Transcript of #MDchat for October 19,2010

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Welcome again everyone to #MDchat! We'll start infusing a bit, but first
MD_Chat let's get acquainted: briefly introduce yourselves!
healthewoman Hi everyone! So excited to discover #MDChat.
RT @MD_Chat: Tonight on #MDchat one of the topics is Lies, Damned
Lies & Medical Science: Read http://bit.ly/cDKqBQ for context.
westr Plz RT
Family doc in #RVA; mostly lurking; didn't have time for homework.
RichmondDoc #mdchat
drseisenberg Steven, heme/onc in rainy (I know, boo-hoo) San Diego #MDchat
OK - we'll start off with our first topic in a moment. Please prepend
MD_Chat responses to topics with T1, T2, etc. Have fun! #MDchat
subatomicdoc Matt Katz, radiation oncologist in New England. #mdchat
Beth here - looking for insight that can be shared w/healthcare consumers
CrescendoCG #mdchat
T1 Medscape v. Wikipedia: What do you consider a reliable online resource
MD_Chat for research? Are there specific one you use? #MDchat
mkmackey Listening in to #mdchat
jodyms Ditto RT @mkmackey Listening in to #mdchat
T1 Don't find either especially useful, and haven't used them for research;
RichmondDoc can't comment on their reliability. #mdchat
subatomicdoc T1: Neither Medscape nor Wikipedia. I go for PubMed. #mdchat
I've used PubMed and Google Scholar for specific papers; UpToDate for
RichmondDoc overview and quick summaries. #mdchat
RT @RichmondDoc: I've used PubMed and Google Scholar for specific
subatomicdoc papers; UpToDate for overview and quick summaries. #mdchat
UptoDate. All day, every day. Don't use Medscape or Wikipedia much for
drseisenberg point of care. #MDchat
 RT @subatomicdoc: T1: Neither Medscape nor Wikipedia. I go for PubMed.
healthpolicygrp #mdchat
DebErupts Listening to #MDChat
@MD_Chat T1 Anne Marie (UK) here so this is well past my bedtime but
amcunningham just in case any of you don't know check out tripdatabase.com #mdchat
mkmackey T1 .@drseisenberg do you access uptodate by mobile or web? #mdchat
RT @RichmondDoc: I've used PubMed and Google Scholar for specific
DebErupts papers; UpToDate for overview and quick summaries. #mdchat
@amcunningham Haven't tried it; will look to use it at the next possible
RichmondDoc opportunity. #mdchat
@amcunningham Thanks for the tip! I'll check out tripdatabase.com in
subatomicdoc more detail. #mdchat
T1: UpToDate is my main go-to for overviews of topics. The MicroMedex
anniekey iPhone app and Epocrates also useful for looking up meds. #mdchat
@mkmackey T1. Web. Will bring patients in on occasion and review with
drseisenberg them. They like it. #MDchat
RT @MD_Chat: T1 Medscape v. Wikipedia: What do you consider a reliable
westr online resource for research? Are there specific one you use? #MDchat
RT @amcunningham: @MD_Chat T1 Anne Marie (UK) here so this is well
past my bedtime but just in case any of you don't know check out
DebErupts tripdatabase.com #mdchat
@MD_Chat This is slightly off topic but I've been thinking tonight about
amcunningham patients checking symptoms online. http://is.gd/g8U6J #mdchat
RT @anniekey: T1: UpToDate is my main go-to for overviews of topics. The
MicroMedex iPhone app and Epocrates also useful for looking up meds.
DebErupts #mdchat
For breaking news and updates re: new meds/developments: Precriber's
RichmondDoc Letter, Medical Letter, Journal Watch #mdchat
@MD_Chat #mdchat my other top Google scholar tip is to set scholar
amcunningham preferences to link out to any uni library that you are attached to.
RT @RichmondDoc: For breaking news and updates re: new
meds/developments: Precriber's Letter, Medical Letter, Journal Watch
jodyms #mdchat
 And, Journal Watch does an e-mail Physicians First Watch that sends a
RichmondDoc daily update; not sure if you have to be a subscriber... #mdchat
@RichmondDoc For up to date check out Richard Lehman's Journal Watch
amcunningham blog- covers JAMA, Lancet, NEJM, BMJ http://is.gd/g8X29 #mdchat
#mdchat - hello all, Peds ID Fellow from Upstate NY here. I have used wiki
peds_id_doc to look up ICD-9 codes...that's about it...
drseisenberg I feel that NCCN guidelines are helpful for oncology. #MDchat
#mdchat T1: otherwise it's eMedicine, UptoDate, PubMed if the topic lends
peds_id_doc itself to that.
