Transcript of #MDchat for Tuesday October 12, 2010

Follow @MD_chat for regular updates

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Hello & welcome to #MDchat! Last week was a great kick-off. But that
MD_Chat 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
MD_Chat chat will evolve. Physicians have important voices. #MDchat

MD_Chat Before we get started with #MDchat, please introduce yourselves!

Former clinician Pulm/CC current health services researcher, blogger; into

murzee HACs and HC organization in the US #mdchat
MD_Chat @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
lsaldanamd #mdchat
MD_Chat @murzee Welcome! #MDChat
@drseisenberg Good to see you. Slow turnout today, but we'll give a
MD_Chat couple minutes & then start! #MDchat
Payformance Hi Debbie Kennedy back for 2nd MDChat #mdchat
drseisenberg @MD_chat Steven. Oncology. #MDchat

Hello #MDChat. Canadian Association of Community Health Centres

CACHCA_RCACCS (CHCs) here. Teams of docs, nurses and others.

RT @MD_Chat: Here's how to make your Twitter chat more focused, less
mgfamiliarnet noisy - http://bit.ly/aIRXGP9 #MDchat
@hjluks You can try another client - TweetGrid.com or just use TweetDeck
MD_Chat & add a column for #MDchat

OK, first topic coming up in one minute! #MDchat We'll have 2 topics.
MD_Chat Please prepend responses to topics with T1, T2, etc. Good luck!

murzee Thanks, @MD_Chat. Good 2 see u, @lsaldanamd #mdchat

ScottAWolfeOWP Scott Wolfe, health/social policy analyst from Toronto. #MDChat
mkmackey Listening in to #mdchat
nursingpins RT @mkmackey: Listening in to #MDchat

T1 Technology in Medicine: What media technologies do you use most

MD_Chat often. Why? What would you like to see come to market? #MDchat

mgfamiliarnet Carlos Martins, family doctor, Porto, Portugal . Hello everyone #MDchat :)
SMSJOE listening in to the conversation #mdchat
Thanks, @murzee, glad I could join in some fashion today. Thanks,
lsaldanamd @hjluks #mdchat

T1: I love video format, want to see more universal platforms easily
lsaldanamd accessible on all platforms/devices. Esp pt education #mdchat
Live now: #MDchat ! You may read it here: http://tweetchat.
mgfamiliarnet 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?
murzee #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
blausengroup #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?
Payformance #MDchat
Between offices. Would love to attend #MDChat but don't want to b guilty
chukwumaonyeije of tweeting while driving #TWD

T1 Presurgical disclosures, consents for example, ability to complete

lsaldanamd consents, post acute care discharge instructions, etc #mdchat

@chukwumaonyeije lol - safe travels - we'll see you next time. Check for
MD_Chat 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
mgfamiliarnet Google Image. Very useful in patient empowerment ;-)
 Check it out! The 2010 Planetree Annual Conference! "October is
#Patient -Centered Care Awareness Month" http://j.mp/cw12zf
EllenRichter #RNchat #MDchat

T1: for research and publication Twotter, blogging. Great sources of

murzee 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
CACHCA_RCACCS #IPChat

T1 absolutely love readthewords.com. clip and paste blog posts the

chukwumaonyeije download audio to listen in car. Nominal fee #MDCHAT.
Sounds very promising MT @murzee: T1: Look forward to new real-time
mkmackey peer review #mdchat

T1 Twitter, FB, You Tube channel (soon), google alerts... inform, engage,
hjluks manage the msg and online rep mgmt #MDchat

murzee Of course that was Twitter, tho' Twotter seems interesting too :) #mdchat

RT @CACHCA_RCACCS #MDChat Community Health Centre physicians

MillionFIT often talk abt tech/tools that enable better interprofessional collaboration

RT @MD_chat T1 Tech in Medicine: What media technologies do you use

Julian_Bond most often. Why? What would you like to see come to market? #MDchat

healthgist http://j.mp/d5Z8gi ♻ @mkmackey Listening in to #mdchat

#MDchat T1 Another media tool that changed my clinical practice is he
mgfamiliarnet use of clinical software in the smartphone.

T1 Another media tool that changed my clinical practice is he use of

mgfamiliarnet clinical software in the smartphone. #MDchat

@murzee T1 Now peer-review MDchat - that sounds very interesting.

