The Rise of the Machine: How Hospital/Practice Administrators Have Assumed Control Over Healthcare

In the past, physicians were responsible for both the business and practice of medicine.  While administrative personnel played an important and complementary role in practice and hospital management, physicians were the cornerstone.  In comparison, today the leadership structure in medicine is now an entirely foreign landscape.  Administrators DOMINATE medical practices today and, according to the New York Times, their salaries are responsible for a high percentage of medical costs.  While the numbers of physicians that are entering the workforce has trended toward a constant number (with little or no growth) the numbers of administrators has risen nearly 3000 percent over the last 30 years.

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Certainly medicine has evolved into more of a business–Physicians that are well versed in business and understand the role of the physician executive are much more successful.  It is clear that there is a role for administrators–they are necessary to coordinate and support the clinical work of physicians and those in the hospital or practice.  However, now administrators have evolved into the overlords of medical practice and are now dictating how and when and where physicians and other healthcare providers work.  Most of these administrative overlords have zero relevant clinical knowledge or experience.

The rise of the administrators has further complicated the healthcare landscape during this period of reform.  The ACA has expanded the numbers of insured and has promised to provide affordable, accessible care for all Americans.  Unfortunately, declining reimbursement and increasing reams of meaningless paperwork, documentation and “core measures” [All created by administrators or legislators] have resulted in the development of a pending physician shortage crisis in the US today.  Much like the fictional SkyNet began to control the world in the Terminator movies thru atomization, administrators have assumed control of medicine and have begun to automize the art of medicine thru protocols and algorithms–all with a complete disregard for real clinical trial proven outcomes data.  As you see in the graphic above, the numbers of new medical students continues to remain steady—very little growth.  Bright young minds are choosing other professions.

So, you may ask, how are we going to provide care to the newly insured?

Administrators will suggest that cheaper and less well trained alternatives to physicians will be the answer.  In Minnesota, for example, Nurse practitioners are now allowed to practice independently without ANY physician oversight or supervision.  Minute clinics such as those hosted by CVS and others have spread throughout the nation.  These clinics have no physician presence and are expected to make clinical decisions based on protocols and algorithms. Now, physicians appear to be a cog in the wheel and must conform to the dictums of those in power.  NO longer are physicians autonomous scientific entrepreneurs.  Creativity in medicine has become suppressed and frowned upon by those in power.  We have become worker bees in the factory of the administrative overlords.  The evolution of the administrator driven practice has left me with more questions than answers—

What has happened to the “art” of medicine?  What about clinical intuition?  IF we are eliminating this component of care completely then why don’t we simply create an army of IBM Watson computers to deliver care at the direction of the “Administrators” ?

At this point in my career, I expect the practice environment to become increasingly hostile for doctors.  For example, just this week, Congress passed a “fix” to the Medicare reimbursement schedule in order to avert yet another 20% pay cut for services.  This “fix” rolls back the antiquated formula by which doctors are paid BUT it further empowers non clinical administrators (and politicians) to determine exactly how doctors should be reimbursed.  While adding payments based on Quality (which I think is certainly a great idea) it stops short of defining quality and will ultimately allow CMS and DHHS to determine what measures will be applied. I expect that these measures will remain clinically irrelevant and lead in no way to improved outcomes for patients.

Physicians must take a stand.  We must advocate for our patients and for our profession.  Medicine cannot survive and continue to innovate without committed, caring and compassionate physicians who are allowed to do what they do best–Practice Medicine.  We must retake control of healthcare and limit the scope of power of hospital and practice administrators.  Or, as Schwarzenegger says–it will be “Hasta la vista, Docs”

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Sharing Bad News or Keeping Secrets—How Physician Communication Impacts Patients and Families

Doctors and Patients bond over time. Information exchange, education and sharing of expertise are critical activities that add to the effective practice of medicine. Delivering bad news is unfortunately an unpleasant part of a physician’s job. Honesty, empathy and clear communication are essential to delivering news to patients and their families—even when the news is unpleasant or unexpected. While communication is an integral part of the practice of medicine, not all healthcare providers are able to relay information or test results in a way that is easily digested and processed by patients. Some physicians may avoid delivering bad news altogether—often keeping patients in the dark. While a paternalistic approach to medicine was accepted as the status quo for physician behavior in the 1950s, patients now expect to play a more active role in their own care. Patients have a right to demand data and understand why their healthcare providers make particular diagnostic and treatment decisions.

