#MDchat

Healthcare Hashtag Twitter Transcript

From: Tue Feb 01 18:00:00 PST 2011
To: Tue Feb 01 19:05:00 PST 2011

Learn more about #MDchat at The Healthcare Hashtag Project

MD_Chat Good evening & welcome to #MDchat! We'll start in a moment but first introduce yourselves!
Tue Feb 1 18:00:04 PST 2011

GailZahtz #Leadershipchat I have to go over to #MDChat but my kids are calling me also- so either way- great
talking!
Tue Feb 1 18:00:12 PST 2011

RichmondDoc Hi, all. Mark, family doc in #RVA; have a conference call to attend to, but will try to watch the chat as
much as possible. #mdchat
Tue Feb 1 18:01:32 PST 2011

swan5675 Deb here.... lurking RN. #mdchat

Tue Feb 1 18:02:08 PST 2011

GailZahtz For the next hour, I really want to be tweeting from #MDChat since I've missed a week, but I'm multi-
tasking too.
Tue Feb 1 18:02:15 PST 2011

mdstudent31 Kevin, 4th year med student, soon-to-be family med resident, about to get iced by the icepocolypse
#mdchat
Tue Feb 1 18:02:19 PST 2011

GailZahtz Oh, intros at #MDChat- patient, caregivers, wife of MD, founder & CEO Life Guide Institute- infinitely
curious.
Tue Feb 1 18:03:10 PST 2011

Reach4MoJOYRN Toni...RN Training Strategist from Kentucky. #MDchat

Tue Feb 1 18:03:13 PST 2011

fidouglas Fi here. British med student, doing research in Auckland NZ at the mo. #mdchat
Tue Feb 1 18:03:24 PST 2011

jodyms Hi all, Jody Schoger, writer, blogger for women with cancer. #mdchat Lurking.
Tue Feb 1 18:04:00 PST 2011
KathyKastner Health Blogger, patient educator. Lurking but loving the topic. Greetings all. #MDChat
Tue Feb 1 18:05:15 PST 2011

GailZahtz For the record @RichmondDoc and @jodyms completely under-rate themselves, so I'll say THEY
ROCK #MDChat
Tue Feb 1 18:05:31 PST 2011

MD_Chat OK, we'll start in a moment. We'll start with one topic & see how it evolves. One rule here though:
Have fun! ...Topic coming up. #MDchat
Tue Feb 1 18:05:42 PST 2011

RichmondDoc @GailZahtz Shucks @jodyms #mdchat

Tue Feb 1 18:06:07 PST 2011

MD_Chat T1 Psychiatric Medicine: Has the mind/body split set back integrative medicine? If so how? Are
psych D/O brushed off too often? #MDchat
Tue Feb 1 18:06:21 PST 2011

GailZahtz @KathyKastner Hi Kathy WAVING- miss you. So weird being off the grid...#MDChat
Tue Feb 1 18:07:28 PST 2011

RichmondDoc We learn the bio-psycho-social model of care in family medicine. Intrinsic connections; cannot
separate them. #mdchat
Tue Feb 1 18:07:29 PST 2011

mdstudent31 T1: Psych D/O are such a huge component to physical illness, often exacerbate severity. Cannot
have a split #mdchat
Tue Feb 1 18:08:09 PST 2011

RichmondDoc T1 "Physical" illnesses often have psychiatric elements, while psychiatric illnesses adversely impact
"physical" illnesses. #mdchat
Tue Feb 1 18:08:15 PST 2011

GailZahtz @RichmondDoc But how many specialists dismiss something as "just stress" or don't treat
holistically? #MDChat
Tue Feb 1 18:08:16 PST 2011

fidouglas Agree with @RichmondDoc - two are far too heavily interconnected - psychological health affects
physical health and vice versa. #mdchat
Tue Feb 1 18:08:38 PST 2011

RichmondDoc @GailZahtz Hence why Family Medicine is awesome! :) #mdchat

Tue Feb 1 18:08:46 PST 2011

GailZahtz T1 I have found that chronic pain is a clear example of the inextricable nature of physical and
emotional #MdChat #HPM
Tue Feb 1 18:09:24 PST 2011
NateOsit #MDchat Hi, lurked here. Med Transcription Analyst Tufts Medical Center
Tue Feb 1 18:09:32 PST 2011

mdstudent31 T1: Physical D/O can also be the result of psych D/O. Need to address both w/ Tx. Tx does not =
meds. Need support #mdchat
Tue Feb 1 18:09:50 PST 2011

