MDchat Twitter Healthcare Chat for January 18, 2011

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#MDchat

Healthcare Hashtag Twitter Transcript

From: Tue Jan 18 18:00:00 PST 2011

To: Tue Jan 18 19:15:00 PST 2011

Learn more about #MDchat at The Healthcare Hashtag Project

s_eller Good evening everyone - Susan here - RN & Educator at Medical School in Chicago #mdchTue Jan 18 18:00:51 PST 2011

EinsteinMed Hey crew! Paul here from Albert Einstein College of Medicine. #MDchatTue Jan 18 18:01:12 PST 2011

EllenRichter Hi there folks! Its #MDchat hour I see! Hope everyone is doing well! Ellen here, an ICU nurse

Legal nurse consultantTue Jan 18 18:01:42 PST 2011

GailZahtz #leadershipchat Thank for letting me drop in. Have to go put on my medical coat and stop by

#MDChatTue Jan 18 18:01:49 PST 2011

RichmondDoc Mark, family doc in #RVA; glad to see familiar faces here, and ready for another hour of activ

discussion! #mdchatTue Jan 18 18:02:30 PST 2011

Mtnmd @EllenRichter Hi, Ellen, great to see you - and everyone. #mdchatTue Jan 18 18:02:46 PST 2011

s_eller @EllenRichter, @GailZahtz@njfrantz - good evening #mdchatTue Jan 18 18:02:57 PST 2011

EinsteinMed @njfrantz Niles - good to see you on... Paul #MDChat

Tue Jan 18 18:03:12 PST 2011

EllenRichter @Mtnmd@RichmondDoc Hi to you too! :) #MDchatTue Jan 18 18:03:45 PST 2011

CrescendoCG Good evening, everyone. Beth here. #mdchatTue Jan 18 18:03:48 PST 2011

njfrantz Good to be seen :) #MDchatTue Jan 18 18:03:56 PST 2011

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AnthonyBurich Good evening - Anthony, RN student following along. #mdchatTue Jan 18 18:03:59 PST 2011

KathyKastner Greetings all. Kathy Kastner patient eductor. of sorts. #MDchatTue Jan 18 18:04:04 PST 2011

EllenRichter @njfrantz@GailZahtz Welcome~ #MDchatTue Jan 18 18:04:14 PST 2011

EinsteinMed @SarahBethRN Welcome! Thanks for joining. #MDChatTue Jan 18 18:04:44 PST 2011

s_eller @KathyKastner@sarahbethrn - welcome #mdchatTue Jan 18 18:04:53 PST 2011

s_eller @philbaumann - hello Phil #mdchatTue Jan 18 18:05:08 PST 2011

RichmondDoc @fidouglas Discussion on #MDChat is pretty broad: our fearless moderator suggeststopics/questions, and the rest is up to us participants.Tue Jan 18 18:05:55 PST 2011

EllenRichter What a nice turnout! Hi @KathyKastner@sarahbethrn@AnthonyBurich and of course

@PhilBaumann! #MDchatTue Jan 18 18:06:09 PST 2011

MD_chat T1 Withholding Info: Are there times when w/holding info from patients is ethical & less harm

than truth? See http://qr.ae/Yw2l#MDchat

Tue Jan 18 18:07:04 PST 2011

EllenRichter @GailZahtz Thanks for the intro! I didnt know you! But now I do :) #MDchatTue Jan 18 18:07:09 PST 2011

RichmondDoc @fidouglas Feel free to listen in & see how this flows; my caution is that if one starts as a lur

one ends up in the discussion. #mdchatTue Jan 18 18:07:16 PST 2011

GailZahtz Aw, TY for the shoutout welcomes! @EllenRichter@s_eller@Mtnmd#MDChatTue Jan 18 18:07:23 PST 2011

fidouglas @RichmondDoc Starting off as a lurker. Here goes... #MDchatTue Jan 18 18:07:53 PST 2011

KathyKastner Indeed and hi 2 u RT @EllenRichter: What a nice turnout! Hi @KathyKastner@sarahbethrn

@AnthonyBurich and of course @PhilBaumann! #MDchatTue Jan 18 18:08:07 PST 2011

AnthonyBurich @EllenRichter Greetings to you! #mdchatTue Jan 18 18:08:14 PST 2011

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s_eller Welcome @fidouglas - you will do fine - we all had a first time here #mdchatTue Jan 18 18:08:41 PST 2011

PhilBaumann @s_eller Hello! #mdchatTue Jan 18 18:08:44 PST 2011

RichmondDoc T1 Withholding information from a patient is unethical. Individual HCPs decide how to break

news, but pts should be aware. #mdchat

Tue Jan 18 18:08:57 PST 2011

s_eller @swan5675 welcome to a group of former lurkers at #mdchatTue Jan 18 18:09:43 PST 2011

RichmondDoc T1 One could argue how much info to provide to pts who cannot make their own decisions (e

elderly pts w/ dementia)... #mdchatTue Jan 18 18:09:49 PST 2011

pjmachado Hello #mdchat ers looking forward to this chat...

