The central part of medicine is patients - don't push them out of social media

Clinical medicine is disappearing fast as topic for blog posts

Something happened to medical blogs in the past 6-12 months. They now seem a lot less interesting, more industrialized and aggregated. They have also become "too safe", generic and detached for regular reading.

There seems to be a rise of group blogs, guest posts and semi-syndicated contents. Several "clinic-focused" health bloggers have retired due to a variety of professional and HIPAA-related concerns.

It looks like clinical medicine is disappearing fast as a topic for blog posts in the U.S., replaced by posts about social media itself. As a side note, "social media" is actually a plural noun (media vs. medium), but it seems to be used mostly in singular form nowadays.

The central part of medicine is patients - don't push them out of social media

The central part of medicine is patients. Yet, we tell doctors: "never, ever blog about patients". This somewhat misguided advice displaces the most important part of the equation - the patients themselves.

Some health bloggers claim that we have to "aim above HIPAA" to avoid privacy breaches and comply with the highest standard of professionalism required by our occupation as physicians. How high "above HIPAA" is good enough though? In most clinical scenarios, the compliance with omitting the 18 unique HIPAA identifiers strikes the right balance.

Physicians must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just, as they would in any other context. When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content first to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities (Source: AMA Policy: Professionalism in the Use of Social Media, 2011; my edits are in bold in the text above).

Different standards for individual doctors vs. health system conglomerates

There seems to be a discrepancy of the methods employed by doctors and institutions when using social media. We tell doctors: "never answer patient questions on Twitter". Yet, Cleveland Clinic runs regular Twitter chats soliciting patient questions which are then answered by doctors and healthcare personnel. Mayo Clinic and other institutions do the same.

A blog is your notebook for lifelong learning

Don't forget the most important thing: A blog is your notebook for lifelong learning. Doctors learn from their patients every day. Patients learn from their doctors every day too. Both groups must try their best to excel in the joint quest to achieve the best possible outcome.

Comments from Twitter:

@scanman (Vijay): 3 doctors, @kmathan @razmohan & I, set up a twitter account @DrTamil to answer medical queries from Tamil tweeters.

@DrVes: You know the comment that you are going to get, right? "It will never happen here."

@macobgyn (MacArthur Obgyn) why do you think that is?

@SarahStewart (SarahStewart): I wonder if medical blogs are reacting to fear of litigation etc.

@DrVes: I'm sure they are. The community itself is not making things easier either.

@Skepticscalpel (Skeptical Scalpel): You're reading the wrong blogs. Try mine http://skepticalscalpel.blogspot.com

@CardioNP (Cardio NP): mirroring medicine in general? Agree w you re blogs; miss the early years ~2004-5. Agree skeptic that ur blog is a nice welcome addition

@marciovm (marcio von muhlen): will change as social media permeates society, informed consent will be feasible re: sharing medical info. Difficult to explain now.

@scanman (Vijay) This tweet - http://bit.ly/mpPL0P - by @DrVes, one of the most consistent medical bloggers, was meant for the Social Media Moral Police.

@vincristine (Vincristine): Who is 'we'? I imagine doctors will tweet what, where and how they choose to tweet, no matter what 'we' say

@laikas Laika (Jacqueline): A lot of interesting observations by @DrVes on the evolvement of medical blogs & social media use. I will take up my #FF habit #ff @DrVes

References:

“The powers of medicines and the practice of healing - to exercise the quiet art” - Virgil, Aeneid http://goo.gl/5BUb3

The making of a modern physician - The Lancet http://goo.gl/SYfTu

Strictly speaking, “Doctor” is a word incorrectly applied to most medical practitioners http://goo.gl/wjA0S

Despite the dire warnings, use of social media among emergency physicians is unusually strong http://goo.gl/QlqnK

AMA Policy: Professionalism in the Use of Social Media, 2011.
Image source: Wikipedia, GNU Free Documentation License.

Disclaimer

I am the Editor-in-Chief of several case-based curricula of medicine and related specialties. This is the information regarding patient data: There is no real life patient data on this website. Please note: we do not write or “blog” about patients. All case descriptions are fictional, similar to the descriptions you can find in a multiple choice questions textbook for board exam preparation. Case courses and descriptions do not follow real cases.

How To: Keep Your Family On-Board for Your Blogging Journey

Some tips from ProBlogger:

- Create Healthy Boundaries. For example, I have established a “no computer time” rule for myself where I don’t use the laptop (or my smart phone) between the time I get home from work and when we get the kids to bed. By setting up this boundary, I free my time and my mind to enjoy my children, play outside or help my wife out with dinner each evening.

