MDchat Transcript Mayy 31, 2011

#MDchatHealthcare Hashtag Twitter Transcript

From: Tue May 31 17:55:00 PDT 2011To: Tue May 31 19:10:00 PDT 2011

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HealthIsSocial "Homework" - Post with topics for #MDchat - 9pm Eastern. http://mdch.at/kWdH8mTue May 31 17:55:48 PDT 2011

MD_chat "Homework" - Post with topics for #MDchat - 9pm Eastern. http://mdch.at/kWdH8mTue May 31 17:55:48 PDT 2011

jinpack #MDchat feeling a bit out of depth today, but will be listening in :)Tue May 31 17:58:28 PDT 2011

Milo_Paradiso hi, i am new here, am a pt on disability #MdchatTue May 31 17:59:39 PDT 2011

RyanMadanickMD #mdchat Hello all, Ryan Madanick here, GI doc at UNC, interested in #meded,#hcsm, etc!Tue May 31 18:00:51 PDT 2011

MD_chat @erinrbreedlove Hi - yes. These media are all open. Professions need their spacesbut ambient osmosis is a nice addition. #MDchatTue May 31 18:01:21 PDT 2011

MD_chat @Milo_Paradiso Hello Milo. Welcome! #MDchatTue May 31 18:01:46 PDT 2011

RyanMadanickMD btw, in case you are unaware...join us on Thursday night, June 2 at 9 pm Eastern forthe inaugural #meded chat! #hcsm #medschool #mdchatTue May 31 18:01:48 PDT 2011

Neil_Mehta I am an internist and medical educator and love edtech #mdchatTue May 31 18:02:21 PDT 2011

RyanMadanickMD @Neil_Mehta Hey Neil, ready for Thursday nite??!! #mdchatTue May 31 18:02:36 PDT 2011

Milo_Paradiso Very cool for #meded, is that for everyone too? do the patients get to do someteaching too ? ;-) #MdchatTue May 31 18:03:05 PDT 2011

peds_id_doc #mdchat Peds ID fellow from upstate NY - going to be late due to putting the kids tobed... #qualitytimeTue May 31 18:03:19 PDT 2011

RyanMadanickMD Absolutely >> RT @Milo_Paradiso: Very cool for #meded, is that for everyone too?do the patients get to do some teaching too ? ;-) #MdchatTue May 31 18:03:32 PDT 2011

RyanMadanickMD @MD_chat thx Phil #meded #MDchatTue May 31 18:03:49 PDT 2011

hjluks Howard Luks... Orthopod ... #mdchatTue May 31 18:04:25 PDT 2011

Milo_Paradiso So thankful for #hcsm and am sure #mdchat too ! It gives hope for #healthcare#MdchatTue May 31 18:05:02 PDT 2011

thehealthmaven Hi everyone! how are you? #mdchatTue May 31 18:05:05 PDT 2011

herlevic #MDchat. IM tennesseeTue May 31 18:05:06 PDT 2011

hjluks @MD_Chat ambient osmosis of rivulets .... :-) #mdchatTue May 31 18:05:06 PDT 2011

Srini2000 Hi Phil. Srini , med instrumentation person. Calling in from India where I am travellingon business #mdchatTue May 31 18:05:17 PDT 2011

RyanMadanickMD @hjluks sounds like you got someone worried today! #mdchatTue May 31 18:05:47 PDT 2011

hjluks @thehealthmaven welcome Lea... #mdchatTue May 31 18:05:54 PDT 2011

MD_chat T1 Medical Education: What legacies in #MedEd need to be ditched and what aughtto replace them? #MDchatTue May 31 18:06:46 PDT 2011

hjluks @ryanmadanickmd I hope so :-) link down, ISP not happy ! #mdchatTue May 31 18:07:01 PDT 2011

jsonyoung Jason Young, Geriatric Mental Health Clinician #MDchatTue May 31 18:07:05 PDT 2011

thehealthmaven @EinsteinMed @NateOsit @hjluks - hi guys! #mdchatTue May 31 18:07:08 PDT 2011

RyanMadanickMD @MD_chat Woo hoo!! a #MedEd topic! #MDchatTue May 31 18:07:11 PDT 2011

RyanMadanickMD @hjluks nice #mdchatTue May 31 18:07:23 PDT 2011

Milo_Paradiso @MD_Chat Ahhh I am inspired... hierarchy needs to be ditched #MdchatTue May 31 18:07:41 PDT 2011

EinsteinMed Hi Lea! RT @thehealthmaven: @EinsteinMed @NateOsit @hjluks - hi guys! #mdchatTue May 31 18:07:41 PDT 2011

Neil_Mehta Get rid of grades, tests, lectures - move to portfolios and problem based learning#mdchatTue May 31 18:07:47 PDT 2011

Neil_Mehta USMLE convert to pass/fail #mdchatTue May 31 18:08:13 PDT 2011

NateOsit @thehealthmaven @EinsteinMed @hjluks Hi Lea! Happy to see you all again :)#MDchatTue May 31 18:08:29 PDT 2011

Neil_Mehta Get students seeing patients early - and in the community #mdchatTue May 31 18:08:38 PDT 2011

hjluks Legacies... hmmm.. *Education* is being turned upside down as more effectivetechniques emerge. Will #meded adopt... or not? #mdchatTue May 31 18:08:39 PDT 2011

RyanMadanickMD T1: I like the Case Western model in a way... #mdchatTue May 31 18:08:44 PDT 2011

Milo_Paradiso @Neil_Mehta Pass/ fail is a bit scary... Unless pass is 80% and more! #MdchatTue May 31 18:09:08 PDT 2011

Mtnmd Replace meanness and hierarchy with real leadership training and modeledbehavior #MDchatTue May 31 18:09:50 PDT 2011

hjluks Residency legacy that needs to go... I was crushed (100 hr work wk) duringresidency and you shld be too :-) #mdchatTue May 31 18:09:55 PDT 2011

bfishgold Hi everyone. #mdchatTue May 31 18:10:06 PDT 2011

Milo_Paradiso As a patient I got interviewed at home by a med student 1st year. it was so nice to belistened and validated with respect #MdchatTue May 31 18:10:44 PDT 2011

Mtnmd 1st day of medical school, patient interaction should begin. Lose the lectures onearthworms and more applicable information. #MDchatTue May 31 18:10:55 PDT 2011