Tue Jan 18 18:09:51 PST 2011

aliciad3 Hi everyone! Alicia, pediatric infectious diseases fellow in Boston. Looking forward to #MDCTue Jan 18 18:10:33 PST 2011

RichmondDoc T1 ...but even then I think medical ethics would side on the principle of patient autonomy and

determination. #mdchatTue Jan 18 18:10:46 PST 2011

EinsteinMed T1: If pt is not emotionally stable - complete disclosure may not be wise. Timing is impt and

support systems must be assessed. #MDchatTue Jan 18 18:11:09 PST 2011

EllenRichter T1 There are those patients who absolutely dont want to hear bad news. Even when told, th

wont hear. #MDchatTue Jan 18 18:11:09 PST 2011

s_eller T1 I have to agree - witholding information is unethical - patients have right to know info -nee

work on how to deliver news #mdchatTue Jan 18 18:11:54 PST 2011

fidouglas T1 In UK, pts can submit a request for their med records. Only denied if risk of harm is to pt

others, but not med professionals. #mdchatTue Jan 18 18:12:01 PST 2011

RichmondDoc T1 One approach is: ask the patient how much they want to know, and provide in the inform

accordingly. #mdchatTue Jan 18 18:12:17 PST 2011

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KathyKastner Wht do u do?RT @EllenRichter: T1 There are those patients who absolutely dont want to he

bad news. Even when told, they wont hear. #MDchatTue Jan 18 18:12:37 PST 2011

EllenRichter T1 Not all health care providers are good at telling information patients may not want to hear

Communication is an art. #MDchatTue Jan 18 18:12:51 PST 2011

RichmondDoc @GailZahtz But who are we/families to decide if a pt can emotionally handle the news? Reashould be just the patient who decides #mdchatTue Jan 18 18:12:53 PST 2011

EllenRichter @KathyKastner T1 You get family to help. You find out the way to get thru to them. There is

always a way, just harder in some #MDchatTue Jan 18 18:13:39 PST 2011

ocamsrazor T1 always tell patients the truth, whole truth, nothing but the truth #mdchatTue Jan 18 18:13:56 PST 2011

CrescendoCG Agree RT @EllenRichter: T1 Not all h/c providers are good at telling information pts may not

to hear. Communication is an art. #mdchatTue Jan 18 18:14:25 PST 2011

AnthonyBurich #mdchat T1 - Patients deserve the right to full disclosure. I think we should tell with sensitivit

support them in coping.Tue Jan 18 18:14:46 PST 2011

westr And U wud know! RT @EllenRichter: T1 There are those patients who absolutely dont want

hear bad news. Even when told, wont hear. #MDchatTue Jan 18 18:14:51 PST 2011

GailZahtz Well, no-one WANTS to be dying. But if they are, for example, they have a right to know and

decide how to spend that time. #MDChatTue Jan 18 18:14:52 PST 2011

RichmondDoc T1 If pts are not ready to hear the info you would like to provide, figure out how far you shou

Get family/spiritual support. #mdchatTue Jan 18 18:14:54 PST 2011

s_eller T1 - should decide with patient and surrogates how much patient can handle and what supp

they need when hearing the news #mdchatTue Jan 18 18:15:08 PST 2011

JeanneAWebb * T1 Withholding information from a patient is unethical. Individual HCPs decide how to brea

news, but pts should be aware. #mdchat...Tue Jan 18 18:15:47 PST 2011

GailZahtz @KathyKastner@RichmondDoc Always for the full team approach. It takes a village to raise

child, a village to comfort the sick. #MDChatTue Jan 18 18:15:47 PST 2011

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RichmondDoc @GailZahtz@KathyKastner Agree. Involve pts, family, counselors (spiritual or mental health

take your time if needed. #mdchatTue Jan 18 18:16:42 PST 2011

aliciad3 T1 That said, often the medical plan is work in progress and the usual back and forths can

understandably cause anxiety... #MDChatTue Jan 18 18:16:48 PST 2011

EllenRichter T1 What a great question! :) #MDchatTue Jan 18 18:17:38 PST 2011

EinsteinMed T1: Many docs need more training on how to disclose difficult info. Pts can be devastated by

manner in which a dx is delivered. #MDchatTue Jan 18 18:18:01 PST 2011

EllenRichter @PracticalWisdom@aliciad3 Welcome folks! You get a late slip! ;) #MDchatTue Jan 18 18:18:18 PST 2011

