Social Media Savvy Doctors

Doctor-patient relationships no longer stop at exam room walls. Medical communication is being transformed. Doctors are tweeting. Patients are posting to medical practices’ Facebook walls. Medicine has entered the world of social media.

Dr. Jeff Livingston at MacArthur OB-GYN in Irving, Texas, uses Facebook and Twitter to share the latest health news with his patients. When Livingston comes across an interesting health-related article, he shares it on the social sites. Post topics range from breastfeeding and weight loss to medication updates. The reason: Informed patients engage in higher-level discussions during exams, he says. And that means time is well spent. Read more »

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.

The DaVinci Robot: Redefining the Art of Surgery

About a year ago, I was in private practice by myself, covering both my practice and that of my partner, Dr. Wollenman, who was ill and recently passed away this July. I was visited by a representative from Intuitive Surgical who asked if I had any interest in learning about robotic surgery. My first reaction was no, because I didn’t see the benefit. Dr. Wollenman and I had been operating together for years, performing most of our hysterectomies vaginally and what could be less invasive than that? Also, to use the robot required a learning curve and time commitment.

As I listened to the rep speak about the technology, and the statistics that over 60% of hysterectomies in this county are performed abdominally (only 10% of mine were abdominal). I thought perhaps the technology would be helpful for ‘other’ doctors who couldn’t operate vaginally. But then the rep discussed other procedures such as myomectomy, endometriosis surgery and vaginal prolapse surgery being done robotically and I started to feel intrigued.

Myomectomy is the removal of uterine tumors called fibroids. It is usually done through an open incision because the uterus is very difficult to suture using traditional laparoscopic techniques. As I watched a video of a laparoscopic myomectomy using the daVinci robot, I was impressed. The surgeon was using the instruments just as if he had shrunk his hands to fit inside of the patient. Cutting, cauterizing and suturing with grace and precision. And the picture was incredible. I was used to performing a myomectomy through an open incision, balancing the size of the incision versus the size of the fibroids and the size of the patient, trying to make it ‘just big enough’, struggling with the lights in the OR to position them so when I moved my head I wasn’t blocking my own view. Here on the video, the picture was beautiful, in 10 times magnified high definition. The rep pointed out to me that in real life it was even better, because the surgeon had a 3D, 10x, high definition picture. My interest grew.

I went home that night, got on YouTube and spent the evening watching videos of various robotic surgical procedures, including surgery for endometriosis and vaginal prolapse, two areas of particular interest to me.

Endometriosis is a benign condition, but can cause significant pain. Often, during surgery for this we find that the endometriosis has implanted over the patients ureters, bladder and rectum. These are particularly sensitive and difficult areas to excise the endometriosis using traditional laparoscopic techniques. But I was seeing the surgeon using the daVinci with precision and dexterity unavailable with traditional laparoscopic instruments (or ‘straight sticks’ as they are nicknamed).

For years, I have been interested in the treatment of vaginal prolapse and urinary incontinence in women. I’ve been to many meetings and conferences to learn the latest surgical techniques. Almost all of what I’ve learned is variations on how to approach the problems vaginally. However, the operation that is considered the ‘gold standard’ to treat vaginal prolapse is called an abdominal sacrocolpopexy. The traditional approach involves making an abdominal incision and fixing a piece of mesh to the tissue in front of the sacrum and the to the vaginal tissues to support it. However, I had gotten away from this, as had many Obgyns, because of the prolonged hospitalization and recovery due to the abdominal incision. Watching videos of laparoscopic sacrocolpopexys with the daVinci robot was very exciting. Patients with complete vaginal prolapse were able to get very good results without the need for large abdominal incisions.

So after seeing the videos and researching the subject some more, I began to think that the daVinci might be a better mousetrap. I made arrangements and traveled to York Hospital in York, PA; which is considered a robotic surgery ‘epicenter’ and observed cases. I was even more amazed and impressed, watching the surgery in person, at the visualization and dexterity afforded the surgeon by the daVinci. I came back to Texas excited and energized to begin training. I made the arrangements and had my training completed in January of 2011. In February of this year, Dr. Sakovich performed the first robotic hysterectomy at Baylor Irving and I performed the second. Needless to say, it was a very exciting time at the hospital as we got the robotic surgery program going amidst our annual DFW ice storm.

Since then, I’ve performed numerous surgeries including hysterectomy, endometriosis surgery, sacrocolpopexy and myomectomy using the daVinci robot. Again each time, I am thrilled and amazed with the visualization I have and the dexterity of the instruments. But one of the things I’ve been most impressed with is how quickly patients are able to recover from surgery. Most of my patients, including those having hysterectomy, are able to go home from surgery the same day and are ready to resume most activities within about 2 weeks. This is an improvement even over my patients who’ve had vaginal hysterectomies.

I would have to say that I’ve become a convert to the advantages of robotic surgery. I’ve also seen some glimpses of the future where we will be able to reduce the number and size of the laparoscopic incisions down to 1 or 2. I truly believe that the robotic surgery technology has allowed me to provide better care for my patients. I feel blessed to have had the opportunity to use the technology and to have joined the group of doctors here at MacArthur OB/GYN who have supported and encouraged my efforts.

Good Morning Texas featuring the da Vinci® Surgical System

Watch Good Morning Texas on WFAA Channel 8 as Dr. Livingston discusses the benefits of the da Vinci® Surgical System, as opposed to the traditional procedures used in previous years, enabling patients to return to normal activity in a shorter period of time.