Recently, a disturbing report indicated that in a database of Medicare patients who were newly diagnosed with Alzheimer’s disease, only 45% were informed of their diagnosis by their physician. While shocking, these statistics mirror the way in which cancer diagnoses were handled in the 1950s with many doctors choosing not to tell patients about a devastating health problem. With the advent of better cancer therapies and improved outcomes, now we see than nearly 95% of all patients are informed of their cancer diagnosis by their physician.

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How can this be? Why would a physician NOT tell a patient about a potentially life changing diagnosis?

I think that there are many reasons for this finding in Alzheimer’s disease and that we must address these issues in order to provide ethical and timely care to our patients.

  1. Time constraints: Electronic documentation requirements and non-clinical duties allow for less time spent with each patient. In order to deliver bad news such as a terminal diagnosis, a responsible physician must not only spend time carefully delivering a clear message but must also be available to handle the reaction and questions that will inevitably follow. Many physicians may avoid discussing difficult issues due to the lack of time available to help the patient and family process a diagnosis. We must create ways to diminish the administrative burden on physicians and free them up to do more of what they do best—care for patients. More reasonable and meaningful documentation requirements must be brought forward. Currently, many physicians spend far more time typing on a computer rather than interacting in a meaningful way with patients during their office visits. Eye contact, human interaction and empathy are becoming more of a rarity in the exam room. This certainly limits the effective delivery of bad (or good) news to patients. Priority MUST be placed on actual care rather than the computer mandated documentation of said “care”.
  2. Dwindling Long-Term Doctor Patient Relationships: Networks of hospitals, providers and healthcare systems have significantly disrupted traditional referral patterns and long-term care plans. Many patients who have been enrolled in the ACA exchanges are now being told that they cannot see their previous providers. Many physicians (even in states such as California) are opting out of the Obamacare insurances due to extremely low reimbursement rates. Patients may be diagnosed with a significant life changing illness such as Alzheimer’s disease early in their relationship with a brand new healthcare provider. When a new physician provides a patient with bad news—of a life-changing diagnosis that will severely limit their life expectancy as well as quality of life—patients often have difficulty interpreting these results. Healthcare providers that have no relationship with a patient or family are at an extreme disadvantage when delivering negative healthcare news. Long-term doctor patient relationships allow physicians to have a better understanding of the patient, their values and their family dynamics. This “insider knowledge” can help facilitate difficult discussions in the exam room.
  3. Lack of effective therapies to treat the disease: No physician likes to deliver bad news. No doctor wants to admit “defeat” at the hands of disease. It is often the case where some healthcare providers will not disclose some aspects of a diagnosis if there are no effective treatments. I firmly disagree with this practice of withholding relevant information as I believe that every patient has the right to know what they may be facing—many will make significant life choices if they know they have a progressively debilitating disease such as Alzheimer’s disease. In the 1950s, many patients were not told about terminal cancer diagnoses due to the lack of effective treatments. However, medicine is no longer paternalistic—we must engage and involve our patients in every decision.
  4. Lack of Physician communication education: As Medical Students we are often overwhelmed with facts to memorize and little attention is given to teaching students how to effectively interact with patients as well as colleagues. Mock interviews with post interview feedback should be a part of pre clinical training for physicians. We must incorporate lectures on grief and the grieving process into the first year of medical school. Making connections with patients must be a priority for physicians in the future—we must equip trainees with the tools they need for success.  Leaders distinguish themselves by the way in which they share bad news.  According to Forbes magazine the critical components of sharing bad news include–accuracy of communication, taking responsibility for the situation, listening, and telling people what you will do next.

