About Dr. Jeff Livingston

Dr. Livingston joined MacArthur OB/GYN in 2003. He is a board certified obstetrician and gynecologist by the American Board of Obstetrics and Gynecology.

LARCs - MacArthur Medical Center

LARCs – Be Pregnant When You Want To Be

Are you ready to be a mom? If you are sexually active and are not ready to be a parent then it is important to choose an effective form of contraception. If you are a parent and your child has become sexually active it is important she start birth control before you become a grandparent. Almost half of pregnancies in the United States are unplanned. Don’t be a statistic. Choose an effective form of birth control that puts you in control. The most effective forms of non-permanent birth control are called LARCs – Long Acting Reversible Contraception. These methods allow you to be pregnant when you want to be and help you take control.

LARCs  – Long Acting Reversible Contraception

Long acting reversible contraception are important birth control methods to understand. These are birth control methods that work for an extended period of time without you having to do anything. Examples of  LARCs  are IUDs (Intratuterine Device) and subdermal implants (Nexplanon). An IUD is a small device that is inserted into the cavity of the uterus. There are currently currently 4 IUDs available in the US – Skyla, Mirena, Paragard and Liletta. There is only one subdermal implant available. It is called Nexplanon and is inserted just under the skin of the arm.

Of all the birth control options LARCs are the most convenient for the user. You have to come in for insertion and can leave with the confidence of having years of protection. When you are ready to parent you simply come in for removal. The return to fertility is almost immediate with pregnancies seen as early as 7 days after removal. They also have the highest continuation rates, excellent safety profiles, few side effects and few medical contraindications.

Although these methods are not right for everyone, they are considered to be the first line treatment choice for all women regardless of age including adolescents. It is not true that you have to have had a baby before you can get an IUD. Studies show that Progesterone IUDs actually decrease the risk of pelvic inflammatory disease.

If you are not ready to be a parent then choose a LARC and only be pregnant when you want to be.

Contraception Counseling Impacts Unplanned Pregnancy

Of the 6.7 million pregnancies in the US each year 48% are unplanned. Disturbingly,  about half occur in women who were using contraception at the time of conception. That statistic haunts me. As health care providers we must take that to heart and change the way we think about birth control counseling. Is there more that we can do to help prevent unplanned pregnancy in those who are actively using birth control?

When we break down the statistics and focus on young people the numbers are even more striking.  Shows like TeenMom and 16 and Pregnant draw media attention to teen pregnancy. Ironically, young women ages 15-19, are the most likely group to have used birth control the last time they had sex. The problem is this age group typically chooses methods with higher failure rates such as cycle timing, condoms, withdrawal method and birth control pills. The result is unsurprising — unplanned pregnancies.

Young patients often ask me, “what is the best birth control?” My answer is always the same – “The one that YOU will use.” There is no “right” answer. Effective contraceptive counseling involves not only providing information and options,  but also matching the right method to the right person.

Research shows that pregnancies occur less often when one chooses a contraception option that requires the least amount of effort. This is not a surprise.  Condoms work great unless you never take them out of your pocket. Birth control pills also are effective but not if you forget to swallow them. Despite the many contraception options available many patients are unaware of the choices. Linguistically speaking the phrase “birth control” is synonymous with oral contraceptives for many people. Birth control refers to many more methods than just birth control pills. Health care providers should never assume patients know all of the alternatives. Pregnancy can be prevented with a variety of nondaily options that are safe and easy to use.

When discussing  contraception with young patients, start with methods that require the LEAST amount of effort and then work backwards to the methods that require the Most effort. Direct patients to the options that have the best track record. Keep in mind that efficacy has a direct correlation with compliance. The more effort the birth control method demands from the patient the less effective it will be long term.