RichmondDoc T1 mind/body dichotomies are inherently artificial; you cannot address one side of any health
concern w/o considering the other. #mdchat
Tue Feb 1 18:10:15 PST 2011

mdstudent31 Amen! #FamilyMedRocks! RT @RichmondDoc: @GailZahtz Hence why Family Medicine is

awesome! :) #mdchat
Tue Feb 1 18:10:33 PST 2011

peds_id_doc @GailZahtz @richmonddoc #mdchat often when we say something is caused by stress it's not
meant to demean it as "just" stress.
Tue Feb 1 18:10:47 PST 2011

GailZahtz @RichmondDoc @mdstudent31 Agree, but I was just reading startling numbers on the decline of
family docs. #MDChat
Tue Feb 1 18:11:06 PST 2011

peds_id_doc @GailZahtz @richmonddoc #mdchat t1 treating holistically is another matter... Not many docs are
truly trained that way.
Tue Feb 1 18:11:22 PST 2011

KathyKastner FamDocs have more complex pt encounters than any other specialty: Medscpe RT @RichmondDoc
: @GailZahtz Family Medicine is awesome! :) #mdchat
Tue Feb 1 18:11:32 PST 2011

MD_Chat T1 Follow-up link re: mind/body split & problems it's caused http://tinyurl.com/4dckc56 #MDchat (for
l8r reading or now)
Tue Feb 1 18:11:35 PST 2011

Reach4MoJOYRN @RichmondDoc Spot on regarding can't address 1 w/o considering the other !!! #MDchat
Tue Feb 1 18:11:48 PST 2011

mdstudent31 @GailZahtz @RichmondDoc Not new numbers. Check out last year's #fammed match numbers
#mdchat
Tue Feb 1 18:11:50 PST 2011

jodyms T1: The most brilliant physicians listen. Key. What is the patient really saying? #mdchat
Tue Feb 1 18:11:51 PST 2011

RichmondDoc @GailZahtz @mdstudent31 We are few, but we are mighty. And there need to be lots more of us.
#mdchat
Tue Feb 1 18:11:55 PST 2011
GailZahtz @peds_id_doc I think communication in language on stress, psychiatric is important to patient.
#MDChat @richmonddoc
Tue Feb 1 18:11:56 PST 2011

peds_id_doc @GailZahtz @richmonddoc #mdchat t1 I have a massage qualification and use aromatherapy, but
rarely get to apply this training in medicine
Tue Feb 1 18:12:01 PST 2011

mdstudent31 @GailZahtz @RichmondDoc Largest increase of all specialties last year was #fammed. Love the
variety, can't wait to be a family doc #mdchat
Tue Feb 1 18:12:59 PST 2011

GailZahtz @peds_id_doc I was thinking more holistically as in the whole person body & mind in relation to T1
#MDChat @richmonddoc
Tue Feb 1 18:13:04 PST 2011

naveen101 #MDChat Question for docs: Is med school "too hard" to get into these days? not hard enough?
Relation to PCP shortage?
Tue Feb 1 18:13:51 PST 2011

RichmondDoc T1 one challenge can be getting patients to understand the connection w/o a patient feeling you are
saying they're "crazy". #mdchat
Tue Feb 1 18:13:55 PST 2011

apjonas #mdchat Hi Pat Jonas, late in the ice in OH,

Tue Feb 1 18:14:07 PST 2011

GailZahtz @peds_id_doc There is evidence-based support for certain applications that are being adopted- like
acupuncture. @richmonddoc #MDChat
Tue Feb 1 18:14:19 PST 2011

RichmondDoc T1 not all patients are receptive to the idea that psychiatric/emotional illnesses can produce physical
sxs. #mdchat
Tue Feb 1 18:14:22 PST 2011

peds_id_doc @GailZahtz @richmonddoc #mdchat t1 i mention massage/aromatherapy as they ARE taught as

holistic approaches to wellness/disease
Tue Feb 1 18:14:23 PST 2011

mdstudent31 Still a problem w/ acceptance of integrative medicine - often dismissed in med school, often by
profs. Not cool #mdchat
Tue Feb 1 18:14:35 PST 2011

mdstudent31 @apjonas sending the ice our way in PA? #mdchat

Tue Feb 1 18:14:55 PST 2011

peds_id_doc @GailZahtz @richmonddoc #mdchat t1 modern medical training is catching on at least. Some docs
still need to be enlightened... ;-)
Tue Feb 1 18:15:05 PST 2011
GailZahtz @peds_id_doc Massage- AKA deep tissue mio-facial post operative something is ALL some PT's
do. It's language. #MDCHAT
Tue Feb 1 18:15:06 PST 2011

swan5675 T1 I think there is prejudice with some healthcare workers regarding "anxiety". #mdchat
Tue Feb 1 18:15:12 PST 2011

fidouglas @RichmondDoc Yeah, I think people might get defensive and think "oh you're just dismissing my
symptoms as being made up". #mdchat
Tue Feb 1 18:15:25 PST 2011

