Transcript of #MDchat for Tuesday October 12, 2010

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Hello & welcome to #MDchat! Last week was a great kick-off. But that was just a start. We'll start in a moment but first a couple notes. For those of you who were here last week, thanks for being there. This chat will evolve. Physicians have important voices. #MDchat Before we get started with #MDchat, please introduce yourselves! Former clinician Pulm/CC current health services researcher, blogger; into HACs and HC organization in the US #mdchat @hjluks Next one will be at night actually. #MDchat Luis Saldana, Emergency and #EHR/Med informatics doc with large hospital system in N Texas, DFW area, on a phone mtg, so lurking #mdchat @murzee Welcome! #MDChat @drseisenberg Good to see you. Slow turnout today, but we'll give a couple minutes & then start! #MDchat Hi Debbie Kennedy back for 2nd MDChat #mdchat @MD_chat Steven. Oncology. #MDchat Hello #MDChat. Canadian Association of Community Health Centres (CHCs) here. Teams of docs, nurses and others. RT @MD_Chat: Here's how to make your Twitter chat more focused, less noisy - http://bit.ly/aIRXGP9 #MDchat @hjluks You can try another client - TweetGrid.com or just use TweetDeck & add a column for #MDchat OK, first topic coming up in one minute! #MDchat We'll have 2 topics. Please prepend responses to topics with T1, T2, etc. Good luck! Thanks, @MD_Chat. Good 2 see u, @lsaldanamd #mdchat

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Scott Wolfe, health/social policy analyst from Toronto. #MDChat Listening in to #mdchat RT @mkmackey: Listening in to #MDchat T1 Technology in Medicine: What media technologies do you use most often. Why? What would you like to see come to market? #MDchat Carlos Martins, family doctor, Porto, Portugal . Hello everyone #MDchat :) listening in to the conversation #mdchat Thanks, @murzee, glad I could join in some fashion today. Thanks, @hjluks #mdchat T1: I love video format, want to see more universal platforms easily accessible on all platforms/devices. Esp pt education #mdchat Live now: #MDchat ! You may read it here: http://tweetchat. com/room/mdchat RT @MD_Chat: T1 Technology in Medicine: What media technologies do you use most often. Why? What would u like to see come 2 market? #mdchat RT @MD_Chat: T1 Tech in Medicine: What media tech do you use most often. Why? What would you like to see come to market? #MDchat #mhealth RT @MD_Chat: T1 Technology in Medicine: What media technologies do you use most often. Why? What would you like to see come to market? #MDchat Between offices. Would love to attend #MDChat but don't want to b guilty of tweeting while driving #TWD T1 Presurgical disclosures, consents for example, ability to complete consents, post acute care discharge instructions, etc #mdchat @chukwumaonyeije lol - safe travels - we'll see you next time. Check for the announcement on the transcript after the show. Cheers! #MDChat #MDchat T1 One of the most useful media tools I use at clinical practice is Google Image. Very useful in patient empowerment ;-)

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Check it out! The 2010 Planetree Annual Conference! "October is #Patient -Centered Care Awareness Month" http://j.mp/cw12zf #RNchat #MDchat T1: for research and publication Twotter, blogging. Great sources of current info. Look forward to new real-time peer review #mdchat #MDChat T1: Community Health Centre physicians often talk abt technologies/tools that enable better interprofessional collaboration #IPChat T1 absolutely love readthewords.com. clip and paste blog posts the download audio to listen in car. Nominal fee #MDCHAT. Sounds very promising MT @murzee: T1: Look forward to new real-time peer review #mdchat T1 Twitter, FB, You Tube channel (soon), google alerts... inform, engage, manage the msg and online rep mgmt #MDchat Of course that was Twitter, tho' Twotter seems interesting too :) #mdchat RT @CACHCA_RCACCS #MDChat Community Health Centre physicians often talk abt tech/tools that enable better interprofessional collaboration RT @MD_chat T1 Tech in Medicine: What media technologies do you use most often. Why? What would you like to see come to market? #MDchat http://j.mp/d5Z8gi ♻ @mkmackey Listening in to #mdchat #MDchat T1 Another media tool that changed my clinical practice is he use of clinical software in the smartphone. T1 Another media tool that changed my clinical practice is he use of clinical software in the smartphone. #MDchat @murzee T1 Now peer-review MDchat - that sounds very interesting. You'll have to develop more on that. Future topic? #MDChat @lsaldanamd have u seen md2p @simonslee has a lot up his sleeve #MDchat

