Medical Futures Lab

Our group’s primary challenge and main research question is “How to best tell the story of Rice University and Dr. William Akers’s contribution to the development of the artificial heart in the Texas Medical Center?”.

So here are some tips from some of the nation’s best storytellers…the folks from Disney’s Pixar Animation Studios.

It may seem strange to be seeking advice from the makers of family films, but we must remember these are the guys that can take literally anything (toys, cars, rats, robots, an old man and a house full of balloons), and turn it into a story that touches the heart of people of all ages.

Thus, even though we’re not writing an original story, being able to take the information that we have and compile it into a compelling, relatable narrative will be key to making this project a success.

In 2012 storyboard artist Emma Coats (@lawnrocket) from Pixar tweeted 22 tips she wanted to impart from her time there and some folks from No Film School compiled it together into a nice list.

Among the 22 tips, here are the few that I think are most relevant to our project:

1. You gotta keep in mind what’s interesting to you as an audience, not what’s fun to do as a writer. They can be very different.

This has been another primary research question that we have been struggling with. We need to identify our audience so that we can identify what would be compelling to them. Presenting Dr. Akers’ story would be much different if we were talking to a group of biomedical engineers than if we were to a group of artificial heart patients. I think we are trying to aim for something in the middle – a story that can showcase the impressive technical designs of Dr. Akers’ work while reminding us that his contributions have served to save many lives, perhaps even lives of the people who will end up coming across this story.

7. Come up with your ending before you figure out your middle. Seriously. Endings are hard, get yours working up front.

This is a good point to make that also ties into the question, what is our ultimate goal in telling this story? Do we want it to just be historical and talk about a certain time period? Do we want to tie it back to the present? Do we want to utilize this story to call people to action? If so, what do we want our audience to do?

11. Putting it on paper lets you start fixing it. If it stays in your head, a perfect idea, you’ll never share it with anyone.

The post-it note activity we’ve been doing in class has really served this purpose. For example, in the last class we were able to brainstorm a really beautiful analogy for our project that I think will be a framework for how we are going to write the story going forward. All because we were just writing ideas on post-its.

15. If you were your character, in this situation, how would you feel? Honesty lends credibility to unbelievable situations.

16. What are the stakes? Give us reason to root for the character. What happens if they don’t succeed? Stack the odds against.

This is the part that is easier as documentary storytellers because instead of imaging the motivations of our characters we can simply ask our characters how they felt at the time – for example, when we interview Dr. Akers. In our research, we’ve begun to get a better sense of our characters’ personalities as we’ve learned a bit about what other important figures at the time, such as Dr. Liotta, thought about Dr. Akers and Dr. Akers. In terms of stakes, our problem-owner and our team were drawn to Dr. Akers when we heard that he felt unappreciated for his contribution to the design of the artificial heart, and that made him a more relatable person to which we could understand why he wanted his story to be told.But what would be the stakes for society if Dr. Akers’ story isn’t told? Who would benefit knowing more about Rice University’s involvement in the development of the artificial heart? Would current students be encouraged to pursue cardiology or biomedical engineering? Would prospective students be more likely to apply to Rice University? Would more heart patients want to be treated at the Texas Medical Center?

One idea I have moving forward is to write out the story of Dr. Akers’ and the artificial hearts as a script for a short film. Instead of primarily seeing legends such as Dr. Debakey and Dr. Akers as pioneers who I admire, I’ll write them into characters with struggles, opinions, and motivations. Being able to capture even the most basic story in an narrative form will help us see ultimately go forward with our problem session.

One of the major problems in the world of medicine today is the looming shortage of primary care physicians with the adoption of the Affordable Care Act. According to a recent studynearly 27 million people will be newly insured under the Affordable Care Act, requiring more than 8,000 additional physicians to meet the country’s health-care needs. So what are physicians currently doing to address this problem?

One recently adopted solution that is gaining popularity among physicians is holding group medial appointments. When this idea was first introduced in one of our class discussions, I was immediately skeptical. I, like many other patients, was instantly uncomfortable with the idea of sharing my personal medical information with a group of strangers. But what I found withfurther research was that shared medial appointments open the possibility for physicians to treat more patients, increase the time spent with patients, and increase appointment availability.

Group medical appointments are most successful when they address routine care for patients with chronic conditions such as diabetes or heart disease. They usually involve each patient having a short one-on-one physical exam followed by a group of about a dozen patients sitting down with their physicians and asking questions and listening to the concerns of the other patients for up to two hours.

