Meaningful Uses For More Than 140.

Mistaken Million

23 Jan 2014

The right wisdom can change lives and shift entire industries. We’re in the midst of a fragile healthcare transition where reimbursement models and capacity to treat patients are being stressed. The consensus is that the front lines of our healthcare system, primary & family care physicians, are being stretched thin.

Even with the day to day long hours, shrinking reimbursements and for some the debt load from years of medical school, those that stay on consider primary care a calling. Or at the very least a noble pursuit that can earn financial stability.

It’s the notion that hard work can reward you in a career that provides a stable livelihood that generations of students aspire to become. It’s the bedrock of modern medicine. Given all the obstacles, is it a wise choice to become a doctor?

Open season on doctors

A recent1 CBS MarketWatch article argues it’s a mistake at the loss of $1 million dollars per physician.

How does the media get to jump to such conclusions? What’s behind this Dr. bashing agenda? Media outlets try and change our perceptions in the pursuit of page views. We’ve seen it before. The more controversial, the more clicks, the more advertisers benefit.

The article was shared on Facebook over 10K times and a few hundred tweets. Several physicians however did raise concerns about the article:

 

Click bait in action

The Headline

Let’s begin with the $1 million claim. The author Kathy Kristof a financial journalist, takes a $185K medical school debt and then amortizes it over 30 years to where it would balloon to $420K. What doctor takes 30 years to pay off medical school? With that logic, by the time of close to retirement age the debt would still be outstanding. I get that the headline is meant to grab the reader, but it’s just plain misleading to onlookers that don’t get past the 6th paragraph.

The reader is left pondering with how the remaining half million becomes personal debt. It’s implied that by comparing other specialities to primary care, the superficial tone is one of ‘you made the wrong decision because some other surgeon is happier and richer than you are.’ Untangible opportunity cost in economists lingo.

The Report

The article points to a NerdWallet report that links to an anti-Obamacare article.2 Political affiliations aside, the survey is detailed with salary breakdowns and citations. I’ll let you be the judge on whether the physician shortage is Obama’s fault or a decades long focus on procedures versus outcomes.

The Embedded Video

Again, more click bait. The video is actually about patient engagement and has nothing to support the argument that choosing a doctorate in medicine is a financial pitfall as Kristof purports.

The Comments

I respect news sites that continue the conversation with their readers. Where every once in a while the author responds to questions or comments from its readership. This CBS article is crickets. Are they really interested in lively discourse or eyeballs to appease advertisers?

There are real consequences to chipping away at intelectual pursuits from the pulpit of the media. Like doubt and unrest from medical students like this one from the article’s comment section:

HELLOJESS22 January 19, 2014 11:11AM As a current med student, this scares me by how accurate it is. After spending two years being stuck in a classroom, I was so excited to get into a hospital.

What if this line of thinking trickles down to parents that hesitate to send their kids to medical school? The primary care shortage gets worse. Specialists that rely on primary care for referrals are affected as well. And patients wait longer due to scarcity of resources.

Wise choices

The only way to combat negative media is to reframe the conversation. To reiterate why doctors really get into medicine:

And further, Dr. Smith sums it up like a financial journalist should have:

For physicians, the article does attempt to give a heads-up and get a rough feel for the lay of the land, even if it’s on an economic comparison basis of the disgruntled. But debt is just a milestone to overcome, not an end all. A bean counter isn’t worth a bean if they can’t help find a way out of that debt. It’s all in the outlook you plan to take and the wisdom you gain.


  1. This CBS article is a rerun (pun intended) and was originally posted September 10, 2013

  2. The survey’s link in the article is broken and after some serching I found it. I haven’t gotten a response from the author yet.

Engaged Invention

19 Jan 2014

Great post by @om, editor-in-chief of GigaOm on Google’s newest endeavor, contact lenses embedded with sensors to measure glucose in tears. Om points to research that contact lenses can cause complications for diabetic patients. He’d rather see something non-invasive.

The response to the lenses I thought was appropriate and had weight as he’s a person with diabetes (PWD).1 I’ve followed his writings for years and never knew.

His main argument spoke to the tech crowd at large but I thought was right to the point of what healthcare IT is trying to go through:

But after the initial excitement was over, cold reality set in. It also prompted me to ask the question: why is it that a company with such good intentions fails to ask itself very basic of questions, something a normal human being would ponder before embarking on a scientific quest?

Then some PWD e-Patients weighed in as well.

Developing anything for someone else’s medical condition is incredibly rewarding but at the same time you’re gripped with the sense that you will never really understand what they have. And that the closest experience to getting it is just plain listening and observing in the utmost awe of what he/she goes through, every hour.

It’s unfair to completely dismiss what Google wants done. It’s touched a chord with those that need an easier way to get through life. But the counterpoint is that Google does so much, with a high degree of turnover, that it gets viewed as tech for tech’s sake.

Whether software or hardware, we still do not have a development methodology that takes into account healthcare social media as part of the development cycle. Healthcare ‘requirements gathering’ for me is to keep listening through the use of the best free, widely adopted, tool we have today: social media.

We ask that a company the size and scope of Google adhere to the principles of real patient engagement. They can set the tone for a new era of engaged invention.


  1. I first learned of the terms PWD and PWOD (persons without diabetes) from following the weekly diabetes #dsma twitter chats. I’d like to think it could also apply to Persons With Diseases/Disabilities.

More Than 140

15 Jan 2014

So we’re into the 3rd week of 2014 at about the time when one begins to doubt their new year resolutions. For me starting a resolution on the 1st of the new year never does form a lasting change. The 1st is when I just begin to think, “OK, so what can we make better this go around?” Those who’ve followed me know that sometime back, I actually use to blog posts on this site. I fell short of making it a habit to write, not because I didn’t have anything to say. Rather, that my conscious energy was spent on twitter. Blogging began to be something that competed for my attention span and so I relegated to living in 140 character limited thought patterns.

So this year my resolution is to get back into long(er) form writing again. But this time, rather than fight the 140 road block, I wanted to find ways to express ideas more intuitively by complimenting twitter. To let twitter drive the thought first and then expand on them here rather than start with an empty canvas.

This past year the big trend for posts was the use of twitter embeds as a way to support a position or cover trending ‘news’.

What I want to attempt this year is use twitter embeds for more than news. Embed to further explain the excetera. To write beyond the 140 character limit.1

Traveling Light

Looking back, I also thought the idea of blogging using a bloated CMS was just overkill. Having to manage a dashboard, run backups, rely on a database, just to get an idea published just dragged the process away from creative expression.

What got me onto Twitter was the relative ease of expressing ideas and opinions. I find todays blog platforms too bloated for personal use. Baggage for baggage sake when it comes to personal blog sites.

To try something new this year and more lightweight, I’m using Github Jekyll to host this website. Posts are text files you upload to github’s repository rather than using a database. For developers it’s now the norm to store code this way but I’m trying this out for the first time myself as a writing tool. It’s both refreshing in its simplicity but takes some getting use to. Here’s hoping there’s more to come on my use of Jekyll.

UPDATE After realising Twitter formated embeds were too visually loud and took up too much space, I’ve switched off Twitter’s native formatting for my own attribution format.

  1. Yes Twit Longer type of services are out there but I find they’re a browser page to a dead end as far as expanding on ideas goes.