Why aren't more docs on Twitter?

I was precepting last week at our busiest outpatient site.  One of the residents there is very interested in all things technology and we got to talking about the iPad.  Knowing that he uses Twitter, I told him about some of the neat ideas I had recently seen there about the use of tablets in patient care. 

The preceptor room is a public place, and it's pretty easy to be overheard.  This resident and I were only about two minutes into this conversation when the comments began to fly from the other residents - and the other preceptor - in the room.

"Twitter?  That's just for celebrities."
"Twitter's a waste of time."
"Twitter's just to make yourself feel important."

Even more discouraging was that my attempts to explain the positives of Twitter - networking, idea sharing, collegial support - were brushed away.

"I have enough things to check every day already with e-mail, Facebook, and texts."
"Twitter is all self-serving.  Does anybody really care what you have to say?"

I have heard these types of comments across all ages and generations.  I have heard them at conferences, among the faculty I work with, in the monthly book group I attend.  Twitter is decidedly not mainstream in medicine, at least not in the circles I travel in.

I have seen and read countless articles, ideas, and opinions that I wouldn't have found without Twitter.  Yes, it takes a little time to find good people to follow, and it then takes a little time to actually follow them.  But the pay-off in new ideas and inspired thinking is marvelous - far better than the same amount of time on Facebook or an RSS reader.

For the most part, physicians are notoriously late adopters of new ideas.  Health systems had to mandate EHRs to get most physicians to use them.  In an age of e-mail and text messages, most of our offices remind people of appointments with a phone call.   Heck, I was a Twitter skeptic a year ago.

Interestingly, though, once docs have these new technologies, they're equally reluctant to change back.  (You should have heard the uproar here the last time the computers went down.  "Write my notes...on paper?!?")  Which leads me to wonder if some of these Twitter bashers would be still so negative if they were actually Twitter users.  So, how about it, Twitter detractors - why not give it a try?

I dare you.

Family Medicine - the antidote to the common sense blues

Reading through the responses to my post from yesterday, I realized that Steph and webhill were taking the conversation in a new direction.* I'd like to expand on their very valid points.

These kind responders shared similar stories of supposedly "abnormal" health metrics that initiated some sort of protocol, even when it didn't make an ounce of sense.  Two healthy newborns subjected to unnecessary (and costly) interventions.  Another similar experience to mine regarding "low" blood pressure.

You don't need any medical knowledge, really, to figure out that Steph's baby didn't need to go to the NICU, or that webhill's didn't need formula.  Heck, you don't need a day of medical or nursing school to know that the resident's patient from yesterday's code story was perfectly fine.

So, what is happening in nursing and medical school that strips that common sense away?  Certainly the first two years of medical school focus on learning the minutiae of how the body works - biochemistry, anatomy, etc.  All that time spent memorizing neurotransmitters and cell receptor signals then yields to being ready to respond instantly to your attending's pimping in the third and fourth years about the coagulation cascade or your patient's colonoscopy biopsy results from eight years ago.

The partialists** especially seemed to delight in these details when I was a medical student.  Frankly, it seemed then - and it seems now - that those practitioners best able to see the whole picture were - and are - the family docs.  Perhaps it's because they are the only ones truly taught to think about the patient as a whole being and not a collection of organ systems and biometrics.

Of course, we need our partialists.  They provide important and complimentary skill sets to ours.  But a family doctor should be at the center of every patient's care.

More family medicine as an antidote to the common sense blues?  It couldn't hurt.

* I genuinely appreciate every one of you readers who, at some point, has taken the time to continue the conversation by responding to one of my posts.  You all are the ones who truly keep things interesting around here.  :)
** Please see entry from 3-1-11 for more about the "partialist" label.