gwennie

jayparkinsonmd:

What is unique about how Sherpaa doctors practice medicine?

You can think of Sherpaa like a corporate medical practice in the cloud. When an employee health issue arises, employees launch the app, create a case, tell us their story, answer our questions, and see their plan. When an employee has a new message from our doctors, they get an email saying they have a new message and they should go to the app to read it. Ninety-eight percent of all communications our doctors have with our patients is done via asynchronous, private messaging within our app. The other 2% is via the phone. It’s essentially secure email within our app. Needless to say, this type of communication is one everyone in the working age population is far too familiar with.

First, let’s define how this is markedly different from the traditional way of practicing.

Sherpaa is online and asynchronous vs. real-time and in-person. Traditionally, communication between doctors and patients is done in real-time in an exam room with time spent on the case dictated to the patient by the doctor. Patients must think on their feet and answer questions upon command without the luxury of contemplating the question, or looking up terms they don’t understand. Although this is how it’s always been done, it’s highly ineffective and inefficient. Granted, there is some value in in-person body language. But that is relatively rare. The vast majority of patient-physician communication is matter of fact.

Sherpaa leverages checklists when taking a history vs. not. Although most doctors are average history takers, there is risk in not having a standardized process of taking a good history from the patient. When taking a history is unstructured and not part of a formalized, repeatable process, things can get missed or you can go down a rabbit hole. At Sherpaa, when a patient reaches out to us with a chief complaint of, say, abdominal pain, all of our patients are asked the same questions, depending on their gender. We’ve created a standardized way to take an accurate, complete history. For the top 200 chief complaints, we’ve created protocols to ask the right questions— questions that rule out the serious issues but also cover all bases and lead us to the right diagnosis. This ties back in to the issue of real-time and in-person. The only way to do this is with a checklist. Essentially, Sherpaa, at almost every point in the process from history taking to treatments, utilizes the concept of a checklist. A checklist is what enables 45,000 commercial planes to take off and land every day with years in between crashes. The same should be used in healthcare to effectively take a history and treat most appropriately.

Sherpaa doctors can take a time out. Just as patients need to sit back and think about the questions being asked them, doctors sometimes need to do this too. If doctors are in an exam room with a patient trying to ask the right questions and stumble upon a situation that either stumps them or is something they don’t have a ton of experience with, how do they, in real-time, educate themselves about the best way to diagnose and treat? Remember, doctors don’t and can’t know everything. Because Sherpaa is asynchronous, our doctors can also take a time-out and read up on the condition and/or how best to diagnose and treat it. It’s extremely valuable and safe.

Sherpaa leverages all diagnostic tools, including time. Doctors have tools to make an accurate diagnosis— asking the right questions, ordering the right blood or imaging tests, conducting a skillful physical exam, and, finally, leveraging the passing of time as a diagnostic test. For example, diseases often have a relatively predictable course. Doctors sometimes say, “well, I don’t know exactly what this is now, but if we wait 12 hours and see how things develop, we’ll have a much better idea.” The problem with this is how the healthcare system isn’t set up to leverage time as a diagnostic tool. A visit separated by 12 hours is double the cost. It’s an opportunity to bill twice, when it should be simply billed once. With Sherpaa, we always have a direct communication line to the patient at all times. As doctors, if we want, we can say to the patient, “we don’t know exactly what’s going on, but with your permission, we’re going to reach back out to you in 8 hours to check in and see how you’re doing.” And, then, 8 hours later, we send a check-in message to the patient to get an update. The passing of time is a wickedly powerful diagnostic tool that doctors who practice traditional medicine simply can’t employ. If you are discharged from the ER, good luck trying to reach that same doctor 8 hours later to give them an update on your condition. So Sherpaa doctors leverage time and they also have the luxury of ordering the right lab and/or imaging tests. Every day, we send people to Quest or LabCorp to get their blood drawn or to radiology centers to get imaging. Those results are then sent back into Sherpaa’s platform and our doctors diagnose and treat accordingly. Since our doctors never see a patient in-person, we can never do a physical exam. But that’s ok for 70% of our cases. One of the four rules of practicing Sherpaa is, “if you are in any way uncomfortable, get the patient seen in-person fast.” And that happens 30% of the time.

Sherpaa treats in an evidence-based way. In the same way we’ve built 200 protocols for taking an accurate history, we’ve also built about 200 treatment protocols based on the best available evidence. You would be highly surprised to know that 90% of everything a doctor does is essentially hearsay, folklore, wisdom, and faith. There is very little scientific evidence backing up the majority of what doctors do. So we’ve taken what little evidence there is in western medicine and created protocols around them. Essentially, safety checklists again. This standardizes care and allows us to understand its efficacy by tracking outcomes. Was this treatment plan effective? What was the outcome? With an always-on direct communication line with the patient, we have the luxury of gathering outcomes and understanding how effective our treatments are. Traditional doctors don’t. Once you’re out of their office, you’re gone and it’s on you to make another appointment to update them on your outcome. That’s wrong.

