It’s quick, it’s easy and we’ve all done it. Don’t blush, whether it’s at our leisure or behind the consultant’s back we can confess to having used the world’s sixth most popular website. You might have seen it, sitting pride of place on the podium of practically any Google result page. Of course, it’s the tell tale sign of one of Web 2.0’s speediest and most successful offspring, Wikipedia.
Now for fear of patronizing a generation who have sucked on the teat of this resource since its fledgling years, the formalities will remain delightfully short. Wikipedia is the free, multilingual, online encyclopedia, which harnesses the collective intelligence of the world’s internet users to produce a collaboratively written and openly modifiable body of knowledge. The technology it runs on is a highly flexible web application called wiki. It is open-source software; hence the explosion of wiki sites all united under the banner of combined authorship. Anyone with internet access can edit the content and do so with relative anonymity. It would be unthinkable that a source, which does not prioritize the fidelity of its content, could possibly play a role in medical education. How ironic it seems that medical students can waste hours pondering which textbook to swear their allegiance for the forthcoming rotation, yet not spare a second thought typing their next medical query into Wikipedia. Evidently it has carved itself a niche and not just among medical students, but healthcare professionals as well. According to a small qualitative study published in the International Journal of Medical Informatics, 70% of their sample, which comprised of graduates from London medical schools currently at FY2 and ST1 level, used Wikipedia in a given week for ‘clinical purposes’. These ranged from general background reading to double checking a differential and looking up medications.
We are so ensnared by the allure of instantaneous enlightenment; it’s somewhat comparable to relieving an itch. "Just Google it..." is common parlance. We need that quick fix. When the consultant asks about his or her favourite eponymous syndrome or you’re a little short on ammunition before a tutorial, the breadth and ease-of-use offered by a service accessible from our phones is a clandestine escape.
The concept of Wikipedia, the idea that its articles are in a way living bodies because of the continual editing process, is its strength. Conversely textbooks are to a degree outmoded by the time they reach their publication date. While I commend the contributors of Wikipedia for at least trying to bolster their pages with references to high impact journals, it does not soften the fact that the authorship is unverifiable. Visitors, lay people, registered members under some less than flattering pseudonyms such as Epicgenius and Mean as custard, don’t impart the sense of credibility students (or for that matter patients)expect from an encyclopedia. Since the prestige of direct authorship if off the cards, it does beg the question of what is their motivation and I’m afraid ‘the pursuit of knowledge and improving humanity’s lot' is the quaint response. There is a distinct lack of transparency. It has become a playground where a contributor can impress his/her particular theory regarding a controversial subject unchallenged. Considering there is no direct ownership of the article, who then has the authority to curate the multiple theories on offer and portray a balanced view? Does an edit war ensue? It is not unheard of for drug representatives to tailor articles detailing their product and erase the less pleasant side-effects. Obviously Wikipedia is not unguarded, defences are in place and there is such a thing as quality control. Recent changes will come under the scrutiny of more established editors, pages that are particularly prone to vandalism are vetted and there are a special breed of editors called administrators, who uphold a custodial post, blocking and banishing rebellious editors. A study featured in the First Monday journal put Wikipedia to the test by deliberately slipping minor errors into the entries of past philosophers. Within 48 hours half of these errors had been addressed. Evidently, the service has the potential to improve over time; provided there is a pool of committed and qualified editors.
Wikiproject Medicine is such a group of trusted editors composed primarily of doctors, medical students, nurses, clinical scientists and patients. Since 2004, its two hundred or so participants have graded an excess of 25,000 health-related articles according to quality parameters not dissimilar to peer review. However, the vast majority of articles are in a state of intermediate quality, somewhere between a stub and featured article. Having some degree of professional input towards a service as far reaching as Wikipedia will no doubt have an impact on global health, particularly in developing countries where internet access is considered a luxury.
