#CPHC Twitter Chat 02/05/13 - Medical Education for Better Patient Communications - Dr.

Saif Abed

Saif_Abed My spotlight guest bio/profile for today's #CPHC Chat http://t.co/7tUzyHuy Check it out! Saif_Abed Start sending me your questions and I'll try to answer as many as I can when #CPHC chat begins! GailZahtz Love the enthusiasm!!! RT @Saif_Abed: Start sending me your questions and Ill try to answer as many as I can when #CPHC chat begins! #CPHC GailZahtz 25 minutes- background info http://t.co/AGOzCsls @sandyhubbard #CPHC GailZahtz @LungCancerFaces thanks for finding me. If u can, plz join us at #cphc today in 15 mins we discuss physician communication @terriswain GailZahtz @StorkBrian @mandibpro @hjluks You should check out #ecosys sometime- discusses education and #cphc works with group on overlap issues Saif_Abed I look forward to hearing from you all and sharing my experiences! #cphc GailZahtz #cphc please start introducing yourself 2ndActHealth RT @giasison: Taking Twitter to the Next Level in Healthcare [slideshare] https://t.co/zllaox3Y Thanks @EinsteinMed @rohal @tmlfox #CPHC ... GailZahtz Welcome all lurkers and lookers- feel free so say hi. Today is all about medical education for better communications! #CPHC Saif_Abed So hi all I'm a Dr, healthcare startup consultant & VC/M&A advisor based in Cambridge, England. #cphc GailZahtz @Saif_Abed Thank you so much for jumping in to guest when we had big questions the other night about medical training for comm #CPHC Nursefriendly Hello, Andrew Lopez, RN from New Jersey :) #cphc alexgraham186 alex graham same as @Saif_abed based at imperial, london #CPHC GailZahtz @alexgraham186 And dr Alex, you work side by side with our guest too! Look forward to watching you tag team :-) #CPHC ChronicPainGPS Hey everyone! Hope this week is treating you well so far! ;o) #cphc GailZahtz @ChronicPainGPS So great to see you! Looking forward to your input on how to have better communications between docs and pts. #CPHC ChronicPainGPS Patti here in Phoenix! Patient Advocate/Educator and Pain Ambassador for @ArizonaPain. Trying to multi-task today - wish me luck! #cphc lttlewys Hi! A little late today again #cphc LungCancerFaces Deana Hendrickson, lung cancer patient advocate, Los Angeles. First time here, so be gentle. #cphc alexgraham186 @LungCancerFaces first time for many I think! #CPHC Teaminspire Hello to Gail and the #CPHC chat, John Novack here from Inspire, the online support community for patients and caregivers.

GailZahtz @teaminspire Hi John! So glad you could join us. @saif_abed is hosting on MedEd for communications. #CPHC Docnieder Lurking in Louisville, in between patients. #cphc GailZahtz @docnieder Thanks so much for stopping by- and I hope dropping pearls of wisdom from your practice in patient communications. #CPHC ChrisCarrollMD Hello to @GailZahtz & #CPHC! Chris Carroll, MD from @ctchildrens GailZahtz @ChrisCarrollMD I knew I saw you in the stream! This is right up your alleycommunications training- please share your thoughts! #CPHC FMDChat Good afternoon to all the carpool riders! #CPHC GailZahtz @FMDChat Great to see you! welcome to the ride! #CPHC giasison Hi all Gia, physician from Manila Philippines. Hard core patient advocate,healthcare social media too! #cphc StorkBrian @GailZahtz Trying 2 follow as the clinic starts to pick up steam #cphc GailZahtz @StorkBrian Thanks for dropping in before clinic- feel free to jump in with ideas on patient communications! #CPHC Nickdawson @GailZahtz @pfanderson @drsteventucker @Steven_Paul @enspektosllc @LAlupusLady @FMDGirl @MtnMD @DrFibro @docnieder trying to lurk #CPHC GailZahtz @nickdawson Terrific to see you lurking!! We are covering medical training for patient comunications! Any 140 insight would be great. #CPHC drseisenberg Hi all! Sorry so late! Patient care! #CPHC

GailZahtz @Saif_Abed I learned from meeting you about how different health communications is in the UK- couuld you explain more #CPHC Saif_Abed Sure, well comm skills training is central to med ed here. It's taught every year in a structured way and is regularly assessed. #cphc Saif_Abed We go through many of scenarios e.g. breaking bad news, talking to distraught patients and family members etc #cphc GailZahtz @Saif_Abed I was reading about the community practice #UKCCC that oversees health comm curiculum in every medical school! #CPHC GailZahtz @Saif_Abed How do you go through the different scenarios? I know this is discussed a lot in #HPM and #EOLChat Hard conversations #CPHC Saif_Abed @GailZahtz Well, each med school tends to conform to national guidelines set by many groups eg regulators & royal colleges #cphc Saif_Abed @GailZahtz Lots of role play actually and we are viewed and observed. We then rewatch tapes and discussed how it all went. #cphc Saif_Abed I have several DVDs of me in role-play scenarios. It's odd watching yourself! #cphc charter4values @Saif_Abed @GailZahtz #CPHC Excellent! Do you use standardized patients, professional actors, other for role play? Saif_Abed @charter4values We use professional actors. #cphc alexgraham186 @Saif_Abed @charter4values also in exams we have real patients (stable ones!) #CPHC