At Macarthur Ob/Gyn we always start with Mirena IUD, Paragard IUD and Nexplanon. We discuss the risks, benefits and potential side effects. These methods involve one visit for insertion and one for removal providing coverage for 5 years, 10 years and 3 years respectively. These methods have the highest efficacy rates and excellent continuation rates. They have excellent safety profiles, few side effects and few medical contraindications. Despite that, nationwide less than 10% of adolescents are using these methods collectively referred to as LARCS (Long Acting Reversible Contraception.) We focus on LARCS because they have the highest success rate at preventing unplanned pregnancy. We spend time addressing fears, misconceptions and myths. We make sure our patients are aware of these options. We use technology in the office via an on screen waiting room power point presentation highlighting the birth control options. We use social media platforms to educate our patients on their birth control choices. As a result a much higher percent of our young patients are choosing LARCs as their preferred method of contraception.

While the patient should ultimately choose the best for her, the health provider should be guiding her to the methods that can best meet her goal of preventing pregnancy. By increasing the use of LARCs we can dramatically impact the number of young women struggling with unplanned pregnancy while using contraception.

Adolescents and long-acting reversible contraception: implants and intrauterine devices. Committee Opinion No. 539. American College of Obstetricians and Gynecologists. Obstet Gynecol 2012;120:983–8.

Researching Health Information Online: Recognize Your Limitations

There are certain situations in my life where I feel really stupid. One is when CNBC’s Squawk Box senior economics reporter Steve Liesman discusses the bond market. While I recognize the words he uses as English grammar,  I find almost every word to be incomprehensible gibberish. Recently, he informed me that “given the Feds propensity towards quantitative easing in Q4 the 10 year yield could hit 3%.” I think that has something to do with money, and I have a suspicion that it might be important.

Another situation in which I am humbled and forced to recognize my own ignorance is when I get my oil changed. I know nothing about cars. It’s just not my thing. About half way through the visit the mechanic comes out with this round thing in his hand. He tells me it’s an air filter. He also tells me based on my past record at the Jiffy Lube that I am due to have it replaced. I realize that I do not know the current recommendations for air filter maintenance on a Jeep. While examining the filter with the mechanic I am unable to determine if the level of grime meets the criteria for replacement. Being totally honest, I am not even sure it is really an air filter or even a car part.

I am ok with this. I don’t have to know these things. We all have our areas of expertise, and there is nothing wrong with having to rely on others to get through life. Before spending the money though, I Googled  the current recommendations for air filters. This was easily accessible material. It verified that based on my past history I was due for a replacement in the near future. This research helped guide my decision making. There was no misconception that I knew more than the mechanic. I used the information to ask better questions and to navigate through an area in my life in which I am uncomfortable. Ultimately, I made the decision based less on my research, but rather in my trust and confidence in the advice of the mechanic.

For patients, a doctor visit can feel like I did at Jiffy Lube. A patient is placed in a situation where there is a profound knowledge gap. As a doctor who believes in the power of online patient engagement, I am torn.  I want my patients to educate themselves online. I want my patients to read, to learn and to educate themselves online. But I have seen patients fall into the trap of the Dunning–Kruger effect — believing they know and understand more than they actually do. The Dunning-Kruger effect demonstrates that people overestimate their ability and knowledge when exposed to a subject. This can be dangerous when dealing with health information.

Health information is widely available online. In a simple Google search one can find a plethora of information on virtually any health topic. The problem is that health information is unsorted and often unvalidated, and thus hard to interpret in order to take action. Information can be very helpful in some cases. But in other cases it can be anxiety producing at best and at worst flat out wrong.

Researching health information is very important, but we must recognize our own limitations. Understanding health information is hard. Science is complicated. Scientific studies often contradict each other. Health questions often just beg more questions, not always definitive answers. For every topic we Google and read about there is likely a PhD who makes a living researching that one question every day. While studying on our own we must also value and respect health professionals’ years of studying, expertise and experience.

My advice to patients is to continue to use the Internet as a supplemental tool to augment the provider-patient relationship not as a wedge to hinder it. Use the Internet to improve your baseline knowledge, to ask better questions, to create a higher level conversation and to better understand the recommendations.

Recognize the content you read may just be the tip of the iceberg and acknowledge your limitations. Ultimately, use your research to help determine your level of trust and confidence in your healthcare provider.

