Monday, March 26, 2012

Social Media and Medicine: A Perfect Marriage?

This is a guest post by Natalia Zurek of regarding the use of social media in medicine.

Celebrities, non-profits and big businesses has discovered the virtual gold mine of social media, so why not the medical profession? It’s not only hospital administrators and doctors who could participate, but the patients themselves. This is the opinion of UK diabetes specialist David Kerr, MD and Lior Tamir, DDS, the founder and CEO of oLyfeMD. The writers and editors at also find the marriage of social media and medicine an intriguing possibility.

In an article for MedCrunch, Kerr and Tamir sketch out what they hope the future can hold for patients, doctors and social media. They foresee doctors and patients leaving established social media sites like Twitter and Facebook to start their own contributor driven websites.

How the Social Media Sites Would Work

Current social media sites, Facebook in particular, have problems keeping data of their members private. The first step in a medical-based social media site would have to be to ensure privacy for the users, especially the patients looking for advice. Security software is already available to protect a web-user’s privacy.

Patients can post their problems and an abbreviated version of their medical histories to the site. They could also do a daily diary entry of what it’s like to live with chronic conditions. The website software could then recommend pages of information specific to an individual patient’s health condition to the patient. Other site users could also comment and share their own experiences with the patient.

Doctors would have to go through  a screening process in order to post medical information onto the site. They would also act as fact-finders and point out any inaccuracies to patients, the community and to the webmaster. Patients can then vote on which doctor they prefer and become the site experts in certain topics, such as cancer or geriatric care.

Advantages for the Medical Industry

Both Kerr and Tamir caution the medical industry against expecting to make a lot of money from participating or supporting medical social media sites. But a social media medical site can still prove to be priceless. Medical workers can see treatments from the patients’ viewpoints. Pharmaceutical companies can see how their products work in the real world and what they need to focus their research and development on. Universities can see where there is the most public support for studies to invest time and personnel in. Clinical trials also would not have to be done in just one or two specific medical
buildings, but can whole or in part be done from holding “clinical trials” in the form of questionnaires on the website. Organizers of clinical medical trials can also post details of what they need in volunteer subjects and call for volunteers. Although there are websites listing current and forthcoming clinical trials, most people are completely unaware that these sites exist.

Advantages for the Patient

This writer sees many advantages for patients and their families through the use of a social media medical site. Many patients become isolated from other people and depressed because of their illness. Even connecting to others online is better than staying in bed all day wrapped in self-pity. Patients with the same medical conditions can share tips and tricks for how to cope with symptoms.

Patients can also learn how to better communicate with their doctors. Many patients do not realize that doctors and nurses are not mind-readers. They are extremely busy and can make mistakes. Patients can learn what information they need to give their doctors and better questions to ask their doctors in order to help heal.

This article was written by Natalia Zurek, a member of team.  It is a project, which aims to provide free accurate medical information and support patients, seeking help on the Internet. 

Monday, March 19, 2012

Nerve Anatomy of the Hand: A Fascinating Connection

Once you've mastered the basic bone anatomy of the hand and figured out the various nerve-related hand diseases, you may start wonder just how our hands appear to contain 5 distinct digits with various degrees of freedom yet often operates as a unified system, without much conscious effort. The NYTimes recently had a piece discussing just this phenomenon:
You may think you’re pretty familiar with your hands. You may think you know them like the back of your hand. But as the following exercises derived from the latest hand research will reveal, your pair of bioengineering sensations still hold quite a few surprises up their sleeve.  
• Make a fist with your nondominant hand, knuckle side up, and then try to extend each finger individually while keeping the other digits balled up tight. For which finger is it extremely difficult, maybe even impossible, to comply?  
 • Now hold your hand palm up, fingers splayed straight out, and try curling your pinky inward without bending the knuckles of any other finger. Can you do it? 
• Imagine you’re an expert pianist or touch-typist, working on your chosen keyboard. For every note or letter you strike, how many of your fingers will move?  
 • You’re at your desk and, without giving it much thought, you start reaching over for your water bottle, or your pen. What does your hand start doing long before it makes contact with the desired object? 
And a high-five to our nearest nonhuman kin:  
 • What is the most important difference between a chimpanzee’s hands and our own? (a) the chimpanzee’s thumbs are not opposable; (b) the chimpanzee’s thumbs are shorter than ours; or (c) the chimpanzee’s thumbs are longer than ours.  
 On, then, to the answer key.
To find out the answers, check out the entire article here. As the article notes, an enormous amount of functional anatomy is packed into the volume of each hand. This is reflected in the homunculus, the visual representation of how the motor skills of the body map to the brain cortex:

Homunculus map of the brain
Source: The Masks We Wear

As you can see, the hand takes up a disproportionately large area compared to its percentage of body volume. The only other body part which compares is the face. Clinically, this means that if you see a patient with hand complaints, you should be extra-sensitive for finding subtle changes from normal. While a full discussion of a careful hand exam is beyond the scope of this post, being aware of some of the links between digits as discussed in the NYT article is helpful to understand the relationships between the digits, especially if someone has suffered hand trauma.

As the article notes, loss of the thumb for example can translate into a loss of 50% of the hand function. Since we use our hands constantly in our daily life, such hand injuries can be highly disabling. Not only are they disabling though: if managed improperly, hand injuries can be incredibly painful. While it's easy for us and our patients to take our hands for granted, careful study will give you, um, a leg up when dealing with hand-related health issues.