charter4values @alexgraham186 @Saif_Abed @GailZahtz #cphc We use professional actors in many of our post grad courses - very powerful GailZahtz @charter4values Where do you use professional actors to help in post grad courses? #CPHC alexgraham186 @charter4values certainly can be, theyre very good! but will never replace an ill patient plus family etc #CPHC ChrisCarrollMD @GailZahtz @charter4values We had Alcoholics Anonymous group that sent us simulated pts in med school. Fabulous learning experience! #CPHC GailZahtz @ChrisCarrollMD I love this idea of having Alcoholics Anonymous members- couldn't other patient advocate groups HELP teaching? #CPHC ChrisCarrollMD @GailZahtz Family advocates as simulated patients would be a great idea for teaching! #CPHC GailZahtz @ChrisCarrollMD I would bet that many advocates would be willing to help with communications- if nothing else everyone has a bad story #CPHC giasison Love this! RT @ChrisCarrollMD: @GailZahtz Family advocates as simulated patients would be a great idea for teaching! #CPHC charter4values @GailZahtz @Saif_Abed #CPHC Yes! We use patient faculty in many programs. Need patients' voices and wisdom. charter4values @GailZahtz @Saif_Abed #CPHC What strategies work best for teaching these? giasison Great Q! RT @charter4values: @GailZahtz @Saif_Abed #CPHC What strategies work best for teaching these? Saif_Abed @charter4values I think the beauty of being recorded is that it lets you reflect on your experience and to accept feedback. #cphc charter4values @Saif_Abed @GailZahtz #cphc Yes. We use recorded videos for teaching med students as well. Reflect on experience. They keep own recordings. Saif_Abed I also find being examined is very effective since it incentivises you to go into hospital and be open to embracing tough situations. #cphc

GailZahtz @nursefriendly Welcome as always Andrew! Are there specific communications training for nurses in the US? #CPHC Nursefriendly Effective communications is a constantly recurring theme in nursing continuing education #cphc Nursefriendly @GailZahtz #Nursing has the most #Facetime with #patients, we hear the most complaints, are complained about most. #cphc alexgraham186 @nursefriendly too much nursing time in UK spent doing unnecessary menial tasks, less patient contact, more complaints #CPHC charter4values @Saif_Abed #cphc Welcome! Specific questions for discussion today, or do we ask ours?

Saif_Abed @charter4values Ask away! #cphc GailZahtz For anyone that is new- we encourage the audience to ask directly- so please do! #CPHC giasison Sharing the top challenges in healthcare comms I observed-social media,reporting health analytics.Innovation in getting msg thru #cphc GailZahtz @giasison Hi Gia! Do you find the Phillipines training different than the US model for communications with patients? #CPHC giasison @GailZahtz Thanks for asking that Gail.Effective communication was taught way back in med school in actual training in my case #cphc Nursefriendly Complaints, Concerns of both patients, employees are often result of poor communnication :( #cphc charter4values @nursefriendly @Saif_Abed @GailZahtz #cphc So true! In one US study, 70% of malpractice depositions was due to poor pt/dr communication. MDWebPro @nursefriendly Absolutely agree! We just wrapped up an eBook about online reviews, and most of the neg was because of communication. #CPHC GailZahtz @MDWebPro Please forward the ebook information along (later-ha!) would love to see it! #CPHC MDWebPro @GailZahtz Will do! It's in the edit and design stage now. #CPHC GailZahtz @Saif_Abed Could we duplicate recording using Healthcare social media- record scenarios with real patients and real docs? #CPHC Saif_Abed @GailZahtz It's an interesting point, I think social media is great for training but it shouldn't replace real life experiences. #cphc Saif_Abed Social media can help us to learn about ourselves and to understand different scenarios. It can let patients share their views too. #cphc

GailZahtz Wow, I am already behind 25 messages- so encourage everyone to ask AND answer!!! #CPHC Saif_Abed Communication is key. We can all learn the facts from a textbook but having a holistic approach is what good medicine is about. #cphc Saif_Abed I talk to a lot of startups and I remind them technology should facilitate the Dr-Pt relationship and that's communication. #cphc MDWebPro @Saif_Abed Tech is one of the many communication tools! #CPHC GailZahtz @MDWebPro Yes, IMO tech can step in to allow more human personal contact- not replace, expand the time of physicians and nurses #CPHC FMDChat @StorkBrian When you get a chance, check out https://t.co/2JWOCMXt. Kidneys are a first stop for FMD. #CPHC Saif_Abed I also found that training as a junior dr our seniors encouraged us to do all the explaining and communicating with pts to learn. #cphc

