Month: April 2011

Physician Advocacy: Staying in Place and Telling Your Story

This month, I have talked to two former trainees who are contemplating major changes in their career- -to leave medicine.  Both are in private practice and are frustrated by many different things that they see in their practice and are inspired to improve the practice of medicine.   While their desire to leave medicine is concerning enough and could be the subject of this entire post,  I was actually struck that both of them contacted me to find out how they could find out more about health policy and get involved.   One of them wondered if they needed to get a Public Policy Degree like I did.  The other one thought maybe she would have to move to DC to become more active in the health policy arena.   I also recall wondering how to get involved many years ago and thinking the same thing.  Fortunately, I was able to find a way to balance my interest in advocacy without giving up my job.  So, before I sent them packing to the Hill or back to school to read seminal texts in public policy and weekly economic homework assignments, I thought there are a few things they could do to engage while they stay in their job if they choose to.

  1. Learn from professional society advocacy experiences.  Some people will react and say that they have a negative opinion about “lobbying” or the special interests of their professional society.  My advice is that if you don’t have a basic terminology of healthcare reform and the healthcare system (i.e. SGR, ACO, etc.), then this is a great place to start -with other physicians who are also learning.
  2. Read the news foraciously – the best way to understand what is happening on the Hill is to keep up with the news.  While this may seem like a tall order, customizing Google news and setting alerts for healthcare reform or whatever it is that you are interested in can be helpful.  In addition, the iPad has amazing news applications that aggregate your favorite news sources and blogs (my personal favorites are PulseNews and FLUD, which even touts itself as the sexy news ecosystem).   My go to sources are still the New York Times Health Section and NPR Health, especially anything written by Julie Rovner.  Another excellent source for health policy which you can add to your reading list include The Healthcare Blog, Kaiser Health News, and the “Bob Blogs” as I refer to them (see the blogroll below) .  Even if you can’t read the article right away, you can often ‘favorite’ it to read later or send to InstaPaper.
  3. Engage in Social Media – Social media has become one of the best ways to stay on top of health policy news, especially thanks to KevinMD and his steady stream of diverse and eclectic contributors that include medical students, patients, physicians, and health policy wonks.  In addition to the usual news sources listed above, you can also keep on top of professional society news (see the medicalsocieties Twitter list) or use healthcare hashtags to stay abreast of the situation.   However, the key to effectively using social media is more than just staying informed, but also interacting and engaging and contributing to the dialogue.  So that brings us to the last way to get involved….
  4. Write – whether it be a comment on a newspaper article or blog post, a letter to the editor to your local newspaper, or a blog post about a specific health policy issue, writing is a great way to get the word out.  Policy narrative has become increasingly valued among physicians.   That is because there is nothing more compelling to the general public or legislators like a personal story. One of our own faculty has specialized in this area and teaches our students how to use policy narrative in their practice.

While some have a natural tendency to write, it may not be intuitive to others.  Fortunately, this year I was lucky enough to attend a session at the IHI meeting led by disciples of Marshall Ganz and dedicated on how to tell your story in a compelling way in 5 easy steps:

  1. Write the story of self (personal narrative)
  2. The story of us (to build a shared vision)
  3. The story of now (to highlight the urgency)
  4. Then present a choice (to raise the tension)
  5. End with asking for a commitment

One of our homework assignments was to practice so I actually chose to write a story to convincing others to come with me to DC for the American College of Physicians Leadership Day since I am leading this year’s Illinois delegation.  So here is my narrative for why you should join me:

When I first went to DC to lobby with ACP Leadership Day, I remember feeling awkward and relying on a medical student who showed me how to approach legislators.  The next year, I remember our student had graduated so I assumed the mentor position for the new people.  Two years later, I got a call that they needed a young physician to testify to Congress about the need for physician payment reform and I was thrilled to be able to do so on my 33rd birthday.  I know you have also wondered about how to get involved with healthcare policy but like me, you are very busy and overcommitted.  The key is that time is of the essence as the future of healthcare legislation is being debated in this election year and your input is critical to shaping the future.  So, I know that this May, you could stay at work and continue your everyday activities or you could decide to take action and go to Washington to witness and contribute to the political dialogue around healthcare.  So, I am asking you to commit to joining me as internists will come together to communicate the importance of affordable healthcare and preserving primary care for Americans. 

Look forward to hearing your stories too.