MD_Chat You'll have to develop more on that. Future topic? #MDChat
@lsaldanamd have u seen md2p @simonslee has a lot up his sleeve
hjluks #MDchat
 RT @MD_Chat: T1 Tech in Medicine: What tech do you use most often.
mkmackey What would you like to see come to market? #healthit #hchit #mdchat
lsaldanamd @hjluks No will check that ou, thx #Mdchat

T1 Software like Epocrates, 5 Min Clin Consult, Clinical Evidence allow me

mgfamiliarnet to have the answers I need at the point of care #MDchat
MD_Chat @murzee ;) #MDChat

@MD_Chat A lot of talk re: demystifying and opening peer review process
murzee by journals. IMO: could be good #mdchat
hjluks peer review MD chat... yikes #MDchat

@MD_Chat hard enuf to get MDs to enage... start with peer review and
hjluks we'll scare them away. Need to wait for more MD participation #MDchat
rlbates Mostly lurking this week. #mdchat

T1 I also would like to see meaningful progress in overcoming safety,

lsaldanamd security concerns of using these tools #Mdchat

@hjluks @murzee It would be hard to do on this particular form, but it

MD_Chat may have value in more robust/specialized platforms. #MDChat

T1 A list of software I use at clinical practice: http://bit.ly/cPEx7w

mgfamiliarnet #MDChat (sorry in portuguese, pl use Google Translator)

OK, some really good uses for T1. We're going to move to the second
MD_Chat topic in a moment. (Going back to old-school tech ;) #MDchat

@mgfamiliarnet Re #MDChat T1 software, like Epocrates. Does it allow

CACHCA_RCACCS collaboration across a care team, or is it all individual MD-specific?
Twitter, Uptodate.com (evidenced-based), NCCN.org
drseisenberg (guidelines/pathways), Sermo a tad #MDchat
@mgfamiliarnet Agree, the smartphone platform is excellent for such
lsaldanamd tools #mdchat

RT @hjluks: @MD_Chat hard enuf to get MDs to enage... start with peer
drseisenberg 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
murzee T1 as relates to my day #mdchat
 @CACHCA_RCACCS #MDChat T1 It doesn't allow team collaboration yet.
mgfamiliarnet 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
lsaldanamd #mdchat
RT @lsaldanamd: Slightly off topic, but did anyone see the WSJ piece on
"scraping" today? A must read on security of online data
murzee #mdchat

rlbates @lsaldanamd Do you have a link to the WSJ piece? #mdchat

PhysicianAssist #MDchat is underway: http://tweetchat.com/room/mdchat

lsaldanamd @mgfamiliarnet #EHR as a social platform? #mdchat

T2 The Physical Exam: NYT posted http://nyti.ms/axeJWp re: the return

MD_Chat to examination basics. Are basics being lost? Or improved? #MDchat

Scrapers' Dig Deep for Data on the Web - WSJ.com: http://bit.ly/dzPvHX

lsaldanamd via @addthis May need subscription, not sure. #mdchat
@rlbates @lsaldanamd 'Scrapers' Dig Deep for Data on Web http://bit.
mgfamiliarnet ly/9GNG2X #mdchat really a must read
. @lsaldanamd must read for sure on scraping in the WSJ. #MDchat
simonslee #swedish100

@MD_Chat Just read that piece this morning. I feel the traditional physical
lsaldanamd exam is limited in capabilities #T2 #mdchat

mkmackey Scraping WSJ article va @Isaldanamd http://bit.ly/cSpQE3 #mdchat

@MD_Chat T2: Great NYT piece! Basics definitely getting lost. Simple
murzee 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.
lsaldanamd Good docs use heuristics to guide them on PE T2 #mdchat

Many curious pts would benefit from a site explaining e-patient

nursingpins possibilities(with examples)- a site we could could refer them to. #MDchat
 #MDChat T2: Is the traditional exam even possible with the rush to the 5-
CACHCA_RCACCS min, 1 issue only consult? Tyranny of through-put and billing!
Wow! RT @lsaldanamd Scrapers' Dig Deep for Data on the Web - WSJ.
rlbates com: http://bit.ly/dzPvHX #mdchat

And value of physical exam depends on context of the patient visit. There
lsaldanamd are times for very thorough basic PE T2 #mdchat

