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The President & Choosing Wisely

Are the physicians for former President George W Bush - are they Choosing Wisely? The debate for unnecessary testing and treatment was sparked again this week with the announcement of the former President receiving a cardiac stent procedure following a routine physical.

The Choosing Wisely campaign is an effort to decrease unnecessary testing and treatment which is driving up the cost of health care in the United States. In a previous post, I wrote about five reasons why I think this campaign will not succeed.

Some have said that the only way a cardiac stent was placed (possibly) was because of cardiac/heart testing during the routine physical. Should routine heart testing be done in patients without symptoms? Choosing Wisely says no...

  • Do not order annual electrocardiograms (EKGs) or any other cardiac screening for low-risk patients without symptoms (American Academy of Family Physicians)
  • Don't perform annual stress cardiac imaging or advanced non-invasive imaging as part of routine follow-up in asymptomatic patients (American College of Cardiology)
  • Don't perform stenting of non-culprit lesions during percutaneous coronary intervention (PCI) for uncomplicated hemodynamically stable ST-segment elevation myocardial infarction (there wasn't even a heart attack here, yet a stent was placed)

Editorials from CBS News, to the Boston Herald, to Bloomberg,com - all these have criticized the physicians of the former President for this course of action. On the other hand, I have had many of my patients this week ask me about heart disease in a healthy 67 year old male who, just a couple of months ago, rode 100k on a bike with injured veterans.

Just like Angelina Jolie's story about cancer risk and cancer markers gave me the opportunity to talk about breast cancer with my patients, this news story has definitely given me the opportunity to talk about heart disease with my patients. The cost debate will continue, but the care debate with patients is always a good one to have...

 

Ariel Castro: Mind Of A Monster

Last week, Ariel Castro was sentenced to life without parole plus 1000 years in prison. Cleveland is about an hour from where I live, and there have been a lot of people following this story, including me, for the past few months.

I was in my car, driving around, last week right before the sentencing when I heard the above statement from Castro. I just could not believe it. It was fascinating and scary at the same time. 

"Most of the sex that went on in the house, practically all of it, was consensual.... There were even times when they would ask me for sex...." 

When I heard that live, I almost stopped the car. How horrific. Blaming the victims? Really? This two minute clip sent chills up my spine. I can't even imagine 10 years of this type of thinking. 

If you haven't already, check out the entire statement. I know that it's on youtube somewhere. This clip is a great insight into the mind of a monster. I know that there is a lot of guilt in that Cleveland Seymore Avenue neighborhood where that house will be torn down. Hopefully, we can all learn from this: If you see something, say something...

My Childfree Life

I was struck by the cover of this week's Time Magazine and the title "The Childfree Life." I do not really make a big deal about it publicly , but my wife and I have been married for about 15 years and we have no children, by choice.

I will not go into detail about why we made the decision. But, I am proud to say that we talked about it for a long time, and we have our reasons why we made the decision. For those of you who have children, can you articulate the reasons why - or is it because that is what society expects? Did you really make the decision together with your partner to have children? Think about it. 

Something curious about the article is that there are almost exclusively opinions from and about women. Is there that much of a "cultural imperative" (as the article says) to be a mother, while males are given a pass even if they become a "first time father at 65." That is interesting to me.

I am not complaining, but just some observations from the past few years. Yes, I have been called "selfish" by some people.  People ask me what it is like being "childless." People say it is "not natural" because society and most religions demand offspring, if for anything else, the perpetuation of the species. I understand and appreciate all those points of view. 

I am always fascinated by media reaction to stories like this. If you want to read more, just a simple search finds a number of interesting op-eds from the LA Times, HuffPo, The Week, Daily Mail, and US News & World Report.

So, I will never mention this topic again. Just thought I would talk about it once since it was sparked by this week's Time Magazine cover. As the article says, "To make this choice, you really have to be able to manage and navigate all assumptions that are going to be made about you. You have to be able to challenge the status quo." 

 

 

#AAFPNC 2013 Attendance Record: So What?