What’s next?

As with most things in medicine, change often occurs “around” healthcare providers without direct physician input. Physicians are appropriately focused on providing excellent care and connecting with patients while politicians and economists craft the future of medicine. The issues with lack of communication of negative findings with patients MUST be addressed. Patients have a right to their own data and have a right to know both significant and insignificant findings. In order to avoid situations where patients are not fully informed about their medical condition, we must continue to remain focused on the patient—even if it means that other clerical obligations are left unattended.

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Buyer Beware: How Patients are Negatively Impacted by the Changing Landscape of the Affordable Care Act (ACA)

As the Obamacare machine continues to grind forward, many patients have re enrolled in a second year of coverage. While most have not had to use their insurance (the young and healthy crowd) others have found their newly minted coverage to be far less than promised. High deductibles, and up front out of pocket expenses, forced many covered by the exchanges to avoid seeking regular preventative care—Prevention was one of then tenets of the ACA plan. Many have found choices limited and have been forced into healthcare systems that are not their first choice.

Now, as the second year of enrollment (and re-enrollment) has concluded, many of us are concerned about the likelihood of rate hikes and changes in coverage. The Obama administration continues to tout the fact that enrollment numbers remain high and that there have been no substantial increases in premiums. However, this is not necessarily the case. Many exchange insurers have cleverly disguised rate hikes through changes in other aspects of the plans. While some advertise that there are absolutely no significant premium increases, customers who shopped carefully on the exchange site were able to find higher prices for Emergency Room visits, and higher charges for non generic drugs. For some plans this means that rather than pay a $250 co-pay for an Emergency Room visit, the customer must pay up to the yearly deductible for the same ER visit before the co-pay rules go into affect. For many, this may be a non-starter. ER visits can be very expensive and can amount to thousands of dollars in just a few hours. Many patients will find themselves having to pay a 3-6 thousand dollar deductible early in the insured year before any of the benefits begin to contribute to reduce individual out of pocket costs. In some plans, the co-payment for a routine physician visit will go down by an average of 20 dollars and many generic drugs will be covered for free. However, specialty visit co-pays will increase and the prices for specialty medications will increase by 40-50%

In an effort to promote re-enrollment in 2015, the government implemented an automatic re-enrollment system. However, this has left many patients with increasing out of pocket costs due to the fact that multiple changes have been made—such as those described above. Many patients were unaware of the need to shop around for re enrollment and are now increasingly unhappy with their plans. Ultimately the ACA and its supporters in Washington have placed statistics and politics ahead of the patient. While the delivery of quality care to the patients who need it SHOULD be the goal, it appears that politics remains the top priority. Increasing out of pocket costs and higher deductibles—many requiring payment in the first half of the year—are having the opposite affect. One of the central tenets of the ACA is to focus on prevention through promoting regular access to primary care physicians for prevention of chronic disease and its complications.   However, rather than promoting and environment where patients are engaged and actively seek preventative care, many are using the insurance simply as a “disaster plan” simply due to the overwhelming costs. While out of pocket limits and guaranteed care consume the healthcare reform talking points of the Obama administration, the reality is that the way in which the ACA is structured and implemented has actually increased personal financial burden for many.

What Can Patients Do?

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Unfortunately, much of the burden of navigating the new healthcare landscape falls to the patient. The Law itself remains a moving target—with changes certain on the horizon. We must remember that insurers are for profit entities and will ultimately find a way to make a profit—often at the taxpayer and patient expense. While many have been encouraged by the Obama administration to continue to offer affordable premiums, most have found other ways to improve their revenue streams. Whether it is thru juggling co-payments and charges, shifting cost, denying procedure approval or limiting choice, all of these changes will–in the end—negatively impact patients. As a healthcare provider, my job is to educate patients about behaviors that may improve their overall health. Now with the implementation of the Affordable Care Act, this responsibility now extends to helping my patients manage their insurance choices. While this is not necessarily a traditional role of a physician, it is important that we make sure that our patients continue to have access to the care they need—without incurring a life altering expense.

