Practicing My Twittering Tweets

Today, I live tweeted psychiatry Grand Rounds from Johns Hopkins on Traumatic Brain Injury.  I've tried to do this before, but I got paged out after just a few tweets.  Today, I made it through the whole lecture.  I didn't tweet the patient presentation, just the lecture part.  I didn't have my laptop, or WiFi access, so I did it from my iPhone on the touch screen where my fat fingers sometimes hit the wrong key.  And while the speaker was excellent, she spoke really, really fast, and I missed a bit.  I did my best.  You can check it out at #jhhgr.  My tweets are a bit disorganized and fragmented, but it's not really the venue for precision.

Next week, the Maryland Psychiatric Society will be holding a seminar on how to do the new CPT coding and I'm hoping I can live tweet that. Again, no WiFi, and it will be my fingers flying as fast as they can on my phone. The seminar is much longer than the talk I tweeted today.  Maybe the speaker will talk a little slower.  So tune in, and if I can, I'll be tweeting the seminar at 6 PM  on  12/4 using hashtag #cpt.

Medical Education Via Twitter: Tweet Tweet

There's an article in yesterday's Hopkins Gazette about Dr. Meg Chisolm and how she's using social media to educate the medical students and psychiatry residents at Hopkins.  Greg Rienzi writes:


Chisolm, an assistant professor in Psychiatry and Behavioral Sciences at Johns Hopkins Bayview Medical Center, said that she is one of a growing number of medical professionals who, despite the present-day climate of strict patient privacy regulations and oversight, see the benefits of using social media to supplement their work and interact with colleagues, patients and the general public.
Chisolm connects with others through her Twitter accounts “whole_patients,” intended to demystify psychiatry and psychotherapy for patients and doctors, and “psychpearls,” which is targeted to learners interested in “clinical pearls” about psychiatry.

To help expose future medical professionals to the benefits and potential pitfalls of social media use, Chisolm and Tabor Flickinger, a clinical education fellow, have set forth on the design of a social media curriculum for students at the School of Medicine. Ultimately, the two plan to design, pilot, study and implement a curriculum that uses social media to promote medical humanism and professionalism.

Ah, we wrote about Dr. Chisolm once before after she gave Grand Rounds at Hopkins on "Prescribing Psychotherapy."    And, by all means, follow her on Twitter!  (Yes, I'll be tweeting this). 

Podcast 54: Tell Me! Information and Technology

Welcome to Podcast Number 54: Tell Me! Information and Technology

Here's what we talk about:

Roy talks about the Maryland Health Information Exchange (HIE) called CRISP, which stands for Chesapeake Regional Information System for our Patients. Note that your health information is accessible to participating health care providers unless you opt out. You can read more at CrispHealth.org. We ramble about the downside of sharing health information electronically. We also complain about how difficult it can be to get medical information now, so there are pros and cons.

Roy talks about career satisfaction of psychiatrists based on a survey done by Epocrates. Roy talks about the increasing job satisfaction of primary care docs -- it's going up! In psychiatry it's also going up, based on data now compared to 3 years ago. Happy shrinks are up to 83% from 70%. Roy encourages med students to join us. Dinah extols the wonders of the diversity of psychiatry. Read the article about the survey Here.

Dinah brings up the age old dilemma of how to write about clinical information in psychiatry without compromising patient confidentially. We talk about how we deal with this problem in Shrink Rap: Three Psychiatrists Explain Their Work. Ah, but it's not just printed matter, but blogging and tweeting and podcasting.

Finally, Roy talks about healthcare providers and social media, referencing an earlier blog post on What To Do When Your Patient Friends You On Facebook.

Once again, thank you for listening and please do write a review on iTunes.

****************************

This podcast is available oniTunes or as an RSS feed orFeedburner feed. You can also listen to or download the .mp3or the MPEG-4 file from mythreeshrinks.com.