–Vineet Arora, MD MAPP


Can We Trust Medical Trainees with Social Media and Other Digital Dilemmas

Last weekend, I was on a panel for internal medicine residents at the American College of Physicians Council of Associates forum in San Diego.  I was invited by Erin Dunnigan and Baligh Yehia, the Co-Chairs of the Council, a position that I have also held earlier in my career.  The topic – was about the debate on social media use among medical trainees and whether it was professional.  Fortunately, I was lucky enough to do it with my rock star colleague Darilyn Moyer, the program director at Temple, who also moderated last years panel on Mean Girls in Medicine with me.

The Temple chief resident, Brooke Worster, started us off by asking the much debated anathema in medical education – what is professionalism – and if it is in the digital domain, it’s even harder to describe.  Then she proceeded to show some videos of medical students that you could say exercise some creativity – from the harmlessly funny to incredibly poor taste and ranging from schools such as UT Southwestern to my own alma mater Washington University in St. Louis.

The questions from the residents were spot on and here were some of the Q&A that followed:

Medical trainees are people too – shouldn’t they able to express themselves in ways  using colorful medical humor either in a show or their profile?

The objection is not for class shows and parodies – those have existed since the very first class medical show that took place at the University of Michigan and called the Galen’s Smoker (this year’s name- “Spleen Girls”).  The issue is more complicated with public consumption of materials never meant to be seen by a public audience.  Then, when a video is seen by a patient, an employer, or another interested stakeholder, alumni, philanthropists, those that donate their body to science (to name a few), the meaning of the video is not clear and those individuals often lose faith in the medical system.  There have been cases where patients have refused care by a residency trainee after seeing their Facebook profile with images that don’t seem suitable for their doctor.  So, while medical trainees deserve the right to blow off some steam and exercise creativity, it should not compromise their ability to see patients or work in the future.

Shouldn’t we just trust students and residents to police themselves on social media?

The answer here is that while most students are capable of policing themselves, a breach of professionalism on the internet is like a NEVER event – especially if it relates to patient information or trainee information that could result in harm.  So, opting for a putting out fires approach will not be effective and it’s important for medical educators to teach students and residents about responsible use of social media.  The good news is that the more one uses social media, the more likely they are to be able to draw that line in the sand.  Our research shows that superusers, or more frequent users, are more likely to oppose regulation but are also more likely to believe that they are responsible for portraying a professional image.  So, by teaching people to use it appropriately, we may actually prevent violations and breaches.

Should schools screen social media as part of its application process?

Interestingly, some students and faculty in the audience advocated for ‘second chances’ and redemption if a student had a inappropriate picture posted since Facebook privacy settings are initially confusing and a student could be misguided initially. But, let’s face it… screening applications for admission to medical school or residency is hard and takes time.  People are looking for ANY red flag to set downgrade your application compared to others.  Don’t give them a reason.  Medicine is not unlike any other industry in which candidates are interviewed to see if they can get the job done and also represent that organization appropriately.  If a video is posted that showcases a student in a tasteless parody with your school logo or name in the background, a hospital or residency is not going to want to take that risk with you.

What can medical schools do to protect themselves?

Well, for starters, schools can have a social media policy that highlight that do’s and don’ts in this area.  Unfortunately, in a recent study by @kind4kids and @MotherinMedicine, most schools do not so we have room for improvement.   The second thing is that schools can also deliver education, not only on the negatives – or how NOT to use social media, but they can also encourage and role model proper use of social media through disseminating course materials, student press, recruitment and admissions, or communicating with their students.  A recent post on a new student blog actually has a Poll this week asking students if they would want to receive information via social media and the majority say yes.

What can students do to ensure that their digital image is safe?

This question actually came from a student that has the same problem as me – a person with another name who happens to be garnering attention for the wrong reasons – in my case, it’s someone with my same name who is an ophthalmologist and has been accused of blinding patients and has many negative patient testimonials.  So, what can I do – well I initially started on LinkedIn to try to distinguish myself from this person and I also took control of my own digital footprint using a Google Profile to highlight who I am and the links on the web that I want people to see.  (You’ll notice my Facebook profile is NOT on my Google Profile).

The same old adage about Vegas applies here- whatever happens on social media stays on social media.  Therefore, just like the national dialogue on health information technology, its important for medical educators and trainees to engage in a constructive dialogue and establish policies that both set standards and teach others how to meaningfully use social media.

–Vineet Arora, MD