AnthonyBurich @GailZahtz: Always for the full team approach. It takes a village to raise a child, a village tocomfort the sick. #MDChatTue Jan 18 18:18:22 PST 2011

aliciad3 Great approach. RT @westr@RichmondDoc: T1 One approach is: ask the pt how much the

want to know, and provide info accordingly. #MDChatTue Jan 18 18:19:08 PST 2011

GailZahtz @PracticalWisdom Waving hi. Good to see you. #MDChatTue Jan 18 18:19:20 PST 2011

s_eller @apjonas@RichmondDoc - I think it is okay to asks patients if they want to involve surroga

before breaking difficult news = prep #mdchatTue Jan 18 18:19:32 PST 2011

KathyKastner By gosh: I think this is being patient centrdRT @westr: RT @RichmondDoc: T1 Ask the pt ho

mch they want 2 know,provide accordingly. #MDchatTue Jan 18 18:19:36 PST 2011

aliciad3 @EllenRichter Thanks Ellen ;) #MDChatTue Jan 18 18:19:43 PST 2011

PracticalWisdom @EllenRichter@PracticalWisdom@aliciad3 Late slip better than pink slip. thanks. Gail wav

back at your. Thanks #MdchatTue Jan 18 18:19:52 PST 2011

EllenRichter T1 Many times a patient needs a surrogate with them. They dont always process bad info ve

well. 4 ears better than 2. #MDchatTue Jan 18 18:19:59 PST 2011

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GailZahtz @s_eller@apjonas@RichmondDoc One approach- see if patient and proxy have "had the

to see who can "take the news" #MDChatTue Jan 18 18:20:32 PST 2011

EinsteinMed @RichmondDoc Agree regarding surrogate as last resort. Even when in shock - many pts va

privacy/self-dignity above all else. #MDchatTue Jan 18 18:20:52 PST 2011

RichmondDoc @s_eller@apjonas Yes--can ask for a surrogate ahead of time; I was thinking more when ocould inform someone w/o pt presence. #mdchatTue Jan 18 18:21:07 PST 2011

s_eller @EllenRichter, @GailZahtz - agree, if patients have identified resources ahead of time, we s

honor that need #mdchatTue Jan 18 18:21:34 PST 2011

westr @KathyKastner Staging- is this sort of thing an actual protocol? #mdchatTue Jan 18 18:21:36 PST 2011

CrescendoCG Agree that surrogates are critical - are pts generally good about having someone at appts w/

I hear mixed reports. #mdchatTue Jan 18 18:21:59 PST 2011

EllenRichter Oh I agree!! RT @GailZahtz:One approach- see if patient and proxy have "had the talk" to se

who can "take the news" #MDchatTue Jan 18 18:22:04 PST 2011

SarahBethRN good discussion. I would not agree w/holding, but sometimes partial disclosure in some

circumstances. or disclosure in pieces #MDchatTue Jan 18 18:22:15 PST 2011

GailZahtz @EinsteinMed@RichmondDoc Maybe 1st find out WHO and HOW the patient has decided

gets the news- pt, proxy, clergy #MDChatTue Jan 18 18:22:27 PST 2011

KathyKastner Yep: A principle of adult ed RT @westr: @KathyKastner Staging- is this sort of thing an actu

protocol? #MDchatTue Jan 18 18:22:45 PST 2011

RichmondDoc T1 In med school they taught that if you say "cancer", most of the rest of the conversation is

after pts hear the Dx... #mdchatTue Jan 18 18:23:12 PST 2011

westr Send a link? RT @KathyKastner: Yep: A principle of adult ed RT @westr: @KathyKastner

Staging- is this an actual protocol? #MDchatTue Jan 18 18:23:33 PST 2011

GailZahtz @s_eller@EllenRichter So perhaps part of "who gets what information" is really a question

do we educate the healthy #MDChatTue Jan 18 18:23:45 PST 2011

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RichmondDoc T1 ...so instead you mention the Dx once pt is ready, and you assess how much they can he

now. Schedule quick follow-up... #mdchatTue Jan 18 18:23:57 PST 2011

westr ELSI nightmare! RT @EllenRichter: T1 What a great question! :) #MDchatTue Jan 18 18:24:16 PST 2011

RichmondDoc ...in order to provide more depth of discussion and what this means. This allows pts to truly h

the conversation. #mdchatTue Jan 18 18:24:20 PST 2011

KathyKastner U ok 4 after chat RT @westr: Send a link? Yep: A principle of adult ed RT @westr: @KathyK

Staging- is this an actual protocol? #MDchatTue Jan 18 18:24:34 PST 2011

EllenRichter How true! RT @RichmondDoc T1 In med school they taught if you say "cancer" most of the

conversation lost after pts hear Dx #MDchatTue Jan 18 18:24:45 PST 2011

s_eller @RichmondDoc - yes but do you need to say "cancer" for comprehension, just as you need

death - agree or disagree? #mdchatTue Jan 18 18:25:05 PST 2011

westr Of course; anytime its convenient. RT @KathyKastner: U ok 4 after chat RT @westr: Send a