There are a few things that I think that patients can do to actively advocate for themselves and others:

  1. Stay Informed: Make sure that you ask questions of your insurer—are their changes to my coverage? How are out of pocket expenses handled? Can I see my doctor and my specialist when I want or need to without incurring a penalty or increased cost?
  2. Shop Around: Just because you have had coverage with a particular company in the past does not mean that you have to remain locked in with them. Make sure you explore all of the options that are available to you through the exchanges. Carefully question insurance company representatives so that you completely understand policies BEFORE you agree to a contract
  3. Demand Transparency: If you are unable to get a clear answer from an insurer about costs and coverage BEFORE you sign up, it is very unlikely that you will get a clear answer once you are a customer. Once you are a customer, make sure that you have a clear idea of the costs involved prior to scheduling a procedure or test. A recent survey sponsored by the Robert Wood Johnson foundation found that nearly 56% of Americans get out of pocket cost information before accessing healthcare services.

As with most things that have occurred with the Affordable Care Act, it is the patient who ultimately suffers. Insurers continue to profit, as do drug makers and hospital systems and administrators. Physicians have seen reimbursement cut to levels that have forced integration with large hospital systems. Most tragically, however, patients tend to be caught in the middle and have seen their healthcare suffer. Surveys indicate that patients are now inquiring as to cost prior to office visits, tests and procedures. Many find that they must put off necessary preventative activities and even more opt not to have needed tests and therapeutic procedures due to cost. It is clear that the ACA has missed its mark. While insuring large numbers of Americans is a noble goal, this insurance must also provide value rather than meaningless statistics to be utilized at a White House press briefing. As my research mentors at Duke University taught me during my training–with any data analysis, it remains that garbage will equal garbage out. WE must find a better way to provide affordable care to our patients. For now, insurers, hospital systems and politicians are using patients as nothing more than a “Profit Center”. As reenrollment continues through this year and the next we must make sure that our patients are armed with the old adage—“Buyer Beware”

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The Perversity of Medicare Incentives and Reform–Turning People & Patients into 10 Minute Time Slots

As the Affordable Care Act continues to impact millions of Americans through its second year of implementation, many things have become clear to both patients and healthcare providers alike–NOTHING is as it seems.  While the ACA has provided healthcare to millions of previously uninsured Americans, it has also robbed many patients of their doctors and has forced others into higher premium, lower service plans.  Even those with insurance are finding that they have little choice.  Many healthcare systems and providers are finding it impossible to accept the Exchange insurances and many long time Medicare providers are also opting out. Why is this happening?  Didn’t the Obama administration see this coming?

Of course not!  In the words of the legendary Nancy Pelosi “We have to pass it to find out what is in it…”

Courtesy of Fox News.  Nancy Pelosi "We have to pass it to know what's in it"

Courtesy of Fox News. Nancy Pelosi “We have to pass it to know what’s in it”

Well, now that we are more than a year into the program, we are all learning exactly what IS in it–more accurately we are finding out what is “NOT” in it….

Physicians have found the ACA to provide significantly lower reimbursements and Medicare continues to make further payment cuts.  If you carefully look at the way incentives within the Medicare code are structured, you begin to see that they are NOT in the best interest of EITHER the patient or the physician.  For example, a 10 minute office visit is reimbursed in some areas at $50 and a 40 minute visit is reimbursed at $140–with the reimbursement for each block of time decrementally reduced.  While physicians would much rather spend more time with each patient–working on prevention and goal setting AND actually developing lasting relationships–Medicare and other government based healthcare plans seem to incentivize the opposite.  In order to remain financially viable, a practice must see more people in less time–reimbursement favors larger numbers of short visits rather than fewer, extended, more productive visits.  Overall healthcare costs are not impacted because we are not able to spend needed time on preventative efforts.  Patients are not engaged and outcomes suffer.

