Tuesday, November 21, 2017

The case against live tweeting

“Live tweeting” of conference presentations continues to be popular. The practice is defined as posting one or more tweets attempting to tell the Twitter audience what the presenter has to say. It is touted as a great way to convey information to those who are unable to attend the conference.

I’m not a fan of live tweeting, and here’s why.

The live tweets are also supposedly used as a substitute for notetaking. I have blogged about some of the studies showing retention of information is better when notes are taken on paper.

Many of the tweets are incomplete and/or incomprehensible because the description of them has to fit within 280 characters—at most two or maybe three sentences.

Good speakers will use short bullet points and verbally explain what they mean. This can be difficult to accomplish in a tweet.

Papers presented at meetings have not been peer-reviewed. [Okay, I understand that peer review is not perfect, but it is the current gold standard for evaluating published medical literature.] Some people may not know this, but program committees can only judge what is in an abstract—which can be misleading. The submitted abstract is usually worded to attract the attention of those deciding which papers will be accepted. When the paper is presented at the meeting, it sometimes only faintly resembles what was contained in the submitted abstract.

People who rely on live tweets for medical news assume the live tweeter understands what has been presented and is able to coherently communicate it. I worry that snippets of misinformation may be widely disseminated.

What about impressions. Some organizations brag about their combined meeting tweets having 240 million impressions. That doesn’t mean 75% of citizens in the US have seen a tweet. Impressions are simply an index of how many twitter accounts could possibly have seen a tweet. Most tweets are not at all. I have almost 18,000 Twitter followers. I average about 2000 impressions per tweet. Most of my tweets get fewer than 10% engagementsdefined as as clicking on a link, expanding detail, likes, and retweets.

Photographs of PowerPoint slides tend to be from bad angles and are often blurry. Here are some examples. Identifying information has been removed to protect the guilty.

The prosecution rests.

Friday, November 17, 2017

Residents, duty hours, and respect

The following is an email I received.

I, a surgical resident, would like to ask for help navigating conversations about resident duty hours. You had a very strongly worded post on the subject. My intent is not to contradict your perspective, but perhaps get and give some insight on this question. First, I wish to show you the conversation with a surgeon "fossil" as I experience it:

Fossil: "In my day we worked __ many hours and operated all night and never slept or ate and were glad of it. It made me the surgeon I am today. You will never have this privilege."

Me: "Wow, I agree. You had it much harder." Meanwhile, I am thinking:

Monday, November 13, 2017

Useless general surgical interventions that should no longer be done

England’s National Health Service (NHS) could save €153 million [$178 million USD] per year by scrapping 71 low-value general surgery practices says a recently published paper in the British Journal of Surgery.

The authors, from Imperial College London, extensively reviewed the literature and Choosing Wisely recommendations from a number of countries.

I agree with many of the 71 including performing a cholecystectomy during the first admission for a patient with symptomatic gallstones instead of waiting for another admission (saving more than €54 million) and not repairing minimally symptomatic inguinal hernias, which they estimate would save over €32 million.

The Telegraph reported, “The team also discovered that robotic surgery has ‘little or no advantage’ when compared with traditional keyhole operations and said it must be ‘considered a candidate for disinvestment.’” This probably wouldn’t fly here in the US, because—like guns—too many robots are already in the hands of users.

Friday, November 3, 2017

What does Jersey City have that New York City doesn’t? Two hospitals with Leapfrog Group “A” safety grades

Leapfrog just released its semi-annual hospital safety grades. Incongruities identified in my previous blog posts [here and here] appeared again.

New York City had no A grade hospitals, only four got Bs, and nationally known hospitals such as New York Presbyterian (Columbia and Cornell), New York University, and Mount Sinai received C grades.

Residents of New York City are in luck because several A-rated hospitals are located just across the Hudson River. Four of them—Jersey City’s CarePoint Health-Christ Hospital, Jersey City Medical Center, CarePoint Health-Bayonne Medical Center, and CarePoint Health-Hoboken University Medical Center—aren’t exactly household names, but they scored better on safety than their New York neighbors.

CarePoint has figured out how to achieve a top rating but can’t compare to the numbers of California Kaiser Foundation Hospitals scoring well on multiple Leapfrog evaluations. The current rankings show 19 of 26 Kaiser hospitals in California were A rated.