I am Dr. Nicholas Genes, pioneer in social media and clinical informatics: How I Work Smarter

How I Work Smarter LogoThere are early adopters of social media, clinical informatics, and educational technologies, and then there’s Dr. Nick Genes – a man wise beyond his years. Nick had one of the very first blogs in Emergency Medicine called Blogborygmi, which he started way back in 2003. Compare this with ALiEM which I started in 2009. So I am not surprised that he is working alongside the giants of EM, such as Professor Tintinalli in his role as a senior editor at Emergency Physicians Monthly, and doing amazing things in clinical informatics. Nick kindly has carved out some free time to share some of his tips for working smarter.

  • GenesName: Nicholas Genes, MD, PhD
  • Location: Icahn School of Medicine at Mount Sinai
  • Current job: At Mount Sinai my duties are split between emergency medicine and clinical informatics – I’m now board-certified in both! Through our electronic health record (EHR) I work on departmental research projects, improved throughput, and clinical decision support. For the hospital, I evaluate new health IT applications and partnerships. Beyond that, I’m senior editor at EP Monthly, reviewing new articles and helping Prof. Tintinalli achieve her vision for the publication. I also research the potential of social media for emergency preparedness and response – hopefully you’ll be hearing a good deal more about this in 2015.
  • One word that best describes how I work: Dispositive
  • Current mobile device: iPhone 6. In my white coat I also carry an iPad mini 2 with a few dozen clinical apps – a practice I first described after the original iPad debuted.
  • Current computers: iMac mid-2011 running OS X Yosemite at home, Dell Optiplex running Windows 7 at the office

What’s your workspace setup like?

My office and home workspaces are similar – two big screens, and an otherwise mostly empty desk. The current project is front-and-center, with other windows pushed off to the second screen for reference, running reports, listening to music, or perusing feeds.

Genes Desk

What’s your best time-saving tip in the office or home?

Keep looking for ways to get unstuck. That means reading books on time management and self-discipline, monitoring productivity blogs and app reviews, and staying in motion. If I’m using the exact same techniques and workflows a year or two from now, that means either technology’s come to a standstill, or my career has.

What’s your best time-saving tip regarding email management?

Lots of others in this series have touted inbox zero – [Lin’s HIWS post, Weingart’s podcast, Tumblr site about Inbox Zero] and that’s great advice. I’d add that, if you can’t turn off your email, “snoozing” them can help you achieve that creative, unburdened state without actually replying to messages as they come in. Mailbox was the first great app to do this and they’ve introduced a desktop version for Mac. If you’re obligated to use MS Outlook, try Acompli for iOS which has a lot of the same snoozing capabilities.

And as smartphone mail management apps have shot ahead of desktop clients, I learned something: most email is best managed from a phone, even if you’re sitting at your desk. Phones encourage brevity, whereas on a desktop, email often becomes an end unto itself.

What’s your best time-saving tip in the ED?

I’d like to stay totally focused on patient care while on shift, but that’s not always possible. My director might pop by and ask me to run a report, a colleague may identify a potential bug in our EHR, or I’ll try to remember a reference to look up and send to one of my residents. I’ve found Siri is more than capable of scheduling reminders – or even meetings (and if you use Omnifocus, your Siri reminders can end up in your Inbox). So at the speed of dictation, you can schedule that task for a later time, and get back to patient care.

ED charting tips

Know what goes into the E/M (evaluation/management) levels, and be mindful of what downstream clinicians will want to learn from your documentation.

If you have specific, restrained macros for sprained ankle exams or URI review of systems, or canned text about why your patient doesn’t meet the threshold for a CT, great, use ‘em. I’d bet, though, that many folks use comprehensive macros that achieve E/M level 5 chart – even for simple encounters where a coder can’t bill above level 3. These folks probably generate canned text that protects them from perceived medicolegal risk, while making it harder for colleagues to decipher what they were actually thinking.

Overly comprehensive macros and verbose canned text might save a few seconds per chart, but raises suspicions – and that might ultimately cost you a lot of time.