Trick or Treat?

I definitely say go for the treat! This is a special time of year. Halloween happens to be one of my favorite holidays. This is a family affair for us and we all look forward to a great evening of fun. We all gather at my house, enjoy a quick meal, then help the kids get into their costumes. The ladies pound the pavement with the kids, going from door to door, while the guys dole out the candy and watch some sporting event. After our trek around at least 3 blocks, we head home with the anticipation of my next favorite activity…checking out the goods the kids collected! This is just as much fun for the adults as it is for the kids as we all sample our favorite treats.

In everything we have discussed so far, moderation is the key. As Dr. Livingston states, “there isn’t much fun in a snack-sized candy bar!” Even those harmless looking small-sized treats can have 100 calories or more per treat. However, there is nothing wrong with enjoying the collected goods. Ten minutes of brisk walking burns approximately 35 calories. My kids usually lose interest in their candy in about a week or so. It is then quietly disposed of, either brought to the work place for consumption or thrown out.

Here are some tips to help everyone through this holiday.

  • Before trick-or-treating, provide your kids with a meal or a healthy snack to avoid over eating the candy when they get home
  • Keep tabs on how much they eat when they get home
  • Don’t keep the candy around the house too long. Throw it away or give it away.
  • Keep candy out of reach and out of sight so you can control when they indulge
  • Try dividing candy into small portions and put in small plastic bags so portions are controlled
  • Don’t buy candy too early. It is too tempting to break open that bag.
  • If your weakness is not what your child brings home, but what is left over after the ghosts and goblins have gone home for the night, try buying candy that is your LEAST favorite
  • Try alternatives to candy: pencils, stickers, nuts, popcorn, etc.
  • We exchange the bubblegum for other choices that are not so hard on the teeth

This is a special night. It is about family. Enjoy…then get back to the treadmill and your routine.

Football and Pedicures

I am a typical guy. I grew up playing football, baseball, and soccer. I used to change from one uniform into another while my Mom drove me from one sporting event to another. I grew up watching all sporting events. All I wanted to know was which team belonged to the city closer to us and that’s who I would root for with all my might. As I grew up, I became a die-hard Cowboys fan. I would hang my Emmitt Smith shirt up every night before game day… and this was while I was in high school, college, and medical school. I now hang a Cowboys flag in front of my house. My family believes that the Cowboys will provide me with my exit from this world via stroke or heart attack over some ridiculous and unimportant play. My mom says, “they don’t pay you, so why do you care so much?” I don’t know why, but I do. She also says, “You have children now, so tone it down a little.” These are all very valid points, but the Mavericks in the playoffs… what sweet victory and revenge over the Miami Heat… The Rangers in the World Series… and on and on.

Yes, I am a very typical guy. But I have learned that things change and so did I after becoming the father of twin girls.

Ella and Emma mean more to me than anything I could have ever imagined. I also have a 2-year-old son named Jacob, and although he is a big momma’s boy, he is the most precious thing ever. So, I have toned it down a notch and have tried to keep things in perspective. I am here for them now. All the other stuff is just stuff. I may be a typical guy, but now I am a typical guy who helps his girls weed through the Barbie Dolls at Toys R Us. I help my girls pick out their clothes on occasion, and allow them to tell me what I should wear. They are five years old now and have had a better sense of style than I do… and they are not afraid to tell me either. I know all about hair conditioner, detangler, and how to brush their hair. I paint toenails and fingernails… And yes, daddy puts on two coats and puts on a coat of sparkles. One day, I had done a C-section, a hysterectomy, and then a mini mani/pedi… the latter the hardest by far. I posted this to Facebook with a picture of Ella’s toes. I got the most responses on this post than any other. Yes, I have changed and now I am more complete.

So, I have learned that life changes and you have to adapt and change for the good of those who depend on you, and those little angels do more for you than you can ever do for them. I never understood how my parents felt, but now I do. Your children need and want you to do these things with them, and as trivial as a mini mani/pedi may seem at the time… it’s not. They need you and you need them. It’s wonderful.

So, I – an avid sports fan, an OB/GYN, a typical guy – had twin girls and changed. Three years later I had a little boy and continued to change. All this being said… the first phrase I taught my girls to say at one year old… you guessed it, “Go Cowboys!! Touchdown!”… and Jacob… he also knows who to cheer for, “Touchdown Cowboys!!”

Health 2.0: Can you have a doctor visit on Facebook?

The world of online health communities is morphing and evolving even as we sit here at our keyboards and google “flu symptoms” then tweet that we’ve got a cold. So what IS emerging from the cutting edge of online health communities? How do they differ and what do they have in common? The Health 2.0 conference presented an impressive array of new online breakout health community models. You can get the run-down on them all here. Check it out:

In Irving, Texas, Dr. Jeff Livingston is an Ob-Gyn who has been using MySpace to connect with pregnant teen patients. Now he has a Facebook HIPPA-compliant portal on a page for MacArthur Ob-Gyn. His practice is reaching patients through a variety of multi-media approaches. Patients can talk to him through Facebook. While his patients wait for their exam, they can watch educational videos. So what do his patients think of this? His teen patients say “how are you going to ignore a message, when you see it on Twitter, and on Facebook. This gives you a better way to connect with your doctor, rather than when you just see him face-to-face.” Read more »