#HPM Tweet Chat 1:19:11

#hpm - Healthcare Social Media Transcript
6/27/12 11:17 AM
#hpm transcript
Healthcare Social Media Transcript
From: To: Wed Jan 19 18:00:00 PST 2011 Wed Jan 19 19:15:00 PST 2011 change time period
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ctsinclair
Welcome to the Hospice and Palliative Medicine Tweetchat. I'm hosting tonight. Lets start with some introductions.... #hpm
Wed Jan 19 18:00:56 PST 2011
equijada
Hi folks, Earl here. Checking in but lurking. #hpm

Wed Jan 19 18:01:50 PST 2011
hospice_mktg
Hello! I'm Emily Barry tweeting on behalf of Transcend Hospice Marketing Group, @hospice_mktg #hpm
Wed Jan 19 18:01:52 PST 2011
ctsinclair
I am Christian Sinclair, palliative doc @kchospice, editor @pallimed, board member @AAHPM, fan of Hailee Steinfeld in True Grit #hpm
Wed Jan 19 18:02:35 PST 2011
DrSnit
@ctsinclair Hey all - have missed you! Melissa here. #hpm

Wed Jan 19 18:02:56 PST 2011
PracticalWisdom
HI Christian and #HPM gang. I"m Lisa, curious Adult Education Scholar, Speaker, Trainer, Presentation Designer, Rascal. #hpm
Wed Jan 19 18:03:06 PST 2011
http://hashtags.symplur.com/healthcare-hashtag-transcript.php?ha&smin=0&tdate=01-19-2011&thour=19&tmin=15&ssec=00&tsec=00&img=1
Page 1 of 28
6/27/12 11:17 AM
ctsinclair
Welcome @gailzahtz @Hospice_mktg (Emily) @DrSnit @PracticalWisdom and @equijada good crowd tonight! #hpm
Wed Jan 19 18:03:39 PST 2011
inhousehospice
Hi! I'm Ash, marketing coordinator at In-House Hospice & Palliative Care in Michigan and Ohio. :) #hpm
Wed Jan 19 18:03:41 PST 2011
GailZahtz
Hi. Feel like it's been ages, but I...health comm background, ehlers danlos pt, mom of sick kid, wife of surgeon, founder HCSM start-up #HPM
Wed Jan 19 18:03:50 PST 2011
mdstudent31
Hey all, Kevin, 4th year med student, soon-to-be family med intern, family med advocate, lurking/observing #hpm
Wed Jan 19 18:04:12 PST 2011
ctsinclair
We'll get started with the first topic in a few minutes... #hpm
Wed Jan 19 18:04:23 PST 2011
renee_berry
RT @ctsinclair: We'll get started with the first topic in a few minutes... #hpm
Wed Jan 19 18:04:50 PST 2011
ctsinclair
For next hour my posts will be on #hospice palliative topics, pls join/RT if you are interested! Tweets are my own #TAMO #hpm
Wed Jan 19 18:05:26 PST 2011
ctsinclair
@mdstudent31 Welcome Kevin, glad to have some med students here. #hpm
Wed Jan 19 18:05:44 PST 2011
GailZahtz
RT @ctsinclair: For next hr my posts will be on #hospice palliative topics, pls join/RT if you are interested! Tweets are my own #TAMO #hpm
Wed Jan 19 18:05:57 PST 2011
renee_berry
---> Love the #hospice & #palliative care community, passionate about advance care planning & social media #hpm
Wed Jan 19 18:06:08 PST 2011
PracticalWisdom
Wow, this really is a great group of folks tonight. Got to put my thinking cap on. #hpm
Wed Jan 19 18:06:15 PST 2011
ctsinclair
@GailZahtz A good friend in San Diego had Ehlers Danlos. we did ice skating coaching for special olympics. Good guy, lost touch #hpm
Wed Jan 19 18:06:31 PST 2011
GailZahtz
@ctsinclair Oh, Christian, according to Klout you are 1) a "celebrity and 2) the person who most influences me- exciting right ;)) #HPM
Wed Jan 19 18:06:43 PST 2011
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6/27/12 11:17 AM
ctsinclair
@PracticalWisdom My first topic is a doozy. #hpm

Wed Jan 19 18:06:47 PST 2011
mdstudent31
@ctsinclair Thanks! I caught the tail-end of one of these but wanted to see if I could be a useful contributor #hpm
Wed Jan 19 18:07:02 PST 2011
hospice_mktg
RT @renee_berry: ---> Love the #hospice & #palliative care community, passionate about advance care planning & social media #hpm
Wed Jan 19 18:07:18 PST 2011
DrSnit
RT @ctsinclair: For next hour my posts will be on #hospice palliative topics, pls join/RT if you are interested! Tweets are my own #TAMO #hpm
Wed Jan 19 18:07:39 PST 2011
ctsinclair
RT @GailZahtz: @ctsinclair Oh, Christian, according to Klout you are a "celebrity" "I can tell you how annoying the paprazzi is :^P " #hpm
Wed Jan 19 18:07:43 PST 2011
PracticalWisdom
@mdstudent31 I've never been disappointed by you! #hpm

Wed Jan 19 18:07:53 PST 2011
GailZahtz
@ctsinclair u knew someone well with it or ice skated? I wouldn't get on ice skates again.18 surgeries have made me afraid of falling. #HPM
Wed Jan 19 18:08:24 PST 2011
mdstudent31
@PracticalWisdom You're too kind :) #hpm

Wed Jan 19 18:08:27 PST 2011
DrSnit
@mdstudent31 hey Kevin. Nice to have you! #hpm

Wed Jan 19 18:08:55 PST 2011
ctsinclair
Important acronym for T1: PCA = patient controlled analgesia aka morphine/fentanyl/opioid pump where patient can give dose #hpm
Wed Jan 19 18:08:58 PST 2011
ctsinclair
@GailZahtz Both! #hpm

Wed Jan 19 18:09:11 PST 2011
mandajane79
am late but here!#hpm

Wed Jan 19 18:09:15 PST 2011
GailZahtz
@ctsinclair I know, the paparazzi are really hot on the tails of palliative docs. It must be a drag! They just write about my clothes #HPM
Wed Jan 19 18:09:16 PST 2011
Page 3 of 28
6/27/12 11:17 AM
PracticalWisdom
@mdstudent31: Nope I"m just straight up! :<) #hpm

Wed Jan 19 18:09:23 PST 2011
ctsinclair
Looks like we have a quorum...let's begin! #hpm

Wed Jan 19 18:09:26 PST 2011
PracticalWisdom
@mandajane79: I"m so glad #hpm

Wed Jan 19 18:09:46 PST 2011
PracticalWisdom
Drum roll #hpm

Wed Jan 19 18:09:56 PST 2011
GailZahtz
@ctsinclair T1 Fentanyl please ;)) #HPM

Wed Jan 19 18:10:05 PST 2011
GailZahtz
@PracticalWisdom You're like a whole acoustic band tonight! Send me the soundtrack ;) #HPM
Wed Jan 19 18:10:35 PST 2011
mdstudent31
@DrSnit Hey Melissa! Glad to be here! #hpm

Wed Jan 19 18:10:42 PST 2011
ctsinclair
Topic 1: Should someone else be allowed to press a PCA button for patient who can't press for themselves? (aka PCA by proxy) #hpm
Wed Jan 19 18:10:42 PST 2011
ctsinclair
@GailZahtz :) #hpm
Wed Jan 19 18:10:55 PST 2011
brigid22
brigid22, LPN/nurisng student, mosstly lurking tonight #hpm

Wed Jan 19 18:10:55 PST 2011
DrSnit
@mandajane79 hey sassy! #hpm

Wed Jan 19 18:11:01 PST 2011
GailZahtz
T1 Add to this- did everyone see the Washington Post article slamming palliative care docs for too much pain management? Awful!!! #HPM
Wed Jan 19 18:11:46 PST 2011
mandajane79
@PracticalWisdom thank you!!!!!#hpm

Wed Jan 19 18:12:04 PST 2011
DrSnit
@brigid22 good to see you here tonight. #hpm

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6/27/12 11:17 AM
Wed Jan 19 18:12:13 PST 2011
mandajane79
@DrSnit hello daaahlin!#hpm

