Since a portion of my web traffic originates from the medical community, I’ve decided to provide an update on a web technology that you’ve all probably heard about, Twitter. We see links to Twitter on websites, news links, and even television ads. Just what does this ubiquitous, cute bird do, and what role can he play in the medical field?

Those of you using Facebook are also probably wondering whether Twitter is any different from your Status. Well, the truth is, it’s not. To take a step back, Twitter serves as a one-way bulletin board. You can post whatever you want on it for the world to see, but others cannot write on your bulletin. Your viewer do not require an account on Twitter, nor do they ever have to log in. In contrast, your status page on Facebook can only be viewed by your designated friends.

The strength of Twitter lies in its accessibility. The owner can post links via SMS, website, email, desktop application, or portable application. It is concise, and viewable by the public with any of the aforementioned posting media. Your followers can receive automated updates on your bulletin. Therefore, it is an expedient means of communication.

I first saw the use of Twitter in medicine from Henry Ford Hospital, where they broadcasted updates directly from the OR. This was innovative, because it was a means for the public to become involved in the operating room. Imagine receving real-time updates on the carotid endarterectomy from OR #12:

“The shunt has been bridged!”

“EEG shows activity!”

“The resident calls for the yellow-tails!”

I would certainly try to incorporate the medium in my OR. Twitter’s application can also be extended beyond the OR. You can post updates from the clinic via Twitter.

“Dr. is running late today.”

“Two openings at 4:15pm today. Okay to walk in.”

The key is, of course, not to abuse posts to the extent that your patients become sick of getting updates. There is certainly a fine balance to be had. That’s it. Go to Twitter.com. Open an account. Play with it. In the meantime, you can follow my Twitter, also viewable on the side column. Real-time. Real news. Good stuff. If you have questions, contact me.

Update (4/23/09; 9:07pm): Mayo Clinic has even jumped onto the Twitter bandwagon, holding a webcast presentation on Twittering. Great stuff.

computing medicine, tech

I laughed the first time I read this question on my risk management training exam, which I am hoping to finish in between the 90hrs I anticipate being in the hospital this week:

The blunt end of the healthcare system can be described as:

a) action by clinicians

b) latent errors

c) inaction by clinicians

Oh boy, I have quite a bit to learn…

medicine humor

I just finished a week of night float at what is probably considered one of the “outside hospitals”.  The nursing pages are painful. I’d typically receive a page every evening notifying me that a patient had not moved his bowels in 3-10 days, and that the constipation protocol was just initiated. Other times, nursing would demand that I order Seroquel to knock out patients who were simply irritating. While I don’t mind constructive advice on patient management, I don’t appreciate illogical verbal pressure from unqualified people to medically subdue a non-hostile, non-psychotic patient who asks for ice chips.  These select ancillary staff workers leave a foul air that mars the reputation of nurses and techs, and I have to remind myself that not all nurses are lazy assholes. On weekends where I’m in the hospital for 30-36hrs, my pager goes berserk every 10 hrs with 10-15 pages within 2 minutes for inconsequential order clarifications–this corresponds to the nursing shift changes. They tend to forget that my shift spans four of theirs.

On Tuesday, my co-resident and I caught a rotund technician lurking around the resident’s lounge. He stated that he left a “paper” somewhere in the lounge and promptly dashed off. Later, we noticed that half of my co-resident’s iced tea was missing, and his sandwich was gone. We should have confronted the tech in the lounge, since all other staff is forbidden from hanging out in our lounge.

While hospital staff that outright harm patient care are terminated, the majority of the subpar group continue to maintain their duties without penalty even though the hospital administration is aware of them. It is unfortunate, but there is a shortage of qualified nurses in American hospitals. I believe that the shortage is expected to worsen in the next decade; it does not look good for inpatient medicine from this aspect. Hopefully, I will be out of the inpatient business by then…

medicine medicine, rant

I’ve been experimenting with some Google Labs Gmail options, and came across the mail goggles feature. When enabled, a simple Ajax menu with basic math appears whenever you attempt to send an email. You must answer five basic arithmetic problems correctly in order for the mail to send. It’s intended to prevent you from sending unintended emails that you’d regret afterward–likely ones that you send late-night or while inebriated.

Initially I was surprised that such an add-on even existed; how often do we send unintended emails? I don’t think I ever do. But hey, accidents do happen. I get emails every week from hospital administration notifying us of an upcoming conference, only to see them retracted (via Outlook). Surely misdirected emails could possibly only come from misdirected souls, right? How could an electronic sobriety meter ever save me from email embarassment?

In any case, I fired up the mail goggle feature last night, and enabled it for the hours from 10pm until 6am. Since I’m working night float this week, it was a great way to test out its efficacy. Early on, I had little problem sending mail. Around 3:45am, however, the problems surfaced. 343-88? 403-159? Damn subtraction. As I was fumbling to send an email I wrote to Joe about how much I hated my rotation, the 60 second timer expired, and I was presented with five new arithmetic operations. Damnit! As I cursed at myself for being stupid, I glanced at the header field and realized that I had erroneously addressed the email to Janine.

While I’m sure Janine, Jacob, or Jim would probably not have known that my email was intended for Joe anyway, Mail goggles had validated its existence. Mistakes happen to even the best of us, especially with sleep deprivation.  If there were only a similar invention that worked for vocalizing thoughts…

computing tech

I have been cycling through paperwork for my new residency over the past few days. The packet contains a mix of poorly photocopied forms, some of which is either illegible or completely cut off. The hospital also graciously included a photocopied Chase Bank flyer dated 2004, which offered $200 for opening a checking account. I called the graduate admissions office (GME) later to clarify some issues:

Me: Hi, I’m starting residency at XXX next month, and I’ve got some questions about some of the forms I received from your office.

GME guy: You need to call YYY.

Me: The forms came from your office, one of them is a verification of medical school training. I’m not…

GME guy: (cuts me off) And?

Me: I’m not in town, and I was going to fax in the form to the Registrar’s office to be stamped. Do you accept faxed signatures?

GME guy: It depends if you sign it. Up to you.

Me: It goes to your office! Ok, I’ll fax it over. I’ve another question: what time and where do I show up for the orientation in June? The forms don’t say.

GME guy: We don’t do orientation.

Me: The form says “Please show up to Occupational Health on time”, but it doesn’t say when and where.

GME guy: This is OHS. You said orientation, confusing me.

Me: (I was getting really pissed off at this point) Yea, OHS. Where do I show up?

GME guy: <paused for 10 secs> You got the green sheet? Read the top.

Me: <looking at the green sheet> It says ..ving Pavilion, and no address.

GME guy: Yup, call the number at the top for info. Irving Pavilion.

<click>

Apparently the address for Irving Pavilion was completely cut off the top of the page. If I didn’t already know where the buildings on campus were, I’d have no idea where to find it.

Ah yes. And now I am reminded why I left NYC…

medicine humor, rant