Routine testing discovered she had diverticulitis, and a follow-up CT scan showed she had a foreign body in her stomach. It turned out to be a pen.

The woman told her doctor that about 25 years earlier, she had been poking at a spot on her tonsil with the pen when she slipped, fell and accidentally swallowed the pen. At the time, both her husband and her doctor dismissed the possibility and said she must have been mistaken. (X-rays taken at the time showed no pen in her gut.)

On this most recent visit to the doctor, the pen was removed — and found to still work. Her symptoms have gone away, and the hospital is using the case as a teaching example of two rules: 1) Abdominal X-rays don’t show every single foreign object, and 2) Even if a patient’s story sounds unbelievable, it may just be true.

Social media has real business benefits within health care — and serious negatives that can be hard to protect against — whether or not you even use the sites.

The open nature of social media sites like Facebook and LinkedIn means that no matter how carefully you manage your own profile — or even if you choose not to use them — there are some things you simply can’t protect yourself from.

Take the case of Jerry Penner, the CEO of Murray-Calloway County Hospital in Murray, Kentucky.

Shortly after coming to the hospital, a hospital VP made a joke about Penner having sent a friend request to all of the VP’s staffers, but not the VP himself. The only problem? Penner hadn’t sent any of the requests.

A little sleuthing turned up a fake profile of Penner that used a photo of him from a hospital web page, and his basic biographical info such as his educational and work history, which were correct aside from a few mistaken dates. There were few posts made on the page, and aside from some poor grammar and spelling, none of the information posted was damaging or harassing to Penner — but he was understandably disturbed.

Penner said his privacy settings on the site are relatively high and he uses the page mostly to communicate with business connections and promote the hospital.

Activity on the fake profile died down until recently, when a flurry of Penner’s real-life friends and colleagues received friend requests from the fake profile. Most upsetting to Penner: One hospital employee received a friend request with an “I love you” note attached.

In that instance, the person was already connected to Penner on Facebook and knew there was an impostor afoot. But Penner has no ideas who else may have received such inappropriate messages, and if those people realize they aren’t coming from him.

Penner said he had received little assistance from Facebook about the fake account — while he can no longer see the page when he logs on, he said other friends of his can.

For medical professionals who are already leery of social media’s privacy pitfalls, this may seem like one more reason not to use it. But not having the ability to monitor what other people say about you (or say as you) on social networking sites can be even more damaging in the long run.

• When patients are admitted, hospitalists enter patient data into a system that uses automatic reminders to ensure certain procedures are followed, for example that certain prescriptions are issued. As the patient is prepped for discharge, the physician will also get a pop-up reminder that the patient needs to be discharged with that prescription.

• Hospitalists have regular meetings with nurse practitioners, nursing team leaders, case managers, and social workers to discuss every patient in the unit and any issues they need to focus on before discharge.

• Members of the care team may also go to a patient’s room to jointly exchange information with patients and their families to discuss discharge plans and follow-up care.

• Within 48 to 72 hours of discharge, patients are contacted by the system to ensure they aren’t experiencing any unexpected symptoms, that they have the medications and home health equipment they need, and that any required follow-up appointments are made.

So far, more than 30,000 doctors have signed up for the Doximity network since its launch seven months ago — that’s twice the number of physicians on LinkedIn, according to Doximity.

The services is a HIPAA-secure communication platform for doctors that lets them connect and collaborate with their professional peers.
Unlike other popular social media sites, Doximity membership is reserved for medical professionals, such as  physicians, nurse practitioners and physician assistants. Members sign up with their real names and verified credentials. The general public can’t access any information on the site, so health care pros can have true — and private — peer-to-peer communication.

Primarily, systems that protect anonymous reporting and don’t emphasize assigning blame for the error get more reports than more traditional reporting systems. That’s the takeaway from a recent report in the journal Pediatrics.

After instituting a new system at a pediatric clinic in North Carolina, the number of mistakes reported increased from an average of five per year to 86.

Under the clinic’s old system, reports weren’t anonymous and frequently led to punishment of some sort for those involved in the error. With the new system, employees were able to report anonymously, and punishments weren’t attached to the error reports. Employees from all areas of the practice were put on a safety team to review reports once a month and find solutions to the reduce the likelihood of a similar mistake happening again.

The most common mistake by far was incorrect data being entered into a patient record, followed by delayed or forgotten lab work and medication errors. About 75% of the mistake reports were addressed by the team with simple procedural changes and staff training.

The incident happened at Bronx-Lebanon Hospital Center in New York last Wednesday when a man fired one or more shots in the waiting area. Police arrested a suspect the next day.