Sherpaa leverages data. Since 98% of what we do is online text communication, we have access to massive amounts of analyzable data from which we can learn. Because the rest of healthcare happens verbally in real-time, that is lost data that can never be used to study and improve best practices. Sherpaa is a vast medical practice full of usable data that can be used to help us get better and better. This allows us to understand “If the patient answered yes to this one question, the diagnosis of x is 90% likely. If the patient answers yes to these 5 questions, x diagnosis is 99% likely. If the patient is treated with this treatment plan for x diagnosis, there will be a 96% cure rate.” This data-driven practice of medicine simply can’t happen anywhere else in healthcare. It can only happen because we can analyze online communication and iterate on best practices.

We’re building something that happens nowhere else in healthcare. It’s quite astounding, unique, and powerful. Once you see it in action as a doctor or as a patient, you understand how revolutionary it truly is.

nevver:

How to Remove a Tick: An Illustrated Guide
Shut the fuck up about vaccinations. Not everyone has to have them, not everyone believes in them. Uneducated fuck.
Anonymous

shrineart:

xaudelle:

aspiringdoctors:

restless-wafarer:

aspiringdoctors:

image

You know, my homie and secret best friend Neil deGrasse Tyson said it best….

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This isn’t an issue of belief or should even be up for discussion. It’s not a debate- like gravity or that the Earth revolves around the Sun isn’t up for debate. It’s a fact, whether or not you like it. Sorry bro.

And any ‘educated fuck’ knows that vaccines are necessary and everyone who can have them should have them.

Have a lovely day, sugar. 

Actually there’s a lot of research and knowledge supporting the fact that vaccines are NOT necessary. It is simply another thing that today’s health system is super big on, just like hospital births and c-sections. And a lot of people actually have long term and short term complications from getting vaccines. Ahem.

Dang guys, you thought I didn’t check my activity log every now and then? Because I knew shit like this would pop up. And, I just finished my block exam and am feeling fiesty.

Actually you’re wrong. That ‘research’ is either completely fabricated OR grossly misinterprets the data OR uses shitty research techniques to get the data they want- all which are grossly unethical, in case you’re curious. I’ve got slides from a recent lecture on vaccines (aka why I am so fired up about this nonsense). You can check out the citations on each slide if you don’t believe me… something unsurprisingly missing from literally every anti-vaccine comment I’ve gotten and website that I have visited. Show me your sources, honey, and if you do, I will blow them out of the water because not a single one stands up to current scientific research standards.

There are however tomes and tomes of research for the safety end efficacy of vaccines. Don’t believe me? Look at a simple google scholar search.

So! Here we go! 

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Holy shit, it’s almost like vaccines SAVE SOCIETY MONEY. In fact, they give money back to society, along with the other programs indicated by red arrows. Which would be really weird for something that is just a healthcare fad like c-sections and hospital births.

And most people have no complications for getting vaccines, and if they do, most of them are short term. In fact, it is devilishly hard to prove an adverse effect was because of a vaccine. Why? Because it’s how we’re wired. We falsely see connections and causes where there are none (called a type 1 error; you are rejecting a true null hypothesis). People are more likely to attribute an adverse health event to a shot- even if that shot is the placebo and the numbers are just the background rate for whatever health event in the population.

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And here is a graph showing the sample sizes necessary to prove that an adverse event is caused or related to a vaccine.

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You know what, it was a really good lecture and I’m going to share more more relevant slides in case any one else feels like contradicting me.

These slides show the public health impact of vaccines. Note the differences between the historical peak and post-vaccine era deaths columns. Because saving literally thousands of lives is totally a conspiracy you should beware of.

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And this is why herd immunity is so important! See how high it has to be for measles? Guess what we’re seeing outbreaks of thanks to anti-vaxxers? Don’t forget that one of the deadly complications of measles is SSPE.

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Look how Hepatitis A infections in older adults when down after kids started getting immunized. Shocking! Could vaccines be… good for …. everyone????

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Ahem.

Bitch just got science’d.

"Just like hospital births and c-sections".

Have you studied any history? Any at all? 

scienceisbeauty:

Yep, this happens. Remember: access to medical information does not turn you in a doctor (and you can say the same for many other areas).
Via de Joy of Tech (geekculture.com)

scienceisbeauty:

Yep, this happens. Remember: access to medical information does not turn you in a doctor (and you can say the same for many other areas).