RT @RichmondDoc: For breaking news and updates re: new
meds/developments: Precriber's Letter, Medical Letter, Journal Watch
healthpolicygrp #mdchat
RT @subatomicdoc: T1: Neither Medscape nor Wikipedia. I go for PubMed.
apjonas #mdchat
@peds_id_doc You can also Google a symptom and "
ICD9"; may take you to Wiki or to other sources, but pretty fast.
RichmondDoc #mdchat
I am biased, but at MDLinx.com we try to cover journals and research that
spulim is relevant to daily practice. UpToDate is the Gold Std #MDchat
chukwumaonyeije Greetings, all. A little late and multitasking. Go Yankees! #mdchat
RichmondDoc @amcunningham Thanks; will look that up! #mdchat
@RichmondDoc #mdchat - that's exactly what I do :) Either it's right on the
peds_id_doc search page results or I can drill to the wiki page.
T1: Use UpToDate, PubMed, Ob&Gyn journal website, AJOG
healthewoman website, NEJM websites #MDchat
@RichmondDoc #mdchat T1: faster for me than paging through the damn
peds_id_doc coding tome we have in the office...
apjonas apjonas, family doc, OH lurking, too #mdchat
Wondering if you recommend the same sites to your patients that you as
mkmackey MDs use for research for patient care? #mdchat
healthgist http://j.mp/d5Z8gi ♻ @mkmackey Listening in to #mdchat
@mkmackey #mdchat - almost never. The jargon is a huge obstacle, and
peds_id_doc the potential for scaring them is too great...
spulim T1 Customized google scholar works well too #MDChat
@mkmackey #mdchat it's hard to find good-quality, useful, readable sites
peds_id_doc for patients/parents for many diseases.
@mkmackey I will generally *tell* patient where I get my info. But I think
chukwumaonyeije its more helpful to lead them to patient focused info. #mdchat
subatomicdoc RT @spulim: T1 Customized google scholar works well too #MDChat
@mkmackey no, I use different sites than I send pts to, my depth is deep
apjonas and I want them to start shallow, esp when ill.#mdchat
@mkmackey The other thing I will do is send patient to presentations I
chukwumaonyeije have personally curated and screened on slideshare.com #mdchat
@mkmackey #mdchat - y'know what though...you've just given me a great
peds_id_doc idea for a new project...patient-centered ID/immune Def website...
RT @apjonas @mkmackey no, I use different sites than I send pts to, my
lisagualtieri depth is deep and I want them to start shallow, esp when ill #mdchat
@subatomicdoc Been years since I checked out Google scholar. Strange
chukwumaonyeije since I'm a huge Google Fan Boy. #mdchat
Sounds like many of you direct pts online (although to diff. sites) - any of
CrescendoCG you that do NOT recommend pts to research online? #mdchat
MEDLine Plus Interactive Health is a good source for Pts. http://bit.
spulim ly/8Xz8Nl #MDChat
@chukwumaonyeije great ideas. I think patients really want physicians to
mkmackey help them find accurate patient information #mdchat
@CrescendoCG I don't think telling patients NOT to search online is an
chukwumaonyeije option. Maybe in the past; but no longer. #mdchat
RT @mkmackey: @chukwumaonyeije great ideas. I think patients really
subatomicdoc want physicians to help them find accurate patient information #mdchat
@CrescendoCG I think empowered and informed pts are in everyone's
RichmondDoc benefit--research away! BUT...remember a few cautions: #mdchat
MD_Chat Shoulder Tap!! Next topic coming up in a moment! #MDchat
RT @RichmondDoc: @CrescendoCG I think empowered and informed pts
chukwumaonyeije are in everyones benefit--research away! #mdchat
@CrescendoCG Not all info is relevant to *your* case and not all info is
RichmondDoc reliable. #mdchat
 @chukwumaonyeije I haven't used Google Scholar too much, but interested
subatomicdoc in tinkering with it #mdchat
@CrescendoCG I may warn about how I'm a Dr, so I'm neg so they can be
apjonas pos. Watch out for all the mandatory neg stuff on med sites #mdchat
@CrescendoCG Use online info to inform discussion, but try not to be
RichmondDoc dogmatic about it. Remember docs' training/experience. #mdchat
@subatomicdoc I'll also give Google Scholar another look. But Pubmed has
chukwumaonyeije actually become a very strong resource lately. #mdchat
@chukwumaonyeije I am constantly amazed at how many people doubt
gfry that empowered patients are in everyone's benefit. So obvious! #mdchat
T2 Medical Research: How are you explaining research to patients? Esp
MD_Chat w/conflicting results? For after chat: http://bit.ly/cDKqBQ #MDchat
T1 interested to know if there is a difference in use of web resources btw
spulim PCPs and Specialists. #MDChat
RT @MD_Chat: T2 Medical Research: How are you explaining research to
mkmackey patients? Esp w/conflicting results? #mdchat
@chukwumaonyeije I agree. I also use Google Reader to RSS ScienceDaily,
subatomicdoc PhysOrg and other news sources. #mdchat
RT @RichmondDoc Use online info to inform discussion, but try not to be
CrescendoCG dogmatic about it. Remember docs training/experience. #mdchat
@CrescendoCG #mdchat - not specifically to avoid, but we often say &
quot;Look it up online, but be aware they talk about the worst-case
peds_id_doc scenario"
@gfry It's truly amazing, indeed. Just like we were discussing on e-patients.
