“A warm smile is the universal language of kindness.”

Do you believe this? A recent question on Ask Mefi wondered the same thing, and received many interesting responses, both agreeing:

It’s supposedly one of the six universal expressions.
In my psychology class in college, the prof told us (IIRC) that these are the six expressions/emotions that babies have before they’re socialized to experience more self-conscious feelings like pride, shame, etc.

and disagreeing:

I’ve read that Vietnamese smile when they are frightened to show subservience and that this made American GIs think they were laughing at them with sometimes tragic results.

This, along with an interesting conversation (detailed below), set me wondering:

If even a smile is not universal, how universal can a medical tool that mediates human expression really be?

And furthermore, how universal can medicine 2.0 be?

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This is a story about handwashing.

Ever since word got out that the hotel in which I’m currently residing may potentially contain an H1N1 case (100% not confirmed – imagine the PR nightmare), the handwashing has been religious. A side effect is that I’ve found myself paying more attention to public washroom facilities like soap dispensers and hand dryers. Of the latter, the behemoth on the left caught my eye…

…along with its accompanying instruction plate:

1. Insert your hands and Airblade will start automatically.
2. Withdraw your hands slowly upwards through the air.
3. On doing this your hands will be dry in 10 seconds!

Meet the Dyson Airblade.

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Welcome to the first edition of mixtapes & meds, a top-whatever list of medicine 2.0 stories and links from my Twitter and around the web, updating weekly.

1. Nothin’ like a good incentive! Bayer’s Didget attaches to the Nintendo DS and rewards young people for monitoring their blood glucose levels. Dedicated checkers get instant access to goodies such as extra game levels.
2. “First, Do Harm.” Mother Jones weighs in with this cutting feature on doctors in the military – from withholding treatment to participating in torture.
3. University of Toronto’s Robart’s Library washrooms apparently have new Dyson Airblade hand dryers. The Dyson website claims it dries your hands in 12 seconds or less (15 is the cutoff?).
4. Say bye-bye to medical receptionists? Design her electronic replacement at OliviaGreets.

DrV’s new post, a discussion on why teenagers don’t use Twitter (itself inspired by a 15-year-old Morgan Stanley intern’s tech report), started me thinking on some conversations I’ve had this week with various teenagers aged 14 to 17.

Now these are pretty web-savvy teens – they have their own domain names, build websites for their schools, and had plenty to say when I picked their brains on Google Wave, Bing, Wolfram Alpha, iPhone, and a lot more. However, they were nowhere near as excited as I was about Twitter. Perceptions of the micro-blogging website (even this terminology was alien to them) generally fell along these lines:

• Twitter is for old people. They’ve heard about Twitter as a networking tool, but believe that networking is “something to worry about when I get a job”. Ditto for the “personal brand”, which has become one of my favourite ideas to talk about of late.
• Twitter is for following celebrities. A few were vaguely interested in following Obama (and Ashton Kutcher?)…otherwise…
• Nobody they know (or care about) is on Twitter. And thus it’s…
• Unnecessary. The old argument that Twitter is an entire social network dedicated to Facebook statuses. Why sign up for another site, especially when the attention span of the internet is so short? Even among fad-happy teenagers, there’s a certain amount of backlash against the concept of hype itself. They want to be given a little credit. And sometimes they would like to be convinced of a tool’s utility over its popularity.
• …And even unsafe? “I don’t want all my stuff on the internet like that.” Broadcasting beyond their immediate Facebook network has little appeal to teenagers. The risks of exposure and loss of privacy far outweigh any perceived benefits.

For example, one of the teens I talked to set up a website with a forum and contact list to help his friends from summer camp stay in touch during the school year. However, he balked when a few camp administrators got wind of the site and signed up. He later explained to me that since the point was to connect with a very specific group of friends, privacy and exclusivity was paramount. They had no news that they wanted to broadcast to the world, but they certainly had information that they wanted to keep from the world. Their purpose was therefore far better served by a private forum than by Twitter.

I’ve decided that it’s not that teenagers have no use for networking – they simply have no use for Twitter-esque professional networking until they reach a very specific activation energy. Perhaps by starting a business or heaven forbid…getting old

Dr. Vartabedian (@Doctor_V) recently posted about the pre-emptive strike delivered by a patient’s mother as DrV was trying to explain the condition. The weapon? Google!

I recently discussed endoscopic biopsy results with a patient’s mother. Her child had inflammation in the upper intestinal tract with cells called eosinophils. As I began to explain the basics of tummy irritation and the significance of the eosinophils in her daughter’s duodenum she cut me off, “Actually doctor, you don’t need to go into too much detail, just spell ‘eosinophil’ for me if you would.”

As it turns out mom was more interested in getting to Google than listening to how I think her daughter’s biopsy results related to her problem.

DrV’s story highlights a fundamental struggle in the development of Patient 2.0.

On one hand, the technology is facilitating patient education and empowerment in a myriad of ways. Knowing the name of a condition, I can look up treatments; knowing my symptoms, I can follow a flow-chart JPEG and self-diagnose; tracking how I eat/sleep/exercise/smoke/drink/etc. via DailyBurn-esque services, I can analyze habits from the comfort of my home. But the flip side is that the infosphere lacks guidance: accessibility to information is not a problem, yet accessibility to knowledge is.

Remember Google Answers? Nowadays, it has been written about in articles counting down the top Google Labs failures (couldn’t compete with Yahoo! Answers), but I believe it is useful to recall the reason for its creation. Google Answers employed real people who searched the Google inundation for the answers to your questions. The important point is that they didn’t simply give link lists; they tailored and annotated the answers extensively. It was like having a personal tour-guide to your own question. Similarly, the best-case scenario for the patient is to have a personal tour-guide to his condition, but the internet alone fails at this. It is a bit like being given the map, but not the guide.

So what does this mean for the current and next generation of physicians?

As DrV pointed out: “The internet isn’t going anywhere. If anything the web’s capacity to support patients will only improve.” It is only natural that patients and their families’ use of the web will grow more sophisticated, whether they are looking because it’s the middle of the night and they can’t go to the doctor, because they aren’t comfortable talking about their condition, or simply because they are interested in trying out these tools for themselves. We cannot begin to elucidate the gamut of reasons. Therefore, the paramount task of physicians will be to master the web to better support tech-savvy patients.

“Pre-Emptive Online Literacy”

Physicians should explore the web themselves and know what their patients will be seeing when they Google, something that DrV call Pre-Emptive Online Health Literacy. For example, a patient might find that the treatment for his condition that garners the most hits or that is treated in the most detail on Wikipedia is the not the one his doctor recommends; the doctor should be ready to explain why certain information on the web is not applicable to the patient’s specific situation.

1 Monologue + 1 Monologue /= Dialogue! If the doctor is able to anticipate the results of patient empowerment and act accordingly, then we have synergy. This is what makes the web truly useful.