Professionalism and

Presenting Yourself in

Social Media

Carisa Champion-Lippmann

Danielle Maholtz

AUB Nml cycle – bleeding every 28 days

lasting 3-5 days 30-50 mL of blood loss AUB is any departure from norm (too

much, too little, inappropriate schedule) DUB – idiopathic heavy and/or irregular

bleeding that cannot be attributed to another cause (anovulation or oligoovulation)

Patterns of AUB

PALM-COEIN classification system of AUB

PALM (structural causes) – Polyps, Adenomyosis, Leiomyomas, Malignancy/hyperplasia

COEIN (nonstructural causes) – Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not Yet Classified

MENORRHAGIA

Excessive flw in duration (>7 days) or volume (>80 mL) Caused by uterine fidrobids, adenomyosis, endometrial

polyps; less endometrial hyperplasia or cancer or cervical polyyps

Teans should be tested for primary bleeding d/o (von Willebrand dz, ITP, platelet disfunction, thrombocytopenia from malignancy) Test for CBC, platelet count, PT/PTT, factor VIII, von Willebrand factor

antigen and activity

Cryptorchidism

• 1% 1 y/o boys• Complete or incomplete failure of the intra-abdominal testes to

descend into the scrotal sac• U/l in most cases• Characterized by an arrest in development of germ cells

associated with marked hyalinization and thickening of the BM of the spermatic tubules

• In most patients the undescended testis is palpable in the inguinal canal

• Condition is completely asymptomatic, found by patient or the examining physiian only when scrotal sac is discovered not to contain the testis

*Hypomenorrhea

*Regularly timed menses with light flow

*Caused by hypogonadotropic hypogonadism (anorexic pts and athletes); Asherman’s syndrome (intrauterine adhesions), congenital malformations, infection, intrauterine trauma, OCPs/depo/progestin IUDs, endometrial ablation all have atrophic endometrium; outlet obstruction secondary to cervical stenosis or congenital abn

Metrrrorrrrhagia – bleeding between regular periods (less than normal)

Caused by cervical lesions, endometrial polyps, carcinoma

Menometrrrorrrrhagia – excessive (>80 mL) or prolonged bleeding at irregular intervals

Caused by uterine fibroids, adenomyosis, endometrial polyps, hypereplasia, cancer

Metrorrhagia and Menometrorrhagia

Oligomenorrhea

• Periods > 35 days apart• Caused by disruption of hypothalamic-

pituitary-gonadal axis or systemic dz (hyperprolactinemia and thyroid d/o); PCOS, chronic anovulation, pregnancy, thyroid dz

Polymenorrhea

• Periods <21 days apart• Usually caused by anovulation

Evaluation History – timing of bleeding, quantity, menstrual hx/menarche, associated

symptoms, family hx Physical – rectal, urethral, vaginal and cervical causes r/o; PCOS symptoms

(hirsutisum, acne, truncal obesity, acanthosis nigricans); thyroid dz (thromegaly, skin changes, diaphoresis, increased pulse); bleeding d/o (bruising, petechiae); PAP smear for cervical dysplasia and cancer; cervical cultures for infection

Lab eval (tailored) Light skipped cycles – preg test, TSH, PRL, FSH (menopaus/POI) Heavy/frequent/prolonged – preg test, TSH, CBC F >45 with AUB needs endometrial biopsy to r/o endometrial hyperplasia and

cancer (or obese if <45 – peripheral conversion of androgens into estrogens in adipose cells)

Pelvic US for endometrial polyps, fibroids, hyperplasia, cancers, adnexal masses Sonohysterogram to see intrauterine defects if pathology on pelvic US MRI to distinguish adenomyosis from uterine fibroids Hysteroscopy to visualize intrauterine cavity D&C provides tissue for diagnosis

Depends on underlying etiology

Sypmtomatic fibroids/polyps – resection/removal

Adenomyosis – hormonal regulation (OCPs, Mirena), endometrial ablation (done bearing children)/resection, hysterectomy