Srini2000 The practice of medicine needs to be more analytical rather than trial and error. Edneeds to emphasize analytical skills #mdchatTue May 31 18:11:27 PDT 2011

RyanMadanickMD Definitely we started first month #mdchat #meded RT @Mtnmd: 1st day of medicalschool, patient interaction sho… (cont) http://deck.ly/~VEDG8Tue May 31 18:11:33 PDT 2011

Milo_Paradiso @Neil_Mehta correct @ regurgitation. However it would be a bit scary to know halfthe new physicians are on the cusp of failiing #MdchatTue May 31 18:11:57 PDT 2011

Mtnmd T1 There are SO MANY things that should be changed, hardly know where to begin.#MDchatTue May 31 18:12:04 PDT 2011

peds_id_doc Some great thoughts coming out of #mdchat on #meded reform...Tue May 31 18:12:15 PDT 2011

Doctor_V Lurking #mdchatTue May 31 18:12:29 PDT 2011

healthblawg Lurking in #mdchatTue May 31 18:13:03 PDT 2011

Costner75 #MDchat residents need more outpatient training. One day per week not enough. Nowonder shortage of PCPs. #MDchatTue May 31 18:13:09 PDT 2011

Mtnmd @hjluks Yes, real leadership mentors, with skills like kindness, power, intellect,caring and tons of basic science info mixed in. #MDchatTue May 31 18:13:12 PDT 2011

RyanMadanickMD T1 how would you standardize evaluation process if not multiple choice, so that it isstandard and valid for all? #MDchatTue May 31 18:13:23 PDT 2011

Milo_Paradiso @Neil_Mehta yikes... #MdchatTue May 31 18:13:53 PDT 2011

KathyKastner Lurking/learning #MdchatTue May 31 18:14:13 PDT 2011

Mtnmd Mixing the science information side by side with real and modeled patients. #MDchatTue May 31 18:14:15 PDT 2011

hjluks @ryanmadanickmd did u chg the question? :-) #mdchatTue May 31 18:14:23 PDT 2011

RyanMadanickMD @hjluks Sort of developed from an answer to T1! #mdchatTue May 31 18:14:42 PDT 2011

Mtnmd Identifying CORE CONTENT for each area. Docs graduating w/ huge gaps due topoor training. #MDchatTue May 31 18:14:51 PDT 2011

Milo_Paradiso Then other competency would be to believe the patient as only very few aremalingerers #MdchatTue May 31 18:14:55 PDT 2011

RyanMadanickMD @hjluks maybe a topic for #meded chat.. #mdchatTue May 31 18:15:08 PDT 2011

healthblawg T1 The elaborate hazing rituals of medical education have got to go. 360 degreeevals. #mdchatTue May 31 18:15:19 PDT 2011

hjluks real world examples... our residents have learned far more by presenting cases to usas if they were talking to family :-) #mdchatTue May 31 18:15:32 PDT 2011

resreports #meded #MDchat RT @RyanMadanickMD med school of future may look more likethe Khan academy, more case-based teaching http://bit.ly/hDa26dTue May 31 18:15:38 PDT 2011

EHRoutlook Are non MDs allowed to lurk or comment? #mdchatTue May 31 18:15:47 PDT 2011

Mtnmd 1st two years could be core content, pt interaction, core content, pt interaction. Makesit real and applicable. #MDchatTue May 31 18:15:52 PDT 2011

RyanMadanickMD @EHRoutlook yes #mdchatTue May 31 18:15:54 PDT 2011

hjluks @EHROutlook of course... #mdchatTue May 31 18:16:09 PDT 2011

RyanMadanickMD Yes >> RT @Mtnmd: 1st two years could be core content, pt interaction, core content,pt interaction. Makes it real and applicable. #MDchatTue May 31 18:16:17 PDT 2011

MD_chat @EHROutlook Hi - yes! Lurk, or jump in and participate as you wish. #MDchatTue May 31 18:16:29 PDT 2011

Mtnmd @resreports @RyanMadanickMD Yes, like top tier MBA programs, do the case, withintelligent, caring input. #MDchatTue May 31 18:16:30 PDT 2011

jackiefox12 My imagined/invented healthcare? "Full circle"--back to physical exams &conversations, which I hear are becoming endangered. True? #mdchatTue May 31 18:16:56 PDT 2011

RyanMadanickMD becoming?? #mdchat #meded >> RT @jackiefox12: My imagined/inventedhealthcare? "Full circle"--back to physica… (cont) http://deck.ly/~9pmgITue May 31 18:17:31 PDT 2011

Milo_Paradiso It would be great also if the poor med student would not feel intimidated for askingquestions to the patients or the chief dr #MdchatTue May 31 18:17:38 PDT 2011

hjluks @ryanmadanickmd @Mtnmd Direct patient exposure important from first yr on...makes 3rd 4th yr transitions easier mr meaningful #mdchatTue May 31 18:18:04 PDT 2011

RyanMadanickMD @Milo_Paradiso with good teachers, there is no intimidation #MdchatTue May 31 18:18:13 PDT 2011

lindseybh @healthblawg Also lurking. #mdchatTue May 31 18:18:15 PDT 2011

AbnormalFacies I agree - my clerkships should come w checklist that myself + residents responsiblefor me compltng @Mtnmd Identifying CORE CONTENT #MDchatTue May 31 18:18:25 PDT 2011

hjluks @Milo_Paradiso we encourage our students to participate... pre-op, post-op and inoffice. #mdchatTue May 31 18:18:57 PDT 2011

LindaP_MD #mdchat intermittently lurking...Tue May 31 18:19:09 PDT 2011

thinkalot Make sure students res r ready for the real world by facilitating learning in realworld#MDchatTue May 31 18:19:15 PDT 2011

Neil_Mehta we got rid of all tests and lectures in our med school. see pts in year 1, all content inPBL, learning portfolios #mdchatTue May 31 18:19:24 PDT 2011

RKmd MS2 on my psych rotation right now... also lurking. First time here! =) #MDchatTue May 31 18:19:27 PDT 2011

RyanMadanickMD T1 You want full change? here, start with OBJECTIVES of 4 yrs of education, build

system backward... #mdchat #mededTue May 31 18:19:31 PDT 2011

Mtnmd @Neil_Mehta Wow, that is great! #MDchatTue May 31 18:20:13 PDT 2011

MD_chat @rkmd Welcome, Rishi. #MDchatTue May 31 18:20:32 PDT 2011

hjluks @Milo_Paradiso of course... old culture still exist... #mdchatTue May 31 18:20:47 PDT 2011