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Say What You Mean and Mean What You Say!

Medicare bureaucrats and federal healthcare regulators say that they would like physicians to emphasize patient education, patient engagement and patient inclusion in decision making yet they are unwilling to compensate doctors for the time these activities require.  In fact, the current system pushes the opposite–mass production of patient visits with limited time for questions and lifestyle modification discussions.  Healthcare providers are actually negatively impacted when they spend more time with patients–often to the point of not being able to remain open and independent without “selling out” to large healthcare systems in order to meet the demands of business overhead.

Most disturbing, however, is the negative impacts these regulations and perverse incentives have on patients and overall patient care.  Patients depend on doctors to advise them and to help them make health care choices.  While patients are much better informed now–mainly due to the availability of information on the internet–they still need to have quality, non rushed,  personal interaction with a physician.  Many patients feel lost and abandoned when they realize that the time that they now get with their doctor is significantly limited or eliminated altogether (as many physicians substitute allied health professionals for themselves during routine office visits).

Ultimately time will tell.  It is my hope that we can somehow reverse the course of the Obamacare disaster in the years to come.  We must find a way to insure and care for all Americans in a way that also allows Doctors to be Healers rather than government automatons.  The practice of Medicine remains a privilege–we must all work to ensure that the sanctity of the doctor-patient relationship is preserved in the future. We must reform both the ACA as well as the often perverse Medicare code in order to allow physicians to provide what is most important to patients and families alike—TIME and PERSONAL ATTENTION.  Only then will we have a system that actually works…..

Big Ben, Covent Garden and The Thames: Lessons Learned from a Visit to London—Collaboration Improves Outcomes

This past week I had the honor and pleasure of introducing my book on Women and Cardiovascular Disease in London. During the book-signing event, I was able to meet with many of my European colleagues from both the media as well as the healthcare space. As the evening’s discussions continued into the night, I once again realized just how much we have left to do in addressing gender disparities in care—it is not just a problem of a single country, it is truly a global issue.   More importantly, I once again became aware of just how small the world really is—and how many problems we share as a world community of healthcare providers. While we are separated by oceans and answer to different governments, healthcare systems and regulations, one thing remains constant—our devotion to the care of our patients as well as our desire to improve care and outcomes for all patients.

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In the US, we have worked diligently over the last ten years to raise awareness for women and cardiovascular disease. We have made great strides in the identification and treatment of women with occult heart disease. While the numbers are improving, disparities in care remain. The American Heart Association and the annual Go Red Campaigns have made a remarkable difference in promoting awareness, advocacy and research. We cannot, however, rest on our accomplishments—we must do more in the US to continue to close the gap. In Great Britain, I think that we can and must do even more. After my discussions during the book signing I realized that the level of awareness in the UK among women, media and healthcare providers is even less than in the US. During the event, I was able to chat with numerous bright and motivated attendees who are excited to be part of a wave of change in cardiac care for women throughout the UK. We identified many ways in which we may be able to improve education and awareness of women and heart disease in Britain and throughout Europe.   Even though the event lasted a little more than 2 hours, we were able to brainstorm numerous ideas and made plans for future discussions. It struck me that through collaboration and cooperation across oceans and among different nationalities that we can not only make an impact in our own countries–We make even bigger impacts (both at home and abroad) through a more global approach. When we work together towards a common goal we are able to tap ideas and harness the potential of larger numbers of professionals with disparate academic and social backgrounds. This can lead to novel solutions.

Collaboration is a way in which individuals or groups can work together to generate solutions. However, collaboration is a complex process where people from different backgrounds must come together to effect change.

