Make sure the underlying muscles are intact

December 1, 2014 6:32 AM

The 2nd episode of the new podcast Reply All is about the "unsettling" Instagram for Doctors app "Figure One".

This is the second podcast from much-covered Start Up meta-start-up Gimlet Media and the first solo podcast by On the Media host (and Mefi's own) Alex Goldman, who (according to MF's Best Of blog) got started in Public Radio by asking Askme "how do I get a job at NPR"? Here he posts about how that worked out for him. Spoiler alert: It did.

posted by Potomac Avenue (19 comments total)

I listened to this podcast this morning and thought "Huh, I should check that app out. Sure, the hosts were audibly moaning as they viewed the images of a diabetic man whose big toe was gnawed off by a rat, but I'm hardy, it can't be that bad." And then I followed the link to the Figure One website (not the app itself, mind you, just the website).

And: nope, nope, nope! Never again.
posted by benbenson at 7:27 AM on December 1, 2014 [1 favorite]

The fact that Figure One exists both explains and is explained by my baby sister who is both a millenial and a doctor (which combination of facts terrifies me).

I have really been enjoying Start Up, and Reply All seems promising as well. I wonder how Gimlet media will fair in a world already populated by Maximum Fun and Radiotopia. I'm pretty sure I heard a dig at Gimlet at the end of the last 99% Invisible when Roman Mars called Radiotopia the "first" public radio collective or somesuch.
posted by sparklemotion at 7:31 AM on December 1, 2014 [1 favorite]

I bet lots of hollywood special effect designers would be very interested in this app .. if not they should be.

Whoever said that reality is not only more disgusting than what you imagined but is also lot more disgusting than what you can imagine ... was right on target.
posted by TheLittlePrince at 7:48 AM on December 1, 2014

Wow, that commentary is both exactly what I expected ("Kill it with fire!" "Wow, never seen that before." "Can't help myself: Nailed it!" ) and surprisingly compassionate ("That poor, poor kiddo" "This is awful, this poor man"). Quasi-anonymous social media brings out the worst in many people, and I'm a bit touched to see that at least the highlighted comments, even with their jokey vibe, are not mean or nasty.

I can totally see how it would be a wonderful educational / consulting tool. You've never seen this before, but there are a dozen other docs who have, and if you can find the right one... (So, it's like AskMe for doctors. Except, replace "Can I eat it?" with "Can I save this limb?" and "DTMFA" with "Amputate it now!")
posted by RedOrGreen at 8:20 AM on December 1, 2014 [1 favorite]

"do you do a purse string to prevent it from prolapsing again?...do they even do purse strings in humans?"

I'm glad this conversation is taking place, and terrified.
posted by justsomebodythatyouusedtoknow at 8:28 AM on December 1, 2014

Haven't heard the podcast yet, but as a healthcare professional I can say
Figure 1 is an awesome app.
posted by charles148 at 8:30 AM on December 1, 2014

The only thing that has stopped me from downloading Figure 1 is the fact that my kids are still young enough that sometimes I need to hand them my phone to entertain them while I'm doing something. But I get a lot of text messages with this kind of thing from old classmates.

My wife takes all kinds of photos of nasty medical things, so she can document them in patient's charts (wounds, rashes, abscesses, etc). But then she doesn't delete them and so our kids (3 and 5) are scrolling through photos on her phone and it's like "oh there's Sashi when he was a baby, there's grandma at her birthday, OH GOD WHAT IS THAT FLIP PAST IT QUICK. SHIT THERE'S FIFTEEN PICTURES OF IT FROM DIFFERENT ANGLES WHY DO YOU EVEN LET THE KIDS PLAY WITH YOUR PHONE??!"

I shudder to think what the kids might understand about what their mother does all day at work.
posted by Slarty Bartfast at 8:37 AM on December 1, 2014 [7 favorites]

I'm kind of afraid to look at this because I think it'll just make me want to go to medical school and I'm way too old/committed to current degree for that at this point.
posted by curious nu at 9:54 AM on December 1, 2014

Figure 1 is pretty horrifying to me, and not for the gross-out reasons. The "unsettling" link touches a bit on the implications for both patient privacy and the trusting relationship between doctors and patients. The app and how it's being used go against everything I've been taught as a nurse about professionalism and trust.

