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The final meds have been coming in for some last-minute prep for their exams. They’re a smart bunch and, for the most part, confidant, warm and don’t take themselves too seriously. Much as I’m enjoying the experience, they sure do ask a lot of questions and seem to spend a lot of time on their phones.
This week, while passing on some of my hard-earned pearls of wisdom, I was more than a little annoyed to see that my student for the day was typing away at his mobile phone as I spoke. Whereas I am well used to being ignored in my own home by social media-addicted teenagers glued to their devices, this felt a little different. ‘This bloody generation,’ I thought to myself. Before I know it, I’ll be asked to pose for a selfie.
“Anything interesting happening on Facebook?” I asked.
“It’s not Facebook,” he remarked, looking completely unfazed, and even a little disappointed in me. “It’s Facebook Messenger. My classmates are messaging me to let me know that I’ve got a tutorial with Prof in an hour. I’ve also been taking notes on the short cases you’ve been showing me on Evernote and sharing them with my friends who are on the wards. I was also checking something you said earlier,” he remarked, without a trace of embarrassment.
“According to this article, the incidence of the HLA B-27 gene in ankylosing spondylitis in Asian populations is a good bit higher than you mentioned. Do you remember where you got that figure?”
My, how things have changed. In my day, no-one but the swottiest, show-offy, and most annoying medical students would take their lives into their own hands by attempting to challenge a consultant’s assertions. No matter how ridiculous or made-up they sounded. To do so would have involved a trip to the library, a manual Index Medicus search, and a two-week wait for the paper to arrive though an interlibrary loan. These days, anyone with access to a phone can do it. It’s a pain in the ass.
Today’s students are of a generation brought up on technology with ‘always on’ access to the Internet. Because they have access to all of the information they need online (ie, they don’t have to memorise everything), they can instantly check facts as they go along and, moreover, they are not afraid to challenge nonsense when they hear it. That has got to be a good thing — even if it means someone like me occasionally being challenged.
Nonetheless, my pride demanded that I have the final word.
“Medicine in the real world,” I announced, in a voice pitched half an octave higher than usual, “is not just about having information, you know. It is about being present, really present with another person, listening, really listening, and doing our best to apply whatever knowledge and technical expertise from that information to human beings.”
Then, after pausing for emphasis: “That takes time, experience, and a degree of humility that you can’t learn from Wikipedia. Now, if you could just put down your phone for a minute and listen, you might learn something.”
The speech, of course, took place in my head as I drove home alone in my car, feeling more than a little dejected and redundant. You wouldn’t dare have an outburst like that in front of a student these days. You might end up on YouTube.
But as it happens, I have some sympathy for the final meds this year. I’m going to be taking part in the exams myself, for the first time since 1989, when I last sat them. I’m more than a little nervous about the whole affair. Not as nervous as them, of course.
At least I’ll be able to bring my phone.
Postscript: The details have been changed to protect the identities of those involved. But I have a good memory for faces.
This article was originally published in the The Medical Independent
Having excitedly accepted an offer to travel to Sydney to speak at a meeting later this year I find myself more than a little bit apprehensive as the presenter of the topic ‘The doctor of the Future’. How can anyone know how we’ll be practicing medicine in, say, 10 years?
The world is changing very, very quickly. Technology has transformed (and even led to the downfall) of news print media, travel, music, telephony and banking. As consumers, we have become spoilt with almost infinite inventories from online retailers. We can book flights and all means of travel online. We have instant access to virtually unlimited quantities of information, massive computing power in our pockets and the way in which we define our social networks has changed in ways we could not have imagined.
If we believe the hype, the practice of medicine is going to be disrupted in similar ways.
As a lover of technology I have allowed myself to get caught up in the hype and promise of technology to a greater extent than many. I have been seduced by (and then fallen out love with) all sorts of gadgets and services. Some have undoubtedly helped; the electronic medical record, email, text messaging & high speed internet have been a blessing. Twitter, the way in which it has redefined and expanded by professional network, has changed the way in which I access medical information. Having well motivated, informed patients has helped and sometimes challenged me in ways I wouldn’t have anticipated even 5 years ago.
