#70: KevinMD: Kevin Explains Everything

December 1, 2017 | By Matthew Watto, MD

Dr Kevin Pho, founder KevinMD.com “Social Media’s Leading Physician Voice” schools Matt, Paul and Stuart on a potpourri of topics including physician advocacy, the dangers and benefits of social media, the pros and cons of electronic health records, health policy, health advocacy and lastly primary care and the integration of advanced practice providers/clinicians. Special thanks to Dr Chris Chiu who helped produce the show and write our show notes.

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KevinMD Pearls

1. Physicians should to become more versed on Healthcare and Health Policy
   • Vox Media – Progressive Bias
   • New York Times – The Upshot; Read both conservative and progressive columns
2. To prevent physician burn-out, you can’t have all your “eggs in one basket”.
   • Have passions outside medicine
   • Providers are not necessarily “in a box” of just clinical medicine
3. How should young physicians utilize social media?
   • Connect with and help educate patients
     • Important to create reputable health content
   • Proactively define their social media footprint
     • Helps give more control what is on the internet about you, otherwise Healthgrades will do it for you
     • Linkedin or Doximity are good starting points
   • Physician advocacy is a springboard to mainstream media that allows us to be involved with the healthcare conversation around us.
4. What risks are there for physicians in social media?
   • Don’t reveal patient privacy without appropriate patient consent
   • The Elevator Test” – Whatever you post online needs to be appropriate as if you are saying it in a crowded hospital elevator
   • Political Opinions
     • Beware of “Twitter-bates”
     • Can be difficult to articulate nuanced discussions in some forms of social media like twitter due to character limitations.
5. Twitter
   • Good way to curate information
   • Difficult to have debates
6. KevinMD.com
   • Initially was meant to be a tool for patient education
   • Evolved to a place where information could be curated and pseudoscience could be debunked
   • Physician advocacy is now one of the most important goals of the site
   • Really tries to represent both conservative and progressive views
7. What is going to be the next big political issue?
   • We need to decide whether universal coverage should be a government obligation.
8. With a grain of wisdom, you need to be able to look at your own argumentative fallacies. You need to understand the pros and cons of your own argument. It is important to listen to viewpoints outside your own “bubble”.
   • Gomerblog – New Attending Receives First Paycheck, Transforms into Fully Developed Republican – http://gomerblog.com/2017/07/first-paycheck-republican/
   • Other countries with universal coverage without single payer
     • Germany – https://en.wikipedia.org/wiki/Healthcare_in_Germany#Health_insurance
     • Switzerland – https://en.wikipedia.org/wiki/Healthcare_in_Switzerland
   • Consider reading
     • David Brooks – https://www.nytimes.com/column/david-brooks
     • Ross Doubda – https://www.nytimes.com/column/ross-douthat
9. The bane of electronic health records
   • “…electronic medical records are generally antiquated programs that are cumbersome to use.” https://www.kevinmd.com/blog/2014/02/electronic-medical-records-obstruct-patient-interaction.html
   • For every hour spent with patients, physicians spend 2 hours on electronic health records http://annals.org/aim/article-abstract/2546704/allocation-physician-time-ambulatory-practice-time-motion-study-4-specialties
   • 52.4% of a resident’s time was spent on tasks indirectly related to patient care, including writing in the electronic medical record http://annals.org/aim/article-abstract/2599281/allocation-internal-medicine-resident-time-swiss-hospital-time-motion-study
   • “Try not to romanticize the paper charts either.” – Paul Williams
10. Different styles of charting
    • Charting during the patient encounter – Difficult
    • Dr. Pho personally doesn’t like to chart during the visit and does it after the visit or during other catch-up time during the day (even at night)
    • Up to the individual clinician
11. Any good EHRs built from the ground up by clinicians?
    • None that have achieved necessary market integration
12. Conspiracy theories why the government has spent so much money on EHR implementations?
    • EHRs do have their own lobbyists that probably had an influence
    • It is a complete travesty that all these EMRs don’t talk to each other
13. How do you see the role of mid-level practitioners or advanced practice clinicians (NPs and PAs)? Thoughts about independent practice or quality control on online NP courses?
    • Vital members of the healthcare team especially with primary care shortages everywhere
    • A proposed answer would be a standardized unified certification exam https://www.kevinmd.com/blog/2013/05/war-nurse-practitioners-doctors.html
    • Team-based approach is ideal but cannot always be done in areas with decreased resources
14. How can we improve our primary care shortage
    • Primary care shortage in the US is tragic. Kevin Pho says 70% specialists vs 30% primary care. AHRQ says is is closer to 50/50 back in 2010. https://www.ahrq.gov/research/findings/factsheets/primary/pcwork1/index.html
    • The inverse ratio of primary care to specialists in other countries like the UK
    • One possible way to improve the number of medical students interested in primary care is to fix debt associated with a medical education.
15. Growth of physicians vs healthcare administrators, how do we curb the tide?
    • We need to take control our own profession
    • Providers need to expand our influence
      • Use social media as a springboard into mainstream media
      • We need patients on our side
      • Going on TV, radio interviews, Op-Eds in the newspaper
      • Physician problems are patient problems too. Frustrated providers → can affect patient care.
16. What advice for those interested in medical writing?
    • Writing thought pieces
    • Op-Ed Project – https://www.theopedproject.org/. How to write pieces that will get noticed in mainstream media
    • Write blog posts with active dialogue and phrasing
17. Physician advocacy is a public health measure
    • Burned-out Mentors will discourage people from going into primary care
    • We need to make primary care providers happier

Goal: Listeners will learn the basics of social media including how to minimize risks and how to leverage it for patient education, physician advocacy and health policy.

Learning Objectives:
After listening to this episode, listeners will…

1. Basics of the different social media platforms
2. Recognize the dangers of social media but also how it can be used for expanding clinician influence
3. Beware of the time demands that EHRs have on a practicing clinician
4. Learn where to get started in medical writing
5. Explain how/why physician advocacy is actually a public health measure

Disclosures: Dr Kevin Pho is the founder of KevinMD.com, which was mentioned several times on the show.

Time Stamps:

• 00:00 Intro
• 00:54 Picks of the week
• 06:58 Getting to know our guest
• 10:30 Why physicians need to understand health policy
• 11:21 Best advice Dr Poh has received in his career and why variety is important to avoid burnout
• 13:45 Advice to young physicians about to start using social media
• 16:40 Why are physicians afraid of social media
• 18:54 Risks of social media
• 21:20 Discussion of “Twitter bates” aka debates
• 23:20 Physician advocacy and social media
• 26:18 The next big health care debate…is it a right?
• 31:03 Why electronic health records are so painful to use?
• 34:49 How can charting be worked into clinic workflow?
• 37:50 Conspiracy theories on EHRs
• 39:11 Advanced practice providers/clinicians
• 46:40 Primary care shortage
• 50:16 Growth of medical administrators and how to take back control as physicians
• 52:38 Advice on how to break into medical writing
• 54:08 Paul ends the show with some wisdom and steals the show
• 55:59 Outro

Links from the show:

1. 2017 Guideline for High Blood Pressure in Adults http://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/11/09/11/41/2017-guideline-for-high-blood-pressure-in-adults
2. Bone Tomahawk http://www.imdb.com/title/tt2494362/
3. @katepaint42 on Twitter https://twitter.com/katepaint42
4. Ego is the Enemy: The Fight to Master Our Greatest Opponent by Ryan Holiday http://a.co/1Vui9m1
5. Please see the other links in the show notes above