RichmondDoc T1 Integrative medicine and CAM would be much more powerful and accepted if more evidence-
based info out there. #mdchat
Tue Feb 1 18:15:37 PST 2011

GailZahtz @peds_id_doc Any ideas on a platform for enlightenment ;) (wink wink) #MDCHAT @richmonddoc
Tue Feb 1 18:15:47 PST 2011

peds_id_doc @RichmondDoc #mdchat t1 this is where the comm skills help, not just to help with awareness of
the issue but how to talk about it with them
Tue Feb 1 18:16:18 PST 2011

GailZahtz @RichmondDoc That's what I was saying, but by your definition, I don't think it's CAM if it's
evidence based. #MDCHAT @peds_id_doc
Tue Feb 1 18:16:25 PST 2011

hollyby Hi there, Holly Yang here. Hospice and palliative medicine MD. Lurking. First time at #MDchat.
Tweets are my own. #mdchat
Tue Feb 1 18:16:32 PST 2011

mdstudent31 T1: Another problem is pt acceptance of integration b/w mind and body. #mdchat
Tue Feb 1 18:16:41 PST 2011

fidouglas Issue with many skeptics regarding CAM is lack of evidence base. If we can separate what works
from what doesn't, that'd be useful. #mdchat
Tue Feb 1 18:16:58 PST 2011

quality1 @RichmondDoc Insurance now often limits "doctor shopping". So what happens when pts don't
accept connection? #MDChat
Tue Feb 1 18:16:59 PST 2011

jodyms @RichmondDoc T1: true, but just saw a post suggesting that resentment causes cancer....it can go
too far #mdchat
Tue Feb 1 18:17:01 PST 2011

DoctorNatasha Joining late. General suburban pediatrician, SM admin for 12 provider group, blogger. Hi everyone
#mdchat
Tue Feb 1 18:17:07 PST 2011
peds_id_doc @GailZahtz @richmonddoc #mdchat t1 right, acupuncture is the best (only?) supported CAM I know
of, but massage feels nice :-)
Tue Feb 1 18:17:07 PST 2011

GailZahtz @hollyby Hi Holly! I haven't seen you in ages! You'll like #MDCHAT They're all friends of mine
(honoured to say that)
Tue Feb 1 18:17:18 PST 2011

RichmondDoc @peds_id_doc Agree, but can be easier said than done. If not presented carefully pt's defenses go
up and little progress made. #mdchat
Tue Feb 1 18:17:19 PST 2011

swan5675 I remember my Gpa recounting how, in absence of MSO4, war's fresh amputees told N.S. was
morphine, and there was reported relief #mdchat
Tue Feb 1 18:17:36 PST 2011

KathyKastner @hollyby Hi Holly! Gr8 to have an #hpm-er here #mdchat

Tue Feb 1 18:17:46 PST 2011

peds_id_doc @GailZahtz @richmonddoc #mdchat t1 aromatherapy on the other hand needs more EBM, and at
least some caution in use. Basically drugs.
Tue Feb 1 18:18:05 PST 2011

GailZahtz @peds_id_doc There must be evidence based for massage for scar tissue post-op. Insurance pays
for it. #MDCHAT @richmonddoc
Tue Feb 1 18:18:07 PST 2011

RichmondDoc @quality1 Depends. Sometimes a partner could take them on. Sometimes, have to do the mature
thing and talk out the differences. #mdchat
Tue Feb 1 18:18:07 PST 2011

mdstudent31 @RichmondDoc @peds_id_doc Especially true with conversion presentations #mdchat

Tue Feb 1 18:18:23 PST 2011

RichmondDoc @GailZahtz @peds_id_doc You can have evidence-based CAM. NIH has an institute focused on
CAN. #mdchat
Tue Feb 1 18:18:40 PST 2011

hollyby @GailZahtz and@KathyKastner. Been BUSY! Tweeting from Tbilisi, Georgia where we are teaching
pain and palliative care topics. #mdchat
Tue Feb 1 18:19:08 PST 2011

RichmondDoc @GailZahtz @peds_id_doc Not all insurance-covered Rx are evidence-based. Not all evidence-
base Rx are covered by insurance. #mdchat
Tue Feb 1 18:19:12 PST 2011

mdstudent31 @peds_id_doc @GailZahtz @richmonddoc acupuncture has a lot of systemic review on Cochrane I
believe #mdchat
Tue Feb 1 18:19:21 PST 2011
apjonas T1 #mdchat I don't see pts who R unaware that mind, brain, body are one. Not a problem. Tng of
many docs sets them up to fight w/pts Re brn
Tue Feb 1 18:19:42 PST 2011