Wed Jan 19 18:12:27 PST 2011
ctsinclair
@GailZahtz No send the link and we will make that topic 2! #hpm
Wed Jan 19 18:12:28 PST 2011
mdstudent31
T1: Good place to start - patient consent and autonomy. If they want PCAbyProxy, lets figure a way to accommodate #hpm
Wed Jan 19 18:13:06 PST 2011
renee_berry
RT @ctsinclair Should someone else be allowed to press a PCA button for patient who cant press for themselves? (aka PCA by proxy) #hpm
Wed Jan 19 18:13:23 PST 2011
brigid22
@ctsinclair @GailZahtz please do :) I would love to read and discuss that #hpm
Wed Jan 19 18:13:26 PST 2011
Pallimed
RT @ctsinclair: Topic 1: Should someone be allowed to press a PCA button for patient who can't press for themselves? (aka PCA by proxy) #hpm
Wed Jan 19 18:13:26 PST 2011
PracticalWisdom
T1: If Pt unable to press the button themselves who would do so? Health care professional/Family member? #hpm
Wed Jan 19 18:13:42 PST 2011
inhousehospice
RT @ctsinclair: T1: Should someone else be allowed to press a PCA button for patient who cant press for themselves? (aka PCA by proxy) #hpm
Wed Jan 19 18:14:10 PST 2011
renee_berry
T1 absolutely, but what should be the guidelines to help that person know the best way to use it? #hpm
Wed Jan 19 18:14:13 PST 2011
DrSnit
T1 If they cannot press it themselves it is no longer pt controlled. It is then a non-pca button. ;) Still getting necessary pain care. #hpm
Wed Jan 19 18:14:30 PST 2011
PracticalWisdom
T1: How would pain be interpreted? #hpm

Wed Jan 19 18:14:32 PST 2011
ctsinclair
Theory why a PCA pump should work is that a patient could self-monitor. Pain = button press, too much med = sleepy->no button. Proxy? #hpm
Wed Jan 19 18:14:33 PST 2011
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6/27/12 11:17 AM
GailZahtz
Here's the feature where they examined palliative docs, who of course prescribe more than other docs http://wapo.st/evTkhw #HPM
Wed Jan 19 18:14:44 PST 2011
ctsinclair
@PracticalWisdom Family or staff might press a PCA button by proxy. No fingerprint scanning that I know of. ;) #hpm
Wed Jan 19 18:15:03 PST 2011
hospice_mktg
T1 agree definitely would need guidelines, understand non-verbals to know if pt is uncomfortable or in pain #hpm
Wed Jan 19 18:15:23 PST 2011
ctsinclair
RT @PracticalWisdom: T1: How would pain be interpreted? "Always a thorny (i.e. painful) dilemma! Patient report is gold standard" #hpm
Wed Jan 19 18:15:39 PST 2011
GailZahtz
Here was the response from the APA http://wapo.st/edZc0Z that was excellent but made bottom of the page #HPM
Wed Jan 19 18:15:42 PST 2011
PracticalWisdom
@ctsinclair: T1 would this not be very time intensive? #hpm

Wed Jan 19 18:15:43 PST 2011
mdstudent31
T1: PCAbyProxy - another part of the advanced directive/living will? #hpm

Wed Jan 19 18:15:53 PST 2011
ctsinclair
@DrSnit Good point about a non aware patient no longer having a true 'patient controlled analgesia' #hpm
Wed Jan 19 18:16:23 PST 2011
ctsinclair
RT @mdstudent31: T1: PCAbyProxy - another part of the advanced directive/living will? "Good thought - who do I trust to give me meds" #hpm
Wed Jan 19 18:16:40 PST 2011
renee_berry
You can put a limit on the amount of times the button can be pressed in a certain time frame right? Thats how it was for me after labor #hpm
Wed Jan 19 18:16:41 PST 2011
inhousehospice
RT @mdstudent31: T1: PCAbyProxy - another part of the advanced directive/living will? #hpm
Wed Jan 19 18:16:43 PST 2011
GailZahtz
@mdstudent31 Remember we were talking about this earlier in the week? About how proxy needs to "have the talk" on more decisions? #HPM
Wed Jan 19 18:16:49 PST 2011
PracticalWisdom
T1: Isn't tolerance an issue if long term pain management is needed? #hpm
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Wed Jan 19 18:16:51 PST 2011
ctsinclair
RT @PracticalWisdom: T1 would this not be very time intensive? "PCA by proxy (nurse or family) saves time vs. drawing up meds #hpm
Wed Jan 19 18:17:20 PST 2011
ctsinclair
@GailZahtz @mdstudent31 And by the way #HavetheTalk is the unofficial hashtag for National Healthcare Decisions Day (4/16) #hpm
Wed Jan 19 18:17:59 PST 2011
renee_berry
Yes! RT @GailZahtz @mdstudent31 re proxy needs to #HaveTheTalk on more decisions? yes! cc @EngageWithGrace #hpm
Wed Jan 19 18:18:08 PST 2011
mdstudent31
@GailZahtz Yes - proxy/POA,etc all need to be part of the decision-making process w/ proper comm. from hcps #hpm
Wed Jan 19 18:18:13 PST 2011
ctsinclair
@renee_berry Yes you can limit how many times the button is pressed. This is one of my concerns with PCA by proxy. #hpm
Wed Jan 19 18:18:26 PST 2011
hospice_mktg
Agree! RT @renee_berry: Yes! RT @GailZahtz @mdstudent31 re proxy needs to #HaveTheTalk on more decisions? yes! cc @EngageWithGrace #hpm
Wed Jan 19 18:18:40 PST 2011
OncoPRN
RT @ctsinclair Should someone else be allowed to press a PCA button for patient who cant press for themselves? (aka PCA by proxy) #hpm
Wed Jan 19 18:18:55 PST 2011
ctsinclair
Is PCA(IVmeds) by proxy any different fundamentally from a family member dosing liquid morphine? #hpm
Wed Jan 19 18:19:00 PST 2011
GailZahtz
Well I won't steal #HaveTheTalk but the idea we had was that there are more implicationslike who is told bad news? Proxy may be best #HPM
Wed Jan 19 18:19:14 PST 2011
mdstudent31
@ctsinclair PCA may be more precise on timing/dosing? #hpm

Wed Jan 19 18:19:55 PST 2011
renee_berry
sounds like a blog post RT @ctsinclair Is PCA(IVmeds) by proxy any different fundamentally from a family member dosing liquid morphine? #hpm
Wed Jan 19 18:20:28 PST 2011
PracticalWisdom
How many family members/Friends would want the responsibility of monitoring pain for their loved one. Tons of responsibility. #hpm
Wed Jan 19 18:20:45 PST 2011
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6/27/12 11:17 AM
ctsinclair
Is PCA by proxy a empowered thing for families or is it a dangerous idea or both? Many families do not want the option removed #hpm
Wed Jan 19 18:20:54 PST 2011
GailZahtz
@equijada If you're lurking- u gave me idea. After I had the talk w/my husband, realized it's much more than death, it's all health #HPM
Wed Jan 19 18:21:28 PST 2011
mdstudent31
@PracticalWisdom the family members/friends need the same amount of support/resources as the patient does at that point #hpm
Wed Jan 19 18:21:32 PST 2011
brigid22
RT @ctsinclair: Is PCA(IVmeds) by proxy any different fundamentally from a family member dosing liquid morphine? #hpm
Wed Jan 19 18:21:36 PST 2011
ctsinclair
RT @PracticalWisdom: How many family/friends want the responsibility of monitoring pain for their loved one. Tons of responsibility. #hpm
Wed Jan 19 18:21:48 PST 2011
GailZahtz
@PracticalWisdom @ctsinclair If the dosing is approved by the doctor, let the patient be in less pain. Who wouldn't want that? #HPM
Wed Jan 19 18:22:30 PST 2011
mandajane79
i think empowered AND dangerous...there are so many factors involved...#hpm