Mtnmd @RyanMadanickMD So true, Ryan. Our system needs a COMPLETE revamp.#MDchatTue May 31 18:20:50 PDT 2011

Dr_Mum I think a mentorship model would be effective. Students learn better when they arenot afraid of failure #MDchatTue May 31 18:20:51 PDT 2011

Christianassad Cardiology Fellow - first time in #mdchatTue May 31 18:20:52 PDT 2011

thinkalot Madhu Singh internist meded enthusiast #mdchatTue May 31 18:21:02 PDT 2011

HealthJusticeCT very much agree with @NateOsit ! Looking at social determinants of health is veryimportant to patient care. #MDchatTue May 31 18:21:17 PDT 2011

Milo_Paradiso i think this is the sad part, old professors teaching old medicine #MdchatTue May 31 18:21:21 PDT 2011

Mtnmd @RyanMadanickMD @hjluks Yes, 20 years later, that worm lecture still gets mygoat!! :) #MDchatTue May 31 18:21:28 PDT 2011

RyanMadanickMD lots of first timers in #mdchat tonight...niceTue May 31 18:21:36 PDT 2011

Mtnmd Remove the abuse. #MDchatTue May 31 18:21:45 PDT 2011

thinkalot @Neil_Mehta we have just started w PBL:some med students seem anxious abt it#mdchatTue May 31 18:22:03 PDT 2011

RKmd @Milo_Paradiso I think having residents/interns teach med students blurs the linebetween old/new gen medicine. #MDchatTue May 31 18:22:22 PDT 2011

NateOsit @ryanmadanickmd T1 Objectives: improve patient care, identify best methods,understand how to use tools... others? #MDchatTue May 31 18:22:24 PDT 2011

Mtnmd Big one: teach teamwork. BIG ONE. #MDchatTue May 31 18:22:28 PDT 2011

MD_chat @christianassad @thinkalot Good evening and welcome! #MDchatTue May 31 18:22:44 PDT 2011

Christianassad From my experience using tablets and ipads to potentiate learning while rounding isvery efficient. More faculty are doing it now #mdchatTue May 31 18:22:46 PDT 2011

resreports #mdchat @mtnmd agree the current meded system is broken. perhaps first two yrsshould be shortened to one, as duke med does?Tue May 31 18:22:46 PDT 2011

herlevic #MDchat. Some business education/class would have been nice along the dayTue May 31 18:22:49 PDT 2011

EHRoutlook Anyone worry about med students not getting an #EMR/#EHR education while inschool? #mdchatTue May 31 18:22:50 PDT 2011

Neil_Mehta @thinkalot @Neil_Mehta There is a learning curve... #mdchatTue May 31 18:22:52 PDT 2011

RyanMadanickMD @NateOsit promote long-term health... #MDchatTue May 31 18:22:55 PDT 2011

RyanMadanickMD Has anyone used Team Based Learning yet? #mdchat #mededTue May 31 18:23:23 PDT 2011

Milo_Paradiso as a patient I enjoy talking to med students, they are at their sweetest :-) #MdchatTue May 31 18:23:24 PDT 2011

LindaP_MD #mdchat if students exposed to patients earlier, there is also more time to see if theyhave skills needed or hone them.Tue May 31 18:23:27 PDT 2011

Costner75 “@Mtnmd: Big one: teach teamwork. BIG ONE. #MDchat” and teach collaborationwith other providers. #MDchatTue May 31 18:23:38 PDT 2011

MD_chat OK - moving to next topic (feel free to discuss first topic, just add T1 to tweets so wecan filter for context later. #MDchatTue May 31 18:23:38 PDT 2011

cdbond Agreed! @NateOsit ! Looking at social determinants of health is very important topatient care. #MDchat

Tue May 31 18:23:41 PDT 2011

NateOsit Importance of public health efforts! RT @ryanmadanickmd: @NateOsit promote long-term health... #MDchatTue May 31 18:24:02 PDT 2011

LindaP_MD #mdchat T1 One student stellar in classroom can have POOR people skillsTue May 31 18:24:17 PDT 2011

Milo_Paradiso However I hate when they are dissed in front of the patient, and it happens #MdchatTue May 31 18:24:42 PDT 2011

AbnormalFacies @Dr_Mum Mentorship model has been instituted widely - no way to ensure goodexperience for students; this is what needs attn #MDchatTue May 31 18:24:55 PDT 2011

Srini2000 When does this heavy focus on cure rather than prevention happen in meded?#mdchatTue May 31 18:25:07 PDT 2011

hjluks @LindaP_MD so vry tru... not impressed by creds as much as I am by other skills andapplication of them... #mdchatTue May 31 18:25:07 PDT 2011

Costner75 “@EHROutlook: Anyone worry about med students not getting an #EMR/#EHR educ#mdchat” No, bc every system different. will learn at 1st job.Tue May 31 18:25:09 PDT 2011

EllenRichter T1 What abt continuing medical educ? Once med school is done, how doeseducation continue? Is that also problematic? Or is that OK? #MDchatTue May 31 18:25:36 PDT 2011

Christianassad @hjluks yes but the problem is that programs usually look at step scores foradmissions not people skills #mdchatTue May 31 18:25:59 PDT 2011

NateOsit @Neil_Mehta @EHROutlook Which EHR? The EHR landscape will look verydifferent in 5 years. Teach basic, vendor neutral concepts #MDchatTue May 31 18:26:05 PDT 2011

RyanMadanickMD It is harder to teach interpersonal skills/professionalism than it is to teach"knowledge" #meded #mdchatTue May 31 18:26:14 PDT 2011

hjluks @MD_Chat chk out this link/paper by @carlosrizo ... this cld turn pharma worldupside down http://goo.gl/9rA9d #mdchatTue May 31 18:26:33 PDT 2011

RyanMadanickMD @EHRoutlook not necessarily, depends on where they are #MDs #EMR #EHR#mdchatTue May 31 18:26:51 PDT 2011

hjluks @MD_Chat ...and push research fwd at a far better pace link again

http://goo.gl/9rA9d #mdchatTue May 31 18:27:12 PDT 2011

EHRoutlook @nateosit teaching vendor-neutral concepts re: #EHRs makes sense to me; whatwoud those be? #mdchatTue May 31 18:27:15 PDT 2011

apjonas T1 Admission committee= 50% primary care, 20% patients, 30 % narrow focusspecialties. #MDChatTue May 31 18:27:18 PDT 2011