Look Into Their Eyes

When I look in the eyes of a pregnant teenage patient, I see my wife. My wife was a teen mother. She was a teen mother who beat the odds. She is NOT a statistic. She is an example of the tremendous potential that lies before each and every teen facing the challenges of teen pregnancy. Pregnancy did not stop her from succeeding. My wife tells the story of riding her bicycle to her doctor’s appointments. She raised her child, graduated high school and worked her way through college and nursing school. Her determination created a successful life for herself and Jaclyn, her daughter. This is what I see when I see young pregnant patients — potential and opportunity. I know that as a doctor I can make a difference that not only helps them but also the lives of their children. For this reason, I dedicate my time and energy working with teens in the office and educating Irving ISD teens about teen pregnancy.

In 2003 I joined  MacArthur OB/GYN, a medical practice in Irving, Texas. I began seeing a large volume of young teenagers in my practice and was surprised at the prevalence of sexually transmitted disease, teen pregnancy and an overall lack of knowledge regarding sexual health. I reached out to the local school nurses and offered myself as a resource. Over time this relationship evolved. Navigating through a politically charged issue like teen pregnancy was a challenge, but after gaining the support of Irving ISD administration I began giving lectures and presentations on Teen Pregnancy and STD prevention. I have spoken to countless Irving ISD students over the past 10 years providing information about sexual choices, personal responsibility, sexually transmitted diseases and pregnancy prevention.

I work closely with the Teenage Pregnant and Parenting students program, TAPPS, a district wide program that meets the needs of pregnant and parenting students. While the national high school graduation rate for teen parents hovers around 40%, the graduation rate for our TAPPS students is over 90%. By creating a partnership between the TAPPS program and MacArthur OB/GYN  we extend the reach of the program beyond the four walls of the classroom. The physicians at MacArthur OB/GYN not only care for the pregnancy, but also work with the student to make sure they are enrolled in the TAPPS program. We enroll them in the YWCA Nurse Family partnership which provides mentorship, prenatal and parenting education. We schedule visits around the school day. We empower the students to be ready to parent and aggressively educate on contraception to avoid a second teen pregnancy. We have demonstrated that identifying the pregnant students and meeting their specific needs can change lives. We see successful pregnancies and help the students achieve success in the classroom. The payoff for these efforts will be seen for generations to come.

In addition, I have served on the Irving ISD Health Advisory council since 2004. We evaluate and recommend programs on sexual health to be adopted by the district. Teens rate sexual health information as the number one issue they want to learn about in health class. Through our efforts we have implemented evidence based, effective and factual information on sexual health district wide.

In my school presentations I give fact based information from a health perspective. The students understand the type of diseases, the methods of transmission and how to avoid them. We also discuss the impact of teen pregnancy. Beyond the health information, I relay a message of individual responsibility. I empower the students to understand that they have choices. Teen pregnancy and STDs are not inevitable but rather a decision that they have control over.

During the presentation I always ask the students to write me a letter in 10 years telling the story of their life. I paint a realistic picture of what most of their stories will be. Statistically speaking the outcomes are not pretty. The sad truth is most of the young students in the office will not have an inspirational story to tell. I challenge these young people to be different. I challenge them to overcome the statistics and to tell me a story like my wife’s — one where they lifted themselves up, overcame the obstacles and created a wonderful, successful life for themselves and their child. At the end of an office visit a few years ago a patient of mine said “I have 4 more years.” I was not sure exactly what she meant. She clarified that six years before  she was sitting in a high school auditorium listening to me speaking at Union Bower High school. She was telling me in 4 more years she will write me a letter telling me how she has graduated college and nursing school. You could see and feel the pride and determination as she told me this. Knowing that my words stuck in her head motivating her to succeed caused me to tear up on the spot. Students like this reinforce to me the importance of having health care providers meet the special need of these young patients. Community leaders must continue to work with the school district to impact the lives of young people. I am not naive. I know that teen pregnancy will continue to be a challenge in Irving, Texas and across the world. But I also know that a health care provider can touch lives. Each day we can serve as one stepping stone helping a young patient along the pathway to a successful life. The physicians at MacArthur OB/GYN are committed to playing our part. Together we can make a difference.

The Daily Show and Health Information Exchanges

Recently on The Daily Show, a very interesting topic was covered — the lack of interoperability of electronic health records. This was a huge surprise to me as one would not expect the Comedy Central to cover a topic frequently discussed only by health information technology policy wonks.

