mdchat transcript - twitter chat january 11, 2010

8/8/2019 MDchat Transcript - Twitter Chat January 11, 2010

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#MDchat

Healthcare Hashtag Twitter Transcript

From: Tue Jan 11 17:45:00 PST 2011

To: Tue Jan 11 19:15:00 PST 2011

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Learn more about #MDchat at The Healthcare Hashtag Project

MD_Chat In just a few minutes, we'll be l ive on #MDchat 9pm Eastern. Topic: Sleep, Perchanceto Be PolicedTue Jan 11 17:45:08 PST 2011

mdstudent31 Getting ready for #mdchat. Topic: Should physicians report their sleep? Will be fun!Tue Jan 11 17:57:43 PST 2011

s_eller @mdstudent31 - yes, it should be good - if I can stay awake for it. ;) Long day #mdchatTue Jan 11 17:58:42 PST 2011

MD_Chat Welcome to tonight's #MDchat everyone! We'll start it up in a moment, but let's warmup with introductions!Tue Jan 11 18:00:02 PST 2011

mdstudent31 A big hello from snowy PA! Kevin, 4th year med student, soon-to-be family med intern,dreaming of the beach #mdchatTue Jan 11 18:02:07 PST 2011

RichmondDoc Mark, family doc in Richmond, VA; back from a week-long service trip to the DominicanRepublic; re-adapting to the cold again. #mdchatTue Jan 11 18:03:10 PST 2011

MD_chat @mdstudent31@s_eller Welcome & good evening! #MDchatTue Jan 11 18:03:15 PST 2011

MD_chat @RichmondDoc Hi Mark. Welcome back to the cold! ;) #MDchatTue Jan 11 18:04:09 PST 2011

s_eller Susan from snowy Chicago -ED Rn who now works at Medical school teaching teamsvia simulation #mdchatTue Jan 11 18:04:23 PST 2011

s_eller @RichmondDoc - good evening Mark - cold seems to be a theme tonight #mdchatTue Jan 11 18:04:55 PST 2011


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EllenRichter Hi there! Ellen here, a critical care RN & legal nurse consultant from south Florida. :)#MDchatTue Jan 11 18:05:09 PST 2011

RichmondDoc @MD_Chat Seriously. Where did the balmy 80-85 degrees go? #TropicalWinter#mdchatTue Jan 11 18:05:18 PST 2011

apjonas #mdchat Hi everyone. I'm Pat Jonas, MD Holistic Family Physician. Dayton, OH(snowing here)Tue Jan 11 18:05:36 PST 2011

s_eller @EllenRichter - Hello Ellen - hope you don't have snow as well ;) #mdchatTue Jan 11 18:05:43 PST 2011

RichmondDoc @s_eller Definitely chilly. Though not nearly as icy as many feared. #mdchatTue Jan 11 18:06:19 PST 2011

EllenRichter It was 82 degrees here today @RichmondDoc :) #MDchatTue Jan 11 18:06:22 PST 2011

mkmackey Kathy Mackey, joining from snowless Houston #mdchatTue Jan 11 18:06:39 PST 2011

MD_Chat OK - we're warming up here. Will start the chat in a moment with our first question.Have fun! #MDchatTue Jan 11 18:07:24 PST 2011

mdstudent31 @EllenRichter I'll be in FL for residency this time next year.... sooon enough, it will be

warm #mdchatTue Jan 11 18:07:24 PST 2011

RichmondDoc @EllenRichter Grrr! or maybe Brrr! :) #mdchatTue Jan 11 18:07:25 PST 2011

CrescendoCG Beth here - not snowing in ME yet (but it's coming...) #mdchatTue Jan 11 18:07:57 PST 2011

s_eller @mkmackey - good evening Kathy #mdchatTue Jan 11 18:08:04 PST 2011

EllenRichter @s_eller@mkmackey@RichmondDoc@apjonas@mdstudent31@philbaumann Hithere! #MDchatTue Jan 11 18:08:05 PST 2011

