Category Archives: Health, Healthcare, Support, Science

Mayo Clinic Social Media Network Annual Conference, Day One

Sylvia Chou (NIH) at the MCSMN 2018 Annual Meeting

I recently returned from the Mayo Clinic Social Media Network Annual Conference and my boss asked me how it went. I replied that every single session was useful. That impressed both of us! Everything. I mean, quite literally, EVERYTHING. It’s all good, and there is nothing they offered that I didn’t want to see.

You can check out the program here, and I didn’t get to all the sessions offered, but I’d like to give you a quick run through of what I did see and why I thought it was so useful. You can’t be everywhere at once, and there were two in particular that I had hoped to see and just couldn’t, but there are links to some of the content! Or you could just browse the #MCSMN tweets in the Wakelets or through Symplur. The official highlights are captured in Mayo’s Day One and Day Two blogposts.

DAY ONE

Training

The big news was that Mayo offers detailed social media training for their own staff and students which has been tested over time and proven solid and useful.  Part of what I’m most excited about with this is access to training that is tool-based, issue-based, and includes online literacies, ethics, reputation management, and professionalism. Mayo has just upgraded their institutional site license from 10 users to the whole campus at a very reasonable cost.

Storytelling

The first keynote was from Dr. Alfredo Quinones-Hinojosa who told the story of having come to the United States as an illegal immigrant and migrant farm laborer and becoming the Chair of Neurologic Surgery at Mayo Clinic. Quite an impressive story (read his book if you want more), but the takeaways from his talk focused on the importance of teams, collaboration, surrounding yourself with people who are smarter than you, and listening to other people’s stories, helping people tell their own stories to create hope, understanding. My favorite quotes from Dr.Q’s talk:

Crisis Management

Dr Q (as he’s popularly known) was followed by a no-tweeting session on crisis communications in social media. The team of presenters (Lee Aase and Cynthia Manley) described real life scenarios, challenges, and solutions. The emphasis was in large part on what you know before the crisis starts — what is your organizational mission, focus, and purpose. Then when something goes wrong, at each step of the way, ask how does what you are doing support your mission, the ethics of your organization. The goodwill and trust you’ve built in advance can be your best defense. They also described challenges in knowing when the online problem is beyond your ability to manage, and some of the tools and strategies used by attackers to control the story to their own ends. The around-the-table conversations afterwards were pure gold.

Civility

Maureen S. Marshall from the CDC spoke on the need for civility in social media, whether you agree or disagree with the views being expressed. This is especially challenging when communicating around controversial topics or people who are frustrated with their experiences with your organization or others. How to encourage civility? Be respectful, don’t judge, don’t block, stick to the facts, use data. You don’t have to reply to everyone; it’s alright to ignore people who are being rude or trying to strike up an argument. Prepare in advance for those who try to hijack Twitter chats or Facebook streams. Consider the scale — what works with an audience of 100 may not work for 6000. Be sensitive to the tricky balance between get folk to share your important messages around safety and tipping over to fear-mongering. Have a fast approval process to pull in content from your experts. Prepare talking points for and with your experts, and share them. Be wary of styling templates, because bad actors can imitate your style to their own ends. Here are my favorite quotes from Maureen’s talk.

    Mistrust & Misinformation

    Wen-ying (Sylvia) Chou was an absolutely brilliant speaker. She presented on her research around health impacts of social media use. Like so many of the other speakers, a focus was the risks associated with fake news and misinformation, echo chambers and filter bubbles. She cited a ton of provocative articles and books. I was particularly  interested in LikeWar, the Weaponization of Social Media. Dr. Chou emphasized the motivations behind sharing, and how that impacts on the message and the receipt of the message. She described ways in which contentious health topics, like vaccines,  were used during the election to distract attention from specific political topics and also to foster mistrust of experts. The most powerful question she asked was, “Do we build trust? Or do we battle misinformation?” The impression I received was that it isn’t always possible to do both. Dr. Chou also relayed real world stories of patients asking questions triggered by things they read through social media, and being judged so harshly by the clinician that they fired the doctor and went elsewhere. Her research team is identifying communication best practices that are successful in addressing misinformation without undermining trust. Her strategy? Affirm their concerns. Praise them for being engaged. Then steer them to better information.