Wed Jan 19 18:22:32 PST 2011
PracticalWisdom
So many families are not geographically close, divorced families, Single never married, etc. Families are now very complex. #hpm
Wed Jan 19 18:23:16 PST 2011
renee_berry
yes RT @GailZahtz After I had the talk w/my husband, realized its much more than #death its all health #HaveTheTalk #hpm
Wed Jan 19 18:23:21 PST 2011
ctsinclair
The Joint Commission (@TJCommission) considers PCA by proxy a sentinel event http://bit.ly/igvSDf #hpm
Wed Jan 19 18:23:27 PST 2011
ctsinclair
RT @mandajane79: i think empowered AND dangerous...there are so many factors involved...#hpm #hpm
Wed Jan 19 18:23:32 PST 2011
mdstudent31
@PracticalWisdom Not to further plug #pcmh, but all of those resources could be available regardless if pt's proxy part of the pts pcmh #hpm
Wed Jan 19 18:23:48 PST 2011
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6/27/12 11:17 AM
DrSnit
PCA(IVmeds) by proxy is more consistent but family member dosing liquid morphine can tweak up or down. #hpm
Wed Jan 19 18:23:52 PST 2011
ctsinclair
RT @GailZahtz: After I had the talk w/my husband, realized its much more than death, its all health "(And choice)" #hpm
Wed Jan 19 18:24:14 PST 2011
renee_berry
family members of #hospice patients are already getting training about care, I don't see how one more tool could hurt if good edu #hpm
Wed Jan 19 18:24:23 PST 2011
GailZahtz
@renee_berry I'm feelin' one of your initiatives coming!!! #HPM

Wed Jan 19 18:24:44 PST 2011
mdstudent31
@DrSnit That's what I figured Re: PCA dosing/timing. Could be mucgh easier for caregiver #hpm
Wed Jan 19 18:24:47 PST 2011
brigid22
Very true RT @DrSnit: PCA(IVmeds) by proxy is more consistent but family member dosing liquid morphine can tweak up or down. #hpm
Wed Jan 19 18:24:56 PST 2011
ctsinclair
@mdstudent31 #PCMH = Patient centered medical home not Pitt County Memorial hospital right? ;^) #hpm
Wed Jan 19 18:25:08 PST 2011
PracticalWisdom
The bottom line for me is that I don't think we have the magic answer on pain/pain management, etc. Pain is so complex. Period. #hpm
Wed Jan 19 18:25:43 PST 2011
mdstudent31
@ctsinclair haha yes, that would be it. Re: PCMH #hpm

Wed Jan 19 18:25:56 PST 2011
renee_berry
haha, I do get very involved.. anything to empower patient care! RT @GailZahtz @renee_berry Im feelin one of your initiatives coming!! #hpm
Wed Jan 19 18:26:00 PST 2011
ctsinclair
So everyone here seems to think a good idea, but what about @TJCommission saying 'PCA by proxy is a big no-no!" #hpm
Wed Jan 19 18:26:02 PST 2011
renee_berry
oo good point RT @ctsinclair @mdstudent31 #PCMH = Patient centered medical home not Pitt County Memorial hospital right? ;^) #hpm
Wed Jan 19 18:26:24 PST 2011
@mdstudent31 Shout out to Pitt County! #hpm

http://hashtags.symplur.com/healthcare-hashtag-transcript.php?ha&smin=0&tdate=01-19-2011&thour=19&tmin=15&ssec=00&tsec=00&img=1 Page 9 of 28
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ctsinclair ctsinclair
Wed Jan 19 18:26:28 PST 2011
Wrapping T1 up soon and we will get to Topic #2 #hpm

Wed Jan 19 18:27:06 PST 2011
GailZahtz
@renee_berry I'm just the idea lady in the group. I watch in awe as you make it happen (with lots of cheering from the crowd) LOL #HPM
Wed Jan 19 18:27:15 PST 2011
mandajane79
RT @PracticalWisdom: So many families are not geographically close, divorced families, Single never married, etc. Families are now very complex. #hpm
Wed Jan 19 18:27:27 PST 2011
PracticalWisdom
@ctsinclair @mdstudent31: Curious George wants to know inside scoop Pitt County. Later conversation? #hpm
Wed Jan 19 18:27:35 PST 2011
renee_berry
I think I'm ready for T2 my head is feeling full trying to discuss these clinical aspects of care .. :) #hpm
Wed Jan 19 18:27:42 PST 2011
mandajane79
RT @DrSnit: PCA(IVmeds) by proxy is more consistent but family member dosing liquid morphine can tweak up or down. #hpm
Wed Jan 19 18:27:52 PST 2011
inhousehospice
RT @renee_berry: I think Im ready for T2 my head is feeling full trying to discuss these clinical aspects of care .. :) #hpm
Wed Jan 19 18:28:19 PST 2011
Mtnmd
This is one of the areas where @THcommission and ideals falls flat on face in light of reality. I think it probably goes on w/every pt? #hpm
Wed Jan 19 18:28:20 PST 2011
PracticalWisdom
Agree!RT@renee_berry I think I'm ready for T2 my head is feeling full trying to discuss these clinical aspects of care .. :) #hpm #hpm
Wed Jan 19 18:28:35 PST 2011
mdstudent31
If PCAbyProxy big no-no, then they imply same re: pain management and caregivers/aids/family giving pain meds in general? #hpm
Wed Jan 19 18:28:37 PST 2011
renee_berry
@GailZahtz thank you ... and I'll say as WE make it happen. Starts with engaging the community... ---------------> #hpm
Wed Jan 19 18:28:46 PST 2011
DrSnit
For some family members doing palliative care it aint their first trip to the rodeo- even for complex families. #hpm
Page 10 of 28
http://hashtags.symplur.com/healthcare-hashtag-transcript.php?h&smin=0&tdate=01-19-2011&thour=19&tmin=15&ssec=00&tsec=00&img=1
6/27/12 11:17 AM
Wed Jan 19 18:28:47 PST 2011
ctsinclair
handing it ver to @GailZahtz to introduce Topic#2: Doctors who prescribe oft-abused drugs face scrutiny http://wapo.st/evTkhw #hpm
Wed Jan 19 18:29:37 PST 2011
PracticalWisdom
@DrSnit: Good Point. But perhaps each Pt/situation is different? #hpm

Wed Jan 19 18:29:43 PST 2011
pfanderson
RT @PracticalWisdom: The bottom line for me is that I don't think we have the magic answer on pain/pain management, etc. Pain is so complex. Period. #hpm
Wed Jan 19 18:29:58 PST 2011
brigid22
RT @mdstudent31: If PCAbyProxy big no-no, then they imply same re: pain management and caregivers/aids/family giving pain meds in general? #hpm
Wed Jan 19 18:30:16 PST 2011
GailZahtz
Okay, not prepared, but have strong feelings- did everyone get the two Washington Post articles on prescription narcotics & response? #HPM
Wed Jan 19 18:30:31 PST 2011
brigid22
@mdstudent31 exactly, it presents a double standard there #hpm

Wed Jan 19 18:30:34 PST 2011
renee_berry
@Atul_Gawande cool to see you tweeting, know you're welcome to join our #hpm ( #hospice & #palliative medicine) Tweetchat Live now
Wed Jan 19 18:30:49 PST 2011
ctsinclair
@GailZahtz I have not yet, but am intersted in the topic of course! #hpm
Wed Jan 19 18:31:15 PST 2011
GailZahtz
Few points- they sector the government looked at were 1. Medicaid/Medicare docs and 2. Palliative docs- most who would prescribe more #HPM
Wed Jan 19 18:31:20 PST 2011
ctsinclair
RT @renee_berry: @Atul_Gawande cool to see you tweeting, youre welcome to join our #hpm ( #hospice & #palliative medicine) chatLive now #hpm
Wed Jan 19 18:31:43 PST 2011
ctsinclair
@renee_berry nice try! #hpm

Wed Jan 19 18:31:49 PST 2011
GailZahtz
The response from the American Palliative Association was that if we make physicians afraid to prescribe, it can lead to suicide, etc. #HPM
Wed Jan 19 18:32:11 PST 2011
RT @GailZahtz: Govt looked at 1. Medicaid/Medicare docs and 2. Palliative docs- most who
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6/27/12 11:17 AM
ctsinclair
would prescribe more #hpm

Wed Jan 19 18:32:16 PST 2011
mandajane79
@ctsinclair @GailZahtz me neither:) #hpm

