDT 2011

RichmondDoc

T1 The road to lower costs will be tough. More preventive care, actually *valuing* health (not illness), more primary care... #mdchat
Tue Oct 11 18:16:04 PDT 2011

JediPD

Medicare Part D cost $58 Billion over 5 years. CMS did not negotiate due to lobbying

@RichmondDoc #mdchat
Tue Oct 11 18:16:18 PDT 2011

yayayarndiva

#occupyhealth caught my attention #mdchat

Tue Oct 11 18:16:22 PDT 2011

katellington

Glad to connect and share @RichmondDoc @NateOsit @apjonas ....#MDChat

Tue Oct 11 18:16:42 PDT 2011

ElinSilveous

@NateOsit @katellington Hi Nate. Hi Kate. #MDchat

Tue Oct 11 18:16:44 PDT 2011

EMIMDoc

This looks to be a fascinating discussion, unfortunately, must leave Will try to follow. #MDchat
Tue Oct 11 18:16:50 PDT 2011

MedPedsDoctor

Agree! MT @EMIMDoc: @apjonas And also, health insurance does NOT equal health care. #mdchat
Tue Oct 11 18:16:57 PDT 2011

yayayarndiva

medical debt- make people sick- literally #mdchat

Tue Oct 11 18:17:05 PDT 2011

NateOsit

@RichmondDoc I think the fundamental issue w/ hc in the U.S. is there are several large industry who profit from our suffering #MDchat
Tue Oct 11 18:17:08 PDT 2011

RichmondDoc

@JediPD Yeah. Interesting that Rep. Billy Tozin got Part D passed w/ PhRMA benefits, then was hired by PhRMA as exec director... #mdchat
Tue Oct 11 18:17:27 PDT 2011

MD_chat

@EMIMDoc Ok, enjoy the rest of your night. #MDchat

Tue Oct 11 18:17:37 PDT 2011

apjonas

T1 Canadians have shortage of cardiovascular surgeons. We have shortage of primary care. Our System makes more $ w/less primary care #MDChat
Tue Oct 11 18:18:05 PDT 2011

NateOsit

Indeed. It can be an nightmarish cycle RT @yayayarndiva: medical debt- make people sick- literally #MDchat
Tue Oct 11 18:18:33 PDT 2011

JediPD

Besides the clinical outcomes (specific to oncology) Europe include UK has a 8% survival for lung cancer vs 16% in the US. #mdchat
Tue Oct 11 18:18:54 PDT 2011

miller7

@apjonas And we are significantly better at workarounds ;) #MDchat

Tue Oct 11 18:19:03 PDT 2011

ElinSilveous

Should there be more emphasis on medical self-care as way to contain coats by eliminating unnecessary visits to docs & ERs? #MDChat
Tue Oct 11 18:19:14 PDT 2011

RichmondDoc

@miller7 We need to make primary care readily available to all and make healthy lifestyle choices easily available to all. #mdchat
Tue Oct 11 18:19:44 PDT 2011

NateOsit

@yayayarndiva Should it not be an industry, then? Do we have a firefighting "industry"? #MDchat

Tue Oct 11 18:19:57 PDT 2011

RichmondDoc

@JediPD We are top-notch in certain high-tech, high-intervention conditions...while lagging in neonatal mortality/life expectancy. #mdchat
Tue Oct 11 18:20:24 PDT 2011

miller7

@RichmondDoc Lifestyle choices are available to all - the rub is having providers available to help patients who want change #MDchat
Tue Oct 11 18:20:56 PDT 2011

yayayarndiva

@NateOsit Think of health care entities that are for-profit #mdchat

Tue Oct 11 18:21:05 PDT 2011

katellington

yeah, I need to give this some thought. RT @yayayarndiva: #occupyhealth caught my attention #mdchat
Tue Oct 11 18:21:16 PDT 2011

