All New Way To Learn The Most You’ve Learned Since Residency Through The Free App Figure1
I do most of my learning by seeing patients and looking things up online or referencing text books. On occasion I learn from specialists and colleagues but that’s a bit more rare these days due to time constraints.
As an urgent care doctor there is a lot of stuff that at first glance I can’t recognize or decide on the next management step. Those are my favorite cases, the bread and butter is just too mundane. I used to rarely pass up the opportunity to learn from the harder cases but as I started getting more fatigued and burnt out I would sometimes just do what was safe.
I essentially was kicking the can down the road, hoping my next management step would fix it or buy enough time for tincture of time to take effect. Ironically, if you are feeling burnt out then practicing medicine like this makes it that much harder to keep going.
Dealing With Tough Cases Efficiently And Effectively
I find that the best way is for me to gather as much information as possible through the history, do a thorough physical exam, review the vitals and either buy myself some time by getting some labs started or excusing myself out of the exam room in order to think – I have no problem telling the patient that I need to step out to figure this case out.
I always take pictures – I love taking pictures of any pathology that is camera-worthy. A rash, a complex injury, oral lesions, fingernails or pictures of imaging. I have a giant online folder of images and surprisingly I remember the cases well. Alternatively, you can rename the files with relevant case history in order to recall the context better.
Overcoming picture-taking shyness. I almost always have my iPhone in my scrub pocket and very matter-of-factly tell the patient that I would love to take some images of the pathology to share with students and colleagues later. As I take the picture I tell them that I won’t have any identifying information on them and that I will never sell the pictures for profit in any way.
Storing Your Personal Image Collection
I’ve thought about creating a very large Powerpoint and perpetually adding to it but it’s tough getting patients to follow through sending you pictures of their pathology as it progresses or improves. I am trying to get in the habit of telling them ahead of time that I would like to contact them in a few days to get follow up images.
If they say it’s okay (whether through a phone call, email or text) I then proceed to rename the file of the image which I took with either the email address or their cell phone number – easy enough.
With virtual medicine advancing so quickly it has become much easier for me to get pictures from the patients and have direct follow-up access to the patient (usually by text message) to get follow-up images. This satisfies my curiosity and makes the patient feel cared for.
How Figure1 Comes Into Play
Enough about my way of doing it. I mentioned Figure1 because it’s a completely free app which allows healthcare providers from all over the world to post digital media and give/get comments on a particular case. It’s brilliantly designed and incredibly easy to use. Let me stress this, it is so fucking easy and quick to use – that’s what sets it apart.
You upload an image, post a quick blurb about it and either ask for input or simply state the learning point. You can post dermatological images, x-rays, pathology slides. EKG reports, radiology reads etc.
What’s amazing is that every kind of specialist you can imagine is on there and they each have incredible knowledge to add. Dentists, radiologists, general surgeons, orthopedic surgeons, dermatologists, physical therapists, pharmacists, PA’s, MA’s and RN’s.
A Sample Posting on Figure1
I love the cases posted by residents and medical students, they usually have the most access to the patient and have the most in-depth knowledge of the cases without any biases.
Here is a case posted by an orthopedic resident. I actually didn’t recall the name of this fracture, glad I viewed the case. A series of 3 images of the xray were posted and comments come in usually minutes after posting – it’s exhilarating.
Below are the first 3 screenshots from this sample case. You can see the succinct bit of patient background that was provided and various comments by other surgeons and other healthcare providers.
On this post alone there is an orthopedic resident, a family doctor, a plastic surgeon, a radiologist, a pharmacist and an RN commenting. Fucking awesome.
When you click on the image you can see the 3 photos that were uploaded which you can zoom in on and scroll through. For MRI’s and CT’s you can upload a series which the user can scroll through.
FEATURES of Figure1
There is an upvoting and downvoting system which is quite helpful. Sometimes you don’t want to post something but do find someone’s comment helpful or you agree with their opinion.
Overall those who post have useful insight, there is a ton to learn from the opinions of the various specialists and students. Learning how others manage the same thing is really helpful. You will get a perspective from clinicians practicing in different countries and different settings.
You can actually search the database by following the hashtagged (#) links to common medical terms. You can also do the search based on organ systems and specialty. This is very helpful when you have a patient who needs a little more convincing.
What Figure1 Is Great For
It’s the most efficient and effective learning I’ve done since UpToDate. I never got much benefit from conferences because I dislike lengthy talks filled with 5% of useful information. I do enjoy EM:RAP but not ready to pay for the service yet.
Figure1 is a fantastic app to browse through posted cases, pick out what appears interesting and upvote or downvote a few comments until you are comfortable enough to post.
Posting is great because it helps you really get into the case and reading the comments is very fast, rarely do I see more than 20 comments on a case. It’s also a way to give back a bit of your knowledge to students and others who don’t have your expertise.
What’s Annoying About Figure1
Really the only thing I can think of is the occasional idiotic comment usually done by RN’s. Yes, I’m hating. The reason I don’t care for those comments is that they clog up the comments stream and half of the time they are sarcastic or display the callousness we’re often trying to avoid in our own working environment.
Navigating Figure1
The app is very easy to use, on the bottom there are 5 icons that let you do everything you need to do.
The Home icon takes you to the most recent post and if you’ve scrolled down quite a bit and need to get back to the top then you simply press it again and you’ll see if any new images have been posted. Images get posted fairly frequently which I enjoy.
Browse lets you look through cases according to anatomy or by specialty. Here you can also follow/unfollow whatever category you are interested/uninterested in. Whatever specialties you don’t care for won’t show up as cases in the home-feed.
Messages, dunno honestly. I guess it’s a way for clinicians to contact each other through a HIPAA-compliant system. I haven’t used it nor am I interested in it at this time but could certainly see the value in it.
Activity is helpful to see what new comments have been posted on cases you are following or if there have been replies to any questions you have posed. You can also see the comments on your own cases you’ve thrown up there.
Profile, this one’s obvious.
Stop The Excuses Keeping You From Giving Back
Many of my colleagues wish they had more resources so that they could teach more or help the sick in other countries. This app is exactly there for those of us who don’t have the time/money/energy to do formal teaching or to volunteer in a resource-poor facility.
Your comments can be very helpful for the clinician who posted the case to determine the next best option for their patient.
It’s funny to see someone from Africa posting an image of a sick patient taken obviously in a resource-poor setting and then read US physicians replying with: do a biopsy, an MRI or get CTA and administer xyz drug.
Medical students and residents may post something obvious but there is always much to be learned when a physical therapist or orthopedist adds their experienced specialty comment to the case. It’s such valuable learning – I would pay a lot of money for such a service but it happens to be free.