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     33     <h1>
     34      Patient-facing slide decks
     35     </h1>
     36     <p>
     37      <time id="post-date">2024-03-23</time>
     38     </p>
     39     <p id="post-excerpt">
     40      While I plan on being a physician-scientist forever, I'm not going to work in academia.
     41 Over the past few years I've put together very cool infrastructure for giving academic talks (click "talks" above),
     42 and it was making me sad that it might not get much use after I leave the university.
     43 But then, a ray of sunshine: Why not use my slide deck infrastructure to help in patient conversations?
     44     </p>
     45     <h2>
     46      talks.beauhilton.com
     47     </h2>
     48     <p>
     49      Academics give lots of presentations. I gave at least one 15min
     50 presentation per week in medical school, and still expect a few 15-45min
     51 presentations per half-year in fellowship.
     52     </p>
     53     <p>
     54      PowerPoint was long ago eschewed in favor of online-first
     55 presentation platforms, typically Google Slides. (Eventually Office365
     56 came out and PowerPoint came on par with Google Slides, but I had
     57 already moved away.) No emailing around files and accidentally sending
     58 the old version, or running into an incompatible version of the
     59 software, and the presentation could be modified all the way up to (and,
     60 occasionally, during) the event itself. All you need is an internet
     61 connection.
     62     </p>
     63     <p>
     64      Eventually I wanted to move away from proprietary infrastructure
     65 altogether, so started using <a href="https://sli.dev">Slidev</a>.
     66 Slidev is geared toward developers, and as such uses all
     67 industry-standard web technologies, nicely packaged up to make it easy
     68 to go from a text file to a nice-looking presentation.
     69     </p>
     70     <p>
     71      The defaults are great, and, since it’s all web standards, the sky is
     72 the limit as far as customization.
     73     </p>
     74     <p>
     75      The presentation lives in a single text file (markdown). This makes
     76 it easily versionable, tracked by git and backed up to [GitHub, GitLab,
     77 self-hosted git solutions, etc.]. Since I keep a copy on GitHub, the
     78 ease of editing while on-the-go approaches the ease of editing a Google
     79 Slide (all you need is an internet connection and to be logged in).
     80     </p>
     81     <p>
     82      Once the presentation is online, I’m only ever a click or two away
     83 from accessing it. I make sure everything is HIPAA-compliant, and to the
     84 public internet it goes.
     85     </p>
     86     <p>
     87      It’s been great for making talks in my academic program, and, when I
     88 thought I would stay in academia forever, it made sense to me to spend
     89 the time to build out my own infrastructure and subdomain for talks.
     90     </p>
     91     <h2>
     92      emphasizing the “physician” in “physician-scientist”
     93     </h2>
     94     <p>
     95      Recently, I realized that I’d be happier shifting the
     96 physician-scientist balance more toward physician and less toward
     97 scientist, at least as measured by days per week dedicated to each.
     98 While I think I’ll always see myself as as physician-scientist, my
     99 future oncology job (hopefully not “jobs,” but who knows) will be in
    100 private practice, where I’ll see patients 3 or 4 days per week and do
    101 research with the other 0.5-2 days that remain.
    102     </p>
    103     <p>
    104      (The following three paragraphs are an aside on how much time is
    105 spent on what in academia, and touches on why I decided to leave. I
    106 should probably move this out and expand it into its own post. It
    107 doesn’t have much to do with the core of this one.)
    108     </p>
    109     <p>
    110      Classic academia is usually patient care 0.5-1 day per week, research
    111 the remainder - but that’s somewhat misleading, since academics
    112 typically have a number of dedicated inpatient weeks, which may or may
    113 not put a damper on the ability to do research during that time,
    114 depending on how busy they get and whether it’s July (with brand new
    115 trainees) or June (with seasoned trainees). Even accounting for this, it
    116 doesn’t even out to the number of patient-care days per year in private
    117 practice, not by a long shot, but for most folks it isn’t so freed from
    118 day-to-day patient care as it is advertised on the tin. There are a some
    119 academics who do a few weeks of inpatient care per year and that’s it,
    120 no clinic, but that’s the exception.