Neil_Mehta how does ed continue? Is that also problematic? We should help student learn howto learn - then no prob later #mdchatTue May 31 18:27:36 PDT 2011

Costner75 awesome point! “@Srini2000: When does this heavy focus on cure rather thanprevention happen in meded?” #MDchatTue May 31 18:27:38 PDT 2011

Mtnmd T2 From the beginning, lifestyle factors should be firmly taught as the first line tx, andgiven skills to do so. Req chng in pmt #MDchatTue May 31 18:27:59 PDT 2011

Neil_Mehta T1 content changes too fast. Med students need to learn how to learn and solveproblems #mdchatTue May 31 18:28:23 PDT 2011

Christianassad Its difficult to teach someoneto care... If you care about your patietns your care aboutlearning. IMO #mdchatTue May 31 18:28:33 PDT 2011

RyanMadanickMD T2 hard to completely separate the two. Docs cannot develop the drugs,pharmaceutical companies cannot treat patients #mdchatTue May 31 18:28:38 PDT 2011

Dr_Mum Student evaluation of mentors and perhaps matching of students to mentors couldhelp reduce bad experiences @AbnormalFacies #MDchatTue May 31 18:28:52 PDT 2011

Melissa_DrMom This is def. true. RT@RyanMadanickMD It is harder to teach interpersonalskills/professionalism than it is to teach "knowledge" #mdchatTue May 31 18:28:57 PDT 2011

EHRoutlook Patients are certainly taking over more responsibility when it comes to drug/treatmentchoices #epatient #mdchatTue May 31 18:28:59 PDT 2011

Srini2000 T2 Reduce influence of Big Pharma on medical practice. Doctors should be able totreat with things that are NOT from Big Pharma. #mdchatTue May 31 18:29:00 PDT 2011

blausengroup MT @Christianassad: "..using tablets &ipads to potentiate learning while rounding isvery efficient. More faculty are doing it now #mdchatTue May 31 18:29:01 PDT 2011

apjonas @KathyKastner @Mtnmd Who writes the meanness training modules currently? Verylow % of meanness oriented role models now. #MDChatTue May 31 18:29:27 PDT 2011

Mtnmd T2 Skills that get someone IN to medical school (studies well in dark closet for 12hours) are the opposite of people skills. #MDchatTue May 31 18:29:32 PDT 2011

RyanMadanickMD @Srini2000 T2 we are able to treat with whatever we want #mdchatTue May 31 18:29:37 PDT 2011

Costner75 “@EHROutlook: @Costner75 @EHROutlook med students learning on first job.students today cut teeth on computers. savvy. #MDchatTue May 31 18:29:47 PDT 2011

EllenRichter They are common-sense traits, quite hard to teach! RT @ryanmadanickmd: It isharder to teach interpersonal skills/professionalism #MDchatTue May 31 18:29:53 PDT 2011

EinsteinMed Interesting RT @hjluks: @MD_Chat ...and push research fwd at a far better pace linkagain http://goo.gl/9rA9d #mdchatTue May 31 18:29:57 PDT 2011

apjonas T1 Acting skills mandatory for all. #MDChatTue May 31 18:30:07 PDT 2011

jackiefox12 @RyanMadanickMD Yes it does definitely depend on doc. Agree with your othercomment, people skills harder to learn #mdchatTue May 31 18:30:11 PDT 2011

hjluks @Neil_Mehta ...and there is far too much content to possibly learn in med school.teach techniques, relevant content in residency #mdchatTue May 31 18:30:25 PDT 2011

Christianassad sorry about the question. New here. What does T1 and T2 mean? #mdchatTue May 31 18:30:36 PDT 2011

RyanMadanickMD @jackiefox12 sometimes you can educate about them, it takes practice though#mdchatTue May 31 18:30:42 PDT 2011

Mtnmd @AbnormalFacies @RyanMadanickMD Yes, so we should choose smart ppl w/excellent ppl skills and teach them the science, not other way #MDchatTue May 31 18:30:48 PDT 2011

RyanMadanickMD @Christianassad Topic 1, #mdchatTue May 31 18:30:49 PDT 2011

NateOsit T2 Shorter patent windows, end pharma DTC advertising, more public/patientfocused industry. #MDchatTue May 31 18:30:57 PDT 2011

jendlake So important now!! RT @Neil_Mehta: T1 content changes too fast. Med studentsneed to learn how to learn and solve problems #mdchat

Tue May 31 18:31:09 PDT 2011

RyanMadanickMD #mdchat AGREE >> RT @Mtnmd: @AbnormalFacies @RyanMadanickMD Yes, sowe should choose smart ppl w/ excellent pp… (cont) http://deck.ly/~GxLJ7Tue May 31 18:31:34 PDT 2011

apjonas @Srini2000 Does little pharma make drugs? #MDChatTue May 31 18:31:35 PDT 2011

mkmackey The endearing qualities of patient engagement..:) RT @apjonas: T1 Acting skillsmandatory for all. #MDChatTue May 31 18:31:44 PDT 2011

Srini2000 @apjonas @Srini2000 Why should everything only be treated with drugs from bigpharma? #mdchatTue May 31 18:32:39 PDT 2011

RyanMadanickMD @Neil_Mehta @hjluks teach concepts, not facts #meded #mdchatTue May 31 18:32:45 PDT 2011

EHRoutlook Could DTC adverts be changed to truly offer educational content? #mdchatTue May 31 18:32:57 PDT 2011

Mtnmd @Christianassad Topic 1 and 2 #MDchatTue May 31 18:33:01 PDT 2011

Dr_Mum T1 Med student selection should be more about interpersonal skills than marks#MDchatTue May 31 18:33:56 PDT 2011

hjluks +1RT @Mtnmd: Skills that get u IN to medical school (studies well in dark closet for12 hours) are the opposite of people skills. #mdchatTue May 31 18:34:04 PDT 2011

EHRoutlook I first learned of a condition I had by having it identified by a pharma commercial. Iasked my MD and I got diagnosed. #epatient #mdchatTue May 31 18:34:06 PDT 2011

Neil_Mehta T2 - stop samples, no Drug reps in teaching institutions #mdchatTue May 31 18:34:42 PDT 2011

