Clinical meeting 1 hour:
Intro summary:
These are some of the flipped classroom lecture notes and slides for coming Thursday's clinical meeting and hopefully these won't need to be presented on the day but may set the stage for the audience there , each one of who should be able to receive this in advance although again it's likely TLDR
Key abbreviations and key words and phrases:
TLDR: https://en.m.wikipedia.org/wiki/TL%3BDR
WR: Will read
Flipped classroom: https://en.m.wikipedia.org/wiki/Flipped_classroom
For the others here's a glossary: https://userdrivenhealthcare.blogspot.com/2023/11/glossary-of-user-driven-healthcare.html?m=1
Image of the clinical meeting circular
First slide:
Clinical Meeting Learning objectives:
Medical education and 6 levels of it's Bloom game explained through a patient practice encounter
Level 1: Remember
Level 2: Understand
Level 3: Apply
Level 4: Analyse
Level 5: Evaluate
Level 6: Create
What is Web 0.0-3.0?
Speaker notes: Today we shall quickly try to understand these concepts projected here as well as in the title by following a real patient's journey witnessing how his life events drive his external and internal medicine events. For the answer to the question on What is Web 0.0-3.0? Check out our glossary (but beware of TLDR) : https://
Second slide:
Bloom's Level 1:
"Remembering"
Capturing and archiving patient events amidst Web 0.0 (no internet)
Web 0.0 bedside history taking in a traditional doctor patient encounter:
Image above of a doctor patient encounter with hand written notes from the same patient's Web 1.0 archive
Click on this video link for a participatory medicine history taking encounter by Dr Himaja, General Medicine PGY3: https://youtu.be/
Web 1.0 patient case report archive : https://pajrcasereporter.
Speaker notes:
The patient physician encounter always invariably begins in trying to remember the events that shape the patient's current requirements. This second PPT slide above, provides a link to a doctor patient encounter captured on video which was a demonstration to AI engineers in the University of Hyderabad (archived here: https://medicinedepartment.blogspot.com/2024/11/technology-end-user-driven-ecosystem.html?m=1)
and the product of that history taking, which is pasted below is supposed to be shown in the next PPT as a graphical timelined image and the entire product of that history taking is also archived here : https://pajrcasereporter.
Slide 3:
Image of the patient's events timeline
Speaker's notes :
How to tackle TLDR, the current bane of human civilization?
Answer : Just hop skip and jump through the keywords and try to make maximum use of visuals!
TLDR patient events:
An 80- year- old male , born and raised in a middle- class family, had a father who practiced as an Ayurvedic doctor, treating people with herbal medications.
He grew up with two elder sisters, one younger sister, and a younger brother.
In his early years, he experienced the tragic loss of his eldest sister to Hansen's disease.
A few years later, his second elder sister passed away after using herbal medications for suspected cancer.
After his father's death from a brain stroke, financial hardships forced him to leave school.
To support his family, he began working in handlooms while attending night school.
The loss of his sisters motivated him to pursue a career in medicine and follow in his father's footsteps.
He got married in 1962.
Later, his younger sister was also diagnosed with Hansen's disease.
After her husband abandoned her, he and his wife took full responsibility for her care until her death.
His younger brother, who was diagnosed with Hansen's disease at the age of six, also passed away eight years ago.
At one point, he purchased a power loom from Bombay and earned a living through it. However, over time, his neighbors also acquired similar looms, leading to increased competition and a decline in customers, which affected his financial stability.
He has four daughters, all of whom are now married.
Fifteen years ago, when his elder sister was diagnosed with diabetes, he decided to get a health check-up. Initially he managed his condition through dietary changes.
A few years later, he began experiencing tingling and numbness in both feet. After consulting at NIMS, he was diagnosed with hypertension, diabetes, and peripheral neuropathy.
Since then, he has been on conservative management.
Slide 3:
Bloom's level 2 Understanding
Medicine is a human journey that plays out in regular life events and each one of us as a human are in this flow together in the same boat.