RichmondDoc

@NateOsit @yayayarndiva Wait...you mean that for-profit constructs surround necessary services are unjust in some way? #mdchat
Tue Oct 11 18:21:19 PDT 2011

yayayarndiva

@miller7 Lifestyle choices are more than just having the "right kind" of provider #mdchat
Tue Oct 11 18:21:41 PDT 2011

miller7

@apjonas Yes, innovations continuing to unfold everywhere! #MDchat

Tue Oct 11 18:22:03 PDT 2011

apjonas

T1 Parallel movement like Direct Primary Care, Multilevel PC marketing (Dr. Amway?), Radical & disruptive= good start #MDChat
Tue Oct 11 18:22:43 PDT 2011

miller7

@yayayarndiva Oh, totally agree!! My point was having a provider tell you what to do is very different than a provider showing you. #MDchat
Tue Oct 11 18:22:49 PDT 2011

RichmondDoc

@miller7 Social determinants of health are huge in affecting health/wellness, and require solutions far beyond indiv. Dr/pt pairs. #mdchat
Tue Oct 11 18:23:03 PDT 2011

NateOsit JediPD

@RichmondDoc Oh Mark... That would be preposterous! ;) #MDchat

Tue Oct 11 18:23:07 PDT 2011

I agree. Primary care in Neonate, Pediatrics and Adults must be addressed. #mdchat @RichmondDoc
Tue Oct 11 18:23:07 PDT 2011

DrJonathan

@EllenRichter Great article! I think pts do absolutely own their lab results, but Drs should suggest they interpret it together. #mdchat
Tue Oct 11 18:23:29 PDT 2011

yayayarndiva

@miller7 show and tell just a part: also need engagement and the resources for change- not a level playing field in the US #mdchat
Tue Oct 11 18:23:47 PDT 2011

RichmondDoc

@JediPD But we fund high-cost, inpatient care long before we adequately fund primary care... #mdchat
Tue Oct 11 18:23:53 PDT 2011

miller7

@yayayarndiva YES!! #MDchat

Tue Oct 11 18:24:19 PDT 2011

RichmondDoc

@JediPD My recall: fastest increasing costs in Medicare are chemotherapy and advanced imaging. Not primary care. #mdchat
Tue Oct 11 18:24:21 PDT 2011

NateOsit

True. Why is that? RT @RichmondDoc: @JediPD But we fund high-cost, inpatient care long before we adequately fund primary care... #MDchat
Tue Oct 11 18:24:29 PDT 2011

yayayarndiva

@miller7 "Behavior" also very loaded- need proper cultural context- awareness of resources #mdchat
Tue Oct 11 18:24:49 PDT 2011

JediPD

Also, personal health is advanced by education and peer pressure. Not by mandates. In US screening is under pressure due to costs. #mdchat
Tue Oct 11 18:24:59 PDT 2011

kdhoffman2

Unfortunately the focus has been on individual change not social change-- #mdchat
Tue Oct 11 18:25:32 PDT 2011

MedPedsDoctor

Ounce of prevention worth a pound of cure. Public health needs more funding: not happening. Newest scans: gotta have it! Problem #mdchat
Tue Oct 11 18:26:10 PDT 2011

RichmondDoc

T1 Other nations fund primary care (low cost, low-tech interventions) first and subspecialty care later--lower cost, better outcomes #mdchat
Tue Oct 11 18:26:12 PDT 2011

katellington

Right, systems and environments matter. @kdhoffman2: Unfortunately the focus has been on individual change not social change-- #mdchat

Tue Oct 11 18:26:42 PDT 2011

JediPD

Bingo. And also the hardware in ortho, cardio and electronic enhancements. Forget free scooters. @RichmondDoc #mdchat
Tue Oct 11 18:26:46 PDT 2011

RichmondDoc

@MedPedsDoctor Even worse: 50% of local health departments cut programs in the last year. Cutting safety net as need increases. #mdchat
Tue Oct 11 18:26:55 PDT 2011

MedPedsDoctor

Mark, you are right. We ARE on the same page, just in different cities. #mdchat
Tue Oct 11 18:27:26 PDT 2011

yayayarndiva

@katellington @kdhoffman- families, neighborhoods, communities matter- need to look at human factor on many levels #mdchat
Tue Oct 11 18:27:41 PDT 2011

NateOsit

@RichmondDoc It would be worth having the discussion again, IMHO. #OWS needs targets if they want to #occupyhealthcare #MDchat
Tue Oct 11 18:27:55 PDT 2011

