Medicine

The Experiments. Accidental MVPs | by danshil | Dec, 2021

danshil

Hey Tam,

As I wrote the last post, I realized that I have done created ‘personal MVPs’ over the years. It may be helpful to know what kind of problems I had, and what solutions I created. Here’s a short list:

Evernote Documentation

Short Problem: How do I remember all the stuff I need to remember in medicine?

Long Problem: In my first year of residency I ran into a serious wall with memory and retention. Prior to residency I was getting by on reading material over-and-over again, doing my best to retain it, and then going into a mark-less, pass-fail exam. It’s easy to remember things when you don’t have to remember things. Then, in residency, I was expected to remember things and act quickly on what I remembered. It was a huge struggle. Coupled with some newly discovered anxiety, I would frequently have memory blocks.
I ended up getting some support in improving my study habits and recollection. One of the techniques was to use study notes as a way to force myself to engage with information. I was never good with physically writing in journals (though that would have been a better solution), so I turned to note taking software. At that time Evernote was the market leader, so that’s what I defaulted to. Occasionally, I’ll see MDs use OneNote or just a set of Word documents for this same purpose. I haven’t seen anyone use Notion, but I imagine some of the baby docs might.

Solution: Use Evernote to take notes.

Outcome: I currently have about 500 Evernote documents. And while there are a small handful I’ll refer to on a regular basis, or feel I should refer to on a regular basis —mostly for procedure review, tables, lists, algorithms, and diagrams — I often find that I don’t trust what I’ve written or copied from other sources. So all of this is somewhat useful for studying, but not very useful for anything else.
Perhaps what these notes are most useful for is structuring my thoughts. I have come to view all medical information as falling into one of five structures [1].
Unfortunately, I don’t think my ability to recall things markedly improved. I still view myself as a middling physician because of this.

Additional info: There is an entire set of tools in medicine called point of care resources. UpToDate is the biggest of these and the one I see used most often. There are some Canadian resources like Centre for Effective Practice, Alberta Health Services, key guideline sites (Hypertension Canada, Diabetes Canada, etc.), article series in journals, some textbooks, etc. I use a combination of these in my day-to-day clinic life. Oftentimes, I’ll just refer directly to the source rather than my notes for the thing that I remember I can’t remember.

Google Drive Repository & Bookmarks

Short Problem: How do I collect all the documents I need to practice medicine?

Long Problem: Medicine has a lot of websites and a lot of PDFs. Sometimes I don’t need to create an Evernote document, but just need to save a copy of a PDF for use later. Maybe offline, or if I’m logging in from a computer at a different location.

Solution: Use Google Drive and create a list of bookmarks.

Outcome: Great. No complaints. I have shared my Medical Resources folder with a ‘public’ gmail account (which is just a regular gmail account that is separate from my personal or work gmail accounts) so that I can safely log into public computers. Through the public account’s bookmark bar I can access permalinks to textbooks at my academic institution. It’s all very helpful, though cumbersome.

The Whatsapp Group(s)

Short Problem: How do you message all the MDs in our region?

Long Problem: I’ll add that our region has a particularly big doctor group.

Solution: Create a Whatsapp group for all the doctors. And one for social activities. And one for picking up extra ER shifts. And one for the Jewish doctor social group featuring partners and Justin wants an invite to that one too. And one for pictures of dogs. And one for kids. And one for the outdoorsy doctor group but I’m not invited to that one. And COVID-19.

Outcome: No complaints. It’s a chaotic jumble, but most people use the main doctor group, leave groups they don’t want, or else mute conversations. Every once in a while you’ll have someone post in the wrong group, not get invited to a group they should be in, or a phone will get hacked [2]. I tried introducing everyone to Slack at the start of the pandemic when the Whatsapp group getting overwhelming (there was a day with 500+ messages). It was a brief, overbuilt, unsuccessful experiment.

Additional info: There are ‘doctor specific’ social groups. There’s nation-wide doctor groups on Facebook — some big ones are for early career, financial advice, and motherhood advice — that I am not active in. There’s #medtwitter. There are provincial forums that exist through the OMA, but I don’t know anyone who uses those. And there are a bunch of doctor specific social networking sites that I have only briefly come across and that make me feel uncomfortable — they often have a lot of pharma sponsorship.