Cervical polyps – polypectomy

Endometrial polyps – Hysteroscopy, polypectomy +/- D&C, endometrial ablation, hysterectomy

Endometrial hyperplasia – progestin therapy, D&C, hysterectomy

Endometrial Cancer – Hysterectomy, BSO, radiation

Hormonal Problems

Anovulation – menstrual regulation with estrogens/progestins and weight loss

Hypothyroidism – thyroid hormone replacement

Hyperprolactinemia – DA agonists

TREATMENT

DUBNo pathologic cause of AUB identified

Most pts with are anovulatory (ovary produces estrogen but no corpus luteum is formed and no progesterone is produced); continuous estrogenic stimulation of the endometrium without the usual progesterone-induced bleeding – endometrium continues to proliferate until it outgrows its blood supply, breaks down, sloughs of in irregular fashion

Occurs in hypothyroidism, hyperprolactinemia, hyperandrogenism, POI/PMOF, adolescence, perimenopause, lactation, pregnancy

Determine if pt is ovulating by basal body temp OR 21-23 serum progesterone

Tx – NSAIDs for chronic, hormonal therapy (OCPs, OrthoEvra Patch, Nuva Ring)

• If estrogen CI (HTN, thrombophilias, hx DVT/PE, >35 y/o and smoke) can use progestin only options (depo, Mirena, Implanon)

• D&C, hysterectomy

Most Common Power Point Mistakes

http://www.youtube.com/watch?v=GxSQ-0FWHNk

Objectives

Learn how to structure and give a strong presentation

Learn some techniques that will allow you to communicate effectively

Learn some personal etiquette rules to follow

Power Point Structure

Introduction

Content

Conclusion

Introduction

Objectives

Motivation

Prerequisite knowledge

Agenda

Content

Overview/Advanced Organizer

Content matches stated learning objectives

Skills/tasks to be learned were demonstrated effectively

Current guidelines, recommendations, or studies incorporated

Conclusion

Summary

References

Slides

Easily digestible portions of information

Directed attention at important information

Font size/style made easily readable

Color scheme/background appealing and not distracting

Images/charts large enough to read easily

Delivery

Room and materials set up according to needs of lesson

Speak and enunciate well

Body language should convey meaning and should not be distracting

Personal Presentation

Speech

Appearance

Tone

Tone

Monotone vs. Emotion

Should match your speech and body language

Speech

Filler Words

Speed

Pronunciation

Enunciation

Appearance

Body language

Stance

Eye Contact

Gestures

Etiquette Fun Facts

At social events, keep right hand free for shaking hands

Always say your full name

Always stand when being introduced

Handshake (practice)

10 second Elevator Speech about yourself and why you are at an event

If you are at the dinner table you drop anything, don’t pick it up

Business Cards

Dinner Etiquette

B and D Fingers

Turn cup over if you don’t want coffee or tea

Fork and knife at end of meal

Bread and Butter

Passing around the table

Fold napkin on chair when leaving table

Place hand bags on the floor

Cut food as you eat it

Don’t drink while your mouth is full of food

Don’t hand your plate to the waiter

Summary

Keep your presentation simple and well organized

Start practicing how you present yourself NOW, however often you want!

Keep in mind there are some rules of etiquette for different situations and try to follow them. We gave you some but there are plenty of resources to continue learning from!

Professionalism

• “Professional competence is the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served.”

• Representing one’s profession by encouraging trust from patients in their physicians.

Inter-professionalism• The first priority of inter-

professional education is to create an inter-professional team approach to healthcare and overall health care delivery. This is theorized to help increase communication, bring a better understanding of individual professional roles, decrease duplication, and improve patient care and outcomes.

Social Media/Electronic Information

Emails and Texts• Professional Communication

• Err on the side of formality.