And yet, improvements in medical treatments aside, when I think of my working day seeing patients, things haven’t altered that much. The nuts and bolts of what I do – listening, touching, empathising, thinking & prescribing hasn’t really changed. Its just that I think (it may too soon to be sure) that technology has freed me up with a little more time to do these things better.
What do you think?
How would you like the doctor of the future to be?
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“Its just like taking you home with me doctor.”
The comment came, accompanied by a wink and warm smile, from a patient called Mary.
Mary was giving me some honest feedback on some informational videos (featuring me) that I had sent to her using a platform called Vidscrip*. Just in case you were wondering.
Vidscrip (formerly Clear.MD) allows doctors to prepare short informational videos for their patients for use before and after visits to their doctor. After her last visit, I had sent her 3 video prescriptions (‘Vidscriptions’) each containing 10-12 short videos (here, here and here) of me answering frequently asked questions about her diagnosis and treatment.
No matter how clear we may think we are when communicating information to our patients, a lot of what we say to our patients is quickly forgotten. The questions that most need answering often occur to patients during the car ride home, while chatting to friends, or when they wake, panic stricken, in the middle of the night. “Did he say to take it BEFORE or AFTER food?”
This often results in unnecessary worry, frantic Google searches and ultimately, telephone calls or extra appointments or to doctors to clarify information. Distressing for patients and a thorn in the side of a busy doctor.
Having used them for years, I was never convinced that printed information sheets (or pamphlets) are ever completely read, or generate the sort of engagement necessary to make information stick. Having experimented with a few videos which I uploaded to Youtube I quickly realised that my carefully prepared presentations were mixed up with all sorts of content from quacks, supplement salesmen, cat videos and overlayed with Google ads.
Then my friend, orthopaedic surgeon (and early pioneer of the use of video in patient education), Howard Luks, introduced me to Vidscrip. Within a week, a tripod, iPhone bracket mount, microphone and green-screen arrived by courier and within a few days (and a few hilarious botched attempts) I was up and running.
I have been using this platform to communicate information to my patients for 18 months now. I have prepared 12 Vidscriptions (incorporating 100 videos) on the more common conditions seen at my clinic, procedures I most frequently perform, and the medications I most often prescribe. I also sourced questions from subscribers to my practice Facebook page and followers on Twitter.
Until recently, the videos were recorded using an camera phone and tripod (usually with an assistant) but recent improvements in the system mean that videos can be recorded, directly to a laptop or desktop computer, and uploaded in seconds. Once uploaded, the videos are instantly formated to the multiple formats necessary for multi-device viewing and video titles automatically superimposed. It also possible to add patient surveys, quizes, feedback questions, and banner adds (mine links to my blog) to each video. It is also possible to share video information prepared by other health care professionals and expert patients (Arthritis ePatient, Hurtblogger has prepared some excellent content for example).
Navigating to the information
The system allows a printed list of ‘Vidscriptions’ to be produced. The relevant vidscrips are then ticked, and handed to my patient . The patient then simply navigates directly to the Vidscrip Website, enters a 5 digit code, and is then directed to the relevant video information. Videos can then be watched on desktop, tablet, iPhone or Android device and then shared by email, Facebook, Twitter (or any social network).
Each of the videos is less than 1 minute as most viewers of online video stop watching after a minute or two . This means breaking topics down into granular form. Vidscrip offers templates which prompt the user on what information to include for medical conditions, medications, procedures, tests etc.
The Vidscrip system also allows tracking of viewer engagement with the content. It possible to determine the number of ‘hits’ for any video, the geographical location of each viewer, and how long each video is viewed for (the average duration of video watched for my content is 86%). This allowed me to re-write an record a number my videos after noticing that viewers stopped watching early on. Ultimately though I have relied on feedback from my patients about the videos. It has been overwhelmingly positive.
To date I have been using it to provide information to patients after a clinic visit to supplement information provided face to face. In coming months I plan to provide access to information to patients before they see me. This will include information about me, my specialty and what to expect on their first visit to hospital.