But how can we be effective and make the biggest impact?

  1. Collaboration is a Journey: Collaboration does not happen overnight. Relationships develop over time. Some of the most important keys to success are communication, mutual respect and compromise as well as a commitment and “buy in” from all invested parties. There are always initial periods of brainstorming and conversation that lead to even bigger ideas. As we work together to solve global issues such as disparities of care for women with heart disease, we must pursue a common goal. Teaming up with others is a powerful way to improve outcomes and improve success.
  2. Collaboration may be best when spontaneous: Collaboration cannot be forced. We must learn to appreciate the talents of others and leverage those talents in a way that produces successful ideas. Working sessions followed by dinner or other gatherings in social settings often produce the most important breakthroughs. Amazing ideas commonly result when we least expect them.
  3. Collaboration requires that we Know Ourselves and Manage Diversity Effectively: The benefit of collaboration is the ability to bring together a diverse group of people with different backgrounds. Collaboration requires that we have cooperation both horizontally and vertically—there must be mutual respect and while maintaining structure and leadership within the group. The diversity of opinions allows us to attack issues from unique angles. The most important factor in producing measurable results for patients is the assimilation of ideas into a new and coherent way of thinking about common problems.

I am excited about the opportunity to collaborate with others throughout the world in order to improve care for women. I believe there is a great opportunity to raise awareness of disparities in care in the UK and throughout Europe. It is my hope that through cooperation and collaboration with my European colleagues, we will be able to improve cardiac care for women all over the world.

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Attending a Funeral: Mourning the Loss of a Friend AND Learning More About the Art of Medicine

(Please note that this blog is based on real people and actual events.  I am grateful to Ed’s family for granting me permission to use his real first name in this blog)

One of the best things about the practice of medicine is the ability to develop long-term relationships with patients and their families.  As physicians, we have the unique privilege of meeting and interacting with thousands of people throughout our careers.  Every once in a while, there are certain people who really make a lasting impact and forever change us as caregivers and as human beings.  Ed was one of those patients.

This week, I said goodbye to one of my long time patients and dearest friends.  Ed, a Korean War veteran, was an amazing man.  He was a dedicated father, a devoted spouse and lived a life that was an example of faith and service to others.  I met Ed through his daughter years ago.  He had moved locally to live near his children and needed a new cardiologist. Fortunately for me, his daughter asked me to take him on as a patient.

Ed had an ischemic cardiomyopathy and suffered from complications of congestive heart failure (CHF).  He was fairly well compensated on medical therapy but continued to have worsening CHF.  During the course of his illness, we eventually  implanted a Biventricular ICD and his symptoms improved significantly.  As with most patients with CHF, over the years, he began to have more frequent hospitalizations for CHF exacerbations.

Through it all, Ed was always cheerful and never complained–in fact it was sometimes difficult to monitor his symptoms due to his demeanor.  Ed always put others before himself.  His wife, suffering from her own chronic illness, was the focus of his final days.  He loved her deeply and wanted to be sure that she was comfortable and well cared for.  Because of my relationship with Ed and his family, I have been made a better cardiologist, and most importantly, a better man.

Men like Ed are few and far between–I was honored to care for him.  My professional role as his cardiologist is what provided me with the fortunate opportunity to be a part of his life and develop a relationship with he and his wonderful family.  As I have said many times before, Medicine is best practiced when relationships and tight bonds are formed between Doctor and patient.  As I left the chapel where the Catholic Mass celebrating Ed’s life was held, I could only wonder if I would ever have the chance to meet another “Ed”.  Healthcare in the US has become more fragmented than ever and care is no longer contiguous in many cases.  Many patients are experiencing access issues and are being told that they can no longer see their long time physicians because of “network” issues or insurance coverage rules.  Doctors are forced to spend more time typing and glaring at  computer screens and less time actually getting to know the “people” behind the diseases they treat.  Connections like I had with Ed are harder to form and personal bonds are less likely to occur in the current environment.  I fear that medicine is becoming more about the “system” and managing regulation than it is about listening and caring for those who suffer from disease.