• Read/Edit/Spell-check• Avoid excessive

formatting.• Forward with caution.• Responding to sensitive

or emotionally charged emails

• Rotations!

Social MediaWho is your audience?

Legal Precedent/Guidelines

• Slow but evolving• Based on jurisdiction• Free speech?

School Policies• 10% of LCME medical schools have policies in

their student handbooks.• Cyber bullying/stalking

Hospitals/Health Networks

• Many large hospitals and networks have media policies that tend to be more strict then schools.

Organizations/Profession

• COSGP• “I do hereby affirm that I will represent and serve my fellow students

in good judgment and diligence, always striving to uphold the principles of the osteopathic oath, so entrusted to me as a future physician.”

• Profession• You represent yourself AND the organizations/groups/communities that

you are affiliated with. • Your professional status is reaffirmed daily. You are responsible for

protecting that professional reputation.

What is concrete?

Tough Call• A patient friend requests a medical student.

o This is almost always inappropriate unless the Dr./medical student- pt relationship has ended. Even after the Dr. pt relationship has ended it would be inappropriate to discuss health related info.

• A medical student tweets that he just finished rounds with the residents on a pt and describes the clinical findings of that patient.- It’s difficult to be certain that info disclosed on twitter is not

identifiable to that particular patent. The best types of posting would include very general information. Other posts by the same student could have indicated their medical school and current rotations leading to circumstances that indirectly indentify the pt. such as by naming a distinct disease or symptom.

Tough Call• A med student writes in her blog naming an attending who did minimal

teaching on rounds and recommending that other students not take clinical electives with that physician OR Med student posts to wall that half the class slept during student doctor Liu’s lecture.• Legitimate critique of an education activity is appropriate so long as

professionalism is maintained. There are ore effective and less public mechanisms for relaying this type of info and the student may be counseled accordingly.

• Med student posts photo of patient with good intentions and receiving the patients’ verbal ok.• Without written consent this is a clear violation of patient

confidentiality even if the pt is not named and no other identifiable info is used.

Tough Call• Med student posts about how the hospital’s equipment they are rotating at should

have been replaced years ago and is unreliable.• The public disclosure of such info increases the liability for the hospital health

system and is clearly unprofessional. There are legitimate and confidential mechanisms for improving quality at the hospital.

• Medical student posts that her teacher/attending wears too much cologne, has bad taste in clothes, has a gross mustache, and takes overly long lunch breaks.• Inappropriate forum and set of comments and demonstrates

unprofessional behavior by the student. There are legitimate and confidential mechanisms for addressing valid concerns in schools and the workplace.

• Medical student wearing a Mayo Clinic Tee-shirt has a picture posted of them at a bar clearly inebriated.• 1) Hospital logo indentifies the affiliation to the institution and • 2) The unprofessional behavior of the student is available for all to see,

including future employers and patients. The med student did not post the photo but should do everything possible to have the photo removed and remove the tagging link to the students own Facebook page.

Ten Recommendations1) Use good judgment.

• Think about how you want the public to view you as a person and as a medical professional since you represent your profession at all times.

• Don’t want to undermine your credibility or the reputation of your colleagues and affiliations.

• Think before you post if there are people you wouldn’t want to see what you are posting, liking, photos, etc.

2) Privacy Settings• Many can view your Facebook so go to settings and click view as

to see your profile as a random non-friend individual.

3) Check your school’s policy and that of the hospitals you rotate at.

4) Seek expert guidance.

• Some schools have a specific person to contact if you have any question about what is allowed and what is not.

5) Protect patient privacy.

Ten Recommendations6) Respect work commitments (make sure not interfering with work

commitments).

7) False and unsubstantiated claims and inaccurate or inflammatory postings may create liability for you.

8) Consider using a disclaimer such as the views expressed on this {post, blog, etc} are my own and do not reflect the views of my {school, rotation site, etc}. However this is not fool proof.

9) Respect copyright and fair use laws.

10) Protect propriety information.