As to whether it saves me time and reduces the number of telephone calls to my office- I’m not yet sure. But at least my patients get to take me home…
More on how to record video content for patients will follow in another blog post
*Disclaimer – Dr. Kavanagh has acted as a medical advisor for Vidscrip.
“Are you bored yet?”
I can remember my old boss asking the question, a few years into my new job as a medical consultant.
How could I have been bored? I was doing what I had always aspired to do, in the city I loved and grew up in, and of course I was being well paid to do it.
But I was. Bored.
The initial excitement of completing my training and of setting up my own practice had waned, and the reality and daily grind of clinical practice was beginning to take its toll. I was keen for a new challenge.
But what else can a doctor do? Medical training is largely vocational. The brotherhood of medicine tends to frown upon those who betray our doctrine. Of course I knew a few doctors who had either left medicine altogether or who had branched out into other areas. None of the options I had seen my collegaues avail of seemed ideal ; working for pharma, working in the financial sector, consulting, full time writing, comedy, film making. The options for a doctor experiencing a mid-life crisis, therefore, seemed limited.
So I took up triathlon. I learned how to bake bread. I grew a beard.
Then along came Twitter.
Twitter introduced me to doctors who had ventured outside the narrow silo’s of our profession – entrepreneurs, geeks, and writers & poets from around the world. I met people from outside medicine keen to improve health – patients, technology entrepreneurs, designers, architects, mathematicians, physicists, philanthropists. All of a sudden my mind was opened to a world outside medicine and of almost endless possibilities for what I might be able to do with myself.
Either directly, of indirectly as a result of ideas I have been exposed to or people I have initially met on Twitter some amazing possibilities began to open up for me and as a result;
I became aware of and attended 3 amazing medical innovation conferences ( TEDMED in Washington, Millenial Medicine in Texas and Doctors2.0 in Paris) and have initiated and helped organise 3 medical conferences of my own.
By harnessing the power of like minded professionals around the world, I have transformed the way in which I learn. Twitter allows me to learn on an ongoing basis in a way that is truly collaborative and dynamic and with a resonance that makes information stick. I have also have also made new friends from around the world (that’s not supposed to happen over the age of 40 apparently).
I now write a regular blog and write a regular column for a medical newspaper.
I have become a medical advisor for a number of health technology companies. In doing so, I have been exposed to the amazing energy and vibrancy of medical entrepreneurs (like John Brownlee of Vidscrip, Paul McCarthy of Fullhealth, and Jim Joyce of VSnap, and John Dineen of Pubble). Its good to be around people who are not afraid to fail.
I have travelled to a number of countries as a medical speaker.
I have learned how to use video technology for patient education and how this technology may actually help humanise doctors improve patient engagement.
Each venturing out suggested another new possibility and choice, an as a result my life is invariably richer and more fulfilled.
Exciting as it all has been (and continues to be), each of these forays has somehow brought me back full circle. Stepping outside medicine for a while, and looking back on my job from a different perspective, I have rekindled some of the enthusiasm I had for medicine as a medical student.
As for boredom? I don’t have time.
DotMed 2013 will be held on Friday December 6th in Smock Alley Theatre in Dublin.
DotMed is a Festival of the future of medicine. This years programme will include presentations from an amazing line up of international speakers on the future of medicine, social media and digital health from Dr. Bryan Vartebedian , Dr. Bertalan Mesko and Lucien Engelen, Dr. Anne Marie Cunningham and Dr. Jordan Grumet .
We’ve also got talks from two medical students (Alan Corbett and Mahmood Mirza ) on their vision for the future of medical education. There’s a workshop from Alexa Miller on how interacting with art can improve the observational skills of doctors, and we’re also going to be told a story about what its like to be stabbed by New York based story teller, patient, architect (and boxer), Ed Gavagan. We’ve even got some live music at the event from award winning We Banjo 3.
Our invited audience will include health care professionals, patients, people from technology industry, Arts practitioners, gallery curators and pretty much anybody who is interested in where health care interfaces with the rest of the world.
We hope attendees will be entertained and educated but also inspired to think a little differently about how they view health and where they’re going to fit into this rapidly changing environment.