Nurses might exclaim and/or laugh about particularly gross bodily happenings in private among fellow nurses. Something has to be pretty bad for a nurse to comment on it, because wounds and poop and all that are pretty much normal, daily things to us. But when we encounter something especially gross, it can help with coping to go to the locker room after a shift and laugh with our nurse buddies about it.

That said, it is really frowned upon to make light of a patient's suffering in a place where someone other than a nurse might hear you. A huge part of nursing is maintaining and restoring, as much as possible, people's human dignity. Even if the lady with the "giant abscess" doesn't hear you marveling at the desk about the "nasty" fluids coming out of her skin (actual example I heard once, and I never respected that nurse again), the guy with the C. diff diarrhea might hear you and wonder what you've said about him to your colleagues. It might make him feel more ashamed of his condition, less likely to ask for the help he needs to get better. Nurses who say things in the halls or at the desk that they wouldn't say in front of their patients are nurses I don't want to work with.

I absolutely mean it when I reassure my patient that I don't mind wiping their bottom or re-dressing their foot wounds, because that is my job - to help them when they can't care for themselves. If I have colleagues who laugh in a public forum about how gross those things are, it undermines my ability to reassure my patients that I still see them as worthwhile, human, more than a funny story about illness and decay.

Physicians and nurses have very different professional cultures, but I like to think that professionalism and respect would be common features. I can't help thinking this app will only serve to erode the doctor-patient relationship. We expect LOLGROSS from the internet, but when something gross happens to you, it's not a LOL situation. You want your doctor focused on getting you better, not giddily posting photos to rack up lots of comments.
posted by vytae at 10:45 AM on December 1, 2014 [13 favorites]

The "unsettling" link touches a bit on the implications for both patient privacy and the trusting relationship between doctors and patients.

vytae, these days the patient must give permission to use their images in any public way, whether a textbook, talk, or article. That said, I also know that having someone in whose hands you have entrusted your life ask you for something is monumentally coercive. As an IRB member, I complained frequently about this coercive aspect of "informed" consent when treating physicians recruited their own patients with serious illnesses into their research. I was unable to get the culture to even see the coercion, much less change the policy.
posted by Mental Wimp at 11:03 AM on December 1, 2014

Mental Wimp, point well taken that people are signing consent for their photos to be used. I agree with you that there is a degree of coercion involved because of the power imbalance inherent in the physician-patient relationship. Moreover, I don't feel like the consent is properly informed, even if it were free of coercion. There's something about "is it ok if I share this photo online with my colleagues" that implies there's a treatment-related purpose to the sharing. Like, you're consulting some fellow physicians who can't come see the patient in person, to get their opinions and help in treating the patient, or maybe for educational purposes for other doctors who might not have seen this condition before. But then when you see the comments being left in the actual app, that's not the tone of the conversation being had. If the consent process was truly "informed," it would be more like "Can I post this online so that other doctors and I can talk about it for our own amusement, oh and by the way, people who aren't doctors can look at it too."
posted by vytae at 11:40 AM on December 1, 2014 [1 favorite]

> these days the patient must give permission to use their images in any public way

Aren't a lot of those permissions signed without being closely read and understood like user licenses and customer contracts?
posted by bukvich at 12:21 PM on December 1, 2014 [1 favorite]

I have really been enjoying Start Up, and Reply All seems promising as well. I wonder how Gimlet media will fair in a world already populated by Maximum Fun and Radiotopia.

And Nerdist. And Earwolf. And it seems to me like most of these are Mefi-level "lifestyle businesses"; Gimlet's hoping to make more money than that, and that seems hard to me given that there's only so much Squarespace/Mailchimp/Stamps.com/Naturebox/Audible ad budget to spread around. (Seriously: it's like there's only about five companies that SPONSOR ALL THE PODCASTS at any one time.)

Gimlet's proposition seems to be "we'll upsell premiums" and that seems to be based mostly on the runaway Planet Money T-shirt kickstarter. But I'm not sure that's particularly reproducable -- or, as one piece of feedback on Startup noted, whether people will be as motivated to kick in to an explicitly for-profit enterprise.

It bothers me a bit too that its first "providing exciting new quality podcasts" offering was really more poaching an existing podcast from NPR; not expanding the pool, just changing the label.

So, I'm skeptical. But it's fascinating that it's being done in public -- or at least the version of "in public" that the Startup podcast presents; it's been really interesting hearing the process.