GailZahtz @RichmondDoc But if there's evidence based research for CAM- it passes doesn't it? #MDCHAT
@peds_id_doc
Tue Feb 1 18:20:07 PST 2011

fidouglas Efficacy to funding relationship not always logical. NHS funds homeopathy. #mdchat
Tue Feb 1 18:20:30 PST 2011

mdstudent31 @RichmondDoc @GailZahtz @peds_id_doc & not all docs get reimbursed the same for providing
same treatments #mdchat
Tue Feb 1 18:20:45 PST 2011

GailZahtz @hollyby Where are you teaching in Tbillsi, Georgia? #MDCHAT

Tue Feb 1 18:20:47 PST 2011

RichmondDoc @GailZahtz @peds_id_doc Yes--that CAM that is EBM is easy to recommend to pts. But not nearly
enough out there. #mdchat
Tue Feb 1 18:20:49 PST 2011

quality1 @RichmondDoc Find some pts interpret discussing connection as blaming them for the sx/illness.
Uphill battle to re-establish rapport #MDChat
Tue Feb 1 18:21:03 PST 2011

RichmondDoc @GailZahtz @peds_id_doc Especially w/ herbal meds: no incentive from makers/marketers to

assess honestly. No FDA approval needed. #mdchat
Tue Feb 1 18:21:26 PST 2011

raovac Its a shared mental model thing RT @jodyms: T1: The most brilliant physicians listen. Key. What is
the patient really saying? #mdchat
Tue Feb 1 18:21:27 PST 2011

GailZahtz @peds_id_doc Just puts the onus on someone to do the EBM on the CAM to support. Not just woo.
#MDCHAT @richmonddoc
Tue Feb 1 18:21:56 PST 2011

FutureDrLucky @mdstudent31 I know this is #MDchat, but u might be interested to hear that integrative medicine is
commonly emphasized in DO programs. :)
Tue Feb 1 18:21:57 PST 2011

RichmondDoc @quality1 Often, if I sense resistance, I very gradually build up to the idea while also ensuring I
work-up poss physical causes. #mdchat
Tue Feb 1 18:22:11 PST 2011

hollyby T1 #Hospice and #palliative medicine is one field that always considers the mind, body, spirit,
family, etc. togther. #mdchat
Tue Feb 1 18:22:19 PST 2011
mdstudent31 @quality1 @RichmondDoc I have seen the same Re: rapport. Very difficult, often dismissed
#mdchat
Tue Feb 1 18:22:23 PST 2011

drseisenberg T1: Mind + body + evidence-based caring = integrative medicine. Played a song on guitar today for
the chemo room. Pts. had fun. #MDchat
Tue Feb 1 18:22:48 PST 2011

GailZahtz @RichmondDoc The issue of herbals is where I will take the side (gasp) of #socpharm which is
there needs to be regs #MDCHAT @peds_id_doc
Tue Feb 1 18:22:50 PST 2011

RichmondDoc @FutureDrLucky For what it's worth, it's MDChat for convenience. DOs and all other interested
parties should dive in. #mdchat
Tue Feb 1 18:23:03 PST 2011

fidouglas Psychological factors have direct effects on physiological factors (elevated cortisol levels during
stress etc...) #mdchat
Tue Feb 1 18:23:13 PST 2011

quality1 @apjonas Wow, fortunate; where do you practice? RT @apjonas: T1 I don't see pts who are
unaware that mind, brain, body are one. #MDChat
Tue Feb 1 18:23:16 PST 2011

mdstudent31 @FutureDrLucky Having contact w/ DO students all the time, know all about it, love it, & will pursue
CAM training & OMM fellowship #mdchat
Tue Feb 1 18:23:23 PST 2011

RichmondDoc @mdstudent31 @quality1 "never underestimate the therapeutic power of self". #mdchat
Tue Feb 1 18:23:31 PST 2011

GailZahtz @RichmondDoc @FutureDrLucky An important distinction: We Support all physicians. Different

countries give different titles ;) #MDCHAT
Tue Feb 1 18:23:56 PST 2011

hollyby @drseisenberg Nice! Music definitely helps! #mdchat

Tue Feb 1 18:24:17 PST 2011

peds_id_doc #mdchat need to sign off early, sorry for the short stay. I see enough good peeps to carry the flag
though!
Tue Feb 1 18:24:42 PST 2011

quality1 .@RichmondDoc: Sadly, not enough hcp of your calibre or this wouldn't remain such a difficult
barrier. #MDChat
Tue Feb 1 18:24:44 PST 2011

apjonas #mdchat I'm trained in aromatherapy. Not billable medically. It's complementary to medical care
Tue Feb 1 18:25:10 PST 2011
drseisenberg @hollyby Were your ears ringing the other day? #MDchat
Tue Feb 1 18:25:30 PST 2011