RKmd @Dr_Mum I know med schools are now trying to transition to a more "case-based"interview style to assess interpersonal skills. #MDchatTue May 31 18:35:06 PDT 2011

beRt_MD @Melissa_DrMom @RyanMadanickMD Hard to tell them to not be a jerk, be a betterlistener, start acting professional. #mdchatTue May 31 18:35:09 PDT 2011

MD_chat @Christianassad Topic 1, Topic 2 - just a way to organize the chat - also helps withtranscription later. #MDchat Make Sense?Tue May 31 18:35:10 PDT 2011

Christianassad @Dr_Mum That would be great. But how do you intervw someone basing oninterpersonal skills. That is the problem. 1000s of applics #mdchatTue May 31 18:35:17 PDT 2011

JediPD Med students need Concepts not content. That can be filled later. It is difficult toseparate sociopaths from the rest by interview #MDchatTue May 31 18:35:29 PDT 2011

Mtnmd @EinsteinMed @jendlake @Neil_Mehta BIG core concepts, like firm undrstndng ofanatmy/physiol, w/ "how to think and analyze" content. #MDchatTue May 31 18:35:36 PDT 2011

hjluks repurcussions of shunning pharma and their CME support cld be dble edged sword.R MDs going to pay 3000 for a course? #mdchatTue May 31 18:36:33 PDT 2011

RyanMadanickMD @apjonas @srini2000 Me...I should make them #MDChatTue May 31 18:36:41 PDT 2011

EHRoutlook Re: T1 -- do you think iPads have promise in med schools? A couple are alreadythere. #mdchatTue May 31 18:36:56 PDT 2011

Christianassad @beRt_MD Step scores... #mdchatTue May 31 18:37:20 PDT 2011

hjluks @apjonas @Srini2000 vry tru.... pharma serves a purpose... we need to betterdefine/determine what interaction is useful for all. #mdchatTue May 31 18:37:27 PDT 2011

RyanMadanickMD @hjluks we cannot completely separate the two, despite what many would have uswant #mdchatTue May 31 18:37:35 PDT 2011

apjonas Problem based Lng and Independent Study are great lng models for many. Patientoriented and refreshing, says the OSU ISP grad. #MDChatTue May 31 18:38:02 PDT 2011

Mtnmd Q: Would personality testing, focusing on positive traits, be appropriate for entranceexams instead of/beside interviews? #MDchatTue May 31 18:38:15 PDT 2011

EHRoutlook The problem may not be big pharma alone, so much as the distribution system inwhich pharma operates. Think 1000% markup at CVS. #mdchatTue May 31 18:38:22 PDT 2011

JediPD The ultimate aim of pharma is profitability but that comes only though good salableproducts. Subpar gets rooted out. #MDchatTue May 31 18:38:28 PDT 2011

KathyKastner +1RT @Dr_Mum: T1 Med student selection should be more about interpersonalskills than marks #MDchatTue May 31 18:38:44 PDT 2011

beRt_MD I sat down with each if my students who have poor interpersonal skills and havegiven critics. Specific examples help. #mdchatTue May 31 18:38:56 PDT 2011

hjluks @EHROutlook hmmm, not sure about that... 3000 = 10 credits, need 100 -= 30k forCME every 2 yrs ??? #mdchatTue May 31 18:38:57 PDT 2011

RyanMadanickMD @HokieMD thx (even though ur a Hokie) #mdchat #mededTue May 31 18:39:10 PDT 2011

thinkalot #mdchat there is lotsa room in medicine for everybody:extroverts&introvert Way oflearning has to shift:framework vs listmaniaTue May 31 18:39:27 PDT 2011

hjluks @carlosrizo @Dr_Mum absolutely... but we need tools to test social skills duringinterview... not easy to assess in 5 minutes #mdchatTue May 31 18:39:43 PDT 2011

Srini2000 @EHROutlook The health care model emphasizes huge markups vs. computerindustry where costs come down and more people access. #mdchatTue May 31 18:39:59 PDT 2011

peds_id_doc @JediPD #mdchat t2 in an ideal world...in reality, good sales pitches and spin keepsubpar products on Market, endangers patients, wastes $Tue May 31 18:40:10 PDT 2011

JediPD Empathy ~~>@Mtnmd: Q: Would focusing on positive traits, be appropriate forentrance exams instead of/beside interviews? #MDchatTue May 31 18:40:20 PDT 2011

mkmackey @hjluks interesting patients can tell in a second if MD will be personable #mdchatTue May 31 18:40:23 PDT 2011

apjonas @KathyKastner @Dr_Mum A mutant brain is a good asset, too. The thoughts per unitof time in medicine are impressive. #MDChatTue May 31 18:40:31 PDT 2011

Neil_Mehta @EHROutlook @Neil_Mehta the 4 dollar generics are there. sampling causes probby forcing use of inappropriate drugs #mdchatTue May 31 18:40:41 PDT 2011

Dr_Mum @Christianassad Interviews should include scenarios and role play as well asquestions about personal motivation #MDchatTue May 31 18:40:45 PDT 2011

EHRoutlook Has anyone heard of the open-source drug discovery model? #mdchatTue May 31 18:41:08 PDT 2011

peds_id_doc @beRt_MD #mdchat t1 personal feedback on comm skills should be part of #mededfor all. Role play, do-overs, practice b4 seeing real ptsTue May 31 18:41:13 PDT 2011

lindseybh Awesome--RT @beRt_MD: I sat down with each if my students who have poorinterpersonal skills and have given critics. #mdchatTue May 31 18:41:28 PDT 2011

Melissa_DrMom @beRt_MD @RyanMadanickMD Better for them to know now than later. Hopefullysome of them will take it to heart. #mdchatTue May 31 18:41:34 PDT 2011

EHRoutlook @Neil_Mehta @EHROutlook I see the role samples for $$ drugs play in overuse, butsome of these $$ drugs actually work. #mdchatTue May 31 18:41:57 PDT 2011

Mtnmd @beRt_MD Yes, teaching professionalism part of mentoring. #MDchatTue May 31 18:42:11 PDT 2011

apjonas T2 Wall Street driven money sucking initiatives have to be thwarted or we continue tobankrupt USA shamelessly and call it "quality" #MDChatTue May 31 18:42:13 PDT 2011

beRt_MD Unfortunately have had to kick students out of med school. Too few and far inbetween. Scary that some get MDs. #mdchatTue May 31 18:42:21 PDT 2011