RichmondDoc

@JediPD Right. How many stents/pacemakers/IEDs have been implanted inappropriately and against best evidence? Many = much $. #mdchat
Tue Oct 11 18:27:56 PDT 2011

RichmondDoc

T1 I know this group knows this, but http://t.co/JW1azKZg is a great overview of social determinants of health. #mdchat
Tue Oct 11 18:28:40 PDT 2011

RichmondDoc

@MedPedsDoctor How many readmissions could have been prevented by paying a nurse to visit pts in home and help after discharge? #mdchat
Tue Oct 11 18:29:44 PDT 2011

katellington

T1 We can hope for the reality of basic primary care as a national concern with full attention across sectors. #OccupyHealth #MDchat
Tue Oct 11 18:29:58 PDT 2011

apjonas

@MedPedsDoctor And profit to hosp and docs til new Medicare rules. Follow the $$, find the problems. #MDChat
Tue Oct 11 18:30:05 PDT 2011

NateOsit

@RichmondDoc hehe, no rush. Maybe another day? Revive #FMRevolution chat? ;) #MDchat
Tue Oct 11 18:30:15 PDT 2011

MedPedsDoctor

@RichmondDoc Agree. That would be a great program IMHO to support which would improve outcomes. Studies show it. #mdchat
Tue Oct 11 18:30:44 PDT 2011

NateOsit

Common solution! RT @apjonas: @MedPedsDoctor And profit to hosp and docs til new Medicare rules. Follow the $$, find the problems. #MDchat

Tue Oct 11 18:30:51 PDT 2011

JediPD

readmissions in 30 days for elderly is a problem not because of desire but for multiple comorbidities that confound #mdchat @MedPedsDoctor
Tue Oct 11 18:30:52 PDT 2011

yayayarndiva

@NateOsit include all primary care- pediatrics, internal medicine and family medicine #mdchat
Tue Oct 11 18:31:04 PDT 2011

RichmondDoc

Old quote: every system is perfectly designed to provide the results that it is getting. We know our results. Change the system. #mdchat
Tue Oct 11 18:31:53 PDT 2011

RichmondDoc

T1 #OccupyHealthcare matters because the answers to these issues are large-scale, political and public health answers. #mdchat
Tue Oct 11 18:32:20 PDT 2011

miller7

@RichmondDoc Similarly, what gets measured gets done... #MDchat

Tue Oct 11 18:32:32 PDT 2011

katellington

T1 Primary care for all should be a baseline for cost-containment, prevention and health care accessibility. #occupyhealth #MDChat cc@PNHP
Tue Oct 11 18:32:41 PDT 2011

ElinSilveous

T1: #OccupyHealth should include a dialogue about quality of life versus length of life & consumer/patient expectations #MDChat
Tue Oct 11 18:32:44 PDT 2011

apjonas

T1 Private networks, community & web based will innovate to bypass fecal vortex of usual suspects taking $$ from HC #MDChat
Tue Oct 11 18:32:52 PDT 2011

RichmondDoc

T1 #OccupyHealthcare is more than a one-on-one doctor/patient encounter. That is at its heart, but community focus is needed. #mdchat
Tue Oct 11 18:33:01 PDT 2011

yayayarndiva

@miller7 or what gets measured gets funded:) #mdchat

Tue Oct 11 18:33:03 PDT 2011

RichmondDoc

T1 Physicians should be activists. We should be calling for reform, pointing out flaws, partnering w/ patients to #OccupyHealthcare #mdchat
Tue Oct 11 18:33:27 PDT 2011

miller7

@yayayarndiva Spoken like a reformed researcher ;) #MDchat

Tue Oct 11 18:33:28 PDT 2011

kdhoffman2

Medicaid is also a major issue. In situations of long term care, it is what pays for everything. Not enough $$ for real care. #mdchat

Tue Oct 11 18:33:35 PDT 2011

miller7

T1 #Occupyhealthcare matters because the community (all of us) should be wanting more than what we are getting from healthcare #MDchat
Tue Oct 11 18:34:06 PDT 2011

yayayarndiva

@miller7 busted:) #mdchat

Tue Oct 11 18:34:07 PDT 2011

MedPedsDoctor

Agree with the primary care comments, but remember, there are other primary care fields besides Fam Med. #medpeds #med #pediatrics #mdchat
Tue Oct 11 18:34:07 PDT 2011

