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.

HTA Endometrial Ablation for Menorrhagia

Endometrial Ablation may be an alternative treatment option for pre-menopausal women with menorrhagia (excessive uterine bleeding) due to benign causes, for whom childbearing is complete. Menorrhagia is frequently treated by performing a hysterectomy. The HTA® System is designed to ablate the endometrial lining of the uterus without the need for surgery.

Ask yourself the following questions:

  1. Does your period last longer than seven days?
  2. Do you use more than 3 pads or tampons per day?
  3. Do you pass clots during your periods?
  4. Does your heavy bleeding affect your work, social, athletic or sexual activities?
  5. Has medication (birth control pills) failed to help your heavy bleeding?

If you answer yes to any one of these questions, you are likely suffering from heavy menstrual bleeding or menorrhagia.

Endometrial ablation is a procedure to treat abnormal uterine bleeding. The procedure is intended to destroy all or most of the tissue that is responsible for menstrual bleeding (the endometrium). After the procedure, patients may never bleed again, or if they do, their bleeding is generally reduced. Not all patients experience a satisfactory reduction in bleeding so all treatment options should be discussed with your doctor. In general, approximately 50% of women that have the ablation have no more menstrual cycles. Of the 50% that do continue to have a cycle, most have little bleeding and are satisfied with their results. The overall satisfaction rate is approximately 95%.

What are the reasons for undergoing the procedure?

If heavy bleeding during your periods is affecting your quality of life and you believe your options are to wait until menopause or to have a hysterectomy, there may be other choices for help without major surgery.

Intended Benefits of the Hydro ThermAblator® System (HTA® System):

  • A potential alternative to hysterectomy or other major surgical procedures.
  • An outpatient procedure usually performed in the office with only local anesthesia.
  • Decreased recovery period and generally fewer significant harmful side effects.

What is the HTA® System and how does the procedure work?

The Hydro ThermAblator System (HTA System) is a device that allows your gynecologist to perform endometrial ablation on an outpatient basis. This procedure involves your doctor inserting a probe into your uterus that includes a tiny telescope for viewing the lining of the uterus. Heated saline is circulated and is intended to destroy the lining of the uterus, even in a partial septate uterus or one with intra-mural fibroids ≤ 4cm, to eliminate or reduce bleeding to normal levels or less.

First, your cervix will be slightly dilated to allow the introduction of the telescope through the vagina, through the cervix and then into the uterus. This gives your gynecologist a view of the inside of your uterus to assure proper positioning. Then, your uterus will be filled with room temperature saline solution to gently clean and flush the uterus. The fluid will be heated to 90º C(194°F) and circulated in the uterus for ten minutes in order to treat the endometrium (lining of the uterus).

When the treatment is complete, the uterus will be flushed with room temperature saline to cool the uterus and the probe. All of the saline will be removed after the cooling phase is completed. Your uterine lining has been treated and will slough off similar to a menstrual period over the next few weeks.

Your gynecologist will do some pretreatment tests that may include a Pap smear, an ultrasound, endometrial biopsy, and/or a hysteroscopy (look inside the uterus with a tiny telescope) to see why you are having excessive menstrual bleeding.

Your physician will give you pain medication before the procedure to reduce cramping during or after the procedure. With the new technology and advancements available at MacArthur OB/GYN, most ablations are done in our office with only a local anesthesia injection.

After the procedure, you may experience some cramping that should go away by bedtime. You will probably have a pink or yellow watery discharge for a few weeks after your treatment. If you experience two days of heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours after the procedure, call your physician.

Most women should be able to return to normal daily activities the next day. You should speak with your physician about the resumption of sexual activity. You should not use tampons for up to seven days after the procedure to reduce the potential risk of infection. Your monthly menstrual bleeding may be heavy for a few months after the treatment as a part of the healing process, and should improve after a few months.