MD_chat T1 Mandated Disclosure of Sleep: See @Doctor_vs post http://bit.ly/hCjbBR Shouldsurgeons or other physicians have to disclose? #MDchatTue Jan 11 18:08:44 PST 2011

RichmondDoc @EllenRichter@s_eller@mkmackey@apjonas@mdstudent31@philbaumann The

gang's all here! Missed y'all last week. #mdchat


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Tue Jan 11 18:08:51 PST 2011

EllenRichter @CrescendoCG Welcome :) #MDchatTue Jan 11 18:10:07 PST 2011

AndyKetch Andy Ketch - listening in on our heros, MD's, to learn. Thank you. #mdchatTue Jan 11 18:11:10 PST 2011

RichmondDoc T1 I think it will be a terribly difficult and unproductive process to try and legislate orrequire certain hours of sleep from MDs. #mdchatTue Jan 11 18:11:13 PST 2011

s_eller Didn't read the post initially - so thanx for sharing link. I agree with Dr. V - hard forsomeone else to make that call for you #mdchatTue Jan 11 18:11:39 PST 2011

RichmondDoc T1 So no, I don't think we should be disclosing. After all, hrs of sleep are not all equal.Are 6 hrs on call = 6 hrs off call? #mdchatTue Jan 11 18:11:50 PST 2011

mdstudent31 T1: Resident restrictions, stressed attendings pick up slack + workforce shortage.Slippery slope, enjoy the ride #mdchatTue Jan 11 18:12:17 PST 2011

RichmondDoc T1 More importantly: we need to teach students differently. We need to demystify thelegend of the doc who pushes on at all costs. #mdchatTue Jan 11 18:12:29 PST 2011

RichmondDoc T1 Teachers need to teach/model the idea of understanding one's own limits, and torest/take sick days when needed. #mdchatTue Jan 11 18:13:14 PST 2011

mkmackey T1 I would be more concerned w sleep deprived med students who lack theexperience as opposed to surgeons who know limits #mdchatTue Jan 11 18:13:27 PST 2011

s_eller T1 - In healthcare, we all have nights when we have less than desirable sleep -individual judgment vs disclosure #mdchatTue Jan 11 18:13:41 PST 2011

fidouglas . @RichmondDoc Maybe give MDs an opportunity to express concern about whenthey are too sleep-deprived to work properly....? #mdchatTue Jan 11 18:13:55 PST 2011

s_eller @RichmondDoc -T1 agree that we need to teach student to understand their ownlimits - when are they impaired #mdchatTue Jan 11 18:14:30 PST 2011

RichmondDoc @s_eller T1 agreed: but med schools and residencies need to teach/guide studentsre: how to judge their status and readiness. #mdchatTue Jan 11 18:14:39 PST 2011

apjonas #mdchat If we're Hawkeye Pierce in war, or in a disaster, maybe a tired surgeon is theonly one available, so we do what we can. BUT...


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Tue Jan 11 18:14:42 PST 2011

RichmondDoc @fidouglas I think that's a great approach: but we need to ensure docs won't feellessened or penalized if they step back when tired #mdchatTue Jan 11 18:15:22 PST 2011

RichmondDoc @apjonas T1 In crisis, there will always be a call for people to push to their limits. Butmost of our lives are not at that level. #mdchatTue Jan 11 18:15:48 PST 2011

s_eller @mkmackey - to be devil's advocate - would med student w/ lack of sleep be morecautious than exp MD who thinks they can function? #mdchatTue Jan 11 18:15:48 PST 2011

apjonas @mdstudent31 Good point about tired attendings. Coffee used to be the drug ofchoice in allnight OB call w/deliveries.#mdchatTue Jan 11 18:16:36 PST 2011

dorameulman Survey: Docs Struggling Financially, but New Tech Makes Job Easier:http://t.co/oGf21pv#MDChatTue Jan 11 18:16:39 PST 2011