Ed taught me many things during the time that I cared for him.  He taught me humility, kindness and selflessness–I have never met anyone quite like him. Most importantly, he taught me the value of relationships and TIME.  Even in death, he inspires me to be more to each of my patients–in spite of increasing government demands on both my time and talents.  Ed never stopped caring for others–he never wavered in his commitments to his God, his wife and his children.  It is my hope that I can stand firm and continue to fight for my patients and their right to receive exceptional care.  While I continue to actively speak out against the Affordable Care Act and the regulation of medicine that separates doctor from patient, I must do so in a way that is constructive and advocates for the patient rather than for the doctor.  That is how Ed would see it–of that I am sure.

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Using Twitter and Social Media to Predict Disease: Identifying Risk and Impacting Change

Social media can be an exceptionally useful tool in Medicine.  Many platforms are  ideal for educating colleagues, patients and the community at large about chronic medical conditions as well as spreading the news of new medical innovations and treatments.  Social media platforms such as twitter, YouTube and Facebook (among others) can allow communication between people from different backgrounds and can connect those separated by oceans and thousands of miles all across the world.  While the medical establishment remains skeptical of social media and is often slow to adopt its routine use, it is emerging as an important part of many practices.

Twitter–both in and outside of its use in medicine–certainly has been shown to stir media controversies, influence politics and significantly impact careers (both positively and negatively) due to its ease of use and potential for immediate widespread dissemination.  Beyond the more traditional uses of social media platforms in medicine, a new study has recently been released that shows that one particular platform may actually be useful in predicting disease.  Researchers at the University of Pennsylvania published a study in the January issue of Psychological Science in which they carefully examined the relationship between the “type” of language posted on twitter and an individual’s risk for cardiovascular disease.  Stress, anger and other hostile emotions have long been associated with increased levels of cortisol, catecholamines (stress hormones) and increased inflammation.  These biologic byproducts of anger and hostile emotion have been associated with an increased risk for cardiovascular events.  Based on this information, researchers set out to identify whether or not the type of language utilized in tweets by a defined population could predict those at greater risk of cardiac events such as heart attack and stroke.  In the study, researchers analysed tweets between 2009 and 1010 using a previously validated emotional dictionary and classified them as to whether they represented anger, stress or other types of emotions.  They found that negative emotion laden tweets–particularly those that expressed anger or hate–were significantly correlated with a higher rate of cardiovascular disease and death.  Conversely, those whose tweets were more positive and optimistic seemed to confer a much lower risk for heart disease and cardiovascular related death.

While this is certainly not a randomized controlled clinical trial–and while we must interpret these results in the context of the study design–it does illustrate an new utility for social media.  As we continue to reach out and engage with patients on social media, our interactions may actually provide more than just communication of ideas–these interactions may produce important clinical data that may provide clues to assist us in the treatment of our patients in the future.  This particular study allowed researchers to predict risk for entire communities based on an analysis of random tweets from those residing in that geographical area.  For primary care physicians, using clues provided from social media interaction may provide insight into both an entire community’s health risk as well as an individual patient’s demeanor and allow for more aggressive screening and treatment for a wide variety of diseases from depression to cardiovascular disease.

Social media use will continue to grow among medical professionals.  I believe that when healthcare providers use all available tools and data in the care of their patients, outcomes will improve.  We must continue to explore the use of social media platforms such as twitter in clinical care and we must continue to examine ways in which the social media behavior of patient populations can predict disease.  I commend the researchers from the University of Pennsylvania for their creativity and vision–we need more creative minds who are willing to use pioneering strategies to improve care for our patients.  We can no longer shy away from social media in medicine–we must embrace it and begin to learn how to use it as a tool to effect change.

 

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