TrishaTorrey Jumping in to #MDchat - note that interpersonal skills in an interview or at lunch arenot reflective of same person under pressureTue May 31 18:42:30 PDT 2011

JediPD The cost to bring one new drug to market: $800,000 to $1.1 million. You see thedilemma. #MDchatTue May 31 18:42:38 PDT 2011

RyanMadanickMD That seems low >> RT @JediPD: The cost to bring one new drug to market:$800,000 to $1.1 million. You see the dilemma. #MDchatTue May 31 18:43:04 PDT 2011

Mtnmd @thinkalot Great concept: framework vs listmania. So, so true!! #MDchatTue May 31 18:43:16 PDT 2011

peds_id_doc @TrishaTorrey #mdchat - very true, hence importance of practicing skillet (nodifferent from placing IV, doing LP under pressure)Tue May 31 18:43:26 PDT 2011

EllenRichter Thats great! RT @beRt_MD: I sat down with each students w/ poor interpersonalskills and have given critics. Specific examples help. #MDchatTue May 31 18:43:31 PDT 2011

AbnormalFacies Often >> Not RT @peds_id_doc #mdchat t2 in reality, good sales pitches and spinkeep subpar products on Market, endangers patients, wastes $Tue May 31 18:44:08 PDT 2011

carlosrizo @hjluks @dr_mum just curious, have you seen a Standardized Doctor Program?#mdchatTue May 31 18:44:29 PDT 2011

Mtnmd @JediPD Yes. Empathy. #MDchatTue May 31 18:44:47 PDT 2011

JediPD @ryanmadanickmd for every 5000 compounds tested only 3-4 make it to Phase 1and maybe 1 goes to phase 3 trials and FDA NDA #MDchatTue May 31 18:45:29 PDT 2011

MD_chat T3 Incentives: How would we structure funding/payments? What fixes to current stateare a must? #MDchatTue May 31 18:45:52 PDT 2011

thinkalot #mdchat unfortunately all the feedback takes time&its a lucky MD that has timefactored in for med studentsTue May 31 18:45:56 PDT 2011

RyanMadanickMD @beRt_MD we had a guy in my class that we think was schizophrenic #mdchatTue May 31 18:46:00 PDT 2011

hjluks @carlosrizo no... but vry vry interesting #mdchatTue May 31 18:46:09 PDT 2011

TrishaTorrey @carlosrizo in convo w/dirctor of stand pt program, was told that interpersonal skillsare observed. No penalty for bad skills. #mdchatTue May 31 18:46:11 PDT 2011

hjluks @MD_Chat did someone mention shoulder? :-0 #mdchatTue May 31 18:46:21 PDT 2011

thinkalot #mdchat teaching med students loses to RVUs all the timeTue May 31 18:46:28 PDT 2011

RyanMadanickMD @JediPD so prob more than $1 million/drug #MDchatTue May 31 18:46:32 PDT 2011

RyanMadanickMD NO!!!! RT @hjluks: @MD_Chat did someone mention shoulder? :-0 #mdchatTue May 31 18:46:43 PDT 2011

Mtnmd MT @peds_id_doc: @beRt_MD #mdchat t1 persnl feedbck on comm skills shld Bpart of #meded. Role play, do-overs, practice b4 seeing real ptsTue May 31 18:47:06 PDT 2011

RyanMadanickMD MAJOR ISSUE >> RT @thinkalot: #mdchat teaching med students loses to RVUs allthe timeTue May 31 18:47:17 PDT 2011

EllenRichter Ha! One track mind! :) RT @hjluks: @MD_Chat did someone mention shoulder? :-0#MDchatTue May 31 18:47:28 PDT 2011

EinsteinMed At Einstein http://bit.ly/eLjbQX RT @peds_id_doc: @beRt_MD #mdchat t1 personalfeedback on com skills should be part of #meded... #mdchatTue May 31 18:47:32 PDT 2011

Srini2000 T3 - emphasize and reward doctor/patient transactions. De-emphsasze all othermiddlemen e.g insurance companies etc. #mdchatTue May 31 18:47:46 PDT 2011

hjluks @ryanmadanickmd @thinkalot then u shouldnt have a teaching position #mdchatTue May 31 18:48:05 PDT 2011

EinsteinMed HA! RT @hjluks: @MD_Chat did someone mention shoulder? :-0 #mdchatTue May 31 18:48:08 PDT 2011

EHRoutlook What do MDs think of the #ACO concept for sharing and restructuring payments?Son of capitation? #mdchatTue May 31 18:48:20 PDT 2011

MD_chat @hjluks I should use Spinal Tap more often ;) #MDchatTue May 31 18:48:24 PDT 2011

NateOsit T3 Incentivize efficiency, compassion, common sense. Get rid of industry bloatware#MDchatTue May 31 18:48:42 PDT 2011

peds_id_doc @carlosrizo @hjluks @dr_mum #MDchat SP programs can be excellent if used right.V effective at teaching comm skills/patient centered careTue May 31 18:48:51 PDT 2011

EinsteinMed Will chats go to 11? RT @MD_Chat: @hjluks I should use Spinal Tap more often ;)#mdchatTue May 31 18:49:09 PDT 2011

hjluks @ryanmadanickmd understood.. not a personal attack :-) #mdchatTue May 31 18:49:15 PDT 2011

beRt_MD Need to get rid of payment to order labs and imaging. Need to de-couple HCP fromowning imaging/lab centers. #mdchatTue May 31 18:50:23 PDT 2011

philiplederer why medical school should be free-- in #nytimes http://t.co/jir2a3I #mdchatTue May 31 18:50:26 PDT 2011

terrysimpson @beRt_MD psychiatrists determine normal. Remember who went into psych?#MDchatTue May 31 18:50:34 PDT 2011

grecoa3 @Mtnmd @peds_id_doc @bert_md we do those things here, but w/ poor timing!Needs to be primary focus, not thrown in during exam week! #mdchatTue May 31 18:51:01 PDT 2011

RyanMadanickMD T3: think about this: 30 minutes for a "routine" surgery...get paid same as a 30 minuteoffice visit?? #mdchatTue May 31 18:51:05 PDT 2011

purplesque @beRt_MD @thinkalot Do you still think its worth it? (Newbie debating long termcareer in academia.) #mdchatTue May 31 18:51:48 PDT 2011