Via de Joy of Tech (geekculture.com)

generalelectric:

Happy Valentine’s Day! This image of a heart was sequenced by a Revolution* CT scanner, which can take a complete 3-D scan of a heart in one beat.
Since this is a real medical device, here’s the fine print: * 510(k) pending at FDA. Not available for sale in the United States. Not yet CE marked. Not available for sale in all regions. Trademark of the General Electric Company.

generalelectric:

Happy Valentine’s Day! This image of a heart was sequenced by a Revolution* CT scanner, which can take a complete 3-D scan of a heart in one beat.

Since this is a real medical device, here’s the fine print: * 510(k) pending at FDA. Not available for sale in the United States. Not yet CE marked. Not available for sale in all regions. Trademark of the General Electric Company.

pokotopokoto:

via FB
nemertea:

mediumaevum:

Anatomical illustration showing the veins.
England; late 13th century. 

Lookit his little tadpole gut.

nemertea:

mediumaevum:

Anatomical illustration showing the veins.

England; late 13th century. 

Lookit his little tadpole gut.

skunkbear:

These are the disease outbreaks that could have been prevented by proper vaccination according to the Council on Foreign Relations. You can explore the interactive map here.

Check out the thousands of whooping cough cases in the United States in 2011 and the measles outbreaks plaguing Europe.

theravennest:

pezzington:

fithome:

imgonnariverdance:

shadowkat104:

kellyjacobsbooks:

HOW TO SURVIVE A HEART ATTACK WHEN ALONE Let’s say it’s 6.15pm and you’re going home (alone of course), after an unusually hard day on the job. You’re really tired, upset and frustrated. Suddenly you start experiencing severe pain in your chest that starts to drag out into your arm and up into your jaw. You are only about five miles from the hospital nearest your home. Unfortunately you don’t know if you’ll be able to make it that far. You have been trained in CPR, but the guy that taught the course did not tell you how to perform it on yourself..!! NOW HOW TO SURVIVE A HEART ATTACK WHEN ALONE… Since many people are alone when they suffer a heart attack, without help, the person whose heart is beating improperly and who begins to feel faint, has only about 10 seconds left before losing consciousness. However, these victims can help themselves by coughing repeatedly and very vigorously. A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest. A breath and a cough must be repeated about every two seconds without let-up until help arrives, or until the heart is felt to be beating normally again. Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating. The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can perhaps buy precious time to get themselves to a phone and dial 911. Rather than sharing another joke please contribute by broadcasting this which can save a person’s life!  Be prepared and become part of the solution. Get your free next-of-kin notification card today. Click here: https://www.InCaseOfEmergencyCard.com/

major signal boost

Reblogging cause this could save someone’s life

This could save many lives, reblog

http://www.heart.org/HEARTORG/Conditions/More/CardiacArrest/Cough-CPR_UCM_432380_Article.jsp

Also, Ladies don’t forget that WOMEN EXPERIENCE DIFFERENT HEART ATTACK SYMPTOMS THAN MEN. Make sure you know what the signs are for female heart attacks too. You don’t want to be out there without knowing.

theravennest:

pezzington:

fithome:

imgonnariverdance:

shadowkat104:

kellyjacobsbooks:

HOW TO SURVIVE A HEART ATTACK WHEN ALONE

Let’s say it’s 6.15pm and you’re going home (alone of course), after an unusually hard day on the job. You’re really tired, upset and frustrated. Suddenly you start experiencing severe pain in your chest that starts to drag out into your arm and up into your jaw. You are only about five miles from the hospital nearest your home. Unfortunately you don’t know if you’ll be able to make it that far. You have been trained in CPR, but the guy that taught the course did not tell you how to perform it on yourself..!!

NOW HOW TO SURVIVE A HEART ATTACK WHEN ALONE…

Since many people are alone when they suffer a heart attack, without help, the person whose heart is beating improperly and who begins to feel faint, has only about 10 seconds left before losing consciousness.

However, these victims can help themselves by coughing repeatedly and very vigorously.

A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest.

A breath and a cough must be repeated about every two seconds without let-up until help arrives, or until the heart is felt to be beating normally again.

Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating.

The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can perhaps buy precious time to get themselves to a phone and dial 911.

Rather than sharing another joke please contribute by broadcasting this which can save a person’s life!

Be prepared and become part of the solution. Get your free next-of-kin notification card today. Click here: https://www.InCaseOfEmergencyCard.com/

major signal boost

Reblogging cause this could save someone’s life

This could save many lives, reblog

http://www.heart.org/HEARTORG/Conditions/More/CardiacArrest/Cough-CPR_UCM_432380_Article.jsp

Also, Ladies don’t forget that WOMEN EXPERIENCE DIFFERENT HEART ATTACK SYMPTOMS THAN MEN. Make sure you know what the signs are for female heart attacks too. You don’t want to be out there without knowing.