Social Media and (Pre) Medical Education

I joined Facebook back in 2004, only months after the site was launched. The internet, though I didn’t realize it at a time, was still a very disconnected place. Social media was fundamentally in its infancy, with Facebook joining only a few other social networking sites (MySpace and Friendster come to mind). Twitter and many other social media sites were just thoughts at that stage. Aside from Facebook, the only way I connected with other people was through AOL Instant Messenger, if even that.

Eight years and some 900 million Facebook users later, social media has exploded onto the scene. Rare are the websites that DON’T have a share button that allows users to share the site with users on many different social media outlets. Early on, I used Facebook exclusively to keep in touch with close friends. In contrast, I created this blog to disseminate information. Soon after I started blogging, I discovered Twitter and the medical community that was burgeoning there. I then began to explore using social media for learning more about healthcare and medicine.

People are slowly recognizing the vast potential of social media, especially in the context of healthcare. Not only is it poised to be an important tool in clinical practice, but also in training new generations of physicians. There is a hashtag #meded for a Twitter conversation that takes place weekly, where participants discuss medical education, any problems observed, and potential solutions. It, along with the #hcsm (Healthcare Social Media) Twitter conversation, represents a great forum to propose innovative ways to improve the field of medicine and medical education. I think for students, especially, it is an incredible asset. One can get a very broad perspective of medical education in general, and can reach out to others who are encountering similar problems and situations on their way to a career in medicine.

Speaking for myself, I am pre-med. When I will shed the “pre” part is unknown at this time, but that’s an entirely different topic. I am working, but I am still thinking about entering medical school down the road. I love Twitter, and I use it in part to connect with doctors and students, and to keep abreast of issues that are going on in both the education side and the clinical practice side. I tend to lurk in the background for both the #meded and #hcsm conversations, observing and learning, but not directly participating. I have learned a great deal, but this is information that will probably come in handy further down the road, when I officially start on the road to becoming a physician. What would be nice right now is a similar community for pre-meds.

There is a somewhat more cohesive community that exists on the Internet to provide a resource for pre-meds, as well as medical students and practicing physicians and other healthcare professionals to pose questions and get answers: Student Doctor Network. This is something that has been around for years, and many students have embraced. I have used this multiple times and I think it’s fantastic. However, it is somewhat static, compared to Twitter at least. Yes, people post answers, but it’s not quite the same. Twitter has the feel of a conversation among friends. The rapid-fire exchange of questions and answers feels more natural, and more human in some ways.

Now of course there is a community of sorts on Twitter. There are many pre-meds who have taken to Twitter for one reason or another, and who sometimes connect with other pre-meds along the way. Yes, we all come together to bond, complain, rage, and sometimes exult about classes, the MCAT, and medical school applications. Yet it would be nice to have a way to discuss issues that plague pre-meds from freshman year to the post-graduate years. Ideally the conversation could be fostered and archived under a hashtag. The resulting posts/tweets can be accessed readily later.

There are so many questions that arise for pre-meds even before they reach college. Which school should I apply to? Should I opt for a combined BA/MD program, or go the “traditional” route? In college, the questions can range from the general (What should my GPA be? What about my MCAT? Where should I do community service? Which doctor should I shadow?) to the painfully specific (What the heck is a racemic mixture? How much acid-base chemistry can one expect on the MCAT? What is the average GPA of students accepted to medical school X?). Pre-med is a label that encompasses a wide range of students from at least the age of 17 or 18 to those who are often in their mid to late 20s, if not older (as is the case for many non-traditional students). A social media community dedicated to pre-med issues would be a wonderful way to not only allow these questions to be answered and grievances aired, but it represents a great opportunity for mentoring of younger students by older ones who have had more experience. Having pre-medical advisers, medical school admissions staff, and medical school professors potentially join these conversations would add much needed perspective about what lies on the other side of that seemingly impervious wall called medical school admission.