Wed Jan 19 18:32:19 PST 2011
GailZahtz
3rd point for conversation is that is it really the government's place to say they know better than md's what is best patient care? #HPM
Wed Jan 19 18:32:48 PST 2011
hospice_mktg
RT @renee_berry: @Atul_Gawande cool to see you tweeting, know youre welcome to join our #hpm ( #hospice & #palliative medicine) #hpm
Wed Jan 19 18:32:57 PST 2011
DrSnit
@PracticalWisdom definitely sistah. for sure!! #hpm

Wed Jan 19 18:33:04 PST 2011
renee_berry
can I RT myslef? :) RT @renee_berry I think Im ready for T2 my head is feeling full trying to discuss these clinical aspects of care #hpm
Wed Jan 19 18:33:04 PST 2011
GailZahtz
Yet, the response and highlight of course would be from Wash Post that there are md's who take advantage by these prescriptions. #HPM
Wed Jan 19 18:33:36 PST 2011
ctsinclair
Siobhan Reynolds who blogged/campaigned for rights of those needing pain relief, shut down her site http://www.slate.com/id/2278244/ #hpm
Wed Jan 19 18:33:53 PST 2011
mdstudent31
T2: Prob is that we often under-treat pain which leads to abuse of these meds. Cannot take every pts pain for granted #hpm
Wed Jan 19 18:33:56 PST 2011
ctsinclair
@renee_berry We will make Topic 3 more light hearted stick around. Got to get to the meaty stuff first. #hpm
Wed Jan 19 18:34:31 PST 2011
renee_berry
@ctsinclair haha a tweet come through, just think it would be a natural place for him to have convo w/community that shares his passion #hpm
Wed Jan 19 18:34:44 PST 2011
GailZahtz
@mdstudent31 That's a good point. Under treatment can lead to over-use when trying to get pain under control. Physicians? #HPM
Wed Jan 19 18:34:46 PST 2011
ctsinclair
RT @mdstudent31: T2: Prob is that we often under-treat pain which leads to abuse of these meds. Cannot take every pts pain for granted #hpm
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6/27/12 11:17 AM
Wed Jan 19 18:34:50 PST 2011
PracticalWisdom
My heart goes out to MD, and other health care providers who write scripts for pain drugs. FDA is coming down. #hpm
Wed Jan 19 18:35:00 PST 2011
ctsinclair
RT @PracticalWisdom: My heart goes out to MD, and other health care providers who write scripts for pain drugs. FDA is coming down. #hpm
Wed Jan 19 18:35:27 PST 2011
GailZahtz
@PracticalWisdom Does the FDA have a place telling physicians how to treat chronic patients? #HPM
Wed Jan 19 18:35:40 PST 2011
joshgriffin
Wishing my #hpm tweetchat friends a great chat this evening. Will hopefully see you next week when things are calmed down.
Wed Jan 19 18:35:50 PST 2011
ctsinclair
Regarding prescribing of opioids (narcotics is broad, incorrect, and stigmatizing - pet peeve), medical board or DEA to oversee? #hpm
Wed Jan 19 18:36:15 PST 2011
GailZahtz
@JoshGriffin All of our condolences go out to you during this time of loss. Only the best wishes on behalf of everyone at #HPM
Wed Jan 19 18:36:30 PST 2011
ctsinclair
@joshgriffin Hey Josh, glad to see you check in! #hpm

Wed Jan 19 18:36:31 PST 2011
ctsinclair
RT @GailZahtz: @PracticalWisdom Does the FDA have a place telling physicians how to treat chronic patients? "not that I know of" #hpm
Wed Jan 19 18:36:50 PST 2011
PracticalWisdom
@GailZahtz @PracticalWisdom. The first example article sounds like person who has a great chance of having the disease of addiction. #hpm
Wed Jan 19 18:37:11 PST 2011
brigid22
T2: everyone's pain is different; what my pain responds to may be different than what your pain does. Some trial and error involved #hpm
Wed Jan 19 18:37:21 PST 2011
DrSnit
@JoshGriffin sending you love! #hpm

Wed Jan 19 18:37:26 PST 2011
mdstudent31
T2: Legit pain v pill seekers - often difficult. So we go middle-ground. Seekers get meds, legit pain do not get enough #hpm
Wed Jan 19 18:37:29 PST 2011
Page 13 of 28
6/27/12 11:17 AM
mandajane79
RT @GailZahtz: @JoshGriffin All of our condolences go out to you during this time of loss. Only the best wishes on behalf of everyone at #HPM
Wed Jan 19 18:37:44 PST 2011
brigid22
Absolutely Not! RT @GailZahtz: @PracticalWisdom Does the FDA have a place telling physicians how to treat chronic patients? #HPM
Wed Jan 19 18:37:54 PST 2011
Mtnmd
#hpm I have a call out to Solomon on this one, but if choice is btwn doctors and govn admin, I'll choose doctors every time. But it's a prb
Wed Jan 19 18:38:03 PST 2011
ctsinclair
@PracticalWisdom @GailZahtz And trying to treat addiction as a medical issue vs. a crime is variable from county to county #hpm
Wed Jan 19 18:38:03 PST 2011
GailZahtz
@PracticalWisdom The reality is that these drugs are medically dependent. That is not the same as addictive behavior for pain patients #HPM
Wed Jan 19 18:38:10 PST 2011
PracticalWisdom
With chronic Pain after a while tolerance builds. If dying then no question treat the pain but if chronic pain it's an issue #hpm
Wed Jan 19 18:38:32 PST 2011
renee_berry
Wait did we say T2? I'm confused #hpm

Wed Jan 19 18:38:40 PST 2011
inhousehospice
RT @brigid22: T2: everyones pain diff; what my pain responds to may be diff than what your pain does. Some trial and error involved #hpm
Wed Jan 19 18:38:43 PST 2011
mdstudent31
@GailZahtz @PracticalWisdom Think of all off-label uses of many meds. Not FDA approved but hcps often not restricted #hpm
Wed Jan 19 18:39:05 PST 2011
ctsinclair
@JoshGriffin My goodness Josh, I had not heard. I recently lost my grandmother too. Hoping things are peaceful. #hpm
Wed Jan 19 18:39:12 PST 2011
GailZahtz
And another issue is- if someone is chronic pt- who is the govt to say that even "dependency" is worse for Quality of Life than pain? #HPM
Wed Jan 19 18:39:25 PST 2011
Mtnmd
#hpm Criminalizing medicine will absolutely cause the last remaining doctors to bolt. Who needs that? A chance at jail w/ every decision?
Wed Jan 19 18:39:32 PST 2011
Page 14 of 28
6/27/12 11:17 AM
ctsinclair
@renee_berry Yeah, T2 - govt crackdown on docs who prescribe pain meds. #hpm
Wed Jan 19 18:39:35 PST 2011
GailZahtz
@renee_berry Sorry, in a surprise move @ctsinclair passed T2 over to me about the Washington Post implications of govt and pain mgmt #HPM
Wed Jan 19 18:40:22 PST 2011
ctsinclair
@mdstudent31 They dont really teach you in medschool or residency about off-label prescribing vs. on label prescribing #hpm
Wed Jan 19 18:40:29 PST 2011
mdstudent31
@brigid22 Everyone's pain threshold changes over time as well as gaining tolerance to meds-another huge challenge #hpm
Wed Jan 19 18:40:30 PST 2011
mandajane79
RT @GailZahtz: And another issue is- if someone is chronic pt- who is the govt to say that even "dependency" is worse for Quality of Life than pain? #HPM
Wed Jan 19 18:40:37 PST 2011
brigid22
@mdstudent31 and then it gets further complicated by addicts in genuine pain and finding dosage that covers pain #hpm
Wed Jan 19 18:40:38 PST 2011
hvto
@ctsinclair @renee_berry govt crackdown on docs who prescribe pain meds - making it hard to get hospice pt meds from the primary #hpm
Wed Jan 19 18:40:38 PST 2011
PracticalWisdom
I've heard of Dr. who are doing their job responsible who the FDA shut down their practice. #hpm
Wed Jan 19 18:40:43 PST 2011
mandajane79
RT @Mtnmd: #hpm Criminalizing medicine will absolutely cause the last remaining doctors to bolt. Who needs that? A chance at jail w/ every decision?
Wed Jan 19 18:40:46 PST 2011
ctsinclair
@GailZahtz You caught the pass well and gracefully! #hpm