chukwumaonyeije net, there is a lot of work to do. #mdchat
RT @gfry: @chukwumaonyeije I am constantly amazed at how many ppl
doubt that empowered patients are in everyones benefit.So obvious!
CrescendoCG #mdchat
T2 Hard to explain research sometimes, esp when we ourselves have
RichmondDoc trouble making sense of the sometimes conflicting results. #mdchat
T2: I'm a history major, so I tell a story at 5th grade level, if possible.
subatomicdoc #mdchat
 #mdchat T2 - we find ourselves explaining a lack of data more than
peds_id_doc conflicting data it seems...one "perk" of pediatrics :-)
healthewoman @mkmackey a lot of the sites I use are subscriber only #MDChat
T2 I try to explain when I feel info is pretty solid and we can rely upon it; I
RichmondDoc point out uncertainty and developing information. #mdchat
@subatomicdoc #mdchat - probably the best approach, even for educated
peds_id_doc and intelligent patients/families. It shows you understand it I think
@peds_id_doc @mkmackey For patients there's a lot of good info on CDC.
healthewoman gov and NIH.gov #MDChat
T2 I think it is also important to be willing to tell pts when the evidence
RichmondDoc suggests changes in therapy or therapeutic goals. #mdchat
@peds_id_doc T2: Start simple, you can always ratchet up the
subatomicdoc sophistication. #mdchat
@MD_chat T2 stress uniqueness of pt & foggy nature of studies
apjonas that ch from context to context. Let pt ponder which gp is them. #mdchat
RT @healthewoman: @peds_id_doc @mkmackey For patients theres a lot
FreshRN of good info on CDC.gov and NIH.gov #MDchat
As for "Damned Lies"...truth mixed with hyperbole.
subatomicdoc @chukwumaonyeije made a great comment earlier. #mdchat
T2 Sometimes difficult to disentangle facts and myths when media report
spulim on studies from conferences before publication #MDChat
@peds_id_doc @mkmackey #mdchat - I also send patients to my blog
healthewoman http://healthewoman.org
@healthewoman @mkmackey #mdchat even some for us Docs too! :-P
peds_id_doc Good point.
@chukwumaonyeije #mdchat My uni doesn't have Pubmed link out so
amcunningham Google scholar is great for finding full access to papers.
T2: My wife is a journalist, so I'm all too familiar with 'sweeps week' effect :
subatomicdoc P #mdchat #journalism
Definitely appreciate the guidance from physicians in navigating health
mkmackey studies etc #mdchat
Agreed! RT @mkmackey: Definitely appreciate the guidance from
CrescendoCG physicians in navigating health studies etc #mdchat
 @CrescendoCG #MDChat I always direct people to on line sources unless
healthewoman they can't access the Internet
@RichmondDoc No- I'm asking you to leave a comment! By coincidence I
amcunningham was thinking about pt info seeking tonight http://is.gd/g8U6J #mdchat
@amcunningham #mdchat - no pubmed linkout? wtf? Our POC PCs don't
peds_id_doc have ANY web access...barred by IT (too much porn apparently...)
subatomicdoc T2: Found it! http://goo.gl/uKSr --> @chukwumanoneije #mdchat
@amcunningham #mdchat we have to use smartphone or office PCs. A real
peds_id_doc pain. Some computers are getting access on a site-by-site basis
Agree RT @chukwumaonyeije @CrescendoCG telling patients NOT to
healthewoman search online is an option. Maybe in the past; but no longer. #mdchat
@subatomicdoc Thank you. Definitely truth mixed with hyperbole.
chukwumaonyeije #mdchat
T2 Pts appreciate how we can share our perspectives on what various
apjonas studies may mean. They can smell the bias if there. Trust rules! #mdchat
RichmondDoc @amcunningham I shall do my best... #mdchat
@subatomicdoc It was like listening to a lecture on flaws in research
chukwumaonyeije presented by entertainment tonight. #mdchat
RT @apjonas: T2 Pts appreciate how we can share our perspectives on what
various studies may mean. They can smell the bias if there. Trust rules!