    121     </p>
    122     <p>
    123      You also pay your own salary out of your research funding, so there’s
    124 a large time burden of not doing research, but writing grants to
    125 convince funders that your research is cool and worth funding. With the
    126 research I do and am interested in continuing, a university
    127 infrastructure adds little, where it isn’t actively working against me,
    128 and I’d rather pay my salary, which will be much bigger, from taking
    129 care of people in clinic than working through the weekend to meet grant
    130 deadlines (while I may also still be on call for the hospital).
    131     </p>
    132     <p>
    133      The university infrastructure is great for basic and clinical
    134 science, and some flavors of data science, but my scientometric stuff is
    135 truly better if done vigilante-style, not attached to academia’s
    136 politics, and predictive modeling/etc. is available and important to
    137 private practice collectives (AON, USON, OneOnc), some of whom have more
    138 robust data infrastructure than the universities do. My most successful
    139 clinical data science project thus far was actually done under the
    140 purview of Business Intelligence for Cleveland Clinic, working with the
    141 Center for Clinical Artificial Intelligence, and the publication was the
    142 side project - this is much more in line with what I may find myself
    143 doing with clinical data science with one of the big three onc groups:
    144 do the thing, do it well, and if you feel like publishing it, gravy. The
    145 scientometric stuff is more classic research, where publication itself
    146 is the deliverable, but even here I’m much more interested in publishing
    147 a living website and tool than a paper in a journal.
    148     </p>
    149     <p>
    150      (And now, back to our regularly scheduled program.)
    151     </p>
    152     <p>
    153      Outside of academia, there’s a high chance I won’t give presentations
    154 nearly as often as I am accustomed to. At first, this made me
    155 simultaneously happy (presentations are so. much. work.) and sad (aww,
    156 my cute little talks website will just gather dust. Poor buddy). Then! I
    157 went to a dinner meeting to learn about renal cancer and get paid to
    158 hang out with friends and eat, and most of the physicians talked about
    159 bringing up primary data to help in discussions with patients. Most
    160 physicians do this when they think it will help, and it certainly wasn’t
    161 the first time I’d heard people talk about it, but the timing was right.
    162 I realized that I have a great use for my talks website, and that I’ve
    163 already been using it this way for some time.
    164     </p>
    165     <h2>
    166      talks in clinic - data for shared decision-making
    167     </h2>
    168     <p>
    169      At least 3 or 4 times in the past few months, I’ve been having
    170 discussions with patients about their prognosis and various options, and
    171 wished I had the graphs to show them without having to poke around
    172 Google and possibly fight with a paywall, then realized I just gave a
    173 talk on the same thing, the talk is on my website, and it has those
    174 graphs.
    175     </p>
    176     <p>
    177      It was very useful to go over the primary data with the patient (not
    178 everybody wants to see this stuff, but a significant number do), and
    179 having a talk I gave to reference immediately lent an additional modicum
    180 of trust to the conversation (most trust is built from showing you care,
    181 but another portion is built from showing you know what you’re
    182 doing).
    183     </p>
    184     <p>
    185      Hearing the physicians at that dinner meeting talk about how they’re
    186 using primary data in their shared decision-making, combined with my
    187 recent decision to go into private practice, and thoughts about what to
    188 do with my website, led me to the following idea: for diseases I’m most
    189 interested in, and for diseases I treat the most, it will be very useful
    190 to have a talk I made and maintain, geared toward patients, to
    191 immediately pull up and have available in clinic, and have the link to
    192 give the patient for review, particularly in those conversations with
    193 their loved ones where they’re trying to remember all the stuff you said
    194 to make a group decision. It would also be easy and useful to have a
    195 slide describing the regimen and its schedule, especially if the way
    196 we’re giving it doesn’t quite match up with the published regimen (e.g.
    197 one of the many regimens that is written as “2 on, 1 off” but we’re
    198 giving it every other week instead).
    199     </p>
    200     <p>
    201      I’m definitely not going to make a talk for every disease or use one
    202 in every conversation, that would be insane and impossible to maintain,
    203 but if I pay attention to the data I use repeatedly, a 30-60min session
    204 adding some of these to a slide deck with a little explanation would
    205 more than carry its weight in future conversations.
    206     </p>
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