Updated 2015-12-25

Monday, March 12, 2012

Comparing Residency Match Systems

This is a repost of an article by Ishani Ganguli, a 5th year medical student at Harvard Medical School, regarding how the U.S. residency match system compares to the UK system. 

On my weekend travels exploring Guatemala’s gorgeous natural offerings (Caves! Volcanoes! Giant lakes! Smaller pools!), I’ve gotten to meet a mix of international medical students on their own final-year electives.

Residency applications aren’t the first topic of conversation, but they come up eventually. Which is how I heard that this is a big two weeks for the Brits. On Monday Oct 11, students applying to foundation programmes (the British equivalent of residency) learned the questions they must answer for 60 percent of their ranking score. They had until today to submit their responses.
Later this year, they’ll be ranked within their medical school based solely on their graded 200-word answers to each of those five questions and class grades (40 percent). These ranks determine if they get their first, or 20th, choice of foundation programme.

The Brit students I’ve talked to bemoan the seemingly arbitrary quantification of their ability to wax eloquent and the paucity of data points on which they’re judged -- especially in a competitive year.

In the States, in contrast, our application files are quite a bit thicker -- in addition to grades and the personal statement, they include a curriculum vitae, three or four letters of recommendation, a summative Dean’s Letter, and (for the selected few) interviews.

I like that our British counterparts are forced to think of personal and observed examples of multi-disciplinary teamwork and cultural sensitivity -- topics that certainly merit attention when selecting doctors. Our personal statement prompts, in comparison, are quite vague.

But I must say that I’m comforted by US programs’ proclivity for information, both as an applicant and as a patient in our health system. Knowing more about the doctors we train, from multiple angles, can only help ensure that they (we) are both competent and genuine.

The article was originally posted here and is being reposted here with permission from the author. The post from Short White Coat, a blog about learning to be a doctor, which is a part of White Coat Notes on You can contact Ishani at

Monday, March 05, 2012

What Doctors Can Do About The Healthcare Crisis

This is a guest post by Ellie Moon about the growth of costs in healthcare and what healthcare providers can do about the coming healthcare crisis.

Medical care today can be a minefield. Doctors are ever more pressed to work longer hours and provide greater levels of care while the needs of patients seem to be ever increasing. In one this is great for business as medical insurance is taken up by patients who are worried that their local health care provider can’t meet their needs.

Costs spiraling

Thomson Reuters reported that health care costs have been increasing for patients at about 7% per year. This is combined with increases in employer contributions at approximately 12% and yet people are still buying up insurance because of fears over lack of services and provision and a desire to have the best possible drugs. Around the world there are various protections in place to protect patients and ensure that critical care is delivered; the NHS is perhaps one of the best examples of this but there is also the European Health Insurance card system and the Emergency Medical Treatment and Labour Act in the U.S. So is there a problem in these government sponsored schemes and services or does private medical care provide better care for patients?

There have certainly been cases where patients have felt greater stress and worry over the quality of their care and this has impacted on the recovery time. It would seem sensible if hospitals, doctors and the administration systems behind the care provided are more focused on reassuring patients over the quality of their care rather than on what is available based on the patient’s insurance package or based on the local hospital’s resources. Unfortunately, these are the times we live in and some patients will get better care simply because they have better insurance and more money. So is there a role for hospital staff to do their best to ensure that the best possible care is made available for everyone?

Of course there is. The amount of litigation that hospitals and staff face is rising and so whilst it is clear that the legalities and consents in a patients care are correctly covered, so is the need to ensure that the patient and the patient’s family feels valued and respected. Doctors need to ensure that they use their emotional intelligence and respond to the needs of those in their care. Medical professionals need to take into account the patient's worries (which could have little to do with their illness but everything to do with their finances) and give the patient time to express their concerns and be listened to. In short, a patient needs to have time to express their worries and concerns and have them relieved or at least lessened, so that they can then focus on getting better.

Medical Staff and Patient Care

Often medical staff are challenged by the behaviour of a patient who is reacting to their situation in a manner charged by emotion. Rational thought can become difficult when faced with bad news, especially regarding your health and there are many thoughts which could be going through the patient's mind:
  • "I’m ill – I could die"
  • "I don’t want to die…"
  • "Why can’t I have that treatment, I can’t afford this…"
  • "This illness is not fair…"
All of these thought processes are understandable when viewed outside a fraught environment but when faced with all the challenges of illness and financial difficulty an argument can become heated and people make accusations. In some cases this can even led to legal action much of which could be avoided if medical staff had the time and resources to exercise a little more empathy and consideration. It is clear that a doctor can’t solve the financial or personal problems a patient may have; however expressing an understanding of those problems can go a long way to helping the patient feel reassured and feel that they had a good experience in hospital (even if they didn’t have gold plated insurance).

So, doctors need to consider the wider context or life outside the hospital and what the patients are going through personally as individuals. A kind word, an understanding comment or smile can reassure patients and their families and build the essential trust needed for them to feel comfortable or at least not upset in the doctor's presence. The patient may, unfortunately be in a position where the care available is not going to meet their needs but this doesn't mean it can't be provided in the best possible way. As medical professionals it is important to provide a safe and neutral environment in which patients can be treated and recover with the help of the best medical package they can afford.

Ellie Moon used to work retail for a living but five years ago she took the leap and began writing full time. As a freelance writer she has had the opportunity to write for a huge range of companies, including a PMI insurance service, which she finds much more satisfying than answering phones all day.

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