Last week was the 40th anniversary of The National Conference of Family Medicine Residents and Medical Students by the American Academy of Family Physicians. Kudos to AAFP for grouping the twitter feeds in Day One, Day Two, and Day Three. The facebook account was also active. They also did well expanding into instagram photos and videos. They even had an app for the meeting!

You'll see from the tweet above that there was record student meeting attendance this year. Three months ago, there was record attendance at the AAFP National Conference of Special Constituencies (another advocacy and leadership meeting). In addition, the Academy enjoyed membership greater than 110,000 as of Spring 2013.

All of these numbers make the Family Medicine community feel pretty good. I have two words to say to this: SO WHAT? Does it mean our work is done? Does it mean it's time to take a break? I don't think so. For me, this is just a start. If I may be so bold, I'd like to offer this free advice to my friends all over the Family Medicine community:

  • AAFP FMIG Network needs to crank it up a notch: How is the AAFP going to establish relationships and follow-up with the record 1017 student attendance to the meeting? A key difference between when I was a student and how is social media. Social media is a tremendous opportunity for the national organization to keep in touch with the grassroots medical student organizations through facebook, twitter, instagram, webinars, and other platforms. Don't lose the momentum that was started last week. Congratulations to all those newly elected national student leaders! But now, your first test in leadership is to establish relationships with your grassroots constituents and to bring the energy and excitement from The National Conference to the local medical student campuses.
  • State Chapters need to tap into resident members from meeting: State level chapters are struggling to gain and maintain new members. What a tremendous opportunity for the state chapters to try to establish and maintain relationships with their Family Medicine Resident members. Residents have distinctly different needs than students. And, I think, that state level chapters are in a position to do some outreach with potential future state leaders.
  • It's all about the Family Medicine Match: To those outside the Family Medicine community, the only statistic that matters is on Match Day 2014. Can the Family Medicine community convert record attendance at this year's leadership meetings into Match Day success? Well, we have 228 days to work our hardest to make that happen. 

I don't pretend to know it all, and I don't pretend to have all the answers. What I do know is that I've been around Family Medicine leadership and Family Medicine advocacy for a number of years. I graduated medical school when Family Medicine's numbers were better. I've also seen when match numbers slid, and I am hopeful with the numbers over the past couple of years. 

If there is one thing that I have repeated over and over and over again, it is this question: How do you convert emotion into action? Those medical students last week see that Family Medicine is the future. The community needs to step up, reach out, and cultivate this energy. Is the Family Medicine Revolution up to the task? Show me, show yourselves, and most importantly, show those students and residents.... 

 

#AAFP2013 Show Wrap-up

What a show we had last night! Thanks go out to our pal Dr. Kim Yu who really did a great job getting people to talk with me at The National Conference on Mike Sevilla Radio Show Episode 312. You'll see in the video above that she opened the show and she closed the show with her perspective as a first time attendee to The National Conference. 

During the course of this action packed 90 minute show, I interviewed A LOT of people including AAFP President Dr. Jeff Cain; AAFP President-Elect Dr. Reid Blackwelder; and AAFP Board Members Bob Wergin, Sarah Marks, and Aaron Meyer. All in all, I did just over a dozen interviews in that time span. Now, I had no idea who was coming on the line - so I improvised the whole thing. Hopefully, it's interesting to all of you out there. Was a really fun challenge for me!

Interviews during Mike Sevilla Radio Show Episode 312: 

Kim Yu opens the show - 11:20 (11 minutes, 20 seconds into the show)

Reid Blackwelder - 14:30; including talking why National Conference is important

Sarah Marks  - 19:14

Margarette Shegog  - 22:10

Bob Wergin - 26:21; including talking Congress of Delegates

Aaron Meyer - 33:34; including talking Family Medicine Congressional Conference

Molly & Jeremy from Nevada - 41:49

Greg Lewis - 48:21

Kevin Bernstein - 51:18; including talking AAFP Foundation

Melody Jordahl - Iafrato - 1:00:00

Andrew Lutzkanin - 1:04:44

Jeff Cain - 1:16:01; including talking about FamMedPac

Kim Yu closes the show - 1:22:34; including talking NCSC

You can listen to the entire audio podcast in the player above or below. You can also download the audio podcast here and listen anytime. I also encourage you to subscribe to the podcast, subscribe to the blog, follow me on twitter, follow me on facebook, check out my linked-in page, and view my youtube page. Enjoy!