GailZahtz @Saif_Abed Did the seniors than provide feedback- constructive or not? #CPHC alexgraham186 @GailZahtz ill jump in, on the whole my feedback was more on the medical stuff than the comms, those guys didnt have the training #CPHC GailZahtz @alexgraham186 Thanks. Who did not have the training? #CPHC alexgraham186 @GailZahtz the older doctors had less of it than we did back in the day, so feedback sometimes was less on the comms side #CPHC GailZahtz @alexgraham186 Do you think older doctors had less desire to communicate with patients or less ability or both? #CPHC alexgraham186 @GailZahtz very variable, some were still of the paternalistic way, others had adapted. now in UK we have revalidation charter4values @alexgraham186 @GailZahtz @Saif_Abed #CPHC Older docs sometimes in position of teaching communication w/o training GailZahtz @giasison Do you find yourself teaching differently in your current position or using what you were taught or both? #CPHC Saif_Abed Also can't emphasise enough inter-disciplinary communication with nurses,physics, OTs keep for effective teamwork. #cphc Saif_Abed I always made sure med students I taught appreciated their entire ecosystem. You can't do it all yourself! #cphc giasison Agree!RT @Saif_Abed: I always made sure med students I taught appreciated their entire ecosystem. You can't do it all yourself! #cphc StorkBrian @GailZahtz Trying something new this week... Going to write some patient education blog posts and "flip the clinic" #CPHC GailZahtz @StorkBrian what do you mean flip the clinic? #CPHC StorkBrian @GailZahtz Hopefully, this flipped office model will allow me to spend more quality time with patients but time will tell #CPHC

giasison Effective communication skills including public speaking would be a great add in med curriculum #cphc Saif_Abed @giasison Completely agree something that I did a lot at school and at med school and it certainly helped my clinical practice. #cphc Saif_Abed But communication isn't just verbal it's understanding what's not said as well. #cphc charter4values @Saif_Abed @GailZahtz #cphc Yes! Using new #interprofessional (IP) competencies for teaching also --http://t.co/pyyoPBiU ChrisCarrollMD @giasison @gailzahtz Communication used to be taught be modeling good behavior, but simulated scenarios can work too! #CPHC GailZahtz @ChrisCarrollMD How did you learn to model behavior within a teaching scenario? #CPHC ChrisCarrollMD @GailZahtz By listening to outstanding communicators. #CPHC GailZahtz @ChrisCarrollMD How do you find outstanding communicators? What identifies them in your opinion? #CPHC

giasison True!MT @ChrisCarrollMD: @giasison @gailzahtz Comms used to be taught be modeling good behavior, but simulated scenarios can work too! #CPHC charter4values @giasison @ChrisCarrollMD @GailZahtz @Saif_Abed #CPHC Yes. Scenarios need to be debriefed carefully, respectfully. ChronicPainGPS @giasison: Agreed! Pub speaking is impt as many R not comfortable in front of the camera. Need 2B able to effectively communicate #cphc GailZahtz @ChronicPainGPS Do you think the same people who are good at public speaking are great at bedside communications? #CPHC ChronicPainGPS @GailZahtz: I think those who comm effectively to public (talk to the ppl) have better chance of good bedside manner; more relatable #cphc DAlawode "@giasison: Effective communication skills including public speaking would be a great add in med curriculum #cphc"Cosigned GailZahtz @DAlawode Thanks for joining! #CPHC DAlawode "@GailZahtz: @DAlawode Thanks for joining! #CPHC" the pleasure is all mine GailZahtz @DAlawode Well feel free to jump in with questions and/or answers- we don't stand on ceremony here- we are all teaching and learning #CPHC GailZahtz I see a number of patients and advocates around also- would love feedback on what helps with patient communications. #CPHC andrewspong @GailZahtz What helps w/ pt comms? Access to means of conveying insights; a belief that submissions will be listened to and acted on #CPHC GailZahtz @andrewspong Thanks for joining also from the UK Andrew! What conveys belief that there will be action? #CPHC 2ndActHealth eye contact, and taking a moment to connect all help in effective #patient communications #CPHC FMDChat @GailZahtz Ask. Listen. Or take a page from Michael Graves and actually try being a patientbecoming a pt changed his design approach. #CPHC Saif_Abed Understanding what your pts and colleagues are going through is very powerful when it comes to improving comm skills. #cphc GailZahtz @Saif_Abed How can physicians better understand what patients are going through? #CPHC Saif_Abed @GailZahtz I think that's an area where technology can help. It can allow us to understand the stressors of patients' daily lives. #cphc Docnieder Comm skills build with pt care. If you R listening, pts help u build them, you realize what works, what doesn't & how each pt is diff. #CPHC giasison @GailZahtz Communication skills is a work in constant progress. Exposure to various cultures,individualities is a challenge #cphc alexgraham186 @giasison absolutely! you will always have a new experience regardless of level #CPHC ncbennevis @giasison I completely agree on this! "holistic medical education", too! #CPHC