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RT @MD_Chat: T1 Tech in Medicine: What tech do you use most often. What would you like to see come to market? #healthit #hchit #mdchat @hjluks No will check that ou, thx #Mdchat T1 Software like Epocrates, 5 Min Clin Consult, Clinical Evidence allow me to have the answers I need at the point of care #MDchat @murzee ;) #MDChat @MD_Chat A lot of talk re: demystifying and opening peer review process by journals. IMO: could be good #mdchat peer review MD chat... yikes #MDchat @MD_Chat hard enuf to get MDs to enage... start with peer review and we'll scare them away. Need to wait for more MD participation #MDchat Mostly lurking this week. #mdchat T1 I also would like to see meaningful progress in overcoming safety, security concerns of using these tools #Mdchat @hjluks @murzee It would be hard to do on this particular form, but it may have value in more robust/specialized platforms. #MDChat T1 A list of software I use at clinical practice: http://bit.ly/cPEx7w #MDChat (sorry in portuguese, pl use Google Translator) OK, some really good uses for T1. We're going to move to the second topic in a moment. (Going back to old-school tech ;) #MDchat @mgfamiliarnet Re #MDChat T1 software, like Epocrates. Does it allow collaboration across a care team, or is it all individual MD-specific? Twitter, Uptodate.com (evidenced-based), NCCN.org (guidelines/pathways), Sermo a tad #MDchat @mgfamiliarnet Agree, the smartphone platform is excellent for such tools #mdchat RT @hjluks: @MD_Chat hard enuf to get MDs to enage... start with peer review and well scare them away. Need to wait for more MDs #MDchat @MD_Chat Not suggesting we peer-review this forum; just responding to T1 as relates to my day #mdchat

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@CACHCA_RCACCS #MDChat T1 It doesn't allow team collaboration yet. A kind of electronic health record #EHR would allow that. Slightly off topic, but did anyone see the WSJ piece on " scraping" today? A must read on security of your online data #mdchat RT @lsaldanamd: Slightly off topic, but did anyone see the WSJ piece on "scraping" today? A must read on security of online data #mdchat @lsaldanamd Do you have a link to the WSJ piece? #mdchat #MDchat is underway: http://tweetchat.com/room/mdchat @mgfamiliarnet #EHR as a social platform? #mdchat T2 The Physical Exam: NYT posted http://nyti.ms/axeJWp re: the return to examination basics. Are basics being lost? Or improved? #MDchat Scrapers' Dig Deep for Data on the Web - WSJ.com: http://bit.ly/dzPvHX via @addthis May need subscription, not sure. #mdchat @rlbates @lsaldanamd 'Scrapers' Dig Deep for Data on Web http://bit. ly/9GNG2X #mdchat really a must read . @lsaldanamd must read for sure on scraping in the WSJ. #MDchat #swedish100 @MD_Chat Just read that piece this morning. I feel the traditional physical exam is limited in capabilities #T2 #mdchat Scraping WSJ article va @Isaldanamd http://bit.ly/cSpQE3 #mdchat @MD_Chat T2: Great NYT piece! Basics definitely getting lost. Simple concept of pre-test probability gone w/o PE #mdchat But I do agree that the passing on of good basics are likely being lost. Good docs use heuristics to guide them on PE T2 #mdchat Many curious pts would benefit from a site explaining e-patient possibilities(with examples)- a site we could could refer them to. #MDchat

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#MDChat T2: Is the traditional exam even possible with the rush to the 5min, 1 issue only consult? Tyranny of through-put and billing! Wow! RT @lsaldanamd Scrapers' Dig Deep for Data on the Web - WSJ. com: http://bit.ly/dzPvHX #mdchat And value of physical exam depends on context of the patient visit. There are times for very thorough basic PE T2 #mdchat AGREE. RT @murzee RT @lsaldanamd: WSJ piece on " scraping" today? A must read on security of online data #mdchat @lsaldanamd Does traditional assessment need 'upgrading'? That is, do traditional methods need to be revisited w/tech in mind? #MDChat RT @simonslee: . @lsaldanamd must read for sure on scraping in the WSJ. #MDchat #swedish100 #MDchat RT @MD_Chat: T2 The Physical Exam NYThttp://nyti.ms/axeJWp re: the return to examination basics. Are basics being lost? Or improved? #MDchat RT @CACHCA_RCACCS: #MDChat T2: Is trad'l exam even possible with the rush to 5-min, 1 issue only consult? Tyranny of through-put & billing! @MD_Chat Yes, would be a fascinating analysis to look at PE item by item and assign clinical value. T2 #mdchat re: Physical Exam... my blog post : Emergence of High Tech- Low Touch Medicine http://goo.gl/uvIH Vry disturbing trend!! #MDchat @ScottAWolfeOWP trad exam a must! can not treat MRI findings without putting them into context of complaints and exam #MDchat @hjluks Agree. Value of trad'l exam goes far beyond $$$ #mdchat T2 Great article. Contact remains essential. Skype is wonderful, but need the old skool touch. #MDchat T2 eg, electronic stethescopes, handheld sono, etc vs traditional methods? #mdchat T2 In my opinion, basics are not being lost. In the future, basics, e.g. physical examination, will remain essential. #mdchat