- Communicate Your Reasons for Blogging. Why are you investing all this time and effort into blogging anyway? Take the time to tell your loved ones why your blog is important to you and how you see it as a benefit for your family.

- Sacrifice Personal Time, Not Family Time

- Seek Their Input

References:

7 Tips to Keep Your Family On-Board for Your Blogging Journey. ProBlogger.
Image source: public domain.

Blogs read by 20% of UK medical students, but only 8% write their own

A wide range of social media tools has become readily available in recent years, to the extent that the use of Facebook in particular is perceived as "second nature" by many students. There is increasing interest in the possibilities of using this social media services for medical education - blogs, wikis, Twitter and Facebook.

This UK study included a self-administered questionnaire survey of 212 first year medical students.

Over 90% used instant messaging. Social networking sites were also highly used - by 70%. There was no significant difference between males and females.

Blogs were read by 20% of students and a small number (8%) wrote their own blogs.

20% of males were users of media sharing and contributed to wikis.

Social bookmarking was rarely used by either gender.

Medical educators need to recognise the potential of social software in medical education but it is essential that students maintain the informality and privacy of these sites. The challenge is how to integrate social software into current curricula and institutional Virtual Learning Environments.

References:
Web 2.0 and social software: the medical student way of e-learning. Sandars J, Homer M, Pell G, Crocker T. Med Teach. 2010 Jun 18.

Comments from Twitter:

@DrVes I didn't expect that 8% of med students in the study wrote blogs - this is not my experience from teaching students and residents at Cleveland Clinic, Case Western and Creighton University.

@sandnsurf Medical education blog vs tumblr/posterous blog possibly. My students are at 10% for blog writing but 1% are actually medical.

@DrVes This is way higher than the stats here in the U.S. "Everybody's on Facebook, nobody has a blog"... :)

@doctorwhitecoat Not to jump mid convo, but at my school, I can say that most don't have blogs... at most maybe 3-5% and those that do... don't update.

@DrVes 2-5% is high. There was only one blogging student at Cleveland Clinic medical school who stopped after 1-2 years.

Related reading:

Assistant professor uses Twitter to teach students dental anatomy at Ohio State University - 113 of 200 students signed up, 56% http://goo.gl/jvyq7

Image source: Blogger.com.

Reasons to stop blogging

I know medical bloggers who stopped blogging or closed their Twitter accounts for similar reasons to those summarized below:

"He says in his final blog post that while he intended the personal blog to be a place where he could talk about ideas, his posts had started to “spark whole conversations that I never intended to start in the first place, conversations that leech precious time and energy while contributing precious little back.”

More related thoughts:

"So many things can go wrong (with social media) if you don’t do it right. You can get stampeded and lose the game. Playing on the sidelines is more appealing.

If you run a hospital and decide to establish a vast living presence on the Web, people will say bad things about your doctors, your nurses, your waiting times in the ER, your food. You’ll have to deal with HIPAA. There’s also a chance that you’ll say something you’ll regret. Playing on the sidelines is more appealing."

On the other hand, consider this:


Duty calls. Image source: Xkcd.com, Creative Commons license.

See a perfect example why you must read medical blogs in this post by a practicing electrophysiologist: The first 4 months of a new era - anticoagulation with dabigatran. You can't find this first-hand real-life experience in any textbook or medical journal.

References:

Twitter Staffer Stops Blogging After Backlash. GigaOM, 2010.

Better to Play It Safe. Phil Baumann, 2010.

Why you should start blogging in 2011

Quotes from an interview with Seth Godin and Tom Peters:

"Blogging is free. It doesn’t matter if anyone reads it. What matters is the humility that comes from writing it. What matters is the metacognition of thinking about what you’re going to say.

No single thing in the last 15 years professionally has been more important to my life than blogging. It has changed my life, it has changed my perspective, it has changed my intellectual outlook, it’s changed my emotional outlook.

And it’s free."

Don't limit yourself to your blog - use Facebook and Twitter

Blogging can be great for personal growth but there is a lot more interaction on Twitter and Facebook nowadays as compared to blogs. If you have a blog, you must also have a Facebook "like" page (previously called "fan" page) and a Twitter account. These serve the dual purpose of distribution and commenting channels ("two-way street").