Above was first published here: https://medicinedepartment.blogspot.com/2025/04/first-draft-of-narketpally-syndrome-and.html?m=1 (also in traditional journal press)
This is also known in Greek as sum (together ) drum (flow/run), borrowed from Sanskrit "sama (together) druma (flow like a tree)" and it's Latin pronunciation was eventually popularized in medicine as syndrome.
Speaker's Notes:
A syndromic approach is key to integrating medical education and practice!
What did we understand (level 2) from this patient's life events? Let's discover more about his illness events and then try to integrate all his syndromic data points!
Slide 4:
Bloom's level 3 --Application
What's an application? Whats an App?
Web 2.0 as WhatsApp!
Slide image 1:
Screenshot of the Web 2.0 conversations between patient's advocate and the doctors soon after a recent admission with suspected stroke
Slide image 2:
Image above also shows the patient's Narketpally Invisible pillow sign of OPLL previously described here:
His cervical spine x-ray
Speaker's notes: TLDR summary, the screenshot shows the conversations between the patient's advocate and doctors touching on how to get him to the hospital followed by sharing the clinical data of the patient with each other on arrival.
TLDR:
Web 2.0: 30-04-2025 13:34] PPM 1: [30/04, 12:42] patient Advocate 80M Rural Metabolic Syn A:
Good afternoon sir
సార్ పెండెం లింగయ్య ఈదులూరు గ్రామం రాత్రి బ్రెయిన్ స్ట్రోక్ రావడంతోటి నల్గొండ లోని ఐకాన్ హాస్పిటల్ లో చేర్చడం జరిగింది. ట్రీట్మెంట్ కు సంబంధించి బిల్లు హెవీగా ఉంటుంది. కాబట్టి కామినేనికి తీసుకు రమ్మంటారా సార్. ట్రీట్మెంట్ కు సంబంధించిన కొన్ని అంశాలను మీకు గ్రూప్లో ఫార్వర్డ్ చేస్తున్నాను సార్. మీ అభిప్రాయం చెప్పగలరు సార్.
[30/04, 13:31]pm: దయచేసి అతన్ని త్వరగా ఇక్కడికి తీసుకురండి! వాళ్ళు అతన్ని వేరే చోటికి ఎందుకు తీసుకెళ్లారు?
Dayacēsi atanni tvaragā ikkaḍiki tīsukuraṇḍi! Vāḷḷu atanni vērē cōṭiki enduku tīsukeḷlāru?
Please bring him here ASAP! Why did they even take him elsewhere?
[30-04-2025 14:43] PPM 1: @PPM5 he has had a stroke again yesterday. Please admit him to ICU as soon as he arrives. @PPM6 discharged him this Monday. Please pm me his IP number so that I can get that EMR summary emailed by staff.
[30-04-2025 14:45] PPM 5: Okay sir
[30-04-2025 14:46] PPM 6: Ok sir.
[30-04-2025 20:41] PPM 6: H/o slurring of speech, tremors, generalised weakness since yesterday night, taken to outside hospital, bp in outside hospital was 130/80, MRI Brain was done sir.
Above pasted from the Web 1.0 site linked here: https://
Slide 5:
Bloom's level 4: Analysis
Image of all the data points arranged in the form of a mind map showing a recognisable disease pattern
Events exposing the body to toxins
Bore water Flouride, Alcohol, Sugar
Metabolic syndrome, OPLL
Vasculopathic symptoms and complications of microangiopathic triopathy as well as macroangiopathy
Participatory medical cognition Analysis:
Dr Sri Teja, General Medicine PGY 2 : https://youtu.be/oG-uV5_
Speaker's notes:
TLDR: Check out the Web 1.0 site linked here: https://
Slide 7:
Bloom's level 5: Evaluation
Diagnosis
Treatment
Diagnostic and therapeutic Uncertainty
Aka clinical complexity
Image above of Critical realist heutagogy as a level 5 Bloom's learning methodology
Dr Shivani , General Medicine Intern, digging into the mechanisms of the patient's current problems demonstrating participatory medicine cognition: https://youtu.be/
Slide 8:
Bloom's level 6: Create
What's a phase 4 Trial?
How does one graduate from being an average physician retailer (Bloom's 1-3) to a precision medicine physician tailor?