During the satirical editorial, John Stewart lambasted the fact that the electronic health records from the VA system are unable to communicate with the electronic health records of the Department of Defense. He pointed out the illogic of having two large departments in the United States government having two different systems that cannot exchange information with each other.

While his editorial was hilarious and brilliant, it failed to recognize that the lack of EHR interoperability is one of the central problems in the entire U.S. health system. It is not just these two government agencies that cannot communicate; the problem is much bigger affecting virtually every doctor’s office and every hospital in the country. Health information technology experts have been shouting from the rooftops about the need to create a seamless way to share health data for a long time.

In fact, solving this problem is one of the primary aims of the Affordable Care Act through the creation of health information exchanges. Here is the basic problem. A patient goes to the doctor and has blood work done. That lab result will go from the lab back to the doctor. If the patient goes to another doctor or hospital, that lab result is not available for review by the new health provider. The new doctor is likely to simply repeat the test. Now multiply this situation thousands of times across the U.S. health system every day and add in radiologic studies, pathology reports, medication list and others and you can easily see the billions of dollars wasted because these independently operating systems cannot talk to each other. The Affordable Care Act created financial incentives to encourage physician adoption of electronic health records. It also created incentives to facilitate data sharing as part of a program called Meaningful Use.

Ironically, the technology needed to solve the problem of independently operating electronic medical record systems not communicating with each other already exists. This is accomplished through the creation of health information exchanges (HIE). Basically, a HIE allows medical information to be shared from one system to another. This means a patient’s health information can live in the cloud and follow them wherever they go. The seamless sharing of health information allows each health provider to have the most updated information to make the best healthcare decisions. This cuts cost, saves time, prevents medical errors and makes life easier for patients and doctors.

So, if the technology to solve this problem already exists why, has it not been done already? There is no easy answer to this question and in my opinion it is unfathomable why HIEs are not up and running everywhere. HIEs are not new.

They exist in some parts of the country with some success (Indiana). Most believe widespread adoption is on the horizon. Policy makers have mostly agreed now on the accepted standard for information sharing. This had been the central “choke point” to developers of this technology. Other issues are EHR vendors hesitate to provide access to proprietary information. Hospitals have concerns about sharing valuable demographic information with competitors. There are many other excuses and all are valid concerns. But while the execution of health information sharing is delayed real people suffer.

John Stewart drew attention to the health concerns veterans — those fighting for our country. He put a face on an important topic that needs to be solved now. He also brought a rather mundane and boring health IT topic to the forefront of pop culture.

One of the keynote addresses at the HIMSS13 this year was delivered by President Clinton. He acknowledged that healthcare costs are approximately 18 percent of GDP, and healthcare costs of other developed countries are in the range of 11 percent to 12 percent of GDP. Healthcare costs at this level are not sustainable especially as baby boomers reach an age that will place a higher level of demand on healthcare.

The emphasis of the keynote address was on the importance of using technology in reducing healthcare costs. Government, business, physicians, hospitals, insurance companies and patients all want to avoid unnecessary tests and have the information timely for patient care.

Technology is available. What is lacking is the will of key leaders to do it now. John Stewart brings an issue that is solvable to “main” street. It is good to laugh at ourselves, but this is not laughing matter.

Am I Pregnant? More Than You Ever Wanted to Know About Pregnancy Tests

This is recurring question for me in practice. Each day someone comes to the office asking if they might be pregnant. In today’s world there is no reason for anyone to be asking this question. There is no reason to guess. There is no reason to wonder if you might be pregnant because you are feeling certain symptoms like nausea and breast tenderness. There is a simple solution everyone can use and in minutes you will have your answer.

Take a Home Pregnancy Test

Home pregnancy tests are very accurate. They are the same tests used in a doctor’s office. Pregnancy tests are available at any pharmacy. They can detect a pregnancy 7-10 days after conception. The best time to take one is when you miss your period. If you doubt the result you can repeat it in 1-2 days. If you were pregnant the hormone level would rise enough for detection.