Thank you for listening

Send your questions and comments to: mythreeshrinksATgmailDOTcom

What to do when your Patient Friends you on Facebook or Follows you on Twitter

I participated long-distance in a social media workshop for the 2010 MedInfo conference (#medinfo2010) in Cape Town earlier this week. Kate Anthony and DeeAnna Nagel from the Online Therapy Institute were also participants, and the provided and excellent discussion of professional ethics, dual relationships, and good therapeutic behaviors as they relate to online interactions with patients and prior patients.

Excerpt:

Jane is your client. Both of you live and work in the same community. Jane is the director of a local charity. She sends you an invitation to be one of her contacts on LinkedIn.

Marcie is a former client. She was a teenager when you treated her. Several years later she has friended you on Facebook with a private message thanking you for being such a positive influence in her life. 

John is a current client who has begun following you on twitter.  He has send you a direct message and has also sent you an @reply to one of your tweets. He recently posted a tweet stating what a great therapist you are with a link to your website.

Mary has been your client for over a year. She has a history of childhood abuse and you have encouraged her to write in a journal. You receive an email from her asking to change times for her next appointment. She closed her email with “By the way, the journal writing has been so helpful, I have decided to start a blog. Here’s the link! www.maryrevealsinherblog.com. You open the link to discover that her first blog entry contains emotionally charged and highly graphic information about past childhood sexual abuse she has not previously revealed in therapy.

Kim was your client for over a year. You have not heard from her in at least that long. She was often hostile during sessions and would call between sessions feigning crisis and then apologise for her behavior during the previous session. The reason for termination was due to her move out of the area. Today you do an internet search for your name and you see that Kim has created a website, www.bewareofbadtherapy.com. Your name is on the website’s blacklist with links to excerpts of verbatim chat transcripts from sessions you held with Kim online.

To listen to their responses to these scenarios, watch the video at http://www.onlinetherapyinstitute.com/ethical-implications-for-therapists/ (the weird sound effects at the beginning last about 20 seconds or so... just wait for them to stop, it's worth it... and you get to hear input from their Second Life cat, Reva).


It would be great to hear your experiences with this issue in the comments, whether as a patient or as a therapist.

Dear Roy....Love, David Pogue

There's an article in The New York Times by David Pogue and I think it was written just for Roy.

Roy, in case you didn't know, is a really really smart person. He knows a lot about psychiatry, and maybe more about technology. The only thing is, he sometimes assumes that everyone else knows what he knows and speaks his language, and often that language includes a lot of technospeak. Try writing a book with someone like this! Oh, I did. So glad to be done for the moment.

So Mr. Pogue tells us that The New York Times editors asked their writers not to use the word "tweet" anymore for fear that readers wouldn't understand. Mr. Pogue writes:

“We don’t want to seem Paleolithic,” he wrote. “But we favor established usage and ordinary words over the latest jargon or buzzwords.”

That the Internet’s reaction was so swift and harsh only proves the point: the techno-savvy population can’t even conceive of the existence of a less savvy crowd. If you use jargon every day, you can’t imagine that millions of people have no idea what you’re talking about.

I do a lot of public speaking. And even today, when I ask my audience how many know what Twitter is, sometimes only a quarter of the hands go up.

The article goes on to define the basics for the uninitiated: Facebook, Twitter, Yelp (my favorite), Foursquare (Huh?), and Linkedin. Mostly, though, I liked that it made me think of Roy. So Roy, can you imagine a world where three-quarters of the people don't know what Twitter is?

APA Annual Meeting in New Orleans 2010 #apanola2010

The American Psychiatric Association's Annual Meeting began on Saturday and goes through to Wednesday.  Lots of great talks here.  I'm trying to learn a lot more about TMS (Transcranial Magnetic Stimulation), for one.  There have been a number of talks on the use of social media, as well, including the use of blogs, facebook, and twitter.


I'll post more soon, but just wanted to give our readers a heads up on the meeting.  Also, you can follow the twitter stream on tweets from the meeting on TweetChat using the hashtag #APANOLA2010.  A stream of these tweets is in our sidebar for the rest of this week, and is also below in this post.