    Chatbots

    Rachel Haviland presented on how chatbots are being and can be used in healthcare. This is easily worth an entire blogpost just on this topic. The formative question from her talk was “What journey do we want to take our patients on?” She framed the ways in which chatbots can support a sense of caring and luxury and immediate thoughtful care, how chatbots can potentially support relationship building. She also discussed some of the risks, the pros and cons. Her marvelous slides are available here.

    Responding to Non-Local Crises

    Monique Tremblay and Tom Hardej’s presentation was a great followup to the morning’s crisis communications discussion, but with a different slant. When there is a crisis elsewhere or when there is social media buzz, how do you choose when and how to engage your communications or brand with that flow? Following examples of brands being blasted for doing this poorly, they described how their organization makes these decisions. Key takeaways:

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On Plastic, Straws, Food, Climate, and Culture — Impacts of Technology Change on Individuals and Communities

Seeking a Middle Ground Between #WarOnWaste and Accessibility (#a11y / #SpoonieLife)

This is not a new topic. We know plastic is bad. Bad for us, bad for animals. Bad for the environment. And then there is the whole deal with the Great Pacific Garbage Patch, comprised primarily of plastic waste. So, bad. However, we’ve spent a couple generations now creating a culture that revolves around bad things like plastic and gasoline, and more. You can’t turn it over in a heartbeat. Because we know it’s bad, we want to fix it RIGHT NOW, but if we try to do that we really need to ask who is going to be impacted and how. This is part of how we need to be thinking about bringing in new technologies, and about replacing old technologies, and the whole spectrum of what are we doing with tech.

If we get rid of plastic straws (as some cities and even countries are doing, along with other single use plastics), who does it help, how does it help them, does anyone get hurt, again how, what are the alternatives, … we need to ask all these questions. We also need to ask what arrangements or substitutions are being put in place BEFORE the change is made, and what are the low hanging fruit with the biggest impact that we should be targeting first. I’m not sure these questions are being asked. It turns out that getting rid of plastic straws has a really big impact on the quality of life and the safety of people with a variety of disabilities. Here’s a wonderful infographic that is getting a lot praise on Twitter.

There are a lot of people who tweet about plastic waste, and the hot new hashtag for this is #WarOnWaste. Several people I know, including several with disabilities, have been responding to these. One in particular has been getting attention lately, a tweet by Elysse Morgan, an Australian news anchor.

I did not read through all the replies to her tweet, which has kind of gone viral in a bad way, but I read a lot of them. They bring up so many issues about how pre-cut foods help to prevent food waste and empower people with disabilities broadly, people in food deserts, amputees, single parents, the elderly, those with fine motor control, reduced upper limb strength, and on and on. A great many issues were brought up, a great many personal stories were told. I collected several of these in a Wakelet collection (Wakelet is the best replacement I’ve found for Storify, but that’s a different blogpost). Here they are if you’d like to scan through them.

Endorsement/Response

Seeking a Middle Ground Between #WarOnWaste and Accessibility (#a11y / #SpoonieLife)

Promoting Human Rights Through Science: What do we do, What can we do, and What’s right to do?

Screenshot of title page

Screenshot of the title page of the article. Please go to the article itself for full description.

“Promoting Human Rights Through Science.” That’s the title of a new article, available today from Science Magazine. (Ironically, unaware of this, today I wore my “March for Science” t-shirt to the office as a “casual Friday” thing.)

Promoting human rights through science
Lauren Segal, Ryan Dz-Wei Chow, Brijesh Kumar, Jenny Nguyen, Kun-Hsing Yu, Jennifer Chen, Emre Ozan Polat, Kaitlyn Elizabeth Porter, Michelle Kelly-Irving, Israel Bimpe, Kristy A. Winter, Runxi Zeng, Majid Ahmed, Dustin Ray Saalman, Joshua Isaac James, Michal Kosinski, Easton R. White, Fernanda S. Oda, Hope Bretscher, Perrine Hamel, Swati Negi, Ali Jawaid
Science 06 Oct 2017:
Vol. 358, Issue 6359, pp. 34-37
DOI: 10.1126/science.aaq1083
http://science.sciencemag.org/content/358/6359/34