EllenRichter T1 Something as personal & individualized as fatigue & abil ity to concentrate can beresult of many factors besides sleeplessness #MDchatTue Jan 11 18:16:43 PST 2011

mdstudent31 @RichmondDoc Not sure how much that myth still lives on. We already observeresidents who have no choice about leaving #mdchatTue Jan 11 18:16:58 PST 2011

mkmackey T1 Professionals in all industries have this issue. A personal decision. #mdchatTue Jan 11 18:17:19 PST 2011

fidouglas We all know when we're too tired and are likely to make mistakes. It's a subjectivething that can't easily be measured. #mdchatTue Jan 11 18:17:24 PST 2011

mdstudent31 @apjonas Good thing it's not four loko #mdchatTue Jan 11 18:17:37 PST 2011

fidouglas But at the moment, I get the impression that doctors don't feel they can express theseconcerns, esp. junior doctors. #mdchatTue Jan 11 18:17:54 PST 2011

RichmondDoc @mdstudent31 That might be true--the stories might be fading. I remember stories ofdocs rounding while receiving IV fluids... #mdchatTue Jan 11 18:18:23 PST 2011

RichmondDoc T1 If we want docs to step back when at their limits, we need to ensure they won't bepenal ized/marginalized; team must pick them up #mdchatTue Jan 11 18:18:51 PST 2011

EllenRichter T1 All health profssnls must be aware of the negative effects of lack of sleep no matterwhat the task: surgery, prescriptions, etc #MDchat


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Tue Jan 11 18:23:59 PST 2011

mdstudent31 @drsteventucker Or on facebook. Students already do this to pass the time withoutrealizing implication #mdchatTue Jan 11 18:24:13 PST 2011

fidouglas @mkmackey Agreed. but while bankers etc. work crazy hours & might risk $, if theychoose to overdo it, they're not risking lives. #mdchatTue Jan 11 18:25:31 PST 2011

apjonas @s_eller@CrescendoCG eventually could lead to patient action guidelines. Pt ck listto querie doc RE items b4 they can get service #mdchatTue Jan 11 18:25:39 PST 2011

drsteventucker @mkmackey#mdchat The crazy part is we know ppl can't function at 100 percent allthe time. Look at sports training. Must stay at 80%Tue Jan 11 18:26:11 PST 2011

mdstudent31 @drsteventucker@EllenRichter I have many med and nursing friends that tweet/statushour countdowns, etc. Not cool #mdchatTue Jan 11 18:26:23 PST 2011

EllenRichter T1 We all real ize how important it is for health providers to maintain appropriatedemeanor when represented on social media sites #MDchatTue Jan 11 18:26:34 PST 2011

RichmondDoc T1 In all honesty, part of being in a profession is being professional. We need to teachthat this includes knowing your l imits. #mdchatTue Jan 11 18:26:47 PST 2011

s_eller @apjonas@s_eller@CrescendoCG - very interesting - l ike the concept of educatingpts on guidelines - also need to empower them #mdchatTue Jan 11 18:27:00 PST 2011

apjonas @s_eller@EllenRichter Good point Brain fog bad no matter the cause.#mdchatTue Jan 11 18:27:35 PST 2011

RichmondDoc T1 If we are going to be professionals, we need to know if we are unsafe & we shouldbe talking w/ colleagues who are unsafe #mdchatTue Jan 11 18:28:01 PST 2011

CrescendoCG @apjonas@s_eller Agree that pts should be aware of guidelines. #mdchatTue Jan 11 18:28:08 PST 2011

MD_Chat Shoulder tap: we'll continue with the topic, just shift it a bit. Coming up in a moment.#MDchatTue Jan 11 18:28:34 PST 2011

mdstudent31 Tracing/tracking social media activity whether on call or at home. Verification of sleepor lack thereof? #mdchatTue Jan 11 18:28:35 PST 2011

RichmondDoc T1 But the culture of medicine is hard to break. Many docs in current practice feel theresident work hours coddle docs in training #mdchatTue Jan 11 18:28:37 PST 2011


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apjonas @MD_chat Thanks for the nudge #mdchatTue Jan 11 18:29:43 PST 2011