RichmondDoc

T1 Physicians are called to improve the health in their patients, and should extend that to the community. Raise your voices! #mdchat
Tue Oct 11 18:34:39 PDT 2011

NateOsit

Agree, healthcare problems are systemic. They cut to the core of social problems in the US. I think #OWS can help address! #MDchat
Tue Oct 11 18:34:59 PDT 2011

JediPD

Cost in HC has many heads. Pharma, Hospital, Over usage of ERs, duplication of test/procedures. Yet focus is on docs as usual #mdchat
Tue Oct 11 18:34:59 PDT 2011

RichmondDoc

@MedPedsDoctor (I speak of what I know...no offense intended in any way) #mdchat

Tue Oct 11 18:35:00 PDT 2011

yayayarndiva

Preaching to the choir- methinks those participating in #mdchat are activists #mdchat
Tue Oct 11 18:35:05 PDT 2011

NateOsit

:) RT @yayayarndiva: Preaching to the choir- methinks those participating in #mdchat are activists #MDchat
Tue Oct 11 18:35:33 PDT 2011

RichmondDoc

@apjonas *Established docs* may be too content w/ jobs. Tap into the energy and commitment in students/residents. #mdchat
Tue Oct 11 18:35:39 PDT 2011

apjonas

@RichmondDoc Good point of differentiation, Onward! #MDChat

Tue Oct 11 18:36:19 PDT 2011

RichmondDoc

@JediPD No doubt that cost pressures come from multiple areas...but docs write Rx, order studies, send for consults. #mdchat
Tue Oct 11 18:36:19 PDT 2011

miller7

@yayayarndiva Since we are the choir, here is one take at an old tune http://t.co/zn8zybCc #Occupyhealthcare #MDchat
Tue Oct 11 18:36:21 PDT 2011

yayayarndiva

@apjonas There are many "discontented" docs- for many medicine was a small practice- now jobs in larger systems #mdchat
Tue Oct 11 18:36:31 PDT 2011

ElinSilveous

Absolutely! RT @BHGContent4Dr: RT @RichmondDoc: T1 Physicians should be activists. We should be calling... #OccupyHealthcare #mdchat
Tue Oct 11 18:36:36 PDT 2011

RichmondDoc

@JediPD We *do not* carry all of the responsibility, but we *do* carry a certain share. #mdchat
Tue Oct 11 18:36:45 PDT 2011

MedPedsDoctor

Current gener of trainees want work-life balance, and r being trained in advocacy. Community/Advocacy required in peds training #mdchat
Tue Oct 11 18:37:01 PDT 2011

MD_chat

Uh oh: I just spotted the Fail Whale for a moment. #MDchat

Tue Oct 11 18:37:47 PDT 2011

JediPD

True RT @RichmondDoc: @JediPD No doubt cost pressures come from multiple areas. docs write Rx, order studies, send for consults. #mdchat
Tue Oct 11 18:37:56 PDT 2011

RichmondDoc

@MedPedsDoctor When I work w/ students, I discuss and I (hope to) model how physicians must be part of the discussion. #mdchat
Tue Oct 11 18:38:05 PDT 2011

ElinSilveous

#OccupyHealthcare should also call for health to be addressed in all policies (transportation, energy, environment, food, etc.) #MDChat
Tue Oct 11 18:38:16 PDT 2011

miller7

@MD_chat Sorry, that was my fault. #MDchat

Tue Oct 11 18:38:41 PDT 2011

RichmondDoc

T1 I highlight to students the failings in our system, and ways they can be addressed, and encourage them to be vocal/active. #mdchat
Tue Oct 11 18:38:47 PDT 2011

MedPedsDoctor

Mark, that is wonderful. This generation seems more engaged in advocacy interest than, say, mine 15 yrs ago #mdchat
Tue Oct 11 18:38:48 PDT 2011

katellington

T1 Primary care for all should be a baseline for cost-containment, prevention and health care accessibility. #occupyhealth #MDChat cc @PNHP
Tue Oct 11 18:39:09 PDT 2011

miller7

MT @ElinSilveous: #OccupyHealthcare should also call for #health to be addressed in all policies (transportation, energy, etc.) #MDchat
Tue Oct 11 18:39:13 PDT 2011