#MDchatTue Jan 18 18:25:30 PST 2011

RichmondDoc @s_eller I think you need to be honest: you need to name the Dx and say what it means. Ha

but otherwise is dishonest. #mdchatTue Jan 18 18:26:23 PST 2011

EinsteinMed @RichmondDoc Re: word "cancer" & hearing no further. Several pts I know well told me the

minds went blank upon hearing the word. #MDChatTue Jan 18 18:26:34 PST 2011

EllenRichter T1 Must be so hard for docs to care for new pt with bad dx. Dont know how they behave, rea

anything. So hard to be theraputic #MDchatTue Jan 18 18:27:00 PST 2011

RichmondDoc @GailZahtz@s_eller Clearly different conversations. But even if the cancer is resectable, st

hard to hear. #mdchatTue Jan 18 18:28:26 PST 2011

pjmachado Doctor that knows his patient well will know how to communicate effectively to his patient- th

no template-it is personal... #mdchatTue Jan 18 18:28:40 PST 2011

PracticalWisdom These are all such important question. Families many times live so far away and folks remai

single/Div. not as much support. #MdchatTue Jan 18 18:28:54 PST 2011

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EinsteinMed @RichmondDoc Some docs say "abnormal growth" or "malignancy" but that can leave pts

confused. #MDchatTue Jan 18 18:28:57 PST 2011

RichmondDoc @GailZahtz@s_eller And even if a serious illness is treatable, still need to consider side

effects/life changes/other harms. #mdchatTue Jan 18 18:29:21 PST 2011

s_eller @GailZahtz@RichmondDoc - agree - goal of conversation can drive how it is delivered- butclear explanation w/ plain language #mdchatTue Jan 18 18:29:23 PST 2011

cmizer17 @RichmondDoc You Needed Med School To Teach You That??? #MDChat No Disrespect

AskingTue Jan 18 18:29:54 PST 2011

RichmondDoc @EinsteinMed "You have a malignant neoplasm of the colon, probably resectable so long a

distant metasteses." Ugh: terrible. #mdchat

Tue Jan 18 18:30:11 PST 2011

KathyKastner Yesss!!RT @EinsteinMed: @RichmondDoc Some docs say "abnormal growth" or "malignan

but that can leave pts confused. #MDchatTue Jan 18 18:30:13 PST 2011

apjonas @s_eller@RichmondDoc pt vocab and readiness determines flow of conversation and use

power words unless OR waiting for pt #mdchatTue Jan 18 18:30:35 PST 2011

s_eller @cmizer17@RichmondDoc - part of what we use standardized patients for - so med studenpractice difficult conversations #mdchatTue Jan 18 18:30:37 PST 2011

RichmondDoc @cmizer17 To teach what? Sorry--I lose myself easily in the Twitter stream in these convos

#mdchatTue Jan 18 18:31:01 PST 2011

s_eller @apjonas@RichmondDoc - agree patient vocab can have impact on flow of conversation

#mdchatTue Jan 18 18:31:46 PST 2011

EinsteinMed @PracticalWisdom Gr8 pt abt distance of families/pts being single/divorced. Docs may have

have access 2 their support systems. #MDchatTue Jan 18 18:31:47 PST 2011

GailZahtz @RichmondDoc@s_eller Really thinking we need to be thinking of education of the healthy

prepare for the un-preparable news. #MDChatTue Jan 18 18:31:54 PST 2011

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PracticalWisdom Critical when giving bad news to have time to listen, make sure tone of voice is correct, no

distractions. #MdchatTue Jan 18 18:31:56 PST 2011

RichmondDoc @s_eller@cmizer17 Standardized patients help; so does a good mentor and teachers who

demonstrate how to deliver bad news. #mdchatTue Jan 18 18:32:07 PST 2011

PracticalWisdom Thanks for the reminder. Opps me too RT @s_eller: @MDchat realized I havent been usingmea culpea #MdchatTue Jan 18 18:33:06 PST 2011

s_eller @RichmondDoc@cmizer17 - I am biased due to my profession, but also believe in the pow

reflective learning - video debriefing #mdchatTue Jan 18 18:33:24 PST 2011

MD_chat @s_eller No worries at all. The topic numbers are nice to have, but this works fine. #MDchatTue Jan 18 18:33:51 PST 2011