For example, Facebook pages get a lot more interaction than blogs for some medical journals - you can count the comments on the NEJM Facebook updates (the range is 9-180) vs. their blog (0). The blog has comments enabled, of course.

Facebook is the clear "winner" in terms of commenting activity, it is not even close:

NEJM Facebook page vs. NEJM blog

The risks of blogging and social media use in healthcare

One Misguided Post, Photo, or Comment Online Can End Your Healthcare Career, according to this About.com guide. It makes you think: Why would any doctor use social media? Some of the benefits are outlined above.

Twitter comments:

@cmeadvocate (Brian S. McGowan PhD): Look at commenting activity on NEJM's Facebook page (100's) vs. NEJM's blog (<10).>

@rsm2800 (Robert S. Miller, MD): Striking difference

@kevinmd (Kevin Pho, M.D.): That's because the NEJM fb page has 170,000+ fans. Blog doesn't generate nearly that much traffic.

@DrVes: One of the reasons, yes. However, the commenting activity on many blogs is down. To compensate, a lot of them started embedding Twitter re-tweets as a substitute for comments. I did it too with this post (you are reading the example).

@DrVes: Thanks for re-tweeting this post http://goo.gl/o9rRl - Blogging introduced me to some of the smartest and most generous people in healthcare. Give it a try. It doesn't matter if anybody reads your blog when you start. If it's useful to you, somebody somewhere will find it useful too.

References:

Seth Godin & Tom Peters on Blogging. 33 Charts.
Effective bloggers are lifelong learners. CopyBlogger.

Why Do I Blog?

Blogging can improve your attention span and focus - unlike social media sites which can be highly distracting http://goo.gl/K4O1V

Is having a blog useful in 2011? Scoble says yes... using Quora http://goo.gl/Gubor

Are doctors required to get patient permission to use non-identifiable X-rays, CTs, EKGs for medical education online?

Sam Ko, MD, MBA asked this pertinent question on Twitter. My answer is below. Feel free to correct me and please provide references for your opinion.

Question: "Are Drs required to get Pt permission to use non-identifiable images for medical education?"

Answer: According to most journals, no.

The NEJM policy is here:

"If a photograph of an identifiable patient is used, the patient should complete and sign our Release Form for Photographs of Identifiable Patients. Any information that might identify the patient or hospital, including the date, should be removed from the image."

This is the BMJ policy:

Images – such as x rays, laparoscopic images, ultrasound images, pathology slides, or images of undistinctive parts of the body – may be used without consent so long as they are anonymised by the removal of any identifying marks and are not accompanied by text that could reveal the patient’s identity through clinical or personal detail.

Case Reports and HIPAA

Physicians must assure that the case report does not contain any of the 18 health information identifiers noted in the HIPAA regulations, unless authorization from the individual (s) has been obtained. The authorization is not required if neither of the 18 identifiers below are used in the case report.

List of 18 Identifiers:

1. Names;

2. All geographical subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code, if according to the current publicly available data from the Bureau of the Census: (1) The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and (2) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000.

3. All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older;

4. Phone numbers;

5. Fax numbers;

6. Electronic mail addresses;

7. Social Security numbers;

8. Medical record numbers;

9. Health plan beneficiary numbers;

10. Account numbers;

11. Certificate/license numbers;

12. Vehicle identifiers and serial numbers, including license plate numbers;

13. Device identifiers and serial numbers;

14. Web Universal Resource Locators (URLs);

15. Internet Protocol (IP) address numbers;

16. Biometric identifiers, including finger and voice prints;

17. Full face photographic images and any comparable images; and

18. Any other unique identifying number, characteristic, or code (note this does not mean the unique code assigned by the investigator to code the data)

References:

Author Center - NEJM Images in Clinical Medicine.

Patient confidentiality. BMJ.

Case Reports and HIPAA Rules

The Human Research Protection Program - UCSF.edu.
HIPAA Resources - The Privacy Rule - NIH.gov.
Single Case Report Policy - Johns Hopkins Medicine.
Medical Case Report Policy - Louisville.edu.
Privacy of Individually Identifiable Health Information. Code of Federal Regulations.

Image source: Bone fracture, from Wikipedia, the free encyclopedia (public domain).

Misconceptions about medical blogs

From the newsletter Australian Pharmacists:

"At the heart of social media is the blog, an online diary where news, gossip, industry issues, opinion and scandal jostle for space."

I cover medical news from educational perspective on CasesBlog but I try not to include "gossip, industry issues, opinion and scandal" and with one post per day, they never "jostle for space".