Mtnmd @MD_chat U mean, funding for med school, or medical care? #MDchatTue May 31 18:51:49 PDT 2011

hjluks @Doctor_V I have an answer... but need 1500 ch :-) #mdchatTue May 31 18:52:06 PDT 2011

NateOsit @beRt_MD Especially since so many labs/imaging get duplicated! We need a bettersystem... #MDchatTue May 31 18:52:07 PDT 2011

JediPD Imposing hurdle of middle-man in enterprise is fraught with distress&dysfunction.#MDchat 1 party wants fair shr & the other wants squeeze.Tue May 31 18:52:12 PDT 2011

RyanMadanickMD T3 Another thought here: I spend 15 minutes looking for polyps, get paid same as theguy who spends 3 (colonoscopy) #mdchatTue May 31 18:52:13 PDT 2011

carlosrizo @TrishaTorrey In airline industry pilots that underperform in simulator go onprobation or loose license. #mdchatTue May 31 18:52:18 PDT 2011

RyanMadanickMD @purplesque YES very much so @beRt_MD @thinkalot #mdchatTue May 31 18:52:48 PDT 2011

peds_id_doc @grecoa3 @mtnmd @bert_md t1 #MDchat used to be that way at SUNYupstate...until I got my way, bwahahahaah! Now start in week 1.Tue May 31 18:53:09 PDT 2011

Doctor_V *rimshot* RT @hjluks: @Doctor_V I have an answer... but need 1500 ch :-) #mdchatTue May 31 18:53:21 PDT 2011

RyanMadanickMD @purplesque Do it for the right reasons @beRt_MD @thinkalot #mdchatTue May 31 18:53:21 PDT 2011

EllenRichter T3 Payments? My dad has terminal lung cancer. PET CTs evry 3 mos to check onchemo. $7000 per PET CT! $250 for radiologist to read. #MDchatTue May 31 18:53:41 PDT 2011

Mtnmd @terrysimpson @beRt_MD Haaaa #MDchatTue May 31 18:54:12 PDT 2011

carlosrizo @peds_id_doc @hjluks @dr_mum social interpersonal skills can be refined andpolished in med school. Need a good baseline #mdchatTue May 31 18:54:23 PDT 2011

Mtnmd @hjluks @Doctor_V 10,000 characters #MDchatTue May 31 18:54:47 PDT 2011

AbnormalFacies Does a lap appy count? I just had one go 3.5hrs, what then? lol T3 think about this:30 min for a "routine" surgery...get paid same #mdchatTue May 31 18:55:04 PDT 2011

beRt_MD Docs use to be shopkeeper, now more r employed. No incentive to do less testing.Pressure to do more given possible litigation #mdchatTue May 31 18:55:22 PDT 2011

drmintz T2- Start the patent clock when a drug is approved, not identified. Incentivize industryto make safe and effective products #mdchatTue May 31 18:55:32 PDT 2011

peds_id_doc @carlosrizo @hjluks @dr_mum #MDchat t1 more than that though - can teachempathy, active listening, proper questioning style, pt engagementTue May 31 18:55:38 PDT 2011

Mtnmd T3 middle men (insurance, etc) HAVE to be removed for most patients to achieveANY kind of cost control. #MDchatTue May 31 18:55:49 PDT 2011

scanman My first peek into #mdchat. Want to find out what the thought leaders are talkingabout.Tue May 31 18:56:07 PDT 2011

peds_id_doc @carlosrizo @hjluks @dr_mum #MDchat t1 studies have shown that trainingdocs/students this way impacts patients, so very teachable!Tue May 31 18:56:10 PDT 2011

RyanMadanickMD @AbnormalFacies Increased complexity, unexpected, bill modifier -22?? #mdchatTue May 31 18:56:10 PDT 2011

drmintz T2-FDA approval should be for either safer or more effective products, not better thanplacebo #mdchatTue May 31 18:56:22 PDT 2011

Mtnmd T3 There are MANY models coming out where patients pay less than haircut/monthfor full OP care, catastrophic ins, only. #MDchatTue May 31 18:56:34 PDT 2011

RyanMadanickMD MT @drmintz: T2- Start patent clock when drug is approved, not identified.Incentivize industry to make safe and effective products #mdchatTue May 31 18:56:34 PDT 2011

EllenRichter Absolutely! RT @Mtnmd: T3 middle men (insurance, etc) HAVE to be removed formost patients to achieve ANY kind of cost control. #MDchatTue May 31 18:56:37 PDT 2011

grecoa3 @peds_id_doc @carlosrizo @hjluks @dr_mum agreed! Poor planning= problemtoo. Our SP sched as easy class during exam week= ignored #mdchatTue May 31 18:56:43 PDT 2011

MD_chat @Mtnmd I mean care #MDchatTue May 31 18:56:50 PDT 2011

beRt_MD @RyanMadanickMD @purplesque @thinkalot Teaching is so worth it. Veryrewarding, we had hand in training excellent physicians. #mdchatTue May 31 18:56:54 PDT 2011

RyanMadanickMD am I a thought leader?? Oy vey RT @scanman: My first peek into #mdchat. Want tofind out what the thought leaders are talking about.Tue May 31 18:57:07 PDT 2011

Mtnmd T3 Cost of MRI: > $3000. Cost, if all ins, etc, removed: $400. THERE is the problem.#MDchatTue May 31 18:57:47 PDT 2011

RyanMadanickMD @EinsteinMed you mean...take care of pts?? #mdchatTue May 31 18:57:50 PDT 2011

TrishaTorrey #MDchat - Q re: middle men - would you want to remove insurance fromhomeowners (fires) or authos (accidents?) not much differentTue May 31 18:57:59 PDT 2011

RyanMadanickMD as things wind up here, just a note that I will be posting a Video blog about recentevents and @mommy_doctor departure #mdchat #hcsmTue May 31 18:58:01 PDT 2011

scanman Join the queue at #mdchat >> RT @DrGhaheri: @RyanMadanickMD @scanmanWait wait. *I* want to be a thought leader too!!!!!Tue May 31 18:58:06 PDT 2011

Mtnmd @RyanMadanickMD Yes, you are. #MDchatTue May 31 18:58:18 PDT 2011

EinsteinMed Sorry. Spinal Tap Joke fail on my part. Knew I should have gone with Stonehenge. :)@MD_Chat @EinsteinMed @hjluks #mdchatTue May 31 18:58:41 PDT 2011

apjonas @ryanmadanickmd In 15 minutes, I get pd 25% of colonoscopy doc for RXdepression, htn, diabetes and ED, plus the "by the way rash". #MDChatTue May 31 18:58:52 PDT 2011

