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#hpm - Healthcare Social Media Transcript

#hpm transcript

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Wed Jan 19 18:00:00 PST 2011

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6/27/12 11:17 AM

ctsinclair

equijada

hospice_mktg

ctsinclair

DrSnit

PracticalWisdom

Welcome to the Hospice and Palliative Medicine Tweetchat. I'm hosting tonight. Let’s start

with some introductions

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

Hello! I'm Emily Barry tweeting on behalf of Transcend Hospice Marketing Group, @hospice_mktg #hpm

I am Christian Sinclair, palliative doc @kchospice, editor @pallimed, board member @AAHPM, fan of Hailee Steinfeld in True Grit #hpm

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

HI Christian and #HPM gang. I"m Lisa, curious Adult Education Scholar, Speaker, Trainer, Presentation Designer, Rascal. #hpm

#hpm - Healthcare Social Media Transcript

ctsinclair

GailZahtz

mdstudent31

ctsinclair

renee_berry

ctsinclair

ctsinclair

GailZahtz

renee_berry

PracticalWisdom

ctsinclair

GailZahtz

6/27/12 11:17 AM

Hi! I'm Ash, marketing coordinator at In-House Hospice & Palliative Care in Michigan and Ohio. :) #hpm

Hi. Feel like it's been ages, but I

kid, wife of surgeon, founder HCSM start-up #HPM

health

comm background, ehlers danlos pt, mom of sick

Hey all, Kevin, 4th year med student, soon-to-be family med intern, family med advocate, lurking/observing #hpm

We'll get started with the first topic in a few minutes

RT @ctsinclair: We'll get started with the first topic in a few minutes

For next hour my posts will be on #hospice palliative topics, pls join/RT if you are interested! Tweets are my own #TAMO #hpm

@mdstudent31 Welcome Kevin, glad to have some med students here. #hpm

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

---> Love the #hospice & #palliative care community, passionate about advance care planning & social media #hpm

Wow, this really is a great group of folks tonight. Got to put my thinking cap on. #hpm

@GailZahtz A good friend in San Diego had Ehlers Danlos. we did ice skating coaching for special olympics. Good guy, lost touch #hpm

@ctsinclair Oh, Christian, according to Klout you are 1) a "celebrity and 2) the person who most influences me- exciting right ;)) #HPM

#hpm - Healthcare Social Media Transcript

ctsinclair

mdstudent31

DrSnit

ctsinclair

PracticalWisdom

GailZahtz

mdstudent31

DrSnit

ctsinclair

ctsinclair

mandajane79

GailZahtz

6/27/12 11:17 AM

@PracticalWisdom My first topic is a doozy. #hpm

@ctsinclair Thanks! I caught the tail-end of one of these but wanted to see if I could be a useful contributor #hpm

RT @renee_berry: ---> Love the #hospice & #palliative care community, passionate about advance care planning & social media #hpm

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

RT @GailZahtz: @ctsinclair Oh, Christian, according to Klout you are a "celebrity" "I can tell you how annoying the paprazzi is :^P " #hpm

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

@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

@PracticalWisdom You're too kind :) #hpm

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

Important acronym for T1: PCA = patient controlled analgesia aka morphine/fentanyl/opioid pump where patient can give dose #hpm

am late but here!#hpm

@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

#hpm - Healthcare Social Media Transcript

PracticalWisdom

ctsinclair

PracticalWisdom

GailZahtz

GailZahtz

mdstudent31

ctsinclair

ctsinclair

brigid22

DrSnit

GailZahtz

mandajane79

DrSnit

6/27/12 11:17 AM

@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

@PracticalWisdom You're like a whole acoustic band tonight! Send me the soundtrack ;) #HPM

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

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

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

@mandajane79 hey sassy! #hpm

T1 Add to this- did everyone see the Washington Post article slamming palliative care docs for too much pain management? Awful!!! #HPM

@PracticalWisdom thank you!!!!!#hpm

@brigid22 good to see you here tonight. #hpm

#hpm - Healthcare Social Media Transcript

mandajane79

ctsinclair

mdstudent31

brigid22

Pallimed

PracticalWisdom

renee_berry

DrSnit

PracticalWisdom

ctsinclair

@DrSnit hello daaahlin!#hpm

6/27/12 11:17 AM

@GailZahtz No send the link and we will make that topic 2! #hpm

T1: Good place to start - patient consent and autonomy. If they want PCAbyProxy, lets figure a way to accommodate #hpm

RT @ctsinclair Should someone else be allowed to press a PCA button for patient who cant press for themselves? (aka PCA by proxy) #hpm

@ctsinclair @GailZahtz please do :) I would love to read and discuss that #hpm

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

T1: If Pt unable to press the button themselves who would do so? Health care professional/Family member? #hpm

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

T1 absolutely, but what should be the guidelines to help that person know the best way to use it? #hpm

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

T1: How would pain be interpreted? #hpm

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

#hpm - Healthcare Social Media Transcript

GailZahtz

ctsinclair

hospice_mktg

ctsinclair

GailZahtz

PracticalWisdom

mdstudent31

ctsinclair

ctsinclair

renee_berry

GailZahtz

PracticalWisdom

6/27/12 11:17 AM

Here's the feature where they examined palliative docs, who of course prescribe more than other docs http://wapo.st/evTkhw #HPM

@PracticalWisdom Family or staff might press a PCA button by proxy. No fingerprint scanning that I know of. ;) #hpm

T1 agree definitely would need guidelines, understand non-verbals to know if pt is uncomfortable or in pain #hpm

RT @PracticalWisdom: T1: How would pain be interpreted? "Always a thorny (i.e. painful) dilemma! Patient report is gold standard" #hpm

Here was the response from the APA http://wapo.st/edZc0Z that was excellent but made bottom of the page #HPM

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

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

@DrSnit Good point about a non aware patient no longer having a true 'patient controlled analgesia' #hpm

RT @mdstudent31: T1: PCAbyProxy - another part of the advanced directive/living will? "Good thought - who do I trust to give me meds" #hpm

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

RT @mdstudent31: T1: PCAbyProxy - another part of the advanced directive/living will? #hpm

@mdstudent31 Remember we were talking about this earlier in the week? About how proxy needs to "have the talk" on more decisions? #HPM

T1: Isn't tolerance an issue if long term pain management is needed? #hpm

#hpm - Healthcare Social Media Transcript

ctsinclair

ctsinclair

mdstudent31

ctsinclair

OncoPRN

ctsinclair

GailZahtz

mdstudent31

PracticalWisdom

6/27/12 11:17 AM

RT @PracticalWisdom: T1 would this not be very time intensive? "PCA by proxy (nurse or family) saves time vs. drawing up meds #hpm

@GailZahtz @mdstudent31 And by the way #HavetheTalk is the unofficial hashtag for National Healthcare Decisions Day (4/16) #hpm

Yes! RT @GailZahtz @mdstudent31 re proxy needs to #HaveTheTalk on more decisions? yes! cc @EngageWithGrace #hpm

@GailZahtz Yes - proxy/POA,etc all need to be part of the decision-making process w/ proper comm. from hcps #hpm

@renee_berry Yes you can limit how many times the button is pressed. This is one of my concerns with PCA by proxy. #hpm

Agree! RT @renee_berry: Yes! RT @GailZahtz @mdstudent31 re proxy needs to #HaveTheTalk on more decisions? yes! cc @EngageWithGrace #hpm

RT @ctsinclair Should someone else be allowed to press a PCA button for patient who cant press for themselves? (aka PCA by proxy) #hpm

Is PCA(IVmeds) by proxy any different fundamentally from a family member dosing liquid morphine? #hpm

Well I won't steal #HaveTheTalk but the idea we had was that there are more implications- like who is told bad news? Proxy may be best #HPM

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

sounds like a blog post RT @ctsinclair Is PCA(IVmeds) by proxy any different fundamentally from a family member dosing liquid morphine? #hpm

How many family members/Friends would want the responsibility of monitoring pain for their loved one. Tons of responsibility. #hpm

#hpm - Healthcare Social Media Transcript

ctsinclair

GailZahtz

mdstudent31

ctsinclair

GailZahtz

mandajane79

PracticalWisdom

renee_berry

ctsinclair

ctsinclair

mdstudent31

6/27/12 11:17 AM

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

@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

@PracticalWisdom the family members/friends need the same amount of support/resources as the patient does at that point #hpm

RT @ctsinclair: Is PCA(IVmeds) by proxy any different fundamentally from a family member dosing liquid morphine? #hpm

RT @PracticalWisdom: How many family/friends want the responsibility of monitoring pain for their loved one. Tons of responsibility. #hpm

@PracticalWisdom @ctsinclair If the dosing is approved by the doctor, let the patient be in less pain. Who wouldn't want that? #HPM

i think empowered AND dangerous

there

are so many factors involved

So many families are not geographically close, divorced families, Single never married, etc. Families are now very complex. #hpm

yes RT @GailZahtz After I had the talk w/my husband, realized its much more than #death - its all health #HaveTheTalk #hpm

The Joint Commission (@TJCommission) considers PCA by proxy a sentinel event http://bit.ly/igvSDf #hpm

RT @mandajane79: i think empowered AND dangerous

involved

there

are so many factors

@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

#hpm - Healthcare Social Media Transcript

DrSnit

ctsinclair

renee_berry

GailZahtz

mdstudent31

brigid22

ctsinclair

PracticalWisdom

mdstudent31

renee_berry

ctsinclair

renee_berry

6/27/12 11:17 AM

PCA(IVmeds) by proxy is more consistent but family member dosing liquid morphine can tweak up or down. #hpm

RT @GailZahtz: After I had the talk w/my husband, realized its much more than death, its all health "(And choice)" #hpm

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

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

@DrSnit That's what I figured Re: PCA dosing/timing. Could be mucgh easier for caregiver #hpm

Very true RT @DrSnit: PCA(IVmeds) by proxy is more consistent but family member dosing liquid morphine can tweak up or down. #hpm

@mdstudent31 #PCMH = Patient centered medical home not Pitt County Memorial hospital right? ;^) #hpm

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

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

haha, I do get very involved

@renee_berry Im feelin one of your initiatives coming!! #hpm

anything to empower patient care! RT @GailZahtz

So everyone here seems to think a good idea, but what about @TJCommission saying 'PCA by proxy is a big no-no!" #hpm

oo good point RT @ctsinclair @mdstudent31 #PCMH = Patient centered medical home not Pitt County Memorial hospital right? ;^) #hpm

@mdstudent31 Shout out to Pitt County! #hpm

#hpm - Healthcare Social Media Transcript

ctsinclair

ctsinclair

GailZahtz

PracticalWisdom

Mtnmd

PracticalWisdom

mdstudent31

DrSnit

6/27/12 11:17 AM

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

@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

RT @PracticalWisdom: So many families are not geographically close, divorced families, Single never married, etc. Families are now very complex. #hpm

@ctsinclair @mdstudent31: Curious George wants to know inside scoop Pitt County. Later conversation? #hpm

I think I'm ready for T2 my head is feeling full trying to discuss these clinical aspects of care :) #hpm

RT @DrSnit: PCA(IVmeds) by proxy is more consistent but family member dosing liquid morphine can tweak up or down. #hpm

RT @renee_berry: I think Im ready for T2 my head is feeling full trying to discuss these

clinical aspects of care

:) #hpm

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

Agree!RT@renee_berry I think I'm ready for T2 my head is feeling full trying to discuss

these clinical aspects of care

If PCAbyProxy big no-no, then they imply same re: pain management and caregivers/aids/family giving pain meds in general? #hpm

@GailZahtz thank you

community

and I'll say as WE make it happen. Starts with engaging the

---------------> #hpm

For some family members doing palliative care it aint their first trip to the rodeo- even for complex families. #hpm

#hpm - Healthcare Social Media Transcript

ctsinclair

PracticalWisdom

GailZahtz

brigid22

ctsinclair

GailZahtz

ctsinclair

ctsinclair

GailZahtz

6/27/12 11:17 AM

handing it ver to @GailZahtz to introduce Topic#2: Doctors who prescribe oft-abused drugs face scrutiny http://wapo.st/evTkhw #hpm

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

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

RT @mdstudent31: If PCAbyProxy big no-no, then they imply same re: pain management and caregivers/aids/family giving pain meds in general? #hpm

Okay, not prepared, but have strong feelings- did everyone get the two Washington Post articles on prescription narcotics & response? #HPM

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

@Atul_Gawande cool to see you tweeting, know you're welcome to join our #hpm ( #hospice & #palliative medicine) Tweetchat Live now

@GailZahtz I have not yet, but am intersted in the topic of course! #hpm

Few points- they sector the government looked at were 1. Medicaid/Medicare docs and 2. Palliative docs- most who would prescribe more #HPM

RT @renee_berry: @Atul_Gawande cool to see you tweeting, youre welcome to join our #hpm ( #hospice & #palliative medicine) chatLive now #hpm

@renee_berry nice try! #hpm

The response from the American Palliative Association was that if we make physicians afraid to prescribe, it can lead to suicide, etc. #HPM

RT @GailZahtz: Govt looked at 1. Medicaid/Medicare docs and 2. Palliative docs- most who

#hpm - Healthcare Social Media Transcript

ctsinclair

mandajane79

GailZahtz

DrSnit

GailZahtz

ctsinclair

mdstudent31

ctsinclair

GailZahtz

ctsinclair

would prescribe more #hpm

6/27/12 11:17 AM

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

RT @renee_berry: @Atul_Gawande cool to see you tweeting, know youre welcome to join our #hpm ( #hospice & #palliative medicine) #hpm

@PracticalWisdom definitely sistah. for sure!! #hpm

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

Yet, the response and highlight of course would be from Wash Post that there are md's who take advantage by these prescriptions. #HPM

Siobhan Reynolds who blogged/campaigned for rights of those needing pain relief, shut down her site http://www.slate.com/id/2278244/ #hpm

T2: Prob is that we often under-treat pain which leads to abuse of these meds. Cannot take every pts pain for granted #hpm

@renee_berry We will make Topic 3 more light hearted stick around. Got to get to the meaty stuff first. #hpm

@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

@mdstudent31 That's a good point. Under treatment can lead to over-use when trying to get pain under control. Physicians? #HPM

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

#hpm - Healthcare Social Media Transcript

PracticalWisdom

ctsinclair

GailZahtz

ctsinclair

GailZahtz

ctsinclair

ctsinclair

PracticalWisdom

brigid22

DrSnit

mdstudent31

6/27/12 11:17 AM

My heart goes out to MD, and other health care providers who write scripts for pain drugs. FDA is coming down. #hpm

RT @PracticalWisdom: My heart goes out to MD, and other health care providers who write scripts for pain drugs. FDA is coming down. #hpm

@PracticalWisdom Does the FDA have a place telling physicians how to treat chronic patients? #HPM

Wishing my #hpm tweetchat friends a great chat this evening. Will hopefully see you next week when things are calmed down.

Regarding prescribing of opioids (narcotics is broad, incorrect, and stigmatizing - pet peeve), medical board or DEA to oversee? #hpm

@JoshGriffin All of our condolences go out to you during this time of loss. Only the best wishes on behalf of everyone at #HPM

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

RT @GailZahtz: @PracticalWisdom Does the FDA have a place telling physicians how to treat chronic patients? "not that I know of" #hpm

@GailZahtz @PracticalWisdom. The first example article sounds like person who has a great chance of having the disease of addiction. #hpm

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

@JoshGriffin sending you love! #hpm

T2: Legit pain v pill seekers - often difficult. So we go middle-ground. Seekers get meds, legit pain do not get enough #hpm

#hpm - Healthcare Social Media Transcript

brigid22

Mtnmd

ctsinclair

GailZahtz

PracticalWisdom

renee_berry

mdstudent31

ctsinclair

GailZahtz

Mtnmd

6/27/12 11:17 AM

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

Absolutely Not! RT @GailZahtz: @PracticalWisdom Does the FDA have a place telling physicians how to treat chronic patients? #HPM

#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

@PracticalWisdom @GailZahtz And trying to treat addiction as a medical issue vs. a crime is variable from county to county #hpm

@PracticalWisdom The reality is that these drugs are medically dependent. That is not the same as addictive behavior for pain patients #HPM

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

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

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

@GailZahtz @PracticalWisdom Think of all off-label uses of many meds. Not FDA approved but hcps often not restricted #hpm

@JoshGriffin My goodness Josh, I had not heard. I recently lost my grandmother too. Hoping things are peaceful. #hpm

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

#hpm Criminalizing medicine will absolutely cause the last remaining doctors to bolt. Who needs that? A chance at jail w/ every decision?

#hpm - Healthcare Social Media Transcript

ctsinclair

GailZahtz

ctsinclair

mdstudent31

hvto

PracticalWisdom

ctsinclair

DrSnit

GailZahtz

6/27/12 11:17 AM

@renee_berry Yeah, T2 - govt crackdown on docs who prescribe pain meds. #hpm

@renee_berry Sorry, in a surprise move @ctsinclair passed T2 over to me about the Washington Post implications of govt and pain mgmt #HPM

@mdstudent31 They dont really teach you in medschool or residency about off-label prescribing vs. on label prescribing #hpm

@brigid22 Everyone's pain threshold changes over time as well as gaining tolerance to meds-another huge challenge #hpm

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

@mdstudent31 and then it gets further complicated by addicts in genuine pain and finding dosage that covers pain #hpm

@ctsinclair @renee_berry govt crackdown on docs who prescribe pain meds - making it hard to get hospice pt meds from the primary #hpm

I've heard of Dr. who are doing their job responsible who the FDA shut down their practice. #hpm

RT @Mtnmd: #hpm Criminalizing medicine will absolutely cause the last remaining doctors to bolt. Who needs that? A chance at jail w/ every decision?

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

@PracticalWisdom chronic pain is still not an addition issue and there is still a place pain management, not addiction assumptions #hpm

RT @ctsinclair: @GailZahtz You caught the pass well and gracefully! #hpm <-Well thank you. Doing my best, first timer. TY for trusting me.

#hpm - Healthcare Social Media Transcript

PracticalWisdom

mdstudent31

brigid22

Mtnmd

ctsinclair

GailZahtz

ctsinclair

GailZahtz

Mtnmd

ctsinclair

mdstudent31

6/27/12 11:17 AM

@ctsinclair @GailZahtz: Agree good catch #hpm

@ctsinclair - the attendings and research you come across show you the way re: off-label uses #hpm

exactly RT @mdstudent31: @brigid22 Everyone's pain threshold changes over time as well as gaining tolerance to meds-another challenge #hpm

#hpm Question: If we all agree on that, then how should those RARE ppl who prescribe for $ be handled/identified?

RT @hvto: hard to get hospice pt meds from primary MD "Anecdotally, seeing more community docs say 'let #hospice doc prescribe" #hpm

Dependency and addiction are NOT the same issues. #HPM

RT @mdstudent31: the attendings and research you come across show you the way re: off- label uses "true but lacks formal understanding" #hpm

While the body may gain dependency from chronic need of opiate meds, that is NOT the same as emotional addiction for a high. #HPM

RT @PracticalWisdom I've heard of Dr. who are doing their job responsible who the FDA shut down their practice. #hpm

RT @GailZahtz: Dependency and addiction are NOT the same issues. "Related but not the same. Hammer that point home" #hpm

Everyone deserves pain relief, even addicts. Tricky but there are ways handle with integrity & professionalism #hpm

RT @Mtnmd: #hpm Question: If we all agree on that, then how should those RARE ppl who prescribe for $ be handled/identified?

@ctsinclair Yep, though pts who fail on-label uses are open to off label and alternative therapies - another can of worms #hpm

#hpm - Healthcare Social Media Transcript

ctsinclair

ctsinclair

GailZahtz

mdstudent31

PracticalWisdom

GailZahtz

ctsinclair

ctsinclair

6/27/12 11:17 AM

RT @Mtnmd: Q: how should those RARE ppl who prescribe for $ be handled/identified? "More aggressive med boards/pharmacy monitoring" #hpm

RT @renee_berry: Everyone deserves pain relief, even addicts. Tricky but there are ways handle with integrity & professionalism "Yes!" #hpm

@hvto ran into that working in WI; gov't pharmacy regulation made it almost impossible to get narcotics for palliative pts #hpm

And after years in the field even after training, palliative doctors know best how to treat their patients, not the FDA or congress. #HPM

Noticing more and more physicians who refuse to prescribe pain meds and refer to pain management - more pt inconvenience #hpm

The definition I use for Addiction. Compulsive use, loss of control and continued use dispite adverse conditions. #hpm

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

@brigid22 I am sure you meant to say 'opioids' as opposed to narcotics. ;) #hpm

@mdstudent31 @ctsinclair System should empower physicians w/a systematic approach for understanding signs & resources for addictions #hpm

"@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?

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

@GailZahtz And are there other ways to police illicit distribution of opioids then at the prescriber. Pharmacy thefts are huge source #hpm

#hpm - Healthcare Social Media Transcript

PracticalWisdom

brigid22

mdstudent31

GailZahtz

ctsinclair

Mtnmd

ctsinclair

GailZahtz

mdstudent31

ctsinclair

6/27/12 11:17 AM

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

@ctsinclair yes, thanks. Brain is a bit mushy these days ;) #hpm

@renee_berry @ctsinclair Instead of fostering a culture of avoidance and referral. Wouldn't that be nice! #hpm

@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

@mandajane79 I think audits/reporting might be a good start. If you can withstand a chart review from med board w/patient interview #hpm

RT @GailZahtz After years in the field even after training, palliative doctors know best how to treat patients, not FDA & congress #hpm

@ctsinclair #hpm Problem is, although better, I have heard horror stories from med boards, too. Not much better, kinda scary stuff.

@GailZahtz That's why it's so important for the #palliative care community to TELL congressional leaders what they see - @HospiceAction #hpm

RT @GailZahtz: Risk of few mds who over-prescribe worth loss to majority? "increasing mortality attributed to illicit oopioid use" #hpm

@ctsinclair Even with audits and reporting, there would have to be a separate barometer for palliative physicians versus non-palliative #HPM

@ctsinclair There are also ongoing discussions re:centralized prescribing/reporting for pain meds - flagged @ pharm or ED b4 problems #hpm

@Mtnmd sigh, that is true. if they were well funded and not so knee-jerk reactionary #hpm

#hpm - Healthcare Social Media Transcript

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6/27/12 11:17 AM

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

Getting ready for Topic #3 - a little bit lighter to end on! #hpm

@GailZahtz good question!and id have to say no if it came down to that double-edged sword #hpm

seems like a

@ctsinclair how closely/if at all is that increase related to terminally ill patients? #hpm

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

@ctsinclair @GailZahtz #hpm Who should be doing the audits? Pharma? Boards? Police? Legal jurisdictions?

@ctsinclair: Thankful, yes indeed! #hpm

@GailZahtz yes, need to look at WHY it is being prescribed. #hpm

RT @renee_berry: Thats why its so important for the #palliative care community (and patients) to TELL congress - >@HospiceAction #hpm

@GailZahtz @renee_berry The same congressional leaders that pulled the shenanigans they did this evening? #hpm

@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

RT @renee_berry: @ctsinclair how closely/if at all is that increase related to terminally ill patients? "not sure" #hpm

@mdstudent31 What shenanigans? #hpm

#hpm - Healthcare Social Media Transcript

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6/27/12 11:17 AM

When there is a control med it's complicated. Ask Ped. who write scrips for ADHD Meds. #hpm

@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

@ctsinclair repealing something they won't be able to repeal and without anything official to replace it with #hpm

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

Topic #3 - What is the oddest/most fun way you have seen for #hospice / #pallaitive fundraiser/event? Any new ideas? #hpm

@GailZahtz @mandajane79 #hpm That is a GREAT question. In past, uniformly the answer was no. Deaths from scripts doubled btwn 99 and 06.

Another related question is how certain meds are decided to be controlled. Most argue, e.g. that Provigal shouldn't be controlled #HPM

RT @ctsinclair: Topic #3 - What is the oddest/most fun way you have seen for #hospice / #pallaitive fundraiser/event? Any new ideas? #hpm

RT @GailZahtz: how certain meds are decided to be controlled. Most argue, e.g. that Provigal shouldnt be controlled #hpm

@Mtnmd was the death from scripts at all related to an aging population who were more likely to take scripts? #HPM @mandajane79

T3 I like the National Hospice Foundation Event in April, very fun, though haven't seen a ton of innovative things happening there #hpm

T3: What I have seen for #Hospice fundraisers: rememberence walks, evening dinner and dance, battle of the bands, balloon festival #hpm

#hpm - Healthcare Social Media Transcript

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6/27/12 11:17 AM

@ctsinclair T3: I put 2gether cookbook of "comfort foods", sold a lot because of the slight

error in the potato salad recipe

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

Okay, tossing the ball over to @renee_berry for a more fun T3 on the National #Hospice April Event #HPM

@renee_berry: Can you share what they did. Curious. #hpm

T3; Potato Salad recipe said "wash & cut your potentates" #hpm

@hvto I like the cookbook idea. We have that at our hospice house. #hpm

@mdstudent31 this is REALLY cool. how do they market it? #hpm

T3: To recruit pet therapy vols, we attended a "dog swim" (last day of waterpark being open, let dogs run around). Successful & fun! #hpm

@mdstudent31: umm, would you like to raise $ for a lovely small business owner? #hpm

@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

@DrSnit It's all through the medical school to faculty, staff, students. We get items from community for silent auction during event #hpm

@hvto Cookbook unusual because I asked for recipes that = comfort. People remembered

xs of being safe, loved

I

learned a lot. #hpm

@GailZahtz @mandajane79 Re: narcotics, it is diversion and abuse. Not the intended audience #hpm

#hpm - Healthcare Social Media Transcript

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6/27/12 11:17 AM

@mdstudent31 We played a few fundraisers too. I think that is a great idea. #hpm

@PracticalWisdom I like raising money :) #hpm

@mdstudent31 Are you going to post some pics/video online so we can jam with you? #hpm

@Mtnmd sorry, I lost you- could you clarify? #HPM @mandajane79

@ctsinclair We also played a benefit for "Physicians for Social Responsibility". Brought all philly area med school bands in #hpm

@mdstudent31: Let's make a Deal! Sold on that idea? #hpm

@PracticalWisdom Starts w/Silent Auction, then dinner, some speaking/thanking/ dessert & dancing in #dc , love that city! #hpm

RT @hvto: T3; Potato Salad recipe said "wash & cut your potentates" "Ahhh #hpm

oh yeah

oops:p

spell check!"

@renee_berry Hey, I'm still in #DC in April! Also, what about if we brought something from #hospice residents that they contributed? #HPM

@renee_berry Thank you. #hpm

RT @mdstudent31: Here is from 2009: http://www.youtube.com/watch?v=qozd6pZsF5c "Awesome cant wait to watch" #hpm

#hpm - Healthcare Social Media Transcript

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6/27/12 11:17 AM

#Hpm I love giving fundraisers and hv raised lots of $. A "Celebrity Cook Off" event followed by cookbook a month later doubles $ and FUN!!

@mdstudent31: This is really great~looked like lots of fun! Congrats #hpm

I know @HospiceValley does some fun events locally, they participate in a duck race, have theme parties, drive @Tesla 's :) #hpm

@renee_berry Also, there's an active group here I know that works on keep elderly home before hospice- they would help. #HPM

I"m glad but surprised Cookbooks are still working. #hpm

Also danced in Penn State's Dance Marathon "THON" for Pediatric Cancer - world's largest student-run philanthropy www.thon.org #hpm

@ctsinclair I think Dan Quayle was channeling thoughts to me #hpm

"@GailZahtz: Also, what about if we brought something from #hospice residents that they contributed? #HPM"<---LOVE that idea!!!

@GailZahtz sounds interesting, we should chat before I'm back in dc #hpm

@GailZahtz #hpm Deaths from abuse typically Johnny stealing grandma's vicodin and sharing or selling.

My undergrad. did an auction of our talents. Fun plus built community. #hpm

@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

#hpm - Healthcare Social Media Transcript

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6/27/12 11:17 AM

Me playing in "Failure to Thrive" a doctor rock band in 2003 #hpm #hcsm

@renee_berry Email or call me. Can only do so much in 140 characters! :) #HPM

@PracticalWisdom Our event does that as well - to raise money for its operation. We auctioned ourselves off (ie cleaning, cooking, etc) #hpm

@mdstudent31 OMG - I feel like we need lighters #hpm

@Mtnmd: When I taught in Drug Rehab lost of housekeepers were stealing Pain meds from their clients. Very common very sad! #hpm

RT @PracticalWisdom: @Mtnmd: When I taught in Drug Rehab lost of housekeepers were stealing Pain meds from their clients. Very common very sad! #hpm

@DrSnit : Free Bird! #hpm

omg

hahaRT @ctsinclair Me playing in "Failure to Thrive" a doctor rock band in

RT @DrSnit: @mdstudent31 OMG - I feel like we need lighters #hpm

@DrSnit haha it's a lot of fun! Can't wait for Saturday's show! #hpm

@ctsinclair that's a GREAT shot #hpm

Clsoing out tonight, on the theme of rock bands, leave us with some wise lyrics! #hpm

#hpm - Healthcare Social Media Transcript

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6/27/12 11:17 AM

you can't always get what you want, but if you try, you just might get what you need #hpm

keep forgetting the #hpm

grr

@PracticalWisdom @Mtnmd Addiction is awful. But that's the place of Md's like @drmanejwala not #palliative or Congress or FDA. #HPM

I"m alive, alert, awake, enthusiastic It's a real song. #hpm

@ctsinclair #hpm We have a real BATTLE OF THE BANDS here tonight, very cool.

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

RT @brigid22: you cant always get what you want, but if you try, you just might get what you need #hpm

Time to study - must be lyrics from some type of song night all! #hpm

Hitting the rheumatology text. Good

@PracticalWisdom #hpm Yes, theft from real patients a problem, and intentional diversion also a problem. But I see the other end of this :)

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

@ctsinclair I listen to that song obsessively sometimes haha http://www.youtube.com/watch?v=rjFaenf1T-Y #hpm

Repeat

Goodnight all! Thanks again for a great tweetchat community. In #hcsm, we are one of the largest specialty tweetchats #hpm

#hpm - Healthcare Social Media Transcript

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6/27/12 11:17 AM

@mdstudent31 nite! break a leg on stage and make sure to post the vid ok!! #hpm

RT @brigid22 you can't always get what you want, but if you try, you just might get what you need #hpm

@PracticalWisdom agree, maybe not pre-topic announcements, but pre-topic reads? #hpm

RT @PracticalWisdom: Could we have time to check out the article in the Washington Post and revisit next week? "Good idea - YES!" #hpm

"and so it is/just like you said it would be,life goes easy on me,most of the time" #hpm

@ctsinclair Did everyone get the links- the first article and the response from the APA? #HPM

@mdstudent31 Good night! Thanks for participating, studying, playing music and raising money. I can tell you will be a good doc #hpm

@GailZahtz @PracticalWisdom @drmanejwala I understand your thoughts. I see both sides. I agree, doctors should lead this issue. #hpm

@ctsinclair Night cats! I've missed you! Thanks for holding space for me! Great chat and great moderating. And lovely people! #hpm

@GailZahtz Send to me and I will will schedule a few tweets for early next week as reminders. #hpm

@DrSnit You always have space here. #hpm

@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

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

#hpm - Healthcare Social Media Transcript

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