Twitter Docs to Follow

Richard writes:

Given the popularity and prevalence of twitter, I put together a list of 50 different doctors on Twitter that you can follow to potentially get some insight on their medical lives. If you wouldn’t mind, could you share my list with your readers?

If you know of any other physicians that you follow on twitter, I'd love to add him/her to the list. Just leave a comment on the blog.


http://blog.onlinecollegeguru.com/health-care/50-doctors-to-follow-on-twitter/

Richard, Richard, Richard, oy~! Where is ShrinkRapRoy on your list? Where is ClinkShrink?
( I don't twitter or go tweet tweet very often so I won't care that I'm not on the list).

Shrink Rap: Grand Rounds is up at CRZEGRL (Veteran's Day theme)

The theme for crzegrl's Grand Rounds this week is Veteran's Day.

The shrinky links:

• doctors & mistakes (Medicine & Technology)
• pharma ads & claims on twitter (HealthBlawg) ... also follow #FDAsm on Thur & Fri for coverage of the FDA's anticipated hearing on social media and Web2.0 (links for live streaming on HITshrink)
• antidepressants for chronic pain (How to Cope with Pain)
• love in the recovery room (Anesthesioboist) ... not really shrinky, just beautiful

Twitter Novel About a Psychiatrist and a Drug Company

So this is something different. A novel... by a psychiatrist... released 140 characters at a time via Twitter (@goosenovel). If you try to read it via Twitter, you have to start at the beginning, so it is easier to catch up by going to his novel site, for the twitter-impaired. It is written by Doug Bremner MD at Emory, who has already written a book about drug safety.

I thought the idea of a twitter novel was interesting (and surely Dinah will have something to say about this).

Twittering Docs

To Roy with love:

From The New York Times Well Blog: When your doctor Twitters !

Or better yet, that blog post references an article by Pauline Chen called Medicine in the Age of Twitter. It talks about social media and doctoring.

I think we're all a little hesitant here. I started a listserv among psychiatrists I know recently, and it's slow going. People have asked if they can be sued. And blogging, well, you know only a handful of us are doing that.

So I liked the New York Times reference pieces.
And thank you all for the kind feedback on Shrink Rap and You! And My Three Shrinks will be back, though probably not for a while.

Blogger's Block

Oh, not really, I'm almost never at a loss for words.
But this is the thing: For three years now I go through my days and when I see or hear something interesting, I think "I'm going to blog about that!" or....I think, "Oh, I wish I could blog about that" but I can't because it would reveal something about a patient.
So I get lots of ideas, but then I get to the computer and sometimes I've forgotten them. Last night, I was with Clink and Roy and we were having an animated (hmmm, is that the right word?) discussion about Richard the Internet Porn Fan (a fictional patient in our book) when one of them said something totally random and I thought "What a great blog post title." What ever it was, it was pretty random, but I wanted to use it, and it was gone. Neither of them remembered what they'd said. Sometimes, I make notes about ideas I've gotten, but ....

And I'm twittering now. Half-heartedly. Roy's been asking me to follow him, so I started. Actually, I'm a total failure. Someone has Un-followed me for being snarky about Twitter. I don't really get it, and being limited to 140 characters is my idea of suffocation. Plus, it's not like a blog were everyone has access to the same info: I twitter about someone's tweet and then realize he doesn't follow me, I just follow him. Or someone else responds to a tweet I never read. And there's really not so much to say in short bursts. But during dinner last night, we had a lengthy discussion on cremation and the interesting disposal of ashes (one friend helped scatter his uncle on the 14th hole where uncle had gotten 3 holes in one!) and I twittered that the temperature used for cremation is 3,500 degrees, per ClinkShrink. Why does she know all these random things.

My brain needs more coffee.