RichmondDoc @GailZahtz @peds_id_doc There need to be evidence-based trials/regs for herbals. Natural ain't
safe. Foxglove and cyanide=natural #mdchat
Tue Feb 1 18:25:36 PST 2011

mdstudent31 @RichmondDoc @GailZahtz @peds_id_doc NIH has database of trials... not many good trials w/
spotty evidence #mdchat
Tue Feb 1 18:26:30 PST 2011

GailZahtz @mdstudent31 Where's the database of trials at NIH? #MDCHAT

Tue Feb 1 18:26:59 PST 2011

RichmondDoc @mdstudent31 @GailZahtz @peds_id_doc Herbal meds = vitamins. No regulation

needed/involved/required to sell them. #mdchat
Tue Feb 1 18:27:23 PST 2011

RichmondDoc @GailZahtz @mdstudent31 This might be a starting point: http://nccam.nih.gov/ #mdchat

Tue Feb 1 18:27:53 PST 2011

mdstudent31 @GailZahtz @mdstudent31 http://nccam.nih.gov/research/results/ #mdchat

Tue Feb 1 18:28:27 PST 2011

apjonas #mdchat German commission E did EBM on herbs, but same ones/doses not standardized. They
didn't test my Saw Palmetto brand/dose
Tue Feb 1 18:28:27 PST 2011

mdstudent31 @RichmondDoc @GailZahtz @peds_id_doc As a former GNC employee for 2 years, I know it first
hand #mdchat
Tue Feb 1 18:28:47 PST 2011

drseisenberg We have accupunture/TCM, psychology, and nutrition as part of our integrative oncology team.
#MDchat
Tue Feb 1 18:28:56 PST 2011

mdstudent31 http://www.nlm.nih.gov/medlineplus/complementaryandalternativemedicine.html #mdchat

Tue Feb 1 18:29:23 PST 2011

mdstudent31 Cochrane database has a great amount of systemic reviews for CAM #mdchat
Tue Feb 1 18:30:03 PST 2011

drseisenberg True integration means real communication amongst all the practioners involved. #MDchat
Tue Feb 1 18:30:07 PST 2011

hollyby From your rocking guitar floating down the coast? :) RT @drseisenberg: @hollyby Were your ears
ringing the other day? #mdchat
Tue Feb 1 18:30:27 PST 2011
apjonas #mdchat nutrition, psychology are mainstream healthcare =billable. Who pays for TCM/
Tue Feb 1 18:30:50 PST 2011

mdstudent31 @drseisenberg Maybe something like #pcmh? #mdchat

Tue Feb 1 18:30:56 PST 2011

GailZahtz @drseisenberg True communication means with all the patient's support systems too doesn't it?
Hard for busy docs. #MDCHAT
Tue Feb 1 18:31:00 PST 2011

DoctorNatasha Agreed! RT @drseisenberg: True integration means real communication amongst all the
practioners involved. #MDchat
Tue Feb 1 18:31:08 PST 2011

hollyby Interdisciplinary teams (MD, RN, MSW, spiritual care, ...) essential for whole patient care.
Definitely helps with communication. #mdchat
Tue Feb 1 18:32:18 PST 2011

GailZahtz @hollyby @DoctorNatasha @RichmondDoc @drseisenberg Yeah for interdisciplinary teams and
communication! #MDCHAT
Tue Feb 1 18:33:18 PST 2011

apjonas @mdstudent31 If they have+ reviews, it's Medical not CAM. There is no M in CA. . Once proven
it's ours #mdchat
Tue Feb 1 18:33:26 PST 2011

mdstudent31 @hollyby TransforMED is helping in this process http://www.transformed.com/ #mdchat

Tue Feb 1 18:33:37 PST 2011

Reach4MoJOYRN TA:RT@hollyby: IDy teams (MD, RN, MSW, spiritual care) essential for whole patient care.
Definitely helps with communication. #MDchat
Tue Feb 1 18:33:44 PST 2011

mdstudent31 @apjonas Or whoever the state says is licensed that can provide it ;) #mdchat
Tue Feb 1 18:34:11 PST 2011