RichmondDoc

@MedPedsDoctor I think they truly are. I think the millenial generation entering medicine is more energized/active than we were. #mdchat
Tue Oct 11 18:39:36 PDT 2011

ElinSilveous

Oops. T1: #OccupyHealth should also call for health to be addressed in all policies (transportation, energy, environment, food...) #MDChat
Tue Oct 11 18:40:09 PDT 2011

2healthguru

@ElinSilveous #occupyhealthcare I love it. Sign me up! #mdchat

Tue Oct 11 18:40:31 PDT 2011

DebErupts

Agree! RT @miller7 RT @ElinSilveous: #OccupyHealthcare should also call for #health to be addressed in all policies #MDchat
Tue Oct 11 18:40:35 PDT 2011

RichmondDoc

T1 Until voters make their politicians understand that business as usual = bankruptcy, then little will change. #OccupyHealthcare #mdchat
Tue Oct 11 18:41:03 PDT 2011

yayayarndiva

#Occupyhealthcare how about cost savings rather than cost containment #mdchat
Tue Oct 11 18:41:37 PDT 2011

RichmondDoc

T1 So we should make our voices heard: value people over $, value health over corporate profits. #OccupyHealthcare #mdchat
Tue Oct 11 18:41:45 PDT 2011

JediPD

Simple solution for preventing duplication of tests: A $10 USB keychain stick loaded with their med test info presented @ doc visit #mdchat
Tue Oct 11 18:41:52 PDT 2011

MedPedsDoctor

Penny saved = penny earned. Cost containment leads to cost savings. #mathisdifferenthereinIndiana #mdchat
Tue Oct 11 18:42:25 PDT 2011

yayayarndiva

.@NateOsit Go to a general assembly at an #OWS site- you will find that #health and #healthcare are already part of the dialogue #mdchat
Tue Oct 11 18:42:55 PDT 2011

ElinSilveous

TY RT @DebErupts Agree! RT @miller7 RT @ElinSilveous: #OccupyHealthcare should also call for #health to be addressed in all policies #MDchat
Tue Oct 11 18:43:01 PDT 2011

RichmondDoc

T1 As clinicians, we should stop ordering tests that have no value. http://t.co/oMVGMZ97 #mdchat
Tue Oct 11 18:43:34 PDT 2011

MedPedsDoctor

Maybe another savings: decrease complexity of health care system. When no one really understands costs of hospitalization: problem! #mdchat
Tue Oct 11 18:43:49 PDT 2011

apjonas

@BernieMD31 A wild one, tonight. Welcome #MDChat

Tue Oct 11 18:44:19 PDT 2011

RichmondDoc

(Here is the citation to the Top 5 Good Stewardship from @NPALive: http://t.co/uoZNr0OD) #mdchat
Tue Oct 11 18:44:32 PDT 2011

miller7

@RichmondDoc This raises another issue - are providers aware of how much tests and such cost? We try to teach this. #MDChat
Tue Oct 11 18:44:46 PDT 2011

RichmondDoc

@MedPedsDoctor And we can continue to find valid, safe, effective ways to provide out-of-hospital care. #mdchat
Tue Oct 11 18:44:55 PDT 2011

ElinSilveous

@yayayarndiva #OccupyHealthcare, Medicare, SS were addressed at local #OccupyAshland #MDChat

Tue Oct 11 18:45:08 PDT 2011

kdhoffman2

Better care requires more time #mdchat

Tue Oct 11 18:45:28 PDT 2011

MedPedsDoctor

Double retreet here: RT RT @RichmondDoc: And we can continue to find valid, safe, effective ways to provide out-of-hospital care. #mdchat
Tue Oct 11 18:45:36 PDT 2011

yayayarndiva

@NateOsit Go there to dialogue rather than to teach:) #mdchat

Tue Oct 11 18:45:50 PDT 2011

MedPedsDoctor

sorry: retreet should be retweet. Wonder how that slip will be interpreted! #mdchat
Tue Oct 11 18:46:11 PDT 2011

miller7

@apjonas You are on fire tonight. Love it. #MDChat

Tue Oct 11 18:46:43 PDT 2011

yayayarndiva

@apjonas @miller Oh a puh-leese many in primary care understand the costs of things- especially working w underserved communities #mdchat
Tue Oct 11 18:47:08 PDT 2011