The good news is that we’ve got a few spaces left for health care professionals. If you’re interested in attending please register your interest or just send me an email on rt.kavanagh @ gmail.com
Please note because of the size of the venue, we are unable to admit delegates who have not registered for the meeting in advance.
“Attending a medical conference using Twitter is like the difference between driving a Mini and a Ferrari”
This nice quote (paraphrased) from my New Zealand twitter community friend, Dr. Rebecca Grainger, nicely sums up the intensity of the dynamic of using Twitter at a medical conference.
Whereas I have been live-tweeting from conferences for a few years now, this year’s experience was dramatically different .The numbers of doctors tweeting at the ACR has increased dramatically and this has added a a whole new dynamic to the meeting;
One of the difficulties I have had with meetings in recent years is that I have been overwhelmed by the amount of information on offer. Twitter now allows a valuable community of information seekers to collect, filter and share knowledge through the lense of their respective experiences. The growing size of the Twitter community means that there is much bigger net available to to do that job efficiently – with specialists from different backgrounds, clinical, and research interests – all working with the focus of trying to understand and summarise information for themselves, their colleagues, and patient community.
Live-tweeting as part of a community also allows participants to feel that they are taking part in the meeting – rather than just being passive recipients of information. It is during the informal information exchange between people that the real learning resonances and cementing of useful information takes place. Twitter information exchange is like the learning experience that takes place in real life between delegates during and between sessions, on the bus to convention centre, or over a beer in the evening – but on a much bigger scale.
Seeing what numerous other co- attendees at a session are thinking affords a number of valuable perspectives on the same information (and a great way of ironing out any misunderstandings of ‘cognitive wobbles’ any tweeter might have had with information coming from the podium). Noticing that the volume of Tweets had dropped during a technically difficult presentation (or when I was bored) reassured me that others were in the same boat. During these periods, it was possible to shift focus to juicy nuggets of information emanating from fellow tweeters at other sessions.
Our community was further strengthened by a series of meetings of tweeting delegates. Being there was for all the world like being at a school reunion – for people who had been at different schools – all at once familiar and fun, with a common shared experience, focus and curiosity..
Thanks to all of the live tweeters from #ACR13 (click here for full transcript and details) and Dr. Paul Sufka (@psufka) for organising the Tweetups and to the American College of Rheumatology for providing the raw data and thanks to the guys at Symplur for the Twitter visualisation
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This week I gave a presentation to the Irish Society for Rheumatology on how I learn using new technologies. This information is primarily directed at rheumatologists but may be of use to anyone interested in keeping up to date with the rheumatology world.
The lists are intended as an introduction. If you think I have left somebody / something crucial off the list, please let me know. It isn’t intended to be exhaustive!
Sign up for Twitter; Identify yourself as a doctor AND upload a picture (so people can identify you – people more likely to engage with you this way), Follow me on Twitter and I’ll help direct you / answer any questions you have; (type @ronantkavanagh into the search box at the top of the Twitter screen after logging in), click on this list of some the more active rheumatology Tweeters online.
If you feel more comfortable staying quiet, and just want to lurk, thats ok (thats what most people do!).
2. Google Rheumatology Community
Request an invite to Google Circles / Rheumatology community group by emailing me on firstname.lastname@example.org (link is here for page but you will require an invite ). Because of the nature of the information that is presented in the forum it is limited to rheumatologists and trainees in rheumatology only.
3. Rheumatology Blogs
My blog (you’re here already!)
Dr. Lothar Kirsch (English ad German)
4. Patient Blogs
ePatient Dave (Dave de Bronkart is not an arthritis patient but well worth reading)
5. Good Medical Blogs
6. The (most excellent) Rheumatology Podcast
(links on their website for iTunes podcast link etc)
7 . Managing journals and references
Download Doc Wise if you have iPad / iPhone
Evernote (for taking notes and saving webpages / pdf’s)
8. Some medical conferences for those interested in the future of medicine
9. Closed Physician Networks (US only but watch this space)
If you have any queries feel comment…
“All of humanity’s problems stem from man’s inability to sit quietly in a room alone.” (Pascal)
So this week I spent an hour of my time listening to a recording of silence.