PracticalWisdom Loved the book conversations at the Kitchen Table. Dr. Naomi ?Kntspl. She talks about

listening/Giving bad news! #MdchatTue Jan 18 18:34:10 PST 2011

KathyKastner @PracticalWisdom: Critical when giving bad news to have time to listen, make sure tone of v

is correct, no distractions. #MDchatTue Jan 18 18:34:32 PST 2011

GailZahtz @MD_chat Bad-da-dum acknowledging the spinal tap for those who missed ;) #MDChatTue Jan 18 18:35:42 PST 2011

westr @KathyKastner You seem to have some background on this topic #mdchatTue Jan 18 18:36:17 PST 2011

s_eller T1 - we have student give bad news to SP - they watch themselves get rated by SP, themse

faculty - practice & feedback. #mdchatTue Jan 18 18:36:17 PST 2011

EllenRichter T1 Bad news should also not be in a hallway or a busy open room. There needs to B approp

environment so communication can occur #MDchatTue Jan 18 18:36:33 PST 2011

SarahBethRN In breaking bad news to patients, i think it is beneficial to spend time listening. we can hear w

the patient needs to know. #MDchatTue Jan 18 18:36:44 PST 2011

PracticalWisdom So difficult to really listen though when you have pts stacked up in the waiting room and you

to make quota for insurance comp #MdchatTue Jan 18 18:36:47 PST 2011

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BonnieRN @EllenRichter is it #MDChat or #RNChat ???Tue Jan 18 18:37:16 PST 2011

MD_chat T2 Nutrition: How can physicians do more to educate patients on nutrition? Does medical sc

CME provide enough training? #MDchatTue Jan 18 18:37:17 PST 2011

GailZahtz T1 And as an add-on bad news not great coming from an intern the patient has never met w

the MD is in surgery elsewhere #MDChatTue Jan 18 18:37:26 PST 2011

RichmondDoc @MD_Chat Re: taps--there is no part of the body that cannot be reached with a strong arm

14-gauge needle. TAP :) #mdchatTue Jan 18 18:37:26 PST 2011

EllenRichter @AureliaCotta Well, maybe a nurse can talk to you first, then :) #MDchatTue Jan 18 18:37:30 PST 2011

EllenRichter @BonnieRN MD :) #MDchatTue Jan 18 18:37:51 PST 2011

AureliaCotta @MHSMchat both you and #mdchat have some hard convos going on......freaking me out to

#mhsmTue Jan 18 18:38:19 PST 2011

EinsteinMed @EllenRichter Agree about no dx in halls and open spaces. Unfortunately - still happens too

#MDChatTue Jan 18 18:38:23 PST 2011

GailZahtz @EllenRichter@AureliaCotta Honestly as a pt also- nurses can have tremendous impact af

news is delivered to help pt. #MDChatTue Jan 18 18:38:30 PST 2011

EllenRichter @BonnieRN But you are welcome to join in. You always have much to offer! #MDchatTue Jan 18 18:38:31 PST 2011

PracticalWisdom The patient needs to know the truth always. The key is to determine how this truth needs to

told. Customization. #MdchatTue Jan 18 18:39:02 PST 2011

EllenRichter @EinsteinMed I know. I know only too well :( #MDchatTue Jan 18 18:39:10 PST 2011

GailZahtz @AureliaCotta Almost have the stun-gun app finished for you iPhone ;) #MDChatTue Jan 18 18:39:12 PST 2011

RichmondDoc @MD_Chat T2: No, medical school does not teach nearly enough about nutrition. Period. Ha

learn on your own--CME, colleagues. #mdchatTue Jan 18 18:39:18 PST 2011

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cmizer17 Amen! RT @RichmondDoc: RT @PracticalWisdom: Critical when giving bad news 2 have ti

listen, no distractions #MdchatTue Jan 18 18:39:29 PST 2011

fidouglas T2 In three years of pre-med, we get two lectures dedicated to nutrition. #mdchatTue Jan 18 18:40:13 PST 2011

s_eller T2 - I work there, and am not sure what med students get in terms of education about nutritio

#mdchatTue Jan 18 18:40:31 PST 2011

aliciad3 T2 very little is taught in med school about nutrition. all docs (esp. pediatricians) need to rea

provide the right info to pts #MDChatTue Jan 18 18:41:30 PST 2011

RichmondDoc T1 most of our nutrition info was in the context of biochemistry lectures; very little info in the

clinical years. #mdchatTue Jan 18 18:41:54 PST 2011

RichmondDoc @ocamsrazor 4th year electives are a great way for in-depth instruction; but should be mean

content in years 1-3. #mdchatTue Jan 18 18:42:54 PST 2011

RichmondDoc @EllenRichter T2 Nutrition: How can physicians do more to educate patients on nutrition? D

medical school, CME provide training? #mdchatTue Jan 18 18:43:39 PST 2011

PracticalWisdom T2: Oh, thank God I thought I was the only one confused. Now I know the smart ones are off

#MdchatTue Jan 18 18:43:42 PST 2011

s_eller @EllenRichter - cracking me up - I had to scroll to find it. #mdchatTue Jan 18 18:43:57 PST 2011