Dr V: The Doctor-Follower Relationship

Dr V over at 33 Charts (medicine.health.socialmedia) wrote a post last week about the "doctor-follower relationship," an interesting play on words that -- in one phrase -- brings ups issues about physician bloggers and tweeters, their readers, commenters, RTers, and the new complexity about where practicing medicine stops and talking about medicine begins. Go to his post to read the whole thing, expecially the commentary. Interesting times...

Recently I received a friend request from a woman in the community where I practice... we had never met but she had read my book. Her baby it seemed was miserable and the wait for an appointment in my clinic was too long for her to bear...

As a doc I offer friendly advice to friends and neighbors when they need help with medical stuff... And why not? I have a connection with these people... So should it be different with my social network? Probably not... Strangers and transients are nothing other than that despite our sometimes-flirtatious Twitter repartee...

Okay, so regarding my screaming baby from Facebook.

Suicidal Tweets, Demi Moore, & The Samaritans

RT John Grohol wrote on PsychCentral:

"I’m sorry, but I’m a bit aghast at this story of someone randomly twittering their suicidal thought to Demi Moore, and then a bunch of people who saw it retweeted by Demi called the police. The police found the person who said they were going to kill themselves, and that person is now under psychiatric evaluation.

I guess this is “news” because someone sent it to Demi Moore. Demi Moore is a celebrity, so anything that touches her is defacto “news.” Does this mean the only way we can get attention/help for mental health issues in the U.S. is by tweeting a celebrity? Really, has it come to that?"

Read the rest here.

Gone the Way of Twitter

He used to write blog posts. Now he Twitters. Same stuff, but Roy likes new toys. His Twitter feed runs along our sidebar, so go for it.

I thought I'd point out that Roy twitted (is that the word? It's soooo unmasculine) about a post on PsychCentral that was later picked up by the NYTimes Well blog:

The Twelve Most Annoying Habits of Psychiatrists

I have to say, I don't agree with number #10, simply because dress and jewelry are such subjective issues and one person's view of gaudy is another expression of individuality and I don't believe that on most things there would consensus among all the patients in a given therapist's practice as to whether their dress was appropriate or not. Therapists should be dressed professionally and comfortably (they should be concentrating on their patients, not their wedgy underwear) but the issue of 'inappropriate displays of wealth' is not a clear barrier. One could say, "I don't like that my shrink's diamond engagement ring is bigger than mine, so they shouldn't wear it." The shrink below wears so much jewelry as to clank? Most shrinks sit quietly during therapy, so clanking shouldn't be a big issue. I would probably agree if the issue were something like "My psychiatrist comes to treatment in just his Speedo." Here's #10 in the original.

10. Inappropriate displays of wealth or dress.

Psychotherapists are first and foremost professionals, and any displays of wealth and style should be discarded in exchange for dressing in an appropriate and modest style. A therapist slathered in expensive jewelry is a put-off to most clients, as are blouses or dresses that show too much skin or cleavage. Too casual of dress can also be a problem. Jeans may suggest too casual an approach to a professional service that the client is paying for.

And it seems I forgot PsychCentral from list of Shrinky Links. Please forgive me.

Shrink Rap: Grand Rounds is up at Doc Gurley

Doc Gurley did something pretty cool for this week's Grand Rounds -- a LIVE edition.  Click on the image to go to her post and listen to GR... or you can read it there, as well.

Interesting or shrinky topics: dating site for folks with mental illness; how to tweet your next conference; "what if real life were like health care?" (this one by Doc Rob is pure brilliance); long-term outcomes of deep brain stimulation (Dr Shock); what's the ICD9 code for saving the whales? (Cockroach Catcher); and the ICD-10 code for Insect bite of anus, Initial encounter (S30.867A).

Shrink Rap: Grand Rounds is up at Health Business Blog!

Check out this week's Grand Rounds by David Williams at Health Business Blog.

Interesting topics include PTSD of being ill, Twitter discussion about remembering doc's instructions, and EMTALA and ER visits.