(Also, it'll be interesting to see what and how PJ and Alex do without the NPR constraints; longer/deeper form? One immediate difference I noticed was the very un-NPR-ey "fucking".)
posted by We had a deal, Kyle at 12:36 PM on December 1, 2014 [4 favorites]

(Oh, and I often wonder how the Savage Love "free short version with ads / subscription long version without ads" model is working, but I don't think Dan really talks about his financials.)
posted by We had a deal, Kyle at 12:39 PM on December 1, 2014

You forgot The Great Courses, and the weird way that both Dollar Shave Club and Harry's have gotten in on the action.

I often wonder how the Savage Love "free short version with ads / subscription long version without ads" model is working, but I don't think Dan really talks about his financials.

Slate is doing that with their podcasts too -- I haven't ponied up yet, because Metafilter took my $5 and I'm not generally interested in what the SlatePlus topics are.
posted by sparklemotion at 1:58 PM on December 1, 2014

Yeeah, add me to the list of professionals who think this skates a bit close to 'bringing the profession into disrepute'.

There's a UK equivalent but it is a) gmc-registered doctors only, so there are potential repercussions if you misbehave - this isn't an idle threat, several doctors have been investigated for comments they've made on the site, b) it's text only, and c) it is genuinely useful - I have learned loads about other specialties, particularly primary care, and there is lots of support from the community for all your general 'am I being unreasonable' queries. It's like a medical AskMe, whereas Figure1 seems more like Reddit. Maybe it will settle down, but locking out non-doctors and getting some proof of identity would be a good first step.
posted by tinkletown at 3:19 PM on December 1, 2014

I don't think this is unsettling at all. It's not like doctors don't already gossip like this, and with more personal info than Figure 1. If anything, it makes doctors better to be practicing their craft like this on their downtime.
posted by frecklefaerie at 3:48 PM on December 1, 2014 [1 favorite]

I'm not a medical professional and I am actually REALLY SQUEAMISH but I absolutely love Figure1. It is CRAZY FASCINATING. There are basically three types of posts: 1) Help me, I have no idea what this rash is; 2) Here is an excellent, clear teaching version of this particular complication or malady; and 3) HOLY SHIT LOOK AT WHAT CAME INTO THE ER. On the third version, the posting doctor or nurse often comments with some version of, "The patient was pretty proud this was the weirdest X-ray I'd ever seen and excited I was going to show it off."

The three things I have learned from Figure1 are how to identify gunshot wounds on X-rays, that diabetes is a terrible disease, and that dermatology consists primarily of doctors saying, "I have no idea what that rash is."

My favorite pictures are the ones of really beautifully-closed complex wounds or surgical incisions. There was an absolutely gorgeous one of a guy whose head got hit by a boat propeller and it sliced the skin from his head in a sort of spiral propeller shape, and the surgeon just did a fantastic job of putting the skin back together, it was honestly a work of art.

(Be forewarned, the obstetrics ones are often sad. Pediatrics tends more towards unexplained rashes and bites from unusual bugs and bones broken in bizarre ways. Heart you'd think would be interesting but there's lots of dull pictures of EKGs posted.)
posted by Eyebrows McGee at 6:21 PM on December 1, 2014 [2 favorites]

I guess I should also add, we take our kids to a teaching hospital pediatrics practice -- the pediatricians are professors of pediatrics at the med school, and there are always, always students -- and I gave birth twice at a teaching hospital. So as a patient I'm actually pretty comfortable with this and as long as my identifying details were removed, I wouldn't really mind doctors sharing a picture of my gross tonsils or my cool incision or my odd toe X-ray or whatever, just because it might help educate others. I definitely wouldn't mind if they were trying to hive-mind a tricky diagnosis. I know not every patient feels that way, but personally I'd be pretty psyched if my medical thing were weird enough to be on Figure1. It'd be like a small consolation for whatever shitty thing landed me in the ER. "Well, I had to get 12 stitches, but I got to have a picture of my gross finger on this app where doctors share their grossest pictures!"

(My kids know they are "helping teach doctors to be doctors" when the med students examine them and sometimes they are already a little pre-emptory with the students and tell them, "No, you have to use THAT one to look in my ear!" which is obviously what a third-year med student on his first rotation in July wants to hear from a 5-year-old.)
posted by Eyebrows McGee at 6:39 PM on December 1, 2014 [3 favorites]