August 18, 2016
July 25, 2016
One of my big keys is to not try to "not violate HIPAA" – that's easy and too low of a bar.
The real key is to not piss off the carpetwalkers: I don't want to have to defend myself in a meeting with Risk Management. Instead, I want to maintain a general profile I can defend to my dean and my department chair (and maybe someday to the promotion & tenure committee).
Twitter is a Giant Elevator
My big overall philosophy is that social media is like talking on an elevator. But: my mom, department chair, medical school dean, the patients' family, and a million other people are in the elevator. Obviously that doesn't mean that I'm always banal and polite. Rather, I recognize that people will see what I write and it is always tied to me.
Easy version: never talk about real patients.
Slightly tougher but still easy: if I do want to talk about real patients, I change enough of the details so that if the actual patient were to see it, the patient wouldn't recognize that it was them.
Two mistakes people make: date of service and age over 90 are HIPAA-protected PHI. The number one thing I do if I am referencing something that happened to a real patient is that I don't do it the same day (or even the same week).
I never even reference "oh look what happened on my drive to work today" so there can't be a real connection between anything I say and a real patient. And I don't share pictures from work or of patients without all of my ducks in a row (if at all).
I'm not opposed to being anonymous, but I'm very much intentionally not. This is partially as a check on myself -- I know whatever I say is tied to me. A big part of it is to avoid the fear of people discovering my secret identity.
I'm not recommending anyone be anonymous on social media, but if I were, I would tell all my relevant bosses (e.g. program director, chair). If something serious "goes down," i.e. there's some sort of scandal, and it's a total surprise and secret to everyone, I imagine that there will likely be a big sense of betrayal.
But I don't want to be anonymous, it means you are giving up a lot of the upside. I imagine the benefits are possible but a lot harder if anonymous. Because the bottom line is that there are legitimate career, academic, and potentially financial benefits to being active on social media as a medical professional.
April 25, 2016
April 8, 2016
Here are my sources:
I started with this paper which was I originally heard on EM Abstracts (Jan 2011):
Brahm NC, Yeager LL, Fox MD, Farmer KC, Palmer TA.
Commonly prescribed medications and potential false-positive urine drug screens.
Am J Health Syst Pharm. 2010 Aug 15;67(16):1344-50.
Special thanks to Jon Cole from Hennepin who made this fantastic video.
Other sources include:
UMHS Guidelines for Clinical Care May 2009
Standridge JB, Adams SM, Zotos AP.
Urine drug screening: a valuable office procedure.
Am Fam Physician. 2010 Mar 1;81(5):635-40.
Reisfield GM, Haddad J, Wilson GR, Johannsen LM, Voorhees KL, Chronister CW, Goldberger BA, Peele JD, Bertholf RL.
Failure of amoxicillin to produce false-positive urine screens for cocaine metabolite.
J Anal Toxicol. 2008 May;32(4):315-8.
Ly BT, Thornton SL, Buono C, Stone JA, Wu AH.
False-positive urine phencyclidine immunoassay screen result caused by interference by tramadol and its metabolites.
Ann Emerg Med. 2012 Jun;59(6):545-7.
Swift RM, Griffiths W, Cammera P.
False positive urine drug screens from quinine in tonic water.
Addict Behav. 1989;14(2):213-5.
Added lamotragine -> PCP
Geraci MJ, Peele J, McCoy SL, Elias B. Phencyclidine false positive induced by lamotrigine (Lamictal®) on a rapid urine toxicology screen. Int J Emerg Med. 2010 Dec; 3(4): 327–331.
Added a few more -> PCP
Phencyclidine (PCP) Test Systems Executive Summary. Chemistry and Toxicology Devices. FDA
2013 Apr 25, Link.
December 30, 2015
Not exactly op notes, but some ED limericks I wrote:@MDaware @TirathPatelMD @Skepticscalpel @krchhabra In my previous life I was an "op note writer." I tried to write limericks— Saurabh Jha (@RogueRad) December 30, 2015
Mr. Jones ate some bad guacamole
press on his belly, he shouts "holy moley!"
we did a CT
and what could it be?
then he went for a lap'r'scopic chole
Mrs. Smith was awoke from her nappy
her belly was feeling quite snappy
white count? twasn't high
a fever? tad shy…
but the CT, of course, showed an appy
there once was a man from Bologna
thought he had caught a touch of pneumonia
he seemed like whiner
and he got a d dimer
no PE; just some bad allodynia
Of course the cake goes to:
November 16, 2015
A number of Very Smart People (including Rob Huang, Minh Le Cong, Chris Nickson, and Reuben Strayer) have all pointed out that Cochrane is supposed to summarize the data, not editorialize:
@DocBrent @HumanFact0rz @CochraneAnaesth cochrane shud stay away from clinical interpretation - just crunch the data, let clinicians decide— Chris Nickson (@precordialthump) November 4, 2015
Ultimately, this isn't that big deal. Hyperkalemia is bad, but rare. But if we can avoid it without worsening time to onset or intubating conditions, why not?
Special thanks to Minh Le Cong & Reuben Strayer for their prepublication peer review.
Also from Twitter::
Discussion of data is always welcomed - especially if there's moderate or low quality of evidence!👍😀 #FOAMed #FOAMcc https://t.co/me4EwmvYmM— Cochrane Anaesthesia (@CochraneAnaesth) November 4, 2015
October 25, 2015
RT yelled at me for touching vent once, I 1 apologized 2 was really nice 3 gave my card 4 never heard about it again https://t.co/zcV9z74jzz— Seth Trueger (@MDaware) October 25, 2015
1 do what's right for the patient 2 be nice to everyone 3 deal with the consequences, which ideally 4 there won't be https://t.co/52UCa6iKC1— Seth Trueger (@MDaware) October 25, 2015