Live from #AAFPNC 2013

One of the things I love about the internet is that it appears that I am at every meeting in person, but I'm not - HA! So, no, I am not attending The National Conference in person this year, but it will appear I am.

Today at 5pm Central Time/6pm Eastern TIme, the Mike Sevilla Radio Show Episode 312 will be broadcasting live from the 2013 National Conference. Yes, I will have a special correspondent calling into the show LIVE from the exhibit floor at the Expo Hall Grand Opening. Hope you can join me for the live show!

In the video above, you see I tried to pull the same trick at the 2010 meeting. It was actually kind of funny, because I had people running all around the exhibit hall and randomly interviewing people. Good stuff. You can listen to the entire audio podcast from that day below.

From a social media standpoint, I'm impressed with what the AAFP team is doing and is attempting. Sure, there is the #AAFPNC twitter hashtag and updates to facebook. This year, they are also trying to create some buzz using vine and instagram pics & video. Kudos to them, and I encourage you to take part and contribute to the conversation! All the best to those attending National Conference this year. Have a great meeting!

Family Medicine Conference Memories

Right now from all across the country, medical students and family medicine residents are making their way to Kansas City for The National Conference. Always an exciting time since it is the beginning of the academic year where students and residents take their next step in training.

Back in medical school (has it been 20 years already), this meeting was my first exposure to the Fundamentals of Family Medicine where "a family physician offers continuing, comprehensive, compassionate, and personal health care in the context of family and community." Through this conference, I fell in love with my specialty.

This meeting also helped me develop My Advocacy Voice through leadership opportunities at the conference. I wrote my first campaign speech there. I ran for my first national office there. I learned (the pain) of parliamentary procedure there. My social media advocacy work today can be traced all the way back to this annual summer event in Kansas City.

Now that I have mentioned Social Media Advocacy, this is my periodic plea to the Family Medicine community (affectionally knows as Family Medicine Revolution or #FMRevolution on twitter), that these four days are an opportunity to showcase Family Medicine all over social media - whether it be tweets, facebook updates, blog posts, or whatever. Please, please, please, please - take this opportunity to share why you love Family Medicine and why everyone from medical students, to the general public, to law makers - why they should pay attention to Family Medicine and why it's important. There. I've said my peace. Let's move on... 

I'm also excited to announce that the Mike Sevilla Radio Program will be broadcast live during the Opening Party on Thursday, August 1, 2013 at 6pm Eastern Time. There will be a reporter LIVE from the exhibit floor to give an update on what is going on. How exciting is that? Track the conference on twitter with the #AAFPNC hashtag and on facebook.

Finally, from the way back machine, is the video above where I gave a 2010 blog update from the meeting (as Doctor Anonymous). At the end of the video, I made the "big" reveal and showed my real name for the first time to my audience. The National Conference has special meaning to me, because it has made me into the Family Physician and Social Media Activist that I am today.

Culture Of Permission

Last week, there was this interesting video conference talking about this fall's Medicine X Conference. Our pals @Doctor_V and @SeattleMamaDoc were on the google hangout talking about physicians and social media. They were also talking about their upcoming session at MedX. The hangout was moderated by our friend @afternoonnapper.

Why don't more physicians participate in social media? The obvious topics of (lack of) time and (the fear of) risk were mentioned. But, another topic that was mentioned was a "Culture of Permission" mentioned by @Doctor_V.

What is this culture of permission? I get this question all the time as well: "Hey Mike, who did you ask before you started utilizing social media?" Did I as my practice, my hospital, my malpractice attorney, or my wife? Actually, I did not. But, he's right in that there is this culture that exists that physicians must ask permission before doing something "risky" like use social media. 