There are many different types of medical blogs, of course.

Image source: public domain.

How do you blog?

A nurse writing a paper for school focusing on the value of blogs for advanced practice nurses asked me the questions listed below. It would be great if you can post your own answers in the comment section below.

How many blog post do read a week?

The blog posts and news items from the RSS feeds are about 2,000-3,000 per day = 20,000 per week.

You read blog posts about?

The big five among the general medical journals (NEJM, JAMA, Lancet, BMJ, Annals of Int Medicine) plus 10 allergy journals, plus Medscape, Reuters Health and WebMD.

How many new topics do you personally post under each sub heading, i.e. Endocrine, Cardiac, etc each week?

1-2 blog posts per day, for example, cardiac topics once a week, endocrine topics once a month.

Some helpful references:

5 Tips to Stay Up-to-Date with Medical Literature

How to deal with the information overload from blogs, RSS and Twitter?
Image source: public domain.

Doctors should blog with their real name - agree or disagree?

From KevinMD:

"Martin Young still has "nagging doubts about doctors who post blogs or replies about healthcare issues without giving their names.

My blog as an extension of who I am as a doctor, putting a carefully considered face to the experience of caring for the sick, as a means of drawing attention to issues that do not get into medical journals. As do most other doctors who host their own blogs.

I often look at those replies to my postings that are anonymous and think, “Who are you? Why do you think the way you do? Why will you not put a name and face to your thoughts?” My personal belief is that the anonymous person may lack conviction, confidence or courage.

I would not accept a referral from an anonymous doctor, or give advice to one. In the same way, I may read anonymous replies to my postings, but they carry much lower weight."

Although I encourage physicians to blog under their own name, I do not think we should "force" them to do so. They should not feel obliged to host their own blog either if they can use such perfectly reasonable free services such as Blogger.com by Google and WordPress.

I assembled a short list of suggestion for medical bloggers several years ago. Here it is:

Tips for Medical Bloggers

- Write as if your boss and your patients are reading your blog every day
- Comply with HIPAA
- Do not blog anonymously. List your name and contact information.
- If your blog is work-related, it is probably better to let your employer know.
- Inquire if there are any employee blogging guidelines. If there are, comply with them strictly.
- Use a disclaimer, e.g. "All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice."
- Get your blog accredited by the Heath on the Net Foundation

References:

Why doctors should blog with their real name. KevinMD.
How to write a medical blog and not get fired?

As A Busy Physician, Why Do I Even Bother Blogging? http://goo.gl/fSF3 - Excellent summary.

Image source: public domain.

Twitter comments:

@DrJenGunter (Jennifer Gunter): depends on blogging agenda.

@DoctorNatasha (Natasha Burgert): I blog and tweet with my real name because it keeps me accountable to my work, honest with my patients, and real with my intent.

@DrElizabethLee: I sign my name to anything I write.

@DrVes: Doctors need to understand the basics, and address the irrational fear of using social media.

Medical blog content and relationship with blogger credentials and blog host

A quantitative content analysis was performed on 398 blog posts from a constructed 1-week sample of posts in WebMD, Yahoo!Health Expert Blogs, and independently hosted blogs.

Most health and medical blog posts highlighted and provided commentary pertaining to medical issues found in external media such as books, television, Web sites, magazines, and newspapers

Only 16% contained actual health or medical information.

Distinct differences in patterns of content were evident between credentialed and noncredentialed bloggers, as well as different blog hosts.

References:
Health and medical blog content and its relationships with blogger credentials and blog host. Buis LR, Carpenter S. Health Commun. 2009 Dec;24(8):703-10.

Comments from Google Buzz:

Shabber Hussain - Now if I can some how know about those 16% medical blogs that "contain actual health or medical information", it should make my day. Feb 26

Arin Basu - I think (I just read the abstract perhaps a closer reading of the full text of the article might be more useful, @Ves, did you have a chance to read the full text?)

* The findings are not unexpected, at least that's what you expect based on "credentialing the blogger who has written the posts"

* There seems on first reading at leas the abstract that there may be quite a bit of bias in that study (just one week snapshot (too few blogs sampled), few selected sites (selection bias right there), and interpretation)

* Not surprised that most blogs contained commentaries published in popular press and journals.

I think that's what blogs should ideally do. Raise awareness, enable and alert people to read & interpret meanings. I'd not expect blogs to replace "actual" texts (well, that's my perspective)

* Which makes @Shabber's point very pertinent, what are those 16% saying, on a one week selective sampling?