AGREE. RT @murzee RT @lsaldanamd: WSJ piece on "

chukwumaonyeije scraping" today? A must read on security of online data #mdchat

@lsaldanamd Does traditional assessment need 'upgrading'? That is, do

MD_Chat traditional methods need to be revisited w/tech in mind? #MDChat
RT @simonslee: . @lsaldanamd must read for sure on scraping in the
hjluks 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?
mgfamiliarnet #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 &
ScottAWolfeOWP billing!
@MD_Chat Yes, would be a fascinating analysis to look at PE item by item
lsaldanamd and assign clinical value. T2 #mdchat

re: Physical Exam... my blog post : Emergence of High Tech- Low Touch
hjluks Medicine http://goo.gl/uvIH Vry disturbing trend!! #MDchat

@ScottAWolfeOWP trad exam a must! can not treat MRI findings without
hjluks putting them into context of complaints and exam #MDchat

murzee @hjluks Agree. Value of trad'l exam goes far beyond $$$ #mdchat
T2 Great article. Contact remains essential. Skype is wonderful, but need
drseisenberg the old skool touch. #MDchat
T2 eg, electronic stethescopes, handheld sono, etc vs traditional
lsaldanamd methods? #mdchat

T2 In my opinion, basics are not being lost. In the future, basics, e.g.
mgfamiliarnet physical examination, will remain essential. #mdchat
 @MD_Chat High Tech Low Touch Medicine leading to too mny MRIs and
hjluks therefore too mny surgeries PE and listening to patient critical #MDchat

RT @hjluks: re: Physical Exam... my blog post : Emergence of High Tech-

drseisenberg Low 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
murzee PE, no diff dx. #mdchat

RT @hjluks: re: Physical Exam... my blog post : Emergence of High Tech-

MD_Chat Low Touch Medicine http://goo.gl/uvIH Vry disturbing trend!! #MDChat
@murzee exactly... mny patients actually asked to have MRI before
hjluks coming to specialists office !!! #MDchat
@mgfamiliarnet But the art of PE is an apprenticeship fxn. Lost if not
murzee taught to med students. #mdchat

Best of the best. Healing with good ole techniques combined with
drseisenberg innovative tools. Not mutually exclusive. #MDchat

lsaldanamd 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.
mkmackey #mdchat #mdchat
RT @lsaldanamd: T2 Every doc should have a context specific exam at his
hjluks ready. #MDchat
@murzee That was part I liked about the piece, was the teaching aspect
lsaldanamd 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.
mgfamiliarnet #mdchat
lsaldanamd @drseisenberg exactly. #mdchat
@drseisenberg in ortho... usually time is only thing necessary :-) No
hjluks 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
quality1 #MDchat

Agree strongly RT @hjluks: RT @lsaldanamd: T2 Every doc should have a

rlbates context specific exam at his ready. #MDchat
 RT @hjluks: @murzee exactly... mny patients actually asked to have MRI
quality1 before coming to specialists office !!! #MDchat

RT @murzee: @mgfamiliarnet But the art of PE is an apprenticeship fxn.

quality1 Lost if not taught to med students. #mdchat

RT @drseisenberg: Best of the best. Healing with good ole techniques

quality1 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
quality1 us to break down. #mdchat
RT @quality1@drseisenberg: Best of the best. Healing w/ good ole
techniques combined with innovative tools. Not mutually exclusive.
lsaldanamd #mdchat
A lead in... why mny MRIs and overtesting leading to overtreatment...
hjluks http://goo.gl/jo67 #MDchat

@murzee I agree: the art of PE must still be taught. In many interesting

mgfamiliarnet manners... And guess what: the students love it :) #mdchat T2

RT @myrealitytech How the iPad Can Change the Human Race: Part 1,
thenerdynurse Healthcare http://bit.ly/964eza #nurse #rn #RNchat #MDchat

Perhaps one day I'll feel a mass, then measure it with a mobile device?
drseisenberg 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
quality1 #MDchat

@hjluks I think that is more about having a rigorous decision support

lsaldanamd 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
quality1 daydreaming... #MDchat
Or not having a good decision making framework at the core of a
lsaldanamd physicians skill set #mdchat
 RT @drseisenberg: Perhaps 1 day feel a mass, measure it w/ mobile
device? Interim help between scans? Just daydreaming. #MDchat >
2healthguru > why not?
rlbates T2: Skin still needs to be visually examined #mdchat

Nice video RT @hjluks: A lead in... why mny MRIs and overtesting leading
drseisenberg to overtreatment... http://goo.gl/jo67 #MDchat

MD_Chat @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
mgfamiliarnet T1&T2
@rlbates Wish there was a device that could help tell me what that rash
drseisenberg is... #MDchat
T2 @rlbates wondering how MDs feel about #telemedicine tools and
mkmackey dermatology #mdchat