Wed Jan 19 18:40:52 PST 2011
DrSnit
@PracticalWisdom chronic pain is still not an addition issue and there is still a place pain management, not addiction assumptions #hpm
Wed Jan 19 18:41:11 PST 2011
GailZahtz
RT @ctsinclair: @GailZahtz You caught the pass well and gracefully! #hpm <-Well thank you. Doing my best, first timer. TY for trusting me.
Wed Jan 19 18:41:18 PST 2011
Page 15 of 28
6/27/12 11:17 AM
PracticalWisdom mdstudent31
@ctsinclair @GailZahtz: Agree good catch #hpm

Wed Jan 19 18:41:23 PST 2011
@ctsinclair - the attendings and research you come across show you the way re: off-label uses #hpm
Wed Jan 19 18:41:29 PST 2011
brigid22
exactly RT @mdstudent31: @brigid22 Everyone's pain threshold changes over time as well as gaining tolerance to meds-another challenge #hpm
Wed Jan 19 18:41:33 PST 2011
Mtnmd
#hpm Question: If we all agree on that, then how should those RARE ppl who prescribe for $ be handled/identified?
Wed Jan 19 18:41:47 PST 2011
ctsinclair
RT @hvto: hard to get hospice pt meds from primary MD "Anecdotally, seeing more community docs say 'let #hospice doc prescribe" #hpm
Wed Jan 19 18:41:52 PST 2011
GailZahtz
Dependency and addiction are NOT the same issues. #HPM

Wed Jan 19 18:41:58 PST 2011
ctsinclair
RT @mdstudent31: the attendings and research you come across show you the way re: offlabel uses "true but lacks formal understanding" #hpm
Wed Jan 19 18:42:18 PST 2011
GailZahtz
While the body may gain dependency from chronic need of opiate meds, that is NOT the same as emotional addiction for a high. #HPM
Wed Jan 19 18:42:38 PST 2011
Mtnmd
RT @PracticalWisdom I've heard of Dr. who are doing their job responsible who the FDA shut down their practice. #hpm
Wed Jan 19 18:42:40 PST 2011
ctsinclair
RT @GailZahtz: Dependency and addiction are NOT the same issues. "Related but not the same. Hammer that point home" #hpm
Wed Jan 19 18:42:40 PST 2011
renee_berry
Everyone deserves pain relief, even addicts. Tricky but there are ways handle with integrity & professionalism #hpm
Wed Jan 19 18:43:03 PST 2011
mandajane79
RT @Mtnmd: #hpm Question: If we all agree on that, then how should those RARE ppl who prescribe for $ be handled/identified?
Wed Jan 19 18:43:17 PST 2011
mdstudent31
@ctsinclair Yep, though pts who fail on-label uses are open to off label and alternative therapies - another can of worms #hpm
Page 16 of 28
6/27/12 11:17 AM
Wed Jan 19 18:43:18 PST 2011
ctsinclair
RT @Mtnmd: Q: how should those RARE ppl who prescribe for $ be handled/identified? "More aggressive med boards/pharmacy monitoring" #hpm
Wed Jan 19 18:43:20 PST 2011
ctsinclair
RT @renee_berry: Everyone deserves pain relief, even addicts. Tricky but there are ways handle with integrity & professionalism "Yes!" #hpm
Wed Jan 19 18:43:40 PST 2011
brigid22
@hvto ran into that working in WI; gov't pharmacy regulation made it almost impossible to get narcotics for palliative pts #hpm
Wed Jan 19 18:43:55 PST 2011
GailZahtz
And after years in the field even after training, palliative doctors know best how to treat their patients, not the FDA or congress. #HPM
Wed Jan 19 18:43:58 PST 2011
mdstudent31
Noticing more and more physicians who refuse to prescribe pain meds and refer to pain management - more pt inconvenience #hpm
Wed Jan 19 18:44:09 PST 2011
PracticalWisdom
The definition I use for Addiction. Compulsive use, loss of control and continued use dispite adverse conditions. #hpm
Wed Jan 19 18:44:11 PST 2011
GailZahtz
The question back is what is the risk we are taking in the few examples they give of md's who abuse the system for personal gain? #HPM
Wed Jan 19 18:44:38 PST 2011
ctsinclair
@brigid22 I am sure you meant to say 'opioids' as opposed to narcotics. ;) #hpm

Wed Jan 19 18:44:42 PST 2011
renee_berry
@mdstudent31 @ctsinclair System should empower physicians w/a systematic approach for understanding signs & resources for addictions #hpm
Wed Jan 19 18:44:48 PST 2011
mandajane79
"@Mtnmd: #hpm Q:If we all agree on that, then how should those RARE ppl who prescribe for $ be handled/identified?"<---some kind of audits?
Wed Jan 19 18:45:04 PST 2011
mandajane79
RT @GailZahtz: And after years in the field even after training, palliative doctors know best how to treat their patients, not the FDA or congress. #HPM
Wed Jan 19 18:45:28 PST 2011
ctsinclair
@GailZahtz And are there other ways to police illicit distribution of opioids then at the prescriber. Pharmacy thefts are huge source #hpm
Wed Jan 19 18:45:46 PST 2011
Page 17 of 28
6/27/12 11:17 AM
PracticalWisdom
wish had time to read the article. Thought they were talking about Some Md's not being responsible for the scripts they were writing. #hpm
Wed Jan 19 18:45:49 PST 2011
brigid22
@ctsinclair yes, thanks. Brain is a bit mushy these days ;) #hpm

Wed Jan 19 18:46:06 PST 2011
mdstudent31
@renee_berry @ctsinclair Instead of fostering a culture of avoidance and referral. Wouldn't that be nice! #hpm
Wed Jan 19 18:46:11 PST 2011
GailZahtz
@mandajane79 Is the risk of trying to find the few minority md's who over-prescribe worth the loss to the majority of patients? #HPM
Wed Jan 19 18:46:12 PST 2011
ctsinclair
@mandajane79 I think audits/reporting might be a good start. If you can withstand a chart review from med board w/patient interview #hpm
Wed Jan 19 18:46:28 PST 2011
renee_berry
RT @GailZahtz After years in the field even after training, palliative doctors know best how to treat patients, not FDA & congress #hpm
Wed Jan 19 18:46:29 PST 2011
Mtnmd
@ctsinclair #hpm Problem is, although better, I have heard horror stories from med boards, too. Not much better, kinda scary stuff.
Wed Jan 19 18:47:16 PST 2011
renee_berry
@GailZahtz That's why it's so important for the #palliative care community to TELL congressional leaders what they see - @HospiceAction #hpm
Wed Jan 19 18:47:25 PST 2011
ctsinclair
RT @GailZahtz: Risk of few mds who over-prescribe worth loss to majority? "increasing mortality attributed to illicit oopioid use" #hpm
Wed Jan 19 18:47:37 PST 2011
GailZahtz
@ctsinclair Even with audits and reporting, there would have to be a separate barometer for palliative physicians versus non-palliative #HPM
Wed Jan 19 18:47:45 PST 2011
mdstudent31
@ctsinclair There are also ongoing discussions re:centralized prescribing/reporting for pain meds - flagged @ pharm or ED b4 problems #hpm
Wed Jan 19 18:47:52 PST 2011
ctsinclair
@Mtnmd sigh, that is true. if they were well funded and not so knee-jerk reactionary #hpm
Wed Jan 19 18:47:59 PST 2011
Page 18 of 28
6/27/12 11:17 AM
GailZahtz
RT @renee_berry: @GailZahtz That's why it's so important for the #palliative care community to TELL congressional leaders what they see - @HospiceAction #hpm
Wed Jan 19 18:48:01 PST 2011
ctsinclair
Getting ready for Topic #3 - a little bit lighter to end on! #hpm
Wed Jan 19 18:48:29 PST 2011
mandajane79
@GailZahtz good question!and id have to say no if it came down to that...seems like a double-edged sword #hpm
Wed Jan 19 18:48:55 PST 2011
renee_berry
@ctsinclair how closely/if at all is that increase related to terminally ill patients? #hpm
Wed Jan 19 18:48:59 PST 2011
GailZahtz
But why are we even spending the energy on flagging this particular issue in medicine when there is much to lose and little to gain? #HPM
Wed Jan 19 18:49:03 PST 2011
Mtnmd
@ctsinclair @GailZahtz #hpm Who should be doing the audits? Pharma? Boards? Police? Legal jurisdictions?
Wed Jan 19 18:49:06 PST 2011
PracticalWisdom
@ctsinclair: Thankful, yes indeed! #hpm