Police say the suspect was shooting at a patient who had been in an altercation earlier in the day. The patient saw some of the people from the earlier fight in the waiting area and called his own friends for back-up. One of those friends is believed to have fired the shots.

The nurse and guard who were shot weren’t the targets and were most likely wounded by fragments of the bullet after it ricocheted off a wall. Both the nurse and guard are in stable condition and expected to recover.

The incident is just the latest raising some questions about the security of patients and workers at hospitals. The hospital is located in a dangerous neighborhood according to some staffers. Although there are security guards at each entrance, metal detectors and similar security devices aren’t in place.

The warning came about after reports in various news outlets that people are selling candy, spit and other theoretically contagious items from children who have chicken pox.

The items are generally sold to parents who eschew at least some vaccines and want their kids to get chicken pox when they are younger and the disease is generally milder.

The scientific validity of such an idea is certainly questionable — chicken pox is most often spread via inhalation. But its illegality is known.

Which is why Jerry Martin, a U.S. attorney for the Middle District of Tennessee issued the warning to parents who may be considering buying such items. Transporting infections material through the USPS is a federal crime that carries a sentence of up to 20 years in prison.

Besides being illegal and ineffective at transmitting chicken pox, medical experts warn the “pox pops” could easily spread other less “desirable” diseases like hepatitis.

The study looked at patients using the POLST form — for Physician Orders for Life-Sustaining Treatment. The form gives patients an easy way to indicate their wishes about a variety of treatments — such as the use of ventilation or feeding tubes — and it’s signed by both the patient and the doctor.

Patients in the study who used the PLOST form had their wishes regarding resucitation followed 98% of the time. Their preferences regarding limited medical interventions were followed just slighltly more than 91% of the time.

About 24% of the patients refined their orders as the end of their lives approached — most patients opted for more comfort-focused care.

The use of the forms has faced some criticism from activists who think patients should always be given treatment to prolong life at any cost.

Of course, getting a prescription for an OTC medication sort of defeats the purpose of it being available OTC.

While patients can have their doctors write prescriptions to submit with their receipts for reimbursement, that’s more time and energy spent by both the patient and the doctor. And for mild conditions that don’t require the patient to see the doctor but do require medications (low level chronic pain, well-controlled asthma, mild allergies, etc.) it may mean an extra doctor visit — and co-pay — in order to get the prescription to get reimbursed.

Efficient it’s not.

In fact, because of the extra hoop-jumping, many people just don’t bother with the reimbursements any more.

But a new service is attempting to make it easier to get the prescription without spending extra time and money in the process.

FSAStore.com is an online store that sells only FSA-eligible items. It now offers customers a service where they can shop with the FSA debit cards that some employers provide and at checkout, the company will automatically flag anything for which a prescription is needed.

Customers can provide their doctor’s contact info and an FSAstore pharmacy partner will get in touch with the doctor to get a script. Another option is for the customer to call the doctor themselves and direct them to send the script directly to the store.

These alternatives are only good, however, for customers using FSA cards. If they’re paying out of pocket, they’ll still have to get the script and submit it with the receipt for reimbursement.

It may have seemed like a good idea to mock obese patients in print, but one surgeon-turned-comedian discovered the joke was on him.

John D. Kelly IV is an orthopedic surgeon at the University of Pennsylvania. He also writes a humor column for Outpatient Surgery Magazine, in addition to do doing stand-up comedy in his free time. He even has a web page devoted to the issue of “healing through laughter.”

Recently, those two worlds got a little too close for comfort.

Under deadline pressure, Kelly says he quickly assembled a bunch of one-liners for his August humor column. Many of the jokes were retreads from Rodney Dangerfield and other well-known comedians. Kelly referred to obese patients as “behemoths.” And under the premise of warning doctors that performing surgery on obese patients might be dangerous, Kelly used such comedy “classics” as: “You should worry about performing surgery on the super-sized if … there is a comma in your patient’s body weight… a patient wears his wristwatch on his finger…[or] has more chins than a Chinese phone book.”

Hysterical!

Also: Cruel and unprofessional!

In a totally unsurprising turn of events, Kelly and the magazine received criticism from sources far and wide, including patients, patient and health advocates, bloggers and the subscribers to the magazine. (The article was eventually pulled from the magazine’s web site.)

Kelly has since issued an apology in the magazine and has been in touch with bloggers who reported on the dust-up. “I blew it. I was not respecting the dignity of my patients. I didn’t recognize that this is a different audience than the comedy clubs. Of course, I will revamp my comedy routines now that I know the potential hurt some jokes can inflict,” was part of the apology he sent to a blogger at FormerFatDudes, a blog about gastric bypass surgery and related topics.

Officials at Penn also issued a statement saying Kelly’s statements don’t reflect the consensus view of the health system.