You should not have this procedure if you desire pregnancy in the future. Endometrial ablation, however, does not prevent you from becoming pregnant and such a pregnancy would be high risk for both mother and fetus. Contraception or sterilization should be used after this treatment since pregnancy can still occur. Please discuss the different options with your physician. Also, all procedures carry risk. Ablation risk factors include bleeding, infection, damage to organs (uterine perforation, etc), and are something you should also discuss with your doctor.

Winner of the 2012 MacArthur OB/GYN Scholarship

When I found out I was pregnant with my daughter, I was 16 years old and just about to begin my junior year of high school. I was afraid and anxious, but most of all worried because of my future. Junior year is the main year that many colleges looked at, primarily because of SAT’s and such. I was afraid that I wouldn’t be able to graduate due to failing grades and the six week maternity leave. I remember crying because I had put it in my head that I possibly won’t be able to attend college since all of my earnings would go towards my child and her expenses. As I attended my classes and walked through the halls at my high school, I wondered, “What’s the point of even being here and graduating if I’m just going to struggle and probably not even go to the university that I want to attend?” I agonized over the thought of dropping out, and I almost did if it wasn’t for the support of Mrs. Samantha Garza.

Mia was born in April of 2011 at the end of my junior year, and that’s when the pressure to go to college intensified. Once senior year began in August of 2011, I started noticing how all of the friends that I used to have were excited to graduate and move on with their lives. I’ve seen a lot of girls who have had children in high school graduate, but either they just settled down and had more kids after high school, or they went to college for a semester and then stopped altogether. I thought long and hard about what I wanted to do with my life and put numbers together. I didn’t want to settle for working long hours just to live from paycheck to paycheck. I didn’t want to be settling for a cramped apartment or living with my parents for the rest of my life depending on welfare to get me by. Although there are some outliers when it comes to this, statistics towards living under the poverty line with no higher education as a teen mother was chasing after me. It just wasn’t in my plans to NOT go to college. My parents never went to college; they didn’t even graduate high school. They came over to the United States to give us a better life and I was set on making them proud. Everyone expects for teen mothers to fail, and with that much negative expectation, I wanted to change the views of people.

When my family found out about my plans, there were mixed feelings about things. I had some support, but mostly I would hear, “How are you going to raise a child if you aren’t working full time” and “you can’t go to college if you have no money.” Either way, there was the issue of money always being brought up wherever I turned. I didn’t want to work full time and set aside college. The pressure was on because I honestly wasn’t going to have any financial help. My parents weren’t going to pay for me and I had no job at the moment, so I desperately searched around in hopes of finding something.

I first heard about the MacArthur OB/GYN scholarship through my high school counselor. She gave me a list of scholarships to look at on the Irving Schools Foundation website and as I was scrolling down, one specific link caught my eye. As I read the requirements for the posting of the OB/GYN clinic, I realized that I fit all of the points to be able to apply for it. I thought to myself, “Well it’s worth a shot, why not?” I went ahead, applied and anxiously waited to hear back from the board. I didn’t think that I was going to be the receiver of the award; it was my pessimistic nature to believe in such thoughts, but when I found out that I won I was so overjoyed that I think I cried a bit. NOW there was no excuse for me not to attend my first year at college. There was no excuse for me to say, “I can’t go to because I don’t have the cash for it.” I signed up for classes at my local junior college and walked into lecture hall on the first day, ecstatic because I was actually attending.

This scholarship gave me more than enough to pay for classes and books for both the first and second semester. My first year of college was paid for, and I grinned ear to ear because my education was all that I had going for me. BUT not only did this scholarship help me with school, it also gave me the last bit of cash that I needed to buy my car to be able to drive to and from work, school and the babysitter’s. It helped me to be able to work and save up so that I can pay for my next year of school without having to worry about making the deadlines for the payment plan I had originally set up. Many people don’t realize how grateful I am to the Wollenman Family and the MacArthur OB/GYN clinic for donating this money to help me. The amount might not have been much for certain people, but it was more than enough for me.