What’s the best advice you’ve ever received about work, life, or being efficient?

I read Pressfield’s The War of Art and Godin’s Poke the Box at a fortuitous point in life, when I was nearing the finish line of training and ready to think about what kind of career I wanted, and what kind of impact I was hoping to have. These are short reads that are worth returning to every year or two, especially when you might feel adrift or caught up in distractions.

Is there anything else you’d like to add that might be interesting to readers?

Some aspects of emergency medicine encourage academic and administrative pursuits – but many don’t. The unpredictable schedule, the short-term, checklist-oriented mindset while on shift, and the comfort with frequent interruptions make us good EPs, but can impede creative project planning or thoughtful, scholarly work.

I try to be conscious of this handicap, and look for ways to compensate for our EM tendencies.

I want to hear from:

  • David Newman: I’ve been a huge fan of his writing, speaking and clinical acumen, and a few months ago we started sharing an office. I thought just by proximity I’d absorb some of his wisdom, but so far, no insights. Maybe an entry in this series would help.
  • Bryan Vartebedian: He’s a Pediatric Gastroenterologist that I met through social media – and he’s become a leading voice in defining professionalism for physicians in this new age.
  • Rick Bukata: I spar with him regularly in the pages of EPMonthly, but have immense respect for what he’s accomplished in his career. While most of the people in this series talk about productivity and efficiency in terms of their digital workflow, I suspect I can learn something from his (presumably different) perspective.

Author information

Michelle Lin, MD

ALiEM Editor-in-Chief

Editorial Board Member, Annals of Emergency Medicine

UCSF Academy Endowed Chair for EM Education

UCSF Associate Professor of Emergency Medicine

San Francisco General Hospital

The post I am Dr. Nicholas Genes, pioneer in social media and clinical informatics: How I Work Smarter appeared first on ALiEM.

Kurz vorgestellt: Was wir schon immer über das Lysefenster beim Schlaganfall wussten.

Ich weiss nicht, wie es Euch geht, aber zwischen “Schlaganfall – ein Notfall” und dem Stichwort “Apoplex” auf dem Melder klafft bei mir immernoch eine Glaubenslücke. Liegt sicher daran, dass ich Patienten nur bis zur Übergabe (oder der Abfahrt des RTW in diese Richtung) sehe. Folgender Artikel hat mir nochmal etwas Glauben geschenkt.

alte4

Effect of treatment delay, age, and stroke severity on the eff ects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials.

Lancet 2014; 384: 1929–35

 

Emberson et al. fassen statistisch aufwändig Patientendaten aus (allen) 9 “Alteplase-Lyse bei Schlaganfall”-Studien zusammen. Ein “gutes Outcome” definierten sie als nicht signifikante Einschränkung 3-6 Monate nach Ereigniss, entsprechend Rankin-Skala 0 oder 1.

Sie wollten insbesondere die Abhängigkeit vom Zeitintervall zwischen Symptombeginn und Lyse, sowie den Effekt bei alten Patienten und schweren Schlaganfällen untersuchen.

Ergebnis 1:

Bis 6 Stunden nach Symptombeginn (konservativ gerechnet 5 Stunden) verbessert die Lyse das Outcome.

Alte1

 

Ergebnis 2:

Das Alter ist egal. Alteplase-Lyse ist bei alten Patienten und schweren Fällen (hoher National Institutes of Health Stroke Scale NIHSS-Wert ) ebenso gut wirksam (vielleicht sogar besser….)

Alte2

 

Ergebnis 3:

Die Lyse erhöht zunächst die Mortalität, rettet im Verlauf aber mehr leben.

Alte3

 

Fazit:

Wenn im Zeitfenster, dann ist Schlaganfall ein Notfall. Eine zügige Lyse rettet langfristig Leben und hilft, dieses zu erleben und selbstbestimmt zu gestalten.

Es hilft jedoch kein Notarzt, sondern Diesel und gute Schnittstellen.