EinsteinMed T2: Curric at med schools slowly changing. Team approach often needed: e.g., certified diab

educators working w/docs. #MDchatTue Jan 18 18:44:16 PST 2011

EllenRichter@RichmondDoc Ah, thanks! #MDchatTue Jan 18 18:44:17 PST 2011

RichmondDoc T2 Med training like our culture overall: we talk a lot about lifestyle/exercise/nutrition but do l

actually promote it. #mdchatTue Jan 18 18:44:36 PST 2011

GailZahtz T2 I think nutrition is a FINE example of how #mHealth and #HCSM can help #physicians an

#patients work together ;)))) #MDChatTue Jan 18 18:44:36 PST 2011

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westr I happen to give some! RT @s_eller: T2 - I work there, and am not sure what med students g

terms of education about nutrition #mdchatTue Jan 18 18:44:41 PST 2011

EllenRichter @s_eller I was scrolling my head off. I lost patience ;) LOL #MDchatTue Jan 18 18:44:45 PST 2011

Mtnmd T2 Symtrimics (disclosure, my company) has turn key, high tech ability 2 ed. pt, Dr and prov

powerful ongoing interactive support.#mdchatTue Jan 18 18:45:00 PST 2011

CrescendoCG @EinsteinMed Are you also seeing more RDs and others on the care team? #mdchatTue Jan 18 18:45:23 PST 2011

RichmondDoc @EinsteinMed Definitely: med students should be required to work w/ dieticians and/or CDE

some extent to learn needed skills. #mdchatTue Jan 18 18:45:27 PST 2011

s_eller @westr - would love to hear how & what you teach #mdchatTue Jan 18 18:45:37 PST 2011

Mtnmd T2 We are able to teach doctor comprehensive wellness care while doing it, which is great fo

patient and for doctor.#mdchatTue Jan 18 18:46:07 PST 2011

KathyKastner YAY RT @EinsteinMed: T2: Curric at med schools slowly changing. Team approach ofen ne

eg certified diabetes ed working w/docs. #MDchatTue Jan 18 18:46:09 PST 2011

EllenRichter T2 Of course nutrition is an important, no vital aspect of health care. No health care provider

should be lax in that area! #MDchatTue Jan 18 18:46:21 PST 2011

PracticalWisdom T2: Many adults to not like to ask questions because they find this embarrassing. #MdchatTue Jan 18 18:46:49 PST 2011

Mtnmd T2 Point is, right now without leaving their practice for weeks or months, no where for docs t

good info. #mdchatTue Jan 18 18:46:51 PST 2011

s_eller @RichmondDoc@EinsteinMed T2 - agree that both MDs & RNs should spend time learning

dieticians or educators #mdchatTue Jan 18 18:47:15 PST 2011

EinsteinMed @CrescendoCG Re: T2 and more RNs. With diabetes yes. Anything behavioral requires mo

time than most docs can provide in a visit. #MDChatTue Jan 18 18:47:19 PST 2011

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RichmondDoc T2 for our medical outreach project, do a lot of nutritional teaching--thinking of having nutritio

come teach students re: this #mdchatTue Jan 18 18:47:28 PST 2011

westr Yup! RT @RichmondDoc: T1 most of our nutrition info was in the biochemistry lectures; very

info in the clinical years. #mdchatTue Jan 18 18:47:38 PST 2011

EllenRichter @Mtnmd T2 How about utilizing the services of a nutritionist for those docs who arent up oncurrent dietary education? #MDchatTue Jan 18 18:47:57 PST 2011

RichmondDoc T2 as we are better at identifying illnesses before meds needed, we really should be better a

teaching nutritional interventions. #mdchatTue Jan 18 18:48:27 PST 2011

PracticalWisdom Perhaps with the focus on nutrition from the White House down this will help. #MdchatTue Jan 18 18:49:00 PST 2011

RichmondDoc @KathyKastner We do the best we can, find online resources that seem useful, work w/

nutritionists if need more intensive care. #mdchatTue Jan 18 18:49:10 PST 2011

KathyKastner Nice! RT @RichmondDoc: @KathyKastner Find online resources that seem useful, work w/

nutritionists if need more intensive care. #MDchatTue Jan 18 18:50:24 PST 2011

GailZahtz @KathyKastner Oh Kathy, anything outside of the O.R. is offered more in Canada- you mus

that :) #MDChat#HCSMCATue Jan 18 18:50:30 PST 2011

PracticalWisdom My daughters Ped. wrote script for Nutrition Education program for children. Great program,

experiential, focus for children. #MdchatTue Jan 18 18:50:32 PST 2011

EinsteinMed @Mtnmd Behavioral change re: diet especially is especially complex. Pts need ongoing sup

which few PCPs have time 2 provide. #MDChatTue Jan 18 18:50:36 PST 2011

KathyKastner Patient Centrd Medical Home RT @GailZahtz: @apjonas Sorry, whats PCMH? New to me.