Wed Jan 19 18:49:09 PST 2011
brigid22
@GailZahtz yes, need to look at WHY it is being prescribed. #hpm

Wed Jan 19 18:49:20 PST 2011
ctsinclair
RT @renee_berry: Thats why its so important for the #palliative care community (and patients) to TELL congress - >@HospiceAction #hpm
Wed Jan 19 18:49:25 PST 2011
mdstudent31
@GailZahtz @renee_berry The same congressional leaders that pulled the shenanigans they did this evening? #hpm
Wed Jan 19 18:49:30 PST 2011
GailZahtz
@Mtnmd @ctsinclair Personally, I'm not in favor of the audits at all. No-one goes to a palliative doctor who isn't really sick. #HPM
Wed Jan 19 18:49:57 PST 2011
ctsinclair
RT @renee_berry: @ctsinclair how closely/if at all is that increase related to terminally ill patients? "not sure" #hpm
Wed Jan 19 18:49:57 PST 2011
ctsinclair
@mdstudent31 What shenanigans? #hpm

Wed Jan 19 18:50:08 PST 2011
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6/27/12 11:17 AM
PracticalWisdom
When there is a control med it's complicated. Ask Ped. who write scrips for ADHD Meds. #hpm
Wed Jan 19 18:50:23 PST 2011
renee_berry
@GailZahtz disagree that there is little to gain, just think it shouldn't be correlated w/hpm ...more issue of addiction -->not in eol #hpm
Wed Jan 19 18:50:35 PST 2011
mdstudent31
@ctsinclair repealing something they won't be able to repeal and without anything official to replace it with #hpm
Wed Jan 19 18:50:50 PST 2011
brigid22
RT @GailZahtz: @Mtnmd @ctsinclair Personally, I'm not in favor of the audits at all. No-one goes to a palliative doctor who isn't really sick. #HPM
Wed Jan 19 18:51:04 PST 2011
ctsinclair
Topic #3 - What is the oddest/most fun way you have seen for #hospice / #pallaitive fundraiser/event? Any new ideas? #hpm
Wed Jan 19 18:51:12 PST 2011
Mtnmd
@GailZahtz @mandajane79 #hpm That is a GREAT question. In past, uniformly the answer was no. Deaths from scripts doubled btwn 99 and 06.
Wed Jan 19 18:51:20 PST 2011
GailZahtz
Another related question is how certain meds are decided to be controlled. Most argue, e.g. that Provigal shouldn't be controlled #HPM
Wed Jan 19 18:51:36 PST 2011
renee_berry
RT @ctsinclair: Topic #3 - What is the oddest/most fun way you have seen for #hospice / #pallaitive fundraiser/event? Any new ideas? #hpm
Wed Jan 19 18:52:22 PST 2011
PracticalWisdom
RT @GailZahtz: how certain meds are decided to be controlled. Most argue, e.g. that Provigal shouldnt be controlled #hpm
Wed Jan 19 18:52:33 PST 2011
GailZahtz
@Mtnmd was the death from scripts at all related to an aging population who were more likely to take scripts? #HPM @mandajane79
Wed Jan 19 18:52:45 PST 2011
renee_berry
T3 I like the National Hospice Foundation Event in April, very fun, though haven't seen a ton of innovative things happening there #hpm
Wed Jan 19 18:52:55 PST 2011
ctsinclair
T3: What I have seen for #Hospice fundraisers: rememberence walks, evening dinner and dance, battle of the bands, balloon festival #hpm
Wed Jan 19 18:53:10 PST 2011
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6/27/12 11:17 AM
hvto
@ctsinclair T3: I put 2gether cookbook of "comfort foods", sold a lot because of the slight error in the potato salad recipe.... #hpm
Wed Jan 19 18:53:23 PST 2011
mdstudent31
T3: Not really hpm, but my med school has benefit concert for Pediatric AIDS this weekend that my band is playing in, raises 30-40k/yr #hpm
Wed Jan 19 18:53:27 PST 2011
GailZahtz
Okay, tossing the ball over to @renee_berry for a more fun T3 on the National #Hospice April Event #HPM
Wed Jan 19 18:53:40 PST 2011
PracticalWisdom
@renee_berry: Can you share what they did. Curious. #hpm

Wed Jan 19 18:53:43 PST 2011
hvto
T3; Potato Salad recipe said "wash & cut your potentates" #hpm
Wed Jan 19 18:53:51 PST 2011
ctsinclair
@hvto I like the cookbook idea. We have that at our hospice house. #hpm
Wed Jan 19 18:54:05 PST 2011
DrSnit
@mdstudent31 this is REALLY cool. how do they market it? #hpm

Wed Jan 19 18:54:14 PST 2011
inhousehospice
T3: To recruit pet therapy vols, we attended a "dog swim" (last day of waterpark being open, let dogs run around). Successful & fun! #hpm
Wed Jan 19 18:54:16 PST 2011
PracticalWisdom
@mdstudent31: umm, would you like to raise $ for a lovely small business owner? #hpm
Wed Jan 19 18:54:45 PST 2011
ctsinclair
@mdstudent31 I played in a band in residency with some pediatricians. Our name "Failure to Thrive" bad i know, apt name for our music #hpm
Wed Jan 19 18:54:53 PST 2011
mdstudent31
@DrSnit It's all through the medical school to faculty, staff, students. We get items from community for silent auction during event #hpm
Wed Jan 19 18:54:54 PST 2011
hvto
@hvto Cookbook unusual because I asked for recipes that = comfort. People remembered xs of being safe, loved...I learned a lot. #hpm
Wed Jan 19 18:55:04 PST 2011
Mtnmd
@GailZahtz @mandajane79 Re: narcotics, it is diversion and abuse. Not the intended audience #hpm
Wed Jan 19 18:55:07 PST 2011
Page 21 of 28
6/27/12 11:17 AM
ctsinclair
@mdstudent31 We played a few fundraisers too. I think that is a great idea. #hpm
Wed Jan 19 18:55:14 PST 2011
mdstudent31
@PracticalWisdom I like raising money :) #hpm

Wed Jan 19 18:55:34 PST 2011
ctsinclair
@mdstudent31 Are you going to post some pics/video online so we can jam with you? #hpm
Wed Jan 19 18:55:36 PST 2011
GailZahtz
@Mtnmd sorry, I lost you- could you clarify? #HPM @mandajane79

Wed Jan 19 18:56:05 PST 2011
mdstudent31
@ctsinclair We also played a benefit for "Physicians for Social Responsibility". Brought all philly area med school bands in #hpm
Wed Jan 19 18:56:06 PST 2011
PracticalWisdom
@mdstudent31: Let's make a Deal! Sold on that idea? #hpm

Wed Jan 19 18:56:13 PST 2011
renee_berry
@PracticalWisdom Starts w/Silent Auction, then dinner, some speaking/thanking/ dessert & dancing in #dc , love that city! #hpm
Wed Jan 19 18:56:20 PST 2011
ctsinclair
RT @hvto: T3; Potato Salad recipe said "wash & cut your potentates" "Ahhh....spell check!" #hpm
Wed Jan 19 18:56:36 PST 2011
mandajane79
oh yeah...#hpm...oops:p
Wed Jan 19 18:56:45 PST 2011
mdstudent31
Here is from 2009: http://www.youtube.com/watch?v=qozd6pZsF5c #hpm

Wed Jan 19 18:56:46 PST 2011
GailZahtz
@renee_berry Hey, I'm still in #DC in April! Also, what about if we brought something from #hospice residents that they contributed? #HPM
Wed Jan 19 18:56:59 PST 2011
PracticalWisdom
@renee_berry Thank you. #hpm