RichmondDoc @mdstudent31 But some SocMed tools allow people to pre-schedule posts for latehours; hard to prove if a person is awake & posting. #mdchatTue Jan 11 18:29:53 PST 2011

healthpolicygrp I have many med &nursing friends that tweet/status hour countdowns, etc. Not cool@mdstudent31@drsteventucker@EllenRichter#mdchat#hcsmTue Jan 11 18:30:08 PST 2011

mkmackey I believe patients should be able to trust that physicans will know their limits and do noharm to patients. #mdchatTue Jan 11 18:30:37 PST 2011

apjonas #mdchat Sully Sul lenberger gives good talk RE use of ck list for pt safety. Rest, sleepand stress mgmt should B on all our ck listTue Jan 11 18:31:54 PST 2011

drsteventucker @RichmondDoc We carried wood in the snow uphill both ways! ;) #mdchatTue Jan 11 18:33:09 PST 2011

RichmondDoc @drsteventucker We wrapped our feet in barbed wire for better traction in the ice andsnow! #mdchatTue Jan 11 18:33:54 PST 2011

apjonas @mkmackey Good thought, but doc need tng in res pgm to emphasize that as a skill#mdchatTue Jan 11 18:34:26 PST 2011

ArthritisAshley Yes! // RT @mkmackey: I believe patients should be able to trust that physicans willknow their limits and do no harm to patients. #mdchatTue Jan 11 18:34:35 PST 2011

drsteventucker @mkmackey How do people feel when they get an email from a doc (or other) with awee hours time stamp? #mdchatTue Jan 11 18:34:43 PST 2011

RichmondDoc T1a The most "adult" approach: emphasize pt safety; teach students/residents to speakup i f they/others are unsafe for their task. #mdchatTue Jan 11 18:34:46 PST 2011

EllenRichter T1a What if doc slept 9 hours but took 2 Percocet for back pain right before start of theprocedure. So they pass the sleep mandate #MDchatTue Jan 11 18:35:00 PST 2011

RichmondDoc T1a but those who speak up need to know that their action is not going to result in anynegative repercussions for anyone. #mdchatTue Jan 11 18:35:23 PST 2011

s_eller T1a I think that students need to be taught not to work when impaired - sleep,emotional stress, ETOH, etc - self monitoring #mdchat


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Tue Jan 11 18:35:29 PST 2011

EllenRichter YES RT @s_eller T1a I think students need to be taught not to work whenimpaired:sleep, emotional stress, ETOH etc - self monitoring #MDchatTue Jan 11 18:36:39 PST 2011

mdstudent31 T1a All members of the team should not be afraid to speak up, no matter what level oflicensure #mdchatTue Jan 11 18:36:49 PST 2011

drseisenberg T1: Never underestimate the magical power of the siesta. Only wish I could block 20min of "siesta time." #MDchatTue Jan 11 18:37:20 PST 2011

mkmackey @drsteventucker I think an off hours email from a physician would mean they aredoing a wonderful job caring for a patient #mdchatTue Jan 11 18:37:51 PST 2011

drsteventucker @EllenRichter Or if they lept well but constantly look at their iPhone and not thepatient/nurse/admin? Distractions are a problem #mdchatTue Jan 11 18:37:55 PST 2011

apjonas @s_eller#mdchat impaired is such a power word that doing otherwise would beillegal. What about distracted? fatigued? infected? etc.?Tue Jan 11 18:38:14 PST 2011

healthgist http://j.mp/d5Z8gi@mkmackey Kathy Mackey, joining from snowless Houston#mdchatTue Jan 11 18:38:54 PST 2011

mkmackey @apjonas I can only imagine the di fficulty in mastering time management in medicine#mdchat

Tue Jan 11 18:39:07 PST 2011

drsteventucker @mkmackey Thats great to hear but I can say I have had patients wonder why I am upin the middle of the night. #mdchatTue Jan 11 18:39:30 PST 2011

jodyms Why is medicine different? RT @RichmondDoc T1 on the Coast Guard... crewexpected 2 address *any* safety issue, regardless of rank #mdchatTue Jan 11 18:39:31 PST 2011