#MDchatTue Jan 18 18:50:54 PST 2011

s_eller @RichmondDoc@KathyKastner - agree that nutrition should be part of early treatment plan

late - including registered expert #mdchatTue Jan 18 18:50:55 PST 2011

PracticalWisdom But the program went broke. Prevention many times is one of the first programs cut. #MdchaTue Jan 18 18:50:57 PST 2011

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RichmondDoc @GailZahtz PCMH: patient-centered medical home; new model of care that is a hot topic in

primary care. @apjonas#mdchatTue Jan 18 18:51:11 PST 2011

GailZahtz @KathyKastner@RichmondDoc What does patient=centered medical home mean though?

education. #MDChatTue Jan 18 18:51:50 PST 2011

EllenRichter @hrana Try Tweetchat.com #MDchatTue Jan 18 18:52:04 PST 2011

KathyKastner LOL :) RT @GailZahtz: @KathyKastner Oh Kathy, anything outside O.R. offered more in Ca

you must know that :) #MDChat#HCSMCA#MDchatTue Jan 18 18:52:12 PST 2011

RichmondDoc @PracticalWisdom T2 prevention, low-tech/high-touch care not valued in our system; we se

favor paying for intervention instead #mdchatTue Jan 18 18:52:20 PST 2011

apjonas @GailZahtz PCMH=patient centered medical home. the savior of primary per gov, docs and

others. #mdchatTue Jan 18 18:52:33 PST 2011

GailZahtz @apjonas@RichmondDoc@KathyKastner Does anyone have a link on PCMH? TY. #MDCTue Jan 18 18:53:11 PST 2011

Mtnmd @s_eller@PracticalWisdom So true, that reimbursement is a big issue. So much to share o

this,no room in 140 characters! HA #mdchatTue Jan 18 18:53:22 PST 2011

PracticalWisdom @RichmondDoc: Same sad story in the Mental Health Field. Sad, very sad #MdchatTue Jan 18 18:53:32 PST 2011

RichmondDoc @GailZahtz@KathyKastner This might give a little more context re: PCMH

http://tinyurl.com/68e8zgq#mdchatTue Jan 18 18:53:35 PST 2011

CrescendoCG @GailZahtzhttp://www.transformed.com/practice-

improvement2.cfm?gclid=CKG7xfKhxaYCFYbb4AodYD4tGw Focus on team, HIT, etc. #mdTue Jan 18 18:53:48 PST 2011

aliciad3 Love it. RT @PracticalWisdom My daughters Ped. wrote script for Nutrition Education progra

children. #MDChatTue Jan 18 18:54:03 PST 2011

melanoma_mama #mdchat Oops, sorry I think I just barged into your chat session.Tue Jan 18 18:54:24 PST 2011

8/8/2019 MDchat Twitter Healthcare Chat for January 18, 2011

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PracticalWisdom @RichmondDoc@GailZahtz@KathyKastner: Golly Mark, you are so valuable. #MdchatTue Jan 18 18:54:39 PST 2011

s_eller Have to say goodnight now folks - it has been a lively chat as always. @PhilBaumann - y

are a host beyond compare - thanks! #mdchatTue Jan 18 18:55:00 PST 2011

Mtnmd @apjonas@GailZahtz I think medical home is a start of a way to think about a simple co

someone cares abt the pt- -retro!!! #mdchat.Tue Jan 18 18:55:10 PST 2011

RichmondDoc @PracticalWisdom@GailZahtz@KathyKastner I try to pull my weight :) #mdchatTue Jan 18 18:55:34 PST 2011

EinsteinMed @s_eller Thanks for stopping by! #MDChatTue Jan 18 18:55:43 PST 2011

swan5675 Thank you for letting me sit in on your brainstorming. #MDchat

Tue Jan 18 18:57:47 PST 2011

CrescendoCG @GailZahtz Pretty much :-) #mdchATTue Jan 18 18:58:10 PST 2011

EllenRichter I like that! RT @GailZahtz T2 I think nutrition is a FINE example of how #mHealth, #HCS

help #doctors & #patients work together #MDchatTue Jan 18 18:58:14 PST 2011

Mtnmd @PracticalWisdom@RichmondDoc@apjonas@GailZahtz So true! #mdchat

Tue Jan 18 18:58:46 PST 2011

hrana @Mtnmd@PracticalWisdom@RichmondDoc Interesting #mdchat tonight. I missed quit

of it but caught the tail end.Tue Jan 18 18:58:46 PST 2011

KathyKastner Wow: ethics, diet, education and all in one hour. Awesome. #MDchatTue Jan 18 18:58:49 PST 2011