If you miss your period or if you think you might be pregnant here is what you do. Wait until it has been at least 10 days from the date of possible conception or even better wait until you miss your period. Buy a home pregnancy test and follow the directions exactly as written on the box. It is best to use the first urine of the morning as it is more concentrated. The tests ability to detect HCG hormone will be higher allowing an earlier positive result if you are pregnant. Usually the tests recommend waiting about 3 minutes before reading it. If you let the test sit too long the the test may show a false positive result. A false positive is when the tests shows you are pregnant when you actually are not.

Pregnancy tests work by detecting a hormone called human chorionic gonadotropin, HCG. A hormone is chemical produced in your body. As soon as fertilization and implantation occurs this hormone begins to be produced. It then roughly doubles (increases by 66%) every 48 hours. Because of this predictable rise in HCG, a home pregnancy test will be accurate about 7-10 days after conception. By the time you miss your period a pregnancy test has an extremely high likelihood of being correct. A home pregnancy test can detect an HCG hormone of about 20. This highly sensitive test allows very early detection. In other words – you can trust the test results.

A blood pregnancy test done in a doctor’s office works a little bit differently. A blood test still detects HCG hormone but with this test an actual numeric level is given instead of a yes or no answer. A blood pregnancy test is slightly more accurate, but they also take longer and require a doctor’s visit. To simply answer the question “Am I pregnant?” a blood test is rarely needed. Here is an example:.

Let’s say you had unprotected intercourse and were concerned you might be pregnant. Ten days later you did a home pregnancy test and it was negative. On that same day you also did a blood pregnancy test. The home test said not pregnant but the blood test showed you were in fact pregnant with a BHCG level of 19. Notice this BHCG level is 1 point too low to for a urine pregnancy test to detect it. It is true that the home test gave you the wrong result, but remember that HCG doubles every 48 hours. If you waited two days and repeated the test urine test your hormone level would be about 38. The urine test would easily detect it. Had you simply waited until you missed your period before taking the home test the HCG level would be way above 20. The home test would have worked fine in the first place.

Often patients have done a home pregnancy test which showed they are not pregnant but they do not believe the result. My advice is to TRUST THE TEST. If you do not believe a negative result simply repeated in 1-2 days. If your test is still negative then you are not pregnant. You may need to schedule a visit to discuss irregular menstrual cycles if your period does not come. If your test is positive then there is no reason to keep repeating the test. Save your money for diapers because you are pregnant. Take your prenatal vitamins and schedule your first prenatal visit.

Take Two Apps and Call Me in the Morning

Will doctors recommend health apps to patients? There has been an explosion in health apps. Patients are using them for weight loss, calorie counting, exercise monitoring, ovulation calculation and for many other health needs. But to truly integrate the concept of health apps in the health care system healthcare providers will need to get involved. There is discussion in the health IT world lately regarding physician adoption of technology specifically mobile health apps, electronic record systems and patient portals. Doctors have now been plugged into the equation for technological innovation. This represents a paradigm shift for doctors. Life was much simpler when all we had was a pager and a stethoscope.

On the other hand, incorporating new innovation is nothing new for doctors. Physicians are constantly exposed to innovation. We are approached with new medications, new surgical devices, new equipment and new lab tests. Frequently, doctors are pitched a new product and have to decide whether to integrate it into practice or to pass for now. With medications, medical devices and lab tests the decision to accept and adopt is complex. It involves analyzing safety, efficacy, cost and other factors.

Some physicians have the early adopter mentality. At home, we are the first to buy the latest iPhone (even though our current one works fine). We also rush out and buy a 3D television (much to the annoyance of our spouses). Early adopters are the first to try a new surgical technique. Other physicians are more likely to wait and view the success or failures of the early adopters before deciding to jump in.

In many ways physicians are already leading the way in mobile health. The majority of doctors are using smart phone and physicians are early adopters of the iPad. Physicians are using apps clinically within the daily workflow. I use AirStrip OB daily to monitor my patients in labor and Epocrates to check medications. Using medical apps has gone mainstream and Health apps are flooding the market. This trend will continue as the Internet itself moves from the laptop to mobile. We know physicians will use health apps but will they prescribe apps to their patients as a direct part of patient care?