giasison @ncbennevis That's right Nadia #cphc GailZahtz @ncbennevis Thanks for joining us. What do you include by holistic medical education with an evidence atmosphere? #CPHC KekeBev @DAlawode @giasison Cultural sensitivity training would be great language barriers only makes patient communication more difficult #cphc GailZahtz @KekeBev Cultural sensitivity training could be significant. How can patients and advocates help with that? #CPHC Saif_Abed @GailZahtz I trained in a very multi-cultural area and role-played cultural sensitivities too. #cphc DAlawode @GailZahtz #CPHC community health committees could help in cultural sensitivity training.Barriers are explained & ways are figured out 2geda GailZahtz @DAlawode Where are these community health committees? #CPHC DAlawode @GailZahtz #CPHC actually called village health committees in Nigeria. We get 2meet them on entry in2 d community 2know cultural bias, needs KekeBev @GailZahtz @Saif_Abed Like the idea of workshops between patients advocates and doctors,cultural role-play, before health crises arise #cphc GailZahtz @KekeBev We could support an advocate group to help train each other! Seriously. #CPHC giasison I'm ALL FOR THIS! RT @GailZahtz: @KekeBev We could support an advocate group to help train each other! Seriously. #CPHC GailZahtz @Saif_Abed Actually a big pet peeve of mine is when attendings don't introduce and transfer trust to the entire team. #CPHC FMDChat Communication is a two-way: it's as much if not more about listening as it is about speaking. #CPHC GailZahtz @FMDChat Communication is definitely two ways. How can docs help patients be better communicators? History is often a problem. #CPHC FMDChat @GailZahtz Docs can help pts be better communicators by asking questions to get at the information they need. #CPHC Saif_Abed @GailZahtz Paired learning. Med students visiting nursing homes, shadowing nurses and walking the walk from all perspectives. #cphc LungCancerFaces @FMDChat Patients or their advocates must communicate and coordinate care just as effectively, if not more, than physicians. #cphc GailZahtz @LungCancerFaces How can we help patients and advocates communicate more effectively? #CPHC lttlewys @gailzahtz @ChronicPainGPS Luv! Patients need to learn how to communicate just as much as Drs need to communicate back #CPHC charter4values @lttlewys @GailZahtz @ChronicPainGPS @Saif_Abed #CPHC True! It's relationship-centered -- goes BOTH ways. Values key.

Saif_Abed Shifting perspectives is important. You're treating a human not a disease! #cphc

charter4values @Saif_Abed @GailZahtz #CPHC Absolutely! Important to remember human dimensions of care always: http://t.co/mf9EEHB7 ncbennevis @GailZahtz medical education need to include core competences empowering in skills to see not only a body but also a soul in patients #CPHC charter4values @alexgraham186 @GailZahtz @Saif_Abed #CPHC Need to train people to teach communication. Different than other topics. LungCancerFaces @GailZahtz Teaching is great, but some Drs. r just better at it. R onc. is best at it, uses cell on the spot to TT other drs. #cphc GailZahtz @LungCancerFaces Absolutely, there is an element that can not be taught- so how do we help the non-natural communicators? #CPHC LungCancerFaces @GailZahtz Patient or advocate must b in charge to some degree. I never leave family member in hosptial alone, ever, unless ICU. #CPHC charter4values @GailZahtz @LungCancerFaces @Saif_Abed #CPHC Need to work to enhance reflection, self-awareness. charter4values @GailZahtz @LungCancerFaces @Saif_Abed #CPHC And understanding, awareness of effect of clinician and what is said on pt Saif_Abed The Dr-Pt relationship is now a continuum of care not just discrete steps. Digital health will enhance it.Comm skills must reflect it. #cphc 2ndActHealth Patients complain that doctors are interrupted during the precious few minutes and sometimes never sit down or enter the room fully #CPHC Nickdawson @2ndActHealth describing being present vs being presumptive - interestingly theater has training for this so actors dont rush lines. #CPHC GailZahtz @nickdawson Being present vs being presumptive- love that- care to share more? #CPHC FMDChat @nickdawson GREAT POINT. Don't ever assume what one is going to hear nextyou might miss an important detail. #CPHC Nickdawson @GailZahtz @FMDChat #CPHC there are good frameworks for active listening for both. Docs can ask things like explain what we discussed tdy giasison @nickdawson @GailZahtz @FMDChat Totally agree Nick. Opening lines are vital in triggering an in-depth talk with peers/patients #cphc

GailZahtz @KekeBev Great to see a new face- feel free to jump in, we encourage everyone to ask questions and answer- we are all learners here #CPHC ChronicPainGPS Good listening skills are essential to good communication; Need 2B able to understand what the pt is saying, where they R coming from #cphc GailZahtz @Saif_Abed Could we also do paired learning with patient advocates and physicians? #CPHC Docnieder Great idea. MT @Saif_Abed: @GailZahtz Paired learning. Med stdts visiting NHs, shadowing RNs and walk the walk from all perspectives. #cphc