I honestly feel that this will really help many future college students a lot. The award goes out to high school students who are involved with a group having to deal with teen pregnancy issues. I personally was involved with TAPPS, the Teenage Pregnant and Parenting Students group. It was run by Ms. Garza and included all of the teen mothers on campus. In a way, we were our own support group as many of us were shunned against by our fellow peers. The people applying don’t have to be a teen parent, but raising awareness towards this is VERY important.

I don’t regret my daughter. She is the reason I decided to attend college to better myself. However having her so young, has made certain things financially, physically and emotionally difficult. So many people can benefit from this help, and it can go toward classes, books, daycare or anything else that might be needed to be able to attend school! I deserve a chance just like everyone else does; after all, what really sets me aside from any other college student other than just a few minor details?

So to everybody reading this, this scholarship helps out in a great deal of ways. Good luck to the next winner! I certainly have benefited very much. I am now currently working on my transfer basics to be able to attend TWU and reach my career plan of becoming a certified Nurse-Midwife. With the help of the Wollenman family and the staff at MacArthur OB/GYN, I’m taking the first step towards the rest of my life. What will help all of you?

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 for weight loss. I like the for my pregnant patients. I suggest the 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.

Scholarship in Memory of Dr. David Wollenman

Dr. David Wollenman was an icon for obstetrics and gynecology here in Irving, TX for over 33 years and brought over 7000 babies into this world. He brought cutting edge surgical techniques to Irving that he learned through experience and at continuing education programs. It was largely due to his influence that we have many of the continuing education goals and current practices here in Irving. He passed from this world last year in July after battling against an aggressive form of brain cancer. Because of his love for the Irving area, the medical field, continuing education and medical advancements, and just because of the person he was, MacArthur OB/GYN is honored to sponsor a scholarship in his memory.

The scholarship is awarded to an Irving ISD graduating senior with academic achievement with an emphasis in math and science and current or previous participation in a teen pregnancy program. This year, the scholarship was awarded to Elvira Mancillas of Nimitz High School.

Elvira, smiling big in the middle of the picture above, is standing here with some of the MacArthur group and Dr. Wollenman’s wife, one of his sons, and his two daughters. Elvira is more than deserving of this scholarship. She will be graduating in the top 15% of her class and plans on pursuing a career in nursing. Her goal is to become a maternity nurse. Elvira knows that goals don’t just happen, so she has a plan and is working hard to make her goal a reality. She plans on completing her prerequisites at Northlake and El-Centro before transferring to TWU to pursue her nursing degree. Elvira has taken Advanced Placement/Honors classes to help prepare for her upcoming education. She is a leader in school and has served as captain of her volleyball team. She has also been involved in track and field and in basketball. For those of you lucky enough to have known Dr. Wollenman, you know what a sports aficionado he always was… “I’m a homer,” he would always say when referencing his love for his local sports teams.

Elvira is one of eight children in her family and really understands what it means to work hard. Not only has she excelled in academics and athletics, but she has been able to hold a job in customer service relations for Pizza Hut. Having been her doctor, I can see how she’d be perfect in a job where people skills are needed. Elvira really is a people person and this will help her as a nurse. She says that perseverance is her main personal strength. I agree and think that she is just tougher than she looks. I took care of her and delivered her daughter just a little over a year ago. Elvira says that she did have to grow up quickly at age 17 when she had her baby girl. Undoubtedly she struggled, but she persevered, worked and is working hard, and has done so well for her and her daughter. I am really proud of her and was happy to hear that she was picked to receive this scholarship.

Dr. Wollenman is the reason I ended up here in Irving, so he has forever impacted my life. He was a mentor to me and to many, and I can’t say enough great things about him. I am so grateful to have known him. Also, I was fortunate to be Elvira’s doctor and deliver her baby. And I am proud of this wonderful young lady and am happy that our practice is helping her get a little closer to achieving her goals, while honoring Dr. John David Wollenman.

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 I enjoy reading the thoughts of other physicians and patients on @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.

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.