These group gatherings allow patients to spend significantly more time with their physician, expanding what would normally be a quick 15-minute appointment to up to 90 minutes of time with the physician.  This time allows the physician to streamline the impartation of information. Rather then having to repeat the same information over and over for each patient with similar chronic conditions, the group environment allows extended time to provide patients with more comprehensive information that is better able to improve care.

One of the major strengths of the ePatient community we have discussed is the ability to be able to connect in online communities where people can relate and share information. Many patients who have participated in shared appointments experience similar advantages. Patients are able to openly discuss learn from the diversity of experiences and questions of other patients, creating a more comprehensive medical knowledge.

While shared medical appointments are not appropriate for every patient they provide an important example of how simple changes in standard medical practices can work to improve care.

My last blog entry posed a question that has yet to be explored: should patients be obligated to share themselves with their doctors via social media? That is, might physicians be able to use social media to learn more about their patients?

To answer this question, I present a scenario:

Susie, a twenty-three year old female, enters the ER with severe iron-deficiency anemia and a shockingly low hemoglobin count. She needs to be transfused right away, but Susie quickly and firmly refuses the transfusion because the idea of having someone else’s blood “freaks her out.” She stays in the hospital for three days when Dr. Smith notices a fresh wound on Susie’s left thigh that is becoming infected. Susie swears that it showed up on its own, but the wound looks like the result of self-mutilation.

Dr. Smith becomes increasingly worried that Susie’s low hemoglobin count is due to self-phlebotomy and that, because of her dramatic refusal of transfusion and her unclear and changing symptoms, she may have Münchausen syndrome.

Dr. Smith decides that, because Susie is being uncooperative and irrational, she will look at Susie’s Facebook page to retrieve honest information. After work, Dr. Smith scrolls through Susie’s pictures and sees photo after photo of blood bags, IVs, and hospitals, as well as statuses bragging about how many times she’s visited the ER that year.

In an attempt to uncover more information, Dr. Smith reads through Susie’s Twitter feed. Almost every tweet mentions a new diagnosis or medical problem.

Is it ethical for Dr. Smith to look at Susie’s Facebook page and Twitter feed to search for information that would confirm her hypothesis? What if the discovered information would alter the course of Susie’s treatment? Would the information retrieved from the social media sites go into Susie’s EMR? Would Susie ever find out?

Social media is taking medicine to new heights, but it’s leaving us with many unanswered questions as well. Platforms like Facebook and Twitter are opening new avenues of communication between patients and physicians, but in doing so, may cause breaches of patient autonomy and confidentiality.

The positive repercussions of using social media in medicine are many, but be warned: we must proceed with caution.

Doctors are becoming more than a white coat and a stethoscope. They are becoming bloggers and photographers; rappers and painters; designers and musicians. Quite simply, doctors are becoming people. Real, true people.

To what do we owe this drastic change of public image?

For the most part, we can attribute it to social media.

We all know that physicians are beginning to utilize social media platforms—such as Twitter, Facebook, Instagram, and LinkedIn—as avenues for effective communication with patients. They are realizing that, by breaking down communicative barriers, they are able to engage patients in a new way.

The way I see it, there are five reasons why physicians should embrace social media:

1. It lets you meet the patients where they are.
2. It increases physician transparency in the medical community.
3. It makes for engaging interactions with colleagues, and therefore helps spread important health information.
4. It’s a way to create and curate medical narratives.
5. It’s not mandated (for the most part).

But, as social media plays a bigger and bigger role in the lives of patients, physicians very well may be obligated to share themselves with patients via social media. It allows patients to get to know their doctors outside the four walls of the hospital and, therefore, keeps them better informed. As we know, informed medical decision-making is a prerequisite for all effective medicine.

Social media may be used as an avenue for storytelling—something that, conveniently, is the foundation of our Artificial Hearts group problem. Cardiologists have made use of social media in a rather unique way: as a tool for education of clinicians, physicians, nurses, and medical students. Rather than embracing patient-driven social media, the field of cardiology is embracing physician-driven social media.

Blogs and social networks dedicated exclusively to cardiology are allowing physicians to distribute, share, and comment on medical content such as images, scientific abstracts, and summaries of clinical trials. One such network is CardioSource.org, founded by the American College of Cardiology

CardioSource.org is an organizational website that has a private social network for users in which issues important to cardiology are discussed. The blog’s content is majority member-sourced, and the members and readers both are predominantly heart-centered medical professionals. In this way, the platform fosters a vivid culture of conversation, curiosity, and compassion.

The ACC has recently expanded CardioSource to LinkedIn, Facebook, and Twitter, and hopes to continue growing for decades to come.

http://www.cardiosource.org/acc.aspx