Saif_Abed @GailZahtz Definitely! But are physicians stateside willing? I can't answer that. #cphc GailZahtz @Saif_Abed The question may be different in that physicians may be willing if systems allow- can some U.S. physicians answer this? #CPHC Saif_Abed Paired learning enhances your decision making and your ability to share your perspectives to everyone so we can work united. #cphc charter4values @GailZahtz @Saif_Abed #CPHC We use paired learning, patients in as co-teachers, actors to represent patients' voices in US. ? if others do KekeBev @Saif_Abed Really like this idea! As an advocate training so far I have more experienced Advocates to shadow but no physicians as yet #cphc

Saif_Abed I remember my toughest moment was telling a pt they had cancer. I learned more in that hour than at any other time. #cphc GailZahtz @Saif_Abed The toughest news can make for such difficult converations can't it? #CPHC giasison @Saif_Abed I can relate. Tough detachment to make when it comes to "crisis" communication. #cphc GailZahtz @giasison How do you make that detachment and yet stay compassionate? #CPHC FMDChat Detachment w/ empathy one may need to tell a person a terrible thing, but one can still interact w/ empathy. #CPHC LungCancerFaces @GailZahtz @giasison I don't know if u can, especially when your patient for yrs. Docs r human. They get attached 2 some degree. #cphc giasison @GailZahtz Tough love. Still a work in progress for me. Opening up to peers like you help a lot! #cphc FMDChat Why does it seem that so frequently we forget to treat others as we would like to be treated? #CPHC charter4values @Saif_Abed @GailZahtz #CPHC Working on this internationally & in US as well. Compassion so important! Nursefriendly @charter4values @Saif_Abed @GailZahtz Interesting that a simple apology so many do not get, could head off #Malpractice cases. #cphc FMDChat Calling on the great @BabaBrinkman's mantra "Performance, Feedback, Revision" applies to communication skills too. #CPHC charter4values @Saif_Abed @GailZahtz #CPHC Excellent learning. Can have students interview and write their pt's story and reflections GailZahtz @charter4values Seems we go back to the power of patient stories- both in video, in person and in writing for teaching! #CPHC GailZahtz So many great ideas: role-playing (including using patient advocates), multi-cultural training, modeling.. what else am I missing #CPHC

Saif_Abed There are frameworks for comm skills here It's not what's said thats' the problem per se but HOW its said. #cphc GailZahtz @Saif_Abed What frameworks for communication skills did you find most helpful? #CPHC LungCancerFaces @Saif_Abed The best doctors know this very well. Some do forget at times. #cphc alexgraham186 pt comms undoubtedly vital, but with rota systems we have a different team almost every day here, comms across disciplines vital #CPHC Saif_Abed Inter-disciplinary comm skills as well as with pts is a great focus here. We need all involved to be effective & compassionate. #cphc ChronicPainGPS Think it wld be great if med schls wld invite real pts/pt ambassadors into classes to learn how to better understand pt perspective #cphc FMDChat @ChronicPainGPS Doing exactly that next week! #CPHC GailZahtz @ChronicPainGPS I would bet that some medical schools would be open to having patients! Let's put on our list!!! #CPHC charter4values @FMDChat @Saif_Abed @GailZahtz #CPHC Great point! Need to make this primary in every interaction. See: http://t.co/mf9EEHB7 ChronicPainGPS @GailZahtz: pt education is a start; pt can't communicate what they don't know. Need 2B willing 2 spend time educating! #cphc ChronicPainGPS @FMDChat: that's wonderful! I would love to do this with respect to treating chronic pain patients! #cphc GailZahtz @ChronicPainGPS I am ALL in on helping chronic pain patients! We have interest from Australia also on this. #CPHC FMDChat @ChronicPainGPS Chronic pain is SUCH a tricky subject. Many in our pt community deal w/ it - another invisible disease. #CPHC ChronicPainGPS Sweet! RT @GailZahtz: @ChronicPainGPS I am ALL in on helping chronic pain patients! We have interest from Australia also on this. #cphc ChronicPainGPS Yup - my Passion! MT @FMDChat: Chronic pain is SUCH a tricky subject. Many in our pt community deal w/it - another invisible disease. #cphc GailZahtz @ChronicPainGPS This may go back to our patient to patient training model to help patients communicate. #CPHC ChronicPainGPS @GailZahtz: Love it! Sign me up! :o) #cphc Ncbennevis @Saif_Abed that's the point! social media can help in the practical training #cphc Saif_Abed @ncbennevis I completely agree we just need to get both patient and clinical buy-in for best effect. #cphc