People focus too much on the bad and potentially bad stuff that can happen with social media. Of course they are out there. However, there are positive aspects to social media as well - like patient education (meaning patient education with right information and not wrong information), establishing a positive online presence for physicians, and utilizing social media for advocacy.

Unfortunately, I will be unable to attend Medicine X this year. But, I will continue to monitor their brilliant marketing of this meeting, as I anticipate more of these google hangout sessions leading up to the fall event. Many say MedX is one of the best meetings of the year to attend. I would agree with that! 

Who Inspires You?

With everything going on in the news, I've been asking myself "Who Inspires Me" these days? When I was growing up in Northeastern Ohio, I was like other kids and inspired my sports figures and people I saw in the movies.

As I get older, I'm finding out that the people we hold on high pedestals are flawed just like us. The higher regard we hold these people, the more disappointment that occurs when we learn that they are just as human as we are.

Inspiration comes from within, and the best thing that we can do is look in the mirror. Even though we may not like what we see, the only thing we can do is improve ourselves, and draw strength from within. 

I talk about this more in Episode 311 of the Mike Sevilla Radio Program. You can view the video above. You can listen above or below, and also download the entire episode right here. Subscribe to the podcast here. 

If you like what you read and hear, I encourage you to subscribe to the blog right here. Also follow me on twitter and Facebook. Also check me out on Linked-In and YouTube. Enjoy! 

Primary Care Progress Interview

Thanks again to Primary Care Progress for the opportunity to be on their webinar last week talking about Health Care Social Media (#HCSM). You can watch the webinar above, and there is also just the audio portion of the webinar in the player above and below. I have also made available the audio portion for download and you can download the audio file here. 

To make it easier for you to navigate this hour long session, I have the following show notes below with time stamps (FYI, the time stamps are for the audio file only and NOT for the youtube video above).

I'm glad there were so many audience questions during this session, hopefully questions that you have as well. So, feel free to click forward and click back on the timeline to the questions that you find most interesting. Enjoy!

First Days of Blogging and the Beginning of Social Media Career (4:50) 

  • Why did you decide to dive right into social media in 2006?
  • How did you find an audience? 
  • How did you know you were becoming a success in social media? 

Change from Doctor Anonymous to Family Medicine Rocks (9:40) 

  • Why did you decide to reveal more of your personality and no longer be anonymous?
  • Did you find your audience changing when you changed to Family Medicine Rocks?

My Take On Current Social Media Landscape (12:15)

  • What's most exciting about social media these days?
  • Why do you invest so much time in social media? 
  • What do you tell newcomers (especially medical students and trainees) about social media on how to get started?

Social Media Break and Return (16:50) 

  • What actually discouraged you from continuing in social media?
  • Has social media changed since you started? 
  • What are the lessons you learned when you were off? 
  • How does someone achieve transparency and authenticity in social media? 
  • Why do you think medical students and other trainees should formally learn social media during their training? 
  • Why can't physicians and clinicians ignore social media? 

Questions From The Audience

  • 29:00 - What advice do you have for separate personal and professional social media accounts?
  • 31:05 - What social media resources do you recommend for patient education? 
  • 33:05 - Who are your "go to" people in health care social media? 
  • 35:42 - What is your favorite social media platform to experience audience connection? 
  • 37:25 - What is your reaction to Jenny McCarthy being named as new co-host on The View? 
  • 42:06 - What are your most effective methods to make sure you get your message out there (especially for those new to social media)?
  • 44:44 - Is there any money to be made in social media? 
  • 46:32 - Do you encourage your clinic to use social media? 
  • 47:34 - I avidly blog and tweet, should I add a facebook presence? 
  • 50:13 - What are the most common reasons why clinicians say they do not use social media? 
  • 53:00 - How can you change the negative view of social media that deans and other medical school faculty have? 
  • 56:46 - Where is the innovation in health care social media?