I’ve been talking about Twitter quite a bit, because that’s what I tend to use most of the time, but other social media tools can be used as well. Facebook’s potential as a teaching tool is being explored in the context of medical education. However, there are some who have reservations with regard to its use in this context, especially if educators are involved, as outlined in this great blog post by Anne Marie Cunningham of Cardiff University in the UK. Blogging, though considered antediluvian by some nowadays, represents another opportunity to detail experiences and forge bonds with others who are in similar situations, and get answers from those who have walked down the same path.

Think of how great it might have been for you to have a community right at your fingertips, where most (if not all) of your pre-med questions can be answered, and readily at that? It’s something that I definitely wished I had early on. While SDN has its benefits, at least on Twitter, there is a greater sense of openness and trust that enhances the learning experience in that context. I have communicated with students and doctors, and they have been wonderful sources of insight. I consider many of them to be friends and invaluable sources of information. It would be wonderful to see universities embrace social media as a powerful source of information and a teaching tool not only for pre-meds, but for all students. Social media participation should be encouraged, but it would be nice to see classes being offered to students that taught them about using social media wisely and managing their online reputation. Perhaps professors can get in on the act and provide information to their students on the social media groups, sites, and hashtags where conversations about topics that are being covered in their class. The possibilities are endless.

Thoughts? Comments?

Social Media as a Tool for Patient Empowerment in Developing Countries

When I was in India recently, I spent time with one of my relatives. While I was there, he came down with a minor cold, and walked to the doctor’s office just down the road. I stayed at home until he came back. When he did return, he had with him a packet of various pills all mixed together. None of them were labeled, nor did they come with a set of instructions. He didn’t know what any of them were, just that his doctor gave them, so he took them.

A week later, I found myself talking to the servant that had come to clean our apartment. Her son had been ill for sometime, and I knew something about the condition from which he had been suffering, because someone had explained to me earlier. Yet when I talked to her soon after she had come back from meeting with her son’s physician, the way she tried to explain his condition to me struck me as completely inaccurate, given the condition in question.

In other instances, I have seen relatives sitting in the doctor’s office. Oftentimes they don’t say anything, and don’t ask anything, instead simply nodding in agreement. Yet when they were out of the office, the questions and doubts start flying. Usually the condition in question remained nebulous even after the appointment, or the procedures were not explained fully. Other times, they would take a decidedly cynical stance when it came to evaluating the doctor’s suggestions, believing that they were more interested in extorting as much money as possible instead of actually treating the condition.

To my eyes, at least in developed countries, patients seem to be more empowered in the context of the doctor-patient relationship. In the ideal scenario, the patient and doctor work together for a solution, with the patient actively engaging the doctor with questions and concerns, and the doctor giving the due attention and compassion. The patient may also have access to additional information through the internet.

Yet in developing countries, including India, many patients still to cling strongly to the doctor-patient hierarchy. What the doctor says, goes, in most cases. In areas with dense populations, few physicians, or a combination of the two, giving the patient the time they deserve can be a formidable task. Among those with less education, a lack of basic medical literacy can further complicate matters.

I recently attended NYMCSPAD (New York Medical College Student Physician Awareness Day). The theme for the day was Social Media in Medicine. All of the speakers–who are very active in social media applied in healthcare and medical education–discussed their personal experiences using social media, as well as advice on how to effectively use social media. One of the points that really stuck out is that patients who continue to ascribe to the “traditional” doctor-patient hierarchy are likely to be left behind. I thought back to my relatives and other people I know who are still content being passive, and not actively taking charge of their care.

There is no denying that social media has taken hold globally. Its value as a tool for patient education and empowerment is slowly being realized in the United States as well as in other countries. Patients, in many cases, vet their doctors by searching for them on social media sites to learn more about them and what they do. Social media is also being embraced in developing countries among physicians, medical students, and public health workers alike. However, I still believe there is still more work to be done to promote patient empowerment in those countries.

The doctor-patient hierarchy–though in many cases a cultural mainstay especially in developing countries–presents a very real barrier when it comes to tightening and improving the healthcare system. According to the World Health Organization, patient empowerment can allow for a more efficient use of resources. Poor medical literacy is another barrier that makes patient empowerment that much difficult among patients who are unsure about the particulars of their own health. While for many in developed countries, information is quite literally at one’s fingertips thanks to smart phones, the same is not necessarily true for the majority of people in developing nations.