I know for myself, it has always been important to me to have my work include opportunities for advocacy for others, a chance to make a difference, to better lives. In the Dentistry Library, we worked to support outreach, information, education, research, and clinical work in the last major social healthcare frontier in the USA. In my job as the Emerging Tech Informationist I am able to be part of the conversations around adopting and developing new technologies and keep the questions in mind of how patients and the public are being included, and how technologies create new disabilities even as they create new opportunities. As a researcher, I work to the best of my ability to ensure that my work has the potential to not only inform interesting questions, but to empower others to apply our work and methods in their own environments. I try to publish in open access journals, I try to use open source tools. I try to make my methods crystal clear and replicable. I try to share my data. I try to partner, widely, and sometimes that means compromising and negotiating and educating around issues of intellectual property, access, openness, transparency, and so forth.

In today’s SCIENCE article, these are the human rights they highlighted:

Right to food
Right to health
Right to be remembered
Right to information
Right to education
Right to privacy
Right to a healthy environment
Right to culture

Of course, by far the most populous section was “The Right to Health,” with discussions of communities, cultural context, disparities, vaccines, delayed diagnosis, disasters, social determinants of health, health literacy, and policy loopholes that can be exploited in ways that undermine health rather than promote it. Powerful stuff.

We need to push this out, especially those of us on social media. This is the sort of thing that directly impacts on how the public view science and scientists, and thus has the potential to downstream impact on funding. But that can’t happen unless the public is aware of this, so it’s important to get this out beyond the Academy. It’s important for us to expand upon this, to tell our own stories of why human rights matter to us, why science matters to us. Just as with poets, and pop singers, and athletes, most of us aren’t doing this to get rich, and most of us won’t get rich. Most of us do research because we want to make a difference, we love the science and research and learning new things, and we see exciting opportunities when we place those side by side. How can we help the general public see that in each of us, and in science overall?

More important, can we use articles like this, stories like these to engage with the public in conversations around these topics. Are the rights mentioned here the ones that are actually important to the people around us, and to our society at large? If so, how do we tell those stories so that they see we’re there, too? If not, why not? Is there something people need to know that they don’t? Is there something they know that we don’t? I’m a big fan of the Cochrane Collaboration’s efforts to include patients on the research teams, not only to inform the process and to support “translation” of findings into practice, but perhaps most importantly to shape what questions are asked and studied, to help assure that these are the problems that really matter. Making the stories of science and scientists widely available and engaging with the public around them is the first step in entending that model into all of science. You can help. Share this article, talk about it, challenge it, ask questions, ask for more.

On D-Day, Exploring the Context of “As We May Think”

As We May Think (Cover)

During National Poetry Month (April), I thought it would be interesting to quote one of the poems published in the same issue of The Atlantic Monthly as the incredible essay, “As We May Think,” by Vannevar Bush.

“As We May Think” was required reading when I was in grad school, and it still it. This is a work that was truly seminal in shaping the origins of the Internet, hypertext, the Web, more. Provocative, inspirational, decades before its time. It’s online, easy to find, and it’s even open and free to the world. When I went looking for poems from the issue, though, that was not easy to find, much less free. I ended up having to request the print copy. Print. Really? You must be kidding me, but no, it’s true. It took me a month to believe I wasn’t going to find it online, and another few weeks for me to place the request for the print and find time to actually look at it.

You know what happens with print? You go looking for one thing, and find something else. You turn a page, and a picture catches your eye. You start to skim one article, but a beautiful word or phrase on the facing page distracts you. Before you know it, you are turning pages whether or not they have anything to do with your original question.

Let me tell you something about the issue of The Atlantic for July 1945. It was published less than a year after D-Day. It was published only a few months after the official end to the war. It was published when people first began to see, to believe, that World War II really was going to end, and stay done. It was the beginning of moving through the shock and trauma of the war, beginning to tell stories that couldn’t be born, that no one wants to remember.