RichmondDoc Final thoughts (1/2): "Act at all times as if the patient is fully autonomous; ... #mdchatTue Jan 18 18:58:59 PST 2011

RichmondDoc (2/2) ... the weaker the patient is, the more vulnerable you are to violating his/her person

#mdchatTue Jan 18 18:59:09 PST 2011

swan5675 After all, the patient is why we are all here. Goodnight and thank you. #MDchatTue Jan 18 18:59:11 PST 2011

8/8/2019 MDchat Twitter Healthcare Chat for January 18, 2011

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RichmondDoc Thanks for the discussion everyone. These chats always keep me on my toes and make

assess where I stand & work to improve. #mdchatTue Jan 18 19:00:10 PST 2011

bfishgold @einsteinmed: that was a great ending statement by you. #mdchatTue Jan 18 19:00:12 PST 2011

njfrantz This move is from where an individual receives care determined by a professional, to on

has person at its heart. #MDchatTue Jan 18 19:00:19 PST 2011

PracticalWisdom We are adults so treat us like adults. RT @RichmondDoc: Final (1/2): "Act at all times as

patient is fully autonomous; ... #MdchatTue Jan 18 19:00:26 PST 2011

PracticalWisdom @swan5675: Thank you. #MdchatTue Jan 18 19:00:46 PST 2011

njfrantz ...with the individual firmly at the centre in identifying what is personally important to delivor her outcomes. #MDchatTue Jan 18 19:00:57 PST 2011

GailZahtz #MDChat great chance for me to repeat- if empowered patients work with a team led by

physician evidence-based medicine, everyone wins. ;)Tue Jan 18 19:01:01 PST 2011

Mtnmd @hrana@PracticalWisdom@RichmondDoc Glad to have you in!! #mdchatTue Jan 18 19:01:22 PST 2011

PracticalWisdom Love itRT @Mtnmd: RT @RichmondDoc (2/2) ... the weaker the patient is, the more

vulnerable you are to violating his/her personhood. #MdchatTue Jan 18 19:01:24 PST 2011

RichmondDoc (quote from A Decalogue for Family Practice Residents Entering Practice--G. Gayle Step

#mdchatTue Jan 18 19:01:52 PST 2011

PracticalWisdom @Mtnmd@hrana@PracticalWisdom@RichmondDoc: Blushing~Thank you! #MdchatTue Jan 18 19:02:22 PST 2011

GailZahtz TY@Mtnmd@EllenRichter@CrescendoCG@PracticalWisdom@RichmondDoc@apjo

@KathyKastner@westr@PhilBaumann@s_eller@AnthonyBurich#MDChatTue Jan 18 19:03:10 PST 2011

EllenRichter @MD_Chat What? You tell us that & then stop? Haha...I wanna know the special stuff!!

#MDchatTue Jan 18 19:03:17 PST 2011

8/8/2019 MDchat Twitter Healthcare Chat for January 18, 2011

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PracticalWisdom KathyKastner: Great to see you tonight. I really, cross my heart want to catch up with y

and chat. #MdchatTue Jan 18 19:04:49 PST 2011

KathyKastner Likewise -sry 2 be bad e-responder RT @PracticalWisdom: KathyKastner: I really, cros

heart want to catch up with you and chat. #MDchatTue Jan 18 19:05:43 PST 2011

AnthonyBurich Thank you all for letting me tag along for the education. Good night! #mdchatTue Jan 18 19:05:55 PST 2011

PracticalWisdom KathyKastner: Takes 2 to Tango. Later ; < ) #MdchatTue Jan 18 19:07:25 PST 2011

EllenRichter @MD_Chat :P Stinker! #MDchatTue Jan 18 19:07:28 PST 2011

westr Like taking candy... From a baby... RT @EllenRichter: @MD_Chat What? You tell us th

then stop? I wanna know the special stuff!! #MDchatTue Jan 18 19:08:10 PST 2011

PracticalWisdom So long farewell we had to say Good bye. #MdchatTue Jan 18 19:08:16 PST 2011

bfishgold @einsteadmed: you are welcome Paul. We have to do it. #mdchatTue Jan 18 19:08:55 PST 2011

PracticalWisdom @westr: You are so spot on. #MDchat

Tue Jan 18 19:09:10 PST 2011

RichmondDoc @westr Is that part of what you teach in your nutrition lectures? Best baby-candy-taking

methods? :) @EllenRichter@MD_Chat#mdchatTue Jan 18 19:09:11 PST 2011

EllenRichter @westr@KathyKastner@MD_Chat ~LMAO #MDchatTue Jan 18 19:09:21 PST 2011

PracticalWisdom You all are Candy for my Brain. The best kind. #MDchatTue Jan 18 19:09:58 PST 2011

bfishgold @einsteinmed: you are welcome Paul. We will do it. #mdchatTue Jan 18 19:10:33 PST 2011