FutureDrLucky @peds_id_doc @mdstudent31 @RichmondDoc Thanks guys! Feeling the love! Cooperation
among all docs is the way to advance medicine. #mdchat
Tue Feb 1 18:34:31 PST 2011

RichmondDoc @FutureDrLucky @peds_id_doc @mdstudent31 Agree--we all need to be working together;

cross-disciplinary care matters. #mdchat
Tue Feb 1 18:36:04 PST 2011

drseisenberg Absolutely. Caregivers need love. RT @GailZahtz: True communication means with all the
patients support systems too doesn't it? #MDchat
Tue Feb 1 18:36:33 PST 2011
hollyby Agree that increasing integrative EBM would help acceptance. If it makes people feel better,
evidence or no, pts will use it. #mdchat
Tue Feb 1 18:36:38 PST 2011

Reach4MoJOYRN @FutureDrLucky @peds_id_doc @mdstudent31 @RichmondDocThanks guys! Feeling the love!

Coop among clinicians=way to advance Healthcare. #MDchat
Tue Feb 1 18:37:08 PST 2011

DoctorNatasha No need to wait for EMR, docs to e-mail, SM, or apps. Pick up the phone to communicate with
providers to do what is best for pt. #mdchat
Tue Feb 1 18:37:15 PST 2011

GinaRClark @hollyby Where do I find that dream come true? #mdchat

Tue Feb 1 18:37:15 PST 2011

GailZahtz @RichmondDoc @FutureDrLucky @peds_id_doc @mdstudent31 @drseisenberg All this love for
cooperation & communication! #MDCHAT
Tue Feb 1 18:37:41 PST 2011

mdstudent31 How do those feel about "punting" to psych instead of primary team addressing mind issues in
hospital. Happens a lot! #mdchat
Tue Feb 1 18:37:47 PST 2011

MD_Chat T1a Follow-up So on the matter of Collaboration - what improves it? What hampers it? Any
examples of it being done well? #MDchat
Tue Feb 1 18:37:50 PST 2011

RichmondDoc T1a: Improves: each side of the encounter actually trying to communicate; hampers: one side or
the other doesn't care/try. #mdchat
Tue Feb 1 18:38:59 PST 2011

Reach4MoJOYRN @MD_Chat T1a f/u..what improves it= communication and team work. #MDchat
Tue Feb 1 18:39:12 PST 2011

GailZahtz @hollyby EBM would definitely increase acceptance, so would protocols at hospitals. Patients
need to be able to talk to docs re use #MDCHAT
Tue Feb 1 18:39:17 PST 2011

apjonas #mdchat what T are we on.? I just got into NLP mode and took 3 deep breaths my inner healer
came in and poof! but now I'm back
Tue Feb 1 18:39:21 PST 2011

RichmondDoc T1a Our Oncology service has multidisciplinary patient-care sessions, and patient-care meetings
to address all needs: great model. #mdchat
Tue Feb 1 18:39:41 PST 2011

mdstudent31 T1a: Fragmentation/"signing off" and lack of communication b/w primary team and specialists
hamper it (that's a given) #mdchat
Tue Feb 1 18:39:43 PST 2011
MD_Chat @apjonas Still on T1, but just asked a follow-up to it
http://twitter.com/#!/MD_chat/status/32628732120276992 #MDchat
Tue Feb 1 18:40:28 PST 2011

GailZahtz @apjonas You made me snort out loud! Okay, goodbye to your inner healer, hello you. But is
your inner healer EB? #MDCHAT
Tue Feb 1 18:40:30 PST 2011

quality1 .@MD_Chat: T1a Organizational culture can support or hinder collaboration. Lack of caring
/empathy, lack of time can hinder #MDChat
Tue Feb 1 18:40:31 PST 2011

mdstudent31 T1a: also have an issue w/ prev. question I raised about "punting" to psych before attempting to
address mind issues #mdchat
Tue Feb 1 18:40:37 PST 2011

DoctorNatasha In our community, I will refer more pts to docs who will send me an email after they see my pt.
Those #s are few, however, #mdchat
Tue Feb 1 18:41:25 PST 2011

apjonas T1a Get- Give- Merge- GO relationship model of Carkhuff assoc. a good collaboration enhancer.
#mdchat
Tue Feb 1 18:42:01 PST 2011

drseisenberg T1a: Laughter improves; Taking oneself too seriously hampers. #MDchat
Tue Feb 1 18:42:05 PST 2011