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@MD_Chat High Tech Low Touch Medicine leading to too mny MRIs and therefore too mny surgeries PE and listening to patient critical #MDchat RT @hjluks: re: Physical Exam... my blog post : Emergence of High TechLow Touch Medicine http://goo.gl/uvIH Vry disturbing trend!! #MDchat How do you interpret test findings if you have not generated a diff dx? No PE, no diff dx. #mdchat RT @hjluks: re: Physical Exam... my blog post : Emergence of High TechLow Touch Medicine http://goo.gl/uvIH Vry disturbing trend!! #MDChat @murzee exactly... mny patients actually asked to have MRI before coming to specialists office !!! #MDchat @mgfamiliarnet But the art of PE is an apprenticeship fxn. Lost if not taught to med students. #mdchat Best of the best. Healing with good ole techniques combined with innovative tools. Not mutually exclusive. #MDchat T2 Every doc should have a context specific exam at his ready. #mdchat Trying to find this a wonderful video of Christenson on the physical exam. #mdchat #mdchat RT @lsaldanamd: T2 Every doc should have a context specific exam at his ready. #MDchat @murzee That was part I liked about the piece, was the teaching aspect of it. #mdchat T2 new tech tools may help us to improve trad physical excamination. New management, productivity targets may help us to break down. #mdchat @drseisenberg exactly. #mdchat @drseisenberg in ortho... usually time is only thing necessary :-) No innovation necessary. #MDchat RT @hjluks: @MD_Chat High Tech Low Touch Medicine leading to too mny MRIs and therefore too mny surgeries PE and listening to patient critical #MDchat Agree strongly RT @hjluks: RT @lsaldanamd: T2 Every doc should have a context specific exam at his ready. #MDchat

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RT @hjluks: @murzee exactly... mny patients actually asked to have MRI before coming to specialists office !!! #MDchat RT @murzee: @mgfamiliarnet But the art of PE is an apprenticeship fxn. Lost if not taught to med students. #mdchat RT @drseisenberg: Best of the best. Healing with good ole techniques combined with innovative tools. Not mutually exclusive. #MDchat RT @mgfamiliarnet: T2 new tech tools may help us to improve trad physical excamination. New management, productivity targets may help us to break down. #mdchat RT @quality1@drseisenberg: Best of the best. Healing w/ good ole techniques combined with innovative tools. Not mutually exclusive. #mdchat A lead in... why mny MRIs and overtesting leading to overtreatment... http://goo.gl/jo67 #MDchat @murzee I agree: the art of PE must still be taught. In many interesting manners... And guess what: the students love it :) #mdchat T2 RT @myrealitytech How the iPad Can Change the Human Race: Part 1, Healthcare http://bit.ly/964eza #nurse #rn #RNchat #MDchat Perhaps one day I'll feel a mass, then measure it with a mobile device? Interim way of helping between scans? Just daydreaming... #MDchat RT @thenerdynurse: RT @myrealitytech How the iPad Can Change the Human Race: Part 1, Healthcare http://bit.ly/964eza #nurse #rn #RNchat #MDchat @hjluks I think that is more about having a rigorous decision support process vs. use of the tools. Skipping steps always bad #mdchat RT @drseisenberg: Perhaps one day I'll feel a mass, then measure it with a mobile device? Interim way of helping between scans? Just daydreaming... #MDchat Or not having a good decision making framework at the core of a physicians skill set #mdchat