RyanMadanickMD @EinsteinMed I disagree! #mdchatTue May 31 18:58:57 PDT 2011

mkmackey Really nice to hear the postive comments from physicians on teaching medicalstudents #mdchatTue May 31 18:59:04 PDT 2011

EHRoutlook @EinsteinMed Ever seen the real stonehenge? #mdchatTue May 31 18:59:09 PDT 2011

Srini2000 @TrishaTorrey Use of insurance is an exception in all these cases #mdchatTue May 31 18:59:11 PDT 2011

RyanMadanickMD @apjonas true, need more equitable pay #MDChatTue May 31 18:59:20 PDT 2011

grecoa3 Wish I could really get into #mdchat.. Alas, #USMLE is summoning..Tue May 31 18:59:35 PDT 2011

MD_chat @scanman Hey Vijay! Welcome to #MDchat - Glad you found it. This is@PhilBaumann You were one of the 1st docs I met on Twitter way back!Tue May 31 18:59:36 PDT 2011

EinsteinMed About the joke? @ryanmadanickmd @EinsteinMed #mdchatTue May 31 18:59:49 PDT 2011

EHRoutlook @apjonas @ryanmadanickmd payment structure for PCPs *definitely out of line*#mdchatTue May 31 18:59:56 PDT 2011

Mtnmd @mkmackey Thanks!!! ♥ ♥ ♥ #MDchatTue May 31 19:00:07 PDT 2011

apjonas Final thought: Medical education is effective for the Medical Industrial Complex,perfectly responding to its needs. #MDChatTue May 31 19:00:09 PDT 2011

RyanMadanickMD @EinsteinMed yep.... 11! #mdchatTue May 31 19:00:33 PDT 2011

JediPD Pilots: 70% of all accidents are pilot errors. Only constant practice & good decisionmaking saves passengers #mdchatTue May 31 19:00:41 PDT 2011

peds_id_doc @grecoa3 @mtnmd @bert_md #MDchat t1 we had good leadership who valued it,brought in the right ppl to teach, supported changeTue May 31 19:00:56 PDT 2011

Srini2000 @TrishaTorrey @srini2000 In homes and cars #mdchatTue May 31 19:00:59 PDT 2011

RyanMadanickMD @md_chat We need change, but it will not come quickly #mdchatTue May 31 19:01:55 PDT 2011

RyanMadanickMD @MD_chat Great chat tonight #MDchatTue May 31 19:02:08 PDT 2011

apjonas @JediPD Agree. I flew helicopters in Vietnam. Practice, practice, practice. Pray, pray,pray! #MDChatTue May 31 19:02:13 PDT 2011

carlosrizo @mkmackey @TrishaTorrey Indeed flying planes is less complex than managing apatient with diabetes. Still all need safe "landings" #mdchat”Tue May 31 19:02:15 PDT 2011

Srini2000 Health Care has become very complex. Not sure it can be fixed. Will have to gut andstart over, which is difficult #mdchatTue May 31 19:02:32 PDT 2011

MD_chat @grecoa3 Study hard, relax well. #MDchatTue May 31 19:02:34 PDT 2011

JediPD Medicine thru politics and media bias is in free fall. The society need to wise up andcomfort the comforters! #mdchatTue May 31 19:03:04 PDT 2011

RyanMadanickMD @EinsteinMed "Lick my love pump" #mdchatTue May 31 19:03:17 PDT 2011

KathyKastner LOL RT @terrysimpson: @beRt_MD psychiatrists determine normal. Remember whowent into psych? #MDchatTue May 31 19:03:24 PDT 2011

Mtnmd I am hopeful that from the apparent demise of our system, a Phoenix of excellenttraining and care will emerge. #MDchatTue May 31 19:03:41 PDT 2011

NateOsit Final thoughts: Healthcare needs to become more patient focused while reducinghealth disparities and inefficiency. 3X threat! #MDchatTue May 31 19:03:47 PDT 2011

mkmackey Love it RT @carlosrizo: Indeed flying planes is less complex than managing apatient with diabetes. Still all need safe "landings" #mdchatTue May 31 19:03:52 PDT 2011

NateOsit :-) RT @Mtnmd: I am hopeful that from the apparent demise of our system, a Phoenixof excellent training and care will emerge. #MDchatTue May 31 19:04:30 PDT 2011

RyanMadanickMD @DrVes LOL @scanman #mdchatTue May 31 19:04:35 PDT 2011

Dr_Mum Thank you all for the discussion #MDChatTue May 31 19:05:20 PDT 2011

AbnormalFacies @EinsteinMed Not only did I get it, but I think it may have been the best #MDchattweet of the night... exit on a high note ;)Tue May 31 19:05:27 PDT 2011

apjonas @mkmackey @carlosrizo The helicopter flying in Vietnam was equal to thechallenge of treating a diabetic patient. #MDChatTue May 31 19:05:41 PDT 2011

AbnormalFacies SPEECH! ;) RT @Mtnmd I am hopeful that from the apparent demise of our system, aPhoenix of excellent training and care will emerge. #MDchatTue May 31 19:06:18 PDT 2011

MD_chat THANK YOU everybody for another lively #MDchat - Transcript will be up soon.Enjoy your week! - @PhilBaumannTue May 31 19:06:24 PDT 2011

mkmackey @apjonas I can only imagine.. thanks for sharing #mdchatTue May 31 19:06:52 PDT 2011

EHRoutlook I feel privileged to be here from the outside looking in. As an EMR specialist I invitequestions anytime on that subject. :-) #mdchatTue May 31 19:06:56 PDT 2011

carlosrizo #mdchat should be mandatory to pass #usmle “@grecoa3: Wish I could really getinto #mdchat.. Alas, #USMLE is summoning..”Tue May 31 19:07:50 PDT 2011

EHRoutlook Anyone interested in an #MDEMR chat? #mdchatTue May 31 19:07:55 PDT 2011

TrishaTorrey #MDchat please join @PhysiciansPract tomorrow 6/1 at 8pmEDT based on myseries -dealing w/ "problem" pts http://dlvr.it/SxrlH #PhysPractChatTue May 31 19:08:24 PDT 2011

MD_chat @EHROutlook Go for it! #MDchat #MDEMRTue May 31 19:09:19 PDT 2011