RT @drseisenberg: Nice video RT @hjluks: A lead in... why mny MRIs and
quality1 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
MD_Chat #MDChat
RT @mgfamiliarnet: @drseisenberg perhaps 1 day our smartphone will
have an ultrasonograph, ecg.. Related video: http://bit.ly/axG2rz :)
quality1 #mdchat T1&T2

#MDChat @hjluks Agreed, exam is a must, but effective exam gen'lly not
ScottAWolfeOWP possible in 5 min. Promotes non-holistic care & tendency to over Rx
@mkmackey @dermdoc holds a telemedicine clinic and likes it, I believe
rlbates #mdchat

Technology comes with a price, not only $$, but sensitivity, specificity,
murzee PPV and NPV, & therefore false results Diff from low-tech? #mdchat

could be possible technically?RT @drseisenberg: @rlbates Wish there was

SMSJOE a device that could help tell me what that rash is... #mdchat
 RT @MD_Chat @drseisenberg A more advanced & medically-
centered Google Goggles might be http://www.google.
lsaldanamd com/mobile/goggles/#text #mdchat
RT @MD_Chat: @drseisenberg A more advanced & medically-
centered Google Goggles might be one way http://www.google.
quality1 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
murzee #mdchat
RT @murzee: Technology comes with a price, not only $$, but sensitivity,
specificity, PPV and NPV, & therefore false results Diff from low-tech?
quality1 #mdchat
habdessamad #mdchat just joined in. I guess I'm late!!

@murzee Exactly my point, it is more about teaching an effective decision

lsaldanamd making framework than the exam #mdchat

RT @lsaldanamd: @murzee Exactly my point, it is more about teaching an

mkmackey effective decision making framework than the exam #meded #mdchat

MD_Chat @habdessamad No worries - Transcripts up after the show. #MDchat

@lsaldanamd But then there is also the $$: is the improv. increment
murzee worth the $$ #mdchat

WOW - OK, we're coming up on an hour of #MDchat. We'll wrap up in a

MD_Chat 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
nursingpins #MDchat
@murzee There is always a value piece of the decision making framework
lsaldanamd IMHO #mdchat
Arrived in PM office... Sorry to miss the chat. Looking forward to next
chukwumaonyeije 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!
drseisenberg #MDchat
 @lsaldanamd Cannot disagree w you there, tho' we do not do it well.
murzee & value is so perspective-dependent... #mdchat

MD_Chat OK, let's hear your parting thoughts before wrapping up! #MDchat

lsaldanamd @murzee That is true. That piece needs to be more objective. #mdchat

lsaldanamd 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

drseisenberg return to examination basics. Are basics being lost or improved? #MDchat
Thanks for sharing. I value physician viewpoints and perspectives
mkmackey #mdchat
Thrilled to see MDs online, engaged and so committed. Thx to all on
CACHCA_RCACCS #MDChat. Looking forward to more!
Thanks very much for orchestrating! Interesting ideas. @MD_Chat
murzee #mdchat

@habdessamad Once I process the transcript I'll tweet it out. But the
MD_Chat archive will be here - http://mdchat.org/category/transcripts/ #MDchat
@lsaldanamd Sure - thanks for dropping in. Great contributions from
MD_Chat everyone! #MDChat
mgfamiliarnet I've liked today's #mdchat See you...

TY, Phil! Enjoyed @md_chat! Part Two of our interview w/ @edbennett

Payformance posting later today. Some nice comments 4 @HealthIsSocial #mdchat
MD_Chat @Payformance My pleasure! #MDChat
Sorry I had to drop out.... good chat, good topics.... look fwd to MDCHat
hjluks one evening Rocket man :-) #MDchat

One day a physician will peer in the mirror and see a patient !!! Engaging
hjluks in soc med and in office is good for all! #MDchat

OK, THANK YOU everyone! Transcript will be up this afternoon. Next chat
MD_Chat is tomorrow 10/13 9pm Eastern. (Testing night out. :) #MDchat

@MD_chat love your idea of using Google Goggles as a diagnostic aid!

arthur_alston #mdchat (Just joined, am a bit late, sorry)
 RT @hjluks: One day a physician will peer in the mirror and see a patient
lsaldanamd !!! Engaging in soc med and in office is good for all! #MDchat
RT @lsaldanamd: Or not having a good decision making framework at the
COSMETICMED core of a physicians skill set #mdchat

Today was a pleasure moderating! Enjoyed the contributions to #MDchat

MD_Chat today. This has been @PhilBaumann Cheers!