ElinSilveous

#OccupyHealthcare must also address consumer/patient expectations. Sometimes, doing nothing is the best medicine. #MDChat
Tue Oct 11 18:47:25 PDT 2011

MedPedsDoctor

@apjonas I agree in general, but the literature Mark mentioned earlier is applicable to Fam Med and all primary care specialties #mdchat
Tue Oct 11 18:47:49 PDT 2011

yayayarndiva

@apjonas @miller and becoming more real for many specialities as patients lose insurance coverage and have to make cash choices #mdchat
Tue Oct 11 18:47:49 PDT 2011

BernieMD31

@miller7 @apjonas Good thing I work in a hospital that is run by us family docs and family med residents. Huge difference! #mdchat
Tue Oct 11 18:48:11 PDT 2011

yayayarndiva

@ElinSilveous not so much about doing "nothing"- rather not writing a prescription 4 every visit:) Dialogue, education is valuable #mdchat
Tue Oct 11 18:48:41 PDT 2011

yayayarndiva

@kdhoffman2 but remember many docs do "uncompensated" time- and have overhead and family bills to cover #mdchat
Tue Oct 11 18:49:09 PDT 2011

BernieMD31

@RichmondDoc Anytime I order meds on our military system, the cost for each pops up. Makes you think about it before ordering #mdchat
Tue Oct 11 18:49:37 PDT 2011

yayayarndiva

@RichmondDoc work in a FQHC for a while- you will learn about costs, rationing and compromise #mdchat
Tue Oct 11 18:49:44 PDT 2011

RichmondDoc

@kdhoffman2 If I spend 45 mins w/ a patient (in a 15 min slot), there is a cascade of unintended consequences. #mdchat
Tue Oct 11 18:49:55 PDT 2011

ElinSilveous

Excellent point mRT @yayayarndiva: @ElinSilveous ... not writing a prescription 4 every visit:) Dialogue, education is valuable #mdchat
Tue Oct 11 18:50:07 PDT 2011

yayayarndiva

@apjonas there is also defensive medicine, CYA tests, fear of being sued #mdchat
Tue Oct 11 18:50:09 PDT 2011

yayayarndiva

@RichmondDoc so you know exactly what I mean:) #mdchat

Tue Oct 11 18:50:47 PDT 2011

miller7

@MedPedsDoctor Yes! Continuity (relationship) and comprehensiveness - essential ingredients for great #primarycare #MDChat
Tue Oct 11 18:51:11 PDT 2011

RichmondDoc

@yayayarndiva So, you run the risk of going a very long time ordering high-cost, lowvalue tests before realizing the system costs. #mdchat
Tue Oct 11 18:51:19 PDT 2011

yayayarndiva

@RichmondDoc very few folks "well insured"- those copays add up for even middle class patients #mdchat
Tue Oct 11 18:51:38 PDT 2011

RichmondDoc

@yayayarndiva Yes, I know exactly what you mean. So we should be teaching students re: unnecessary costs and unneeded tests/care. #mdchat
Tue Oct 11 18:51:51 PDT 2011

MedPedsDoctor

For many, the business model is still RVUs: see more patients = get bigger bonus. #problem #mdchat
Tue Oct 11 18:52:09 PDT 2011

RichmondDoc

@yayayarndiva The copays are adding up. This is why I think the idea of #OccupyHealthcare can go further than 5-10 yrs ago. #mdchat
Tue Oct 11 18:52:23 PDT 2011

yayayarndiva

@RichmondDoc Also the fine art of history and physical- get lost in a "high productivity" order every test mode of practice #mdchat
Tue Oct 11 18:52:29 PDT 2011

BernieMD31

@yayayarndiva @RichmondDoc One of many reasons why I went military #mdchat

Tue Oct 11 18:52:45 PDT 2011

RichmondDoc

MT @MedPedsDoctor: For many, the business model is still RVUs: see more patients = get bigger bonus. #problem #tragedy #WrongGoal #mdchat
Tue Oct 11 18:52:49 PDT 2011

