Monthly Archives: February 2015

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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