When I first read “As We May Think” it seemed all shiny and glossy, this vision of what might someday become computers, personal assistants, ready flexible access to information. The dream that was so much bigger than people realized at the time, bigger than I realized when I read it in grad school. I had no idea that this was one essay of a larger series that The Atlantic was publishing on science and the war, no real idea of the world in which it was written. Sure, we studied WWII in school, read about the concentration camps, the war bonds, the atom bomb, the refugees, the destruction of historical treasures across Europe, the bombing of London, the evacuations, the debates in America about whether or not to enter the war, the American resistors who joined the war efforts in Europe early and were shunned as unpatriotic for the rest of their lives.

It never really came alive for me, though, in the way that it did when my computers broke this week and I went through the journal issue that contained Vannevar Bush’s essay. Some of what I found there:
– “paper bombs” as tools to influence thought
– Ad: advertisements on new technologies created for the war that had drastic impacts on food and home lives of civilians (from ice cream to oranges to vitamins)
– serious examinations of media reporters, “their reliability, their prejudices, and their mistakes”
– the role of propaganda on both sides of the conflict as obvious and visible even at the time
– first person reports of Buchenwald, shocking ghastly stories neglected from modern reports of the camps
– bitter heart-wrenching poems of soldiers from the fronts
– sweet stories of life back home, still edged with fatigue and loss and an undertone of the global anxieties, and stories of life with what we now call PTSD or depression or anxiety or others
– “Should Jews Return to Germany?”
– Ad: the misunderstood science that led to putting iodine in gasoline
– “Prithee, Little Book, Who Made Thee?”
– Ad: “Coal? Yes, indeed, it’s a big item in the drugstore!”
– Ad: “For the first time in history, a world without poverty and without war is technically possible. Whether we achieve it depends on how well we understand the ‘Economies Of Peace’.”
– book reviews of and advertisements for works by Henry James, Upton Sinclair, Thomas Mann, John Crowe Ransom, W. H. Auden, and other familiar names.

Somehow, “As We May Think” takes on a different flavor in the context of essays, and poems like this snippet from Sasserath, which resonate so very differently now than when they were written, that echo with limits and struggles that repeat now in some places and yet have become fictions in others.

“We who must live on substitutes for life,
The powdered egg, the dehydrated spud, …
Or learn the art of love with plastic limbs …”
“On Anodynes, by Simpson Sasserath, RT2/c

Reading and seeing “As We May Think” in the context of the series of which it was a part, similarly lends a depth that makes it seem even more extraordinary. The series was called, “A Scientist Looks at Tomorrow,” beginning in 1945 ad stretching to at least 1947. It included titles such as these:

– The Social Animal / Caryl P. Haskins
– Stars, Proteins, and Nations / Philippe Le Corbeiller
– A Design for Fighting / Harlow Shapley
– Penicillin, Plasma Fractionation, and the Physician / Dr. John F. Fulton
– A Physicist Returns from the War / I. I. Rabi
– Psychiatry and the Way / Big. Gen. William G. Menninger
– DDT and the Balance of Nature / V. B. Wigglesworth

I’m now curious to find them all, as a fascinating window into what was considered the cutting edge of emerging technologies in the mid-1940s. But the few sentences that resonated with me most closely came from a few months after the Bush essay, towards the end of the year, in an essay called, “The Return to Love,” by Rollo Walter Brown.

We can take our choice. If we do not believe that the awakening, the generosity, the loyalty, the warmth, expressed in love can transform the world into something more livable than what we now have, then we can take the alternative and believe that husbands and wives who cannot endure each other, neighbors who cannot endure each other, races who cannot endure each other, people who scoff at anyone who would make an improvement, can somehow, added together, constitute one world living in amity. We can wait among our raucous hatreds until somebody somewhere decides to enforce his special hatred with some super-super atomic bomb. That is something definite and “realistic.” But might we not have a more interesting world if we tried love?

Accessibility through Social Media for Libraries 101

Just a quick collection of resources I find helpful in using social media to create better and broader access (and accessibility) for library events and more.

ACCESSIBILITY

There are many ways of interpreting the word “access.” The ones I encounter most often are 1) access (as in this thing exists somewhere I can find it or get hands on it, which I think of as ‘discoverability’) and accessibility (as in I can use this, even if I’m a person with a disability, whether my functional difference is visible or invisible).