Source: https://xkcd.com/927/

The Doctor Community Site

Short Problem: How do I create something like my Evernote, Google Docs, and bookmarks that can be distributed to all the doctors in my group?

Long problem: It is not super unusual for MDs to have a list of resources that they access, like my collections above. Another doc who does something similar was looking to create a site that our group could access to get info that was local to our region. There’re a lot of social complexities in the region that we practice in — large area, tough history, multiple quirky public-insurance programs, semi-public or band-funded initiatives that bubble up for a few months then disappear — that make it hard to practice in. Information exists in people’s heads and we share this info on the Whatsapp group. There was a question as to whether we can do something more permanent.

Solution: Create a Google Site connected to a Google Drive

Outcome: Meh. This is a great example of all the problems that one can run into in creating a medical project. The site itself is fine, though klunky and not aesthetic. It’s not used much.

Additional info: Here are some potential reasons why the site is not used

  1. Doctors are used to using the old way to get information, and this is a new way to get that information. There is not a big enough improvement in the new way to make people switch. Plus it’s another source of information on top of all the others we get (emails, Whatsapp messages, emails, EMR inbox items, emails, etc.), and none of the old ways were shut down to create a new way.
  2. Editing even simple files on a site like this requires basic technical literacy. Many doctors don’t even know how to rename files on their desktop. Try teaching someone like version control. .
  3. A project like this requires a lot of time and energy organizing information, keeping it up-to-date, etc. It needs dedicated support staff involvement, which is hard to organize. In part due to points 1 and 2, administration’s response to new information is often “I’ll just forward this to everyone by email and that’s enough”. For the rest of us, this means we’ll often hunt through our inbox for relevant emails when we remember we need them. Or else we’ll message people on Whatsapp asking if anyone remembers the zoom link we got in the email, or remember what was said during the last string of Whatsapp conversations about diabetes.

The Pediatric Dosing Calculator

Short Problem: Calculating pediatric dosages often involves referring to algorithms, tables, and doing a calculation. How can I do this in a busy clinic?

Long Problem: Let’s say a kid comes in with an ear infection, and you decide to prescribe antibiotics (which you won’t always do). In order to figure out what to prescribe you have to take the child’s age, weight (which might need to be quickly estimated), recent antibiotic exposure, and allergies into consideration, and then do a calculation and write a prescription that makes sense for the parent using a reasonable formulation of the antibiotic product. It’s a lot of repetitive, mindless tasks that, frankly, can be automated. There are pediatric dosing calculators, but they can only do the most basic of calculations.

Solution: Create a Google Sheets with all the commonly used drug dosing that I come across in family practice and urgent care.

Outcome: This is so helpful. I will use something like this pretty much every time I come across a child with an upper respiratory tract infection, urinary tract infection, pneumonia, croup, asthma, etc. I mostly use it to double check a calculation I do by hand, as I am worried I mistyped a digit or a formula (Google Sheets doesn’t have LAMBDA() functions) into the sheet.

Additional info: There is another app that is similar to this called PediSTAT that I will use in the emergency room occasionally. That app is a digital version of a Broselow Tape that is standard care in pediatric emergencies, but it doesn’t cover non-emergency medical uses. I also find my Google Sheet easier to work with for a few reasons — it allows for typing, it’s easy to reference, and it rounds drug dosages in a more practical way.
Really, this should be something that the Canadian Pediatric Society, MUMS Health, or a children’s hospital create. I have no idea why they haven’t.

A Decluttering Chrome Extension

Problem: I’m distracted a lot by unhelpful visual clutter in my web-based, ‘open source’ EMR.

Solution: Build a custom Chrome extension to remove unused, distracting visual elements.

EMR without extension
EMR with extension

Outcome: As you can see, the difference between the two versions is minimal. If I showed you a screenshot with an actual patient chart and information, though, you’d see how busy this interface becomes when it’s used in practice. Often, the information you want to see is so hidden and so poorly curated/labeled that it can compromise patient care. I wanted to build the extension to do a few more things in my EMR, but it became tricky without diving into the source-code which is a sketchy thing for an MD to do. Not to mention being far above my knowledge level in coding.

By Megan_Rexazin




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