EllenRichter T1a Same goes for docs, nurses, pharmacists etc. No one should work at a loss due toany impairment. People must know own limits #MDchatTue Jan 11 18:39:36 PST 2011

s_eller @apjonas - T1a understand your point about word - but fatigued or infected can alsobe less than optimal - who decides impairment? #mdchatTue Jan 11 18:40:17 PST 2011

jodyms @mkmackey@drsteventucker and if same late-night tweeting doc has 7 am surgery?We equate late nights, hard work wi th caring #MDChatTue Jan 11 18:41:15 PST 2011

mdstudent31 Speaking up -something taught, encouraged to do, yet still struggle with. Remember


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the patient, make the right choice #mdchatTue Jan 11 18:41:15 PST 2011

mkmackey @drsteventucker a dedicated-doctor.. you could use the email settings to have youemail sent at a regular hour? #mdchatTue Jan 11 18:41:31 PST 2011

a_singledrop Wow. Timely. We definitely just discussed the issue of disclosing sleep hours in ethicsclass this afternoon! #mdchatTue Jan 11 18:42:31 PST 2011

drsteventucker @jodyms Some argue medicine is different because of moral obligations/constraintsthat may not apply in other economic activities #mdchatTue Jan 11 18:42:45 PST 2011

mkmackey @apjonas wow #mdchatTue Jan 11 18:43:14 PST 2011

RichmondDoc @a_singledrop Was there some sort of consensus? #mdchatTue Jan 11 18:43:30 PST 2011

RichmondDoc @drsteventucker@jodyms I think docs feel strong obligation to profession/pts; this*should* include emphasis on safety/capabilities #mdchatTue Jan 11 18:44:11 PST 2011

EllenRichter @a_singledrop Interested to hear what you all deduced from your ethical chat today!#MDchatTue Jan 11 18:44:13 PST 2011

a_singledrop My classmates agreed that reporting it would be unrealistic. Many (esp surgeonwannabes) scoffed at the idea even being brought up. #mdchatTue Jan 11 18:44:47 PST 2011

drsteventucker @apjonas Practice in Asia veyr different. I am general ly available 24/7/365 on my cellphone and email #mdchatTue Jan 11 18:44:51 PST 2011

apjonas @apjonas@drsteventucker@mkmackey My mirror has to provide good feedback REmy energy to stay fresh, sane & available Or one of them#mdchatTue Jan 11 18:45:36 PST 2011

drsteventucker @EllenRichter@RichmondDoc@ArthritisAshley Hey! We could all wear a #FitBit!

http://www.fitbit.com/#mdchatTue Jan 11 18:46:07 PST 2011

RichmondDoc @a_singledrop Not terribly encouraging, then. Sounds like the war stories and fear ofbeing the "weak link" are still going strong. #mdchatTue Jan 11 18:46:19 PST 2011

apjonas @drsteventucker ? No vacation? Could become stressful after a year or two #mdchatTue Jan 11 18:47:19 PST 2011

jodyms @RichmondDoc@drsteventucker Great points. Emphasis on safety to me is part of the


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professional obligation #mdchatTue Jan 11 18:47:30 PST 2011

RichmondDoc @drsteventucker@EllenRichter@ArthritisAshley Oof. Another reason the profession*should* act: we want to avoid such requirements. #mdchatTue Jan 11 18:47:44 PST 2011

mdstudent31 Setting residency hour restrictions will lead to more yrs of residency training. Does thatmean more CME time for docs? #mdchat

Tue Jan 11 18:47:59 PST 2011

EllenRichter @drsteventucker Theres an interesting apparatus! LOL, I wonder how much of a hitoverall fitness transparency would make! #MDchatTue Jan 11 18:48:03 PST 2011

drsteventucker @apjonas Vacation-Yes, Travel - Yes, still the phone is there. Hard to disconnectwhen away (but I can!) #mdchatTue Jan 11 18:48:40 PST 2011

drsteventucker @EllenRichter Fitness transparency? I love it! Docs should publish params like lipids,BP, sleep, FOB? :) #mdchatTue Jan 11 18:49:34 PST 2011

apjonas @mkmackey I know a lot of 6-7 hour sleep docs. Stress of mental processing variouspt situations huge factor in docs regrdls of slep #mdchatTue Jan 11 18:49:39 PST 2011

CrescendoCG @drsteventucker@EllenRichter LOL. Not sure patients need to be *that* empowered.#mdchatTue Jan 11 18:51:08 PST 2011

MDPartner @RichmondDoc How does a student learn when things are better left unsaid?