Golden rules of social media accessibility: http://www.danya.com/files/sma_poster.pdf

Accessibility Hub: Social Media Accessibility – Facebook, Twitter, and YouTube: http://www.queensu.ca/accessibility/how-info/social-media-accessibility

Social Media for People with a Disability: https://mediaaccess.org.au/web/social-media-for-people-with-a-disability

SSB Bart Group: Accessibility in Social Media: http://www.ssbbartgroup.com/blog/accessible-social-media/

ePolicyWorks: 5 Things: https://www.epolicyworks.org/epw/wp-content/uploads/2013/11/ePolicyWorks_SocialMediaAccessibilityTips.pdf

District of Columbia: Office of Disability Rights: Technical Assistance Manual: Section 508: Website and Social Media Accessibility: https://odr.dc.gov/sites/default/files/dc/sites/odr/publication/attachments/Web%20and%20Social%20Media%20AccessibilityTechnical%20Assistance%20Manual.docx

Accessibility U: Accessible Social Media: http://accessibility.umn.edu/tutorials/accessible-social-media

Global Disability Rights Now: Creating Accessible Social Media Campaigns: http://www.globaldisabilityrightsnow.org/sites/default/files/related-files/243/Social%20media%20and%20accessibility.pdf
[comment: I find it super ironic that a site on disability rights is providing accessibility content as a PDF.]

LIBRARY EXAMPLES & ARTICLES

Use of social media by the library, current practices and future opportunities: A white paper from Taylor & Francis: http://www.tandf.co.uk/journals/access/white-paper-social-media.pdf

University of Virginia: Library: Legal Information about Media Accessibility: http://www.library.virginia.edu/services/accessibility-services/media-accessibility-resources/legal-information-about-media-accessibility/

Social Media and the Science Library: How It Really Works: http://www.rsc.org/globalassets/14-campaigns/m/lc/lc16026/royal-society-of-chemistry-social-media-ebook.pdf

#FridayReads: Library and campus engagement through social media: https://link.highedweb.org/2017/02/fridayreads-library-and-campus-engagement-through-social-media/

TOOLS

One of the benefits of social media is that it makes content more readily discoverable by a broader audience in time and space. One of the drawbacks is that many social media platforms aren’t easy to use by people with various disabilities. This is just a tiny sampling of some of the information or tools that might help with some parts of that, although not others.

Facebook: https://www.facebook.com/
– Facebook Accessibility: https://www.facebook.com/accessibility/

Twitter: https://twitter.com/
– Easy Chirp: http://www.easychirp.com/

Lanyrd: http://lanyrd.com/

Storify: https://storify.com/

SOCIAL MEDIA POLICIES

If you don’t have a social media policy, you will probably live to regret it. Here are some examples.

Why Have a Social Media Policy for Your University Library? http://www.proquest.com/blog/2013/why-have-a-social-media-policy-for-your-university-library.html

Creating a Social Media Policy: What We Did, What We Learned: http://www.infotoday.com/mls/mar13/Breed–Creating-a-Social-Media-Policy.shtml

Example social media policies from libraries

Cleveland Public Library: https://cpl.org/thelibrary/usingthelibrary/policy-on-the-use-of-cpls-social-media-sites/
Monroe County Public Library: https://mcpl.info/geninfo/social-media-policy
Plum Creek Library: http://www.plumcreeklibrary.org/jackson/Docs/social%20media%20policy.pdf
TAZEWELL COUNTY PUBLIC LIBRARY: https://tcplweb.org/wp-content/uploads/sites/22/2015/03/TCPL-Social-Media-Policy.pdf
Thomas Crane Library: http://thomascranelibrary.org/sites/default/files/Social%20Media%20Policy.pdf
UNC University Library: http://blogs.lib.unc.edu/news/index.php/social-media-policy-for-library-employees/
Washington State University Libraries: http://www.wsulibs.wsu.edu/policies/social-media

GUIDELINES ETC.