Reach4MoJOYRN T1a...another great model "daily rounds" work done by #Peter Pronovost at John Hopkins. Wrote
book..Safe Pts Smart Hospitals. #MDchat
Tue Feb 1 18:42:48 PST 2011

quality1 @DoctorNatasha Sad to say but when I am a pt, I ask all docs to send report to my PCP and get
push back. Collaboration still not std #MDChat
Tue Feb 1 18:43:11 PST 2011

mdstudent31 T1a: Poor communication b/w docs & support staff (nurses, etc.) also causes probs. Just as
important as comm bw docs #mdchat
Tue Feb 1 18:43:17 PST 2011

apjonas #mdchat using checklists and practicing as a team enhances collaboration

Tue Feb 1 18:43:20 PST 2011

hollyby @GinaRClark Interdisiplinary work is happening more in HC settings, but is core to #palliative
med. I'm grateful to work w/ a team! #mdchat
Tue Feb 1 18:43:31 PST 2011

FutureDrLucky Awesome. RT @dreisenberg Mind+body+evidence-based caring = integrative med. Played song

on guitar today 4 chemo room. Pts. had fun. #MDchat
Tue Feb 1 18:44:00 PST 2011
quality1 (Things that help or hinder collaboration) RT @drseisenberg: T1a: Laughter improves;
Taking oneself too seriously hampers <Gr8 point #MDChat
Tue Feb 1 18:44:01 PST 2011

mdstudent31 T1a: Pts have increased satisfaction w/ care when all biopsychosocial needs are addressed
adequately- best w/ team #pcmh #mdchat
Tue Feb 1 18:45:00 PST 2011

hollyby T1a: Collaboration and interdisciplinary team work takes culture change and needs a
champion in each health care setting. #mdchat
Tue Feb 1 18:45:02 PST 2011

GailZahtz TY everyone at #MDCHAT at #LEADERSHIPCHAT and the RT's of http://bit.ly/fW8p9o "So

you think you can lead a start-up?" Signing off :))
Tue Feb 1 18:45:18 PST 2011

DoctorNatasha T1a - Good models enhance/support MDs plan... they limit conflicting plans that may confuse
pt, undermines PMD. #mdchat.
Tue Feb 1 18:45:41 PST 2011

FutureDrLucky Agree. Saw 2 much of this as RD. RT @mdstudent31 Poor com b/w docs & support staff
causes probs. Just as important as comm bw docs #mdchat
Tue Feb 1 18:45:52 PST 2011

GinaRClark @hollyby You are indeed fortunate. The team approach seems logical but not as common as
patients' hope for. #mdchat
Tue Feb 1 18:46:52 PST 2011

mdstudent31 @FutureDrLucky Docs often take nursing/support staff for granted. Need good rapport w/
vital members of team #mdchat
Tue Feb 1 18:47:11 PST 2011

drseisenberg T1a: Culture eats strategy for breakfast (Motto of Tribal Leadership). #MDchat
Tue Feb 1 18:47:16 PST 2011

apjonas #mdchat When we have an interdisciplinary budget, we'll have better support for teams. Silos
don't collaborate well
Tue Feb 1 18:48:39 PST 2011

mdstudent31 @apjonas Agreed: silos do not work for any well-functioning organization or team. Recipe for
collapse and poor pt care #mdchat
Tue Feb 1 18:49:52 PST 2011

HospitalPatient Is a Registered Nurse's "allegiance" to his/her Patient or to the Ordering Doctor? That is,
when "push comes to shove" #mdchat
Tue Feb 1 18:50:02 PST 2011

drseisenberg T1a: The 5 C's. Communication, Collaboration, Culture, Community, Compassion. #MDchat
Tue Feb 1 18:50:46 PST 2011
FutureDrLucky So true, @mdstudent31. Medicine works best as a team approach, w/ docs & ancillary staff
working together as one cohesive group! #mdchat
Tue Feb 1 18:50:57 PST 2011

mdstudent31 @HospitalPatient It is the RN's allegiance to get on right page w/ doc when looking out for pt.
Speak up, speak often for pt sake #mdchat
Tue Feb 1 18:51:17 PST 2011

HospitalPatient Clearly, as a Patient, I understand an RN's "role" but some "go to bat" 4 patients and others r
driven ONLY by Doc's orders. #mdchat
Tue Feb 1 18:51:38 PST 2011

HospitalPatient A Patient's input (e.g. drug side effects) sometimes gets lost when that "communication
chain" is not so "pure." #mdchat
Tue Feb 1 18:52:35 PST 2011

mdstudent31 @HospitalPatient All members of team should be empowered to talk to each other,
regardless of "rank", whatever that is #mdchat
Tue Feb 1 18:52:44 PST 2011

MD_Chat @mdstudent31 Are the nurses "support staff" for docs, or is it the other way around? ;) Or
aren't we all support staff for patients? #MDchat
Tue Feb 1 18:53:05 PST 2011