Saif_Abed The Cambridge-Calgary Model is the classic. You're going through this journey with a patient together not one leading the way. #cphc GailZahtz @Saif_Abed Do you have a link for the Cambridge-Calgary model? #CPHC giasison @Saif_Abed Great share Saif! We need models to help us pattern effective comm skills #cphc Saif_Abed http://t.co/ZHy4fACl #cphc Saif_Abed There's a pretty detailed link! Workshops are great but we can't have discrete teaching events only. We need longevity. #cphc charter4values @ChronicPainGPS @GailZahtz @Saif_Abed #CPHC Education key! Many models: Calg-Cambr, Kalamazoo, 4 Habits GailZahtz @Saif_Abed How do we have longevity? #CPHC Saif_Abed @GailZahtz It's difficult, Continuing Medical Education programs can be effective. #cphc GailZahtz @Saif_Abed Are continuing medical education programs really that effective? Can physicians lose some skills in time? #CPHC Saif_Abed @GailZahtz Again it depends on the individual some use a checkbox exercise and others use it to enhance their skills. #cphc alexgraham186 C-C model does work, when you manage pt ideas, concerns, expectations, you have done the hard part of comms #CPHC GailZahtz @alexgraham186 What is C-C model? Please explain more! #CPHC alexgraham186 @GailZahtz cambridge-calgary model I had to shorten it! #CPHC GailZahtz @alexgraham186 I heard it brought up a couple of times- perhaps you can post at http://t.co/L1nNRT6F during the week on this? #CPHC alexgraham186 @GailZahtz also in UK drs now have to 'revalidate' every few years so they are on top of skils #CPHC charter4values @Saif_Abed @FMDChat @GailZahtz #CPHC Do same here in US. Lifelong learning expected; regulations support this. Saif_Abed If you're not seeing patients regularly at medical school then you're not learning medicine you're just memorising facts. #cphc giasison +1000/MT @Saif_Abed: If you're not seeing pts regularly at med school then you're not learning medicine you're just memorising facts. #cphc GailZahtz @peds_id_doc Hope we can get your input on this issue during the week! Go run for patient care!! #CPHC GailZahtz @NurseTTG Thanks for joining us- how can providers be more "present?" #CPHC GailZahtz @giasison Very kind what you said earlier by the way (just sayin') #CPHC ChronicPainGPS Would also REALLY be nice to see more conferences include patient panels/speakers to enable our voice to be heard! Not often included! #cphc

GailZahtz @FMDChat Patients at conferences is a continuing ongoing attempt- but patients must also be good models at conferences of value. #CPHC KekeBev @ChronicPainGPS @GailZahtz so true and I find that the area of patient education is where Advocates really try to begin their work #cphc FMDChat @GailZahtz It's being used at Stanford's Medicine X, Doctors 2.0 & You, and w/ a TED event overseas. #CPHC GailZahtz @FMDChat What is being used at Stanford, etc? #CPHC Saif_Abed Pts have so much to share but they should understand that Drs are learning too! All this new tech/reform can be intimidating! #cphc Giasison @Saif_Abed We learn from each other. #cphc FMDChat @Saif_Abed We do understand docs are still/always learning - but we don't appreciate it when doctors act as though it's otherwise. #CPHC Saif_Abed @FMDChat Unfortunately some Drs think they're gods but times are changing hopefully. #cphc FMDChat @Saif_Abed A doctor who doesn't know a particular thing but is willing to learn about that thing grows to be a better doc. #CPHC charter4values @Saif_Abed @FMDChat @GailZahtz #CPHC We're all human beings. Need to teach that. Saif_Abed @FMDChat Completely, medical schools here in the UK make us pledge to devote our lives as lifelong students. #cphc giasison Medicine is an actively evolving science so constant medical educ updates/best practices is much needed. #cphc ChronicPainGPS That's awesome! Always learning! MT @Saif_Abed: medical schools here in the UK make us pledge to devote our lives as lifelong students #cphc charter4values @FMDChat @Saif_Abed @GailZahtz #CPHC Yes! It's about reflection, selfawareness, open-mindedness. Need to cultivate in all. Saif_Abed An important point I was taught was that comm skills are about accountability and transparency. #cphc charter4values @Saif_Abed @GailZahtz #CPHC Focus priority on human dimensions of care--core values--for all interactions to inform all GailZahtz @charter4values How do you teach humanity? #CPHC Saif_Abed When I taught students I told them to think beyond the clinic walls, your pt has a life so learn about it and be responsible. #cphc GailZahtz @Saif_Abed Can physicians find the time to learn about the life outside of the clinical walls? #CPHC giasison @Saif_Abed Empathic communication skills goes beyond our clinic walls. #cphc Saif_Abed @GailZahtz They can learn to ask the right questions & spot the right cues when they're in the clinic to learn about life outside. #cphc