All in all, a very interesting article. I think it needs to be closely read and discussed in medical blogosphere. Feb 26

Image source: public domain.

"Blogging fame does not pay the bills"

From Social Media Examiner:

Wendy Piersall provides some insights into the "dark side" of being popular online:

- Fame does not pay the bills
- Being on the front page of Digg does not bring you success
- It takes lots of work to get internet fame and even more work to maintain the internet fame

See the video interview at Social Media Examiner.

References:
The Dark Side of Blogging Fame (a Wendy Piersall Interview). Social Media Examiner.

Image source: public domain.

What is the oldest medical blog?

Medical Blog Anniversaries

Dr. Rob explains why he has been blogging for 4 years http://goo.gl/seKp. Then, he decided to go on hiatus at the end of 2010. If I remember it correctly, Dr. Rob has done that before and then came back to blogging. We hope he reconsiders and returns to blogging later in 2011 or 2012.

Dr. Bates has been blogging for 3 years, leading to over 1,000 posts and many new friends http://goo.gl/eB1e

I have maintained medical blogs since 2004 but never thought about blog anniversaries - blogging seems such a mundane task of daily life.

What is the "life expectancy" of a medical blog?

The studies are ongoing but the current record is around 8-10 years... http://goo.gl/5LRx

In the medical blogging world, the physician bloggers who produce high volume of original content often quit after 1-2 years. There is too much to handle. Medical blogging is a difficult task that requires a lot of time and mental energy (scientific accuracy, HIPAA compliance, ethics, etc.), and the financial rewards are nonexistent or negligible.

What is the oldest medical blog?

As pointed out in the comments, the "oldest" medical blog probably is Family Medicine Notes, followed by GruntDoc.

Related:
As A Busy Physician, Why Do I Even Bother Blogging? http://goo.gl/fSF3 - Excellent summary.

Twitter comments:

@gruntdoc (GruntDoc): That's why I'm pacing myself - @DrVes: You know it best - you were there at the beginning and the only one still blogging... :)

@Doctor_V (Bryan Vartabedian): Would love to see post from @gruntdoc (one of the oldest medblogs) on longevity. He's seen lots. Seen patterns.

@giustini (Dean Giustini): Moving to microplatforms Twitter & Facebook (from blogs) in medicine is trendy but they tend to cut off discussion & cause an exodus - @DrVes: Agree, but this is different. High-volume medbloggers used to quit after 1-2 years even before FB/Twitter... :)

@DrOttematic (Jessica Otte, MD): I only do a few posts a month unless spectacularly inspired. It's natural and not too demanding that way. I can't imagine how the high-outputters even last a year at it - @DrVes: Doctors are dedicated people. If you want to know "How Doctors Think", don't read books - read their blogs.

@giustini (Dean Giustini): Physicians are good at 'pattern recognition' after observing - daily blogposts are onerous / intellectually unsatisfying. I find that time & effort in blogging does not equal reward/recognition systems in medicine; partly true in my field too - @DrVes: True. Only printed publications count in academic promotion as of 2010... :) -

@giustini (Dean Giustini): This is why I think your blog is a standout. Has your publishing output decreased since starting your blog? what about presentations? - @DrVes: I publish more blogs than ever before (medicine, allergy, peds, etc.). Fewer presentations and conferences.

@giustini (Dean Giustini): Have you considered writing a book like "Medical pioneers in the web 2.0 era"? A review of blogging/ experiences; quotes from others? -- @DrVes: I have considered some book ideas (not this one in particular) but unfortunately have little time to do it. May be later, in 2012 - @giustini (Dean Giustini): We should write it sooner. The end of 2010 marks a natural demarcation line between web 2.0 and web 3.0.

@erinrbreedlove (Erin Breedlove): I'm an undergrad student and "baby" med blogger but hope to make your list someday. So rewarding. :) - @DrVes: I don't have a list. If you have a reflection of your blogging anniversary, I will reference it in the blog post... :) - @erinrbreedlove (Erin Breedlove): I knew that...no anniversary yet! May! Have a neat series I think you'd like, though. Working on it now. http://bit.ly/dFNkP2

@geeners (Gina Rybolt): I think I am the oldest nursing blog :) Just turned 8 in December 2010 - @rlbates: Impressive! Glad you're still active.

@DrVes: Why blogs are "better" than Twitter - it's difficult to have a discussion on Twitter but it works as a commenting system. Check the comments above, for example.