March this year saw the medical pages of the English Wikipedia reach a lofty 249,386,264 hits. Its ubiquity is enviable; it maintains a commanding lead over competing medical websites. The accessibility of this information has catapulted Wikipedia far beyond its scope as a humble encyclopedia and into a medical resource. Patients arrive to clinics armed with the printouts. As future doctors we will have to be just that one step ahead, to recognise the limitations of a source that does not put a premium on provenance but is nevertheless the current public health tool of choice.
Illustrator Edward Wong
This blog post is a reproduction of an article published in the Medical Student Newspaper, November 2013 issue.
Hey guys! I’m Nicole and I’m a second year medical student at Glasgow University. I’ve decided to start this blog to write about my experiences as a med student and the difficulties I encounter along the way, hopefully giving you something you can relate to.
Since June of last year I have been suffering with a personal illness, with symptoms of persistent nausea, gastric pain and lethargy. At first I thought it was just a bug that would pass on fairly quickly, but as the summer months went on it was clear that this illness wasn’t going to disappear overnight.
I spent my summer going through a copious amount of medications in hope that I’d feel better for term starting. I visited my GP several times and had bloods taken regularly. After 2 months, I finally got given a diagnosis; I had a helicobacter pylori infection. I started eradication therapy for a week and although it made my symptoms worse, I was positive would make me better and I’d be well again within the week.
The week passed with no improvements in my condition. Frustrated, I went back to my GP who referred me for an endoscopy. Term started back the next week and despite feeling miserable I managed to drag myself out to every lecture, tutorial and lab. Within a few weeks I began to fall behind in my work, doing the bare minimum required to get through. Getting up each morning was a struggle and forcing myself to sit in lectures despite the severe nausea I was experiencing was becoming a bigger challenge each day.
In October I went for my endoscopy which, for those of you that don't know, is a horribly uncomfortable procedure. My family and friends assured me that this would be the final stage and I’d be better very very soon. The results came back and my GP gave me a different PPI in hope that it would fix everything.
I waited a few weeks and struggled through uni constantly hoping that everything would magically get better. I gave up almost all my extra-circular activities which for me, the extrovert I am, was possibly the hardest part of it all. I wanted to stay in bed all the time and I become more miserable every day. I was stressing about falling behind in uni and tensions began to build up in my personal life. It got to the point where I couldn’t eat a meal without it coming back up causing me to lose a substantial amount of weight. I got so stressed that I had to leave an exam to throw up. I was truly miserable.
I seen a consultant just before Christmas who scheduled me in for some scans, but it wasn’t until January. I was frustrated at how long this was going on for and I thought it was about time I told the medical school about my situation. They were very understanding and I was slightly surprised at just how supportive they were. I contacted my head of year who arranged a visit with me for January.
During the Christmas break I had a chance to relax and forget about everything that was stressing me. I got put on a stronger anti-sickness medication which, surprisingly, seemed to work. The tensions in my life that had built up in the last few months seemed to resolve themselves and I began to feel a lot more positive!
I met with my head of year just last week who was encouraged by my newly found positive behaviour. We’ve agreed to see how things progress over the next few months, but things are looking a lot brighter than before. I’ve taken on a new attitude and I’m determined to work my hardest to get through this year. I’m currently undertaking an SSC so I have lots of free time to catch up on work I missed during the last term.
My head of year has assured me that situations like the one I’m in happen all the time and I’m definitely not alone. I feel better knowing that the medical school are behind me and are willing to help and support me through this time.
The most important thing I have taken from this experience is the fact that you’ll never know the full extent of what a patient is going through. Illness effects different people in different ways and it may not just be a persons health thats affected, it can affect all aspects of their life. This experience has definitely opened my eyes up and hopefully I’ll be able to understand patients’ situations a little better.
A doctor is nothing without patients. But, unless they make themselves known in the community, and make themselves available, they are not going to be able to attract a lot of patients. One of the most important thing for many people is that doctors have convenient hours. This is no longer a nine to five world, and people often need to have appointments that will fit in with their schedules. One way that doctors can gain a good reputation in the community and increase their caseloads is to be accessible. This means offering things like early or late hours. When doctors increase their availability, it means fewer trips to the emergency room for patients when they need to see doctors after hours.