HospitalPatient @mdstudent31 @HospitalPatient THX - That's how it should be. #mdchat

Tue Feb 1 18:53:13 PST 2011

apjonas @HospitalPatient Remember who pays the nurse and the doc. Remember to also follow the
money when wondering about allegiance, etc. #mdchat
Tue Feb 1 18:53:33 PST 2011

HospitalPatient Unfortunately, "Reality" in Big Hospitals with Egos, Pressure, Politics, etc. - the Patient is
LAST in that chain. NOT fun. #mdchat
Tue Feb 1 18:54:05 PST 2011

HospitalPatient @apjonas @HospitalPatient LOL GREAT #mdchat

Tue Feb 1 18:54:24 PST 2011

mdstudent31 @MD_Chat We are all support for each other. Pt is also "support staff", their input on
decisions/communication just as important #mdchat
Tue Feb 1 18:54:34 PST 2011

quality1 @apjonas @HospitalPatient Sorry to disagree, but believe most HCP I work with are NOT
more loyal to payck than to patients. #MDChat
Tue Feb 1 18:55:17 PST 2011

mdstudent31 @HospitalPatient That's why I didn't rotate at "big hospitals". >80% of care provided in
community - where medicine really happens #mdchat
Tue Feb 1 18:55:32 PST 2011
MD_Chat @mdstudent31 Agree - the whole process is collaborative among all parties. #MDchat
Tue Feb 1 18:56:01 PST 2011

HospitalPatient @quality1 @apjonas @HospitalPatient I was just kidding. I know what was meant. #mdchat
Tue Feb 1 18:56:06 PST 2011

HospitalPatient @quality1 @apjonas @HospitalPatient I am SO grateful to folks like you who are driven that
way. Thank you. #mdchat
Tue Feb 1 18:56:40 PST 2011

Kind4Kids That's what systems-based practice is all about, the ability to call effectively on others
http://goo.gl/J64IC #mdchat
Tue Feb 1 18:57:03 PST 2011

quality1 @HospitalPatient Don't think its the size of the hospital but the calibre of the ldrship. Worked
in 700 bed hosp where care rocked! #MDChat
Tue Feb 1 18:57:48 PST 2011

HospitalPatient @Kind4Kids Systems-Based Practice "reads" well but reality - at least from a patient's
perspective - is TOTALLY different. #mdchat
Tue Feb 1 18:58:03 PST 2011

MD_Chat WOW - hour's coming up!!! These chats go so so so fast! Let's wrap up in a moment. Hit us
with your concluding thoughts. #MDchat
Tue Feb 1 18:58:26 PST 2011

HospitalPatient Granted, Emergencies and Pressure plays into that but .. #mdchat
Tue Feb 1 18:58:32 PST 2011

HospitalPatient @quality1 @HospitalPatient "Caliber of Leadership" as the Benchmark is Fantastic. I hope

you run the next Hospital I enter. :) #mdchat
Tue Feb 1 18:59:12 PST 2011

Reach4MoJOYRN It's all about the patient & for the sake of the patient. #MDchat
Tue Feb 1 18:59:56 PST 2011

RichmondDoc Final thought: good teams are horizontal: communication, suggestions, feedback need to
flow in all directions; leaders must be open. #mdchat
Tue Feb 1 19:00:01 PST 2011

HospitalPatient Good Leaders MUST Listen. Many do not. That's how I know QUICKLY when I must go
above a Doctor at a Hospital (as a Patient). #mdchat
Tue Feb 1 19:01:20 PST 2011

mdstudent31 Mind/Body cannot be separated - necessary for medical team AND Patient to understand its
importance for overall health #mdchat
Tue Feb 1 19:01:53 PST 2011
apjonas #mdchat Team challenge is integrating complexity of ea discipline within team's complexity 2 make team
inseparable just like mind/body/brain
Tue Feb 1 19:02:33 PST 2011

Kind4Kids @HospitalPatient Fully agree, there is much work to be done in reality. #mdchat
Tue Feb 1 19:03:01 PST 2011

hollyby Listening is key to communication, interdisciplinary work, and whole patient care. #mdchat
Tue Feb 1 19:03:34 PST 2011

MD_Chat This was an awesome chat! All of you do such an amazing job here - diverse views, great vibe!! Great
contributors each of you!! #MDchat
Tue Feb 1 19:03:53 PST 2011

MD_Chat THANK YOU, everybody! I'll have the transcript up in a moment. See our blog too http://MDchat.org for
Newsletter/Transcripts #MDchat
Tue Feb 1 19:04:56 PST 2011