While the knee-jerk reflex for many is to develop an app that can be used on smart phones, it doesn’t solve the whole problem, especially considering that smart phones aren’t as pervasive a presence in most of the world as they are here. In India, there are about 20 million smart phones available, but given that there are just over a billion people in India, it represents a very small percentage of the population. However, there are over 900 million cell phones in use. Similar trends are true for other developing nations, with cell phones being available to at least 50% of the population in many cases. Cheap cell phones are often readily available to the majority of the population. I have often observed the very poorest toting a cell phone.

Facebook, Twitter, and other social media platforms are all useful in their own right. Among social media tools, Twitter seems particularly well suited as a way to improve medical literacy and increase patient empowerment in developing countries. While most users use Twitter through Twitter apps and clients on their smart phones and computers, even those with cell phones can send and receive tweets. Before I got my first smart phone back in 2009, I used my regular cell phone to tweet.

So who would these patients tweet or follow? Doctors, medical organizations, medical schools, and other research institutions are just a few that come to mind. The issue with developing nations on the whole is elevating the patient so that they are on an equal playing field with their doctors. They need to feel like they can ask questions of their healthcare providers, that they can trust these providers, and be well-informed about their health and any prescribed treatment. While part of this can be solved by trying to impress upon the patient that the doctor is a partner in their healthcare, part of it can also be solved by improving the patient’s medical literacy.

Medical literacy has been of particular interest to me ever since I took a class on immigrant health for my public health program. A lack of medical literacy can contribute to a whole litany of problems, including early deaths. The issue in many developing countries is not only the lack of medical literacy but the lack of literacy in general. Combining this with the fact that many still cling to preconceived notions and superstitions can further complicate things. Here, the use of a non-written medium, such as Youtube, can be used to effectively transmit information about various aspects of healthcare. The use of video allows for not only circumventing text entirely, but easily adapting the content to the local languages and cultures. Given the likely poor access to technology in poorer communities, the onus is on physicians and public health officials to make this information available to them.

This is something I have thought about for a while, but revisited with renewed interest after attending NYMCSPAD. Do you know of programs currently utilizing these and other approaches that have been conducted to date? What are they? Do you have any other thoughts on how to promote patient empowerment in these regions? Comment away!

The Cost of The Flu

As the weather warms up, flowers start to bloom, and allergies kick in (sigh), it’s fair to say that the flu season is (pretty much) behind us. However, it’s important to understand the financial cost of each flu season.

I got an email from someone at FrugalDad (http://frugaldad.com) with a link to an infographic that very clearly lays out the costs of preventing/treating the flu. What stuck out to me was the pretty significant difference in cost between vaccination versus enduring a bout of the flu and all the costs that can come with it. Bottom line: vaccination not only saves you a lot of the physical agony that can come with suffering from the flu, but it can save you a lot of money as well.

Source: FrugalDad.com

Concierge Medicine

I came across this article in the New York Times about Internet medical practices. It’s something I’ve been very interested in, especially in light of the recent push for health care reform amidst increasing cost of care with fewer doctors available to provide services, notably primary care.

It seems as though medicine has been dogged about maintaining the old ways, and while it embraces technology in the context of new treatments, little has changed as far as the way practices are run. With devices like the iPhone and Android-based phones, with its multitude of apps, some practices have found ways to use these and other technologies to their advantage. This has resulted in automation of many processes that would normally be handled by an army of administrative assistants, cutting costs, and saving time that can then be spent with patients.

While not everything can be done online (auscultation, palpation, neurological tests, etc.), some things such as monitoring blood pressure (as referenced in the article) can be done relatively easily over email. It certainly beats the usual method i.e. go to the clinic, wait for hours, get maybe 10 minutes with your primary care doctor, and maybe a prescription if warranted, all for the sniffles. I find this incredibly frustrating, and I’m pretty sure I’m not alone. So, if there is a way for me to stay home, communicate with my doctor, and get the same care (if not better), then I’m all for it.