#mdchatTue Jan 11 18:51:31 PST 2011

mkmackey @apjonas I am sure it is hard to decompress #mdchatTue Jan 11 18:52:03 PST 2011

apjonas @drsteventucker@EllenRichter Web site area for pers hlth parameters of doc. LikeDoc-Harmony for pts to match w//doc hlth/lifestyle #mdchatTue Jan 11 18:52:17 PST 2011

drsteventucker @MDPartner@RichmondDoc WHAT does a student learn when things are left

unsaid? #mdchatTue Jan 11 18:52:21 PST 2011

RichmondDoc @MDPartner What things? Some personal things, maybe. But if sleep deprivationresults in possibly risking pt safety...? #mdchatTue Jan 11 18:52:44 PST 2011

apjonas @MDPartner@RichmondDoc professonal role modeling and citizenship tng helpfulfor student development #mdchatTue Jan 11 18:53:48 PST 2011

@MDPartner@RichmondDoc- maybe topic for another chat, what things do you think


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s_eller are better left unsaid? We teach 2 verbalize threats #mdchatTue Jan 11 18:54:01 PST 2011

drsteventucker @mdstudent31@MDPartner@RIchmondDoc Bottom line - in all relationships bestNOT to leave any concerns unsaid. #mdchatTue Jan 11 18:54:22 PST 2011

ArthritisAshley @drseisenberg@EllenRichter@RichmondDoc - #MDchat True, most people lackproper sleep - but then again a lot of ... http://tmi.me/5lEHGTue Jan 11 18:54:30 PST 2011

mdstudent31 @drsteventucker@MDPartner@RichmondDoc Problem w/ many errors already isprobs w/ communication. Fostering more hurts pts #mdchatTue Jan 11 18:55:19 PST 2011

EllenRichter @ArthritisAshley LOL hey thats no fair! You used more than 140!! ;) #MDchatTue Jan 11 18:55:46 PST 2011

mkmackey Better to send that afterhours email! :) RT @drsteventucker: in all relationships bestNOT to leave any concerns unsaid. #mdchatTue Jan 11 18:56:35 PST 2011

EllenRichter @ArthritisAshley T1 Sleep deprivation affects pilots, bus drivers, train conductors,anyone whose job peoples lives depend on #MDchatTue Jan 11 18:56:54 PST 2011

RichmondDoc @s_eller@MDPartner If there is a colleague whose physical/emotional status makesthem unsafe, that should be addressed. #mdchatTue Jan 11 18:57:32 PST 2011

mdstudent31 After being up for >30 hours, adrenaline rush is no excuse to compromise pt safety -what is this proving? #mdchatTue Jan 11 18:59:37 PST 2011

mkmackey Glad there are those who find being a physician rewarding.. hearing how challengingthe profession is at #mdchatTue Jan 11 18:59:57 PST 2011

drsteventucker @mdstudent31 And it compromises the doctors/students heal th as well. #mdchatTue Jan 11 19:00:29 PST 2011

RichmondDoc But, although docs should be wi lling to address impaired peers, peers should not puteach other in that position. Be responsible! #mdchatTue Jan 11 19:01:06 PST 2011

EllenRichter @RichmondDoc Too bad many turn their heads away from dealing with impaired orunsafe colleagues. Some just dont want to make waves. #MDchatTue Jan 11 19:02:20 PST 2011

MD_chat Is anyone going to get to sleep after this chat? ;) #MDchatTue Jan 11 19:02:51 PST 2011

apjonas @RichmondDoc Loving our profession implies a willingness to help each other andprotect patients. Confrontation for better or better #mdchat


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mdchat transcript - twitter chat january 11, 2010

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