GailZahtz @Saif_Abed Wouldn't check lists of questions for both physicians and patients help in asking the right questions? #CPHC Saif_Abed @GailZahtz Yes definitely but must also focus on how we ask and how we observe too. #cphc Nickdawson Theres a role in GME for soft skills RT @GailZahtz: @charter4values How do you teach humanity? #CPHC GailZahtz @nickdawson How can we make soft skills in the curriculum? #CPHC Nickdawson @GailZahtz dont have an answer, but know some avant garde med school deans who are working on it. Starts w selection process. #CPHC FMDChat @nickdawson Can we canonize those deans? #CPHC Saif_Abed @nickdawson Now selection a huge issue by itself! Is academic excellence enough to be a good Dr...can of worms right there! #cphc Nickdawson @Saif_Abed good can to open :) #CPHC Recent study found students who excelled in humanities faired as well as science & math gurus in GME Saif_Abed @nickdawson Before med school my top subjects were economics & history so that's good to hear! :) #cphc Nickdawson @Saif_Abed history and English here :) #CPHC Saif_Abed @nickdawson Well good to meet you! #cphc GailZahtz @nickdawson Selective process of what? Think we could grow from here even if vague. #CPHC GailZahtz Seems each week we accept a new initiative, and I am definitely hearing support for a patient community of practice! #CPHC ChronicPainGPS Partnership is key! Drs need 2B willing to set ego aside and work WITH pts to find best solution; individualized care! #cphc GailZahtz @JjrkCh Thanks for joining in- do you like this patient to patient advocacy community of practice idea? #CPHC Saif_Abed An important point I feel those is we need more leaders as role models for junior Drs/med students. #cphc giasison AMEN! RT @Saif_Abed: An important point I feel those is we need more leaders as role models for junior Drs/med students. #cphc Saif_Abed What I've always appreciated is that open, honest communications create trust and reduce anxiety which can improve outcomes. #cphc giasison @Saif_Abed Being able to openly communicate breaks all barriers towards change. #cphc KekeBev @Saif_Abed I like that you said increased trust 'can improve outcomes' because even in treatment ppl forget that attitude counts #cphc Saif_Abed @KekeBev I did small study & learned reducing anxiety in parents can improve children's outcomes. Amazing. #cphc

KekeBev thats amazing do you have a link to the study? #cphc @Saif_Abed 'I learned reducing anxiety in parents can improve children's outcomes.' Saif_Abed @KekeBev I'm sure I could dig it up I think it was to do with cardiac surgery if I recall correctly. #cphc GailZahtz @Saif_Abed We can provide you any room to post answers and content and links post chat- no worries! And it will be archived too. #CPHC charter4values @Saif_Abed @KekeBev @GailZahtz #CPHC Not surprising. Understanding pt/parents's perspective, listening to latent content, responding R key. GailZahtz @KekeBev Both trust and attitidude can have tremendous impace on outcomes! #CPHC ChronicPainGPS Mutual trust and respect. Attitude makes a BIG diff! MT @GailZahtz: Both trust and attititude can have tremendous impact on outcomes! #cphc GailZahtz Interesting: @saif_abed volunteered to guest because we started on medical education- but the full relationship must include patient! #CPHC GailZahtz @LungCancerFaces How do you develop long term relationships with physicians for better relationships? #CPHC charter4values @GailZahtz @Saif_Abed @GailZahtz #CPHC Been trying to figure that out for years! Role-modeling, reflection, feedback, appreciative inquiry. LungCancerFaces @Saif_Abed While in recovery post surgery, saw a doc tell patient she had breast cancer & just walk away to join a party in next room #cphc Saif_Abed @LungCancerFaces That's disgusting and shameful. Sorry for being blunt but that's my response. #cphc FMDChat @Saif_Abed @LungCancerFaces Totally agree. Wow. Just... wow. #CPHC FMDChat HCPs who deserve it/earn it need to hear "thank you" and "I appreciate your help." Goes a long way for the long term. #CPHC KekeBev @Saif_Abed probably need to foster and support a strong community to create that longevity. has to emerge from a real place of need #cphc charter4values @GailZahtz @Saif_Abed #CPHC Developed charter to make human aspects priority & focus4 education, practice, research. GailZahtz @FMDChat Completely agree! Patients don't say thank you often enough. #CPHC ChronicPainGPS I do a LOT. MayB that's why I have good relatnshp w/my Drs! MT @GailZahtz: @FMDChat Patients dont say thank you often enough #cphc GailZahtz @ChronicPainGPS Me too. I had a nurse thank me 5 times for just saying the truth of how great the practice is. #CPHC giasison Love this!MT @FMDChat: HCPs who deserve it need to hear "thank you" and "I appreciate your help." Goes a long way for the long term. #CPHC Saif_Abed @KekeBev We need medical leaders or Drs to be supported to promote the message then can we have longevity in the Dr community. #cphc GailZahtz @Saif_Abed How can we support the message? #CPHC