It would be incredibly cool if some of the more specialized areas could also save time by doing some of their tests through an Internet-based medium, as well as implementing similar measures to reduce overhead costs. Of course this would only apply to a few areas, perhaps psychiatry, some aspects of neurology, and select others. Nonetheless, it is worth considering, and perhaps could be done relatively easily, given the ability of devices like the iPhone to be used to monitor things like heart rate already.

What do you all think?

Has the Medical Profession Become Any Kinder to Women?

Women doctors have made amazing strides in the field, where only half a century earlier, it was almost exclusively dominated by men. Yet while the doors have opened to women doctors in most aspects, there is one notable exception: motherhood.

My favorite story of women breaking into this, male-dominated field is the one of Agnodice, who disguised herself as a man so that she could study medicine in ancient Greece. Many girls want to grow up to be both well-regarded doctors and wonderful mothers, but it seems that for the most part, they can’t have their cake and eat it too. Men can enter whatever field they want with little consequence, women must make sacrifices. I acknowledge that this seems to be changing, but the pace is still painfully slow.

To paraphrase a professor of mine, the world is still cruel to women. They are encouraged to pursue their career and focus on it with razor sharp focus, while their biological clocks tick away, independent of any aspirations they may develop down the road to start a family. Once the residency and fellowship parade is over (as the case were for aspiring doctors), and a woman is ready to start a family, it may already be too late. I’m all for women being driven and seizing life by the horns, but sometimes the cost is pretty great.

And then, there is me and those like me, who are from immigrant families who insist upon marriage and having at least the first child before age 30. If I am lucky, I will enter medical school at 24, take four years, and enter whatever specialty I can. Depending on what specialty that is, the years devoted to residencies and fellowships may be as low as 3 or as high as 6-7. People can say “Rebel! Blaze your own trail, do what you need to do to get what you want.” Yet in cultures where filial piety is prized and expected, it is far harder to go against the grain, even when your own wishes may be at stake. How does one reconcile cultural and societal obligations with the rigors of medical school/further training?

From what I can gather (and please correct me if I’m wrong) but several residencies tend to not look kindly on women who are pregnant or who have very young children. Each specialty requires a certain number of years of training. It makes sense, of course, that the more high-stakes residencies (for example neurosurgery) would probably require more time to train physicians in that field. Obviously I’d want my neurosurgeon (heaven forbid that I need one) to have had rigorous training. Yet there are 194 certified women neurosurgeons, out of something like 3000 neurosurgeons in total in the U.S. The difference between those numbers is alarming. It’s enough to discourage most women from even entertaining the idea of going down that road, but I’m not like most women. Many women seem to end up vying for the more “family-friendly” positions like family physician or pediatrician, or at least ones that finish up training quickly.

I am not one of those people, I’m aiming for one of the neuro residencies (neurosurgery if I can help it).* I love the complicated nature of the field, and yes, I love the potentially maddening level of stress that’s involved. It’s a field I greatly respect and I want to be a part of, but could potentially be turned away because I want to devote the same kind of attention to my family.

I went to a seminar being conducted at SUNY Downstate, giving advice for medical students as to when they should get married and start families. Literally, the window of opportunity was a few months at best for both, where the birth of a child could potentially set students back a year. Clearly under these restrictions, days-long, traditional Indian weddings are out the window. If I were to get pregnant year 3 or 4, that could be potentially problematic, whereas the first two years were a bit better (but by no means ideal). Heaven forbid you wanted to take care of your child until they were at least more communicative or mobile, and when their fear of strangers was under control (Piagetian child psychology sets this at around 2 years of age). Then perhaps the babysitter could be introduced, if you don’t mind having a babysitter or nanny (I do mind). Children are for many people, a vital part of their lives, and they have the right to get as much time early on with their parents as they can. Yet as far as I can tell, the policy seems to be to leave everything to after you start practicing. That’s great for some people, but others are (still) bound by age-old traditions and (sometimes antiquated though biologically sound) cultural expectations regarding marriage and childbirth.