Updated: 01/01/2011

Benefits and Dangers as Doctors Start to Use Social Media

From Medscape:

"Dr. Choi has more than 3000 Facebook friends, many of whom are patients and colleagues.

But he draws the line at talking about cases with colleagues or sending diagnoses or test results to patients on networking sites. "I can't do any patient care using their messaging or using the site because it's not HIPAA-compliant," Dr. Choi says. "I'll pick up the phone to discuss a case."

Because doctors can be hesitant to share their e-mail addresses -- and regular e-mail is not secure to HIPAA standards -- it's not unheard of for people to find their doctors on Facebook. But the doctors interviewed generally say they avoid making diagnoses or communicating test results over the Internet."

References:

Doctors and Social Media: Benefits and Dangers. Medscape, 2010.
http://www.medscape.com/viewarticle/711717

Johns Hopkins Medicine podcast now has a blog

The weekly podcast by Johns Hopkins Medicine now has a blog hosted for free at Blogger.com by Google:

http://hopkinspodblog.blogspot.com

I have been a regular listener for years and have found the podcast to be both educational and enjoyable - not a common combination.

The weekly podcast looks at the top medical stories of the week for people who want to become informed participants in their own health care. The presenters are Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine, and Rick Lange M.D., professor of medicine at Johns Hopkins and vice chairman of medicine at the University of Texas Health Science Center at San Antonio.

See my list of health podcasts at Google Bookmarks here.

Image source: Johns Hopkins

29 Debates About the "Right Way" to Blog

ProBlogger collected 29 Debates Bloggers Have about Blogging. Some of my responses are listed below, see ProBlogger's site for the complete list. Please share your thoughts in the comments.

RSS Feeds - Full vs Partial Feeds
- My opinion: Full feed.

Comment Sections – Comments vs No Comments
- Comments always open.

Post Frequency – Post More vs Post Less

- Short posts daily.

How Many Blogs? – Focus upon One Single Blog vs Having Many Smaller Blogs.
- I have 3-4 blogs.

Domain Names – long vs short, hyphens vs non hypens, .com vs other extensions (like .net, .org), local vs global domain extensions
- Short names, free domain names by Blogger.com.

Hosting – hosted vs self hosted
- Hosted by Blogger.com.

Post Titles – descriptive vs keywords
- I use natural language post titles - descriptive.

Content – Link content vs Original content
- Mostly links and comments, I wish I had more time to write lomg-form original content.

Design – Professional Design vs Templates
- I modify the templates to create my "own" designs. It's quite enjoyable actually.

Ownership – Use Social Media vs Build Your own properties
- I think your blog should be your "home" on the web.

Post Length – Long in Depth Posts vs Short, Sharp Posts
- Again, I wish I had the time to write long posts but I don't.

Topic – Niche vs Broad Topics
- Niche topic blogs work better.

Blogger Name – Anonymous blogging vs Using Your Name
- Using your name is a much better approach for medical bloggers.

Subscribers – RSS is Best vs Email is Best
- I like RSS better.

SEO – Writing for Search Engines vs Writing for Humans
- I write for humans only.

Personal Blogging – Sticking to Topic vs Injecting Personality and Personal details
- I try to write objectively from a scientific perspective. Personal stories are probably better suited for a paper diary.

Comment Moderation – Highly Regulated and Moderated vs Anything Goes
- I moderate all comments and delete all self-promotional and possibly offensive material.

Social Media vs Search – focus upon social media rather than search engines as traffic sources
- If you write quality content, Google will find you.

LinkBait – Anything goes (e.g.. Personal Attacks) vs Strong Boundaries Around What is and Isn’t Acceptable
- I don't use link baits and I have never posted anything even close to a personal attack on my blogs.

Bloggers Participation in Comments – Respond to Every Single Comment vs Let Readers Talk to Each Other and Don’t Interact
- I don't feel compelled to respond to every single comment. Let readers interact.


This Google video shows that it takes about 2 minutes to start a blog on Blogger.com. Creating a web site has never been easier.

References:
29 Debates Bloggers Have about Blogging. ProBlogger, 2010.

Scaring physicians away from using social media

Is there a doctor who wants to spend 3 hours per day on social media while running the risk of being sued?