MedPedsDoctor

#meded chat theme recently was exactly on costs of care and how to teach it. @RyanMadanickMD please pipe in if you are on Tw #mdchat
Tue Oct 11 18:53:05 PDT 2011

RichmondDoc

@BernieMD31 I thought it was so that you could see the world, be all that you can be, get an edge on life, and all that. #mdchat
Tue Oct 11 18:53:39 PDT 2011

kdhoffman2

an article in NYTimes http://t.co/35OkPE39 might be useful #mdchat

Tue Oct 11 18:54:27 PDT 2011

MedPedsDoctor

Be all that you can be: applicable to anyone in medicine. Gr8 field, but not for the weak of heart #mdchat
Tue Oct 11 18:54:57 PDT 2011

ElinSilveous

TY for sharing this RT @kdhoffman2: an article in NYTimes http://t.co/2iountwO might be useful #mdchat
Tue Oct 11 18:55:43 PDT 2011

MedPedsDoctor

Parting thoughts: be all that you can be. Change the world: one patient, one system at a time. #mdchat
Tue Oct 11 18:56:03 PDT 2011

NateOsit

In #occupyhealthcare, the word inequality should never be in "quotes". Our system is broken, and needs to be fixed! #OWS #MDchat
Tue Oct 11 18:56:16 PDT 2011

RichmondDoc

@kdhoffman2 Interesting model...so long as it is accessible to *all* those who need it, not just those who can pay for services. #mdchat
Tue Oct 11 18:56:23 PDT 2011

kdhoffman2

Another is the article in NEJM on electronic healthhttp://www.nejm.org/doi/pdf/10.1056/NEJMsa1102519 #mdchat

Tue Oct 11 18:56:44 PDT 2011

RichmondDoc

@kdhoffman2 We know that those w/ #MentalHealth problems use more care, and have worse outcomes. Part of problem/solution. #mdchat
Tue Oct 11 18:56:55 PDT 2011

RichmondDoc

Final thought: we have seen the enemy, it is us. Doctors, patients: join together and push for changes that benefit *all* of us. #mdchat
Tue Oct 11 18:57:24 PDT 2011

MD_chat

Wow - what a hella chat tonight here on #MDchat.

Tue Oct 11 18:57:27 PDT 2011

ElinSilveous

Should we use #OccupyHealth, or #OccupyHealthCare Preference? #MDChat

Tue Oct 11 18:57:32 PDT 2011

MD_chat

To sit here an watch the stream as moderator is one of the coolest things to experience. :-) #MDchat
Tue Oct 11 18:58:02 PDT 2011

ElinSilveous

:) RT @MedPedsDoctor: Parting thoughts: be all that you can be. Change the world: one patient, one system at a time. #mdchat
Tue Oct 11 18:58:06 PDT 2011

apjonas

Arise, the Activist in the hearts of physicians and take back our patients and our nation from the "heart of darkness" #MDChat
Tue Oct 11 18:58:07 PDT 2011

RichmondDoc

Final thought 2: We need to discuss #OccupyHealthcare; further the movement and the discussion: http://t.co/aK5pKrH1 #mdchat
Tue Oct 11 18:58:21 PDT 2011

NateOsit

I think we shld use #OWS, no need to separate! RT @ElinSilveous: Should we use #OccupyHealth, or #OccupyHealthCare Preference? #MDchat
Tue Oct 11 18:58:23 PDT 2011

MD_chat

@MedPedsDoctor hella good. #MDchat

Tue Oct 11 18:58:26 PDT 2011

katellington

Awesome! RT @MD_chat: Wow - what a hella chat tonight here on #MDchat.

Tue Oct 11 18:58:33 PDT 2011

MD_chat

@miller7 Cheers! #MDchat

Tue Oct 11 18:58:49 PDT 2011

MedPedsDoctor

To sit here and watch the stream as a participant is just as incredible. Fellow chat peeps are some Gr8 people! #mdchat

Tue Oct 11 18:59:14 PDT 2011

ElinSilveous

:) :) Huge Smile on Face RT @MD_chat: To sit here an watch the stream as moderator is one of the coolest things to experience. :-) #MDchat
Tue Oct 11 18:59:14 PDT 2011