Hopefully, the domination by men that still seems to be inherent will continue to be addressed, and will encourage more women to live their lives a bit more easily while pursuing their dreams. If any women doctors come across this, I’d love to hear your perspective, given that mine is pretty limited.

*This is all contingent on my getting into medical school. I’m not going to crow about medicine without putting in that little point in there, I’m not in medical school yet. Hopefully I will be soon, gotta take it one step at a time. Even contemplating residencies is a long way off, but it can’t hurt to start contemplating a little now!

One Nation…On Meds

I should probably start out by saying I’m not entirely sure what to make of the readiness with which doctors prescribe a pill for anything and everything. This is mostly based on my observations and what I’ve heard. I’m not a doctor (though I want to be) and I’m trying to understand this as best as I can given my relative lack of medical knowledge. Yet my gut instinct is to say that doctors are all too willing to find a condition to fit a pill, or a pill to fit a condition (and for everything else, an antibiotic). This seems to especially be the case with psychiatric conditions. Everyone that’s depressed seems to be prescribed pills. I concede that are some that legitimately need medication in order to function, but for the vast majority, it seems unnecessary.

I’m going to stick with antidepressant/stimulant meds for this one. Fibromyalgia and antibiotics deserve their own post.

Thank you Keith Olbermann

Thank you for upholding the integrity and honor that comes with going to Cornell, no matter which part of Cornell. I was in Human Ecology, you were in Agriculture and Life Sciences. Our paying less money per semester does not make us any less of a Cornellian, or any less of an Ivy Leaguer.

I was not aware of Ann Coulter’s comments about your Cornell education, deeming it “the land-grant, non-Ivy League school…” (for those who want to see the full article, go to her website) For the record, Ann Coulter is my least favorite Cornell alum–if the word “favorite” can even be used reasonably to describe her in any regard (like describing a favorite illness?)–falling well below even the oft-maligned Paul Wolfowitz. She is a disgrace to the University, not for her Republican views but for her small-minded approach to the problems that plague our society. She does not consider the other side, it’s her way, or the highway.

Cornell University seeks to promote intelligent dialogue among people from different views (which is the case with most universities I suppose). At Cornell, the Cornell Review and Turn Left (right-wing and left-wing publications, respectively) coexist relatively peacefully. We have a thriving religious works department, and discussion is always encouraged among the different religious groups. Ms. Coulter, meanwhile, killed two birds with one stone in an interview with Beliefnet, by calling liberals “godless” and claiming churches that don’t agree with her “are called mosques.”

I’m not one to be blunt about things, but I’ll make an exception this time. I don’t like her, I think most people who know me are well aware of that (and I think it’s fair so say if she knew me, she wouldn’t like me either, so it’s mutual). I don’t usually complain about the incessant nonsense that seems to emanate from her on a daily basis. Yet hearing this just rubbed me the wrong way.

I am a Cornell graduate. I am not any less qualified than any of my friends from Arts and Sciences, Engineering, Art, Architecture, and Planning, or the School of Hotel Administration. I took most of my classes in Arts and Sciences, since I was pre-med, and the chemistry and physics classes were only offered in Arts. Most of my Cornell career was spent in either Baker or Rockefeller. My freshman writing seminars were in Arts. Some of my humanities requirements were also in Arts. The rest was in Ag or Hum Ec (oh and one elective cross-listed in Engineering). What was the difference between my education and someone in one of the privately-endowed schools? I paid less for my education. I’m a New York State resident, and I went to the College of Human Ecology. In-state residents get a break, something that is definitely not unique to Cornell. Yes I got my Cornell degree, which is proudly sitting on the mantel of my fireplace, at a graduation ceremony where other graduates from all the Cornell colleges were present. We heard the same speech by President Skorton, we sat in front of the same, proud collection of college deans, we all sang the “alma mater.” My state-side college peers and I just did it for around half of what the rest of them paid. Big deal. I am no less of a Cornellian than anyone else, past, present, or future.