In addition to having better hours, there are other ways that doctors can attract new patients. These include:
Electronic Health Records
One of the things people hate the most about visiting a medical office is having to fill out a bunch of forms each time they visit. When you have electronic health records, they will only have to fill out one form. All of their information will be recorded and easy to access, so you will always have the information you need, when you need it. You can even use the system to send out prescriptions to pharmacies.
Better Telephone Hours
Many people don’t have time to call for a medical appointment when they are working, and prefer to call during their lunch hour or even after work. If your office closes for lunch, you are going to miss getting calls from patients who need to call at this time. Have a member of your staff on hand to answer the phones during the lunch hour. That way, patients will be able to get through, and you won’t be missing any calls. If there is no one to answer the phone, most people are likely to call another doctor, and will never call you back again. You may also want to consider extending your telephone hours, so patients can call after 5 pm.
You need to get your name out there, and one way to do it is to be up front with pricing. Often, patients will want to know what procedures cost before having them done. You can use Yempl.com to inform potential patients about your rates. They compare your information to that of other doctors in order to make the best decisions.
No matter how organized your office is, there are still bound to be patients waiting in the office for appointments. They are not getting anything done while they are just sitting around, but they can be more productive when they are able to connect to the Internet. You can provide free Wi-Fi services so your patients can use their mobile devices to connect to the Internet and check emails, shop, chat with friends, get work done, and more. With so many people carrying mobile devices these days, it makes little sense not to offer this service.
Create a Web Portal
When you have a web portal that is easy to use, patients can schedule appointments, reschedule appointments, access and print out forms before their visits, and more. You can use the portal to easily update things like contact, insurance, and personal information about your patients. This is a great way for patients to be able to make payments, get prescription refills, get results from tests, and get messages from doctors to avoid missed phone calls. Be sure to include a smartphone app so patients can contact you from anywhere.
Image Source: Seaside Medical Practice
I was approached by Meducation to become a resident blogger, and was initially surprised by the invitation as - I must explain upfront - I am not a clinician of any type! I'm one of those project managers. So when considering where to begin to write my first blog post I decided to focus on the use of technology in medical education.
Then when I began writing my first post I was reminded of the complexities of such a topic! And I realised that this is not something that can be covered in one post.
So this is where I thought I would start:
Technology is changing our lives at an ever increasing rate, and it is influencing the way we do a range of tasks from the use of technology in the hospital to the use of technology in education, notwithstanding all other aspects of our lives and the way we communicate. We are educating children in schools at the moment who will have careers and jobs that don't even exist at the moment, the rate of change is exponential. But with this consistent churn of information, communication and technological developments, how do you keep up? Where do you start? As a teacher, as a learner.
I wanted to concentrate this post on considering some of the challenges which can be encountered when working in medical education. One of the pivotal issues is probably resistance. Resistance has a negative connotation and I use it cautiously. Resistance can be in many forms and can arise for a number of reasons.
Technology brings about change, and inherently change can make people nervous. And with change you often encounter resistance; resistance to change, resistance to adapt, resistance to engage - the fear of the unknown. With an ever evolving world, where technology is infiltrating the way we live, work and learn, it is natural that this will influence the way we deliver education, including medical education.
Technology is so fast moving it can considerable time to become familiar with new mediums of developing educational resources, by which time often new iterations and new technologies have arrived.
However, for those providing subject matter expertise for educational resources it is essential that they under the medium through this will be delivered. And for learners, which we all are, it is important to understand how you learn and how technology can help you do this.
With the changes to the NHS and developments in education technology do people find some comfort in being able to both deliver and receive education in a traditional manner?
This poses a unique and very interesting challenge to answer for those involved in medical education, in trying to meet the demands of those seeking information and education in new and interesting ways with those who enjoy traditional classroom based education - all from both the point of view of the 'teacher' and the 'learner'.
How to we satisfy the appetite of those seeking cutting edge education with the demand for traditional classroom learning? Is it possible to meet the needs of all?