Trust and the Serendipity Engine: Twitter

In this wonderful, 10 minute video done at the NYC Web 2.0 Conference in mid-November 2009, Chris Brogan opines on the value of Twitter, especially search on Twitter. He tells of his experience with discovering the Roger Smith Hotel, just down the way from the Four Seasons which is losing business to the Roger Smith. Why? Because colleagues responded to his twittered question about where to stay and then so did a live communicating voice (through Twitter) from the Roger Smith.

However, don't be distracted by the forgoing narrative as it's the deeper message that Brogan speaks to a commercial world using the web for commercial business that resonated for me. I've written about Brogan before, elsewhere, and urge you to read that post and Brogan's Trust Manifesto, for it is the loss of trust that so many clinicians experience--perhaps not so much with their patients--in working with all of the components of the health care system that support clinicians in the care of their patients. Brogan in this video, once again speaks to building trust, using the contemporary tool of relationship development: Twitter.

Brogan recommends using your @replies much more than most users do to this point. 80% of his tweets are replies--he suggests that users reply to others 12 times for every one original tweet and addresses many other aspects of using Twitter.

He goes on to raise a series of questions:

How do we share?
How do we extend experiences and relationships?
How do we collaborate?
How do we make new distribution?
How do we develop relationships that yield?

"The difference between an audience and a community is which way we turn the chairs."

Brogan closes with this quote from Ralph Waldo Emerson, "Do not go wherever the road may lead, but go where there is no road and leave a trail."

I'm proud to have done that in my work in Emergency Medicine; I'm just warming up for the next act.

Giving thanks for the sacrifice of those we've lost and powerful writer of "The Lost"

Moving and powerful remembrance from a leader and survivor of the Afghanistan war. Soon to learn of plans for expansion of this war, "How do you ask a man to be the last man to die for a mistake?" J. Kerry, 1971.

Engage with Grace at your Family Thanksgiving

Engage with  Grace and help your loved ones understand and act on your purpose at the end of your life even as today all celebrate and give thanks together.

HealthCamp Philadelphia--Less than a month to go

HealthCamp Philadelphia

The BarCamp movement of self-produced intense conferences reminds me of the charrettes I'd hear about from my close friend and college roommate when he was in architecture school. HealthCamp has grown out of BarCamp and on Saturday, March 28, 2009 HealthCamp Philadelphia begins at 8:00 AM in the Hamilton Building on the Thomas Jefferson University at 11th and Locust Streets. The slide show summarizes the day and its goals.

Comparative Effectiveness Research--The View from Wachter's World

Bob Wachter discusses the challenges of implementing the comparative effectiveness research results we have in hand. From the perspective of leading physicians and frequent contacts with a diverse range of specialists and sub-specialists in my tertiary care providing community, teaching hospital I find myself nodding in agreement with Wachter's observations.

Everyone but the citizen's ox gets gored by comparative effectiveness research implementations. I use the term citizen advisedly, taking my cue from Obama; for some number of patients may well feel that they lose out as individuals, even as the polity benefits.

Tough implementation ahead with lots of squabbling before we're done accomplishing a fraction of the result the policymakers are seeking.

Customer-Consumer Confusion and now Patients, too

EP Monthly's "WhiteCoat's Call Room" posts two links and discusses "Patients or Customers"?

Patient, customer and consumer have specific meanings, not accurately used in the posts from Aggravated DocSurg and Detroit Receiving's EM Blog.While I'm in general agreement with many (not all) of the sentiments expressed in the two posts, it's important to get the correct meaning of the terms.

Customer= he who pays
Consumer= he who uses

The definitions are from Princeton Wordnet, but they're the same as what I was taught at Wharton 20+ years ago.

Part of our challenge in forming relationships in the ostensible business (good or service exchanged for value) is that for many users of physician services (i.e., patients) both the patient and physician experience customer-consumer confusion with consequent misalignment of incentives.

Patients will be increasingly demanding of receiving value in their care for value given directly (fee-for-service) or through employer and tax-based services. They will find the employers holding them accountable for "smart shopping" or the government steering in other ways--or both.

My father was a proud physician, he cared only for patients. Were I to view the world as he did, I would be struggling to feed my family. In this year of the 200th anniversary of Charles Darwin's birth, let's remember that it is not only individuals, but also entire species and perhaps professions for whom survival is not guaranteed; one must adapt or die.

Emergency Physicians "When in doubt, they image."

Or so says Internist Robert Centor at DB’s Medical Rants. He then goes on to offer the predictable rationale of malpractice risk as the driver for this behavior. KevinMD weighs in and cites GruntDoc who advances the economic calculation which suggests there's little benefit to attention to this phenomenon. A lengthy and continuing exchange of comments can be found on DB's and GruntDoc's sites.

At least some emergency physicians order the imaging we do because other physicians want us to do so. The ED has become the defacto "unfocused factory" where the emergency physician is expected to work up the patient to the point that the patient can be admitted to or referred to the specific focused factory for definitive care.

Today our hospitals and physician practices manifest a myriad of focused factories, the chest pain-ACS focused factory, the joint-replacement focused factory, the respiratory distress-COPD-CAP focused factory and I could go on at length. This is exactly what the specalist medical environment wants--indeed insists that the hospital deliver and we emergency physicians respond.

Furthermore, hospitals have come to realize that with approximately half of revenue generated by patients admitted through the ED it makes sense to concentrate resources on the workup of these patients. Thus hospital diagnostic, treatment and support services focus on ED patients--not the least because those patients arrive to the hospital 168 hours every week. Hospitals, including my own, have installed the most sophisticated 64-detector, dual-source CT-scanner in the ED so that we will use them to better define which of our patients require which specialized services.

When physicians stop pointing fingers and start accepting the reality of industrialization of our once professional, cottage practice we may be able to generate intelligent patient-centered alternatives to the financial policy driven managerial practices we presently experience.