Where to start first

Federal Social Media Accessibility Toolkit https://hackpad.com/Federal-Social-Media-Accessibility-Toolkit-xWKKBxzGubh

Federal Social Media Accessibility Toolkit Hackpad: Improving the Accessibility of Social Media for Public Service https://www.digitalgov.gov/resources/federal-social-media-accessibility-toolkit-hackpad/

More resources

Section 508: Create Accessible Video and Social Media https://www.section508.gov/content/build/create-accessible-video-social

Media Access Australia: Social Media for People with a Disability: https://mediaaccess.org.au/web/social-media-for-people-with-a-disability

Improving the Accessibility of Social Media in Government: https://www.digitalgov.gov/resources/improving-the-accessibility-of-social-media-in-government/

Social Media and Accessibility: Resources to Know:
https://www.digitalgov.gov/2015/01/02/social-media-and-accessibility-resources-to-know/

Your Opinion Matters

Legendary Phoenix: Your Opinion

I find myself disturbed by today’s TeeFury special, by Legendary Phoenix. The image shows Rick, a stereotypical scientist in a white lab coat with messy hair, a unibrow, eyes ripe with ennui, bags under his eyes, a pointy nose, and a glum descending (and condescending) mouth. The scientist is saying (in a word bubble), “I’m sorry, but your opinion means very little to me.”

TeeFury: Legendary Phoenix: Your Opinion

I expect some science geeks to jump up and down with glee and say, “You see? It’s not about OPINIONS! Ha! Gotcha!” However, one of the greatest challenges in science communication and science literacy is this perception that scientists are unpleasant, self-centered, passionless, people unwilling to listen or hold a civil conversation within the public sphere. “Your opinion means very little to me” could be “because I really prefer evidence over opinion” or it could be “because I’m socially inept and don’t care what people think” or it could be “because I bloody well don’t think you have anything to offer, and so I’m not listening” Or all of the above (and more).

And however you read it, these imply scientists have nothing to learn from experience, no compassion, no courtesy, no duty to educate or inform or improve science literacy among the broader populace, no understanding of intellectual sharing or community building, etcetera. Of course, real life is actually the opposite, on all counts, but this is the common perception.

This common perception has resulted in dangerous and ill informed policy decisions, reduced funding for research, strategically ill-applied research funding, poor translation of science findings into practice, and ultimately, unnecessary deaths and misery among those (all of us) who would benefit from the implementation of scientific discoveries.

“Scientific literacy is an urgent and important issue. Why should we care? The answer is simple: Our way of life and our survival are at stake.” – G. Wayne Clough, Secretary Smithsonian Institution

Your opinion matters

What I want to say is, “Your opinion matters. It matters because I care about how you got to your opinion, and I can learn from that. It matters because you might have information or resources or data that informs that opinion which aren’t available to me. It matters because I might have information or resources or data that aren’t available to you, and which might help both of us. It matters because if we put together what you have and what I have and more, we might get a picture of the problem or solution that are closer to what we really need. It matters because what how you feel about your opinion and how I feel about my opinion give an emotional context that is important in telling stories and shaping policy. It matters because IT MATTERS. So, tell me what your opinion is, share your sources and stories, listen to mine, and let’s learn together.”

I’m not buying the t-shirt. Or maybe I should, so that I can have this conversation over and over again.

The “July Effect” and Tips for New Doctors

THE “JULY EFFECT”

It’s that time of year again. Maybe you’ve already heard of the “July Effect”? Here’s a post making the rounds again today illustrating the depths of sarcasm and irony with which this meme is sometimes considered in healthcare.

Ask a July 1st Medicine Intern http://gomerblog.com/2015/07/medicine-intern/

But this is an idea that goes back for years. The gist of the idea is that it’s dangerous to go to the doctor in July because the new interns start then.

Here are a few pieces presenting that perspective.

Kirchheimer, Sid. Avoid the Hospital in July. Why? New doctors and nurses report to work for the first time. AARP June 2013. http://www.aarp.org/health/doctors-hospitals/info-06-2010/why_you_should_avoid_the_hospital_in_july.html

Headed to the Hospital? Beware the ‘July Effect’ — July means a fresh crop of medical residents. Should that scare you away? http://health.usnews.com/health-news/patient-advice/articles/2014/07/21/headed-to-the-hospital-beware-the-july-effect

This idea has been around for decades, at least since the 1980s.