This useful critical review by a freelance journalist at the NEJMJobs site has a focus on some of the litigation risks inherent to the use of social media in healthcare:

http://www.nejmjobs.org/career-resources/social-media-and-physicians.aspx

"Dr. Pho, who spends up to three hours a day in social media activities, is surely in a minority of physicians who devote considerable time to blogging, Twittering, or engaging in Facebook updates.

Social Media Activity Risks Difficult to Predict

Despite the potential professional benefits of social networking participation, some physicians are approaching the social media realm with trepidation, for fear that personal and professional presences will overlap in a manner that increases liability exposure.

That’s a valid concern, because the medico-legal aspect of social media activities has been little explored and is not well understood. In addition, the obvious risks of incurring HIPAA violations should patients’ health information be unwittingly exposed are a deterrent. “The laws haven’t caught up with social media and networking, so to be safe I don’t blog about my patients,” Dr. Pho said. “Even though I think that interesting or challenging cases can be used as a learning tool, too much of my professional livelihood is at stake.”

None of the physicians interviewed for this article have accepted patients’ requests to become Facebook friends, and all cited concerns that doing so would “cross the boundary” between a personal and professional relationship.

"I think that very few doctors are interacting with patients directly on Facebook because we’re so terrified of being accused of practicing medicine and getting sued. Whatever you type is eternal and a perfect record of whatever you said,” she said. “That makes it all even more scary.”

“We’re concerned about this because there have been instances in which physicians have used Facebook in an inappropriate manner,” said David Troxel, MD, The Doctors Company’s medical director. “Social media networks are not HIPAA compliant and are just not appropriate for any physician-patient communication, so it’s a real liability threat because it’s so easy to lapse into a casual conversation.”

The NEJMJobs article linked in the paragraph above does not discuss the use of social media for medical education of students, residents and patients.

Another area that was not highlighted enough was the widespread use of Facebook "fan pages" by hospitals and physicians to attract patients and create relationships. Does this mean that the patients can be "your fans" but not "your friends"?

Overall, this article is a good review of some of the risks involved with the social media adoption in healthcare.

However, for a more nuanced approach to social media use by physicians, please review this detailed primer by the cardiologist Dr. Wes:

http://drwes.blogspot.com/2010/03/for-cardiologists-twitter-primer.html

Related:
Facebook Friend Request - A young doctor gets a message from a dying patient - NYTimes, 2010.

Social Media Raise Liability, Ethical Questions for Doctors as Internet is challenging traditional boundaries. Boston Globe, 2010.

Image source: OpenClipArt.org, public domain.

Updated: 04/13/2010

Guidance on Blogger Disclosure and FTC Guidelines

According to Edelman:

You don’t have to disclose anything if you are just a fan. If you happen to love Toyota and write about them, you don’t need to make a special disclosure that you own a Toyota. However, if Toyota gives you a car to use for two weeks, you must disclose this. It is Toyota’s responsibility to tell you that you need to disclose.

Transparency is key – if you are being paid, you must say that you are being paid. If you are receiving products or services, you must disclose such.

There is no difference in disclosure for product vs. services vs. coupons or discounts. You must disclose all of them.

You must disclose somewhere in the post itself. It is not enough to post a blanket disclosure in the "About Us" section or sidebar of your site. The same applies to tweets. You must disclose in each tweet.There are popular hashtags for disclosure, which include #paid #ad #spon and #sample.

You can also go directly to the source - see the FTC and WOMMA guidance documents on disclosure:

http://www.ftc.gov/opa/2009/10/endortest.shtm
http://womma.org/ethics/disclosure

References:

SXSW Essentials: Practical Guidance On Blogger Disclosure And FTC Guidelines

What Should Be In A Blog’s Disclaimer? http://goo.gl/6gGf

Generate a blog disclosure policy here: http://bit.ly/bvEM94

Image source: Blogger.com.

How to Exercise WHILE Blogging or Doing Other Computer Work

The exercises below have been adapted from a ProBlogger post. Most of the names have been modeled after popular social media services such as Twitter, RSS, Blogger, etc.

1. Cyber Squats. Set your chair aside for a few minutes and instead move to a semi-squat position with thighs parallel to the floor. Hold for 1 minute.

2. RSS Raises. As you’re sitting at your desk, straighten your knees and lift your legs out in front of you.

3. Ten Minute "Move it!" Break. Alternate jogging in place with jumping jacks – do a minute of each and repeat 5 times.

4. Twitter Tummy Tone. Tighten your abdominal muscles for 30 seconds and then release.

5. Social Squeezes. Tighten your gluteal muscles for 30 seconds and then release.

6. Ten Minute "Move it!" Break. Grab a step stool and climb up and down.

7. Inbox Incline. While you’re sitting with your feet on the floor, raise your heels so you are on the balls of your feet and lower them.