peds_id_doc #mdchat
@RichmondDoc @CrescendoCG empowered and informed pts are much
healthewoman easier to work with if they've done their homework #mdchat
subatomicdoc @chukwumaonyeije Haha! Yes, E.T. presents....your health! #mdchat
T2: The language of research is limited and focused. Don't mistake the
chukwumaonyeije media spin for the science! #mdchat
RT @healthewoman: @peds_id_doc @mkmackey #mdchat - I also send
healthpolicygrp patients to my blog http://healthewoman.org
RT @chukwumaonyeije: T2: The language of research is limited and
peds_id_doc focused. Don't mistake the media spin for the science! #mdchat
@gfry... and to answer your query from earlier, in my experience e-patients
chukwumaonyeije are far less litigious. Considerably. #mdchat
 RT @chukwumaonyeije: T2: The language of research is limited and
subatomicdoc focused. Don't mistake the media spin for the science! #mdchat
RT @subatomicdoc:@chukwumaonyeije: The language of research is
mkmackey limited and focused. Dont mistake the media spin for the science! #mdchat
T2: Fun to print abstract and sift through it together. Explaining as we go.
drseisenberg Gotta love p values. #MDchat
I barely have time to e-write the scripts...wow, discuss studies? really?
ocamsrazor #mdchat
RT @apjonas: T2 Pts appreciate how we can share our perspectives on what
various studies may mean. They can smell the bias if there. Trust rules!
healthpolicygrp #mdchat
@ocamsrazor I think it can help patients understand the plan of care if you
RichmondDoc talk out some of the reasons; maybe better adherence? #mdchat
RT @drseisenberg: T2: Fun to print abstract and sift through it together.
mkmackey Explaining as we go. Gotta love p values. #mdchat
@ocamsrazor It's difficult. And frankly for many visits going through
chukwumaonyeije studies is unnecessary. #mdchat
@RichmondDoc @ocamsrazor #mdchat - better adherence, fewer
peds_id_doc followups...less complications...more time to spare in the long run
Shoulder tap: Our hour is coming up! We'll wrap-up in a few minutes!
MD_Chat #MDchat
RT @RichmondDoc:I think it can help pts understand the plan of care if
CrescendoCG you talk out some of the reasons; maybe better adherence? #mdchat
@ocamsrazor I can help pts understand why we're changing Rx plans, why
RichmondDoc we're adjusting meds. Pts = partners as much as possible. #mdchat
@chukwumaonyeije @ocamsrazor #mdchat I have the advantage of being
peds_id_doc an academic subspecialist though...30-60min appt slots :-P
@ocamsrazor If my doc pulled out a journal article or RCT at my yearly
chukwumaonyeije checkup I'd be concerned about her... #mdchat
Interesting perspectives from the different specialties.. appreciate the
mkmackey discussion on #mdchat
OK - we're going to wrap up things. Before we leave, let's hear your parting
MD_Chat thoughts! #MDchat
 @chukwumaonyeije ...but one can discuss recent information w/o quoting
RichmondDoc P-values, reading RCTs verbatim, etc; summary is OK. #mdchat
@peds_id_doc the good old days.When I went from academics to private
chukwumaonyeije prac. I told folks it was like going from retail to wholesale. #mdchat
subatomicdoc Parting thought: .....I got nothing :) #mdchat #tappedouttonight
@peds_id_doc @chukwumaonyeije @ocamsrazor Sweet! I See 30 pts a day
healthewoman -have no 30 min time slots that aren't stagger booked #MDChat
ivory tower medicine...not the same as real world med. generics rule! in the
ocamsrazor clinics #mdchat
Parting thought: "Cure sometimes, relieve often, comfort always.
RichmondDoc "--Dr. Edward Trudeau #mdchat
@ocamsrazor Generics rule in the academic world, too; maybe more so
RichmondDoc compared to my private practice experience. No drug reps now. #mdchat
@MD_Chat Thanks for a great chat, nice to meet new med tweeps:
healthewoman suggested future topic: work life balance #MDchat
If anyone has time I would recommend the comment thread at e-patients.
chukwumaonyeije net on the Atlantic article...http://bit.ly/9j89oa #mdchat
@healthewoman @chukwumaonyeije @ocamsrazor #mdchat - I can't
fathom keeping 30 pts straight in my head...like a conveyor belt! Not for
peds_id_doc me..
spulim Thank you Phil for hosting #MDChat!
THANK YOU everyone. Our next #MDchat will be next Tuesday 10/26 9pm
MD_Chat Eastern! Transcript will be up later.
END CHAT

MDchat for October 19, 2010 - Moderated by @PhilBaumann

Follow @MD_chat for regular updates
MDchat.org