So thank you Keith for standing up for the rest of the Cornellians from Ag, Hum Ec, and ILR.

I’m calling on all Cornell alumnae (and all current Cornellians) to email Ann Coulter expressing your feelings. I don’t care what college you’re from, but stand up for your status as a Cornell alum, regardless of which college you’re from. We’re all Cornellians at the end of the day. Ultimately, that’s all that matters.

So What Were Your Views on Alternative Medicine?

This is from a post I did about two months back.

Out of the 18 people that responded (which means the results are not remotely statistically significant), 72% (13 people) believe in using alternative medicine in conjunction with allopathic therapies. 17% (3 people) discounted alternative medicine entirely. 1 person believed in alternative medicine alone and 1 person didn’t realize there was such a thing as alternative medicine (I find that hard to believe).

Nonetheless, it was a fun little poll. More polls to come in future posts!

Letter to Nadya Suleman

Dear Nadya,

First, congratulations on the recent birth of your children.

I get that you love children. I can’t think of many people who don’t love children. I get that you wanted to be a mother. That is the dream of most girls. Didn’t you achieve that dream after the first two or three children?

I don’t know what mental force drove you towards having fourteen children, that too, all by in-vitro fertilization. Each treatment involves a whole series of hormones that can cause dramatic mood swings, weight gain, and the very real risk of future infertility. There is certainly nothing wrong with in-vitro fertilization as an option for having children. However, as a patient who has suffered from depression, how could you subject yourself to that after already giving birth to the first few children?

Did you even consider what a house of fourteen children–ranging from the days-old octuplets to a seven-year old–would actually be like? Babies are a handful as it is, requiring round-the-clock care. Multiply that by eight, then add a few toddlers and young children who will all be vying for your attention. There will be screaming, there will be crying, there will be tantrums, messes, homework, trips to and from school, the doctor, and then just the day-to-day chores and errands.

You are a single mother, collecting disability payments as your only source of income. You were on the way to getting your masters, but dropped that part of the way to have more children. Your parents have taken care of your children thus far, but they can’t handle eight more. Even with a nanny, it is still a formidable task. There is nothing wrong with being a single mother–something that our society definitely understands, though you claim otherwise–but a single mother with fourteen children is a cause for concern. Even a mother with a strong support system with that many children raises a few red flags.

Have you considered how much it will cost to raise all of them to adulthood? It has been calculated to be around $200,000 per child. Multiply that by 14. Have you considered that they may go to college? The cost of tuition is only going up. Throw in at least another $10,000 per year, per child. You get the idea.

What were you thinking?

You may want to be a mother, but I think you are more in love with the idea of being a mother than the actual task of motherhood, with all its bells and whistles. You are probably in love with the idea of having children, which is in some ways, you may view as a validation of your femininity, especially after suffering previous miscarriages. Yes, you claim you will be at the disposal of all of your children, that you will give them your attention, and your love. Yet I’m not totally convinced that you know that motherhood involves a lot more than just unconditional love. Motherhood is not easy. It is something to love, but it is certainly not easy even with one child, let alone fourteen.

Please consider the gargantuan task ahead of you, and do what you need to do to ensure the best future for your children. We’re all rooting for you.

Best wishes,

Saroj

Headbanging is Bad for Your Health

This seems kind of obvious to me…but in case it wasn’t clear:

http://blogs.discovermagazine.com/discoblog/2009/01/06/health-hazard-alert-head-banging-may-hurt-your-brain/

There are far less vigorous things one can do that would cause whiplash, concussions, and possible stroke. I don’t really get the point of headbanging to begin with. Doesn’t it just feel hurt at all, feeling your brain sloshing around like a marble in a bottle of water? It just didn’t feel logical to do that. There are better ways to keep time with music. Then again, it’s woven into the fabric of heavy metal.

Don’t get me wrong, I like metal…well some bands here and there…the ones that sing more than scream.

So I guess all that’s left is throwing the goat…which I guess doesn’t have quite the same effect as combining it with headbanging.

Random post, I know, but a little randomness never hurt anyone.