charter4values @giasison @Saif_Abed @Saif_Abed @GailZahtz #CPHC Yes! It's about a 'way of being' rather than just skills to demonstrate. Still need skills. giasison @charter4values @Saif_Abed @GailZahtz Well said! #cphc charter4values @GailZahtz @Saif_Abed #CPHC International Charter for Human Values in Healthcare. Welcome Partners in this! See: http://t.co/mf9EEHB7 Saif_Abed @GailZahtz Patient and medical community needs to create a platform for those with innovative ideas to share and action their ideas. #cphc KekeBev @Saif_Abed I agree. Who can provide that support to Doctors? The community? patients? legislators? We are working on this in my area #cphc GailZahtz @Saif_Abed I just saw you tweet on a platform for creative ideas... IMO I believe we are building that in this community- agree/not? #CPHC FMDChat @KekeBev Re: support to docsthere is tendency to forget pts have CAREERS too. Pts are more than illnesses. Use pts' skills. #CPHC Saif_Abed @GailZahtz Definitely, that's what I devote my life/work to now. Working with startups to turn ideas--->innovations w/ clinical effect #cphc KekeBev @FMDChat I feel advocates n patients should encourage the community to be more active with health info communication BEFORE crisis #cphc charter4values @FMDChat @KekeBev@Saif_Abed @GailZahtz #CPHC Humanistic approach views pts & docs in relationship--both experts working together on issues. GailZahtz @KekeBev Most definitely patients and family need to learn their part in the communications for better relationships- y idea great. #CPHC FMDChat @KekeBev Agree completelyimproving health literacy and engagement are critical to improving care. #CPHC GailZahtz @FMDChat Health literacy, almost every week (of our long, now 5th week!) has come up somewhere. #CPHC KekeBev @GailZahtz thanks! now a practical strategy to bring that to life... hmm :) this is something I am working on as a volunteer advocate. #cphc GailZahtz @HealthStream Seems this idea of involving family and patient advocates in learning has taken off! #CPHC GailZahtz @ViscotMedical Welcome along- glad you've been lurking and now RT'ing- everyone counts here! #CPHC Nursefriendly @nickdawson @GailZahtz @FMDChat Asking #Patients to restate discussion in their own word can be very revealing. #cphc Ncbennevis #CPHC this is the logo I mentioned "patients included " http://t.co/wMZktlzg GailZahtz @ncbennevis Very nice. Where has this logo been used? #CPHC FMDChat @GailZahtz The patients included logo. http://t.co/LcKWwKcA #CPHC charter4values @GailZahtz @ncbennevis @Saif_Abed #CPHC Have also heard quote "nothing about me without me."

GailZahtz @charter4values Absolutely- within our core values as a community: trusted relationships, respect, collaboration, caring! #CPHC GailZahtz @FMDChat Oh, how do you get the logo used at a facility? #CPHC Saif_Abed Remember paired learning should happen early in one's career. We need to all appreciate each other roles & responsibilities. #cphc Saif_Abed Effective comm skills are the lifeblood of good clinical practice. We're all responsible for it, Drs,pts,nurses,govt,innovators #cphc charter4values @Saif_Abed @GailZahtz #CPHC Agree! It's about relationships, values, caring, respect, collaboration All R responsible! charter4values @FMDChat @KekeBev @Saif_Abed @GailZahtz #CPHC Agree! Need to place focus on relationships, values as things that improve outcomes, quality. GailZahtz @KekeBev Easy shmeazy- help start the patient advocacy community of practice for Carpool Health Community! #CPHC GailZahtz I know some will stay and some will go- but we will be opening up video, and other platforms this month- so please send requests! #CPHC Saif_Abed Unfortuntaly all, I need to exit this AMAZING discussion. Feel free to keep tweeting me and I'll try to reply! #cphc GailZahtz @Saif_Abed Thank you SO much on behalf of everyone for being such a great guest! We have Q & A cards if people want to use online #CPHC Saif_Abed If you're interested I write about DigitalHealth on HITConsultant too. Good night from the UK and I look forward to talking soon #cphc KekeBev @GailZahtz @Saif_Abed same here! great talk everyone I really enjoyed the tips and sharing #cphc charter4values @Saif_Abed @Saif_Abed #CPHC Thank you! ChronicPainGPS @Saif_Abed: thanks for all your great input! Have a great day! #cphc GailZahtz Thank you to everyone- so good to see so many new faces too. And thanks to the "seasoned" for carrying where I couldn't! #CPHC Saif_Abed If you guys think of any projects Stateside let me know! #cphc Drseisenberg @Saif_Abed sorry to miss it; will read transcript! #CPHC GailZahtz @drseisenberg When reviewing transcripts- you will be pleased to see so many of your/our original values continue to duplicate & grow! #CPHC drseisenberg @GailZahtz yay! #CPHC GailZahtz With the new platforms and initiatives- where would everyone like to start archiving requests and ideas? #CPHC alexgraham186 @GailZahtz just had EPIC tech problem at my end, i can upload some stuff to CPHC this week and we can discuss further topics! #CPHC

GailZahtz @alexgraham186 I had an EPIC tech problem yesterday- no worries- look forward to your posts and input-send to me. Maybe 3 way skype! #CPHC alexgraham186 @GailZahtz absolutely we're always keen to share our clinical/management knowledge and help others! #CPHC