The silence I listened to was from a 3 track CD called Anail (Anail – the Irish word for ‘breath’). It is a series of recordings of the type of silence that can be heard at the ruins of three ancient Irish churches in North Tipperary at dawn. Bear with me.
The recordings include the quiet sound of wind blowing, birds singing, the rustle of wings taking flight, sheep baahing quietly in the distance, periods of actual silence and (to prove that the recordings were made in Ireland) the sound of rain falling on leaves. It is beautiful to listen to, calming and not at all as boring as it sounds.
The Anail recording is part of a project which hopes to teach school children life coping skills and to enhance their mental well being through mindfulness and meditation. Mindfulness is initially learned by teaching us how to focus on the present moment (using our breathing as a central focus to anchor our minds) while meditating. It acknowledges the inevitability that thoughts will intrude but allows us to learn to simply allow them to come and go. These recordings are intended to act as an acoustic backdrop to that meditation – allowing those meditating something to focus on – but also protecting the listener from the sounds and distractions of world around them.
Although this all sounds a bit ‘new agey’ there is a growing evidence that mindfulness based techniques may be useful for our mental health. Mindfulness based approaches help reduce stress levels in healthy individuals, increase feelings of empathy towards others, and may even add to the effectiveness of medical treatments for depression and anxiety. There is also emerging evidence that mindfulness techniques may help prevent burnout in health care professionals. Doctors and Nurses take note.
Although I think it will take some effort to convince younger children (and even their parents) to sit and listen to a recording of silence, I think it is an important way of raising awareness of the need to step back from the hectic, ‘always on’ world around us and to learn how to notice and pay attention to the voices from within us.
“In my adult life, the time I have actually lived inside the present moment would have amount to no more than a single day; it would have thrown its light into all the others, like a brazier in a dark arcade. Instead I find my way by sparks, and what they briefly make visible” (Don Paterson, ‘The Book of Shadows’)
The Cd is available to purchase online here.
Like a lot of other social media addicts, I fear my brain may be changing.
Constantly feeding my brain with a diet of high calorie online information and ideas, I am finding it increasingly difficult to switch the darn thing off. Hyped up on the sorts of epiphanies presented through TED talks, I sometimes have difficulty concentrating on the less stimulating conversations that make up the bulk of every day life. Where I used to read a novel a week, I am struggling to read fiction of any length and have a general feeling that I am skimming along the surface of things without time to reflect and dig deep.
Of late, I have been imposing some discipline on my exposure to the online world and using some tools to restore myself to my pre-Twitter state. Heres’ some tips that I hope those similarly afflicted will find helpful
1. Delete all social media apps and email from your phone
Having access to the perfect distraction tool on a device that I carry everywhere means that I am never bored. Therein lies the problem. Being constantly exposed to other peoples’ amazing ideas online, I have no time to allow ideas of my own to bubble up from the deeper recesses of my subconscious in those quieter moments of inactivity. 3 months ago I deleted all social media apps from my phone. The temptation to constantly check your Twitter feed wanes very quickly once it is not immediately available to you. Although I still check my Twitter and RSS feeds regularly on my desktop, I’m not doing it while waiting for the kettle to boil or while sitting in traffic on the way home from work.
Once I deleted social media apps from my phone, I found myself checking and rechecking my phone for (and responding to) email messages. Although removing email from my phone seemed like the natural next step, I was afraid of missing something important. I therefore initially signed up to a service called Awayfind. Away find is an email filtering service that will alert you (by text message) if you have received an important email – without the need to have to open your email client. You can set it to let alert you if certain person has emailed you (I couldn’t really think of anyone who I needed to add to the list) or pre-specified topics you don’t want to miss (I couldn’t think of any). Once I realised that I was unlikely to miss anything important I relaxed. If you call checking your email a few times an hour on my desktop relaxed.