8. Ten Minute "Move it!" Break. Do walking lunges around the house. You can add some weights and do bicep curls at the same time.

9. Blogger Breather. Close your eyes and focus on your breath. Count to 10 as you slowly inhale through your nose, thinking positive thoughts. Exhale through your mouth, again counting to 10. Release all the tension and stress out of your body.

10. Sign Off Stretches. Shoulder shrugs – with your head at your chest, shrug your shoulders up and down. Neck Rolls – relax your shoulders and let your head roll forward. Slowly rotate your head in a circle. Repeat five times.

How to stay healthy while traveling: This is a mnemonic for exercises that can be done with just body weight: PLSS

P ushups
S itups
L unges
S quats


Exercises that can be done with just body weight: PLSS.

Exercise slows telomere shortening (and aging). Telomeres are the chromosome tips which shorten each time a cell divides, making them a possible marker of aging. A study of 2400 twins showed that physically active people had longer telomeres than sedentary people. According to the authors, this provides a powerful message that could be used by clinicians to promote the potentially antiaging effect of regular exercise.


Human chromosomes (grey) capped by telomeres (white). Image source: Wikipedia, public

domain.

If you need any more convincing, please see this "health promotion" video that clearly shows the benefits of exercise:

"Health Promotion" video: Benefits of exercise.

References:
10 Ways to get Fit WHILE Blogging. ProBlogger, 2009.
How to stay healthy while traveling

How to overcome the fear of blogging or writing in public

You will get some ideas from the following conversation on Twitter:

@dreamingspires: I realised that a previous problem in my blog was that I was writing for people more qualified than me - instead of health professionals just starting out.

@DrVes: One of the best approaches to educational blogging is to write for yourself as you learn or write for beginners - which is basically the same thing.

@dreamingspires: good advice - as an(ex)publisher suddenly having to write myself as opposed to hiding behind someone else doing it is... a learning process.

@DrVes: Did Twitter help?

@dreamingspires: Twitter helped in the sense of connecting me into a community, I didn't 'micro-blog' though.

@DrVes: Twitter makes you more comfortable to write in public - you don't have to "micro-blog"... :)

@dreamingspires: This IS true and my experience - it reduced my stage fright!

@DrVes: Also, you may have micro-blogged on Twitter or somewhere else without even knowing it... I set up my blog posts to publish automatically in the future -- it may help with your "stage fright".

@dreamingspires: To be honest I am unsure what micro-blogging is -- specific tweets on a topic like you do, or a mini conversation? Yes, I also now autopublish via Twitter feed, and now using Stumble too. OK - microblog is an 'opinion'/link/statement.

@DrVes: Anything you post on Twitter is micro-blog as long it's not only replies... A comment on a comment is not a blog. I think you qualify as a fully-fledged blogger and microblogger now... :)

@dreamingspires: You mean I've MADE IT?! Newbie happiness.

@DrVes: It's official: You've made it. You're a blogger now. Expect you share of nasty comments and spam... :)

Physicians and social media - ACP Hospitalist features Dr. Rob

From ACP Hospitalist:

"Dr. Lamberts’ words aren’t just vanishing into cyberspace. His blog, Musings of a Distractible Mind, gets about 20,000 visitors who view 50,000 pages a month, according to his own analytics data. By the end of 2009, his list of Twitter followers numbered nearly 1,500 and counting.

Today’s physicians have an ever-expanding number of social media vehicles through which to express themselves. Tools like Twitter, Facebook and blogging can potentially help physicians better educate and interact with patients, perhaps even humanizing themselves in the process. But mishandling that powerful online megaphone can potentially risk, or at the very least blur, the doctor-patient relationship, according to social media-savvy physicians.

Initially, when he was virtually unread, Dr. Lamberts said he blogged about a few interesting cases, always cloaking the patient details. But he soon halted that practice."

I follow a similar approach described in detail in the website disclaimer:

"There is no real life patient data on this website. Please note: we do not write or “blog” about patients. All case descriptions are fictional, similar to the descriptions you can find in a multiple choice questions textbook for board exam preparation. Cases course and description do not follow real cases."

http://clinicalcases.org/2002/01/disclaimer-and-terms-of-use-agreement.html

Image source: OpenClipArt.org, public domain.

Related: