Pauline W. Chen: A Surgeon's Reflections

Medicine in the Age of Twitter

I blog, I tweet, and I use Facebook. I find social media to be an enormously useful tool in my work. But when I mentioned this to a medical colleague of mine, he replied, "I can barely keep up with email. I'm not about to open up that black box."

More than 60% of adults now go online for health-related information, and a majority of those individuals access social media platforms. Nonetheless, there are only a handful of articles in peer-reviewed journals and no evidence-based guidelines for clinicians to use when it comes to social media. For example, should a doctor diagnose or prescribe on Facebook or a blog? Is a doctor liable if she or he misses a patient's tweets about the acute onset of shortness of breath? 

In this week's "Doctor and Patient" column, I explore social media and the patient-doctor relationship. How should doctors and patients use blogs, twitter, and Facebook, if at all? And do they strengthen the therapeutic relationship or detract from it? 

Please leave your comments below or at Tara Parker-Pope's "Well" blog.

Letting the Patient Call the Shots

I would like to believe that the care I give patients is patient-centered. But two weeks ago, Dr. Donald M. Berwick made me wonder if I could do more.

Dr. Berwick, President of the Institute for Healthcare Improvement in Cambridge, Mass., and a leading authority on healthcare quality, published a piece titled, "What 'Patient-Centered' Should Mean: Confessions of an Extremist." In it, he wrote that the U.S. would need radically different systems if we are to provide patients with truly patient-centered healthcare. As Dr. Berwick writes, “[We] would all be far better off if we professsionals recalibrated our work such that we behaved with patients and families not as hosts in the care system, but as guests in their lives.”

In this week's "Doctor and Patient," I interview Dr. Berwick. How do you define "patient-centered care"? Please leave your comments below or on Tara Parker-Pope's "Well" blog.

Talking Frankly at the End of Life

I have spent a lot of time in the last few years thinking, writing and speaking about end-of-life care. But it all became very personal recently. My mother-in-law died two weeks ago.

With a designer's flair and a dazzling memory, my mother-in-law looked like Donna Reed in her youth, with Rita Hayworth legs. She adored her family and friends and loved nothing more than to be where the "action" was, in the midst of conversation and laughter. Over the course of her 86 years, she counted hundreds among her friends. Hundreds. When one of her sons died some forty years ago, she and my father-in-law received over six hundred condolence letters.

In the last year, however, my mother-in-law saw her once vibrant social life whither away. Severely debilitated by a lifelong battle with rheumatoid arthritis, a 10-year struggle with a series of strokes, and, more recently, multiple non-healing leg ulcers that necessitated an above-the-knee amputation, my mother-in-law found herself wheelchair-bound and restricted by all the medical equipment she required.

But her last weeks and her death fourteen days ago ultimately reflected the life that she loved. She threw a party with my sister-in-law's help. She was surrounded during her waking hours by family and new friends. And she was, as I heard her whisper one day, "so very happy."

What made all of this possible were a series of conversations, conversations initiated by doctors and nurses about end-of-life care. There was the conversation a couple of months ago where we learned that my mother-in-law was dying and would benefit from hospice. And there were the many daily conversations about what my mother-in-law desired and what she did not.

Her experience reminded me of a study that came out last fall in The Journal of the American Medical Association. Dr. Alexi White and her co-investigators showed that end-of-life care discussions with the terminally ill not only improved the quality of life of the dying but also eased the grief of their survivors.

I interview Dr. White in this week's "Doctor and Patient" column, and I write about my mother-in-law's experience and the effect of these kinds of conversation on my family.

What are your experiences with end-of-life care discussions as a clinician, a patient, or a family member? Please leave your comments below or on Tara Parker-Pope's "Well" blog.

Bringing Out the Mother in All of Us

"Doctoring," a senior physician once commented during rounds, "brings out the mother in all of us."

At first the other doctors-in-training and I laughed at his remark. The comparison between our mothers and the highly trained professionals we wanted so much to be seemed humorous.

But our laughter quickly abated. We knew that there was indeed some similarity between the duties we had as doctors and the responsibilities our mothers bore. And, for at least a few of us on rounds that afternoon, it was not clear how we would or could manage both.

In this week's "Doctor and Patient" column, I write about balancing work and family responsibilities. Is it different for women who are doctors? And does each role affect the other? Please leave your thoughts on this topic either below or on Tara Parker-Pope's "Well" blog.

The Surgeon and the Torture Memos

Earlier this week, a friend asked me how aspiring surgeons learn to cut. She couldn’t imagine ever putting a knife to someone else’s flesh.

“Habituation,” I told her. “You get used to it.”

I’ve spent a lot of time since that discussion thinking about my response. Like others in this country, I read about the recently declassified contents of four memos that describe brutal interrogation techniques condoned by the Bush Administration and carried out by the Central Intelligence Agency. But as horrified as I was by the content in these 100-plus pages, what continues to haunt me are the descriptions of the individuals responsible.

Many of them seem like ordinary professionals. Some appear to be not all that different from, well, me.

Can anyone become habituated to the horrific?

I explore this question in this week's "Doctor and Patient" column, and I’d  love to read your comments, either below or on Tara Parker-Pope’s “Well” blog.