Wed Jan 19 18:57:01 PST 2011
ctsinclair
RT @mdstudent31: Here is from 2009: http://www.youtube.com/watch?v=qozd6pZsF5c "Awesome cant wait to watch" #hpm
Wed Jan 19 18:57:29 PST 2011
Page 22 of 28
6/27/12 11:17 AM
Mtnmd
#Hpm I love giving fundraisers and hv raised lots of $. A "Celebrity Cook Off" event followed by cookbook a month later doubles $ and FUN!!
Wed Jan 19 18:57:34 PST 2011
PracticalWisdom
@mdstudent31: This is really great~looked like lots of fun! Congrats #hpm

Wed Jan 19 18:57:43 PST 2011
renee_berry
I know @HospiceValley does some fun events locally, they participate in a duck race, have theme parties, drive @Tesla 's :) #hpm
Wed Jan 19 18:57:46 PST 2011
GailZahtz
@renee_berry Also, there's an active group here I know that works on keep elderly home before hospice- they would help. #HPM
Wed Jan 19 18:57:48 PST 2011
PracticalWisdom
I"m glad but surprised Cookbooks are still working. #hpm

Wed Jan 19 18:58:09 PST 2011
mdstudent31
Also danced in Penn State's Dance Marathon "THON" for Pediatric Cancer - world's largest student-run philanthropy www.thon.org #hpm
Wed Jan 19 18:58:18 PST 2011
hvto
@ctsinclair I think Dan Quayle was channeling thoughts to me #hpm

Wed Jan 19 18:58:20 PST 2011
mandajane79
"@GailZahtz: Also, what about if we brought something from #hospice residents that they contributed? #HPM"<---LOVE that idea!!!
Wed Jan 19 18:58:32 PST 2011
renee_berry
@GailZahtz sounds interesting, we should chat before I'm back in dc #hpm

Wed Jan 19 18:58:34 PST 2011
Mtnmd
@GailZahtz #hpm Deaths from abuse typically Johnny stealing grandma's vicodin and sharing or selling.
Wed Jan 19 18:58:35 PST 2011
mibetteridge
RT @Colleen_Young: Thx @MeredithGould @TheGr8Chalupa. @mibetteridge designed #hcsmca avatar. (Keep singing) #hcsmeu #hcsm #mhsm #hpm #RNchat #MDchat
Wed Jan 19 18:58:55 PST 2011
PracticalWisdom
My undergrad. did an auction of our talents. Fun plus built community. #hpm
Wed Jan 19 18:59:02 PST 2011
GailZahtz
@Mtnmd Right, so if death from abuse isn't even the patient, why is the FDA and Congress monitoring MD's and Pt's? #HPM
Wed Jan 19 18:59:14 PST 2011
Page 23 of 28
6/27/12 11:17 AM
ctsinclair
Me playing in "Failure to Thrive" a doctor rock band in 2003 #hpm #hcsm http://twitpic.com/3rlrhr
Wed Jan 19 18:59:21 PST 2011
GailZahtz
@renee_berry Email or call me. Can only do so much in 140 characters! :) #HPM
Wed Jan 19 18:59:49 PST 2011
mdstudent31
@PracticalWisdom Our event does that as well - to raise money for its operation. We auctioned ourselves off (ie cleaning, cooking, etc) #hpm
Wed Jan 19 19:00:04 PST 2011
DrSnit
@mdstudent31 OMG - I feel like we need lighters #hpm

Wed Jan 19 19:00:04 PST 2011
PracticalWisdom
@Mtnmd: When I taught in Drug Rehab lost of housekeepers were stealing Pain meds from their clients. Very common very sad! #hpm
Wed Jan 19 19:00:06 PST 2011
mandajane79
RT @PracticalWisdom: @Mtnmd: When I taught in Drug Rehab lost of housekeepers were stealing Pain meds from their clients. Very common very sad! #hpm
Wed Jan 19 19:00:29 PST 2011
PracticalWisdom
@DrSnit : Free Bird! #hpm

Wed Jan 19 19:00:33 PST 2011
renee_berry
omg...#celebrity hahaRT @ctsinclair Me playing in "Failure to Thrive" a doctor rock band in 2003 #hpm #hcsm http://twitpic.com/3rlrhr #hpm
Wed Jan 19 19:00:39 PST 2011
hvto
RT @DrSnit: @mdstudent31 OMG - I feel like we need lighters #hpm

Wed Jan 19 19:00:42 PST 2011
mdstudent31
@DrSnit haha it's a lot of fun! Can't wait for Saturday's show! #hpm
Wed Jan 19 19:00:54 PST 2011
mdstudent31
@ctsinclair that's a GREAT shot #hpm

Wed Jan 19 19:01:07 PST 2011
ctsinclair
Clsoing out tonight, on the theme of rock bands, leave us with some wise lyrics! #hpm
Wed Jan 19 19:01:12 PST 2011
ctsinclair
The #hpm Daily is out! http://bit.ly/gJpc2i Top stories today by @ctsinclair @hospice_mktg @hospicepharmacy @hcsmca @zarakramer
Wed Jan 19 19:01:19 PST 2011
Page 24 of 28
6/27/12 11:17 AM
DrSnit
@ctsinclair nice! #hpm

Wed Jan 19 19:01:48 PST 2011
brigid22
you can't always get what you want, but if you try, you just might get what you need #hpm
Wed Jan 19 19:02:12 PST 2011
mandajane79
keep forgetting the #hpm...grr

Wed Jan 19 19:02:24 PST 2011
GailZahtz
@PracticalWisdom @Mtnmd Addiction is awful. But that's the place of Md's like @drmanejwala not #palliative or Congress or FDA. #HPM
Wed Jan 19 19:02:33 PST 2011
PracticalWisdom
I"m alive, alert, awake, enthusiastic It's a real song. #hpm

Wed Jan 19 19:02:40 PST 2011
Mtnmd
@ctsinclair #hpm We have a real BATTLE OF THE BANDS here tonight, very cool.
Wed Jan 19 19:02:44 PST 2011
ctsinclair
Lyrics from Edward Sharpe song "Home": "Alabama, Arkansas, I do love my ma and pa, but not the way that I do love you" #hpm
Wed Jan 19 19:03:37 PST 2011
ctsinclair
RT @brigid22: you cant always get what you want, but if you try, you just might get what you need #hpm
Wed Jan 19 19:03:59 PST 2011
mdstudent31
Time to study - must be lyrics from some type of song... Hitting the rheumatology text. Good night all! #hpm
Wed Jan 19 19:04:26 PST 2011
Mtnmd
@PracticalWisdom #hpm Yes, theft from real patients a problem, and intentional diversion also a problem. But I see the other end of this :)
Wed Jan 19 19:04:46 PST 2011
PracticalWisdom
ctsinclair: Suggestion. Could we have time to check out the article in the Washington Post and revisit next week after we have read it? #hpm
Wed Jan 19 19:04:48 PST 2011
renee_berry
@ctsinclair I listen to that song obsessively sometimes haha ...Repeat http://www.youtube.com/watch?v=rjFaenf1T-Y #hpm
Wed Jan 19 19:04:53 PST 2011
ctsinclair
Goodnight all! Thanks again for a great tweetchat community. In #hcsm, we are one of the largest specialty tweetchats #hpm
Wed Jan 19 19:05:18 PST 2011
Page 25 of 28
6/27/12 11:17 AM
DrSnit
@mdstudent31 nite! break a leg on stage and make sure to post the vid ok!! #hpm
Wed Jan 19 19:05:20 PST 2011
Mtnmd
RT @brigid22 you can't always get what you want, but if you try, you just might get what you need #hpm
Wed Jan 19 19:05:36 PST 2011
renee_berry
@PracticalWisdom agree, maybe not pre-topic announcements, but pre-topic reads? #hpm
Wed Jan 19 19:05:39 PST 2011
ctsinclair
RT @PracticalWisdom: Could we have time to check out the article in the Washington Post and revisit next week? "Good idea - YES!" #hpm
Wed Jan 19 19:05:43 PST 2011
mandajane79
"and so it is/just like you said it would be,life goes easy on me,most of the time" #hpm
Wed Jan 19 19:06:13 PST 2011
GailZahtz
@ctsinclair Did everyone get the links- the first article and the response from the APA? #HPM
Wed Jan 19 19:06:34 PST 2011
ctsinclair
@mdstudent31 Good night! Thanks for participating, studying, playing music and raising money. I can tell you will be a good doc #hpm
Wed Jan 19 19:06:35 PST 2011
Mtnmd
@GailZahtz @PracticalWisdom @drmanejwala I understand your thoughts. I see both sides. I agree, doctors should lead this issue. #hpm
Wed Jan 19 19:06:45 PST 2011
DrSnit
@ctsinclair Night cats! I've missed you! Thanks for holding space for me! Great chat and great moderating. And lovely people! #hpm
Wed Jan 19 19:06:50 PST 2011
ctsinclair
@GailZahtz Send to me and I will will schedule a few tweets for early next week as reminders. #hpm
Wed Jan 19 19:07:12 PST 2011
ctsinclair
@DrSnit You always have space here. #hpm

Wed Jan 19 19:07:29 PST 2011
PracticalWisdom
@ctsinclair:Once again you did an amazing job. It's challenging and you do a great job. Thanks for all you do. Good Night everybody! #hpm
Wed Jan 19 19:07:31 PST 2011
mandajane79
thank you all for allowing me to join in again!starting to get more used to this:)and thanks @ctsinclair for hosting!good ?s!!! #hpm
Page 26 of 28
6/27/12 11:17 AM
Wed Jan 19 19:07:40 PST 2011
PracticalWisdom
@ctsinclair: I second that motion. #hpm

Wed Jan 19 19:07:57 PST 2011
GailZahtz
@ctsinclair http://wapo.st/evTkhw That is the first article that the Post put up front cover in their special edition. #HPM
Wed Jan 19 19:08:08 PST 2011
ctsinclair
@PracticalWisdom @mandajane79 You all make it so easy! #hpm

Wed Jan 19 19:08:22 PST 2011
mandajane79
@Mtnmd @GailZahtz @PracticalWisdom @drmanejwala i always see all sides:/sort of a downfall for me sometimes #hpm
Wed Jan 19 19:08:26 PST 2011
PracticalWisdom
@GailZahtz: Thank you! #hpm

Wed Jan 19 19:08:47 PST 2011
mandajane79
@ctsinclair @PracticalWisdom :) #hpm

Wed Jan 19 19:09:08 PST 2011
Mtnmd
@mandajane79 @GailZahtz @PracticalWisdom @drmanejwala Me, too! #hpm

Wed Jan 19 19:09:46 PST 2011
PracticalWisdom
@mandajane79: I would call that a Blessing! Lots of pieces to make a solid foundation. The diversity I think makes us + #hpm
Wed Jan 19 19:09:59 PST 2011
Mtnmd
@ctsinclair Thanks so much!! #hpm

Wed Jan 19 19:10:07 PST 2011
GailZahtz
http://wapo.st/edZc0Z is reply from the American Academy of Pain Management- excellent and put on the bottom of the page #HPM @ctsinclair
Wed Jan 19 19:10:27 PST 2011
hvto
RT @Mtnmd: @ctsinclair Thanks so much!! #hpm

Wed Jan 19 19:10:36 PST 2011
ctsinclair
And as always looking for helpers for the hpmresources blog: http://hpmresources.pbworks.com #hpm
Wed Jan 19 19:12:12 PST 2011
ctsinclair
Night all! #hpm

Wed Jan 19 19:12:17 PST 2011
Page 27 of 28
6/27/12 11:17 AM
KathyKastner
fooey. teenager-related issues made me miss what sounds like fab #hpm. look forward to reading. Go @ctsinclair 4 largest specialty chat
Wed Jan 19 19:12:56 PST 2011
GailZahtz
@ctsinclair Goodnight. Thanks for your trust, encouragement and leadership in #HPM and all of #HCSM.
Wed Jan 19 19:12:59 PST 2011
GailZahtz
@KathyKastner You missed it! @ctsinclair passed the moderating ball to me with 5 minutes notice mid-chat- whew! #HPM
Wed Jan 19 19:13:44 PST 2011
PracticalWisdom
Good Night everyone: http://www.youtube.com/watch?v=cp7_u0kcQRo #hpm

Wed Jan 19 19:13:50 PST 2011
KathyKastner
RT @renee_berry: Everyone deserves pain relief, even addicts. Tricky but there are ways handle with integrity & professionalism #hpm
Wed Jan 19 19:14:05 PST 2011
KathyKastner
Oh boy! How Awesome! RT @GailZahtz: You missed it! @ctsinclair passed the moderating ball to me with 5 minutes notice mid-chat- whew! #HPM
Wed Jan 19 19:14:50 PST 2011
Page 28 of 28

#HPM Tweet Chat 1:19:11

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#hpm - Healthcare Social Media Transcript

Hi folks, Earl here. Checking in but lurking. #hpm

@ctsinclair Hey all - have missed you! Melissa here. #hpm

#hpm - Healthcare Social Media Transcript

#hpm - Healthcare Social Media Transcript

@PracticalWisdom My first topic is a doozy. #hpm

@mdstudent31 I've never been disappointed by you! #hpm

@PracticalWisdom You're too kind :) #hpm

@mdstudent31 hey Kevin. Nice to have you! #hpm

@GailZahtz Both! #hpm

am late but here!#hpm

#hpm - Healthcare Social Media Transcript

@mdstudent31: Nope I"m just straight up! :<) #hpm

Looks like we have a quorum...let's begin! #hpm

@mandajane79: I"m so glad #hpm

Drum roll #hpm

@ctsinclair T1 Fentanyl please ;)) #HPM

@DrSnit Hey Melissa! Glad to be here! #hpm

brigid22, LPN/nurisng student, mosstly lurking tonight #hpm

@mandajane79 hey sassy! #hpm

@PracticalWisdom thank you!!!!!#hpm

@brigid22 good to see you here tonight. #hpm

#hpm - Healthcare Social Media Transcript

Wed Jan 19 18:12:13 PST 2011

@DrSnit hello daaahlin!#hpm

T1: How would pain be interpreted? #hpm

#hpm - Healthcare Social Media Transcript

@ctsinclair: T1 would this not be very time intensive? #hpm

T1: PCAbyProxy - another part of the advanced directive/living will? #hpm

#hpm - Healthcare Social Media Transcript

Wed Jan 19 18:16:51 PST 2011

@ctsinclair PCA may be more precise on timing/dosing? #hpm

#hpm - Healthcare Social Media Transcript

i think empowered AND dangerous...there are so many factors involved...#hpm

#hpm - Healthcare Social Media Transcript

@renee_berry I'm feelin' one of your initiatives coming!!! #HPM

@ctsinclair haha yes, that would be it. Re: PCMH #hpm

@mdstudent31 Shout out to Pitt County! #hpm

#hpm - Healthcare Social Media Transcript

Wed Jan 19 18:26:28 PST 2011

Wrapping T1 up soon and we will get to Topic #2 #hpm

#hpm - Healthcare Social Media Transcript

Wed Jan 19 18:28:47 PST 2011

@DrSnit: Good Point. But perhaps each Pt/situation is different? #hpm

@mdstudent31 exactly, it presents a double standard there #hpm

@renee_berry nice try! #hpm

#hpm - Healthcare Social Media Transcript

would prescribe more #hpm

@ctsinclair @GailZahtz me neither:) #hpm

@PracticalWisdom definitely sistah. for sure!! #hpm

#hpm - Healthcare Social Media Transcript

Wed Jan 19 18:34:50 PST 2011

@joshgriffin Hey Josh, glad to see you check in! #hpm

@JoshGriffin sending you love! #hpm

#hpm - Healthcare Social Media Transcript

Wait did we say T2? I'm confused #hpm

#hpm - Healthcare Social Media Transcript

@GailZahtz You caught the pass well and gracefully! #hpm

#hpm - Healthcare Social Media Transcript

@ctsinclair @GailZahtz: Agree good catch #hpm

Dependency and addiction are NOT the same issues. #HPM

#hpm - Healthcare Social Media Transcript

Wed Jan 19 18:43:18 PST 2011