It is very important that app developers understand the physician mindset if you expect us to use apps and to recommend your product to patients. We will not utilize or recommend a health app just because it is cool or just because we can. Adoption is unlikely to be based on cost, efficacy and safety. Your app needs to meet two simple criteria. First, the app needs to make physicians’ lives easier. Second, it needs to make the care we provide our patients better.

Currently I prescribe a few in clinical practice. I suggest TweetWhatYouEat.com for weight loss. I like the iPregnancyApp.com for my pregnant patients. I suggest the HealthTap.com app for access to physician driven health information. Our practice is about to release our own app for our practice in 2013.

So will physicians recommend apps to patients? Absolutely! Give us something worthwhile and we will be all over it. We ask very little in return – make our lives easier and make the care we provide better.

Wikipedia Goes Dark but the Doctor is In

Today Wikipedia and other websites have gone dark in protest of the online privacy bill. This got me thinking about the issues of copying the online work of physicians across the country. There is a growing group of physicians like me who are involved in social media, blogging and online patient outreach. Most of us do this based on a passionate belief that patient engagement matters. We believe that providing high quality information online is important. We believe that these efforts will lead to more engaged patients and ultimately better patient outcomes. We believe that by using technology we can expand the doctor-patient relationship beyond the four walls of the office.

I have given dozens of lectures across the country teaching physicians how to develop a social media strategy. I am well aware that as a result of these presentations many physicians will go check out the work MacArthur OB/GYN is doing and seek to replicate it. I have seen some physician’s Facebook pages that bear a striking resemblance to the MacArthur OB/GYN Facebook page. To that I say “Great! Go for it.” Imitation is the best form of flattery. Those of us leading the way, like my Twitter friends in #HCSM and fellow Healthtap docs, are trying to create a movement. We hope to develop more E-patients and more “E-doctors.” In fact, most of what I am doing online I learned from following smart, progressive people on Twitter. I love reading blog posts by @dr_v on 33charts.com. I enjoy reading the thoughts of other physicians and patients on KevinMD.com. @hjluks is now my friend. #HCSM moderator @danamlewis is one of my internet idols. Following smart people and adapting their ideas into our lives is the way we make progress.

If using my words and thoughts help move this movement along then, by all means, copy me. Share our Facebook posts, retweet me, share my Healthtap answers and follow me on Google Plus. I am all for it. By doing this together we can show patients and physicians the value of integrating social media into their practice. More and more physicians will develop a strong web presence and patients everywhere will benefit.

Doctor, Google Thyself

Have you ever Googled yourself or your practice? Did you know that you have an ever growing online reputation? Whether you know it or not, doctors have an online presence. When you type your name in a search engine you may be surprised by what you find. Everything you do professionally creates a digital footprint. If you are involved in social media then you are contributing to your online reputation. If not, your online reputation is being written for you. There is a conversation taking place about you online, but unfortunately you may not be included in it.

A simple Google search of your name will likely show your practice website. Your name will also appear in numerous third party review sites. Take the time to read a few. You may be surprised. You will find your name and your practice appearing on people’s Facebook and Twitter pages too. While at first this may be disturbing, I view it as an opportunity.

The Internet has revolutionized healthcare. Health information is now available to everyone with the touch of a button. Pew Internet shows that 80% of people look up information online. A patient experience goes like this. Before a patient sees you they research their symptoms to try and decide what is wrong. Next, they search online for doctors and read online reviews to decide who to see. Then, they schedule an appointment to see you. After the appointment they go back online to see if you knew what you were talking about.

Patients have moved beyond simply reading about health information. They now want an interactive experience. One of my favorite people on Twitter, Phil Baumann, likes to say “Health is social.” By interacting in social networks patients become e-patients: equipped, enabled, empowered, engaged, equals, emancipated and even experts. As doctors we can be frustrated by this and passively complain in the background or we can choose to embrace it. Like it or not, social media is here to stay in healthcare.

Embrace this excitement. Own your online reputation by providing the online information your patients are asking for. Your patients should not have to rely on Wikipedia to know what to do. They should be able to get high quality information directly from you. By getting involved in social media you can promote your area of expertise and define your image. You can create your own digital footprint. You can improve patient education, increase referrals, promote practice loyalty and increase utilization of services leading to practice growth.

This has worked well for Macarthur OB/GYN. By providing high quality health information on our website, podcasts, social media channels and innovative use of technology in the office we are helping our patients make better informed decisions. A perfect example is during the six week postpartum exam when I ask a simple question like, “What would you like to do for birth control?” In years past the answer would be “what are my options?” A brief discussion of the 32 flavors of contraception would follow. Nowadays, our patients say definitively what method they want to use. They tell me what they want. Throughout their pregnancy they have been exposed to birth control options in our waiting room power point presentation as well as through social media channels. They know the options, have thought about it and clearly communicate an educated decision. Our visits become more efficient and higher quality discussions take place. A win-win for doctors and patients.

Our journey to social media began years ago when my teenage daughter suggested I start a Myspace page as a way to reach my teenage patients and address issues such as unplanned pregnancy and sexually transmitted disease. I learned how social media serves to humanize doctors in the eyes of patients – making us more accessible and improving communication. We then evolved into Facebook, Twitter, blogging and YouTube. All of this has worked well but these sites have limitations. Content created has a short half-life as postings get pushed down the wall and older content gets lost and forgotten. All are great platforms to push out information but none are great for pulling out the needs of specific patients. None overcome the problem of direct one-on-one communication. To solve this, we established a practice portal through our EHR software. This provided a secure messaging system which is a great tool to allow HIPAA compliant one-on-one online communication from doctor to patients. You can read about this here: How secure messaging helps this doctor connect with patients.

New networks are popping up to help overcome the limitations of the existing networks. Doximity is an excellent network designed to facilitate HIPAA compliant doctor to doctor communication. Another new platform called HealthTap brings doctors back into the online conversation. Users ask medical questions. Doctors answer these questions through the creation of their own virtual practice. While engaging patients, HealthTap aggregates the content created so it will stay available forever for the benefit of others. Internet users can find concise health information that they know has been written by qualified medical professionals.

I am not sitting on the sidelines and allowing my online reputation to be created for me. I am actively engaging. I choose to create my own digital footprint and encourage my patients to engage in their own health.

My Thoughts on 16 and Pregnant

I had the honor of moderating a discussion for the Sex::Tech 2011 Conference with the producers of MTV’s 16 and Pregnant and The National Campaign to Prevent Teen Pregnancy. I was fascinated by the responses of members in the audience. It was also interesting to be monitoring in real time the online stream via Twitter. So what did I conclude?

I concluded that the issue of teen pregnancy seems to bring out passionate opinions regardless of where you stand politically. Some people felt the show treated the teen moms too harshly. Others criticized the show for not being harsh enough. Some argued the show serves as a deterrent to teen pregnancy while others felt the show promoted it. Responses were both strongly supportive and resoundingly negative. I suspect some who volunteered opinions had not even seen the show.

I don’t think as a society we will ever agree on exactly what the right message is to send teens about sexuality. In fact, that sentence in and of itself will probably trigger a visceral response among some (which kind of proves my point).

The producers of the show are telling story. Actually, they are simply weaving together a 40 minute narrative based on the reality that each teen mom creates for herself. The life the teen mom leads creates the outcome on the screen. The result: 2.8 million people are watching it, and even more are arguing about it. How we react to the stories of 16 and Pregnant says less about the show itself and more about us and our own attitudes about sexuality. The power of the show is the simple fact that we’re talking about it.

wud_pollockImagine looking at a Jackson Pollock painting. The painting is just a thing on a wall. Each of us looks at it and sees something different. Some read deep meaning into the colors and dynamic arrangement of design. Others just see paint randomly splattered on a canvas. 16 and Pregnant is just a show. The cultural phenomena surrounding it is something different. Like any good piece of art, the show is stimulating an emotional response in the viewer. Kids are talking about it. Adults and sex educators are talking about it. Parents and kids are talking about it together. Conversations about adolescent sexuality, teen pregnancy and birth control are happening. The show is increasing awareness about the issue of teen pregnancy. We should all agree on that fact. How does the show impact society? Is it good or bad? Well, it is a work of art. Watch the show and decide for yourself.

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