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RT @drseisenberg: Perhaps 1 day feel a mass, measure it w/ mobile device? Interim help between scans? Just daydreaming. #MDchat > > why not? T2: Skin still needs to be visually examined #mdchat Nice video RT @hjluks: A lead in... why mny MRIs and overtesting leading to overtreatment... http://goo.gl/jo67 #MDchat @drseisenberg Dreams do come true - if ya work at them ;) #MDChat @drseisenberg perhaps 1 day our smartphone will have an ultrasonograph, ecg.. Related video: http://bit.ly/axG2rz :) #mdchat T1&T2 @rlbates Wish there was a device that could help tell me what that rash is... #MDchat T2 @rlbates wondering how MDs feel about #telemedicine tools and dermatology #mdchat RT @drseisenberg: Nice video RT @hjluks: A lead in... why mny MRIs and overtesting leading to overtreatment... http://goo.gl/jo67 #MDchat @drseisenberg A more advanced & medically-centered Google Goggles might be one way http://www.google.com/mobile/goggles/#text #MDChat RT @mgfamiliarnet: @drseisenberg perhaps 1 day our smartphone will have an ultrasonograph, ecg.. Related video: http://bit.ly/axG2rz :) #mdchat T1&T2 #MDChat @hjluks Agreed, exam is a must, but effective exam gen'lly not possible in 5 min. Promotes non-holistic care & tendency to over Rx @mkmackey @dermdoc holds a telemedicine clinic and likes it, I believe #mdchat Technology comes with a price, not only $$, but sensitivity, specificity, PPV and NPV, & therefore false results Diff from low-tech? #mdchat could be possible technically?RT @drseisenberg: @rlbates Wish there was a device that could help tell me what that rash is... #mdchat

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RT @MD_Chat @drseisenberg A more advanced & medicallycentered Google Goggles might be http://www.google. com/mobile/goggles/#text #mdchat RT @MD_Chat: @drseisenberg A more advanced & medicallycentered Google Goggles might be one way http://www.google. com/mobile/goggles/#text #MDChat RT @ScottAWolfeOWP: #MDChat @hjluks ...effective exam genlly not possible in 5 min. Promotes non-holistic care & tendency to over Rx #mdchat RT @murzee: Technology comes with a price, not only $$, but sensitivity, specificity, PPV and NPV, & therefore false results Diff from low-tech? #mdchat #mdchat just joined in. I guess I'm late!! @murzee Exactly my point, it is more about teaching an effective decision making framework than the exam #mdchat RT @lsaldanamd: @murzee Exactly my point, it is more about teaching an effective decision making framework than the exam #meded #mdchat @habdessamad No worries - Transcripts up after the show. #MDchat @lsaldanamd But then there is also the $$: is the improv. increment worth the $$ #mdchat WOW - OK, we're coming up on an hour of #MDchat. We'll wrap up in a moment & make some announcements! It is poss to find a treatable prob in every person given enough tests/exams - probably best to treat and diag complaints/symptoms #MDchat @murzee There is always a value piece of the decision making framework IMHO #mdchat Arrived in PM office... Sorry to miss the chat. Looking forward to next time and the transcript. #MDCHAT TYVM RT @MD_Chat: WOW - OK, were coming up on an hour of #MDchat. Well wrap up in a moment & make some announcements! #MDchat

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@lsaldanamd Cannot disagree w you there, tho' we do not do it well. & value is so perspective-dependent... #mdchat OK, let's hear your parting thoughts before wrapping up! #MDchat @murzee That is true. That piece needs to be more objective. #mdchat Thanks for letting me jump in. Hope to join next time. #mdchat TY RT @MD_Chat: The PE: NYT posted http://nyti.ms/axeJWp re: the return to examination basics. Are basics being lost or improved? #MDchat Thanks for sharing. I value physician viewpoints and perspectives #mdchat Thrilled to see MDs online, engaged and so committed. Thx to all on #MDChat. Looking forward to more! Thanks very much for orchestrating! Interesting ideas. @MD_Chat #mdchat @habdessamad Once I process the transcript I'll tweet it out. But the archive will be here - http://mdchat.org/category/transcripts/ #MDchat @lsaldanamd Sure - thanks for dropping in. Great contributions from everyone! #MDChat I've liked today's #mdchat See you... TY, Phil! Enjoyed @md_chat! Part Two of our interview w/ @edbennett posting later today. Some nice comments 4 @HealthIsSocial #mdchat @Payformance My pleasure! #MDChat Sorry I had to drop out.... good chat, good topics.... look fwd to MDCHat one evening Rocket man :-) #MDchat One day a physician will peer in the mirror and see a patient !!! Engaging in soc med and in office is good for all! #MDchat OK, THANK YOU everyone! Transcript will be up this afternoon. Next chat is tomorrow 10/13 9pm Eastern. (Testing night out. :) #MDchat @MD_chat love your idea of using Google Goggles as a diagnostic aid! #mdchat (Just joined, am a bit late, sorry)

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RT @hjluks: One day a physician will peer in the mirror and see a patient !!! Engaging in soc med and in office is good for all! #MDchat RT @lsaldanamd: Or not having a good decision making framework at the core of a physicians skill set #mdchat Today was a pleasure moderating! Enjoyed the contributions to #MDchat today. This has been @PhilBaumann Cheers!