Dedra Buchwald, MD; Anthony L. Komaroff, MD; E. Francis Cook, ScD; Arnold M. Epstein, MD, MA. Indirect Costs for Medical Education: Is There a July Phenomenon? Arch Intern Med. 1989;149(4):765-768. doi:10.1001/archinte.1989.00390040007001. http://www.ncbi.nlm.nih.gov/pubmed/2495778

Of course, it’s not as simple as the popular press would like to make it sound, and there is far more research presenting the opposing (but less well known) view, or that it is a small effect and one which impacts only certain patients in specific circumstances. Basically, the idea is that The “July effect” is mostly not true, and has been well debunked.

“For the subset of patients with internal medicine diagnoses, the expected “July Phenomenon” was observed, with significant relative declines in diagnostic and pharmaceutical charges in teaching hospitals over the academic year. In contrast, surgery patients showed an increase in length of stay and various charges over the academic year in teaching hospitals. There were no meaningful effects of housestaff experience on mortality, operative complications, or nursing home discharge. These results indicate that housestaff training is significantly related to the use of hospital resources for inpatients, but that the degree and direction of the effects differ by specialty.” (Rich et al, 1993)

“Although this study finds no support for a “July Phenomenon” in terms of quality of clinical care, house officers were found to be more likely to have poor documentation practices earlier in the academic year.” (Shulkin, 1995)

“There was no evidence of an increase in negative outcomes early in the academic year compared with the end of the academic year. We believe that a systematic approach to the diagnosis, resuscitation, and treatment of trauma prevented a July phenomenon.” (Claridge et al, 2001)

“Although small differences in outcome exist with respect to the academic time of the year, the timing of these differences indicates that there is not a “July phenomenon” in obstetrics at our institution.” (Myles, 2003)

“We find that the annual house-staff turnover results in increased resource utilization (i.e., higher risk-adjusted length of hospital stay) for both minor and major teaching hospitals and decreased quality (i.e., higher risk-adjusted mortality rates) for major teaching hospitals. Further, these effects with respect to mortality are not monotonically increasing in a hospital’s reliance on residents for the provision of care. In fact, the most-intensive teaching hospitals manage to avoid significant effects on mortality following this turnover.” (Huckman & Barro, 2005)

“The data suggest a “July effect” on some outcomes related to shunt surgery, but the effect was small. Nonetheless, the potential morbidity of shunt failure, infection, and the cost of treatment indicate that continued vigilance and appropriate supervision of new staff by attending surgeons is warranted.” (Kestle et al, 2006)

“Conclusions: High-risk acute myocardial infarction patients experience similar mortality in teaching- and non-teaching-intensive hospitals in July, but lower mortality in teaching-intensive hospitals in May. Low-risk patients experience no such July effect in teaching-intensive hospitals.” (Jena et al, 2013)

“Particularly in major teaching hospitals, we find evidence of a gradual trend of decreasing performance that begins several months before the actual cohort turnover and may result from a transition of responsibilities at major teaching hospitals in anticipation of the cohort turnover.” (Huckman et al, 2014)

“Data from a single institution study did not show a “July Phenomenon” in the number of operating minutes, overutilized minutes, or the number of ORs working late in July.” (Sanford et al, 2016)

“These data, in combination with the findings of Shah et al,1 suggest that the July phenomenon can largely be debunked in the modern era of surgical education.” (Thiels et al, 2016)

… and much more (Pubmed, Wikipedia)

The basic fundamental idea is, unless you are a high-risk patient, it is PERFECTLY SAFE TO SEE THE DOCTOR IN JULY.

TIPS FOR NEW DOCS

Why is it safe? Because the new docs are well trained, and have experience in a variety of situations. This all made me very interested in the annual event on Twitter in which experienced docs share tips with new docs just starting out. The biggest and best hashtag is #TipsForNewDocs, but others included #DearIntern, #DearResident, and #DearPatient.

I’ve collected a bunch of these awesome tips for all those new docs that started today, and you can find them here.