Speaker's notes: How do physicians tailor patient's requirements with available resources?
TLDR Web 2.0 examples:
1) Patient's own diet plates and trying to match it with the Harvard plate!
TLDR Web 3.0 example:
Instant feedback from August AI on his shared foodplates as demonstrated and archived in his Web 1.0 site here: https://
TLDR Web 2.0 examples:
09-10-2024
PA - Should the patient continue with the above medicines?
PPM 1 - He can stop the Sodium bicarbonate and continue with the rest.
PA - His Creatinine level was 2.4 in August.
Should he check them again?
He wants to know why to stop Sodium bicarbonate tablets?
Above pasted from the patient's Web 1.0 page here: https://
TLDR Web 3.0 examples:
PPM 1 - Can check.
That's a good question necessitating our case reporter to get into the evidence search and processing mode. As usual we can begin with @Meta AI here to answer the question after refraining it for her.
What is the efficacy of oral Sodium bicarbonate tablets in Chronic renal failure? Please substantiate your statements with randomized controlled data mentioning the studies and analyse each one of them in a PICO format taking care to mention the absolute values of Intervention and Outcomes numbers and not percentages.
Meta AI :
To address the question regarding the efficacy of oral Sodium bicarbonate tablets in Chronic Renal failure. I'll provide an overview and summarize relevant studies in the PICO format.
Above pasted from the patient's Web 1.0 page here: https://
TLDR Web 2.0 examples:
Given the patient's poverty and complete dependence on the nearest government health center for free medicines, which unfortunately doesn't provide anything other than Mixtard how do we tailor the mixtard doses to fit the patient's current requirements?
Examples from today's Web 2.0 interaction with the patient's advocate:
[10/05, 13:14] Patient Advocate 56F Migraine Hypothyroidism 2000: He is not at home and did not bring the sugar strips alongwith him.
[10/05, 13:15] pm: Then he should not have increased his dose
[10/05, 13:15] Patient Advocate 56F Migraine Hypothyroidism 2000: Will inform
[10/05, 13:19] Patient Advocate 56F Migraine Hypothyroidism 2000: He will check his post lunch and share here.
[10/05, 18:20] 80M Rural Expert Patient DM2 Metabolic Syn: Eroju javatagina taruvata7 units mariyuannamtinna taruvata7 units tisukunnanueppude pulaluvahhinavi appuduhudalo telpagalaru
[10/05, 18:35] Patient Advocate 56F Migraine Hypothyroidism 2000: Dinner 2 hrs tharuvatha check cheyyandi
[10/05, 18:38] 80M Rural Expert Patient DM2 Metabolic Syn: Gamanika tragemndu mariyu tinemnudu
[10/05, 18:48] Patient Advocate 56F Migraine Hypothyroidism 2000: Had ragi at 7am, 7U insulin, before lunch 7U insulin, received sugar strips just now. can you please advice when sugar should be checked. translation for the above text. I asked him to check 2 hrs post dinner. hope its fine. @pm doctor?
[10/05, 19:34]pm: Yes fine and FBS and ppbs after breakfast tomorrow
[10/05, 19:36] Patient Advocate 56F Migraine Hypothyroidism 2000: Okay
[11/05, 18:44]pm: The afternoon insulin dose taken yesterday appears to have acted well for the fasting but the morning insulin dose was inadequate for post breakfast and post lunch sugar control
[11/05, 19:38] 80M Rural Expert Patient DM2 Metabolic Syn: Before dinner I need to take insulin?? or else I need to remain same without taking any dose before dinner now??? ,coz now sugar levels are 340 I need to take insulin or not???
Before breakfast a had taken 7 units I have taken was Java, for rice at afternoon I had taken 8 units of insulin as prescribed.
[11/05, 19:41]pm: Then you will need to buy a plain regular insulin vial (which looks like water) and take 4U from that before dinner. Your current insulin from government supply which is Mixtard cannot be taken more than two times a day
Above TLDR has been pasted from the Web 1.0 site linked here: https://
Web 3.0 examples of the above? Unfortunately it's Bloom's level 6 tailoring and this is still in the domain of humans and not yet taken by AI!
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