2. Buy a disposable phone for vacation use
Fans of the series ‘The Wire’ will be aware of the concept of ‘a burner’ phone. A ‘burner’ is a basic ‘pay as you go’ mobile phone purchased by drug dealers to be used only a couple of times and then to be disposed of. Difficult to trace, lacking even basic internet access, and with a keyboard small enough to make it almost impossible to send text messages. I have taken to using a ‘burner’ on vacation’ leaving my iPhone turned off, to limit (to zero) the number of calls I get from work and any temptation to reinstall social media apps or email. Not sure if Marlo Stanfield would be impressed, but it gives me some proper head space for a few weeks a year.
3. Try Freedom.app
How often have I sat down to write a blog or prepare some slides for a presentation and found myself 30 minutes later on some Website that has nothing to do with what I’m writing about and not even realizing how I got there. There’s a nifty app called Freedom (Mac only) which allows you to disconnect your computer from the internet if you want to avoid being distracted when you have some real work to do.
4. Get Some Headspace
It is ironic that the thing I have found the most use in calming my internet addled brain is an app I downloaded from the iTunes and which I run on my smartphone. Developed by an ex Buddhist monk, Andy Puddicombe its called Headspace and it allows you to meditate every day, without recourse the chanting of a mantra, the use of wind chimes, incense or the Andy’s physical presence in your sitting room. Its available to download, free of charge (for the first 10 days) from getsomeheadspace.com.
Although, by most standards I am probably more connected online than most, putting some distance between myself and the the online world has allowed me a greater sense of control over my online activities, a bit more downtime and having stepped back made me realise quite how hectic it had got. I’m getting back into reading fiction (ok, some short stories) too and trying to reground myself in the real world. Thats where the really good content is….
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Although readers of this blog will be aware that I’m a big fan of the new RSS Reader Feedly, I sense that its use by the broader medical community may be limited by a general lack of familiarity with RSS technology in general. A show of hands at a presentation I gave last week indicated that only 2 out of a room of about 20 healthcare professionals had actually heard of RSS.
I was therefore interested to learn about new iPad app called Docwise which allows users to collect updates from their favourite medical journals without having to use RSS directly.
Docwise is an ejournal / magazine for iPad which allows doctors to easily gather and display content from multiple medical journals, news sources and search terms all in one place. Once a doctor has registered their area of specialist interest on the app, journals relevant to their specialty are offered for inclusion. All recent articles from their chosen journals are then displayed in a nice clean ‘card’ format across the screen, along with some appropriately linked stock pictures (which help liven up the usual dull appearance of a short text summary of an article).
Clicking on the relevant article then links automatically to the original article abstract on the journal Website. Where you are a member of an institution which has signed up for the service, it is also possible to see the full text of the article. There is also an option to allow push alert which notifies you when the full free text of the article is available.
It possible to ‘favourite’ an article for later reading, download an article for reading offline, and add search terms (which will allow automatic searches across all subscribed journals). It is possible to share articles on Twitter, Facebook and email. The app also tracks the amount of time spent using and and reading artciles and allows this information to be collected by Docwise to produce a summary which can be sent to users.
The screen output is very attractive (resembling Flipboard), easy to read and navigating the various screens is very intuitive. The great strength of this app is that it allows content to added without having to search for the relevant RSS feeds for relevant journals (the term RSS isn’t mentioned once). It all works in the background.
Although I appreciate that this app is new and that additional features and platforms (iPhone, Android and browser compatable versions) will likely be added over time, I think it could benefit from a few additional features e.g.;
A wider range of options for social sharing (e.g. Evernote, Buffer.app, Google Circles).
It would also be great to see what other people are sharing i.e. ‘most Tweeted’ or ‘Most emailed’ articles for any particular journal.
Like many doctors, I’m interested in a lot more than what is presented to me from medical journals or trade press. It would nice to see some additional news sources added (e.g. from lay press – New York Times, The Guardian Health etc) or the ability to add blogs. The ability to subscribe to, or at least manually add RSS feeds, from other sources would also be welcome. A more seemless way of making posts disappear from the feed once read would also a good addition.
Docwise will appeal strongly to healthcare professionals who want to keep up with updates relevant to their specialty without the nuisance of having to receive those ever so annoying table of contents emails. At present it is likely to suit those who are happy to keep their information feeds exclusively related to healthcare but those with broader interests might have to wait a little while before more features are added.
I’m looking forward to future updates.