Tweeting GI: Changes for the GI Clinic

October 28, 2010

AGA is part of a growing health-care community on Twitter and has interacted with a number of gastroenterologists who are active on the microblogging site. We enjoyed a recent series of tweets from Meenakshi Budhraja, MD, (aka @gastromom) about her return to academia after decades in private practice, so we invited her to expand her thoughts in AGA eDigest beyond Twitter's 140 character limit. If you are interested in joining the tweeting GI community, go to and select our list of GIs on Twitter.

After nearly 20 years of practicing gastroenterology in the private setting, I recently found myself back in academia supervising GI fellows. Going "back to school" made me realize that there is a lot of informal education missing from the curriculum. As a GI physician, mom and an active tweeter, I am here to offer future gastroenterologists the following advice.

Structure the Visit
Break down the visit into three portions:
•    Be a friend: always say something personal to the patient before addressing the medical issues.
•    Be their doctor: sandwich the “business” of the visit in the middle, including history, physical examination, discussion of results, etc. Keep instructions simple and understandable (no more than two or three points).
•    Be positive: stress the likelihood of response to medication and lifestyle changes.

Engage the Patient
Success as a physician depends not as much on academic knowledge as on communication skills. If using electronic health records, find a way to include the patient. Specifically ask patients about their use of the Internet and recommend appropriate Web sites. Set up communication with the patient on secure e-mail to discuss labs/X-ray/ dietary advice, etc. for interactions that do not require a physical exam. Explore the use of social media, smart phones and apps with your IT department.

No training is complete until you get to see the patients and families in their home environment. Home visits should be worked into the curriculum. I propose at least six over three years.

Know Food
We are entering an era of predictive, personalized, preventive and participatory medicine in which food will play a major role. Learn about food and how it is grown, processed and marketed. Food is a lot more than calories, carbohydrates, fats and protein. Not a day goes by without a patient asking me, "What should I eat?" As gastroenterologists, our patients expect us to know about food and we should. Read some Michael Pollan. Incorporate cooking lessons in the curriculum and learn how to make at least three comfort foods. I call this the "softer side of GI."

And of course, feel free to follow me on Twitter @gastromom.

Meenakshi Budhraja, MD, is a gastroenterologist based in Little Rock, AR.

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